Diabetes: dental considerations

For the medical management of diabetes, see the Diabetes Guidelines.

In dental practice, first-aid management of hypoglycaemia is outlined here.

For patients with diabetes, take a thorough medical history and determine if their diabetes is well controlled and stable. Consult the patient’s medical practitioner if needed. A glycated haemoglobin (HbA1c) above the patient’s target is an indicator of poor glycaemic control. Glycaemic targets are individualised; a common glycated haemoglobin target is 53 mmol/mol (7%) or less.

Poorly controlled diabetes is associated with postprocedural complications such as infection and poor wound healing. Although the risk of postoperative infection can be higher in patients with poorly controlled diabetes, antibiotic prophylaxis is not indicated (see Indications for surgical antibiotic prophylaxis in dentistry). Patients with poorly controlled diabetes are at increased risk of periodontal disease. Diabetes may be associated with sialadenosis, which can cause impaired salivary gland function.

For all patients with diabetes, provide regular dental care, including instructions in oral hygiene and denture maintenance.

Consider the possibility of undiagnosed diabetes in patients with sudden onset or progression of periodontal disease, poor response to periodontal treatment, poor wound healing, or recurrent or persistent bacterial or fungal oral infections—refer the patient to a medical practitioner.