Endocrine
Dental Management of Patients with Diabetes mellitus
Confirm recent HbA1c & glycaemic control
Glycaemic control influences infection and healing risk.
Emergency vs routine management
If EMERGENCY — what to do
- • Check capillary glucose before treatment.Ref: American Diabetes Association. Standards of Care in Diabetes — 2024 (Hypoglycaemia; Perioperative care). Diabetes Care 2024;47(Suppl 1)
- • Hypoglycaemia (glucose < 4 mmol/L / 70 mg/dL, sweating, confusion): give 15–20 g fast-acting glucose orally, recheck after 15 min; if unconscious give glucagon 1 mg IM and call emergency services.Ref: Resuscitation Council UK. Medical emergencies and resuscitation — Standards for dental practice, 2020 (updated 2023)
- • Glucose > 16.7 mmol/L (300 mg/dL), ketones or systemically unwell: palliative care only and urgent physician referral.Ref: Little JW, Miller CS et al. Dental Management of the Medically Compromised Patient, 10th ed., Elsevier 2023
- • Treat odontogenic infection aggressively — infection worsens glycaemic control.Ref: Little JW, Miller CS et al. Dental Management of the Medically Compromised Patient, 10th ed., Elsevier 2023
If ROUTINE — what to do
- • HbA1c < 8%: routine care.Ref: Little JW, Miller CS et al. Dental Management of the Medically Compromised Patient, 10th ed., Elsevier 2023
- • HbA1c 8–10%: proceed with caution and infection control; HbA1c > 10%: defer elective surgery and refer for control.Ref: Little JW, Miller CS et al. Dental Management of the Medically Compromised Patient, 10th ed., Elsevier 2023
- • Morning appointments after the usual meal and medication.Ref: American Diabetes Association. Standards of Care in Diabetes — 2024 (Hypoglycaemia; Perioperative care). Diabetes Care 2024;47(Suppl 1)
Clinical precautions
- • Confirm recent HbA1c
- • Morning appointment after normal meal & medication
- • Avoid hypoglycaemia
Information & tests to request
- • Most recent HbA1c (%)
At a glance by procedure
Initial assessment before lab results or timing details are entered.
| Procedure | Initial assessment |
|---|---|
| Examination / radiographs | MODIFY / CAUTION Confirm recent HbA1c & glycaemic control |
| Supragingival scaling / polish | MODIFY / CAUTION Confirm recent HbA1c & glycaemic control |
| Deep scaling / subgingival RSD (subgingival calculus) | MODIFY / CAUTION Confirm recent HbA1c & glycaemic control |
| Root canal treatment | MODIFY / CAUTION Confirm recent HbA1c & glycaemic control |
| Simple extraction (1–3 teeth) | MODIFY / CAUTION Confirm recent HbA1c & glycaemic control |
| Surgical / bony extraction | MODIFY / CAUTION Confirm recent HbA1c & glycaemic control |
| Implant placement | MODIFY / CAUTION Confirm recent HbA1c & glycaemic control |
References
- ADA — Diabetes & Dental Care
- American Diabetes Association. Standards of Care in Diabetes — 2024 (Hypoglycaemia; Perioperative care). Diabetes Care 2024;47(Suppl 1)
- Resuscitation Council UK. Medical emergencies and resuscitation — Standards for dental practice, 2020 (updated 2023)
- Little JW, Miller CS et al. Dental Management of the Medically Compromised Patient, 10th ed., Elsevier 2023
Related guides
This guide supports — and does not replace — professional clinical judgment. Always consider the individual patient and consult the treating physician when indicated.