Oral manifestations of previously undiagnosed non-insulin dependent diabetes mellitus

An updated review on pathophysiology and management of burning mouth syndrome with endocrinological, psychological and neuropathic perspectives

Burning mouth syndrome (BMS) is a chronic oro-facial pain disorder of unknown cause. It is more common in peri- and post-menopausal women, and sex hormone dysregulation is believed to be an important causative factor. Psychosocial events often trigger or exacerbate symptoms, and persons with BMS appear to be predisposed towards anxiety and depression. Atrophy of small nerve fibres in the tongue epithelium has been reported, and potential neuropathic mechanisms for BMS are now widely investigated. Historically, BMS was thought to comprise endocrinological, psychosocial and neuropathic components. Neuroprotective steroids and glial cell line-derived neurotrophic factor family ligands may have pivotal roles in the peripheral mechanisms associated with atrophy of small nerve fibres. Denervation of chorda tympani nerve fibres that innervate fungiform buds leads to alternative trigeminal innervation, which results in dysgeusia and burning pain when eating hot foods. With regard to the central mechanism of BMS, depletion of neuroprotective steroids alters the brain network-related mood and pain modulation. Peripheral mechanistic studies support the use of topical clonazepam and capsaicin for the management of BMS, and some evidence supports the use of cognitive behavioural therapy. Hormone replacement therapy may address the causes of BMS, although adverse effects prevent its use as a first-line treatment. Selective serotonin reuptake inhibitors (SSRIs) and serotonin and noradrenaline reuptake inhibitors (SNRIs) may have important benefits, and well-designed controlled studies are expected. Other treatment options to be investigated include brain stimulation and TSPO (translocator protein 18 kDa) ligands.

A Study of Diabetes Associated Oral Manifestations

Aim:

The aim of this work was to determine the frequency of oral changes in diabetic patients and to study the relationship between periodontal disease and diabetes mellitus.

Materials and Methods:

The study sample consisted of 440 known diabetic patients between the age group of 20–80 years, of which 212 were males and 228 were females. One hundred and six patients were below 40 years, 138 patients between 41 and 50 years, 97 in 51–60 years, and 99 above 60 years of age. Data were statistically analyzed by Student's t-test.

Results:

Nearly 57% of the patients showed a Russell's Periodontal Index score of 2–4.9, which suggested an established periodontal disease. Risk factors for the people above the age of 40 years to develop diabetes were 76%.

Conclusion:

The frequency of oral manifestations in diabetic patients was significantly high, hence showing a relationship of gingival and periodontal diseases with diabetes mellitus.

A comparative study of glutamate oxaloacetate transaminase (GOT) and glutamate pyruvate transaminase (GPT) levels in the saliva of diabetic and normal patients

Diabetes has been reported to affect salivary glands adversely in humans and experimental models. Glutamate oxaloacetate transaminase (GOT), glutamate pyruvate transaminase (GPT) and lactate dehydrogenase (LDH) are salivary enzymes that also are widely distributed in animal tissues. We determined GOT and GPT levels in saliva samples of 100 type 1 and 30 type 2 diabetic patients using reflectance spectrophotometry and compared them to 30 age and sex matched healthy controls. Statistically significant differences were observed in the mean values of GOT and GPT in type 1 diabetics compared to type 2 and control groups. Significantly higher GOT levels were found in the 1-20 year age group of type 1 diabetics. Our findings suggest that salivary gland damage is due to the same immunological attack that affects pancreatic β cells and results in type 1 diabetes.

Type 2 diabetes and edentulism as chronic co-morbid factors affecting Indian elderly: an overview

In past 50 years, type 2 diabetes has emerged as one of the major public health problem. India leads the world with the largest number of diabetic patients and has a huge elderly population. The present article discusses the effect of diabetes and edentulism on the overall general health of elderly. The prevalence of type 2 diabetes and edentulism in Indian elderly and their inter-relationship has been discussed. Dentists must provide optimum oral care with special attention towards comprehensive periodontal management and oral hygiene awareness among diabetics to prevent tooth loss. Dental and medical professionals can improve patient management of the oral and overall effects of diabetes by implementing various awareness programs; organizing camps; distributing informative pamphlets and dietary counseling. Dentists can detect undiagnosed cases of diabetes and refer patients to physicians for further evaluation and management.

Burning Mouth Syndrome

The aetiology of BMS remains an enigma, however novel evidence suggests a neuropathic basis, which may explain concomitant vulvodynia in some patients.The constant high level spontaneous chronic pain in BMS has significant functional and psychological repercussions for these patients.Cognitive behavioural therapy remains the sole evidence based management of this condition, whilst some patients respond to treatment with Tricyclic antidepressants, SSRIs or SNRIs, compliance with medication remains an issue due to pharma side effects.Increasing evidence suggests that there may be 3 subgroups that should be managed differently.

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.

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.

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.

High prevalence of glucose metabolism disturbance in patients with lichen planus

AIM

To establish the prevalence of diabetes mellitus (DM) and insulin resistance in patients with lichen planus (LP), and to examine whether diabetic status showed any relation with the type of LP.

PATIENTS AND METHODS

Thirty patients with LP and 30 age, weight, and sex matched volunteers were included. Serum fasting glucose, insulin, hemoglobin A1c levels were determined, a standard oral glucose tolerance test (OGTT) was performed.

RESULTS

Of patients with LP, eight (26.7%) had DM (four newly diagnosed), however, only one (3.33%) diagnosed as DM in control group (p=0.007). Six patients (20.0%) with LP and four healthy persons (13.3%) had IGT (p>0.05). Glucose metabolism disturbance (DM+IGT) was detected in 14 (46.7%) of the patients and in 5 (16.7%) of the controls (p=0.026). HbA1c, fasting serum glucose, and insulin resistance (HOMA) were statistically higher in patients compared to controls.

CONCLUSION

Our finding documented that approximately one half of the patients with LP had glucose metabolism disturbance, and one fourth had DM. We believe that further studies are needed to explain this close relationship between DM and LP.

Burning Mouth Syndrome: Will Better Understanding Yield Better Management?

"Burning mouth syndrome" (BMS) refers to a chronic orofacial pain disorder usually unaccompanied by mucosal lesions or other clinical signs of organic disease. BMS is typically characterized by a continuous, spontaneous, and often intense burning sensation as if the mouth or tongue were scalded or on fire. Burning mouth syndrome is a relatively common condition. The estimated prevalence of BMS reported in recent studies ranges between 0.7 and 4.6% of the general population. About 1.3 million American adults, mostly women in the postmenopausal period, are afflicted with BMS. The etiology of this disorder is poorly understood even though new evidence for a possible neuropathic pathogenesis of idiopathic BMS is emerging. Burning mouth syndrome may present as an idiopathic condition (primary BMS type) distinct from the symptom of oral burning that can potentially arise from various local or systemic abnormalities (secondary BMS type), including nutritional deficiencies, hormonal changes associated with menopause, local oral infections, denture-related lesions, xerostomia, hypersensitivity reactions, medications, and systemic diseases including diabetes mellitus. In more than a third of patients, multiple, concurrent causes of BMS may be identified. It is important to note that the diagnosis of BMS should be established only after all other possible causes have been ruled out. Professional delay in diagnosing, referring, and appropriately managing of BMS patients occurs frequently. Treatment should be tailored to each patient and it is recommended to practice the treatment in a multidisciplinary facility. This article discusses our current understanding of the etiology and pathogenesis of BMS. The authors have tried to emphasize new pharmacological approaches to manage this challenging disorder.

Management of burning mouth syndrome: systematic review and management recommendations

Primary burning mouth syndrome (BMS) is a chronic, idiopathic intraoral mucosal pain condition that is not accompanied by clinical lesions or systemic disease. There is some uncertainty whether this condition should be referred to as a disease, a disorder, or a syndrome but there are insufficient data to justify any change in taxonomy at present. BMS occurs most often among women and is often accompanied by xerostomia and taste disturbances. More recently a neuropathological basis has been proposed so that BMS may be regarded as an oral dysesthesia or painful neuropathy. However, our incomplete understanding of the epidemiology, etiology, pathophysiology, and lack of diagnostic criteria are barriers to critical investigation and selection of effective treatments. There is only limited evidence to guide clinicians in the management of patients with BMS. Treatable secondary causes should be investigated before diagnosing primary BMS. Topical clonazepam and cognitive therapy have been proven efficacious in some patients. Emerging evidence supports the effectiveness of the antioxidant, alpha lipoic acid, with further studies of this agent being warranted. Additional research into mechanisms, diagnostic criteria, and randomized controlled interventional studies are needed.

Personality analysis of patients complaining of sialorrhoea

BACKGROUND

Sialorrhoea, the symptom of apparent excessive secretion of saliva is a relatively uncommon complaint. Some authors consider that in the absence of clinical findings, then these patients have a psychiatric disorder masquerading as a physical illness. However, there is little evidence in the literature to support this conclusion and a detailed psychological assessment of this population has not previously been reported.

METHODS

In total, 18 patients and 18 age- and sex-matched controls were studied. All had a history of a complaint of excess salivation in the absence of any oral mucosal or systemic abnormality. All patients completed an Eysenck Personality Questionnaire.

RESULTS

There were no differences in the extroversion of psychoticism scores between the study and control group. However, the result showed significant increases in the neuroticism and Lie Scale score in the patient group.

CONCLUSIONS

The overall results of this study indicate that the complaint of sialorrhoea in otherwise healthy individuals does not have an organic basis and suggest that sialorrhoea is associated with high levels of neuroticism and a tendency to dissimulate.

Nocturia and the burning mouth syndrome (BMS) in the elderly

The aim of this study was to assess the relationship between BMS and nocturnal micturition in a group of elderly men and women. The study comprised 6103 elderly men and women recruited from a group of pensioners by means of a questionnaire (n=10,216; response rate 61.3%). The mean (+/-S.D.) ages of the men and women were 73.0+/-6.0 years and 72.6+/-6.7 years, respectively. The questionnaire included questions on their health, diseases and symptoms, drugs, sleep habits and the number of nocturnal voiding episodes. BMS was reported by 2.4% of the men and 8.5% of the women (p<0.0001). The occurrence of BMS was unaffected by age in both sexes. In women, but not in men, there was a stepwise increase in BMS in parallel with increased nocturnal micturition. There was a strong relation between nocturnal thirst and drinking on the one hand, and reports on BMS on the other hand. BMS was also increased in diuretics users in both sexes. The results may indicate that negative fluid balance as a consequence of nocturnal polyuria is an overlooked pathogenetic mechanism in the genesis of BMS in the elderly.

Candidal overgrowth in diabetic patients: potential predisposing factors

This study was designed to investigate the potential factors that influence the prevalence of the oral carriage of Candida species in patients with type II diabetes mellitus. One hundred and twenty-eight diabetic patients (68 males and 60 females, mean age 54 +/- 7 years) were sequentially enrolled along with 84 (44 males and 40 females mean age 52 +/- 8 years) healthy subjects. Samples were obtained by swabbing the oral mucosa of all participants. Yeast isolates were identified by germ tube test, with API 32 ID system, and by chlamydospore production on 'cornmeal' Tween-80 agar. Candida spp. was recovered from the oral cavity of 64% of the diabetic group, in contrast to 40% of the control group. Candida albicans was the most frequently isolated species in both groups. Potential etiologic factors such as xerostomia, dentures, age, gender and diabetes on oral carriage of Candida spp. were evaluated. The oral carriage of Candida spp. was significantly higher in 'diabetic' patients compared with the healthy subjects but it seems that parameters such as xerostomia, dentures, age, gender and glycemic control cannot be directly associated with Candida growth in the oral cavity in the presence of diabetes.

Update on diabetes mellitus and related oral diseases

Diabetes mellitus (DM) is a group of complex multisystem metabolic disorders characterized by a relative or absolute insufficiency of insulin secretion and/or concomitant resistance to the metabolic action of insulin on target tissues. The chronic hyperglycaemia of diabetes is associated with long-term systemic dysfunction. The present article summarizes current knowledge of DM and details the oral and dental implications of this common endocrine disorder.

Diabetes and oral tumors in Hungary: epidemiological correlations

OBJECTIVE

Numerous publications have already demonstrated that diabetes is a risk factor for the development of periodontal diseases and various inflammatory lesions in the oral mucosa. A possible correlation between diabetes and oral premalignancies and tumors was examined in this study, as no literature data are available concerning this problem.

RESEARCH DESIGN AND METHODS

Stomato-oncological screening was carried out on 200 diabetic patients in the medical departments; the control group included 280 adult dentistry outpatients. The lesions found were classified into three groups: inflammatory lesions, benign tumors, and precancerous lesions. A retrospective diabetes screening of 610 inpatients with histologically confirmed oral malignancies was also performed. The control group comprised 574 complaint- and tumor-free adults. Fasting blood glucose levels were determined in both groups, and the tumor location was registered in the cancer patients.

RESULTS

Benign tumors were found in 14.5% and precancerous lesions in 8% of diabetic patients. In the control group these values were significantly lower, at 6.4 and 3.2%, respectively (P>0.01). Earlier Hungarian screening studies indicated similar frequency of these lesions in the general population. The proportion of oral cavity lesions was higher among diabetic patients compared with that of the control patients. In the oral cancer patient group, diabetes was present in 14.6% and an elevated blood glucose level in 9.7%. These values are significantly higher than those for the tumor-free control group (P<0.01). The gingival and labial tumor location was significantly more frequent among diabetic cancer patients than in the nondiabetic group (P<0.01). The combination of diabetes and smoking means a higher risk for oral precancerous lesions and malignancies.

CONCLUSIONS

Diabetes may be a risk factor for oral premalignancies and tumors.

[Mouth dryness and burning sensation of the oral mucosa: causes and possibilities for treatment]

Both sets of complaints, mouth dryness and a burning sensation of the oral mucosa, can have a variety of causes. Local and regional as well as systemic causes can be responsible for burning mouth syndrome. Diseases of the oral mucosa can have genetic, inflammatory, or neoplastic origins. Autoimmune diseases and allergies as well as different afflictions relating to internal medicine can be accompanied by a burning sensation in the oral mucosa. Neurological and psychiatric illnesses must be clarified during interdisciplinary diagnostics in order to identify idiopathic forms. The causes of mouth dryness are similarly complex. In addition to inadequate fluid intake, particularly in elderly patients, drug side effects or systemic diseases are frequently also responsible. Treatment is directed at the underlying disease; in ambiguous cases, symptomatic therapy can provide relief for medical complaints.

Candida-induced stomatopyrosis and its relation to diabetes mellitus

BACKGROUND

Glycaemic disorders and oral candidosis can be accompanied by burning mouth sensations. However, no clear relation between all three disorders is known.

METHODS

Seventy-two native Upper-Austrians with burning mouth sensations were examined and smears for Candida estimation were taken from the spots where the sensations were felt. All patients with previously unknown diabetes mellitus (DM) were subjected to an oral glucose tolerance test (OGTT). Use of glucocorticoid-containing anti-asthmatic sprays and the body mass index (BMI) were determined.

RESULTS

Of the examined non-inhalers of sprays, 52% had increased candidal density. A correlation between that increase and type 2 DM was found. The burning sensations in all patients with increased candidal density subsided completely after anti-mycotic therapy.

CONCLUSION

The perception of burning sensations was hypothesised to occur via stimulation of the capsaicin (vanilloid) receptor by Candida metabolites. The Candida-induced stomatopyrosis should be regarded as a single symptom indicating (predisposition to or established) type 2 DM in non-inhalers of the concerned population.

Oral health in the elderly with non-insulin-dependent diabetes mellitus

Non-insulin-dependent diabetes mellitus (NIDDM) is a common endocrine disease affecting the elderly in particular. Long-term complications involve the vasculature; vision, renal, and neural function; and the periodontium. Knowledge about the oral health of the elderly and the effects of NIDDM is limited. The objective of this study was to compare the oral health of patients aged 60+ years, who have NIDDM, with patients who do not have NIDDM. To evaluate oral health, we recorded retention and condition of the teeth, periodontal health, and condition of the oral mucosa. We also assessed oral hygiene, smoking history, regularity of dental checkups, and medication use. The study group was selected from among patients who came to the ambulatory care clinic at University of Medicine and Dentistry, New Jersey, Center for Aging with a diagnosis of NIDDM. The control group, which did not have NIDDM, was selected from among the same patient group and was matched for age and gender. Patients with severe dementia, those having fewer than 10 teeth or those who were in need of antibiotic prophylaxis were excluded from the study. Patients underwent a short interview and a clinical evaluation. Our study involved 32 elderly adults with NIDDM and 40 elderly adults who did not have NIDDM. Both groups had similar oral hygiene levels and regularity of professional dental care. In addition, the plasma glucose levels among the study group were well controlled. This study did not show statistically significant differences in oral health parameters between participants with diabetes and those in a control group.

Dental management considerations for the patient with diabetes mellitus

BACKGROUND

The prevalence of diabetes mellitus, or DM, in the United States is increasing steadily. The increasing longevity of the American population and more effective diagnostic protocols mean that the dental practitioner will be treating an increasing number of patients with the disease.

METHODS

The authors present relevant information about DM, including a recently revised nomenclature system, pathophysiology, complications, new diagnostic criteria, medical and dental management considerations, and associated oral conditions.

CONCLUSIONS

There are many important medical and dental management issues that dentists should consider when treating patients with DM.

CLINICAL IMPLICATIONS

The information presented in this report should help general dentists deliver optimum treatment to patients with DM.

Nosocomial Candida albicans acquisition in a geriatric unit: epidemiology and evidence for person-to-person transmission

This prospective study, which included 69 patients over a two-month period, was conducted to evaluate the incidence of community-acquired carriage and hospital-acquired yeasts in elderly patients hospitalized in a short stay care unit. Furthermore, possible person-to-person transmission was investigated by means of genotyping the Candida albicans isolates obtained from samples (throat swabs, urine and stools) systematically taken from the patients at different times during the hospitalization and from healthcare workers (throat swabs and handwashes) in the middle of the observation period. This study showed a high prevalence rate of 64% for community-acquired yeast carriage and a 40% incidence rate for hospital- acquired yeasts. Mycological analysis of the samples from the healthcare workers revealed eight of them to be colonized in the oral cavity. In addition, pulsed field gel electrophoresis and mitochondrial DNA analysis of the C. albicans isolates demonstrated person-to-person transmission. This study suggests that regular mycological sampling should be done as hospitalized elderly patients are frequently colonized by yeasts. Likewise, oropharyngeal swabs from healthcare workers may be helpful in this setting.

Type 2 diabetes and oral health: a comparison between diabetic and non-diabetic subjects

A controlled cross-sectional study with the aim of studying oral health in patients with type 2 diabetes was carried out in a health care district in Sweden. The study included 102 randomly sampled diabetic patients and 102 age- and gender-matched non-diabetic subjects from the same geographical area, treated at the same Public Dental Service clinics. Oral conditions were measured at clinical and X-ray examinations. Diabetes-related variables were extracted from medical records. Diabetic patients suffered from xerostomia (dry mouth) to a significantly higher degree than non-diabetic controls did (53.5 vs. 28.4%; P=0.0003). Sites with advanced periodontitis were more frequent in the diabetic group (P=0.006) as were initial caries lesions (P=0.02). Diabetic subjects showed a greater need of periodontal treatment (P=0.05), caries prevention (P=0.002) and prosthetic corrections (P=0.004). Diabetes duration or metabolic control of the disease was not related to periodontal status. However, patients with longer duration of diabetes had more manifest caries lesions (P=0.05) as had those on insulin treatment when compared with patients on oral/diet or combined treatment (P=0.0001). The conclusion is that individuals with type 2 diabetes in some oral conditions exhibited poorer health. Close collaboration between the patient, the primary health care and oral health professionals could be a way of improving the diabetic patient's general and oral health.

The prevalence of calcified carotid artery atheromas on the panoramic radiographs of patients with type 2 diabetes mellitus

OBJECTIVE

Type 2 diabetes mellitus, which afflicts 15 million Americans, is associated with accelerated cervical carotid artery atherosclerosis and a heightened risk of stroke. This study attempted to determine the prevalence of calcified atherosclerotic lesions in a group of patients with type 2 diabetes mellitus.

STUDY DESIGN

The panoramic radiographs of 49 men (age range, 55 to 81; mean age, 66.2 years) receiving routine dental treatment and insulin for diabetes at a Department of Affairs Veterans clinic were evaluated for calcified atheromas. Age-match controls, free of diabetes, were assessed in a like manner. Statistical comparison of the atheroma prevalence rates was by means of the Fisher exact test, and statistical comparison of atherogenic risk factors was by means of t test with Bonferroni adjustment and, where necessary, the Mann-Whitney U test.

RESULTS

The radiographs of the diabetics (mean age, 66.9 years) revealed that 20.4% had atheromas whereas those of the controls (mean age, 68.1 years) demonstrated that 4% had atheromas (a statistically significant difference; P =.0275). Also statistically significant was the prevalence of atherogenic risk factors (plasma glucose, low-density lipoproteins, and serum triglycerides) identified in the diabetic group. The radiographic appearance of the atheromas manifested by both groups of individuals, however, was similar, with the lesions located 1.5-2.5 cm inferior-posterior to angle of the mandible.

CONCLUSIONS

People with type 2 diabetes have a greater prevalence of calcified atheromas on their panoramic radiographs than do nondiabetics.

Oral candidal carriage and infection in insulin-treated diabetic patients

AIM

To evaluate candidal load and carriage of candidal species in 414 insulin-treated diabetes mellitus patients with and without clinical signs of infection. Host factors that could influence candidal load in diabetic patients with oral candidosis were also investigated.

METHODS

Candidal species were recovered from 414 insulin-treated diabetes mellitus patients attending two hospital diabetic clinics, using an oral rinse technique.

RESULTS

Seventy-seven per cent of diabetic patients carried Candida species in their oral cavity, with C. albicans being the species most frequently isolated. C. dubliniensis was found for the first time in this patient group. Forty per cent of patients colonized with candidal species had no clinical signs of oral candidosis. Where oral candidosis was present, erythematous candidosis was the most common clinical presentation. Candidal load was not associated with age, sex or glycaemic control. However, it was significantly increased in those patients who were tobacco smokers, and non-significantly increased in those patients who wore dentures, or who had clinical signs of oral candidosis.

CONCLUSION

The epidemiology of oral candidal carriage and infections in diabetic patients is complex and includes species which have not been previously reported in this group of patients. The development of oral candidosis in insulin-treated diabetes mellitus patients is not the result of a single entity, but rather, a combination of risk factors.

Salivary glands

This article discusses the anatomy, physiology, and pathology of the parotid, submandibular, and sublingual glands, which often are referred to as the major salivary glands. Overall, diseases of the salivary glands are relatively uncommon; however, as an organ system, they have the greatest diversity of pathology. Acute viral and bacterial inflammatory diseases are the most common salivary gland abnormalities; tumors are uncommon. The imaging approach to these lesions is discussed.

What the mouth has to say about diabetes. Careful examinations can avert serious complications

Periodontal disease is a major but preventable complication of diabetes mellitus. Patient education, good glycemic control, regular dental care, appropriate diet, and a team approach that involves physicians, dietitians, dentists, and other health professionals offer the best chance for optimum care for these patients. Other oral complications of diabetes include tooth decay, xerostomia, candidiasis, and oral peripheral neuropathy. The mouth may also reflect secondary causes of diabetes, and oral examination may provide clues to diseases that coexist with type 1 diabetes. Truly, the mouth has much to say about diabetes.

Evaluation of major parotid glycoproteins in patients with burning mouth syndrome

OBJECTIVE

This study was to investigate the potential role of salivary glycoproteins in burning mouth syndrome.

STUDY DESIGN

This study compared major parotid glycoproteins in a group of patients with burning mouth syndrome and age-, sex-, race-matched healthy controls.

RESULTS

By use of a glycoprotein detection kit, saliva from both patients and controls exhibited three major parotid glycoprotein banding patterns consisting of either one or two bands, molecular weights 58 kDa and 77 kDa. The strong lectin reactivity of major parotid glycoproteins with Ricinus communis agglutinin suggests that galactose is the most prevalent terminal sugar. In addition, major parotid glycoproteins were shown to express blood group antigen H. On the basis of metachromatic characteristics and immunologic reactivity, major parotid glycoproteins appear to be members of the proline rich protein multigene family, proline rich glycoprotein, genetic polymorphism G1. No qualitative difference was observed in major parotid glycoprotein banding patterns between patients and controls.

CONCLUSION

These findings do not support a role for major parotid glycoproteins in burning mouth syndrome.

Perception of stimulus size in patients with burning mouth syndrome

Twenty subjects with burning mouth syndrome (BMS) and 20 control subjects were tested for oral size perception. Blindfolded subjects assessed the size of holes (2.38-12.70 mm diameter) presented to the tongue, using their fingers to select a matching hole from a comparator series of 31 holes (0.76-15.87 mm diameter) using first static then phasic touch. Both groups overestimated the size of the holes less than 10 mm in diameter but no systematic disparity was evident with holes greater than 10 mm in diameter. The relationship between the stimulus size and the illusion (expressed as the ratio of apparent size to real size) was hyperbolic, with the illusion tending towards unity for holes greater than 10 mm. No differences were found in object size perception amongst patients with BMS or control subjects. It is therefore unlikely that altered oral size perception is a precipitating factor or accompanying feature in patients with BMS.

Sweet taste and diet in type II diabetes

The relationship between sweet taste function and dietary intake was studied in 21 patients with type II diabetes mellitus and 16 age-, weight-, and sex-matched controls. Subjects rated the sweetness intensity and pleasantness of a series of beverage samples sweetened with sucrose: 1.5-24%, fructose: 1-18%, or aspartame: 0.25-4%. They also kept 7-day food records. No group differences were found in sweet taste perception, pleasantness ratings, daily energy intakes, or macronutrient composition of the diets. However, subjects with diabetes consumed less sucrose but 3.5 times more alternative sweeteners than did controls. Peak pleasantness ratings for the beverage samples were positively correlated with dietary sweetness content in the subjects with diabetes but not the controls. These findings suggest that in diabetes, hedonic ratings for a sweetened beverage were related to dietary sweetness intake rather than changes in sweet taste perception.

Burning mouth syndrome

Burning mouth syndrome is a common condition particularly affecting elderly women. Numerous precipitating factors are recognized that lead to a burning sensation in clinically normal mucosa. By taking each precipitating factor into account, a favorable treatment outcome usually can be achieved. This article highlights the significance of precipitating factors in burning mouth syndrome and suggests a treatment protocol based on current scientific evidence.

Oral health and oral health behaviour in a population of diabetic outpatient clinic attenders

The control of oral health in individuals suffering from diabetes mellitus may affect a diabetic individual's insulin requirements. This study examined the oral health status and behaviours of a group of diabetic patients and compared the results to those obtained in a recent UK national survey of oral health. The results showed that, despite reporting higher levels of oral self-care, the diabetic population suffered from higher rates of caries than "normal" individuals. These differences could not be accounted for by the treatment received from dentists. It is concluded that diabetic patients are more caries prone than the general population and that the cause of this difference should be sought, as the traditional aetiological agent for caries cannot account for the increased caries rate. If the aetiology of the findings of this study were determined, progress could be made in the search for indicators of increased caries risk.

Oral disorders associated with diabetes mellitus

The protean manifestations of diabetes include various associated oral disorders such as sialosis, xerostomia, impairment of taste, and localized infections of which oral candidosis is the most commonly observed. The association of specific oral diseases and diabetes is of importance both in the detection of undiagnosed diabetes and in the elucidation of the pathogenesis of various oro-facial diseases. The clinical features and possible causes of oral disorders recognized to be associated with diabetes are reviewed with emphasis on good oral hygiene in the diabetic patient.