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Question:

From Lancaster, California, USA:

My teen son needs his wisdom teeth pulled. One of them is giving him a lot of grief. He can barely eat. We saw the oral surgeon at the dentist yesterday and he wants to get a consent form from my son's doctor stating that he is able to have the teeth pulled. This means that my son has to go another week and a half before he can get the teeth pulled, which means another week and a half of pain. The surgeon is afraid that my son may not heal properly because he is a diabetic. Is this a common thing? My son has never even had a cavity so this is new to us.

Answer:

As I am aware of it, an oral surgeon is currently trained in assessment of a patient's diabetes status. Many also have dual degrees (MD and DDS). If the patient has been poorly compliant with medical treatment, this might be an effort to have the endocrinologist "shoulder" the liability burden. However, in all of this, someone has forgotten about how patients with diabetes respond to pain and infection and the influence of this and the stress of the situation on the patient.

It is also possible that the oral surgeon might be planning to sedate the patient, but still much of their training encompasses how to manage these patients. In the meantime, the patients sugars might get higher due to pain or infection and further increase the chances of post-operative problems. The oral surgeon may also want a current A1c but he can order that test himself and it is a great predictor of control. If this patient's A1c were higher than 8%, there might be issues post-operatively. He may just want a good history.

The request might also be an issue of reimbursement. If a physician deems a dental procedure medically necessary and related to well-being of that patient with diabetes, then, in those instances, medical insurance will pay.

There could simply be a misunderstanding between the patient's parents and the oral surgeon. But, in this day and age of a litigious society, I have seen what had previously been "routine" or "simple" dental procedures become more complicated by "defensive" practitioners. A diabetes patient's A1c can easily be found out by a phone call, so I am thinking this might be more of a reimbursement issue. That is more or less dictated by insurers. The wisdom tooth pain can be managed. In general, it is primarily due to eruption pain. Young males don't do well with pain in the first place and have forgotten the last painful procedure of circumcision!

FV

DTQ-20080626132023
Original posting 26 Jun 2008
Posted to Aches and Pains and Surgery

  
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Last Updated: Tuesday April 06, 2010 15:10:16
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