Routine prophylactic antibiotic use in diabetic dental patients.

There is no scientific evidence in the literature to support the premise that well-controlled, or even moderately well-controlled, nonketotic diabetic patients are prone to infection when undergoing uncomplicated dentoalveolar surgery. Routine administration of prophylactic antibiotics should be considered only in situations where prophylactic antimicrobials would be used for a nondiabetic patient. Poorly controlled diabetics (whether Type I or II), with fasting glucose levels above 250 mg/dL, should be referred for improved control of their blood sugar before non-emergency surgery is performed. If emergency surgery is needed for a poorly controlled patient, then prophylactic antibiotics are prudent, using the accepted principles of such use. Infections in diabetic patients, regardless of their control levels, should be managed aggressively, including possible early referral to oral and maxillofacial surgeons.