Diabetes is one of the major risk factors for various complications in the body including the teeth.
Almost 70% – 80% of the population suffers from diabetes in India with predominance to males. The increased rate of diabetics has led them to be listed as a new epidemic.
The six major complications associated with diabetes are:
- Cardiovascular disorder
- Delayed wound healing
- Periodontal diseases
Several studies have stated the strong association between diabetes mellitus and periodontal (gum) diseases yet the awareness among diabetics regarding its oral implication is very poor.
Diabetes is treated with oral glycemic drugs to normalize blood sugar levels. In case of severe diabetes or juvenile diabetes insulin injections are prescribed. For more effective delivery of insulin, a pump called insulin pump is suggested in people who are in need of more insulin shots. Insulin pills are still under trials to face future needs. The frequent evaluation of diabetic levels is necessary to maintain the medications accordingly.
HbA1C is hemoglobin mixed with glucose. The combination arises as a result of the haem-protein part of the red blood cells (RBC) mixes with the glucose present in the blood. This helps in detecting the average plasma concentration of blood glucose levels. It is considered a key factor to analyze the overall picture of the diabetic levels over a period of months. An increase in the HbA1C level is considered a greater risk for a diabetic individual.
- Below 6% – Normal
- 6% – 6.4% Prediabetes
- More than 6.5% – Diabetes
ORAL COMPLICATIONS ASSOCIATED WITH DIABETES:
- Dental caries
- Salivary gland dysfunction
- Burning mouth syndrome
- Oral mucosal diseases like lichen planus, candidiasis, etc.
Increased susceptibility to periodontal diseases is seen among the patients with uncontrolled diabetes as they have altered host response, collagen metabolism (for the purpose of wound healing) and vascularity (blood supply).
Diabetics show an exaggerated inflammatory response to the bacterial change in the oral cavity due to Periodontitis and it is coupled with delayed wound healing and repair of the tissues.
There is Progressive destruction of the supporting tissues of teeth, pocket formation in the gums & recession of gums leading to tooth loss.
The long term chronic inflammatory state induced by untreated Periodontitis may contribute to insulin resistance and worsen the glycemic control of the individual.
Thirst/polydipsia is one of the characteristic features of diabetes mostly due to decreased salivary flow and dehydration. The dryness of mouth is a common complaint posted by diabetics.
Management of Xerostomia (dryness of the mouth) is the chief way to control associated oral diseases and the improvement of salivary function. Diabetics must also avoid the intake of spicy/ acidic/ alcoholic/ carbonated beverage & tobacco.
Individuals with diabetes are susceptible to periodontal diseases and salivary gland dysfunction leading to increased risk of bacterial activity and their accumulation.
This condition favors the colonization of Streptococcus mutants & Streptococcus lactobacilli. The increase in the cariogenic bacteria results in teeth caries.
ORAL MUCOSAL LESIONS:
The complication caused by diabetes like Immunosuppression, delayed wound healing and salivary dysfunction paves way for the increased bacterial accumulation, shift in pH, recurrent ulceration, stomatitis (inflammation of the lining layer of the mouth) and oral fungal infections like oral candidiasis / oral thrush.
Fissured tongue (valley like depression along the tongue) is a common prevalence. The anaerobic shift with decreased salivary flow plays a major role in delayed wound healing.
BURNING MOUTH SYNDROME:
It is an orofacial neurosensory (sensory function related to the nervous system) disorder with an unknown cause but most commonly seen in diabetes.
Bilateral burning sensation of the oral mucosa with no underlying clinical or laboratory findings is seen. Taste impairment is also accompanied by this.
Treatment protocol followed for Xerostomia is also followed for this condition. Since the underlying cause is unknown the patient is asked to stay hydrated and to promote the use of chewing gums that improve salivation and to follow a proper diet.
ORAL COMPLICATIONS IN CONTROLLED Vs UNCONTROLLED DIABETES:
A diabetic presents with the following oral complications:
- Gum diseases.
- Tooth decay.
- Tooth loss.
- Dryness of mouth.
- Bad breath.
- Delayed wound healing.
- Oral environmental microbial shift.
The above complication can be reduced to a certain extent with proper maintenance of oral hygiene and control of the blood sugar levels. In an uncontrolled diabetic all the complications present with more severity and associated systemic complication.