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Insights on Controlling Blood Sugar in the Dentist's Chair


May 15, 2008

According to the American Dental Association (ADA), people with diabetes are more prone to periodontitis, tooth decay, oral fungal infections, taste diminishment, gingivitis and delayed healing time than people without the disease.

That’s because uncontrolled blood sugar levels can cause and worsen those symptoms and conditions. According to the ADA, sugary and starchy foods contribute to high glucose levels in saliva, which can wear down tooth enamel, causing decay and cavities. Periodontal disease, which affects the gums and bones that hold the teeth in place, occurs at higher rates among diabetics.

Of course, those diseases often lead people with diabetes to the dentist chair, and it’s there that they must undertake a juggling act between blood sugar control and the after-effects of dentistry.

For people with diabetes, maintaining control of blood sugar levels after oral surgery can be frustrating. What we eat and the amounts we eat can become dangerously limited. As a diabetic who has undergone four wisdom tooth extractions and six fillings within the past two years, I am constantly looking for better ways to maintain control over my blood sugar.

Plan for the Unexpected

It is very important to plan for delays or extra procedures. Last summer, to beat the midday rush, I scheduled a dental appointment for 8:30 a.m.  I didn’t eat breakfast because I had experienced a bad reaction when I ate before a biopsy requiring a local anesthetic two weeks earlier. I reasoned that I would be out of the office by 10 a.m. and would be able to eat soon thereafter.

When I arrived, I learned that my dentist was ill and that because the procedure could not wait, a substitute dentist would do the necessary work. I told him that I was a diabetic and requested that I have a few minutes for my blood sugar to go up. I also notified him that I was on other medications and had an insulin pump as well.  (If you have an insulin pump, make sure you notify the doctor and the nurses assisting in the procedure.)

After checking my blood sugar and finding that it was 89, I popped a glucose tablet into my mouth and settled down in the chair for what I assumed would be a quick procedure.    
After reviewing my X-rays and examining my mouth for himself, the substitute dentist gave me a local anesthetic and requested that additional X-rays be taken. They revealed much worse news: There were new cavities between the teeth where the existing fillings were, and two other teeth needed fillings.

The dentist also found that although the spaces where my bottom wisdom teeth had been had healed perfectly, the top two teeth had become wedged against the back of my jaw. On top of having cavities of their own, they needed to be extracted as soon as possible.

By the time the procedure started, it was 10:30 a.m. I did not walk out of the office until two hours later. When I checked my blood sugar at home, I found it was 302 mg/dl–the result of forgetting to restart my pump. It was 2 p.m. before I was able to eat. I realized that instead of stopping my pump completely, I should have switched to a temporary bolus.

The lesson? Remember to ask your endocrinologist if you need to temporarily reset your basal and bolus rates to correspond with the amount of food you will be eating or if you need to wait extended periods before eating.

What to Eat?

The first time I had cavities filled, there was some tenderness after the procedure but I was able to mince my way through a sandwich. But that was nothing compared to my extractions, after which I subsisted on chicken noodle soup, applesauce and penicillin.

During this latest procedure, the dentist had wedged a bite guard to separate my upper and lower jaw for the good part of an hour while he drilled in front of, behind, and between my teeth. I left feeling incredibly sore and drove straight to the grocery store, where I picked up two cans of chicken noodle soup and a box of oatmeal. I soon learned that for extended periods of modified eating, I get easily bored with having only two options.

One problem for people with diabetes is finding options that fit within our dietary standards. Tenderness after oral surgery can make it harder to get the required amount of nutrients. Applesauce was a great solution for me after my wisdom teeth extraction. There are lots of flavors: cinnamon with pears and mixed berry are just a few. You can even find neon-colored applesauce to amuse children (and get them to eat).

None of the options I found were sugar-free–they were loaded with fructose corn syrup. I was afraid to eat them, believing that whatever I selected would raise my glucose levels past their normal limit.  I wondered if I should check out the baby food aisle. Two stores later, I found a sugarless applesauce and used artificial sweetener to flavor it.

Some Post-Surgery Suggestions

My experience left me wondering what other options there were.  I knew I needed to incorporate more nutrients and variety into the food that I ate. I found that grits, Cream of Wheat, stews, soft-boiled vegetables, mashed potatoes, Jell-O, pudding and yogurt make great options. (It goes without saying that I avoided spicy foods and chewing near the operation site.)

Other options include the Glucerna line of liquid products from Ensure. Baking or microwaving an apple to softness and eating baked or sweet potatoes are also good options. Water, tea and juice, in moderation, can help keep you hydrated after the surgery. After my wisdom tooth removal, I went through a box of green tea, which for me was easy to digest.  
Homemade fruit smoothies and sugar-free ice cream helped soothe my sore throat after I had my tonsils removed. I also made stews, which can incorporate a variety of vegetables, rice and grains.

I’m putting a positive spin on my upcoming oral surgery, chalking it up as a chance to try out a new juicer and dust off my blender.

Tiffany Brand graduated from Agnes Scott College with a B.A. in English Literature-Creative Writing in May 2007. She has had type 1 diabetes for 16 years. She previously wrote "Get Yourself and Your Supplies Abroad Safely," which Diabetes Health published in May 2007.


Categories: Blood Sugar, Diabetes, Diabetes, Food, Insulin, Insulin Pumps, Oral Health, Type 1 Issues



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Comments

Posted by omegaman on 15 May 2008

I'm wondering about your diet. Mashed potatoes, sweet potato, oatmeal, fruit smoothies, grits, cream of wheat... all high carbohydrate foods. How can you maintain anything close to normal blood sugars while eating this stuff? (And by the way, I don't think any of it is healthy. In fact, I don't consume anything like it and seem to be completely healthy.) No wonder your bs was 302 after your proceedure.

Posted by Anonymous on 16 May 2008

1st question, why would you turn off your pump during the procedure? Pumps allow a temp basal rate to be run...and as a longstanding diabetic...YOU ALWAYS need background/basal insulin!
2nd question, you didn't seem to look very hard for sugar free items in the grocery stores! I have found numberous products in the applesauce aisle that are flavored AND sugar free! Look harder!
As a post gastric bypass patient, I can attest that there are MANY sugar free options out there..you just have to look for them.

Posted by Anonymous on 16 May 2008

I am a little confused after reading this article. I can't even fathom going to a medical appointment and not having breakfast. That's just a recipe for disaster. I always check my sugar before an appointment to make sure I will be ok through the appointment. I also am not understanding why a the woman stopped her pump during a dental appointment. She wasn't active and normal freezing wears off in about an hour. I also can't understand why after dental surgery or basic dental procedures,why one would be that concerned about food variety. Obviously, if you have to be careful because of your sore mouth, you eat wehat you're able to at that time. Who cares oif there's enough variety. If you're on the pump you are able to have a very flexible eating plan anyways. I am just totally confused by this article.

Posted by Anonymous on 16 May 2008

I concur. After my tooth extractions, crowns, and fillings, I drink Atkins or Boost high protein shakes, eat low carb greek yogurt, and make soups out of pureed fresh veggies adding unflavored whey protein powder as needed. I scramble eggs and tofu, or make omelets with sauteed veggies- all soft foods, all reasonably low in carbs. Last time, I even juiced greens- to get my salad in. My sugar always stays in range with these choices.

Posted by ndocroth on 16 May 2008

Last time I had my pathology text open "peritonitis" was an inflammatory disease of the abdominal and not the oral cavity... Perhaps writer and editor meant "periodontal" disease?

Posted by Anonymous on 19 May 2008

I encourage anybody with a dentist appt. to take their diabetes meds (including insulin) and eat before going to the appt. Unless the dentist wants you to fast for surgery, then you need to ask your endo how to handle your insulin for the safest outcome. Also, don't forget that cooked non-starchy veggies can be mashed and with a little seasoning are very tasty! and should be included in a healthy meal plan. Also, I believe the writer meant "periodontitis" not "peritonitis". Peritonitis refers to the abdomen, not to the mouth.

Posted by Anonymous on 22 May 2008

From-Tiffany Brand
to omegaman. The foods I listed are just suggestions-I should have added some low carbohydrate options as well and I definitely don't recommend eating the foods I listed in the same sitting.

The reason my pump was off was that my blood sugar was extremely low before the procedure. The procedure took as twice as long as it normally did-and (user error) I did not plan accordingly for that.


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