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Thecenterforpediatricdentistry.comOral 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
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
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. Children with Type 1 Diabetes continued
• 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:
• 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) Permission is given to reproduce this fact sheet. Fact sheets developed by the University of Washington DECOD For persons with disabilities, this document Oral Health Fact Sheets for Patients with Special (Dental Education in the Care of Persons with Disabilities) Program is available on request in other formats. Needs 2010 by University of Washington and through funding provided to the Washington State Department of Health Oral Health Program by HRSA grant #H47MC08598).
1-800-525-0127 (TTY/TDD 1-800-833-6388).
Dritter Teil: Gentechnikrecht im internationalen Überblick § 15 GENTECHNIK UND TIERSCHUTZ IN HUMANMEDIZIN UND PATENTRECHT . 329 I. Gentechnik und Humanmedizin: weitere Beispiele zum Umgang mit Tieren . 329 1. Keine Nebensache: kopflose Tiere . 329 2. Vom Tierembryo zum Menschenklon . 330 3. Tiere zwischen Forschungsfreiheit und Wirtschaftsinteressen . 331 II. Tierschutz und Patentrecht: Argu