JNROnline Journal Journal of Natural Remedies

ISSN:2320-3358 Vol. 22, No. 1(1), (2021)

ISSN:0972-5547

RISK FACTORS FOR ORAL DISEASES IN CHILDREN WITH DIABETES

MELLITUS
Feruza R. KAMALOVA
Bukhara State Medical Institute named after Abu Ali ibn Sino
Bukhara, Uzbekistan
Oynisa O. YARIEVA
Bukhara State Medical Institute named after Abu Ali ibn Sino
Bukhara, Uzbekistan
Ilkhom I. AKHMEDOV
Bukhara State Medical Institute named after Abu Ali ibn Sino
Bukhara, Uzbekistan
ABSTRACT
Diabetes mellitus (DM) continues to be a heavy burden on the national health services of
all countries of the world. It is one of the main causes of early disability and high mortality in
children. Despite the adoption of national programs to combat diabetes in most countries of the
world, its prevalence is increasing not only among adults, but also among children. Thus,
according to the International Diabetes Federation and WHO, there are more than 200 million
people with diabetes worldwide. An expert assessment conducted by authoritative diabetologists
of the world suggests that by 2010 there will be more than 239.4 million people in the world, and
by 2030 - about 380 million patients with diabetes.

KEYWORDS: Diabetes mellitus, metabolic syndrome, dental diseases, quality of life, oral
microflora, caries, periodontitis, gingivitis.

Modern research in the field of dentistry is aimed at identifying the relationship between
moral health and various metabolic and systemic diseases. Diabetes mellitus (DM) is one of the
most common metabolic disorders in the general population and predisposes to various
concomitant diseases and complications that affect the general state of health [1].
According to WHO experts, promoting a healthy lifestyle is the most effective way to
provide medical care to the population, both in terms of human resources and the high cost of
medical care. Sufficient information and education about the knowledge of diabetes is effective
in the control and treatment of this disease, and according to studies, proper preparation can
reduce 80% of the complications of diabetes mellitus (DM) [2, 11].
Diabetes is a serious global health burden. According to the International Diabetes
Federation in 2013, 8.3% of adults (i.e. 382 million people) had diabetes worldwide; by 2035,
this number will rise to 592 million. Diagnosis, treatment and care of patients with type 1
and type 2 DIABETES worldwide costs approximately US $ 1,200 billion. This disorder is
growing rapidly in both developed and developing countries, especially type 2 diabetes,
which is associated with modern lifestyle habits such as reduced physical activity, diet,
obesity, and genetic factors. Interestingly, 3 of the 10 countries with the highest prevalence
of diabetes are in the Middle East: Saudi Arabia (24%), Kuwait (23%) and Qatar (23%) [3,
10].

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The prevalence of purulent-inflammatory diseases of the maxillofacial region in

patients with chronic somatic pathology: hypertension, coronary heart disease, diabetes
mellitus (DM) is high. Optimization of the treatment and rehabilitation processes in such
patients requires the search for more advanced approaches to the complex rapid diagnosis of
the dynamics of both dental and somatic conditions [4, 8].
DM is a multifactorial disease that is characterized by a chronic rise in blood glucose
levels or hyperglycemia and is caused by impaired insulin secretion and / or insulin dysfunction.
DM is also called a silent epidemic and a major public health problem and accounts for 9% of all
deaths worldwide [5, 9].
Today, diabetes is one of the most important medical and social problems in all countries
of the world. The incidence and prevalence of DM is constantly increasing. DM is one of the
provoking factors in the development of many dental diseases. Thus, severe metabolic and
vascular disorders occur in DM, which complicates the treatment of both the underlying disease
and dental complications in such patients, increases the duration of rehabilitation, leads to early
disability, and reduces the life expectancy at working age.
The peak incidence occurs during puberty, about 10-12 years in girls and 12-14 years in
boys. It is reported that the incidence of insulin-dependent diabetes is increasing in many
countries around the world. Worldwide, there are 500,000 children aged 15 years with DM1. The
prevalence is increasing at a rate of 3% each year. In India, many hospital records and clinical
data indicate that young diabetics (onset of diabetes before age 15) they make up 1-5% of the
total number of registered patients with diabetes [6].
The relationship between type 1 diabetes and various aspects of oral health has been
investigated in a number of studies around the world. Although some associations have been
confirmed, some others are still being discussed, and the results of individual studies are often
contradictory, not only because of differences in methodology, but also because of the
multifactorial etiology of most oral pathologies [7].
Only a limited number of studies have been conducted in children with type 1 diabetes.
However, most of the results of studies conducted in adults with type 1 diabetes can be applied
to the child population.
The main complications of DM affect organs and tissues rich in capillary vessels, such as
the kidneys, retina, and nerves. These complications are secondary to the development of
microangiopathy. Similar changes in small vessels can be found in the tissues of the oral cavity.
Most attention is paid to the relationship between diabetes and periodontal diseases (such as
gingivitis and periodontitis). Studies have shown that there is an increase in gum inflammation
and plaque in children with DM-1. The occurrence of dental caries in patients with DM did not
reveal a specific relationship between them. Patients are focused on following a diet with a
limited intake of sucrose, lack of knowledge about the hygiene habits of maintaining oral health,
can lead to poor glycemic control and the occurrence of diseases associated with the oral cavity.
Systemic complications, poor oral health, and lack of knowledge in these patients may have an
impact on overall health and well-being. Various changes in the oral cavity that occur in somatic
diseases require special management tactics for such patients. Thus, in type 2 diabetes, dryness in
the oral cavity, viscous and thick saliva are detected in more than 70% of patients, hyposalivation
is diagnosed in all patients with diabetes, etc. [8].

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It was found that changes in the periodontal area in children with diabetes manifest
earlier than changes in the fundus. The opposite relationship is also established: purulent-
inflammatory processes in the maxillofacial region aggravate the course of DM. The composition
and properties of oral fluid in patients with DM significantly differ in all indicators from those in
somatically healthy individuals. One of the most significant signs of changes in the composition
of oral fluid is an increase in glucose content by almost an order of magnitude compared to
healthy individuals. There is a direct relationship between the glucose content in the oral fluid
and its content in the blood. The content of calcium and phosphorus changes: the level of
calcium in the oral fluid increases and the level of phosphorus decreases. These changes in the
oral fluid lead to a violation of its main functions - mineralizing, cleansing, protective and the
predominance of demineralization processes over remineralization [9].
The state of oral health should be taken into account when caring for children with
diabetes. The oral health of these patients can have a significant impact on their overall health
and the development of the disease. Periodontal disease and dental caries are the two most
common chronic diseases affecting patients with DM. Inflammatory changes in periodontitis
may not be limited to the oral cavity, but may also cause systemic consequences [10].
Patients with type 1 and type 2 diabetes (DM1, DM2) have an increased prevalence of
gingivitis and periodontal disease (PD). In patients with DM, PD develops at a younger age, and
it also worsens with a long course of DM. PD negatively affects glycemic control and other
complications associated with diabetes.
Children's caries is a multifactorial disease of the oral cavity, which is often detected in
patients with obesity and diabetes. The associations between gingivitis, PD and caries are similar-
inadequate oral hygiene and unhealthy diet. Insufficient brushing of teeth and the use of sugary
foods can lead to even more harmful consequences for the oral cavity. Maintaining oral health
will prevent chronic oral diseases and mitigate the effects of chronic inflammatory processes
[11].
According to experts, the prevalence of diabetes worldwide was 2.8%, the prevalence will
increase to 4.4% by 2030. Reduced insulin production and subsequent hyperglycemia in DM1
are caused by the destruction of β-cells, including the presence or absence of pseudo-atrophic
islets [12].
Studies have found that periodontal pathogenic microflora causes an increase in tissue
resistance to insulin, due to what worsens the metabolic control of glycemia. The high
concentration of glucose in the gingival fluid in patients with DM promotes the reproduction of
microorganisms. The persistence of the subgingival microflora contributes to the violation of the
adhesion of neutrophils, chemotaxis, and phagocytosis.
In adults with type 1 and type 2 diabetes, there is a higher prevalence of gingivitis and
periodontitis; more periodontal inflammation; more pronounced destruction of the alveolar
bone; more lost teeth and constant poor glycemic control. Periodontal diseases in DM lead to it
leads to the development of systemic inflammation, which increases the likelihood of subclinical
atherosclerosis and lesions of the coronary vessels of the heart, increases the risk of heart attack
and stroke, and increases the mortality rate from coronary heart disease and nephropathy [7].
It is proved that hyposalivation in DM develops due to atrophic changes in the salivary
glands and is up to 60%. The decrease in salivation against the background of tissue glycation

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creates favorable conditions for the development of dysbiosis with the activation of pathogenic
and fungal microflora [5].
The most effective impact on the negative risk factors for the development of oral
diseases in children is to increase the level of dental literacy and the formation of a stable
motivation in children to maintain health, only the establishment of good oral hygiene and
instilling in the child the correct eating behavior reduces the need for sanitation by 10 %.
Studies by several authors have shown that the risk factors for oral diseases in children
with DM are: changes in the oral microflora and eating habits; decreased secretion of
unstimulated and stimulated saliva in children with DM; higher buffering capacity and PH of
saliva; higher saliva viscosity; higher levels of carbohydrates, glucose and total protein in the
blood and saliva of children; high levels of IgA and IgG, low levels of lactoferrin and lysozyme.
The complex of preventive measures includes: training of kindergarten teachers in
methods of brushing children's teeth and methods of controlling the hygienic state of the oral
cavity; conducting classes with kindergarten teachers on the education of healthy habits in
children through games and classes, as well as promoting a healthy lifestyle with parents;
conducting preventive examinations of children in preschool children's institutions in order to
control the hygienic state of the oral cavity, sanitation of the oral cavity.
DM-1 is considered a risk factor associated with oral fungal infections. Candida albicans
is the most common type of fungal infection in diabetics.
In many developing countries, the number of patients with diabetes is increasing,
especially among young people, which negatively affects their quality of life and increases the
period of hospitalization, with a subsequent increase in the burden of health care costs. Gum
disease usually appears at an earlier age in adolescents with diabetes.
Assessment of the state of oral hygiene and periodontal health of patients with DM is
particularly important, as adolescents account for a large number of patients with DM.
Experiencing rapid biological and hormonal changes, adolescents develop independence from
their parents. It is believed that DM is associated with the development of psychological
problems in adolescence.
Moreover, due to the small number of plasma cells, chronic gingivitis in children is
similar to the initial stage of the disease in adults, which is non-destructive and non-progressive.
Hyperglycemia caused by DM increases the concentration of glucose in saliva, as well as
its concentration in the gingival slit fluid. The presence of increased levels of proinflammatory
mediators in the gingival slotted fluid of periodontal pockets in diabetics compared to non-
diabetics, leading to significant destruction of the periodontium with an equivalent bacterial
challenge, was shown.
According to some studies, DM is not a direct etiological factor, but is a predisposing
factor to periodontal diseases. Diabetes can not be considered an etiological factor of
gingivitis or periodontitis; metabolic disorders resulting from diabetes can lead to systemic
problems that reduce resistance to infections.
DM increases the susceptibility and severity of infections by reducing the functional
activity of neutrophils (the first line of defense) and, therefore, contributes to delayed wound
healing. Clinical studies in patients with DM have clearly demonstrated consistent defects in
the chemotactic, phagocytic, and microbicidal activity of neutrophils.

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The risk of developing periodontitis increases 2-3 times in people with DM compared
to people without it, and the level of glycemic control is key in determining the risk. Like
other complications of diabetes, the risk of periodontitis increases with poor glycemic
control. Most studies on periodontitis and DM have focused on type 2 diabetes, but type 1
diabetes has also been associated with increased periodontal destruction in children and
adolescents.
The pathogenic processes that link the two diseases are the focus of much research,
and it is likely that the increased inflammation that arises from each condition negatively
affects the other. Diabetes increases the risk of periodontitis, contributing to increased
inflammation in the periodontal tissues [13].
These increased reactions lead to increased secretion of cytokines such as interleukin-
1β(Il-1β), tumor necrosis factor-α (TNF-α) and IL-6, increased oxidative stress, and impaired
receptor activator promoting bone resorption. As a result of local tissue damage, the
breakdown of periodontal connective tissues, alveolar bone resorption and exacerbation of
periodontitis increases. Obesity and pro-inflammatory adipokines (cytokines secreted by
adipose tissue) make an additional contribution to the pro-inflammatory environment. It has
also been shown that people with periodontitis and diabetes have increased levels of
circulating TNF-α, C-reactive protein (CRP), and markers of oxidative stress, as well as
decreased levels of these mediators after periodontal treatment [11].
When analyzing the results by age in children, it was found that with increasing age, the
number and percentage of "unsatisfactory" hard tissues of teeth gradually increased, so if in
children under 3 years of age, the " good "score prevailed over the" bad " one, then in
children from 3 to 7 years of age this indicator was 2.0 times, in children from 7 to 12 years-
1.9 times, in children from 12 to 17 years of age, the increase was only 1.2 times [13].
It was found that with an increase in age, the change of temporary teeth to permanent
teeth occurred with full compliance with the age physiology of children, but with an increase
in the age of children, the condition of the hard tissues of the teeth gradually deteriorated.
An increase in" satisfactory" and "unsatisfactory" oral conditions was associated with a
decrease in the number and percentage of "good" oral conditions in children. This
established scheme is recommended to be used when planning the financing of medical and
preventive measures, the distribution of the staff of dentists and periodic medical
examinations organized for children of preschool and school age. It was found that with an
increase in age, the change of temporary teeth to permanent teeth occurred with full
compliance with the age physiology of children, but with an increase in the age of children,
the condition of the hard tissues of the teeth gradually deteriorated.
An increase in" satisfactory" and "unsatisfactory" oral conditions was associated with a
decrease in the number and percentage of "good" oral conditions in children. This
established scheme is recommended to be used when planning the financing of medical and
preventive measures, the distribution of the staff of dentists and periodic medical
examinations organized for children of preschool and school age. [14].

CONCLUSION
To maintain the dental health of children suffering from DM, it is necessary to conduct a
detailed instruction of parents during the dental appointment on the rules of oral care and on the
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optimal choice of means for individual oral hygiene in children. Thus, the use of the proposed
program for the prevention of dental diseases in the practical activities of dentists contributes to
the prevention of possible dental complications, as well as to improving the quality of life of
patients in this category with the saving of state financial costs for social benefits for illness and
disability.

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