Did you know that it is estimated that the number of patients with diagnosed diabetes will increase by 165% from 2000 through 2050 in the United States? In the 2020 report from the CDC, it was noted that 34.2 million people in the US already have diabetes, 21.4% of whom are undiagnosed, and that a further 88 million individuals have prediabetes. Approximately 90% of patients with diabetes have Type 2 diabetes.
Patients with diabetes are at increased risk for cardiovascular disease, renal disease, peripheral neuropathy, retinopathy and loss of sight. Uncontrolled diabetes can have a devastating effect on systemic health. We are all familiar with the relationship between diabetes and periodontal disease. Periodontal disease is associated with poorly controlled diabetes and periodontal disease is a factor in the control of diabetes. Other oral issues for patients with diabetes include burning mouth, increased risk for infections and dry mouth.
We should also be considering blood glucose levels during a dental appointment. As dental hygienists, we can champion monitoring of blood glucose levels.
In addition to reviewing the medical history form which needs to be regularly updated for all patients during visits, patients can be asked additional questions, and routine blood pressure and pulse readings taken. For patients with diagnosed diabetes and periodontal disease, its also important to understand how well or poorly their diabetes is controlled. For patients with diabetes or considered at risk for diabetes, knowing their blood glucose level at the time of their dental appointment is important in helping to avoid emergencies.
The Hb1ac test measures the percentage of glycosylated hemoglobin, which indicates the average over the prior 2 to 3 months. In patients with diabetes, the Hb1ac level reaches 6.5% or higher.
To measure the blood glucose level at the time of a dental appointment, a fingerstick glucometer test is used and provides a value for that moment.
The fingerstick glucometer test is advised for patients with or at risk for diabetes; glucose levels in a given patient are variable and can be quite different at given moments. This test makes it possible to determine at the time of the appointment whether the patient's blood glucose level is within a normal range, too high or too low. A low glucose level is considered to be 70 mg/dl or less and a high glucose level to be 200 mg/dl or more.
Patients with low glucose levels are at risk for hypoglycemic medical emergencies. The patient should not have their dental procedure until their blood glucose level is with the normal range. For patients with high glucose levels, severe infection and delayed healing can occur - it's recommended that elective surgical procedures are rescheduled and provided when the patient's blood glucose level is within the normal range.
Who can perform the test depends on your State Dental Act and licensing. It may only be dentists, or also other dental professionals with or without direct supervision. There are other regulations and the type of test to consider as well.
- Understanding a patient's medical history is essential
- Knowing the blood glucose level at the time of the dental appointment for a patient with or at risk for diabetes and postponing care if indicated can help avoid hypoglycemic emergencies
- As dental hygienists, we can champion glucose monitoring