A patient has an HbA1c of 9% and a small periapical radiolucency on tooth #30 with no pain or swelling. What is the MOST appropriate next step?

Correct answer: C. Refer to physician for diabetes management before dental treatment

• A. Proceeding with RCT without modification ignores the significantly elevated HbA1c and the associated infection/healing risks in poorly controlled diabetes.
• B. Deferring all treatment indefinitely is not appropriate if the patient has active periapical pathology. The goal is optimization of glucose control followed by treatment.
• C. CORRECT. An HbA1c of 9% indicates POORLY CONTROLLED diabetes (target <7% for diabetic patients). Before performing dental procedures in an uncontrolled diabetic (especially with periapical pathology that may be harder to resolve without glycemic control), the physician should be contacted to optimize diabetes management. Poorly controlled diabetes impairs healing and increases infection risk.
• D. Extraction in an uncontrolled diabetic without physician consultation and glucose optimization increases infection risk, impairs wound healing, and risks acute metabolic complications (hypoglycemia, DKA).