Oral Health Fact Sheet for Dental Professionals
Children with Type 1 Diabetes Diabetes type 1 is a disease in which the body does not produce insulin, resulting in a high level of sugar in the blood. (ICD 9 code 250.0)
Prevalence Manifestations Clinical of untreated diabetes
• Increased risk of dental caries due to salivary hypofunction
• Accelerated tooth eruption with increasing age
• Gingivitis with high risk of periodontal disease (poor control increases risk)
• Salivary gland dysfunction leading to xerostomia
Other Potential Disorders/Concerns
• Ketoacidosis, kidney failure, gastroparesis, diabetic neuropathy and retinopathy
• Poor circulation, increased occurrence of infections, and coronary heart disease
Management Medication
Insulin injections (no oral health side effects)
Behavioral Dental Treatment and Prevention
• Ensure glycemic control at appointment time. Review recent diabetes control with patient, and caregiver/
parent as appropriate. Hemoglobin A1c (HbA1c) <7 indicates good control in previous 3 months, > 8
• Schedule short morning appointments. Ensure that child has eaten a meal and taken usual medication prior
• Monitor oral disease progression, oral hygiene, diet, and smoking habits frequently. Consider increased recall
and perio maintenance frequency. Treat periodontal disease aggressively. Periodontal disease can significantly
worsen diabetes and associated cardiac disease.
• Consult with child’s physician before surgical procedures as insulin dosage may need to be adjusted.
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• In children with candidiasis, prescribe sugar-free Nystatin (clotrimazole troches typical y contain sugar and
• For children with recurrent HSV infection, management with systemic and topical medications is indicated
to decrease frequency and duration of infection. Increased oral comfort will improve child’s ability to manage
• Consider antibiotic coverage for children with poorly controlled diabetes since there may be increased risk of
infections and delayed wound healing. Treat oral infection and ulceration aggressively.
• Provide tobacco prevention and cessation education. People with diabetes who smoke are 20 times more
• Hypoglycemic episode: Symptoms include mood changes, hunger, weakness, and decreased spontaneity
leading to tachycardia, sweating, and incoherence. If occurs, terminate dental treatment immediately and
administer 15 grams of fast-acting carbohydrate (glucose tablets, sugar, juice, etc). Monitor blood glucose
after treatment to determine if additional carbohydrate is necessary. If patient is unable to swallow or loses
consciousness, seek medical assistance and administer glucagon subcutaneously. Pediatric dosage schedule
for glucagon: < 20kg; 0.02-0.03 mg/kg or 0.5 mg and > 20kg: 1mg.
Look for signs of physical abuse during the examination. Note findings in chart and report any suspected abuse to
Child Protective Services, as required by law. Abuse is more common in children with developmental disabilities
Additional information: References
• Skamagas, M., Breen, T.L., LeRoith, D. (2008) Update on diabetes mellitus: prevention, treatment, and
association with oral diseases. Oral Dis, 14(2):105-114.
• Lal a, E., Cheng, B., Lal, S., Tucker, S., Greenberg, E., Goland, R., Lamster, I. (2006) Periodontal changes in
children and adolescents with diabetes: a case-control study. Diabetes Care, 29(@): 295-299.
• Vernillo, AT. (2003) Dental considerations for the treatment of patients with diabetes mellitus. J Am Dent
Additional Resources
• Free of charge CDE coursE hours); E hours)
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