Diabetes is term used to describe a group of metabolic disorders, distinguised by altered glucose tolerance and impaired carbohydrate metabolism.
Oral and dental manifestation of diabetes
- Enlarge gingiva- The affected tissue may be inflamed, in which case the gums are red, soft, shiny and bleed easily. Gingivitis may be localised or generalised, and can be caused by systemic diseases especially diabetes.
- Mutiple periodontal abcess- Classic description of undiagnosed /poorly controlled diabetes patients is mutiple periodontal abcess, leading to rapid destruction of periodontal support. Case reports on life-threatening deep neck infection from a periodontal abscess and fatal palatal ulcers exemplify the severity of these conditions.
- Altered taste sensation- Patients have a blunted taste response, which displays a degree of specificity to glucose, is partially reversed after correction of hyperglycemia, and is independent of somatic or autonomic nerve function. This taste abnormality may influence the premorbid choice of nutrients, with a preference for sweet-tasting foods, thereby exacerbating hyperglycemia.
- Alteration in microflora of oral cavity- Patients with diabetes are more susceptible to developing oral bacterial infections. They are well known to have an impaired defense mechanism hence considered to be immuno-compromised. Diabetics with diabetic complications and poor metabolic control are more prone to spreading and recurrent bacterial infection
- Increases dental caries- Few studies have reported on the incidence of root-surface caries as a significant problem in older patients with diabetes.It is well known that patients with diabetes are susceptible to oral infections that lead to tooth decay and loss.Salivary secretion dysfunction, periodontal and sensory disorders could increase the likelihood of developing new and recurrent dental caries and tooth loss
- Decreases salivary flow
- Burning mouth and tongue- Oral dysesthesia or burning mouth syndrome (BMS) is a painful condition affecting the oral cavity (palate, tongue, throat and gingivae). Other abnormal oral sensations may coexist with the burning mouth sensation such as tingling, numbness, dryness or sore mouth at the same time8.Increases chance of dry socket after dental extraction.
- Lichen planus- There are also indications that patients with elevated salivary glucose levels carry candida intraorally more often than those with lower glucose levels. The implication being that diabetes may be related to the pathogenesis of lichen planus. The evi-dence for an immunological defect and deficient leukocyte functions superimposed on the metabolic abnormality of diabetes seems increasingly convincing.
- Impaired wound healing- Poor soft tissue regeneration and delayed osseous healing in patients with diabetes are known complications during oral surgery. Therefore, the management and treatment of patients with diabetes undergoing oral surgery is more complex. It was reported that delayed vascularisation, reduced blood flow, a decline in innate immunity, decreased growth factor production, and psychological stress may be involved in the protracted wound healing of the oral cavity mucosa in patients with diabetes.
- Median rhomboid glossites.
- Destructive periodontal diseases- Periodontal disease is the most prevalent oral complication in diabetes patients and has be enlabeled the "sixth complication of diabetes mellitus".
- Oral candidosis- is an opportunistic infection frequently caused by Candida albicans species. Many predisposing factors can lead to this infection; these include smoking, xerostomia and endocrine and metabolic diseases.
There are several clinical implications.
- A lack of awareness of oral complications among both diabetics and health providers.
- An understanding of the way diabetes affects oral health is necessary for both clinicians and patients, therefore research in this field should be encouraged.
- The need for regular follow-up of patients with diabetes mellitus by both dentist and physicians.
- The major role that dentists should play in recognising the signs and symptoms of diabetes and their oral complications.
- Advice and counselling for diabetic smokers regarding smoking cessation.
- Vigorous treatment of oral infection either bacterial or fungal in these patients, especially if they have poor glycaemic control.