Case Report

Supervisor :

dr. A. Yudho S. Akp, Sp.PD, FINASIM

by :

Fatimatuz Zahroh 131611101051

Natasha Destanti H. 131611101063
Safira Niza U. 131611101087

Faculty Of Dentistry Jember University

Departement of Internal Medicine
Balung General Hospital
Jember
2018
Tooth Extraction Management in Diabetic Patient with High Random Blood
Glucose Level
The patient should to be assessed in case of the following symptoms and signs
are found during the clinical examination. The blood glucose level must be measured
before the procedure. When the random blood glucose level >200 mg/dL or higher,
the treatment should be delayed until the blood glucose level is normal. Denstist
should reschedule the appointment and referred to internist. Furthermore, dentist
should give information to patient why the treatment must be delayed. If tooth
extraction is held while the blood glucose level above normal, it tend to be more
susceptible to infection with tooth extraction wounds and may extend to surrounding
tissues. Microangiopathy that occurs in people with diabetes mellitus can cause blood
vessels to be ineffective. This is what causes wound healing in people with diabetes
mellitus become slow. When the blood glucose level is normal, the treatment can be
done (Karbassi, 2015).
Pretreatment in Patients with Diabetes

- Dentist must gathered information about mechanisms of the drugs

used, as well as their interaction with other drugs.
- Morning appointments should be preferred.
Endogenous cortisol levels are typically higher at this time. Because cortisol
increases blood sugar levels, the risk of hypoglycemia is less. For patients
using short- and/or long-acting insulin therapy, appointments should be
scheduled so they do not coincide with peak insulin activity, which increases
the risk of hypoglycemia.
- Before extraction procedures, diabetic patients are requested to take
their morning medications and have their routine meal.
It is important to confirm that the patient has eaten normally before the
appointment and has taken all scheduled medications. If a procedure is
planned with the expectation that the patient will alter normal eating habits
 ahead of time (e.g., conscious sedation), diabetes medication dose may need
to be modified in consultation with the patient’s internist.
- Antibiotic prophylaxis before treatment must be administered to
prevent infection.
- Patients must not be kept waiting for a long period of time, and
attention must be paid to pain control (ADA, 2017).
Management Considerations in the Oral Treatment Process
- Vital sign serve as a guide to the control and management of disease in
the patient with diabetes. Patient with abnormal pulse rate and rhtym or
elevated blood pressure should be in practitional control.
- The blood glucose level must be measured before the procedure. The
procedure can proceed if blood glucose is between the values of 100 and 200
mg/dl; if it exceeds 200 mg/dl, we should consult to internist.
- In the case that treatment continues for a longer-than-expected period
of time, the blood glucose value must be monitored every hour.
- Atraumatic methods must be used due to the high probability of
fracture or complications during tooth extractions performed to prevent the
risk of osteoporosis.
- For most patient with diabetes, routine use of local anesthetic with
1:100.000 epinephrine is well tolerated. Of note, however, epinephrine has a
pharmacologic effect that is opposite that of insulin, so blood glucose could
rise with the use of epinephrine (Little et al., 2018).
Prophylactic Approaches with regard to Oral Health in
Patients with Diabetes
- Remind patients that daily and regular dental care is essential for the
treatment and metabolic control of diabetes.
- Diabetic patients must be educated about the impact of oral hygiene on
the treatment of diabetes.
- Diabetic patients without metabolic control must be informed of the
increased periodontal disease and caries risk related to raised saliva glucose
levels.
 - Nutrition plays a crucial role in the regulation of diabetes, so any oral
rehabilitation that the patient needs for a healthy diet must be promoted/
induced immediately.
- Patients at risk of developing diabetes who have not been diagnosed
yet must be referred to a related specialist (Yilmaz et al., 2015).

Reference :
1. ADA Science Institute. Oral Health Topics: Diabetes. 2017.
2. Karbassi, M. H. Akhavan, Raha Salehi, Khatere Kheirollahi, Mehrdad
Ghaffari Traghi, Maryam Jalili, Bahare Yousefipour. 2015. The Relationship
between Socket Blood Sugar and Post-Extraction Complication in Type II
Diabetic and Non-Diabetic Patient. Iranian Journal of Diabetes and besity. Vol.
7: No. 1.

3. Little, James W., Craig S. Miller, Nelson L. Rhodus. 2018. Dental

Management of the Medically Compromised Patient 9th Edition. Missouri:
Elsevier.
4. Yılmaz, M. Temel, Taner Yücel, D.D.S, Professor Ahmet Kaya, Özen Doğan
Onur, Sehnaz Karadeniz. 2015. Clinical Guidelines In Dentistry For Diabetes.
Turki : Turkish Diabetes Foundation - Turkish Dental Association