Romanian Journal of Oral Rehabilitation

Vol. 4, No. 3, July - September 2012

IMPACT OF DIABETES MELLITUS ON ORAL CAVITY

Roxana Ionela Vasluianu1*, Alice Murariu2, Doriana Forna1, Magda Ecaterina Antohe1,
Norina Consuela Forna1
1
Department of Removable Prosthodontics
2
Departament of Surgery
Faculty of Dentistry, University of Medicine and Pharmacy "Grigore T. Popa" - Iasi, Romania

*Corresponding author: Roxana Ionela Vasluianu, Department of Removable Prosthodontics

Faculty of Dental Medicine
University of Medicine and Pharmacy "Grigore T. Popa" Iasi, Romania
16, Universitatii Street, 700115
E-mail: roxana302000@yahoo.com

ABSTRACT
Introduction The pathology from the level of the oral cavity may represents sings of homeostasic
disequilibrium or structural modifications on the level of the entire organism. The oral manifestations can be
indicators in order to establish an early diagnosis for the general disease. Material and methods The patients
suffering from diabetes mellitus were examined and they presented different pathological aspects both on
general level and of the oral cavity. Within the evaluation, there were included the people that showed pain
determined by dental decay, with pulp and periodontal complications, with acute periodontal inflammatory
phenomena, masticatory and aesthetic dysfunctions, tension and gingival itching. For each patient, we took into
account the type of diabetes, the values of the glycaemia and the followed treatment. Results In the case of the
affections, on the level of the mucosa, we found lesions on the level of the tongue, marginal periodontal and
labial mucosa and the edentulous ridge. Diabetes mellitus is a risk factor for the modifications on the level of the
oral cavity because the patients suffering from diabetes have affections characterized by seriousness and rapid
evolution. Conclusions Even if there are several general affections that can influence or accelerate the
edentation, the diabetes greatly influences both the rate of the loss of odonto - parodontal units and the
deterioration of the edentulous prosthetic area.

Key words: diabetes mellitus, oral cavity lesions

INTRODUCTION unit is the most affected part by the

Diabetes mellitus is a disease about which modifications induced by diabetes mellitus
it was written in the Egyptian journal that was that determined the exacerbation of the caries
“a disease causing the elimination of some and periodontopaty and finally leading to the
abundant and frequent urine". Chinese loss and mobilisation of teeth from the arch
medicine described it as a disease of thirst, and the appearance of different clinical forms
accompanied by polyuria, polyphagia and of edentulous [7, 8, 10].
polydipsia. In 1712, Cullen added to the term In order to prevent the major oral
diabetes, the term mellitus. Diabetes mellitus complications caused by diabetes, it requires the
is a metabolic disease that determines early establishing of the diagnosis and applying
premature irreversible degenerative lesions in a treatment for diabetes mellitus follow by a
the entire organism. The odonto-periodontal correct therapy for oral affections [1, 4].

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Vol. 4, No. 3, July - September 2012

Diabetes develops in people of all ages, but angular cheilitis could appear at the corners
the prevalence has increased dramatically over of the mouth, usually associated with a oral
the past several decades. Diagnosis is made on candidosis. This form is commonly found at
the basis of a host of systemic and oral signs the diabetes patients with removable
and symptoms, including gingivitis and prostheses (Fig. 1).
periodontitis, recurrent oral fungal infections Median rhomboid glossitis is a result of
and impaired wound healing [3, 6, 11, 13]. the candida albicans infections associated
with other factors represented by tobacco or
MATERIAL AND METHODS the modification of the oral pH (Fig. 2).
The patients, 57 female and male, suffering Diabetes mellitus patients or the patients
from diabetes mellitus were examined and who followed a treatment with antibiotics for
they presented different pathological aspects a long time presented an increased risk for the
both on general level and the oral cavity. appearance of this affection. The lesions are
Within the evaluation, there were included the known as central papillary atrophy, red spot,
people that showed pain determined by dental soft, lacking filiform papillae situated of the
decay, with pulp and periodontal median line of the dorsal side of the tongue.
complications, with acute periodontal Another manifestation of diabetes and an oral
inflammatory phenomena, masticatory and sign of systemic immunosuppression is the
aesthetic dysfunctions, tension and gingival presence of opportunistic infections, such as
itching. For each patient, we took into account oral candidiasis (Fig. 3). Symptomatic
the type of diabetes, the values of the candidosys is associated with various
glycaemia and the followed treatment. conditions, including nutritional deficiencies,
diabetes, xerostomia and immune deficiencies
DISCUSSIONS and disorders.
The onset of symptoms is rapid in type 1 In order to appreciate the modification of
diabetes and symptoms of type 2 diabetes the salivary glands we have to perform tests
develop more slowly, and frequently without which investigated the physical, chemical and
the classical triad. Due to the unbalances antimicrobian properties of the saliva. It was
produced on the level of the entire organism, found in the case of the patients with diabetes
we can find circulatory modifications, mellitus a decrease of secretory functions, the
retinopathy, peripheral neuropathy, amiotrophy hyposialia being determined by diabetic
and the infections which are more frequent and polyuria, in the case of the untreated patients
they could present different types of or incorrectly treated and by diffuse process
complications. At the patients with neuropathy, of glandular sclerosis.
the salivary flux decreases nearly 50% and they The modifications of the alveolar bone are
could accuse the sensation of the dry mouth. determinated by the systemic factors and the
Beside the quantitative modifications, they are masticatory forces [5, 12]. However, there is
also qualitative modifications of the saliva. This the possibility that the differences in the
data emphasizes the loss of the enervation on maxillar bone and posextractional mandibular
the level of the salivary glands, at the patients loss rate, for different patients, to be
with neuropathy. maintained in the case of bone losses that
In the specialized literature, there are data refer to the entire skeleton. The modifications
that establish a real relation between the that appear on the level of the covering
angular cheilitis, median rhomboid glossitis mucosa are tightly related to the metabolical
and the presence of the oral candidosis. The modification on the level of the bone support.

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Vol. 4, No. 3, July - September 2012

When the two processes are concordant, the mellitus an increase of the level of calcium
mucosa remains tightly attached to its bone favourable to the formation of calculus
support maintaining its resilience within deposits. The abundant calculus deposits can
normal limits. Massler attributed the be found in most of the patients suffering
vulnerability of the mucosa on the from diabetes mellitus which can be
modifications produced in the hydric balance explained through the high concentration of
between intra and extracellular compartment, calcium from the saliva and the poor oral
tissues, following the deshydratation hygiene determined by pain and gingival
produced as a result of the decrease of the bleeding during brushing (Fig. 6).
renal function. The edentulous appears more Several mechanisms have been proposed
rapid and more accentuated at patients with for explaining the increased susceptibility to
type 1 diabetes due to the complications that periodontal diseases, including alterations in
appear on the level on the stomatognat system the host response, subgingival microflora,
(Fig. 4, Fig. 5). collagen metabolism, vascularity, gingival
The periodontal disease is registered as crevicular fluid and hereditary patterns.
"the 6th complication of diabetes mellitus" The relationship between diabetes and
(LÖE 1993). The mechanisms through which dental caries has been investigated, but no
diabetes act on the gum are: modification of clear association was found. It is important to
the local mechanism and the accumulation of notice that patients with diabetes are
intermediary compounds, with toxic action susceptible to oral sensitivity, periodontal and
through acidosis and vascular modifications salivary disorders, which could increase their
and of the nervous formation characterized by risk of developing new and recurrent dental
capillary meiopragy and arterial and venous caries. For example, several studies have
vascular sufferings and the appearance of the reported a greater history of dental caries in
diabetic nevritis [2, 9]. It was noticed in the people suffering from diabetes.
saliva of the patients suffering from diabetes

Fig. 1. Angular cheilitis Fig. 2. Median rhomboid glossitis

Fig. 3. The candidosis associated with Fig. 4. Accentuated resorption of the

xerostomy edentulous ridge

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Vol. 4, No. 3, July - September 2012

Fig. 5. Accentuated resobtion of the edentulous Fig. 6. Abundant calculus deposits

ridge

CONCLUSIONS severe forms of chronical periodontal disease.

Diabetes is a complex disease A check of the level of insulin at patients type
characterized by numerous variables that can I corresponds to the degree of periodontal
influence the development of complications. affection. Any person suffering from diabetes
Although there are several general diseases mellitus requires a close, careful preparation
that can influence or hurry up the appearance that aims at protecting him against the post-
of the edentulous, diabetes mostly influences surgery complications through the best
both the loss rate of the odonto-periodontal metabolical re-balance. The goal of the
units and the damage of the prosthetic field. therapy is to promote oral health in patients
The detailed knowledge of the field is with diabetes, to help prevent and diagnose
important because it influences the prognostic diabetes in dental patients receiving routine
of the prosthetic treatment. In the case of the stomatological care and to enhance the
patients suffering from diabetes mellitus, it quality of life of the patients suffering from
could be noticed an increased incidence of the this incurable disease.

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