From the Research
Patients with Type 1 Diabetes Mellitus (T1DM) and Addison's disease generally do not require prophylactic antibiotics for routine dental procedures. The current evidence does not support the use of prophylactic antibiotics for endocrine disorders like T1DM or Addison's disease 1. However, if the patient has poorly controlled diabetes (HbA1c > 10% or blood glucose > 200 mg/dL), postponing elective dental procedures until better glycemic control is achieved may be advisable. For emergency dental work in poorly controlled diabetics, some clinicians might consider prophylactic antibiotics (such as amoxicillin 2g orally 1 hour before the procedure), though this is not universally recommended.
Patients with Addison's disease may require stress-dose steroids for invasive dental procedures to prevent adrenal crisis, typically doubling their usual daily glucocorticoid dose on the day of the procedure 2. The rationale behind not routinely prescribing antibiotics is that endocrine conditions themselves don't significantly increase infection risk from dental bacteremia, and unnecessary antibiotic use contributes to antimicrobial resistance and potential adverse effects. A study published in 2020 found that patients with Addison's disease and T1DM are at increased risk of certain acute metabolic disorders, including adrenal crisis and hypoglycemia 3. However, this study does not provide evidence for the use of prophylactic antibiotics in these patients.
Some key points to consider when treating patients with T1DM and Addison's disease include:
- Monitoring blood glucose levels closely during dental procedures
- Adjusting insulin doses as needed to maintain good glycemic control
- Providing stress-dose steroids for invasive dental procedures to prevent adrenal crisis
- Avoiding unnecessary antibiotic use to prevent antimicrobial resistance and potential adverse effects. A recent study published in 2021 highlights the importance of continuous glucose monitoring in suggesting adrenal insufficiency in patients with type 1 diabetes 4. However, this study does not provide evidence for the use of prophylactic antibiotics in patients with T1DM and Addison's disease. Overall, the decision to use prophylactic antibiotics in patients with T1DM and Addison's disease should be made on a case-by-case basis, taking into account the individual patient's medical history and risk factors.