Page 10 - GP Spring 2018

Traumatic ulcers drugs called Alpha-Glucosidase Inhibitors: References
Geographic tongue Glyset (Miglitol) and Precose (Acarbose). 1. 2017 White Paper by University of California,
Burning mouth syndrome Berkeley School of Public Health. Suneil Koliwad,
Fissured tongue With the recognition of hypoglycemia, the MD., PhD. 2017.
2. Diabetes and the Dental Patient: John Hardeman,
Benign migratory glossitis common use of orange juice (fructose) or MD, DDS, Dentistry Today, May 2017, pages 111-
Lichen planus candy (sucrose) will not reverse the altered 114.
Angular cheilitis consciousness and, may, in fact, result in 3. Centers for Disease Control and Prevention. Na-
Delayed healing the patient going into a full loss of con- tional diabetes statistics report, 2017. Centers for Dis-
ease Control and Prevention website. www.cdc.gov/
Hypo-salivation sciousness (LOC). diabetes/pdfs/data/statistics/national-diabetes-sta-
tistics-report.pdf (PDF, 1.3 MB) . Updated July, 18
Periodontal disease in diabetic patients This is because these medications act by 2017. Accessed August 1, 2017.
may be more severe and progress more rap- prolonging the time for the breakdown of 4. Rao SS: Impaired Glucose Tolerance and impaired
idly due to the associated impaired immu- fructose and sucrose. Therefore, the best fasting glucose, Amer Fam Physician 69:1961-
1968,2004.
nity and healing challenges. This is due, in form of sugar to give to patients on these 5. Teeuw, W. (2017) Periodontitis as a possible early
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part, to the hyperglycemia and ketoacidosis medications is “Glucose Gel.” This should sign of Diabetes Mellitus; British Medical Journal:
that changes the phagocytosic activity of be in the emergency kit of all dentists. Open Diabetes Research and Care 2017;5:e000326.
the macrophages and the chemotactic ef- doi:10.1136/bmjdrc-2016-000326.
6. Taubes, G. (2017) The Case Against Sugar: Alfred
fect of polymorphonuclear neutrophils. 9 Diabetic patients in an altered conscious- A. Knopf, New York.
ness state may be difficult to reason with 7. Economic cost of Diabetes in the U.S., Diabetes
As dentists, we have a unique opportunity (due to the lack of glucose going to the Care, 2013:36;1033-1046, June, 1, 2013.
to detect these many early warning signs brain) and, as such, you must be firm and 8. Personal communication with Dr. Tom Viola at the
that may lead to an early diagnosis and now, assertive with their taking the Glucose gel GNYDM on Nov. 26, 2017.
9. The American Academy of Oral Medicine: Diabe-
with the addition of this new code for in-of- or other forms of sugar. You may consider tes Mellitus. March 3, 2017.
fice testing for A1c, an even greater oppor- saying, “Take this now and we can argue 10. Vasconcelos BC, Prevalence of oral mucosa le-
tunity to help in the fight against diabetes. later.” sions in Diabetic patients: a preliminary study: Braz J
Otorhinolaryngol 2008;74:423-428.
Three important considerations when Having a heightened index of suspicion
treating diabetic patients: when a diabetic patient is exhibiting signs After graduating from
and symptoms of hypoglycemia is critical New York University
1) Hypoglycemia Unawareness to preventing a crisis situation from devel- College of Dentistry in
Over time, repeated episodes of hypoglyce- oping. If a diabetic patient exhibits an al- 1978, Dr. Daniel G. Pom-
mia can lead to hypoglycemia unawareness. tered consciousness and is given sugar in pa completed a General
The body and brain no longer produce signs a form that is consistent with their medica- Practice Residency at
and symptoms that warn of low blood sug- tion and history, a blood sugar level should Long Island Jewish Hos-
ar, such as sweating, shakiness, or irregular be taken. If the patient and the dentist are pital, followed by special-
heartbeats. When this happens, the risk of comfortable then the dental treatment for ty training in Oral and Maxillofacial
severe, life-threatening hypoglycemia is in- that visit may proceed. However, if a lon- Surgery at Lincoln Hospital, New York
creased. If this occurs in the dental office, ger procedure is scheduled, then consider- Medical College. In 1982, he became a
it can be a crisis as the dentist has no warn- ation should be given for a more complex Fellow of The American Association of
ing of the impending hypoglycemic event carbohydrate like peanut butter and crack- Oral and Maxillofacial Surgeons and
before the patient becomes unconscious. A ers. If there is any question prior to starting in 1992 a Fellow in The International
2
thorough history is required to determine treatment, a glucometer should be used to Congress of Oral Implantologists. Dr.
if your patient with DM may present with check the patient’s blood glucose levels. Dan Pompa has been a guest lecturer at
this sign of hypoglycemia. Your “situation- Having a glucometer in the dental office Columbia University College of Dental
al awareness” should be heightened espe- is also recommended to rule out the cause Medicine and New York University Col-
cially if your patient is a recently diagnosed of any seizure as being hypoglycemic in lege of Dentistry and is now a guest fac-
diabetic Type II, is not compliant with med- origin. Most drug stores today offer their ulty at NYU College of Dentistry and the
ications or lifestyle changes, and has expe- own brand glucometers that contain up to University of Florida College of Dentist-
rienced frequent hypoglycemic episodes. 10 free test strips to make the testing com- ry. Dr. Pompa has lectured extensively,
plete. These are inexpensive and are usual- including at the Academy of Osseointe-
2) Diabetic Patients on Beta Blockers ly under $30. gration, the International Interdisci-
Diabetic patients on beta blockers will not plinary Congress on Craniofacial and
necessarily show sweating and shaking as What is the best time of the day to treat Skull Base Surgery, and has presented
the beta blockers will prevent this. These diabetic patients? at the annual Greater New York Dental
patients may develop altered conscious- Meeting numerous times throughout the
ness or loss of consciousness without prior Morning appointments are preferred be- years. In November 2013, Dr. Pompa
warning just like patients with hypoglyce- cause this is the time of high glucose and became a Seminar Series Speaker/Con-
mia unawareness. low insulin activity, thus reducing the risk sultant for the American Dental Asso-
of hypoglycemia. In addition, this is the ciation. More information about him is
3) New Diabetic Medications (Alpha Glu- time we produce the most amount of corti- available at www.APS4DDS.com.
cosidase Inhibitors) and how they affect sol which results in a heightened ability to
the treatment of diabetic patients show- deal with stress.
ing signs and symptoms of hypoglycemia
Today we have a new class of diabetic Diabetes.org is an excellent source of in-
formation for the patient and the practi-
tioner regarding hypoglycemia. 2
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