Evaluating All Potential Oral Complications of Diabetes Mellitus

Abstract

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.

IDF Diabetes Atlas: Diabetes and oral health – A two-way relationship of clinical importance

“…Green dots indicate where the bone level ideally should be; red dots show the actual reduced bone level as a result of inflammatory processes. Reprinted with permission [9]. Please see Fig.…”

“…Please see Fig. 1 in the original source for complete figure legend [9]. from different countries, where appropriate and applicable, and examples of studies from a variety of countries will be mentioned.…”

“…An extensive 2019 review by Verhulst and colleagues described and illustrated potential oral complications of diabetes (Fig. 1)[9].…”

Immediate implant-prosthetic dental rehabilitation of patients with diabetes using four immediately loaded dental implants: a pilot study

“…1,2 T2DM is associated with a wide range of systemic complications such as retinopathy, nephropathy, neuropathy, and cardiovascular pathology. [3][4][5] Notably, T2DM complications can occur in the oral cavity. 3 The association between T2DM and periodontal disease has been extensively described; notably, some authors have reported a strong association between these disorders even in the prediabetes stage.…”

“…[3][4][5] Notably, T2DM complications can occur in the oral cavity. 3 The association between T2DM and periodontal disease has been extensively described; notably, some authors have reported a strong association between these disorders even in the prediabetes stage. 6 A number of studies have shown positive associations between T2DM and various dental diseases, such as dental caries and periodontal disease, 3,6,7 which may result in tooth loss.…”