Following on from our previous post, this is article three in our “Medication and Dental Surgery: How your medical history influences treatment decisions“ series. This article discusses diabetes and how it influences dental treatment with regards on how to take your diabetic medications.

If you are coming to NQ Surgical Dentistry to have an extraction or surgical procedure under local anaesthesia (oral injections), you should take your normal medication and eat your normal food intake.  There should be no need for any change to your diabetic medication.  If you have a blood sugar monitor, please bring it with you to your surgical appointment to do a test both before and on completion of your procedure.

If you are going to be treated at a day surgery unit and receiving a general anaesthetic for the extraction or surgery and you have been told to fast for 6 hours before your general anaesthetic, your usual medication dose will have to be modified to ensure your blood sugar level does not become too low when you fast.  In most cases, diabetic patients are treated at the start of the morning operating list to make their blood sugar management less complex.  The majority of diabetic patients will have an understanding of their diabetic management and will know their usual blood sugar values.  It would be best to discuss the management of blood sugar with Dr. Priestland well before the date of surgery.  For longer procedures, Dr Priestland will involve the anaesthetist in your diabetic management around the time of your surgery and you will then be assured of a stable blood sugar despite the need for a period of fasting.

Some diabetic patients may have their surgery planned at the practice under a local anaesthetic with intravenous sedation.  If this is the case, fasting is required before sedation and therefore diabetic medication dose may be altered.  It is important to discuss this part of your care with Dr Priestland well before the date of surgery. If you have a blood sugar monitor, please bring it with you to your surgical appointment to do a test both before and on completion of your procedure.

It is important that diabetic patients perform home monitoring of their blood sugar level after surgery.  While the level will fluctuate during the day and night and after food, it is best to limit the range of this fluctuation.  A stable and well-controlled blood sugar is safer and will place a diabetic patient at less risk of health complications.

Healing after surgery in diabetics need not be a problem if their blood sugar is stable.  A patient with a widely fluctuating level will be far more likely to suffer from post-operative infection and delayed healing.

Avoiding an infection is therefore especially important for diabetics. For this reason, Savacol mouthwash (containing Chlorhexidine 0.2%) must be used as a gentle mouth bath for 2 minutes every morning and night after brushing the teeth for 3 days before surgery (if possible) and for 10 days after surgery.  This will help to control the vast numbers of bacteria that exist in the mouth and thereby reduce the chance of infection.

It is best not to “swish” the mouthwash around the mouth vigorously.  If you “swish” around you may open up the stitches or disturb the surgical site and the blood clot that has formed.  If the blood clot is lost from the extraction socket, then the tooth socket can become a food trap.  Consequently, bacteria and food accumulate and an infection may occur leading to a “dry socket”.   A dry socket is characterised by increasingly severe pain, usually arising 3-7 days after surgery.  Usually, the gum surrounding the extraction site is very tender.

Dry sockets are easy to treat but you will need to call the practice (normal working hours from Mon to Thu 0800-1730 call 4725 1656) or call Dr Priestland’s mobile number outside these hours (his number is to be found on the post-operative instruction leaflet you were given at your consultation appointment and on the practice business and appointment cards).

You will need to make an appointment to return as soon as we can see you to gently flush out any accumulated food particles and then Dr Priestland will place a dry socket dressing called Alvogyl, into the infected tooth socket.  Within 30 minutes much of the pain will have been eliminated and over the next 24-48 hours, the dressing will treat the infection.

We advise all diabetic patients to follow the advice they will have received from their own doctor and from their diabetic nurse concerning the management of their diabetes.  Diet is an important part of diabetic control and medication is a support therapy to maintain health.  But good dietary decisions are the foundation of successful diabetic management.

If you are a diabetic patient unsure of any of these instructions or worried about developments since your treatment please contact the friendly team at NQ Surgical Dentistry today on (07) 4725 1656 or call in to see us at 183 Kings Rd, Pimlico QLD 

Other posts in this series

• Medication and Dental Surgery: How your medical history influences treatment decisions
• Osteoporosis medication influences dental extractions and dental surgery
• Diabetes and dental treatment or surgery
• Dental extractions and surgery after radiation therapy of the head and neck
• Knee or hip replacement surgery influences future dental management
• The influence of cardiac disease on dental management
• Anticoagulant and anti-platelet medications influence management of dental extractions and dental surgery
• Angina (heart-related chest pain) medications and dental treatment
• Codeine sensitivity or allergy
• Patients who routinely take steroid medications