Oral Manifestations of Diabetes

D iabetes is a clinically and genetically heterogeneous group of metabolic disorders manifested by abnormally high levels of glucose in the blood. This hyperglyce-mia results from either a deficiency of insulin secretion caused by pancreatic β-cell dysfunction or resistance to the action of insulin in liver and muscles, or both (1). Periodontal disease is one of the most common chronic inflam-matory diseases and is characterized by gradual destruction of connective tissue surrounding the teeth, eventually leading to tooth loss. Periodontitis occurs primarily in adults, and its incidence increases with age (2). Type 2 diabetes and chronic periodontitis are both common in older age-groups. The relationship between both these diseases has been extensively studied. The prevalence of type 2 diabetes is increasing rapidly. According to World Health Organization estimates , the number of adults with diabetes worldwide will increase from 171 million in 2000 to 366 million by 2030 (3). India has been called " the diabetes capital of the world " because of its high diabetes rates; ~41 million Indians have diabetes, accounting for one-fifth of all diabetes cases worldwide (4). The prevalence of periodontal disease in India is also alarming, with incidences of Both diabetes and periodontitis are more severe and progress more rapidly when these conditions occur simultaneously. Many studies have reported correlations between periodontal health and various diabetes-related factors such as A1C and duration of diabetes. In the U.S. Third National Health and Nutrition Examination Survey (2), adults with an A1C >9% had a significantly higher rate of severe peri-odontitis than those without diabetes. Periodontitis is considered a " sixth complication of diabetes " (6). A study by Williams and Mahan (7) involving 2,273 people with diabetes found a 60% prevalence of periodontal disease ; the incidence of periodontitis was two-to fourfold higher. Oral Manifestations of Diabetes The effects of diabetes on oral health have been studied extensively. Diminished salivary flow is a common oral feature of diabetes and may or may not include symptoms of a burning sensation in the mouth or tongue and concomitant enlargement of the parotid salivary glands (8). Table 1 shows the prevalence rates of these and other oral manifestations in controlled and uncontrolled diabetes (9). As the table clearly shows, these manifestations are more prevalent in individuals with uncontrolled diabetes (10). ©2016 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the …