Diabetes mellitus (DM) is a metabolic condition affecting metabolism of fats, carbohydrates and proteins. Two basic types are: insulin-dependent (IDDM; Type 1) and non-insulin-dependent (NIDDM; Type II)*. Both types affect children. Poor glycemic control (HbA1c > 8) is associated microangiopathy and salivary hypofunction and can lead to the following conditions:

1. Periodontal disease: Reduction in salivary flow; dehydration of alveolar mucosa from mouth breathing; decrease in bone mineral density
2. Impaired wound healing
3. Oral candidiasis: Immunosuppressive and anti-inflammatory effects of steroids; higher salivary glucose promoting fungal overgrowth
4. Xerostomia: Certain cardiac medications (diuretics, ACE inhibitors) may cause and increased risk.
5. Dental caries: Reduced salivary flow rate and pH; presence of fermentable carbohydrates; reduction in buffering capacity

Alleviating Measures

• Review recent diabetes control with patient/caregiver and caregiver and consult with patient’s pediatric and/or endocrinology provider as indicated and always before a surgical intervention
• Instruct child to eat and to adhere to usual medication regime prior to examinations
• Monitor nutrition, oral hygiene and suggest modifications as indicated
• Chew sugar-free gum to stimulate salivary flow and restore moisture
• Use caries preventive measures (sealants, fluoride supplements, antimicrobial mouthwashes)
• Aggressively treat periodontal disease and oral candidiasis
• Consider antibiotic prophylaxis for children with poor glycemic control in consultation with pediatric and/or endocrinology provider
• Screen for tobacco use and provide prevention and cessation counseling
• Monitor for signs of hypoglycemia during examinations and procedures and intervene as necessary