Oral Surgery for the Diabetic Patient

Dr. Keyvan Abbaszadeh
Oral Maxillofacial Surgeon, London ON

In this latest episode in a series of presentations on oral surgery for the general practitioner, Dr. John O’Keefe, Director of Knowledge Networks CDA, invites Dr. Keyvan Abbaszadeh, Oral Maxillofacial Surgeon from London ON, to discuss the management of the diabetic patient before, during and after oral surgery.

In an in-depth presentation, Dr. Abbaszadeh takes a deep dive into the key concerns from an oral surgery perspective, including what you need to know in the medical history, the management of diabetic medications, and how to deal with a hypoglycemia emergency in the dental office.

Here are some of the key takeaways from the presentation…

• Take a thorough history:
  • Date of onset of diabetes
  • Type of diabetes
  • Medications
  • Control/stability of disease (HbA1c level)
  • Complications
  • Compliance
  • Prior experiences in healthcare settings
  • Other systemic issues
• When performing oral surgery on a diabetic patient, consider booking an early appointment as they tend to be physiologically better in the morning
• Glycemic management on the day:
  • Has their blood sugar been taken, and if so, what is it?
  • Have they eaten, and if so, what?
  • How do they feel when glucose is too low or too high?
• If sedation is not being used, ensure that the patient has had a good meal prior to the appointment.
• Ensure profound anesthesia and anxiety control as stress levels can affect glucose levels.
• Ensure that the patient has adequate post-op analgesia.
• Ensure normal diet post-op, if possible.
• Management of medications (in consultation with physician)
  • Skip short-acting dose on day of surgery
  • Modify long-acting meds, even as early as the night before.
  • If patient cannot eat post-op, medications may need to be modified.
  • Antibiotics – empiric use of antibiotics is advisable with the narrowest spectrum appropriate for the case.
  • Do not change medication without guidance from the patient’s physician.

We hope you find the conversation useful. We welcome your thoughts, questions and/or suggestions about this post and other topics. Leave a comment in the box below or send us your feedback by email.

Until next time!
CDA Oasis Team