Dr. Andra Rettman’s complete guide to dental care for patients with diabetes. What is the link between diabetes and dental treatment? How is a treatment plan built for diabetes patients? What are the potential complications, and what should be considered when placing implants in patients with diabetes?
Diabetes is a common metabolic disease characterized by high blood glucose levels. The disease is divided into two main types:
Type 1 diabetes – about 10% of patients in Israel belong to this category. It was formerly known as insulin-dependent or juvenile diabetes and mainly appears in young patients under the age of 30. It is an autoimmune disease in which the body attacks itself and destroys the cells in the pancreas responsible for producing the hormone insulin.
Type 2 diabetes – about 90% of patients in Israel belong to this category. By definition it is not insulin-dependent and is associated with the older population. It usually stems from cellular resistance to insulin, combined with obesity, metabolic syndrome, lifestyle and genetic predisposition. The disease is diagnosed by blood tests showing high glucose levels, and includes symptoms such as frequent urination, increased thirst or hunger, weight loss and sometimes blurred vision.
Other, less common types of diabetes are known today, such as gestational diabetes, drug-induced diabetes, diabetes secondary to various diseases (cancer, infections), MODY (maturity-onset diabetes of the young), LADA (latent autoimmune diabetes in adults) and others.
Diabetes treatment is determined according to the severity of the disease. Usually, blood glucose can be controlled by combining lifestyle changes – quitting smoking, a healthy diet, physical activity and maintaining a healthy body weight – with medications acting through various mechanisms, including stimulating insulin secretion from the pancreas, inhibiting glucose production in the liver, reducing sugar absorption from the intestine, slowing gastric emptying, inhibiting glucose reabsorption in the kidney, and up to daily use of insulin with different durations of action.
Our dental clinic specializes in dental care for patients with complex medical backgrounds and a range of underlying conditions, whose treatment requires knowledge of the adjustments needed in dental care in light of their medical background and the medications they take.
Dental treatment for diabetes patients must include a personalized plan that takes into account the type of diabetes, the severity of symptoms, the various oral manifestations, treatment and coping strategies, and familiarity with managing emergencies that may occur (hypoglycemia).
The multi-system symptoms of diabetes are directly related to glycemic control and may affect the patient’s daily life.
Poor glycemic control directly affects the mouth. Glucose secretion in saliva affects dental health, the salivary glands may be affected, and there may be signs of reduced immune function.
There is a two-way relationship between diabetes and gum disease: poor glycemic control may worsen existing gum disease and cause tooth loss, while untreated gum disease in turn affects the ability to control diabetes.
In a patient with uncontrolled diabetes, we may find in the mouth:
Yes, mainly when patients’ diabetes is not controlled. On the other hand, a patient with well-controlled diabetes is at exactly the same level of safety as any patient without diabetes.
Yes. Leading research shows that dental implants can be placed in diabetes patients, after preliminary blood tests for glycated hemoglobin (HbA1c) confirming that the diabetes has been controlled for several months before the implant. In this situation, implant placement in a person with diabetes is almost identical to that in anyone else. When diabetes is uncontrolled, the risk of implant failure and complications around the implant (infections, impaired healing) increases.
Yes. Leading research shows that dental implants can be placed in diabetes patients, after preliminary blood tests for glycated hemoglobin (HbA1c) confirming that the diabetes has been controlled for several months before the implant. In this situation, implant placement in a person with diabetes is almost identical to that in anyone else. When diabetes is uncontrolled, the risk of implant failure and complications around the implant (infections, impaired healing) increases.
In addition, recovery and healing may be slower and longer in patients with diabetes, so minimally invasive interventions and close follow-up are advisable.
Patients without diabetes also sometimes suffer from dental anxiety. In diabetes patients, stress and psychological pressure may raise blood sugar levels, so the use of anesthesia or a range of medications that help the patient cope and even disconnect from the situation may be considered.
Dr. Rettman’s dental clinic provides dental treatment under sedation and general anesthesia.
Yes, mainly when patients’ diabetes is not controlled. On the other hand, a patient with well-controlled diabetes is at exactly the same level of safety as any patient without diabetes.
