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Journal of Dental and Oral Health

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Research Article

Most Frequently Observed Oral Complications in Patients with Diabetes Mellitus

Yousuf Ali Lakdawala, Sabeen Masood, Rehan Ahmad

Correspondence Address :

Sabeen Masood
Altamash Institute of Dental Medicine
City Karachi, 75400, Pakistan
Tel: 0314-2127933
Email: sabeen_786@live.com

Received on: September 15, 2018, Accepted on: October 01, 2018, Published on: October 08, 2018

Citation: Yousuf Ali Lakdawala, Sabeen Masood, Rehan Ahmad (2018). Most Frequently Observed Oral Complications in Patients with Diabetes Mellitus

Copyright: 2018 Sabeen Masood, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract
The purpose of the study was to find out the common oral manifestations in diabetic patients seen at Altamash Institute of Dental Medicine, Karachi, who came for their dental checkup from 2 April to 21 July 2018. A descriptive Cross-sectional investigation was conducted. Questionnaires regarding different oral manifestations were used. Complete medical and dental history was taken from every patient and after thorough clinical examination of oral dental tissues; tooth spacing and mobility were found to be the most common problems after periodontal disease. Uncontrolled serum glycemic levels appear to play a major role in their occurrence.

Keywords: Diabetes mellitus, Oral complications, Periodontal disease
Fulltext
Introduction
Diabetes is a clinically and inherently heterogeneous group of metabolic disorders manifested by hyperglycemia in the blood. Effects of diabetes on oral health have been studied extensively [1]. Diabetes mellitus affects all age groups but is more common in adults, World Health Organization (WHO) has recently professed it to be a pandemic [2]. Oral manifestations of diabetes mellitus broadly categorized into two types: those affecting the hard tissues and the soft tissues of the oral cavity [3]. In the oral cavity, manifestations of diabetes can include a dry or burning mouth, periodontal disease, bone loss, tooth mobility, spacing, halitosis, gingival recession [4]. The association of specific oral diseases and diabetes is of importance both in the detection of undiagnosed diabetes and in the clarification of the pathogenesis of various orofacial diseases [5]. Diabetes exists in a bidirectional relationship with periodontal disease and may lead to other oral pathologies [6]. The objective of the study is to provide a systematic overview of the literature on the various oral manifestations that may occur in diabetic patients.

Methodology

Cross-sectional study was performed on patients having diabetes mellitus who came for their dental checkup in Altamash Institute of Dental Medicine, Karachi, from 2 April to 21 July 2018. Sample size was determined using IBM Sample Power prior to the data collection. Letter from the ethical committee Altamash Institute of Dental Medicine and appropriate consent from all the individuals participating in the study, was taken.
Total of 200 patients were part of the study. 80 of the pre-diagnosed patients with the inclusion criteria of deranged serum glycemic levels and HbA1c results were included in the study. Patients without any of the diagnosed comorbid were considered to be grouped as Non-Diabetic group.
The average range of the participants was 45 +/- 9 years for the group of patients with diabetes and it was 44 +/- 12 years for the group of participants in non-diabetic group. The oral glucose tolerance test was performed after 2 hours of glucose intake which ranged between 148mg/dl to 250mg/dl.
Most common oral presentations were identified through extensive analysis of published research articles within former 5 years, from MEDLINE database, which appear to be periodontal disease, dental caries, xerostomia, oral mucosal changes (for example Fungal infections (like Candidiasis), oral ulcers). Taking all the important manifestations into account a comprehensive data collection form was designed and data was recorded following consent, thorough history and clinical examination. For the diagnosis of periodontal disease community periodontal index (CPI) was used along with the radiographic examination. For xerostomia a comprehensive questionnaire criterion by Fox et al18 was used. For dental caries and periodontal disease, a combined clinico-radiographic approach was applied and for oral mucosal changes like candidal infections, oral ulcers and other lesions relevant clinical examination and diagnostic investigations were taken into account. The data was analyzed using SPSS 20.

Results

80 patients out of 200 participants were identified as patients suffering from diabetes mellitus, by inclusion criteria. Out of list of oral manifestations obtained from the literature search, periodontal disease was found as most common manifestation making up to 95% (76 individuals of) diabetic patient group which reached the statistical significance with p value of <0.01. Other common manifestations like xerostomia, halitosis and candida associated lesions of oral cavity were found to be 81.25% (65 individuals), 55% (44 individuals) and 7.5% (6 individuals) respectively. Significance values for all of them were found to be <0.01. Chi square test was applied on gathered data to Figure 1 out the statistical correlation between diabetes and periodontal disease, and diabetes and xerostomia which was found to be statistically significant with p value of <0.01. For correlation between xerostomia and periodontal disease "p value" was found to be <0.01, which means that the association reached statistical significance. Table 1 and Figure 2 gives brief summary of the results obtained. Out of 80 patients, 75% (60 individuals) were using oral hypoglycemic drugs and 25% (20 individuals) were using oral hypoglycemic drugs along with insulin (Figure 3).

Discussion

Due to the diversity of investigations published by numerous researchers on oral complications of diabetes it is rather difficult to corelate all their work due to variety of inclusion criteria cast-off by each. In general diabetics have greater prevalence of periodontal disease then the ones who are healthy [7-9]. In fact, there is three times more risk of periodontal disease in diabetic patient compared to non-diabetics [10-12]. With the course of the following study periodontal disease predominates all the diabetic oral manifestations and a statistical co-relation is also observed between diabetes and periodontal disease, which is probably because of formation of advanced glycosylation end products (AGEs) due to poor glycemic control [6]. The extent of glycemic control of a patient is likely to be a major influence over the risk of developing periodontal disease [13,14]. For example, the third National Health and Nutrition Examination Survey (NHANES III) from United States clearly demonstrated 2.9 times more risk of developing periodontitis in contrast to nondiabetic individuals and no significant rise in risk in subjects with controlled diabetes [15]. Dentists are well aware of the importance of diagnosis of diabetes due to its oral complications like periodontitis, xerostomia and oral mucosal changes like candida associated infections [16]. Xerostomia is frequent among patients of diabetes mellitus as reported by several epidemiological studies [17-19]. The results observed in the following study also demonstrate similar pattern which was supported by the statistically significant values obtained for their co-relation. Xerostomia can noticeably augment dental caries along with other oral complications like parotid gland enlargement, angular cheilitis inflammation and ulcers of the tongue and oral mucosa oral candidiasis, halitosis etc., [20]. Candidiasis and diabetes mellitus are co-related and therefore deranged glycemic control i.e. increased insulin resistance can increase the likelihood of candidal infection [21]. There are some limitations to this study because of limited resources like time and money. Due to time constrain a sample of only 200 respondents were selected. Secondly this survey is limited to only one dental institute in Karachi as going to other institutes requires much more resources than the ones available at the time of the study.. The results of this survey are only based on questionnaires as this data collection instrument is more time and cost effective.

Conclusion

Understanding the relationship between diabetes and periodontitis is important. The study suggests that diabetes is a significant risk factor for periodontitis and the risk of periodontitis is greater if glycemic control is poor. People with poorly controlled diabetes are at an increased risk of periodontitis and alveolar bone loss. So, in order to enhance the health care provided to diabetic patients, sufficient knowledge of diabetes should be necessary for the endocrinologist and dentists.
References
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Tables & Figures

Figure 1: OPG showing severe bone resorption and missing teeth


                                                        Table 1

            
                                                                               Figure 2



                                                                  Figure 3

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