A Parent’s Guide to Dental Care for Children with Diabetes

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Oral health and blood sugar levels are connected to each other. A tooth infection or gum disease may increase your child’s blood sugar level. Children with diabetes may have more gum disease than children without diabetes.

 

The dentist may not be able to treat your child if his/her blood sugar level is over 250mg/dl at the time of a dental appointment.

 

Children with diabetes need to see a pediatric dentist regularly.

A child should have his/ her first dental visit no later than 12 months of age. Your child’s dentist will recommend how often he or she should go to the dentist.

 

Children with diabetes can have special oral problems.

Gum disease can develop earlier and progress faster than children who do not have diabetes.

Gum disease is damage to the gums and bone that hold the teeth in the jaw. The teeth may become loose over time.

The first phase of gum disease is gingivitis. This is redness and/ or swelling of your child’s gums. Daily brushing and flossing and regular dental check-ups can help with this.

The second, more severe, phase is periodontitis.  This is when there is damage to the bone around teeth. Deep cleaning by the dentist and very careful brushing and flossing at home are needed to treat this.

Diabetes can cause children to have less spit in their mouth (dry mouth) which can increase their chances of getting cavities.

Children with diabetes are at a higher risk for developing thrush (candidiasis), a fungal infection that can look like white or red patches in the mouth.

Children with diabetes may not be able to taste their food.

Children with diabetes may have bad breath that does not go away from brushing because of the growth of bacteria in the mouth.

Diabetes may cause children’s teeth to come in earlier.

 

Prepare your child for a visit to the dentist:

Make sure your child has their scheduled meal and takes his/ her medicine on time.

Make sure he or she has a good night’s rest before the appointment.

Check your child’s blood sugar at the usual time(s).

 

Questions to ask your child’s dentist:

Do I need to modify my child’s diet or medicines for the dental appointment?

No.  Please do not change your child’s diet or medicines. If this is needed, the dentist will consult with your child’s endocrinologist and you will get written instructions on what to do.

When is a good time in the day to schedule my child’s appointment?

Usually morning appointments are better for children with diabetes. They can have their usual breakfast and take their morning medicine, then receive dental treatment. This way, by the time the numbing medicine wears off, your child can have their next meal as per schedule.

Should I bring my child’s glucometer for the dental appointment?

Yes. If your child’s blood sugar needs to routinely checked, it is a good idea to bring the glucometer with you. Most dental office have a glucometer in case you forget. Sometimes the dentist may check your child’s blood sugar level before starting dental treatment.

Can my child be sedated for dental treatment?

Probably not. For sedation to be done safely, a child needs to be fasting for at least 6 hours. This can be a problem in maintaining a safe blood sugar level in a child with diabetes.

Can my child get the laughing gas if they are scared?

Yes. Laughing gas can usually be given children with diabetes.

Can my child have braces (orthodontic treatment)?

Maybe. Braces increase the plaque build-up on teeth and increase the risk for developing cavities. If your child has well controlled blood sugar and no cavities or gum disease, he/ she can get braces. However, if your child has gum disease, braces may not be suitable for your child.

Will my child’s diabetic diet interfere with cavity prevention?

No. Your child’s nutritionist would most likely have recommended foods with low glycemic index. These foods cause a low rise in blood sugar. These foods are also less likely to cause cavities. It is important to pay attention to your child’s snacks, because often children snack on foods and drinks with added sugar.

Does my child need prescription fluoride products?

The dentist may prescribe these based on the dental examination and x-rays.

What type of products can I use to help improve my child’s oral health?

Here are some options to discuss with your child’s dentist and find out what is best for your child:

For a dry mouth:

Drink plenty of water

Use alcohol-free mouth rinses like Biotene®/ Oasis® mouthwash

For gum disease:

Antibacterial mouthwash

Alcohol-free chlorhexidine mouthwash

To floss your child’s teeth:

Dental pick (supervise your child)

Gumchucks®

Water Flosser for Kids®

 

How can I prevent cavities and gum disease in my child?

Brush your child’s teeth every morning and night with a soft toothbrush.

Use toothpaste with fluoride in it and has the ADA seal of approval on the tube.

Floss after brushing at night. Flossing cleans between the teeth where the bristles of a toothbrush cannot reach.

Drink fluoridated water.

Stay away from foods that have added sugar. In-between meal snacks should not be sweet treats.

Do not drink juices, sodas, or sports drinks often.

 

Questions your child’s dentist might ask you:

Who are your child’s doctors and how can I get in touch with them? 

What medicines does your child take? What are the dosages? How does your child take the medicine (Are they liquid, pills or injections?)  Does your child have an insulin pump?

How often do you check your child’s blood sugar level?

What was your child’s most recent blood glucose and HbA1c?

Does your child have any drug and food allergies?

When did your child eat last?

Did your child take his/her medicine on time?

Has your child ever had a diabetes-related emergency or needed to go to the emergency room for uncontrolled blood sugar level?

What does your child eat for meals and snacks? What do they drink?

Has your child had any complications or problems when having dental work done in the past?

Is your child afraid of the dentist?

 

What should you ask your child’s pediatrician regarding dental care if your child has diabetes?

Does my child need any extra protection while receiving dental care?

Is there anything the dentist should do differently for my child?

Is there a blood sugar level beyond which my child should not receive elective dental treatment?

 

When should my child see a dentist?

A child should see a dentist within 6 months of the first tooth coming in or by the first birthday- which ever happens first. It is never too late to start taking your child to the dentist.

How often should my child see the dentist?

Most children should see the dentist every 6 months. However, if your child is at high risk for dental caries, the dentist may recommend more frequent visits, such as every 3 or 4 month.

 

How to find a pediatric dentist:

American Academy of Pediatric Dentistry: www.aapd.org

American Board of Pediatric Dentistry: www.abpd.org 

Additional Information on Diabetes: https://medlineplus.gov/diabetesinchildrenandteens.html

Note: The information you see describes general oral health information for children with diabetes, but it does not apply to everyone. This information is not medical advice. Please contact a healthcare provider if your child has a medical problem. If you think your child may have a medical emergency, please call your child’s doctor or an emergency number immediately.

 

Text by Priyanshi Ritwik, DDS, MS

Edited by Julie Schiavo, MLIS, AHIP