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Question:

My 77 year old aunt, who has had diabetes for about six years, is scheduled for dental work (filling and perhaps root canal work if the cavity is large), and her fasting blood sugar varies from 136-154 mg/dl [7.6-8.6 mmol/L]. I came across some information on the Internet that recommended antibiotics be given prior to dental treatment for those with impaired immunity. Do people with diabetes belong in this category? Will she need an antibiotic before the procedure? Are people with diabetes at risk of infection from blood borne bacteria during dental treatment? During dental treatment, is it possible for bacteria to spread from the mouth via the bloodstream to infect other parts of the body? Would people with diabetes be particularly susceptible to this since they are prone to infections?

Answer:

Some dental treatment is more invasive than others. Invasive dental procedures would include extractions, gum cleanings, and root canals. The ability of the person with diabetes to resist infection from dental procedures depends on the level of glycemic control. The poorer the control, the greater the opportunity for an infection to occur.

Dental infections can spread metastatically in rare instances. When this occurs and with what frequency is unknown. In the medical era before antibiotics, systemic spread of dental infection was more common and documented. Dental infections were at one time the fourth leading cause of death (nearly two hundred years ago).

People with diabetes are more prone to infections when they are in poor glycemic control. This is due to alterations in the immune status which is dependent on their level of control. Patients who have an average glucose of 200 mg/dl [11.1 mmol/L] or more have been shown to have a diminished white blood cell function.

I would not injudiciously place your aunt on antibiotics, but weigh the type of procedure being performed and its invasiveness with her level of glycemic control before deciding. A medical consultation is of utmost importance.

FV

[Editor's comment: See Surgery Pre-Op Advice, at the Diabetes Monitor, for some additional thoughts. WWQ]

DTQ-20010825074559
Original posting 30 Aug 2001
Posted to Surgery

  
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Last Updated: Tuesday April 06, 2010 15:09:26
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