Oral Manifestations of Diabetes

Oral Manifestations of Diabetes
Abstract
Diabetes is a disease falling under the category of chronic diseases, and it is prevalent among people of all age groups. The most common type of diabetes is type-two that called diabetes mellitus. Type 2 diabetes is one of the leading killer-diseases in the world. This paper presents a review of literature based diabetes mellitus, especially the oral manifestations of diabetes. Oral manifestations are the signs and symptoms within the oral cavity, and these symptoms are observed to be predominant among the patients suffering from diabetes mellitus. The aim of conducting the review of literature on oral manifestations of diabetes is to increase the society’s awareness of these symptoms. With the awareness, people who observe the symptoms can go for checkups and begin treatment if they are found to be diabetic. The review finds that diabetes patients have oral manifestations such as periodontitis, dysfunction of the salivary glands, loss of sensitivity to taste, fungal and bacterial oral infections, slow healing of oral wounds, loss of neuro-sensitivity, and tooth loss/decay.

Introduction
One of the diseases that have become major public health concerns is Diabetes. Type two of Diabetes, called Diabetes mellitus, has become a common problem among many people. The cause of diabetes mellitus is the failure of the body system to secrete insulin. There are two circumstances that can lead to diabetes mellitus. First, there can be under-secretion of insulin. Secondly, there can be a total failure of the body to secrete insulin. Consequently, the metabolic disease results due to the failure of the body to regulate its sugar, hence diabetes mellitus is a condition of hyperglycemia, meaning that there is excess sugar in the blood (Shelesh and Swarnlata , 2010).Although diabetes is a disease that affects the entire human population, its prevalence is higher among the older generation that the younger generations. Due to the first rate at which the prevalence of diabetes grows, the World Health Organization has declared diabetes as a global disaster or a pandemic disease, meaning that there is need for the world to act swiftly towards reducing the disease in manageable ways. It is a disease that has a lot of complications, and to understand how to contain it properly, it is important to understand its symptoms clearly. The complications of the disease, according to Baldwin (2010), are both micro and macro vascular.
There is a growing association of diabetes with many oral complications, especially Diabetes mellitus. The oral cavity, especially the soft-tissues in the cavity, suffers from various inflammatory ailments because of diabetes. The problem, however, as Baldwin (2010) notes, is that there are low levels of awareness about the association between Diabetes mellitus and oral cavity diseases. Research has revealed that among the complications that are associated with diabetes, periodontal diseases are the sixth most serious complications that arise from diabetes. It is, therefore, important to understand the how diabetes manifests through the oral cavity, and the diseases within the oral cavity that can offer an indication that one suffers from diabetes. Knowing the symptoms can make a patient report for a diabetes diagnosis.
Purpose
The aim of this paper is to review literature on the oral manifestations of diabetes. Diabetes is one of the leading killer-diseases in the world, and there is, therefore, the need for its proper understanding. The oral manifestations of diabetes can help especially in the populations of people suffering from diabetes but have not been diagnosed. They can use the oral manifestations as symptoms that can lead to diabetes. To achieve the objective of the paper, the student conducts a search of studies that have been conducted on the oral manifestations of the disease. PUBMED is a database that has many articles on the topic, and it is, therefore, the database that the student uses to conduct the search.
Review of Literature
Research has established that there are various diseases affecting the soft tissues of the oral cavity which are associated with diabetes mellitus. People with diabetes mellitus also suffer from gingivitis. Gingivitis is a dysfunction of the salivary glands that alters the composition of saliva and the sensitivity of the mouth to taste. Patients with diabetes mellitus have also shown symptoms of suffering from bacterial and fungal diseases within the oral cavity. People with diabetes mellitus also report having mucosal wounds that delay to heal. The oral cavity of the patients also loses its neuro-sensitivity, and the diabetes patients also show signs of tooth loss and dental carries.
Current research indicates that the prevalence rates for periodontitis have grown. According to Paul (2011), Periodontitis refers to a disorder affecting the periodontal tissues. It also affects the gingivae, and its initiation is a bacteria. The bacterium releases the toxins that cause the inflammation of the periodontal tissues. As the gingival inflammation grows, there is the formation of the gingival pocket due to the detachment of gingivae from the surface of the tooth.
Research and the medical community have not explained the proper relationship between periodontitis and diabetes, although diabetes patients continue showing symptoms of periodontitis. Patients with both type 1 and 2 of diabetes have shown that there is the increasing prevalence of periodontitis among them, according to Kuo and Kang (2010). However, medical research has not yet exploited fully how diabetes or hyperglycemia/hypoglycemia induces periodontitis. Theory, however, has proposed that when a patient suffers from diabetes, there are changes that happen on the collagen statue. In addition, there are changes in the immune system of the patient due to diabetes, and such changes are imagined to be linked to periodontitis, especially the wounds in the oral cavity that take long time before healing. Theory also suggests that the accumulation of the end-products of glycation in the oral cavity explain why diabetes patients suffer from periodontitis in high prevalence (Kuo and Kang, 2010). When an individual suffers from hyperglycemia, there is the continuous production of the cytokines that are pro-inflammatory, for example the prostaglandin which causes inflammations within the oral cavity. Apart from research linking diabetes to be the cause of periodontitis, research has also shown that when the periodontal conditions worsen, the patients’ hyperglycemic condition or diabetes also worsens. Kuo and Kang (2010) also find that among patients with diabetes, there a risk of contracting periodontitis is three times higher than it is among people without diabetes.
Apart from periodontitis, patients with diabetes also register high rates of salivary dysfunction. Saliva has a major role to play in keeping the oral cavity healthy. It means that any disease that affects the production of saliva undermines the health of the oral cavity. Negrato and Tazia (2010) is a longitudinal experimental study that investigates the relationship between diabetes and salivary dysfunction. The study finds that patients with diabetes do not have the normal way of producing the right volumes of saliva as the glands that produce saliva are inhibited in such patients. The glands that are responsible for the secretion of saliva, according to Negrato and Tazia (2010), include the parotid, sub-lingual, and sub-mandibular glands. The researchers diagnosed patients with diabetes and had a separate group of non-diabetic patients. Their findings proved that among the diabetic patients, the rate of production of saliva were generally lower than the non-diabetic patients. The research indicated that the patients with poorly controlled diabetes had their parotid glands and the other glands responsible for secreting saliva compromised (Negrato and Tazia, 2010). The researchers also observed that among the diabetes patients, there were high complains about drying oral cavities and they needed to drink a lot of liquids to keep their oral cavities wet. Negrato and Tazia (2010) explain that due to the constant dryness of the oral cavity, the soft tissues of the mouth become irritated and the irritation causes swelling and pain within the oral cavity.
Furthermore, studies on patients with diabetes have found that the patients’ taste becomes dysfunctional. One of the causes of taste dysfunction in diabetes patients is the problem with the secretion of saliva. However, according to Chomkhakhai et al (2010), there are metabolic and endocrine diseases whose prevalence increases among the diabetic patients. The diseases also explain why diabetes patients experience altered taste dysfunction. Also, the study by Chomkhakhai et al (2010) reports that patients with poorly controlled diabetes have higher chances of suffering from taste dysfunction compared to the general population of no-diabetic people. Furthermore, Chomkhakhai et al (2010) finds that when the patient experiences taste disturbance, his glycaemic control is inhibited, and the inhibition causes the patient’s low ability to keep good diet.
There are also fungal and bacterial infections of the oral cavity that occur because of diabetes. An example of a fungal infection of the oral cavity is oral candidosis, which is caused by fungi called Candida albicans (Chomkhakhai et al, 2010). There are various predisposing factors that are believed to cause the fungal infection, for example, cigarette smoking and xerostomia. However, any endocrine and metabolic diseases within the body can also cause oral candidosis. Oral thrash is another fungal infection that is prevalent among the diabetic patients. The thrush is characterized by the presence of white thrush in the oral cavity, and when the white thrush is wiped, there is bleeding of the cavity (Chomkhakhai et al, 2010).
Another oral manifestation of diabetes is poor healing of the wounds in the oral cavity. Previously, the paper has explained the predisposing factors and infections that cause inflammations and wounds in the oral cavity. According to Kuo and Kang (2010), however, patients with diabetes register extremely long periods for their oral wounds to heal. Kuo and Kang (2010) explain that the immune system of the people with diabetes is compromised. In addition, the oral cavity does not perform its functions normally, for example, the secretion of saliva by the oral cavity is compromised. Inhibition of saliva-production causes irritation, swelling, and cracking of the cavity due to dryness, and such factors explain why it is not easy for the wounds to heal fast. Chomkhakhai (2010) explains that doctors must be aware about the complication of delayed healing of the oral wounds among diabetes patients. Consequently, when they perform surgeries on the oral cavity, they expect the process to be a complex one. Other factors that explain the delayed healing of the oral wounds in diabetes patients include reduced flow of blood in the body of a diabetes patient, high levels of stress and depression, and vascularization (Kuo and Kang, 2010).
Finally, the diabetes patients also report symptoms such as the disorder of neuro-sensory within the oral cavity, tooth loss, and dental carries. The neuro-sensory disorder involves numbness of the oral cavity, meaning that the patient becomes less sensitive to heat. The patient can take extremely hot substances without sensing the heat, and such excessive heat causes burning of the inner mouth tissues. Patients with uncontrolled diabetes show the Burning Mouth Syndrome (BMS), and its underlying cause has been established to be diabetic neuropathy, according to Kuo and Kang (2010). The researchers also explain that it’s a popular fact that the diabetic patients are highly predisposed to oral diseases that cause tooth decay and loss. These diseases can develop due to dysfunction of the salivary glands. Also the sensory and periodontal diseases among diabetes patients can explain the problems of tooth loss and decay. However, Kuo and Kang (2010) explain that research has not exploited fully the relationship between diabetes and tooth decay/loss, and that the oral health complications could explain the problems of tooth decay and loss more than diabetes. On the other hand, Kuo and Kang explain that research has shown that the reduction of saliva among patients with diabetes mellitus leads to the problems of tooth decay and loss. Diabetes patients who suffer from xerostomia are commonly affected by tooth decay and loss.
Methods and procedures
a) Topic Selection
I selected my topic through Google search. Using the search engine, I located various topics in the area of diabetes. I brainstormed to choose the topic of diabetes and its oral manifestations. I considered performing research in this area so that I could develop findings that could explain some of the oral manifestations of diabetes. I considered the topic important because people who suffer from the oral complications could use them as symptoms of uncontrolled diabetes. Such people could go to hospitals for medical check-ups and if they are found positive (with diabetes), they can begin treatment. I conducted further search and found that there was a lot of recent literature and studies that have been performed in this area.
b) Source Search and Selection
I performed a careful search of research studies on the topic of the oral manifestations of diabetes. I managed to locate 123 studies. However, using the criterion of recency of the studies I selected six of the studies that I used to perform the literature review. The requirement was that the studies that I would use had to be within a recency period of five years. I also selected the studies on the basis of their perceived depth with which they explained the oral manifestations of diabetes.
c) Libraries and Search Engines
I used the PubMed database to conduct my research. The reason for selecting the database was that I found many studies on the topic through the database compared to other databases. In addition, the database was available at the PMI online library, making it easy to use for my research.
d) Search Terms
I used a number of search terms to conduct the search. The terms included diabetes, types of diabetes, diabetes mellitus, diabetes inspidus, oral, periodontitis, complications, and fungal, etc. I located 5,640 articles using the general search terms. However, I used Boolean strings as the filters for narrowing down my search. While narrowing down, I combined the terms diabetes and oral manifestations: “Oral manifestations of diabetes” as the new phrase for narrowing down to the preferred articles.
e) Age of sources
I used sources that were under the age of five years. Consequently, I selected the studies that were conducted after 2010. I considered this age as important because I could find the most recent and fresh findings made on my research question.
Discussion
The literature review shows that there are several oral complications that are linked to diabetes. The strength of the review is that it is based on empirical experimental studies that were conducted with diabetes patients. The experiments also had control groups of non-diabetic patients, meaning that the findings of the experiments were accurate. As the literature review indicates, patients with diabetes show oral complications, for example, wounds in the oral cavity, periodontitis, tooth decay and tooth loss, among the other complications discussed in the literature review. However, the weakness of the findings is that some of the oral complications lack a direct explanation in diabetes. Tooth decay and tooth loss, for example, are oral complications that lack their direct explanation in diabetes. However, it is observed, through the experimental studies, that diabetic patients show these oral complications. If they are not directly related to diabetes because they are not caused by metabolic failures of the body, then this is an area that requires research. The question that the student develops out of it is: Why do diabetes patients show complications of tooth decay and tooth loss?
Strengths and Weaknesses of Data collection method and Literature
The method used in collecting data for this research was location of articles from PUBMED. The strength of the method is that PUBMED is a database that has several studies on the research problem. In addition, the student selected the research articles using the criterion of recency. This criterion ensured that only the researches that were within the range of 5 years were included in the sampling frame. Although the method encourages the use of studies that were conducted recently, it is also a weakness because there are studies that do not fall within this range but could have made good findings on the oral manifestations of diabetes. The method’s other weakness is that it encourages bias on the researcher’s side. After sampling 123 studies that fell within the range of five years, it was at the discretion of the student to select the studies that exhausted the topic properly. The method of data collection relies on previous studies. Such dependence creates the possibility of furthering the limitations that the researchers committed in their studies. The method does not also create new findings but only analyzes the findings of the previous studies to find the oral manifestations of diabetes. However, the student manages to use the method to find oral manifestations of diabetes according to the previous researchers. The student has used the method, for instance, to find that the previous studies did not offer adequate explanations for the symptoms of tooth decay and loss in relation to diabetes. This is an area that needs further research as the student suggests, meaning that the previous studies did not explore fully the oral manifestations of diabetes and this is a mistake the student is bound to commit due to reliance on the past studies.
Opinion
In my opinion, previous studies have succeeded in finding the oral manifestations of diabetes. They have attempted to explain how diabetes, especially diabetes mellitus, causes these complications. Kuo and Kang (2010), for example, find that there is delayed healing of oral wounds among patients with diabetes. The researchers also find that since the production of saliva is inhibited in the patients, they suffer vascularization, and they have high stress levels with low immunity, these are the factors that explain why their oral wounds delay to heal. However, the previous studies have not given sufficient explanation for tooth decay and loss. Kuo and Kang (2010) have suggested that the conditions in the oral cavity and not diabetes itself may explain the problems of tooth decay and loss. There is need for additional research to find the exact cause of tooth decay and loss among diabetes patients.
Conclusion
Diabetes patients are at risk of suffering from various oral cavity complications. The literature review has shown that the oral complications among diabetes patients include periodontal diseases, salivary dysfunction, delayed healing of oral wounds, bleeding of the soft tissues, loss of neuro-sensitivity of the oral cavity, fungal and bacterial infections, and tooth loss and decay. Previous research has focused on type 2 diabetes (diabetes mellitus) because it is the most common type of diabetes all over the world: many diabetes patients suffer from diabetes mellitus. Although the oral health complications are common among diabetes patients, not all the complications have a direct relationship with diabetes mellitus. Lack of good sugar regulation cannot explain, for example, why the patients’ teeth decay. This suggests that not enough research has been done, and there is the need for further research to explain why the diabetes mellitus patients experience tooth loss and decay. It is not enough to guess that the factors in the oral cavity are the causes of these complications.

References
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