Child Dental Patient with DIABETES

Clinical cases

Clinical case 1

Antonia, age 5y

Main dg: DM

Dental dg:

  • multiple untreated caries in deciduous dentition, pulp involvement
  • chronic periodontal inflammation;
  • expected crowding in permanent dentition

Barriers for dental treatment:

  • Overindulged child due to her medical condition, with very poor cooperation, attitude endorsed by parental sympathy
  • Complex oral pathology requiring complex management


Treatment planning



1. Eliminate pain

2. Eliminate infection

3. Improve periodontal condition

4. Caries prevention for first permanent molars



1. Win CHILD’s trust

2. Win PARENTS’ cooperation

3. Win CHILD’s cooperation

4. Establish a long-term relationship



First important achievements: Acceptance of nitrous oxyde mask and panoramic x-ray


Treatment sessions - as short as possible, maximum one quadrant/session
Analgesia – was obtained by infiltration local anaesthesia (articaine+adrenaline)
preceded by topical anaesthetic gel; non-traumatic infiltration technique


Compromised deciduous molars were extracted, restorations were placed and permanent molars were sealed with glass-ionomer sealants (GC Fuji Triage)


Oral hygiene did not dramatically improve with time


Frequent food intake (due to main pathology) and poor hygiene continuously induced caries and gingivitis.
Non-cavitated lesions were resin-infiltrated.
Professional cleaning and fluoride varnish were applied on every occasion


Clinical case 2

Andreea (f) age 10 y

Dg. (gen): type I DM
Dg. (dental): mixed dentition, untreated caries, +/- pulp involvement
Dg. (orthodontic): class II sub.2, crowding

Main concerns:

  • pain
  • gingival bleeding
  • practitioners’ reluctance to provide treatment ­čí¬ repeated refusals

Focus :

  1. On main complaint of the patient – pain from untreated caries
  2. On the periodontal status (gingivitis)
  3. On the orthodontic problem (?)

Problems encountered :

  1. Poor cooperation for hygiene orthodontic treatment
  2. Poor understanding for the need of regular check-ups

Successful endodontics, restorations, caries prevention by sealants provision
Hygiene still needs improvement
Orthodontic aspects remain unsolved