Australian Dental Journal
The official journal of the Australian Dental Association
Australian Dental Journal 2013; 58: 536–543
LETTERS TO THE EDITOR
doi: 10.1111/adj.12117
Letters may comment on articles published in the Journal and should offer constructive criticism. When appropriate, comment on the letter is sought from the author. Letters to the Editor may also address any aspect of the profession, including education, new modes of practice and concepts of disease and its management. Letters should be brief (no more than two A4 pages).
DIABETES, WOUND HEALING AND COMPLICATIONS The authors of the study ‘The healing of dental extraction sockets in patients with Type 2 diabetes on oral hypoglycaemics: a prospective cohort’1 should be commended for proving what has been observed anecdotally for some time – that those patients who have well controlled diabetes or who are on oral hypoglycaemics do not have an increased risk of impaired wound healing after dentoalveolar surgery. Diabetes is an important chronic disease in Australia whose incidence is growing at a staggering rate. By 2031, it is estimated that 3.3 million Australians will have Type 2 diabetes.2 Therefore, more patients with Type 2 diabetes will present to general dental practitioners (GDP), periodontists and oral and maxillofacial surgeons requiring treatment for diabetes related dental diseases, general dental care and oral surgery. This underlies the importance of the findings of the present study. It appears from the results that most patients who have Type 2 diabetes treated with oral hypoglycaemics can be managed for basic extractions in general dental practice. The authors of the present study did not recommend the use of antibiotic cover or special precautions in this patient group.1 However, it should be noted that the study was performed in an oral and maxillofacial surgery unit where the staff either have medical degrees or commonly treat patients with complex medical co-morbidities. Thus in the GDP or periodontal setting, communication with the patient’s medical practitioner would still seem prudent to ascertain the level of long-term glycaemic control and thus the possible risk of complications. It would be worthwhile, however, keeping in the back of one’s mind that serious complications can still occur in the diabetic population, particularly if one is poorly controlled or undiagnosed, although the frequency of such sequelae is fortunately rare. Although the use of insulin in Type 2 diabetic patients is generally restricted to those with poor or difficult glycaemic control, some patients on oral hypoglycaemics may also have poor long-term control of their blood glucose levels. There are previous reports of patients with poor glycaemic control with 536
Type 2 diabetes who presented with a massive facial infection and airway obstruction after the placement of dental implants, as are cases of hyperosmolar coma with diabetic ketoacidosis in patients with Type 1 diabetes as a result of dentoalveolar infections or extractions.3,4 Nonetheless, the authors have produced important results in a prospective fashion that will influence clinical practice and should be congratulated on their work. REFERENCES 1. Huang S, Dang H, Huynh W, Sambrook PJ, Goss AN. The healing of dental extraction sockets in patients with Type 2 diabetes on oral hypoglycaemics: a prospective cohort. Aust Dent J 2013;58:89–93. 2. Vos T, Goss J, Begg S, Mann N. Australian Burden of Disease and Injury Study, Projected Health Care Costs Report. University of Queensland and AIH. 2004. 3. Barrowman RA, Grubor D, Chandu A. Dental implant tourism. Aust Dent J 2010;55:441–445. 4. Chandu A, Macisaac RJ, Smith AC, Bach LA. Diabetic ketoacidosis secondary to dento-alveolar infection. Int J Oral Maxillofac Surg 2002;31:57–59.
DR ARUN CHANDU Oral and Maxillofacial Surgeon Western Health The Royal Dental Hospital of Melbourne Melbourne, Victoria
(Received 11 June 2013.)
DIABETES, WOUND HEALING AND COMPLICATIONS: AUTHORS’ REPLY We were pleased that Dr Chandu appreciated our study on dental extractions for Type 2 diabetics on oral hypoglycaemics.1 It must be noted that this study was carefully constructed so that it only included ambulance Type 2 diabetics on oral hypoglycaemics. These form the majority (95%) of all diabetics. This study was actually performed in the extraction clinic of Adelaide Dental Hospital which is a designated general practice clinic. The extractions were performed by senior dental students, supervised by junior dental house officers. Thus, this simulates © 2013 Australian Dental Association
The official journal of the Australian Dental Association
Australian Dental Journal 2013; 58: 536–543
LETTERS TO THE EDITOR
doi: 10.1111/adj.12117
Letters may comment on articles published in the Journal and should offer constructive criticism. When appropriate, comment on the letter is sought from the author. Letters to the Editor may also address any aspect of the profession, including education, new modes of practice and concepts of disease and its management. Letters should be brief (no more than two A4 pages).
DIABETES, WOUND HEALING AND COMPLICATIONS The authors of the study ‘The healing of dental extraction sockets in patients with Type 2 diabetes on oral hypoglycaemics: a prospective cohort’1 should be commended for proving what has been observed anecdotally for some time – that those patients who have well controlled diabetes or who are on oral hypoglycaemics do not have an increased risk of impaired wound healing after dentoalveolar surgery. Diabetes is an important chronic disease in Australia whose incidence is growing at a staggering rate. By 2031, it is estimated that 3.3 million Australians will have Type 2 diabetes.2 Therefore, more patients with Type 2 diabetes will present to general dental practitioners (GDP), periodontists and oral and maxillofacial surgeons requiring treatment for diabetes related dental diseases, general dental care and oral surgery. This underlies the importance of the findings of the present study. It appears from the results that most patients who have Type 2 diabetes treated with oral hypoglycaemics can be managed for basic extractions in general dental practice. The authors of the present study did not recommend the use of antibiotic cover or special precautions in this patient group.1 However, it should be noted that the study was performed in an oral and maxillofacial surgery unit where the staff either have medical degrees or commonly treat patients with complex medical co-morbidities. Thus in the GDP or periodontal setting, communication with the patient’s medical practitioner would still seem prudent to ascertain the level of long-term glycaemic control and thus the possible risk of complications. It would be worthwhile, however, keeping in the back of one’s mind that serious complications can still occur in the diabetic population, particularly if one is poorly controlled or undiagnosed, although the frequency of such sequelae is fortunately rare. Although the use of insulin in Type 2 diabetic patients is generally restricted to those with poor or difficult glycaemic control, some patients on oral hypoglycaemics may also have poor long-term control of their blood glucose levels. There are previous reports of patients with poor glycaemic control with 536
Type 2 diabetes who presented with a massive facial infection and airway obstruction after the placement of dental implants, as are cases of hyperosmolar coma with diabetic ketoacidosis in patients with Type 1 diabetes as a result of dentoalveolar infections or extractions.3,4 Nonetheless, the authors have produced important results in a prospective fashion that will influence clinical practice and should be congratulated on their work. REFERENCES 1. Huang S, Dang H, Huynh W, Sambrook PJ, Goss AN. The healing of dental extraction sockets in patients with Type 2 diabetes on oral hypoglycaemics: a prospective cohort. Aust Dent J 2013;58:89–93. 2. Vos T, Goss J, Begg S, Mann N. Australian Burden of Disease and Injury Study, Projected Health Care Costs Report. University of Queensland and AIH. 2004. 3. Barrowman RA, Grubor D, Chandu A. Dental implant tourism. Aust Dent J 2010;55:441–445. 4. Chandu A, Macisaac RJ, Smith AC, Bach LA. Diabetic ketoacidosis secondary to dento-alveolar infection. Int J Oral Maxillofac Surg 2002;31:57–59.
DR ARUN CHANDU Oral and Maxillofacial Surgeon Western Health The Royal Dental Hospital of Melbourne Melbourne, Victoria
(Received 11 June 2013.)
DIABETES, WOUND HEALING AND COMPLICATIONS: AUTHORS’ REPLY We were pleased that Dr Chandu appreciated our study on dental extractions for Type 2 diabetics on oral hypoglycaemics.1 It must be noted that this study was carefully constructed so that it only included ambulance Type 2 diabetics on oral hypoglycaemics. These form the majority (95%) of all diabetics. This study was actually performed in the extraction clinic of Adelaide Dental Hospital which is a designated general practice clinic. The extractions were performed by senior dental students, supervised by junior dental house officers. Thus, this simulates © 2013 Australian Dental Association
