Diabetes mellitus is a syndrome of abnormal carbohydrate, fat and protein metabolism due to the absolute or relative lack of insulin. There are three general categories of diabetes. Type 1 results from an absolute insulin deficiency; type 2 is the result of insulin resistance and an insulin secretory defect, and type 3 gestational is a condition where there is abnormal glucose tolerance during pregnancy.

Diabetes develops in people of all ages and have a great racial discrepancy. Research has shown that a greater percentage of blacks are affected. A survey conducted in 1996 found that 8.7 per cent of whites aged 65 and older had diabetes compared with 19.9 per cent of blacks. During the last two decades, the prevalence of diabetes has increased, and its burden and complications are likely to increase as the population grows older.

Signs and symptoms

Oral signs and symptoms of diabetes

Gingivitis and periodontitis

Studies have shown that people with diabetes, especially poorly controlled diabetes, have a significantly higher prevalence of periodontitis, gingivitis and alveolar bone loss. In addition, evidence supports that periodontitis infections contribute to problems with glucose control. Treating chronic periodontitis infection is essential for managing diabetes.

Dental caries (tooth decay)

Patients with diabetes are susceptible to periodontitis and salivary disorder which could increase their risk of developing new and recurrent dental caries. Several studies have reported a greater history of dental caries in persons with diabetes.

Salivary dysfunction

People with diabetes have been reported to complain of dry mouth and experience salivary glands dysfunction.

Oral Mucosal Diseases

Diabetes is associated with a great likelihood of developing certain oral disorders like lichen planus (white patches) and recurrent aphthous stomatitis (mouth ulcer) as well as oral fungal infections.

Oral infections (Candidiasis)

Another manifestation of diabetes is the presence of opportunistic infections such as oral candidiasis. Fungal infections of the mouth and removable dentures are more commonly found in adults with diabetes.

Taste disturbances

Taste is a critical component of oral health, which is adversely affected in patients with diabetes. One study reported that more than one-third of adults with diabetes had diminished taste perception, which could result in hyperphagia and obesity. This sensory dysfunction makes it difficult to maintain a proper diet and can lead to poor glucose control.

Burning sensation

Patients with diabetes have reported increased complaints of having burning sensation and soreness in the mouth. This burning-mouth syndrome has been associated with diabetes mellitus. Patients may experience long-lasting numbness in the mouth, which could clearly affect oral hygiene maintenance.

Conclusion

Diabetes mellitus affects people of all ages and its prevalence has increased. Providing safe and efficient medical care for patients with diabetes requires an understanding of the disease and familiarity with its oral manifestations. The goal of therapy is to promote oral health in patients with diabetes, to help prevent and diagnose diabetes in dental patients and to enhance the quality of life for patients with this incurable disease.

Dr Dennis Jones is a dentist in private practice. Email: yourhealth@gleanerjm.com.