When treating a diabetic patient, low blood sugar is something that we should be concerned about

Internationally known dentist and president of the Austrian Society for Periodontology, Corinna Bruckmann MD, MSc, answers questions from dentists all over the world who are curious about the management of diabetic patients in their practices.

The treatment of diabetic patients demands the consideration of the two-way relationship between oral health issues and diabetes, as well as always being ready to consider various other factors and to give personalised advice to this kind of patient. Learn more about the specifics of managing diabetes patients from the answers this expert gave to the following five questions that popped up during Curaden Academy’s webinar.  

1. Xerostomia – what are the best practices for patients with this symptom?

Xerostomia is a symptom of a combination of several problems in diabetic patients – neuropathy, microvascular problems, plus, in many patients, poor diet, meaning a very high level of low-molecular carbohydrates that are sticking to the tooth surface. First of all, it is important to advise patients to drink enough water. Not sweet beverages – just water or tea without sugar. It’s important to have sufficient fluid intake. 

The current President of the Austrian Society for Periodontology, Corinna Bruckmann MD, MSc, is an international expert on periodontology and implantology, and also a consultant for the Austrian Institute for Health (ÖBIG): the task force for the development of an Austrian diabetes strategy, work group 3.

With many awards, broad clinical and research experience, general medical and a specialised dental academic-background, she dedicates her time to sharing her knowledge as a course content coordinator at the Medical University in Vienna. She is also a periodontal consultant in a private practice in Vienna. Her research is focused mainly on the (Epi)genetic background of periodontitis and epidemiology of periodontitis and also on hyaluronic acid application in the mouth.

Of course, you have to check if the kidney function is okay. If there is a kidney malfunction, your patients must not fill up with fluids. And then it is important to keep all the surfaces of the oral mucosa and the teeth clean. There are also substances on the market like methylcellulose and hyaluronic acid that serve as saliva substitutes. These help patients a lot. Hyaluronic acid moistens the mucosa surfaces and serves as an anti-inflammatory agent. It is also important to quit smoking, to stop drinking coffee, not to eat overly salty foods, and generally just to treat your mucosa kindly.

2. Can a patient with diabetes have dental implants, and how long will they last?

Sure. Patients with diabetes that is well-maintained – who have good blood sugar control and their glycosylated hemoglobin is within the normal range – can be treated just like all other patients. Of course, it is good to see them more often than patients that don’t have any systemic disease, but otherwise they don’t need to be treated any differently.

The patients should be extremely well-trained on how to maintain and clean their implants and they need to have professional implant cleaning at regular fixed intervals. That interval should be adjusted according to their personal needs. Generally, there should not be any problem with well-controlled diabetic patients. 

In people with poorly controlled diabetes the rate of dental implant failure is quite high. This is mainly because wound healing after implant installation might be impaired, and also because diabetic patients are at a greater risk of infection. The situation gets even worse if diabetic patients have a history of periodontitis, if they smoke, and if they don’t maintain regular intervals for dental cleaning. This is asking for complications.

Another pandemic: Diabetes! Why should the dental team bother?

Would you like to update your knowledge on the mutual relationship between periodontitis and diabetes and learn the latest findings with regards to its screening? Join Curaden Academy’s webinar by Corinna Bruckmann, MD, MSc to learn more about treating patients with diabetes and periodontitis.

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3. What types of oral hygiene products do you recommend to diabetic patients?

The most important thing is that the toothpaste should contain fluoride. Nowadays, patients are a little bit hesitant to use fluoride toothpastes. Honestly, I don’t know why. Especially if they have xerostomia, it is extremely helpful to have not only one source of fluoride (toothpaste) but also at other times throughout the day to use another product – for example a mouth rinse – that contains fluoride. Fluoride is a very good agent for addressing the problem of root surface caries in people suffering from xerostomia. 

Otherwise, they should use normal oral hygiene products for cleaning the tooth surfaces, including the interdental areas. Please, make sure that patients are well-trained in caring for their interdental areas since many patients tend to avoid them, and the problem almost always lies right between the teeth.

The most frequent problem is that even when they try to clean those areas, they use an interdental cleaning device that is too small for their interdental area. Floss only should be used in very very narrow interdental spaces, otherwise it’s better to use an interdental brush. You can also advocate the application of chlorhexidine gel if there is an inflammation.

“Make sure that patients are well-trained in caring for their interdental areas since many patients tend to avoid them, and the problem almost always lies right between the teeth.”

4. How should you extract a tooth from a diabetic patient with non-regulated blood sugar?

If it is an emergency treatment, you can do it anytime. We won’t deny a patient an urgent emergency treatment. You should keep an eye on him or her and, please, have a blood glucose meter in your practice. It is not a problem when the level of blood sugar is high; it’s the opposite. Low blood sugar is something that we should be concerned about.

But don’t be afraid. Just proceed with a finger pricker, measure the glucose level, and if it is low increase the patient’s glucose levels – especially if he or she seems dizzy or disorientated. For sure, you don’t want the patient to suffer from hypoglycemia during any dental treatment. It is okay to give food to patients, especially if they seem uncomfortable. Adrenalin from stress or local anaesthesia causes high blood pressure and is also associated with a higher need for sugar in the body’s cells. 

5. Is it appropriate to do in-office screenings in the dental environment? We often see a patient more frequently than their physician.

Yes, it is very useful. I recommend using questionnaires to find possible risks. There is also the possibility to screen glycosylated hemoglobin levels with devices that are not too expensive. Of course, you have to evaluate if it will pay off because it takes time, it needs equipment, and it needs training of your staff. But it can be very helpful. Please, if you see that a patient has all the risk factors for diabetes or prediabetes, address him or her and ask them to fill in the questionnaire – this really costs nothing and can help to raise awareness for this very prevalent condition.

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