Dental procedures in patients with diabetes

Use clinical judgment to decide whether a patient with diabetes can be safely treated with outpatient dental treatment, or if they require dental treatment in hospital. Most patients with diabetes have a routine of medications, diet, activity and blood glucose monitoring that maintains blood glucose concentration within safe limits. Provided this routine is not interrupted, most dental treatment can proceed in an outpatient setting. Management of a patient with stable diabetes undergoing a dental procedure in an outpatient setting outlines the approach to outpatient dental treatment for patients with stable diabetes, with practical advice to avoid causing hypoglycaemia.

Optimal glycaemic control periprocedurally improves outcomes in patients with diabetes. If possible, postpone elective dental procedures until glycaemic control is optimised; however, do not delay treatment of acute or infective dental conditions. If unsure whether dental treatment can safely proceed, consult the patient’s medical practitioner.

Sodium-glucose co-transporter 2 (SGLT2) inhibitors may need to be stopped temporarily before a dental procedure—see here for more information.

If preprocedural fasting is required (eg for general anaesthesia or intravenous sedation) for a patient with diabetes, an anaesthetist or other appropriate medical practitioner must supervise the dental procedure—see Periprocedural management of adults with diabetes for more information.

Figure 1. Management of a patient with stable diabetes undergoing a dental procedure in an outpatient setting

Before the procedure

  • Determine the patient’s usual routine (eg medications, diet, activity, blood glucose monitoring).
  • Determine whether any type of activity destabilises the patient’s blood glucose control.
  • For patients taking SGLT2 inhibitors, see additional advice here.
  • Determine the extent and type of dental treatment required.
  • Ask patients to bring their glucose monitor on the day of the procedure if they use one.

Scheduling the procedure

  • Schedule the procedure for the morning, so that any potential sequelae can be resolved during the day.
  • Consider the patient’s usual meal times and medication regimen; aim to minimise interruption to their routine.
  • Avoid extensive treatments and long appointments.

Day of the procedure

  • Check that the patient has followed their usual meal times and medication regimen and is feeling well.
  • If the patient has missed a meal, if possible, ask them to eat and start treatment 30 minutes later; otherwise reschedule the appointment.
  • Do not give patients glucose or a sweetened drink ‘just in case’; this is ineffective and can destabilise their diabetes management.
  • If a patient feels ill during the procedure, stop treatment. Assess their blood glucose concentration if a blood glucose monitor is available. If unsure of the cause of their symptoms, call 000. For the first-aid management of hypoglycaemia occurring in a dental practice, see Management of hypoglycaemia in dental practice.
  • Do not allow the patient to leave your care if they are unwell or confused.

After the procedure

  • Advise patients to maintain their usual caloric intake, activity level and medications, even if their mouth is sore.
  • Provide dietary advice on preparation of soft foods if they are likely to have difficulty eating.
Note: SGLT2 = sodium-glucose co-transporter 2