Medical Emergencies · single question
A patient with poorly controlled diabetes (HbA1c of 9%) presents with a small asymptomatic periapical radiolucency on #30. What is the MOST appropriate management?
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Correct answer: B. Simple extraction can be performed without modification
An HbA1c of 9% represents moderately poorly controlled diabetes (not critically uncontrolled). For a simple extraction with a manageable lesion, dental treatment can proceed with appropriate monitoring. The ADA threshold for deferring elective treatment is generally HbA1c >10–12% or random blood glucose >400 mg/dL. For HbA1c of 9%, simple extractions can be performed — monitoring blood glucose and physician communication are prudent, but treatment is not completely deferred.
- A. This option correctly identifies physician communication, but the key point is that treatment CAN proceed at HbA1c 9% with standard precautions.
- B. CORRECT. For HbA1c of 9% (moderately uncontrolled, but not critically so), simple extractions can be performed with appropriate precautions — monitoring blood glucose, ensuring post-op healing follow-up, and communicating with the physician. Treatment is not absolutely deferred at this HbA1c level.
- C. Referring to the physician is prudent communication, but deferring ALL treatment at HbA1c 9% is overly restrictive — simple procedures can proceed.
- D. Complete deferral is reserved for critically uncontrolled diabetes (HbA1c >10–12% or random glucose >400 mg/dL). At 9%, treatment can proceed with precautions.
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