From the Research
The optimal blood glucose level prior to tooth extraction should be below 180 mg/dL for non-emergency procedures and below 234 mg/dL for emergency procedures, as suggested by the most recent and highest quality study 1.
Key Considerations
- The study 1 analyzed 1080 studies and included 36 studies in the systematic review, providing strong evidence for the acceptable levels of blood glucose for tooth extraction in diabetics.
- The study found that high blood glucose levels reduce the secretion of nitric oxide, leading to poor circulation and slow-healing socket, and uncontrolled diabetics are at high risk of infection due to high ketone levels in the blood.
- Another study 2 published in 2024 found that glycemic levels between 151 and 240 mg/dL have no significant impact on post-extraction healing compared to levels ≤150 mg/dL in diabetic patients, but managing blood sugar levels is still critical to prevent adverse outcomes.
Recommendations
- Patients with diabetes should aim to maintain their blood glucose levels below the recommended targets before tooth extraction.
- On the day of the procedure, patients should check their blood glucose before arriving at the dental office, and if glucose levels exceed the recommended targets, it's advisable to reschedule the extraction unless it's an emergency.
- Patients taking insulin should consume a normal meal and take their usual insulin dose before morning appointments, while those with afternoon appointments should eat lunch and take appropriate insulin.
- Oral hypoglycemic medications can generally be taken as usual on the day of extraction.
- Maintaining proper glycemic control is crucial because hyperglycemia impairs wound healing, increases infection risk, and can complicate anesthesia management, while hypoglycemia during the procedure could lead to serious complications including loss of consciousness.
- Patients should bring their glucose monitoring equipment and fast-acting carbohydrates (like juice or glucose tablets) to the appointment as a precaution against hypoglycemia.