Explore essential strategies with Dr. Leslie Fang, PhD, for managing diabetic patients in dentistry—from tailored treatments to advanced care for better outcomes.
By Genni Burkhart
This topic is included in DOCS Education's "Top 25 Safety Statements," which can be found here.
In the U.S., 37.3 million people—about 11.3% of the population—are living with diabetes, with 28.7 million already diagnosed and another 8.6 million undiagnosed. Diabetes affects individuals across all social, economic, and ethnic backgrounds. Notably, nearly 26.4 million Americans aged 65 and older (or 48.8%) have prediabetes.
These statistics mean that in a dental practice with 1,000 patients, a dentist could expect 110-120 patients with diabetes, each with unique considerations. For dental professionals, diabetes can introduce complexities in treatment options, especially for sedation dentistry, where protocols must consider both diabetic and hypertensive conditions.
In response to this growing need, DOCS Education and the esteemed Dr. Leslie Fang, PhD—a leading physician, educator, DOCS faculty member, and entrepreneur—offer an insightful program dedicated to oral sedation dentistry for patients with diabetes and hypertension.
Type-Specific Considerations
- Type 1 Diabetes: Insulin Deficiency
Type 1 diabetes results from insulin deficiency and often requires intensive management due to higher risks of metabolic complications. Patients with Type 1 should raise a “red flag” due to the complexity of their condition, especially when it comes to dental care. With about 1.45 million Americans managing Type 1 diabetes, these patients are frequently more challenging in a dental setting due to the potential for severe complications and the longer duration of the disease.
- Type 2 Diabetes: Insulin Resistance
Type 2 diabetes, affecting 37.3 million Americans, results from insulin resistance. Controlling Type 2 diabetes starts with lifestyle changes, such as diet and exercise, but many also require oral medications and insulin injections.
- Prediabetes
It’s estimated that 96 million Americans have prediabetes—a major risk factor for developing Type 2 diabetes. That’s over 1 in 3 adults in the U.S., highlighting the importance of taking a thorough health history with information regarding the last time the patient has seen a physician.
Management Challenges
Diabetic patients often present with other health conditions, including hypertension, cardiovascular disease, peripheral neuropathy, and renal disease. These complications make them more prone to oral infections, which, if uncontrolled, can worsen blood glucose levels.
Patients with poor diabetic control (measured by HbA1c levels) are particularly susceptible to infection. In dentistry, this may necessitate less restrictive antibiotic use to manage oral infections effectively.
Technological Advances in Diabetes Management
In recent years, technology has revolutionized diabetes care. Many patients now benefit from Continuous glucose monitoring (CGM) systems like Dexcom G6 and closed-loop insulin pumps like the Omnipod 5. These advancements enable better glucose control, reducing the risks of complications and, thereby, oral health.
Medications for Diabetes Management
While Metformin remains the cornerstone treatment for Type 2 diabetes, newer medications offer added benefits:
- GLP-1 Receptor Agonists (e.g., Ozempic) and GLP-1/GIP Receptor Agonists (e.g., Mounjaro) help control blood sugar and promote weight loss.
- SGLT2 Inhibitors (e.g., Jardiance) improve cardiovascular health and aid in fluid balance, making them valuable for patients with congestive heart failure.
- DPP-4 Inhibitors (e.g., Januvia) provide another option for managing Type 2 diabetes.
These medications support glucose control and improve cardiovascular health, which is crucial for diabetic patients also at a heightened risk of heart disease.
HbA1c: The Gold Standard for Diabetes Control
Monitoring HbA1c levels provides insights into a patient’s average blood sugar over the last 3 months.
A healthy HbA1c is typically under 6%, and values above 8.5% signal poor control—a “Red Flag” in dentistry. In fact, lowering HbA1c by just 1% reduces mortality and complications, underscoring the value of glycemic control in reducing risks, even in dental procedures.
Communicating with Patients
Equally important to staying informed on the latest treatments, technology, and research on diabetes is communicating to patients how their oral health directly impacts their overall health and diabetes management. Here are some practical insights that can help guide conversations and education with patients:
- The Two-Way Street of Diabetes and Gum Health
Diabetes increases the risk of gum disease, and interestingly, severe gum disease can make blood sugar more challenging to control. Sharing this connection with patients can help them see how taking care of their mouth benefits their diabetes, too.
BMC Oral Health - Diabetes and Oral Comfort
Diabetes can cause discomfort in the mouth, affecting eating, speaking, and confidence. Addressing these effects can improve patients’ quality of life beyond the dental chair. Educating diabetic patients on good oral hygiene and its benefits on daily comfort is a powerful motivator.
Frontiers in Public Health - Preventive Care Makes a Difference
Research shows that people with diabetes often skip essential oral care routines, yet they're more susceptible to gum disease than those without. Encouraging preventive habits like regular cleaning and check-ups can help diabetic patients avoid complications and keep their smiles healthy.
CDC - A Surprising Link: Toothbrushing and Blood Sugar
Studies suggest routine teeth brushing supports blood sugar control, particularly for Type 2 diabetics. Highlighting this benefit can make patients view toothbrushing as a crucial part of managing their diabetes and something that shouldn't be skipped.
Diabetes Spectrum - Missing Teeth as a Potential Diabetes Risk
Research links poor oral health, including tooth loss, to a greater risk of diabetes. Regular dental exams help catch these signs early, making routine visits essential to preventive care.
Diabetes Research and Clinical Practice
The Importance of Proactive Measures
Diabetes presents unique challenges for dentists, impacting both treatment and recovery. By proactively addressing these needs, you can support patients' overall health and improve outcomes, especially in procedures requiring healing and infection control. Educating patients on the connection between oral and systemic health goes beyond treating their teeth—it empowers them to make choices that benefit their whole health. Staying informed on the latest treatments enables you to make a meaningful difference in patient's lives, both in and out of the dental chair.
For more information on this topic, Dr. Fang's course explores case studies and presents real-world experiences. It also provides 1 hour of CE credit with a digital certificate issued upon completion, equipping dental professionals with the knowledge to safely and effectively care for diabetic patients.
Author: With over 14 years as a published journalist, editor, and writer, Genni Burkhart's career has spanned politics, healthcare, law, business finance, technology, and news. She resides in Northern Colorado, where she works as the editor-in-chief of the Incisor at DOCS Education.
