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Special Needs

Dental Professionals Treating Children with Type 1 Diabetes

Oral Health Fact Sheet for Dental Professionals Treating Children with Type 1 Diabetes

Diabetes type 1 is a disease in which the body does not produce insulin, resulting in a high level of sugar in the blood. (ICD 9 code 250.0)

Prevalence

< 1% in children

Manifestations

Clinical of untreated diabetes

  • High blood glucose level
  • Excessive thirst
  • Frequent urination
  • Weight loss
  • Fatigue
  • Poor growth in infants

Oral

  • Increased risk of dental caries due to salivary hypofunction
  • Accelerated tooth eruption with increasing age
  • Gingivitis with high risk of periodontal disease (poor control increases risk)
  • Salivary gland dysfunction leading to xerostomia
  • Impaired or delayed wound healing
  • Taste dysfunction
  • Oral candidiasis

Other Potential Disorders/Concerns

  • Ketoacidosis, kidney failure, gastroparesis, diabetic neuropathy and retinopathy
  • Poor circulation, increased occurrence of infections, and coronary heart disease

Management

Medication

Insulin injections (no oral health side effects)

Behavioral

None

Dental Treatment and Prevention

  • Ensure glycemic control at appointment time. Review recent diabetes control with patient, and caregiver/ parent as appropriate. Hemoglobin A1c (HbA1c) <7 indicates good control in previous 3 months, > 8 indicates very poor control.
  • Schedule short morning appointments. Ensure that child has eaten a meal and taken usual medication prior to treatment.
  • Monitor oral disease progression, oral hygiene, diet, and smoking habits frequently. Consider increased recall and perio maintenance frequency. Treat periodontal disease aggressively. Periodontal disease can significantly worsen diabetes and associated cardiac disease.
  • Consult with child’s physician before surgical procedures as insulin dosage may need to be adjusted.
  • In children with candidiasis, prescribe sugar-free Nystatin (clotrimazole troches typically contain sugar and
    should be avoided).
  • For children with recurrent HSV infection, management with systemic and topical medications is indicated
    to decrease frequency and duration of infection. Increased oral comfort will improve child’s ability to manage
    diabetes through diet.
  • Consider antibiotic coverage for children with poorly controlled diabetes since there may be increased risk of
    infections and delayed wound healing. Treat oral infection and ulceration aggressively.
  • Provide tobacco prevention and cessation education. People with diabetes who smoke are 20 times more
    likely to develop periodontitis.
  • Hypoglycemic episode: Symptoms include mood changes, hunger, weakness, and decreased spontaneity leading to tachycardia, sweating, and incoherence. If occurs, terminate dental treatment immediately and administer 15 grams of fast-acting carbohydrate (glucose tablets, sugar, juice, etc). Monitor blood glucose after treatment to determine if additional carbohydrate is necessary. If patient is unable to swallow or loses consciousness, seek medical assistance and administer glucagon subcutaneously. Pediatric dosage schedule for glucagon: < 20kg; 0.02-0.03 mg/kg or 0.5 mg and > 20kg: 1mg.
  • Look for signs of physical abuse during the examination. Note findings in chart and report any suspected abuse to Child Protective Services, as required by law. Abuse is more common in children with developmental disabilities and often manifests in oral trauma.

References

  • Skamagas, M., Breen, T.L., LeRoith, D. (2008) Update on diabetes mellitus: prevention, treatment, and association with oral diseases. Oral Dis, 14(2):105-114.
  • Lalla, E., Cheng, B., Lal, S., Tucker, S., Greenberg, E., Goland, R., Lamster, I. (2006) Periodontal changes in children and adolescents with diabetes: a case-control study. Diabetes Care, 29(@): 295-299.
  • Vernillo, AT. (2003) Dental considerations for the treatment of patients with diabetes mellitus. J Am Dent Assoc, 134: 245-335.

Additional Resources

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