My 16 year old daughter was told to plan for wisdom teeth extraction in the next year, and I want to know should an emergency occur. She’s been on the pump two years and has excellent hemoglobin A1c’s — less than 7% on her last check. My experience with two children without diabetes causes me to know that the “routine” service oral surgeons do won’t work very well for her. Do you have any suggestions?

The information as to dental management of the person with type�1 diabetes is limited. I like to make the following suggestions:

Since this person is well-controlled, I would recommend a board-certified oral and maxillofacial surgeon.
I would recommend a nutrition consultation with the diabetes educator and the diabetes specialist prior to the removal of the third molars due to the changes in diet in the post-operative period which could be 1 to 5 days.
Emotionally prepare the patient that he/she will be going through a potentially tough time.
Do an early morning appointment. Do not allow the dental surgeon to remove the insulin pump if he/she has one!
If sedation is done, the individual will have to been fasting for 12 hours generally. Insure that the blood sugar is checked before and after the surgery. Most surgeries are done outpatient in the oral surgeon’s office.
Careful follow-up and communication with the diabetes team is important in the both the pre- and post-operative periods.

FV

[Editor’s comment: See: Surgery Pre-Op Advice for some additional thoughts.

SS]