Medical Case Details:
Can anyone pls tell me is it advisable to do extraction in a patient of blood glucose level ??I guess no ..
if so how to manage that patient before extraction??
Discussions
Dr. Soheel Hussain Zargar
Dentist
Diabetic patients needs to be taken special care.
First of all you need to have fresh tests for Fasting blood glucose which should be around 100 t 125mg/dl and post prandial to be around 140mg/dl.These are safest ranges in which you can try extraction at dental clinic.
However if we report a diabetic patient it is always better to do an extraction if he is hyperglycemic than hypoglycemic where hypoglycemic shock can precipitate.
Now when should we do extraction :Preferably asking patient to get with him glucometre and do tests before extraction is planned.
Next is in always tell the patient to come for extraction after eating something .As i already mentioned hypoglycemia is always a dangerous thing than hyperglycemia.so if a patient is hyperglycemic then no problem.you can do if you are confident and have enough human and technical support at clinic.
Another thing is there is chance of bleeding which cant stop as in diabetes wounds also doesnt heal easily.so always get patients CBC,CTBT tests done.
Try atraumatic extraction as much as possible without much instrumentation.you can try elevator with patience and it can do the job.
Fourth always try to suture the extraction site even if there is less need as dry socket chances are highest in diabetic patients.
Rest after extraction keep patient for wsit and watch for 30 minutes to avoid any hypotensive episode to happen.
At last it is better to manage complicated patients if you have technical and manpower support available.
Dentist
Diabetic patients needs to be taken special care.
First of all you need to have fresh tests for Fasting blood glucose which should be around 100 t 125mg/dl and post prandial to be around 140mg/dl.These are safest ranges in which you can try extraction at dental clinic.
However if we report a diabetic patient it is always better to do an extraction if he is hyperglycemic than hypoglycemic where hypoglycemic shock can precipitate.
Now when should we do extraction :Preferably asking patient to get with him glucometre and do tests before extraction is planned.
Next is in always tell the patient to come for extraction after eating something .As i already mentioned hypoglycemia is always a dangerous thing than hyperglycemia.so if a patient is hyperglycemic then no problem.you can do if you are confident and have enough human and technical support at clinic.
Another thing is there is chance of bleeding which cant stop as in diabetes wounds also doesnt heal easily.so always get patients CBC,CTBT tests done.
Try atraumatic extraction as much as possible without much instrumentation.you can try elevator with patience and it can do the job.
Fourth always try to suture the extraction site even if there is less need as dry socket chances are highest in diabetic patients.
Rest after extraction keep patient for wsit and watch for 30 minutes to avoid any hypotensive episode to happen.
At last it is better to manage complicated patients if you have technical and manpower support available.
▲ 1
04.Oct, 06:33pm
Dr. Deepti Jakhmola
Dentist
Hello Dr Priyanga
Diabetes Mellitus is not a contraindication for extraction but in these patients we need to take care of few points
*always check for blood glucose level even if the patient tells he is controlling. Go for HbA1C estimation.Glycated hemoglobin is a form of hemoglobin that is measured primarily to identify the three-month average plasma glucose concentration.?
The ratio should be 6.If it is raised then go for extraction under the guidance of physician
*Always try to schedule morning appointments for diabetic patients as stress level is low.
*make sure patient is not empty stomach
*keep all hemostatic measures ready.
*Try to make the procedure least traumatic.
*Explain post operative instructions clearly.Better to provide print out of instructions.
*call patient for follow up check up after 1 day and then after 3 days .
Dentist
Hello Dr Priyanga
Diabetes Mellitus is not a contraindication for extraction but in these patients we need to take care of few points
*always check for blood glucose level even if the patient tells he is controlling. Go for HbA1C estimation.Glycated hemoglobin is a form of hemoglobin that is measured primarily to identify the three-month average plasma glucose concentration.?
The ratio should be 6.If it is raised then go for extraction under the guidance of physician
*Always try to schedule morning appointments for diabetic patients as stress level is low.
*make sure patient is not empty stomach
*keep all hemostatic measures ready.
*Try to make the procedure least traumatic.
*Explain post operative instructions clearly.Better to provide print out of instructions.
*call patient for follow up check up after 1 day and then after 3 days .
▲ 1
05.Oct, 12:10am
Dr. Divya Banu M
Dentist
Ask the patient to get recent HbA1c result. 5.6-6.5 is normal, till 7 you can go for extraction, make sure patient has taken food, medicines. Wisdom tooth removal, go in for prophylactic antibiotics too, or any infectious cause leading to extraction, antibiotics is necessary. If uncontrolled diabetic, get a physician consent, and you can start the patient on antibiotics course (again if infection) 2 days before extraction, which will be continued 2-3 days after extraction too (and if the patient is on the antibiotic course, no need of prophylactic antibiotics).
Be sure of any hypoglycemic event/medical emergency. Have the necessary emergency medicines. And advise the patient about the proper oral hygiene and how and why healing could be delayed and chances of infection are there and why antibiotic is necessary. And yes, as already mentioned by a doc, a suture is advisable + good care of post-extraction oral hygiene is a must.
Dentist
Ask the patient to get recent HbA1c result. 5.6-6.5 is normal, till 7 you can go for extraction, make sure patient has taken food, medicines. Wisdom tooth removal, go in for prophylactic antibiotics too, or any infectious cause leading to extraction, antibiotics is necessary. If uncontrolled diabetic, get a physician consent, and you can start the patient on antibiotics course (again if infection) 2 days before extraction, which will be continued 2-3 days after extraction too (and if the patient is on the antibiotic course, no need of prophylactic antibiotics).
Be sure of any hypoglycemic event/medical emergency. Have the necessary emergency medicines. And advise the patient about the proper oral hygiene and how and why healing could be delayed and chances of infection are there and why antibiotic is necessary. And yes, as already mentioned by a doc, a suture is advisable + good care of post-extraction oral hygiene is a must.
▲ 1
05.Oct, 09:57am
Dr. Priyanga. K
Dentist
Thanku drs...
The patient is hypoglycemic (54mg/dl)
He came for RS extraction in his 18.
Should I put patient under medication before extraction???
if so what are the medicines??
can anyone help
Dentist
Thanku drs...
The patient is hypoglycemic (54mg/dl)
He came for RS extraction in his 18.
Should I put patient under medication before extraction???
if so what are the medicines??
can anyone help
05.Oct, 11:20am
Dr. Soheel Hussain Zargar
Dentist
Get him consulted by endocrinologist as glucose level below 60mg|/dl can prove fatal.Rest you can prescribe antibiotics
hosever if he has pain try nimesulide or ketorol instead others as such patients often have respiratory difficulties
Dentist
Get him consulted by endocrinologist as glucose level below 60mg|/dl can prove fatal.Rest you can prescribe antibiotics
hosever if he has pain try nimesulide or ketorol instead others as such patients often have respiratory difficulties
▲ 1
05.Oct, 11:26am
Dr. Osman Adam
Dentist
HbA1C estimation is enough to measure under patient control technique inside the clinic
Dentist
HbA1C estimation is enough to measure under patient control technique inside the clinic
17.Dec, 03:21pm
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