Early warning signs of impending hypoglycaemia masked by post-extraction labial paraesthesia.
Temporary lingual and labial paraesthesia are not uncommon following the removal of mandibular third molar teeth. In patients with insulin-treated diabetes circum-oral paraesthesia is a common and important sign of impending hypoglycaemia. This report highlights the case of a 17-year-old girl with Type 1 (insulin-dependent) diabetes who, following the extraction of her four wisdom teeth, experienced minor circum-oral sensory disturbances. These effectively masked her early warning signs of impending hypoglycaemia which had hitherto allowed her to have very good glycaemic control. Trembling, sweating and loss of concentration became the new presenting symptom complex, which she found both disabling and worrying. Fortunately, within six months the paraesthesia had subsided and the patient was once again able to appreciate her usual warning symptom of impending hypoglycaemia.
Department of Medicine, Withybush General Hospital.
N I
NI
Jowett
L B
LB
Cabot
D000293:Adolescent; D017742:Dental Care for Chronically Ill; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000503:physiopathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000150:complications / Q000175:diagnosis*; D008046:Lip / Q000294:innervation; D008964:Molar, Third / Q000601:surgery; D010292:Paresthesia / Q000209:etiology*; D014081:Tooth Extraction / Q000009:adverse effects*