Dental care of the patient with diabetes mellitus: clinical practice recommendations

Abstract

Diabetes mellitus (DM) encompasses a group of metabolic diseases that have in common the presence of hyperglycemia. Besides its clinical complications, the poorly controlled DM is also associated with oral health disorders (e.g., periodontal disease, xerostomy, hypossalivation, susceptibility to infections, difficulty in healing). This paper aims to update the dental-surgeon on the current knowledge of DM and presents a protocol to guide the dental care of the diabetic patient. The literature review used the MEDLINE and LILACS database searching for articles published in the past ten years utilizing the following keywords: diabetes mellitus, dentistry, oral health and periodontal disease. The results are structured in topics. The first part presents updated information regarding the diagnosis, clinical, oral manifestations and treatment of the DM. The second part, proposes a clinical protocol in which are discussed, in a didactic manner (e.g., history, physical examination, subsidiary evaluation), the most common doubts related to the dental consult of the diabetic patient (e.g., antibiotic prophylaxis during procedures with high risk of bacteremia, use of antiinflammatory, sedatives and anesthetics with vasoconstrictors, definite versus palliative treatment, how to proceed in the event of hypoglycemia and hyperglycemia, when to suspect of a DM yet non diagnosed). At the end, a clinical sheet summarizes the most important aspects of this evaluation. Patients with well controlled diabetes can be treated similarly to non-diabetics for most routine dental needs. The dental
practitioner, in communication with the assistant physician, plays an important role in the promotion and maintenance of the diabetic patient's quality of life.