Table 3.46.

Key considerations for dental management in diabetes mellitus (see text)

	Management modifications*	Comments/possible complications
Risk assessment	2	Hypoglycaemia; angina; hypotension; cardiac arrest
Appropriate dental care	2/4	Type and severity of the diabetes; type of anaesthetic; extent of surgery; the diabetician should advise on the regimen
Pain and anxiety control
– Local anaesthesia	0
– Conscious sedation	0
– General anaesthesia	3/4	See Table 3.45
Patient access and positioning
– Access to dental office	0
– Timing of treatment	1	Early to mid-morning after breakfast and antidiabetic treatment
– Patient positioning	1	Postural hypotension
Treatment modification
– Oral surgery	2
– Implantology	2
– Conservative/Endodontics	1
– Fixed prosthetics	1
– Removable prosthetics	1	Denture-induced stomatitis
– Non-surgical periodontology	2
– Surgical periodontology	2
Hazardous and contraindicated drugs	2	Avoid aspirin, steroids and tetracyclines

^*0 = No special considerations. 1 = Caution advised. 2 = Specialised medical advice recommended in some cases. 3 = Specialised medical advice mandatory. 4 = Only to be performed in hospital environment. 5 = Should be avoided.