My nine year old daughter, who is on a pump and has an A1c A1c of 7.8%, needs orthodontia, and the orthodontist is recommending extraction of two permanent teeth in order to make room for all of her other teeth. We are concerned about her blood sugar control during and after this procedure. What risks are involved in having teeth pulled? What precautions would you recommend? We intend to discuss this with her endocrinologist at her next appointment but would like to get your input also. We are very concerned that the cost of perfection is too high if it will risk her health.

If the roots of the teeth to be extracted are not deep, the likelihood is that the operation will be a very brief one under local anaesthetic. In any case, it would be important for the dentist to discuss the issue with your daughter’s endocrinologist and for you to monitor blood sugars before and after the procedure. This is one of the situations I which being on a insulin pump may be an advantage. The teeth can then be taken out in a fasting state and a bolus given afterward for any immediate blood glucose adjustment.

DOB
Additional comments from Dr. Stuart Brink:

These are relatively simple procedures and could be easily handled much as you would sick days. Schedule the procedures first thing in the morning. If being done with local anesthetic, then not much risk of glucose control problems. If using short general anesthetic, if done in the morning without breakfast, hold the bolus, cut back the basal rate temporarily. After the procedure, do a blood glucose check, cover the actual value and resume as you would any other day with frequent blood glucose checks. We have lots of kids who have this done with pumps or with multidose insulin regimens without problems. If any questions, have your daughter’s endocrinologist or nurse talk to the orthodontist.

SB
Additional comments from Lois Schmidt Finney, diabetes dietitian:

With frequent blood glucose testing and a probable increase in the basal rate, she should do fine. She will probably be on something for pain and an antibiotic and these meds may also cause an increase in blood glucoses. She will probably need to have a soft diet, so no carrots, etc., but that is easy enough to accommodate. All in all, her procedure should go fine, but testing is so important.

LSF

[Editor’s comment: Also see Surgery Pre-Op Advice.

SS]