Diabetes and Oral Health: An Endocrine Disorder

The human endocrine system plays an important role in the regulation of the oral cavity. Hormone secretion and regulation can vastly alter the status of bacteria, cells, and other microscopic organisms which exist in the mouth. One endocrine disorder which has a tremendous impact on oral health is that of diabetes. This article focuses on diabetes and its negative effect on the oral cavity.

Diabetes is characterized by chronic hyperglycemia which results in diminished insulin production and/or impaired insulin action resulting in inability of glucose transportation into tissues. Over 15.7 million individuals are affected. Diabetes can be classified into two categories. Type I has a child onset, destroys beta cells of islets of Langerhans in pancreas and most individuals are insulin dependant. Type II exhibits an adult onset, peripheral resistance to insulin action, impaired secretion, increased glucose production. This is the most common form (90-95%) and is best controlled with diet and exercise.

The status of diabetic patients is determined by a simple blood test. This test measures the amount of glucose in the blood. Normal values for a fasting adult individual ranges from 90 - 130 mg/dL. Recently, a newer test called the hemoglobin A1C (HbA1C) has given diabetics a more accurate representation of their status. An HbA1C can give a long term evaluation of the amount of glucose on the hemoglobin molecule. A normal value is generally under 6.3% and can measure a history as far as 30 days old.

Oral changes associated with diabetes include cheilosis, mucosal drying, burning mouth and tongue, diminished salivary flow, alterations in the flora of the oral cavity and increased rate of dental caries. Periodontal changes include enlarged gingiva, sessile or pedunculated gingival polyps, polypoid gingival proliferations, abscess formation, periodontitis, and loosened teeth. Periodontal disease in diabetics follows no consistent or distinct pattern.

A majority of studies show a higher prevalence and severity of periodontal disease in individuals with diabetes than without, with similar local factors. A study of Pima Indians shows that 40% of adult Pima Indians have type 2 diabetes. These affected subjects had an increase in prevalence of periodontal disease than those without diabetes. Another study focused on the treatment outcome of periodontally involved patients. It was consistently shown that those subjects who had periodontal disease and diabetes had a slower course of healing as well as a poor response to surgical therapy in comparison to their healthy counterparts.

There are many theories that have been proposed in regards to the changes seen in the oral cavity in diabetics. Increased glucose could change the environment of the microflora which could increase severity of bacterial infection. Poly-morphonuclear leukocytes (PMN's) may have impaired chemotaxis, defective phagocytosis, and impaired adherence. Increased collagenase activity, decreased collagen synthesis, reduction in height of alveolar bone has been show in laboratory animals. Increased advanced glycation end products (AGE) result in less soluble collagen results in fewer repairs and allows for advanced gingival destruction.

Regardless of which form of diabetes a patient has, it is imperative to seek routine dental care. Careful monitoring of a patient's oral health can prevent many future problems. For most patients, a six month recall examination is sufficient; however the dentist may shorten the interval based upon the needs on each individual patient.