Anon. asks:
I have a number of patients in my practice with Insulin Dependent Diabetes and Non-Insulin Dependent Diabetes. Is either condition an absolute contraindication for placing dental implants? Relative contraindication? How do I evaluate these patients to determine which of them is a suitable candidate for implant restoration and which is not?
Patients with Diabetes: How Do I Evaluate Suitability for Implants?
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Diabetics that are controlled are just like normal people, but if they are out of control, that is when all of the problems begin.
The key number you should always ask about is the patient’s A1c. This will tell you how well controlled the patient is with their blood sugar.
A bone graft in an uncontrolled diabetic can be life threatening.
Glycosylated hemoglobin is a test that indicates how much sugar has been in a person’s blood during the past two to four months. It is used to monitor the effectiveness of diabetes treatment.
You should do it and if the patient is well controlled then no problem, he’s a normal patient.
But if uncontrolled refer him for treatment and management.
If your patient checks their own glucose with a meter ask what the range has been. You want it close to 150 and definitely no episodes above 250. When in doubt do an A1c. It should be 7 or less.
what is an A1c
Dear Dr R, I was wondering the same thing – here’s some info I doenloaded from the web.
To explain what the A1c test is, think in simple terms. Sugar sticks, and when it’s around for a long time, it’s harder to get it off. In the body, sugar sticks too, particularly to proteins. The red blood cells that circulate in the body live for about 3 months before they die off. When sugar sticks to these cells, it gives us an idea of how much sugar is around for the preceding 3 months. In most labs, the normal range is 4-5.9 %. In poorly controlled diabetes, its 8.0% or above, and in well controlled patients it’s less than 7.0%. The benefits of measuring A1c is that is gives a more reasonable view of what’s happening over the course of time (3 months), and the value does not bounce as much as finger stick blood sugar measurements.
There is a correlation between A1c levels and average blood sugar levels as follows:
While there are no guidelines to use A1c as a screening tool, it gives a physician a good idea that someone is diabetic if the value is elevated. Right now, it is used as a standard tool to determine blood sugar control in patients known to have diabetes.
A1c(%) Mean blood sugar (mg/dl)
6 135
7 170
8 205
9 240
10 275
11 310
12 345
The American Diabetes Association currently recommends an A1c goal of less than 7.0%.
Of interest, studies have shown that there is a 10% decrease in relative risk for every 1 % eduction in A1c. So, if a patients starts off with an A1c of 10.7 and drops to 8.2, though there are not yet at goal, they have managed to decrease their risk of microvascular complications by about 20%. The closer to normal the A1c, the lower the absolute risk for microvascular complications.
Could any one please suggest a proper weaning pattern about Fosemax before placing dental implants