Oral symptoms and signs in elderly patients with type 2 diabetes mellitus. A focus on diabetic neuropathy

The Associations of Dental and Periodontal Lesions with the Microvascular Complications in Patients with Type 2 Diabetes Mellitus: A Case-Control Study

BACKGROUND

Diabetes mellitus is closely related to periodontal disease and dental lesions, disorders which through dental infection and metabolic imbalance become negatively potentiated and cause a vicious circle that is almost impossible to break. The aim of this research was to study if the severity of dental and periodontal lesions is related to the presence of microvascular complications and glycemic control in patients with type 2 diabetes mellitus (T2DM).

METHODS

In total, 112 subjects with T2DM that underwent a dental evaluation were enrolled in this case-control study. The study group included 56 patients with complicated lesions, whereas the control group included 56 patients whose gender and age matched the study group and that presented superficial lesions. The statistical analysis was carried out using SPSS 26.0, with the result being considered statistically significant if the p values were <0.05.

RESULTS

Statistically significant differences were recorded between the two groups regarding the value of blood glucose, HbA1c and fibrinogen, as well as kidney function. Statistically significant differences were also recorded between the two groups when analyzing the presence of microvascular complications, as well as individually analyzed, in the case of diabetic peripheral sensory-motor neuropathy (p < 0.001), but also of diabetic retinopathy (p < 0.05). This study developed a score with a predictive value for the presence of complicated dental and periodontal lesions, including blood glucose, fibrinogen, diabetic retinopathy, and diabetic peripheral neuropathy (AUROC 0.847, p < 0.001).

CONCLUSIONS

There is a high frequency of dental and periodontal complications in patients with T2DM. Patients with microvascular complications, elevated fasting blood glucose, and chronic inflammation, as evidenced by elevated fibrinogen, are more likely to develop complicated dental and periodontal lesions.

Distinct microbiome of tongue coating and gut in type 2 diabetes with yellow tongue coating

The gut microbiome plays a critical role in the pathogenesis of type 2 diabetes mellitus (T2DM). However, the inconvenience of obtaining fecal samples hinders the clinical application of gut microbiome analysis. In this study, we hypothesized that tongue coating color is associated with the severity of T2DM. Therefore, we aimed to compare tongue coating, gut microbiomes, and various clinical parameters between patients with T2DM with yellow (YC) and non-yellow tongue coatings (NYC). Tongue coating and gut microbiomes of 27 patients with T2DM (13 with YC and 14 with NYC) were analyzed using 16S rDNA gene sequencing technology. Additionally, we measured glycated hemoglobin (HbA1c), random blood glucose (RBG), fasting blood glucose (FBG), postprandial blood glucose (PBG), insulin (INS), glucagon (GC), body mass index (BMI), and homeostasis model assessment of β-cell function (HOMA-β) levels for each patient. The correlation between tongue coating and the gut microbiomes was also analyzed. Our findings provide evidence that the levels of Lactobacillus spp. are significantly higher in both the tongue coating and the gut microbiomes of patients with YC. Additionally, we observed that elevated INS and GC levels, along with decreased BMI and HOMA-β levels, were indicative of a more severe condition in patients with T2DM with YC. Moreover, our results suggest that the composition of the tongue coating may reflect the presence of Lactobacillus spp. in the gut. These results provide insights regarding the potential relationship between tongue coating color, the gut microbiome, and T2DM.

Is acupuncture an effective treatment for temporomandibular disorder?: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Acupuncture is used for treating various disorders, but its effects on temporomandibular disorder (TMD) remain unclear. This study aimed to assess the effectiveness and safety of acupuncture for TMD via a systematic review of randomized clinical trials.

METHODS

A total of 11 Korean and worldwide databases were searched to identify acupuncture studies in adults with TMD. A Cochrane risk of bias assessment was performed on all articles; a meta-analysis, which involved the categorization according to the type of control used (inactive control, active control, or add-on), was subsequently performed. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation methodology.

RESULTS

The qualitative analysis of randomized clinical trials with acupuncture as the intervention included 32 articles, 22 of which were included in the quantitative analysis (471 participants). Acupuncture significantly improved outcomes (effect rate, relative risk [RR]: 7.00, 95% confidence interval [CI]: 1.91, 25, 62; visual analog scale, standardized mean difference: 0.49, 95% CI: 0.24, 0.73) versus active controls (effect rate, RR: 1.19; 95% CI: 1.12, 1.27). In the analysis of add-ons, acupuncture significantly improved the effect rate and pain intensity (effect rate, RR: 1.36; 95% CI: 1.04, 1.77; visual analog scale, mean difference: -1.23; 95% CI -1.79, -0.67). However, the quality of evidence was determined to range from low to very low.

CONCLUSION

Acupuncture in TMD significantly improved outcomes versus active controls and when add-on treatments were applied. However, as the quality of evidence was determined to be low, well-designed clinical trials should be conducted in the future.

Causal association between body mass index and temporomandibular disorders: a bidirectional two-sample Mendelian randomization analysis

BACKGROUND

Observational studies have shown that body mass index (BMI) is highly correlated with the occurrence of temporomandibular disorders (TMDs). However, these studies failed to present a causal relationship. Thus, we aimed to performed a Mendelian randomization (MR) study to investigate causality between BMI and TMDs.

METHODS

We performed a two-sample bidirectional MR analysis using large-scale genome-wide association studies (GWAS). Data were obtained from a large-scale BMI dataset (N = 322,154), TMDs dataset (N = 134,280). The causal effects were estimated with inverse-variance weighted (IVW) method, MR Egger, weighted median. Sensitivity analyses were implemented with Cochran's Q test, MR-Egger intercept test, MR-PRESSO, leave-one-out analysis and the funnel plot.

RESULTS

In the forward MR analysis, a genetic prediction of low BMI was causally associated with a higher risk of TMDs (IVW OR: 0.575, 95% CI: 0.415-0.798, p: 0.001). Similar results were obtained using other complementary methods (MR Egger OR: 0.270, 95% CI: 0.104-0.698, p: 0.009; weighted median OR: 0.496, 95% CI: 0.298-0.826, p: 0.007). In the reverse MR results, TMDs was shown to have no significant effect on BMI (all p > 0.05). No pleiotropy and heterogeneity were detected in the bidirectional analysis (p > 0.05).

CONCLUSION

A lower BMI might be causally associated with increased risk of TMDs, supporting the importance of weight control for the prevention of TMDs. Clinicians should pay more attention to the low-BMI patients among those seeking medical advice due to temporomandibular joint discomfort.

Vidarabine, an anti-herpes agent, prevents occlusal-disharmony-induced cardiac dysfunction in mice

We recently reported a positive relationship between occlusal disharmony and cardiovascular disease via activation of β-adrenergic signaling in mice. Furthermore, inhibition of type 5 adenylyl cyclase (AC5), a major cardiac subtype in adults, protects the heart against oxidative stress. Here, we examined the role of AC5 in the development of occlusal-disharmony-induced cardiovascular disease in bite-opening (BO) mice, prepared by cementing a suitable appliance onto the mandibular incisor. We first examined the effects of BO treatment on cardiac function in mice treated or not treated for 2 weeks with vidarabine, which we previously identified as an inhibitor of cardiac AC. Cardiac function was significantly decreased in the BO group compared to the control group, but vidarabine ameliorated the dysfunction. Cardiac fibrosis, myocyte apoptosis and myocyte oxidative DNA damage were significantly increased in the BO group, but vidarabine blocked these changes. The BO-induced cardiac dysfunction was associated with increased phospholamban phosphorylation at threonine-17 and serine-16, as well as increased activation of the Ca2+-calmodulin-dependent protein kinase II/receptor-interacting protein 3 signaling pathway. These data suggest that AC5 inhibition with vidarabine might be a new therapeutic approach for the treatment of cardiovascular disease associated with occlusal disharmony.

State of Evidence on Oral Health Problems in Diabetic Patients: A Critical Review of the Literature

Diabetes mellitus (DM) is a global health problem, having recognized that in the next 20 years the number of diabetic patients in the world will increase to 642 million. DM exerts enormous repercussions on general health diabetic (especially derived from vascular, cardiac, renal, ocular, or neurological affectation). It entails in addition a high number of deaths directly related to the disease, as well as a high health care cost, estimated at $673 billion annually. Oral cavity is found among all the organs and systems affected in the course of DM. Important pathologies are developed with higher prevalence, such as periodontitis (PD), alterations in salivary flow, fungal infections, oral cancer, and oral potentially malignant disorders (OPMD). It has been proven that PD hinders the metabolic control of DM and that the presence of PD increases the possibility for developing diabetes. Despite the relevance of these oral pathologies, the knowledge of primary care physicians and diabetes specialists about the importance of oral health in diabetics, as well as the knowledge of dentists about the importance of DM for oral health of patients is scarce or non-existent. It is accepted that the correct management of diabetic patients requires interdisciplinary teams, including dentists. In this critical review, the existing knowledge and evidence-degree on the preventive, clinical, diagnosis, prognosis, and therapeutic aspects of oral diseases that occur with a significant frequency in the diabetic population are developed in extension.

State of Evidence on Oral Health Problems in Diabetic Patients: A Critical Review of the Literature

Diabetes mellitus (DM) is a global health problem, having recognized that in the next 20 years the number of diabetic patients in the world will increase to 642 million. DM exerts enormous repercussions on general health diabetic (especially derived from vascular, cardiac, renal, ocular, or neurological affectation). It entails in addition a high number of deaths directly related to the disease, as well as a high health care cost, estimated at $673 billion annually. Oral cavity is found among all the organs and systems affected in the course of DM. Important pathologies are developed with higher prevalence, such as periodontitis (PD), alterations in salivary flow, fungal infections, oral cancer, and oral potentially malignant disorders (OPMD). It has been proven that PD hinders the metabolic control of DM and that the presence of PD increases the possibility for developing diabetes. Despite the relevance of these oral pathologies, the knowledge of primary care physicians and diabetes specialists about the importance of oral health in diabetics, as well as the knowledge of dentists about the importance of DM for oral health of patients is scarce or non-existent. It is accepted that the correct management of diabetic patients requires interdisciplinary teams, including dentists. In this critical review, the existing knowledge and evidence-degree on the preventive, clinical, diagnosis, prognosis, and therapeutic aspects of oral diseases that occur with a significant frequency in the diabetic population are developed in extension.

State of Evidence on Oral Health Problems in Diabetic Patients: A Critical Review of the Literature

Diabetes mellitus (DM) is a global health problem, having recognized that in the next 20 years the number of diabetic patients in the world will increase to 642 million. DM exerts enormous repercussions on general health diabetic (especially derived from vascular, cardiac, renal, ocular, or neurological affectation). It entails in addition a high number of deaths directly related to the disease, as well as a high health care cost, estimated at $673 billion annually. Oral cavity is found among all the organs and systems affected in the course of DM. Important pathologies are developed with higher prevalence, such as periodontitis (PD), alterations in salivary flow, fungal infections, oral cancer, and oral potentially malignant disorders (OPMD). It has been proven that PD hinders the metabolic control of DM and that the presence of PD increases the possibility for developing diabetes. Despite the relevance of these oral pathologies, the knowledge of primary care physicians and diabetes specialists about the importance of oral health in diabetics, as well as the knowledge of dentists about the importance of DM for oral health of patients is scarce or non-existent. It is accepted that the correct management of diabetic patients requires interdisciplinary teams, including dentists. In this critical review, the existing knowledge and evidence-degree on the preventive, clinical, diagnosis, prognosis, and therapeutic aspects of oral diseases that occur with a significant frequency in the diabetic population are developed in extension.

Relationship between periodontitis and microangiopathy in type 2 diabetes mellitus: a meta-analysis

OBJECTIVE

Whether periodontitis increases the risk of diabetic microangiopathy remains controversial. The present meta-analysis aims to investigate the relationship between periodontitis and diabetic microangiopathy in patients with type 2 diabetes mellitus.

METHODS

PubMed, EMBASE, Web of Science, the Cochrane Library, CNKI, and WanFang data were searched without language restrictions. The methodological quality of the studies included was assessed using Newcastle-Ottawa Scale method, and meta-analysis was performed by Review Manager 5.3. Odds ratio (OR) and 95% confidence interval (CI) were used to assess the risk of periodontitis for diabetic microangiopathy among patients with type 2 diabetes.

RESULTS

Thirteen cross-sectional studies, covering 10 570 participants, were included in the present meta-analysis. The results demonstrated that periodontitis was associated with increased risk of type 2 diabetic microangiopathy (OR: 2.43, 95% CI: 1.65-3.56), diabetic retinopathy (OR: 4.33, 95% CI: 2.19-8.55), and diabetic nephropathy (OR: 1.75, 95% CI: 1.07-2.85), while periodontitis was not associated with diabetic neuropathy (OR: 0.99, 95% CI: 0.19-5.12). Subgroup analysis among the studies in Asian (OR: 3.06, 95% CI: 1.94-4.84) and North American (OR: 1.42, 95% CI: 1.08-1.86) populations confirmed the existed association between periodontitis and type 2 diabetic microangiopathy. The relationship still existed in groups with sample size larger than 500 (OR: 1.77, 95% CI: 1.34-2.34) and smaller than 500 (OR: 3.33, 95% CI: 1.38-8.03). A sensitivity analysis confirmed the stability of the results by excluding moderate quality studies or removing articles one after the other.

CONCLUSION

Current evidences have proved that periodontitis is associated with increased risk of diabetic microangiopathy in patients with type 2 diabetes mellitus. This conclusion may provide useful evidence for correlated clinical researches. PROSPERO registration number CRD42021247773.

Computed tomography texture analysis of mandibular condylar bone marrow in diabetes mellitus patients

OBJECTIVES

Diabetes mellitus (DM) is associated with a broad range of complications, such as retinopathy, nephropathy, neuropathy, and cardiovascular disease. Therefore, predicting DM from head and neck images is a challenge for clinicians. The purpose of this study was to assess the mandibular condylar bone marrow in DM patients using computed tomography (CT) texture analysis.

METHODS

This retrospective study included 16 DM and age and sex matched 16 control patients (11 men, 5 women; mean age, 56.8 ± 14.4 years; range 31-78 years). Patients with Type I DM, prior history of taking bisphosphonates, osteoarthritis of the temporomandibular joint, and CT images with metal artifacts were excluded from this study. Bilateral mandibular condylar bone marrow was manually contoured on axial CT images. The presence or absence of DM is the primary predictor variable. Texture features of the region of interest was the outcome variable, that were analyzed using an open-access software, MaZda Ver.3.3. For each group, 20 features out of 279 parameters were selected with Fisher, probability of error and average correlation coefficient methods in MaZda. Bivariate statistics were computed with the Mann-Whitney U test and the P value was set at .05.

RESULTS

One histogram feature, 15 Gy level co-occurrence matrix features, and four gray level run length matrix features showed differences between the DM patients and non-DM patients (P < 0.05).

CONCLUSIONS

Several texture features of the condyle demonstrated differences between the DM and non-DM patients. CT texture analysis may potentially detect DM from the condylar bone marrow.

Management of periodontal disease in patients with diabetes- good clinical practice guidelines: A joint statement by Indian Society of Periodontology and Research Society for the Study of Diabetes in India

There is a huge body of literature suggesting an association and a bidirectional relationship between periodontal disease and diabetes. Diabetes and periodontal diseases are both chronic diseases with a high prevalence. Dentists/periodontists, in their daily clinical practice, very often attend to diabetes patients with diverse oral health conditions and cater to their dental treatment needs. Safe and effective periodontal therapy in this population requires a broad understanding of diabetes, medical management of diabetes, and essential modifications to dental/periodontal therapy that may be required. This paper describes a joint statement put forth by the Indian Society of Periodontology and the Research Society for the Study of Diabetes in India aiming to provide expert consensus and evidence-based guidelines for optimal clinical management of periodontal conditions in diabetes patients or patients at risk for diabetes. Although this paper is not envisioned to be a comprehensive review of this topic, it intends to provide the guidelines for dental professionals and periodontists.

Oral candidiasis and denture stomatitis in diabetic patients: Systematic review and meta-analysis

Here, the prevalence of oral candidiasis and denture stomatitis among diabetic patients compared to healthy ones was summarized through a systematic review with meta-analysis. Medline, Scopus, Web of Science, Lilacs, Cochrane Library, Embase, and the grey literature were searched without restriction, until May 2020. Eligibility criteria were established, data were extracted, and quality assessment was conducted by two trained examiners. Qualitative synthesis was based on the recommendations of Fowkes and Fulton. Two meta-analyses were performed on studies investigating patients with: a) oral candidiasis and b) denture stomatitis. Out of 6034 screened studies, seven were eligible for qualitative and quantitative synthesis; of these, three evaluated oral candidiasis and four evaluated denture stomatitis. Qualitative synthesis showed that the main methodological problems of the studies included sample size, source of controls, matching, and randomization. Diabetic patients had a similar chance of developing oral candidiasis to non-diabetic patients (OR1.40 [0.96; 2.04], p = 0.08, I2 = 94%). However, diabetic patients had a higher chance to present denture stomatitis compared to non-diabetic patients (OR 1.92 [1.42, 2.59] p < 0.0001, I2 = 0%). Therefore, diabetic patients have a higher chance of developing denture stomatitis compared to non-diabetic patients. However, for all analyses, the certainty of the evidence was considered to be very low.

Predictors of periodontal disease among rural Indian type 2 diabetic population

BACKGROUND

Periodontal Disease (PD) is associated with complications of diabetes. Control of the PD reduces glycated hemoglobin (HbA1c) level. This study aimed to evaluate the relationship of PD with duration, severity of diabetes and eGFR.

MATERIAL AND METHOD

A Prospective observational study conducted at Sidhi Vinayaka Hospitals (SVH) Sangareddy during the period of January 2014 to December 2019. Total 1436 patients with a definite diagnosis of type 2 diabetes (T2DM), between the ages of 45-60 years were included. They were classified according to CPITN score for PD and compared against the variables.

RESULTS

A total of 1436 consecutive outpatients attending to SVH were included. Among them 662 (46.1%) were males and 774(53.9%) were females. The mean age of the patients was 48.3(SD ± 10.62) and mean duration of diabetes was 2.9(SD ± 4.18). The mean fasting blood glucose was 198.5(SD ± 85), mean post prandial blood glucose was 277.2 (SD ± 107.7) and mean HBA1c was 9.98% (SD ± 2.6). Among the study group 1198 (83.4%) had none/mild (Grade I) PD, 192(13.4%) had moderate/severe (Grade II) PD and 46(3.2%) were completely edentulous (Grade III).

CONCLUSION

There is a linear correlation between PD and age of patient, duration of diabetes, eGFR and level of glycemic status among rural population with T2DM.

The association of periodontal disease with the complications of diabetes mellitus. A systematic review

This review investigated the association of periodontal disease with diabetes mellitus (DM) and diabetic complications. PubMed/MEDLINE was searched including search terms "periodontal" OR "periodontitis" AND "diabetic complications" OR "diabetic retinopathy" OR "diabetic nephropathy" OR "diabetic neuropathy" OR "cardiovascular disease diabetes" OR "myocardial infarction diabetes" OR "cerebrovascular disease diabetes" OR "stroke diabetes" OR "peripheral vascular disease diabetes". Fourteen studies included in this review consistently reported an increased risk for diabetic complications including microvascular, macrovascular and death in the presence of periodontal disease. Higher risks for diabetic retinopathy (odds ratios: 2.8-8.7), neuropathy (3.2-6.6), nephropathy (1.9-8.5), cardiovascular complications (1.28-17.7) and mortality (2.3-8.5) were reported for people with diabetes with periodontitis compared to those with diabetes who have no periodontitis. This novel review summarizes current data providing further evidence of a link between poor oral health and DM and its complications. It has also drawn attention to major limitations of the available data linking periodontal disease and diabetic complications.

Trigeminal nociceptive function and oral somatosensory functional and structural assessment in patients with diabetic peripheral neuropathy

This case-control study primarily compared the trigeminal nociceptive function, the intraoral somatosensory profile and possible structural nerve changes between diabetic peripheral neuropathy (DPN, n = 12) patients and healthy participants (n = 12). The nociceptive blink reflex (nBR) was recorded applying an electrical stimulation over the entry zone of the right supraorbital (V1R), infraorbital (V2R) and mental (V3R) and left infraorbital (V2L) nerves. The outcomes were: individual electrical sensory (I₀) and pain thresholds (I_P); root mean square (RMS), area-under-the-curve (AUC) and onset latencies of R2 component of the nBR. Furthermore, a standardized full battery of quantitative sensory testing (QST) and intraepidermal nerve fibre density (IENFD) or  nerve fibre length density (NFLD) assessment were performed, respectively, on the distal leg and oral mucosa. As expected, all patients had altered somatosensory sensitivity and lower IENFD in the lower limb. DPN patients presented higher I₀, I_P, RMS and AUC values (p < 0.050), lower warm detection thresholds (WDT) (p = 0.004), higher occurrence of paradoxical heat sensation (PHS) (p = 0.040), and a lower intraoral NFLD (p = 0.048) than the healthy participants. In addition, the presence of any abnormal intraoral somatosensory finding was more frequent in the DPN patients when compared to the reference group (p = 0.013). Early signs of trigeminal nociceptive facilitation, intraoral somatosensory abnormalities and loss of intraoral neuronal tissue can be detected in DPN patients.

Evaluating All Potential Oral Complications of Diabetes Mellitus

Diabetes mellitus (DM) is associated with several microvascular and macrovascular complications, such as retinopathy, nephropathy, neuropathy, and cardiovascular diseases. The pathogenesis of these complications is complex, and involves metabolic and hemodynamic disturbances, including hyperglycemia, insulin resistance, dyslipidemia, hypertension, and immune dysfunction. These disturbances initiate several damaging processes, such as increased reactive oxygen species (ROS) production, inflammation, and ischemia. These processes mainly exert their damaging effect on endothelial and nerve cells, hence the susceptibility of densely vascularized and innervated sites, such as the eyes, kidneys, and nerves. Since the oral cavity is also highly vascularized and innervated, oral complications can be expected as well. The relationship between DM and oral diseases has received considerable attention in the past few decades. However, most studies only focus on periodontitis, and still approach DM from the limited perspective of elevated blood glucose levels only. In this review, we will assess other potential oral complications as well, including: dental caries, dry mouth, oral mucosal lesions, oral cancer, taste disturbances, temporomandibular disorders, burning mouth syndrome, apical periodontitis, and peri-implant diseases. Each oral complication will be briefly introduced, followed by an assessment of the literature studying epidemiological associations with DM. We will also elaborate on pathogenic mechanisms that might explain associations between DM and oral complications. To do so, we aim to expand our perspective of DM by not only considering elevated blood glucose levels, but also including literature about the other important pathogenic mechanisms, such as insulin resistance, dyslipidemia, hypertension, and immune dysfunction.

Yellow Tongue Coating is Associated With Diabetes Mellitus Among Japanese Non-smoking Men and Women: The Toon Health Study

BACKGROUND

Yellow tongue coating is one of the clinical signs for diabetes mellitus according to traditional East Asian medicine. Few reports have been available on the association between yellow tongue coating and the prevalence of type 2 diabetes in the general population. We examined that association among population samples of non-smoking men and women.

METHODS

The study subjects were Japanese non-smoking men (n = 315) and women (n = 654) aged 30-79 years who resided in Toon city and participated in the Toon Health Study from July 2011 through November 2014. Tongue coating was assessed by a nationally licensed acupuncturist and classified into three categories of white (normal), light yellow, and yellow. We performed an oral glucose tolerance test to confirm the presence of diabetes mellitus and prediabetes. The associations between yellow tongue coating and the prevalence of diabetes mellitus and prediabetes were examined using multivariable logistic regression analyses, adjusting for age, sex, body mass index, drinking status, and physical activity.

RESULTS

The multivariable odds ratios of diabetes mellitus were 1.39 (95% confidence interval [CI], 0.72-2.67) for light yellow tongue coating and 2.23 (95% CI, 1.16-4.30) for yellow tongue coating compared with white tongue coating. The respective multivariable odds ratios of prediabetes were 1.13 (95% CI, 0.80-1.61) and 1.43 (95% CI, 0.96-2.12).

CONCLUSIONS

Yellow tongue coating was associated with higher prevalence of diabetes mellitus and tended to be associated with that of prediabetes among Japanese non-smoking men and women.

Salivary flow and xerostomia in patients with type 2 diabetes

BACKGROUND

Saliva is secreted by the major and minor salivary glands. There are a number of physiological factors that can reduce this secretion such as age, sex, body weight, number of teeth present in the mouth or time of day. This decrease may also be caused by the use of certain drugs, radiotherapy for head and neck cancer, chronic rheumatic diseases such as Sjögren's syndrome and other systemic disorders such as diabetes mellitus (DM). Objective of this study was to investigate the effect of type 2 DM on salivary secretion and its relation to the sensation of xerostomia.

METHODS

Forty-seven patients with type 2 DM and 46 healthy individuals, aged 40-80, participated in the study. Samples of saliva were collected, at rest and after stimulation, at baseline and after the administration of a meal. A questionnaire of 10 items was used to define the patients' sensations of xerostomia. For statistical analysis, the Mann-Whitney test was used to assess the difference in salivary flow between the two groups and the relationship between the response to each of the questions and salivary flow levels. The degree of the patients' sensation of xerostomia was analysed by the Fisher test.

RESULTS AND CONCLUSIONS

There was a significant decrease in total saliva levels at rest in patients with type 2 DM compared to the control group. The study group also experienced higher levels of dryness at night and on waking as well as a greater sensation of lingual burning compared to the control group.

Assessment of Temporomandibular Joint Dysfunction in Patients with Stroke

GOAL

The aim of this study was to assess temporomandibular joint dysfunction in patients with stroke.

MATERIALS AND METHODS

Total of 100 participants, 50 healthy and 50 who had stroke, were recruited into this study. Digital caliper and algometer were used to assess temporomandibular joint range of motion and masticatory muscle pressure pain threshold. Labial commissure angle measurement was used for the assessment of facial paralysis severity. Fonseca questionnaire was used for temporomandibular joint dysfunction assessment and categorization. In addition, dominant mastication shift was measured by the question that asks the pre and poststroke dominant mastication side.

FINDINGS

In intergroup comparison, significant decrease was found in all temporomandibular range of motion parameters in favor of stroke group (P < .05). Despite the fact that no significant difference was found between groups for the pain threshold in masticatory muscles except for middle part of the left temporalis muscle, values were higher in healthy group (P > .05). As a result of intergroup examination of labial commissure angle degree, Fonseca questionnaire score, it was found that labial commissure angle and Fonseca questionnaire scores were higher in stroke group (P < .05). Intragroup examination of patients with stroke showed that dominant mastication side shift was seen in patients with stroke (P < .05).

CONCLUSION

It was concluded that, temporomandibular joint dysfunction prevalence was higher in stroke group compared with healthy group and use of modalities specific to temporomandibular joint dysfunction treatment would be beneficial.

Oral Alterations in Diabetes Mellitus

Diabetes mellitus is one of the most common chronic diseases which continue to increase in number and significance. It presents the third most prevalent condition among medically compromised patients referring for dental treatment. Diabetes mellitus has been defined as a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Hyperglycemia leads to widespread multisystem damage which has an effect on oral tissue. The present article summarizes current knowledge regarding the association between diabetes mellitus and oral and dental health.

Salivary flow and xerostomia in older patients with type 2 diabetes mellitus

OBJECTIVES

To assess salivary flow in older patients with type 2 diabetes mellitus (DM2) and its association with xerostomia.

METHODS

Cross-sectional clinical study conducted with older patients diagnosed with type 2 diabetes for at least one year receiving treatment at the Integrated Center for Diabetes and Hypertension of Ceará (CIHD) in the city of Fortaleza, Ceará, Northeastern Brazil. Oral clinical examination was carried out to assess the decayed, missing and filled teeth index (DMFT). Perception of the presence of xerostomia/dry mouth was assessed using the Visual Analogue Scale. Stimulated salivary flow was measured and samples were obtained using an extra-soft silicone device.

RESULTS

120 older patients with diabetes (60 insulin-dependent and 60 non-insulin-dependent) aged 65-91 years, with a mean age of 72.26 ± 6.53 years, were assessed. Of these, 111 (92.5%) presented a decrease in salivary flow while 59 (49.2%) reported moderate to severe xerostomia/dry mouth. The DMFT Index presented a mean of 27.53 ± 4.86 teeth.

CONCLUSIONS

Reduced salivary flow was found in the group assessed in the present research; however, this finding is not in accordance with the perception of xerostomia/dry mouth reported by the patients.

Measurement reliability of current perception threshold and pain threshold in parallel with blood sampling

The irritation and pain associated with oral blood sampling necessary to monitor glycemic control can alter oral sensation, but no studies have measured the reliability of oral sensation testing when performed concurrently with blood sampling. The primary and secondary aims of this study were to verify the measurement reliability of current perception threshold (CPT) and pain threshold (PT) tests performed before and after blood sampling and to investigate the differences in CPTs/PTs obtained from the oral cavity, hand, and foot, respectively. CPT/PT measurements were obtained from the oral mucosa and the tips of fingers and toes of 18 volunteers (10 males and 8 females, average age = 26.3 years) using electrical stimulation at frequencies of 5, 250, and 2,000 Hz. Participants also provided blood samples by pricking their own index fingers with a small needle. All subjects completed the following 3 conditions at once-weekly intervals as follows: (a) sensory measurements followed by blood sampling (SB block); (b) blood sampling followed by sensory measurements (BS block); (c) sensory measurements without blood sampling (CO control block). Cronbach's α coefficients were over 0.78 for the SB, BS, and CO blocks, and are considered to be acceptable for assuring measurement reliability. The oral cavity had significantly lower CPT/PTs than both hands and feet, such that the threshold increased in the order oral cavity < hand < foot. CPT and PT measurements performed concurrently with blood sampling are both reliable and region specific, and for which the oral cavity is the most sensitive testing region.

Oral Symptoms and Mucosal Lesions in Patients with Diabetes Mellitus Type 2

Background: Good glycoregulation at patients with diabetes mellitus is essential for prevention of many complications, including those in oral cavity. Results of numerous studies indicate that xerostomia and neurosensory oral disorders are present in type 2 diabetics. A review of the literature shows contradictory results about prevalence of oral mucosal lesions in diabetics. The aim of this study was to evaluate the presence of xerostomia, neurosensory disorders and mucosal lesions in oral cavity of type 2 diabetics.

Material and Methods: This study involved 90 adults, 60 with type 2 diabetes and 30 healthy subjects, aged 45-65 years. With regard to value of HbA1c level diabetics were divided into two groups: 30 subjects with satisfactory glycoregulation (HbA1c<9%) and 30 subjects with poor glycoregulation (HbA1c≥9%). All patients recruited into the study completed a questionnaire that included their demographic, medical and oral health data. Clinical examination of the oral mucosa was performed by a single examiner.

Results: In relation to the presence of xerostomia and dysgeusia between satisfactory controlled diabetics and healthy subjects a significant difference was observed (p<0.05). Compared with healthy subjects, poor controlled diabetics had significantly higher presence of xerostomia (p<0.001) and neurosensory disoders (p<0.05). A higher prevalence of oral mucosal lesions was found in poor controlled diabetics, but significant difference between groups was not observed (p>0.05). A significant positive correlation was revealed between smoking and glossodynia as well as smoking and glossopyrosis (p>0.05).

Conclusion: Glycemic control level seems to influence the susceptibility of type 2 diabetics to xerostomia and neurosensory disorders. Less clear is whether diabetes are corellated to oral mucosal lesions.

Prevalence of Oral Mucosal Disorders in Diabetes Mellitus Patients Compared with a Control Group

Chronic hyperglycemia is associated with impaired wound healing and higher susceptibility to infections. It is unclear whether patients with diabetes mellitus (DM) present more oral mucosal disorders compared to control groups. The objectives were to compare (a) the prevalence rates of oral mucosal disorders in the DM and non-DM population and (b) the prevalence rates of specific disorders in the DM and non-DM population. Full-text articles were included if they met the following inclusion criteria: (a) they must be original articles from scientific journals, (b) they must be only cross-sectional studies in English, (c) the prevalence of oral mucosal disorders in DM patients must be evaluated, (d) results must be compared with a healthy control group, and (e) oral mucosal disorders must be specified in DM and non-DM group. All studies showed higher prevalence of oral mucosal disorders in DM patients in relation to non-DM population: 45-88% in type 2 DM patients compared to 38.3-45% in non-DM groups and 44.7% in type 1 DM patients compared to 25% in non-DM population. Tongue alterations and denture stomatitis were the most frequent significant disorders observed. The quality assessment following the Joanna Briggs Institute (JBI) Prevalence Critical Appraisal Tool showed the low quality of the existing studies.

Is there a relationship between oral health and diabetic neuropathy?

Diabetic neuropathy is the most common microvascular complication of diabetes mellitus with high morbidity and mortality, and low quality of life. It has a broad spectrum of clinical forms, although distal symmetrical polyneuropathy is the most prevalent. Several oral complications including burning mouth syndrome, dry mouth, and impairment of the senses taste and smell are less-known manifestations of diabetic neuropathy and often overlooked. Periodontitis, tooth loss, and temporomandibular joint dysfunction may be also present in these patients and are equally debilitating. Periodontitis was declared the sixth complication of diabetes in 1993 and may contribute to poor glucose control. Hence, periodontitis and diabetes mutually and adversely affect each other. This review summarizes the available body of scientific literature that discusses oral manifestations in patients with diabetic neuropathy and identifies important areas where more research is needed.

Comparison of pulpal anesthesia and cardiovascular parameters with lidocaine with epinephrine and lidocaine with clonidine after maxillary infiltration in type 2 diabetic volunteers

OBJECTIVES

The pulpal anesthetic and cardiovascular parameters obtained by 2 % lidocaine with epinephrine (LE; 1:80,000) or clonidine (LC; 15 mcg/ml) were studied in diabetes mellitus (DM) type 2 and healthy volunteers (72), after maxillary infiltration anesthesia.

MATERIALS AND METHODS

Onset and duration of pulpal anesthesia were measured by electric pulp tester; vasoconstrictive effect of used local anesthetic mixtures by laser Doppler flowmetry (LDF) through pulpal blood flow (PBF); systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were registered by electrocardiogram monitoring.

RESULTS

Onset of pulpal anesthesia was shorter for LC than for LE in healthy, while it was not different in diabetic participants; duration of pulpal anesthesia was significantly longer in type 2 diabetic participants, regardless of used anesthetic mixture. Significant reduction of PBF with LE was observed during 45 min in healthy and 60 min in diabetic participants, while with LC such reduction was observed during 45 min in both groups. LE caused a significant increase of SBP in the 5th and 15th minutes in diabetic versus healthy participants, while LC decreased SBP from the 10th to 60th minutes in healthy versus diabetic participants.

CONCLUSIONS

DM type 2 influences duration of maxillary infiltration anesthesia obtained with LE and LC, and systolic blood pressure during LE anesthesia.

CLINICAL RELEVANCE

The obtained results provide elements for future protocols concerning intraoral local anesthesia in DM type 2 patients.

Thermal burn of palate in an elderly diabetic patient

BACKGROUND

Burns of the oral mucosa may be caused by thermal, mechanical, chemical, electrical or radiation injury. Clinically, these burns can produce localised or diffuse areas of tissue damage depending on the severity and extent of the insult. Most oral thermal burns produce erosions or ulcers on the palate or tongue.

MATERIALS AND METHODS

A case of palatal burn in a 66-year-old diabetic patient caused by drinking hot cereal is presented. The role of diabetes in causing oral mucosal dysesthesia that predisposed the occurrence of this burn is also discussed.

CONCLUSION

Insensate palatal burn as a rare complication of diabetes mellitus is reported here. With the disease being more widespread now, its potential oral complications will be seen with increasing frequency.

Dietary behaviors and oral-systemic health in women

The impact of dietary behaviors and food consumption and their relation to oral health are significant public health issues. Women and men exhibit different dietary behaviors. Understanding the influences of dietary behaviors on oral health from the perspective of gender disparities, however, is limited. This article provides the intersections of dietary factors and oral-systemic health for which women are at greater risk than men. Topics include the effect of dietary choices on oral health disparities seen in female patients. Interventional strategies at the local and community level that are designed to influence the balance between dietary habits and oral-systemic health are discussed.

Diabetes mellitus and oral mucosa alterations: prevalence and risk factors

AIMS

To investigate the prevalence of oral mucosa alterations in patients with type 2 diabetes and to identify possible risk factors related to oral mucosa alterations.

METHODS

146 patients with type 2 diabetes and 111 age- and gender-matched healthy controls subjects were consecutively recruited from Araraquara School of Dentistry to answer a structured questionnaire designed to collect demographic data as well as current and former history of diabetes. Clinical examination of the oral mucosa was carried out by a stomatologist.

RESULTS

A higher prevalence of oral mucosa alterations was found in patients with diabetes than in patients without diabetes (p<0.001), with significant difference to development conditions (p<0.0001), potentially malignant disorders (p<0.0001) and fungal infections (p<0.05). In the multiple logistic regression, diabetes (odds ratio 9.9 IC 5.11-19.16) and smoking habit (odds ratio 3.17 IC 1.42-7.12) increased the odds of oral mucosa alterations significantly.

CONCLUSIONS

Patients with diabetes mellitus not only showed an increased prevalence of oral mucosa alterations but also a significant percentage of potentially malignant disorders. These findings elucidate the necessity of regular clinical examination to ensure early diagnosis and prompt management of oral mucosa lesions in patients with diabetes.

Periodontal disease and risk for neuropathic foot ulceration in type 2 diabetes

AIMS

Diabetic neuropathy (DN) has been associated with oral dryness, tooth loss and an increased risk for foot ulceration, but the association between periodontal problems and DN has not been fully elucidated. This study investigated whether the risk for neuropathic foot ulceration (DM-NFUR) was associated with periodontal disease (PD) in patients with type 2 diabetes mellitus.

METHODS

This cross-sectional study examined 122 patients with type 2 diabetes for PD; findings were compared with results for presence of DM-NFUR. PD severity was classified as none/mild (NM-PD), moderate/severe (MS-PD) and edentulous (E).

RESULTS

NM-PD was found in 40.2% patients; MS-PD, in 32.0%; and 27.8% were edentulous. DM-NFUR was detected in 18.4% of the patients in the NM-PD group, in 68.2% in the MS-PD group, and in 61.8% of completely edentulous individuals. PD was significantly correlated with DM-NFUR (p<or=0.001). After adjustment for sex, age, diabetes duration, dental health care and education, PD and edentulism were independently associated with DM-NFUR (odds ratio(adjusted); 6.6; 95% CI 2.3-18.8; p<or=0.001, and odds ratio(adjusted) 4.9; 95% CI 1.6-15.3; p<or=0.01).

CONCLUSIONS

Patients with DM-NFUR have substantially more MS-PD and edentulism. Further studies should evaluate whether diabetic neuropathy is a risk factor for PD.

Candida-associated denture stomatitis in type 2 diabetes mellitus

OBJECTIVE

To describe the clinical appearance of Candida-associated denture stomatitis (DS) in subjects with type 2 diabetes (T2DM). The relationships between the types of DS, oral complaints and associated conditions were assessed in terms of glycemic control as determined by glycated hemoglobin (HbA1c) measurements.

MATERIALS AND METHODS

Demographic and clinical data were obtained from questionnaires and oral examinations of 110 edentulous patients with T2DM and 50 control subjects.

RESULTS

Type II DS commonly occurred in diabetics (57.3% vs 30%; p=0.002) together with DS related oral complaints (60.9% vs 24%; p<0.001) compared with controls. Burning sensation of the mouth (BS) was the most common complaint. Dryness of the oral mucosa (DOM) (50.9% vs 6%; p<0.001), angular cheilitis (26.4% vs 8%; p=0.01) and glossitis (27.3% vs 6%; p=0.003) occurred more frequently in diabetics. Oral complaints and associated conditions of DS coincided with elevated HbA1c levels (p<0.001). Diabetics with extensive type of inflammation had higher HbA1c levels than type I/III DS subjects (p<0.001).

CONCLUSIONS

Diffuse type of inflammation was associated with T2DM. BS and DOM were the most common oral complaints. Inadequately controlled diabetes with Candida-associated DS was linked to a high incidence of an extensive type of inflammation, oral complaints and associated conditions.

Oral mucosal lesions in non oral habit diabetic patients and association of diabetes mellitus with oral precancerous lesions

AIMS

This study was aimed to determine the prevalence of oral mucosal lesions (OML) in patients with diabetes mellitus (DM) and non-diabetic subjects without any oral habits and to investigate the association of DM with oral precancerous lesions.

METHODS

This cross-sectional study involved 420 diabetic and 420 non-diabetic control subjects without any oral habits. Detailed oral examination was performed based on international criteria.

RESULTS

A significantly greater proportion of subjects with DM (45%) had one or more OML in comparison to non-diabetics (38.3%). Patients with DM showed a significantly greater prevalence of geographic tongue, denture stomatitis and angular cheilitis than non-diabetics (p<0.05). The results also showed an association between occurrence of one or more OML and metabolic control of diabetic patients (p<0.05). For precancerous lesions, lichen planus was found in two diabetic patients while none of controls had any precancerous lesion (p>0.05).

CONCLUSIONS

Prevalence of OML was significantly higher in diabetic patients than non-diabetics and this prevalence was associated with the metabolic control of the patients. However, no association was observed between DM and oral precancerous lesions.

Morphological changes of gingiva in streptozotocin diabetic rats

Gingivitis and periodontitis are chronic bacterial diseases of the underlying and surrounding tooth tissues. Diabetes mellitus is responsible for tooth deprivation both by decay and periodontal disease. The streptozotocin-induced diabetes results in a diabetic status in experimental animals similar to that observed in diabetes patients. The aim of the study was to investigate the relationship between the gingival lesions and the microangiopathy changes in streptozotocin-induced diabetes mellitus. Forty male Wistar rats were divided into two groups (control and experimental). Diabetes mellitus was induced by 45 mg/kg IV streptozotocin. The histological investigation of the marginal gingival and the relevant gingival papilla showed inflammation of the lamina propria and the squamous epithelium as well as marked thickness of the arteriole in the diabetic group, but no changes were observed in the control group. The results suggested a probable application of a routine gingival histological investigation in diabetic patients in order to control the progress of disease complications. It may be concluded that histological gingival investigation can be used as a routine assay for the control of the diabetic disease and prevention of its complications.

Burning mouth syndrome and peripheral neuropathy in patients with type 1 diabetes mellitus

OBJECTIVE

Burning mouth syndrome (BMS) has been attributed secondarily to diabetes, poor glycemic control, and diabetic neuropathy. The prevalence and predictor factors of BMS were compared in type 1 diabetes mellitus (T1DM) and nondiabetic subjects.

STUDY DESIGN

An assessment of 371 adult T1DM subjects and 261 control subjects participating in a cross-sectional epidemiological study of oral health complications of diabetes was performed. Subjects were participants of the Pittsburgh Epidemiology of Diabetes Complications study. Prevalence of BMS was determined by response to the following questions: "Do you now or in the last month had any persistent uncomfortable sensations in your mouth or tongue? If yes, would you describe the feeling as tingling, burning, sore, numb, or other?"

RESULTS

Burning mouth syndrome symptoms were reported by 28 T1DM and control subjects (4.6%). Eleven had oral pathologies that might explain the BMS, including atrophy of the tongue papillae, fissured tongue, denture stomatitis, and candidiasis. The prevalence of BMS within the two groups with no pathologies was similar; 12/371 (3.2%) vs. 5/233 (2.1%). Multivariate analyses of the 12 T1DM subjects with BMS found significant associations for female gender (P=.042) and a diagnosis of diabetic peripheral neuropathy (P=.024).

CONCLUSIONS

In this T1DM population, BMS or related discomforts occurred slightly more frequently than in the control group. Symptomatic T1DM subjects were more likely to be female who had also developed peripheral neuropathy. These findings and other similarities between BMS and diabetic peripheral neuropathy suggest that a neuropathic process may be an underlying source of BMS in some patients who have no apparent oral abnormality.

Improving cross-cultural awareness. A review of Australian indigenous health for UK dentists

OBJECTIVE

The aim of this paper is to give an insight into the unique health issues faced by the indigenous population of Australia and their direct relationship to oral health, to help overseas dentists wishing to work in Australia to treat these groups of patients successfully and effectively. This applies equally to indigenous Australians living in remote Australia as well as to those living in general suburbia.

DATA SOURCES

A Medline search was carried out for any articles in dental and medical journals pertaining to Australian indigenous health and Australian oral health.

DATA SELECTION

Wherever possible, articles cited were obtained in full and where this was not possible, abstracts were obtained. Where no abstract was available, the article was not considered for evaluation.

DATA EXTRACTION

Articles were reviewed by a single observer and were subject to meeting inclusion criteria indicated in the review.

DATA SYNTHESIS

Articles were divided into historical, diet, oral health and general health categories. Subjective descriptions were then made.

CONCLUSIONS

The adoption of a 'westernised' diet by the Australian indigenous community has placed them as a high risk population for dental caries and periodontal disease. They also show some of the highest rates in the world for Non-Insulin Dependent Diabetes Mellitus (NIDDM) and Rheumatic Fever. The UK dentist should be aware of these health issues and their relationship to indigenous oral health before embarking on work within Australia.

In vitro antifungal susceptibility to six antifungal agents of 229 Candida isolates from patients with diabetes mellitus

The most common antifungal drugs in current clinical use for the treatment of oral candidosis are polyenes and azoles, mainly used topically. Poor glycaemic control in association with other local factors, such as the presence of oral dental prostheses, salivary pH, salivary flow rate and tobacco habits, may lead to the development of oral candidosis. Topical antifungal agents are frequently used to prevent the development of candidal infections in patients with poor metabolic control, particularly in the elderly wearing dentures. The aim of this study was to assess the antifungal susceptibility of Candida isolates to six antifungal agents using a commercially available kit, Fungitest. The isolated were collected from patients affected by diabetes mellitus from two different geographic localities (London, UK, and Parma, Italy) and from a group of healthy non-diabetic subjects. No differences in antifungal susceptibility to the six agents tested were observed between Candida isolates from diabetic and non-diabetic subjects. However, differences were observed between the two geographically different diabetes mellitus populations. Oral yeast isolates from diabetes mellitus patients in the UK more often displayed resistance or intermediate resistance to fluconazole (P=0.02), miconazole (P<0.0001), and ketoconazole (P=0.01) than did isolates from diabetes mellitus patients in Italy. In addition, more C. albicans isolates were found in diabetic and non-diabetic subjects that were susceptible to fluconazole (P=0.0008 and P=0.01, respectively) than non-albicans isolates. The difference in the antifungal resistance of isolates from the two populations of diabetes mellitus patients may be related to differences in the therapeutic management of candidal infections between the two centres.