Association between hyperglycemia and post-exodontia complications in patients with Type II Diabetes Mellitus: A Scoping Review


Introduction: Diabetes mellitus (DM) is a prevalent chronic metabolic disorder worldwide, with Type II DM (T2DM) emerging as the most widespread variant. In Chile, approximately 11% of adults aged 20 to 79 suffer from this condition. Given its high prevalence, dental surgeons should be trained to evaluate risk factors, particularly the potential complications linked to tooth extraction in individuals with T2DM.
Objetive: To describe the available scientific evidence on post-exodontia complications associated with hyperglycemia in patients with Type II diabetes mellitus.
Materials and Methods: An exploratory systematic review was conducted following the PRISMA-ScR extension protocols using the databases PubMed, EBSCO, Scopus and the Cochrane Library. The search employed the following algorithms: ((“Diabetic patient complications” AND “Dental extractions”)), ((“Diabetes” AND “tooth extraction”)), ((“Glycemia” AND “Tooth extraction complications”), ((“Blood glucose” AND “Tooth extractions”), ((“Dental extraction sockets” AND “Diabetics”).
Results: Out of a total of 973 articles, 25 were included for this review. Six relevance criteria were considered, revealing safety parameters for conducting extractions in patients with T2DM, with capillary blood glucose levels not exceeding 200 mg/dL for elective extractions and 240 mg/dL for emergency extractions.
Conclusions: There is limited evidence correlating threshold values of hyperglycemia with post-extraction complications in patients with T2DM. Most authors agree that the primary concern is not T2DM itself, but hyperglycemia. Furthermore, there is minimal consistency in the recommended care protocols for these patients.
Keywords: Diabetes mellitus; Tooth extraction; Complications post-exodontia; Surgery, oral; Hyperglycemia; Review.


1. Ministerio de Salud. “PLAN NACIONAL DE SALUD BUCAL 2021 – 2030”. 2021.Avalaible at:
2. Moraga L. Tendencia de actividades odontológicas realizadas enatención primaria del servicio de salud Valparaíso -San Antonio, CHILE: 2008 A 2018. Rev. Chil. Salud Pública. 2020;24(2):104–14.
3. Keays R. Diabetes. Curr Anaesth Crit Care. 2007; 18(2):69–75
4. Care D, Suppl SS. Classification and Diagnosis of Diabetes : Standards of Medical Care in Diabetes — 2022. Diabetes Care. 2022;45(Suppl):17–38.
5. Mayer-Davis EJ, Kahkoska AR, Jefferies C, Dabelea D, Balde N, Gong CX, Aschner P, Craig ME. ISPAD Clinical Practice Consensus Guidelines 2018: Definition, epidemiology, and classification of diabetes in children and adolescents. Pediatr Diabetes. 2018;19 Suppl 27(Suppl 27):7-19. doi: 10.1111/pedi.12773. PMID: 30226024; PMCID: PMC7521365.
6. Poudel P, Griffiths R, Wong VW, Arora A, Flack JR, Khoo CL, George A. Perceptions and practices of general practitioners on providing oral health care to people with diabetes - a qualitative study. BMC Fam Pract. 2020;21(1):34. doi: 10.1186/s12875-020-1102-9. PMID: 32054440; PMCID: PMC7020546.
7. Gazal G. Management of an emergency tooth extraction in diabetic patients on the dental chair. Saudi Dent J. 2020;32(1):1-6. doi: 10.1016/j.sdentj.2019.07.004. Epub 2019 Aug 5. PMID: 31920272; PMCID: PMC6950840.
8. Tourkmani AM, Alharbi TJ, Rsheed AMB, AlRasheed AN, AlBattal SM, Abdelhay O, Hassali MA, Alrasheedy AA, Al Harbi NG, Alqahtani A. Hypoglycemia in Type 2 Diabetes Mellitus patients: A review article. Diabetes Metab Syndr. 2018;12(5):791-794. doi: 10.1016/j.dsx.2018.04.004. Epub 2018 Apr 12. PMID: 29678605.9.
9. Wolfsdorf JI, Glaser N, Agus M, Fritsch M, Hanas R, Rewers A, Sperling MA, Codner E. ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Pediatr Diabetes. 2018;19 Suppl 27:155-177. doi: 10.1111/pedi.12701. PMID: 29900641.
10. Romero Cevallos EI, López Laaz SA, Osorio Coronel GE, Chumbi Zumba PA. Síndrome hiperosmolar hiperglucémico. RECIAMUC. 2020;4(3):227–34.
11. R R, M.R. M, Kumar SP. Mucormycosis Following Tooth Extraction in a Diabetic Patient: A Case Report. Cureus. 2020 Aug 15;
12. Fonseca Escobar D, Parada Fernández F, Carvajal Guzmán M, Sepúlveda Verdugo C, Cortés Vásquez S. Manejo odontológico del paciente diabético. Revisión narrativa. Rev Asoc Odontol Argent. 2021.
13. Dhanavelu P, Senthilnathan R, Vijay Aravind R. Diabetes mellitus and extraction. Drug Invent Today. 2019;11(9):2217–9.
14. Aishwarya S, Senthil Murugan P, Suresh V. Comparison of post extraction healing in diabetic patients with two different blood glucose levels a case control study. Int J Dent Oral Sci. 2021;8(7):3124–8.
15. Gupta B. Assessment of post operative wound healing in diabetic patients after extraction. Int J Adv Sci Res. 2017;3(7):77.
16. Gholinejad Ghadi N, Seifi Z, Shokohi T, Aghili SR, Nikkhah M, Vahedi Larijani L, Ghasemi M, Haghani I. Fulminant mucormycosis of maxillary sinuses after dental extraction inpatients with uncontrolled diabetic: Two case reports. J Mycol Med. 2018;28(2):399-402. doi: 10.1016/j.mycmed.2018.01.003. Epub 2018 Mar 13. PMID: 29545122.
17. Prabhu S, Alqahtani M, Al Shehabi M. A fatal case of rhinocerebral mucormycosis of the jaw after dental extractions and review of literature. J Infect Public Health. 2018;11(3):301–3.
18. Krishnan B, Prasad GA, Saravanan R, Madhan B, Kadhiravan T. Do preoperative glycosylated hemoglobin (HbA1C) and random blood glucose levels predict wound healing complications following exodontia in type 2 diabetes mellitus patients?—a prospective observational study. Clin Oral Investig. 2020;
19. Okonkwo UA, Dipietro LA. Diabetes and wound angiogenesis. Int J Mol Sci. 2017;18(7):1–15.
20. KO KI, SCULEAN A, GRAVES DT. Diabetic wound healing in soft and hard oral tissues. Transl Res. 2021;236:72–86.
21. Rela R, Sejao AV, Singh A, Singh PK, Kumar M, Gupta SK, Rangari P. Antibiotic Prescribing Knowledge, Awareness, and Attitude of Dental Surgeons Practicing in the Urban Indian Population. J Pharm Bioallied Sci. 2021;13(Suppl 2):S1637-S1641. doi: 10.4103/jpbs.jpbs_394_21. Epub 2021 Nov 10. PMID: 35018045; PMCID: PMC8686960.
22. Maftei GA, Martu MA, Martu MC, Popescu D, Surlin P, Tatarciuc D, Popa C, Foia LG. Correlations between Salivary Immuno-Biochemical Markers and HbA1c in Type 2 Diabetes Subjects before and after Dental Extraction. Antioxidants (Basel). 2021 Oct 30;10(11):1741. doi: 10.3390/antiox10111741. PMID: 34829612; PMCID: PMC8615044.
23. Radović K, Brković B, Roganović J, Ilić J, Milić Lemić A, Jovanović B. Salivary VEGF and post-extraction wound healing in type 2 diabetic immediate denture wearers. Acta Odontol Scand. 2022;80(1):9–14.
24. Power DJ, Sambrook PJ, Goss AN. The healing of dental extraction sockets in insulin-dependent diabetic patients: a prospective controlled observational study. Aust Dent J. 2019;64(1):111–6.
25. Gadicherla S, Smriti K, Roy S, Pentapati KC, Rajan J, Walia A. Comparison of extraction socket healing in non-diabetic, prediabetic, and type 2 diabetic patients. Clin Cosmet Investig Dent. 2020;12:291–6.
26. Shakeel J, Siddiq M, Mushtaq O, Raza SA, Rauf Z, Rathi AJ. Pattern of tooth extraction in a Tertiary Care Hospital-Karachi, Pakistan. Professional Med J. 2022; 29(6):905-911. doi: 10.29309/TPMJ/2022.29.06.6508
27. Wang WY, Wang J, Wang EB. Correlation analysis of pre-operative glucose control targets and tooth extraction prognosis in elderly diabetic patients. Zhonghua Kou Qiang Yi Xue Za Zhi. 2021;56(1):70–4.
28. Hoyos-R JD, Jaimes-O S, Alvear JD, Toloza C NA, Vásquez-F DM, Velandia-G JN, Velasco AV. Factores fisiopatológicos y metas terapéuticas perioperatorias que influyen en procedimientos quirúrgicos reconstructivos mediante colgajos en pacientes con Diabetes Mellitus. Rev Médicas UIS. 2017;30(1):35–43.
29. Agani Z, Ahmedi J, Ademi Abdyli R, Prekazi Loxha M, Hamiti-Krasniqi V, Rexhepi A, Stubljar D. The changes in levels of blood cortisol, glucose, and oxygen saturation in type 2 diabetic patients during tooth extraction. Clin Exp Dent Res. 2022;8(6):1449-1455. doi: 10.1002/cre2.641. Epub 2022 Jul 31. PMID: 35909305; PMCID: PMC9760155.
30. Yang S, Li Y, Liu C, Wu Y, Wan Z, Shen D. Pathogenesis and treatment of wound healing in patients with diabetes after tooth extraction. Front Endocrinol. 2022;13:949535.
31. Sambrook PJ, Goss AN. Contemporary exodontia. Aust Dent J. 2018;63:S11–8.
32. Piedade EFS, Gulinelli JL, Queiroz TP, Rosa VM, Santos PL. Surgical complications in systemically compromised patients: analysis of 992 medical records. RGO, Rev Gaúch Odontol. 2020;68: e20200031.
33. Muzaffar A, Murtaza B, Muzaffar A, Qunain R, Iqtidar Z, Sherazi U. Comparison of Post-tooth extraction Wound healing in Patients with Optimal Diabetes control and Poor Diabetes control. Isra Med J. 2020; 12(4): 197-201.
34. Lund Håheim L, Rønningen KS, Enersen M, Olsen I. The Predictive Role of Tooth Extractions, Oral Infections, and hs-C-Reactive Protein for Mortality in Individuals with and without Diabetes: A Prospective Cohort Study of a 12 1/2-Year Follow-Up. J Diabetes Res. 2017;2017:9590740. doi: 10.1155/2017/9590740. Epub 2017 Jun 21. PMID: 28713837; PMCID: PMC5497614.
35. ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Seley JJ, Stanton RC, Gabbay RA, on behalf of the American Diabetes Association. 6. Glycemic Targets: Standards of Care in Diabetes-2023. Diabetes Care. 2023;46(Suppl 1):S97-S110. doi: 10.2337/dc23-S006. PMID: 36507646; PMCID: PMC9810469.
36. ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Seley JJ, Stanton RC, Gabbay RA, on behalf of the American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Care in Diabetes-2023. Diabetes Care. 2023;46(Suppl 1):S19-S40. doi: 10.2337/dc23-S002. Erratum in: Diabetes Care. 2023: Erratum in: Diabetes Care. 2023 Sep 1;46(9):1715. PMID: 36507649; PMCID: PMC9810477.
How to Cite
OLIVARES, Ignacio et al. Association between hyperglycemia and post-exodontia complications in patients with Type II Diabetes Mellitus: A Scoping Review. Journal of Oral Research, [S.l.], v. 13, n. 1, p. 75-85, may 2024. ISSN 0719-2479. Available at: <>. Date accessed: 23 june 2024. doi: