Authors' response

Firstly, we would like to thank you for taking the time to read our article¹ and sharing your thoughts on the topic. We would like to clarify that the focus of the article was to share knowledge and understanding of the impact of diabetes on routine treatment in general dental practice with the readership. The article was not intended to explore diabetes as a condition beyond the depth of the opening introduction; nor was it the intent to explore medical emergencies such as diabetic ketoacidosis or hyperosmolar hyperglycaemic state.

We appreciate that raised blood glucose is the most important presenting clinical ‘sign’ of diabetes. However, in the following context ‘Polyuria, polydipsia, polyphagia, along with hypoglycaemic episodes are the most common presentations of the disease’,² we were referring to the common presenting symptoms of diabetes rather than clinical signs. We believe that patients are unlikely to present with recordings of hyperglycaemia to their general medical or dental practitioner. Thus, we consider it actually much more important for a general dental practitioner suspecting diabetes mellitus to enquire about these symptoms.

We are pleased that you drew attention to alternative methods of diagnosing diabetes other than HbA1c. The World Health Organization and Diabetes UK³ currently recommends other methods, such as the presence of diabetic symptoms (eg polyuria, polydipsia and unexplained weight loss) plus: a random venous glucose ≥11.0 mmol/l, a fasting plasma glucose ≥7.0 mmol/l or two-hour plasma glucose concentrations ≥11.1 mmol/l two hours following an oral glucose tolerance test. However, this was not explored further as we do not believe it is relevant to the daily practice of general dental practitioners. However, we appreciate the importance of HbA1c as a measure of long-term control and its importance on surgical consent; hence, we recommended in the oral surgery section of the article to assess HbA1c prior to surgical treatment.

We appreciate the importance of the point relating to the lack of discussion regarding hypoglycaemia presenting in general dental practice. However, we did not cover specific detail relating to the diagnosis and management of medical emergencies in the main body of the text; discussing this topic (which was not the intention of the article) and the impact of raised blood sugar on routine dental treatment would not do justice to either within the provided word limit. We would direct readers to this article by Greenwood and Meechan⁴ for guidance on medical emergencies presenting in the dental practice.

We apologize if certain statements were ambiguous. This article aimed to be a broad narrative review rather than an in-depth systematic review of available information. On review we have noticed one error in the text which we apologize for: the sentence reading ‘1 in 16 people in the UK being currently undiagnosed’ should actually read ‘1 in 16 people in the UK being currently diagnosed or undiagnosed’.

We appreciate the comment regarding NICE guidance and recommendation on dietary requirements as schemes such as DAFNE are extremely important tools in the management of diabetes. However, we did not cover dietary restrictions relating to quality of life in detail as we felt that it was outside of the scope of everyday general dental practice.

Thank you very much for your comments and we appreciate your interest in the article.