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Diabetes Mellitus

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Diabetes Mellitus

 

 

 

 

DIABETES MELLITUS is a group of metabolic diseases in which there are high blood sugar levels over a prolonged period.

FACTS TO KNOW:-

Diabetes mellitus-

Health concern and common chronic metabolic disease worldwide.

Diabetes mellitus represents a group of metabolic diseases that are characterized by hyperglycemia due to a total or relative lack of insulin secretion and insulin resistance or both. The metabolic abnormalities involve carbohydrate, protein, and fat metabolism. Diabetes mellitus affects all age groups but is more common in adults. The World Health Organization (WHO) has recently declared it to be a pandemic. Its prevalence has increased dramatically over the past few decades and it is expected to triple in the next decade. Diabetes mellitus is considered a leading cause of death due to its microvascular and macrovascular complications. The most common types of diabetes are type 1 (also known as insulin-dependent) and type 2 (also known as non-insulin-dependent). Type 2 is the more prevalent type.

Countries with the highest rates of diabetes in the Eastern Mediterranean region and the Middle East are the United Arab Emirates, Saudi Arabia, Bahrain, Kuwait, and Oman.

Oman is one of the countries that have a high prevalence of diabetes mellitus, especially type 2 diabetes, and its prevalence is expected to increase in the next twenty years.

SYMPTOMS:-

1) POLYURIA

2) POLYPHAGIA

3) POLYDYPSIA

COMPLICATIONS:-

Heart disease

Stroke

Cardiac failure

Chronic kidney failure

Foot ulcers

Damage to the eyes

CAUSES:-

Due to either pancreas not producing enough insulin or the cells of the body not responding properly to the insulin produced.

3 MAIN TYPES:-

1} TYPE 1

2} TYPE 2

3} GESTATIONAL DIABETES

TYPE 1- Results from the pancreas fail to produce enough insulin.

Its causes are UNKNOWN.

TYPE 2- Begins from INSULIN resistance, a condition in which cells fail to respond to insulin properly.

CAUSE: Excessive body weight and not enough exercise.

GESTATIONAL DIABETES – It occurs in pregnant women without a previous history of diabetes.

SIGNS:-

1} Blurry vision

2} Headache

3} Fatigue

4} Slow healing of cuts

5} Itchy skin

  •  Prolonged high blood glucose can cause glucose absorption in the lens of the eyes, which leads to the changes in its shape, resulting in vision changes.
  • A number of skin rashes occur during diabetes collectively called as DIABETIC DERMADOMES.

PATHOPHYSIOLOGY:-

Metabolism of glucose is regulated by complex orchestration of hormones activities. Dietary sugars are broken down into various carbohydrates. The most important is glucose, metabolized in nearly all body cells. Glucose enters the cell by facilitated diffusion (glucose transport proteins). This facilitated transport is stimulated very rapidly and effectively by an insulin signal (glucose transport into muscle and adipose cells is increased up to twenty-fold). After glucose is transported into the cytoplasm, insulin then directs the disposition of it – conversion of glucose to glycogen, to pyruvate and lactate, and too fatty acids. Diabetes was initially diagnosed by the use of oral glucose tolerance tests and the criteria were changed many times by WHO and ADA. The former term like  – insulin-dependent diabetes mellitus,  non-insulin-dependent Diabetes Mellitus, juvenile-onset Diabetes Mellitus, or adult-onset Diabetes Mellitus were abolished.

ORAL MANIFESTATIONS AND COMPLICATIONS:-

> Several soft tissue abnormalities have been reported to be associated with diabetes mellitus in the oral cavity.

> These complications include periodontal diseases (periodontitis and gingivitis).

Salivary dysfunction leading to a reduction in salivary flow and changes in saliva composition, and taste dysfunction.

Oral fungal and bacterial infections have also been reported in patients with diabetes.

There are also reports of oral mucosa lesions in the form of stomatitis, geographic tongue, benign migratory glossitis, fissured tongue, traumatic ulcer, lichen planus, lichenoid reaction, and angular cheilitis.

In addition, delayed mucosal wound healing, mucosal neuro-sensory disorders, dental caries, and tooth loss has been reported in patients with diabetes.

The prevalence and the chance of developing oral mucosal lesions were found to be higher in patients with diabetes compared to healthy controls.

PERIODONTAL DISEASES:-

Periodontitis is one of the most widespread diseases in the world affecting the oral cavity and is highly prevalent in both developed and developing countries.

Periodontitis is a chronic inflammatory disorder affecting the gingiva and the periodontal tissue initiated by bacteria.

The micro-flora in the dental plaque that forms daily adjacent to the teeth causes this inflammatory process.

Eventually, the toxins that are released by the microorganisms in the dental plaque will start the gingival inflammation as a result of failure to remove the dental plaque on a daily basis.

A periodontal pocket is formed as a result of the progression of the gingival inflammation causing the gingiva to detach from the tooth surface.

This periodontal pocket is filled with bacteria and its toxins.

As the disease worsens, the pocket will get deeper carrying the dental plaque until it reaches the alveolar bone that will eventually be destroyed with the periodontal attachment.

This process is very common and causes the destruction of periodontal tissues, loss of alveolar bone, and, finally, tooth loss.

There are many factors contributing to this type of inflammation besides the presence of bacteria in dental plaque. A susceptible host is one of them.

SALIVARY DYSFUNCTION:-

> Saliva has a major role in maintaining a healthy oral cavity.

> Saliva is produced by major salivary glands (parotid, sub-mandibular and sub-lingual) and numerous minor salivary glands distributed in the oral cavity.

> Salivary dysfunction has been reported in patients with diabetes.

> A cross-sectional epidemiological study was conducted in 2001 to look at the prevalence of hyposalivation and xerostomia (dry mouth) and to determine the relationship between salivary dysfunction and diabetes complications. This study was conducted in type 1 diabetes and control subjects without diabetes.

> They found that symptoms of reduced salivary flow rate and xerostomia were more frequently reported by patients with diabetes than the controls, especially by those diabetics who had developed neuropathy.

> Other studies conducted in type 2 diabetics also confirmed that xerostomia and hypo-salivation were more prevalent in this group of patients.

> It has been shown that poorly controlled type 2 diabetics have a lower stimulated parotid gland flow rate compared to well-controlled patients and patients without diabetes.

> An increase in salivary pathogens was also reported in these patients.

> Patients with diabetes usually complain of xerostomia and the need to drink very often (polydipsia and polyuria).

> The constant dryness of the mouth would irritate the oral soft tissues, which in turn will cause inflammation and pain.

> Patients with diabetes with xerostomia are more predisposed to periodontal infection and tooth decay.

> The cause of this is not yet fully understood in patients with diabetes but may be related to polydipsia and polyuria or alternation in the basement membrane of the salivary glands.

> It is known that diabetes mellitus is associated with chronic complications such as neuropathy, microvascular abnormalities, and endothelial dysfunction that lead to deterioration of micro-circulation and this may play a role in the reduction of the salivary flow rate and composition.

> Sialosis is defined as asymptomatic, non-inflammatory, non-neoplastic, bilateral chronic diffuse swelling mainly affecting the parotid glands.

> Sialosis has been found to be more prevalent in patients with diabetes mellitus.

FUNGAL INFECTION:-

> Oral candida sis 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.

> Other factors were also implicated such as old age, medications, Cushing’s syndrome, malignancies, and the use of dentures.

> Oral candida sis has been classified into primary and secondary.

> Primary oral candidosis is sub-classified into acute (pseudomembranous and erythematous), chronic (pseudomembranous, erythematous, and hyperplastic), and candida associated lesions.

> Pseudo membrane candidiasis is also known as oral thrush.

> It is characterized by the presence of a creamy white patch which, when wiped, reveals underlying erythematous and bleeding oral mucosa.

> The soft palate is the most commonly affected area followed by the cheek, tongue, and gingivae.

> It could be chronic in immunocompromised patients.

> Erythematous candida sis can present as acute or chronic infection.

> It is believed to result from the usage of steroid and broad-spectrum antibiotics and mainly affects the tongue.

> Hyperplastic candida sis is known as candidal leukoplakia.

> It appears as an irregular whitish raised plaque-like lesion commonly seen in the buccal mucous membrane near the commissures.

POOR ORAL 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 are 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.

ORAL MUCOUS DISEASE:-

>  Both lichen planus and recurrent aphthous stomatitis have been reported to occur in patients with diabetes.

> Oral lichen planus (OLP) is a skin disorder that produces lesions in the mouth. OLP is reported to occur more frequently in patients with TYPE 1 diabetes compared to TYPE 2 diabetes.

> The reason for this is that type 1 diabetes is considered an autoimmune disease, and OLP has been reported to have an underlying autoimmune mechanism.

> Patients with diabetes are subjected to a prolonged state of chronic immune suppression especially in type 1 diabetes.

>  In addition, acute hyperglycemia causes an alteration in the immune responsiveness in diabetes mellitus.

>  Atrophic-erosive oral lesions are more common in patients with diabetes with OLP.

DENTAL CARIES:-

> 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

> The relationship between diabetes and the development of dental caries is still unclear.

> It is well-known that the cleansing and buffering capacity of the saliva is diminished in patients with diabetes mellitus resulting in an increased incidence of dental caries, especially in those patients who suffer from xerostomia.

CONCLUSION:-

Diabetes mellitus is a chronic, non-communicable, and endemic disease. Type 2 compared to type 1 diabetes mellitus is more prevalent worldwide and increasing, especially in Oman.

> Oral manifestations and complications in patients with diabetes mellitus have been recognized and reported recently as a major complication of diabetes mellitus.

>  There is increasing evidence that chronic oral complications in patients with diabetes adversely affect blood glucose control.

> Prevention and management of oral complications, especially periodontal disease, in patients with diabetes is important due to their possible adverse effect on hypoglycemic control.

> Promotion of a healthy oral cavity in patients with diabetes is paramount.

> There are several clinical implications from this review. These include:

1) A lack of awareness of oral complications among both diabetics and health providers.

2) An understanding of the way diabetes affects oral health is necessary for both clinicians and patients, therefore research in this field should be encouraged.

3) The need for regular follow-up of patients with diabetes mellitus by both dentists and physicians.

4) The major role that dentists should play in recognizing the signs and symptoms of diabetes and their oral complications.

5) Advice and counseling for diabetic smokers regarding smoking cessation.

6) Vigorous treatment of oral infection either bacterial or fungal in these patients, especially if they have poor hypoglycemic control.

 

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