(By Dr. Joseph D. Lim and Dr. Kenneth Lester Lim, BS-MMG, DDM, MSc-OI)
THE THIRD of the reviews presents evidence suggesting a number of associations between oral diseases (periodontitis, tooth loss, oral cancer) and diabetes mellitus (diabetes).
There is evidence that oral healthcare/management of oral disease, most notably periodontal care, has a short-term beneficial influence on diabetes outcomes but there is no evidence that this is sustained over the long-term and/or reduces the development of the complications of diabetes, says F. D’Aiuto, Professor in Periodontology, Head of Periodontology, Eastman Dental Institute, London, who led the review.
The review suggests that diabetes is associated with periodontal disease, tooth loss, and oral cancer in particular, and that the management of oral diseases, most notably periodontal care, has a short-term beneficial influence on metabolic outcomes related to diabetes.
Diabetes mellitus is a long-term condition characterized by an inability to control glucose levels in the blood due to an absolute or relative lack of the hormone insulin.
The association between oral health and diabetes is important because diabetes impacts on general health.
The majority of people with diabetes can be classified as having type 1 or type 2.
Type 1 diabetes is an autoimmune disease, whereby the body’s own immune system, rather than infections, attacks the body’s own host tissues. It tends to occur at a younger age and insulin treatment is essential.
Type 2 diabetes is eight to nine times more common than type 1. It occurs as a result of a combination of lack of response to insulin (insulin resistance), and a lack of insulin production. It tends to occur in later life and in the early stages may be treated with oral medication.
Elevated glucose levels are associated with a number of complications including blindness, kidney failure, and minor and major leg amputation, which can be prevented by maintaining low glucose levels through a combination of both lifestyle change and medication.
Diabetic foot disease occurs as a result of peripheral neuropathy; high glucose levels are associated with a wide range of both chronic and acute neuropathies that affect the full anatomic breadth of the peripheral nervous system from the nerve root to the skin, mirroring the spectrum of peripheral nerve diseases in general.
In addition, diabetes is associated with an increased risk of vascular complications such as myocardial infarction, stroke and peripheral vascular disease.
Obesity is a strong risk factor for the development and progression of diabetes; indeed, the increased incidence of overweight and obesity worldwide explains the ever increasing number of people affected by type 2 diabetes.
Both type 1 and 2 diabetes have been associated with many oral diseases.
Observational studies have suggested diabetes links with periodontal diseases (including peri-implant disease), caries (with its risks of tooth loss), oral mucosal disease (including oral infections), oral cancer, salivary dysfunction and oral dysesthesias, including taste disturbances.
However, with all the studies investigating these associations there has been little consensus with respect to the overall effect of diabetes mellitus on oral health and vice versa.
A rapid review of articles published between 2005 and 2015 investigating the relationship between diabetes and oral health shows evidence that diabetes (type 2) is a risk factor for periodontitis.
There is also evidence that patients with diabetic complications, most specifically diabetic neuropathy, appear to have poorer oral health, including periodontitis, than those without neuropathy or damage to the nerves outside of the brain and the spinal cord.
However, there is scant evidence that periodontitis promotes the development of type 2 diabetes. Nor that gum disease adversely affects glycemic control and complications in patients with diabetes.
In summary, while there is strong evidence that diabetes is a recognized risk factor for periodontitis, more research is needed to ascertain the association between the two.
Patients with diabetic complications, most specifically diabetic neuropathy, appear to have more tooth loss than those without neuropathy. This finding is consistent with the view that diabetes and its complications are associated with poorer oral health.
Conflicting evidence on the association between diabetes and increased prevalence of caries or tooth decay was found. Greater levels of dental plaque were noted in patients with diabetes and this may have implications for future risk of caries.
A high-quality systematic review suggests that type 2 diabetes is associated with an elevated risk of oral cancer and precancerous lesions. Patients with type 2 diabetes have a higher case mortality on diagnosis of oral cancer, independent of tobacco, alcohol and obesity factors.
Patients with diabetes complications, most specifically diabetic neuropathy, appear to have greater mouth dryness. There is limited evidence on the role of diabetes in increasing the risk of salivary dysfunction.
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Dr. Joseph D. Lim, Ed. D., is the former Associate Dean of the College of Dentistry, University of the East; former Dean, College of Dentistry, National University; Past President and Honorary Fellow of the Asian Oral Implant Academy; Honorary Fellow of the Japan College of Oral Implantologists; Honorary Life Member of the Thai Association of Dental Implantology; and Founding Chairman of the Philippine College of Oral Implantologists. For questions on dental health, e-mail jdlim2008@gmail.com or text 0917-8591515.
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Dr. Kenneth Lester Lim, BS-MMG, DDM, MSc-OI, graduated Doctor of Dental Medicine, University of the Philippines, College of Dentistry, Manila, 2011; Bachelor of Science in Marketing Management, De la Salle University, Manila, 2002; and Master of Science (MSc.) in Oral Implantology, Goethe University, Frankfurt, Germany, 2019. He is an Associate Professor; Fellow, International Congress of Oral Implantologists; Member, American Academy of Implant Dentistry and Fellow, Philippine College of Oral Implantologists. For questions on dental health, e-mail limdentalcenter@gmail.com./PN
