General Health

What is the Correlation between Diabetes and Oral Health?

The link between oral hygiene and systemic diseases like diabetes has not been sufficiently explored in the medical world. Various systemic diseases first manifest in the oral cavity before showing bodily symptoms. Recognising the symptoms at an early stage can prevent progression of the disease thereby improving prognosis.

Patients with diabetes tend to suffer from various manifestations such as the diabetic foot, retinopathy, nephropathy and oral disorders. Elevated blood sugar levels due to diabetes can lead to tooth loss, which can affect the patient’s self-esteem, lead to malnutrition and call for dental prosthetics. Following proper and hygienic oral cavity routine can greatly help to improve to the quality of life in diabetic patients.

How does oral health affect diabetes mellitus?

An oral disease can cause oral and systemic inflammatory changes in the body thereby altering blood sugar levels. Missing, mobile or painful teeth leads improper chewing and insufficient nutrition which can progress to Type 2 diabetes or reduced control of blood glucose further deteriorating the existing condition. Hence, dental professionals can detect even the slightest of changes in blood sugar levels via the oral cavity of the patient and direct them to a general physician.

Treating certain oral inflammatory diseases through non-surgical kind periodontal treatment or decayed teeth removal can decrease blood sugar levels. Deep teeth cleaning” or “deep scaling” techniques followed by implementing oral hygiene habits can help lower Hba1c levels in diabetic patients. Periodontal treatment lowers the concentration of inflammatory biomarkers such as Tumour Necrosis Factor-α (TNF-α) and C-Reactive Protein (CRP) present in the gingiva crevicular fluid of the gums as well as in in the saliva and serum.

How does Diabetes mellitus affect oral health?

Any minor increase in blood glucose levels can manifest as oral diseases. Diabetes mellitus is known to affect all the hard and soft tissues in the oral cavity. If an adolescent or an adult has unregulated diabetes mellitus, they will most definitely have gingivitis. In patients aged 65 and above, the gingivitis becomes aggressive affecting the periodontium leading to periodontitis. Periodontitis is known to increase the Hba1c levels – both initiating and exacerbating diabetes mellitus in people.

Some of the oral health conditions caused due to diabetes are:

  1. Periodontitis and bone loss: Periodontitis is often seen in patients with diabetes due to a compromised immune system making them more susceptible to infections and delayed wound healing.
  2. Periapical lesions: Periapical lesions or periapical periodontitis is also rampant in diabetic patients. Thickening of the basement membrane of the dental pulp was observed in these patients. Due to poor wound healing, diabetic patients oftentimes suffered from painful dental pulp infections.
  3. Oral cancer: The incidence of oral cancer was 15% higher in diabetic patients than non-diabetic patients.
  4. Caries: Diabetes increases glucose levels in the saliva and leads to a dry mouth condition which serve as a favourable condition for bacteria to thrive and lead to dental caries.
  5. Candidiasis or oral thrush: Similarly increased salivary glucose level in the saliva enable the growth of Candida albicans in the oral cavity leading to candidiasis.
  6. Dry mouth and oral ulcers: Diabetic patients urinate more often which can reduce saliva in the mouth. This can lead to issues such as dry mouth (xerostomia), burning sensation in the oral region or ulcers. The burning sensation can also be attributed to oral thrush.

Medications such as Metformin which is used to treat Diabetes mellitus can cause xerostomia. This side effect was confirmed through a 2021 study done on Diabetic rats.

Periodontitis and diabetes mellitus affect each other adversely forming a chronic and vicious cycle. Inter-professional referrals between dentists and general physicians can be of great advantage for patient management and prognosis. Thus, maintaining good oral health is a tool in the prevention and management of Diabetes.

 

Author: 

Sanjana Raman graduated from D Y Patil University with a degree in dentistry. She believes in the power of promoting dental education and learning through discussing various related medical topics.

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