Management of an emergency tooth extraction in diabetic patients on the dental chair

Abstract

Background and objectiveApproximately 75% of diabetic patients in Saudi Arabia had poor glycaemic control. A high proportion of these patients will attend dental surgery clinics for treatment. Therefore, dentists should be well-prepared to control any complications they might arise on the dental chair during the dental procedures. Management of the associated risk factors is important to limit disease complications and improve the health of patients with diabetes.The objectives of this review were to determine the maximum acceptable level of blood glucose for tooth removal in diabetics, show a systematic technique for the management of patients with diabetes on the dental chair. By using PRISMA guidelines, analysis of the published articles and reports across the world is considered one of the most appropriate available methods to obtain strong evidence about the acceptable levels of blood glucose where teeth extraction can be done safely.ResultsA total of 1080 studies were retrieved using the search strategy. After screening 185 titles, abstracts and 85 full-text articles, 36 studies were included. The outcome of this systematic review revealed that fasting blood glucose level of 240 mg/dl is a critical point for any dental treatment because the warning signs of diabetes start coming out. Maximum acceptable levels of blood glucose for removal of teeth in diabetics are 180 mg/dl (before meal) and 234 mg/dl (2 h after a meal). High blood glucose levels reduce the secretion of nitric oxide (powerful vasodilator) in the body which leads to poor circulation and slow-healing socket. Uncontrolled diabetics are at high risk of infection because of the high ketone levels in the blood.ConclusionFasting blood glucose level of 180 mg/dl is a cut-off point for any selective dental extraction. However, Random blood glucose level of 234 mg/dl (13 mmol/l) is a cut-off point for an emergency tooth extraction. Tightly controlled diabetic patients (blood glucose level below 70 mg/dl) are susceptible to hypoglycemia.

Evaluation of Surgical Treatment of Oroantral Fistulae in Smokers Versus Non-Smokers

“…This failure could not be attributed to smoking alone, as there were confounding factors such diabetes mellitus, large fistula and bony defect, and an occluded osteomeatal complex. A review by Gazal G, regarding the effect of blood glucose levels on healing processes, emphasizes that patients with uncontrolled diabetes are at high risk of infection due to the high ketone levels in their blood [ 38 ]. This patient subsequently underwent FESS surgery and additional closure of OAF by a combination of palatal, buccal and buccal fat pad flaps with complete closure up to six months follow-up postoperatively.…”

Management of periodontal disease in patients with diabetes- good clinical practice guidelines: A joint statement by Indian Society of Periodontology and Research Society for the Study of Diabetes in India

“…[ 6 ] Elective periodontal surgical treatment, if indicated, shall only be performed for patients with HbA1c levels ranging from 6 to 8, at the time of initial or subsequent visits. [ 1 2 3 4 5 6 7 8 ] Poorly controlled (HbA1c values >8) diabetes patients with periodontal disease shall be put on maintenance therapy, that is, supportive periodontal treatment (SPT) and planned for periodontal surgical procedures, only after the glycemic levels decrease to the range of 6–8 HbA1c. [ 3 4 ] Patients shall be referred to the general physician for control and evaluation of glycemic status.…”

“…[ 3 4 ] Patients shall be referred to the general physician for control and evaluation of glycemic status. [ 1 2 3 4 5 6 8 ] No periodontal intervention (surgical) should be instituted for diabetes patients reporting to the dental clinic, with HbA1c levels >10, except emergency treatment and that too in consultation with the general physician of the patient. [ 7 8 ]…”

“…[ 1 3 ] Patients with HbA1c levels ranging from 6 to 8 have no greater risk of postoperative infection than those without diabetes. [ 1 7 8 ] As there is an increased risk of periodontal disease in poorly controlled diabetes patients, individuals with periodontal disease who have HbA1c values above 8 should be advised active maintenance therapy after NSPT. This should include meticulous evaluation of a patient's periodontal status, frequent oral prophylaxis, oral hygiene instruction reinforcement, and consistent supervision of periodontal health.…”

<p>Comparison of Extraction Socket Healing in Non-Diabetic, Prediabetic, and Type 2 Diabetic Patients</p>

“…[10][11][12][13] Although there exists a systematic review on the management of tooth extraction in diabetic patients, there is a paucity of literature on the outcomes of tooth extraction in people with diabetes. 14 Due to lack of proper documented literature, minor oral surgical treatments including extractions are deferred by many oral health professionals in diabetic patients citing reasons like delayed wound healing and increased risk of postoperative infection. In such situations, physician consultation is warranted amounting to unnecessary delay in treatment and also unnecessary administration of preoperative antibiotics and analgesics.…”