Videocapillaroscopy of the Oral Mucosa in Patients with Diabetic Foot: Possible Diagnostic Role of Microangiopathic Damage?

Abstract

Introduction: Diabetic foot represents one of the most serious and expensive complications of diabetes and is subject to a high percentage of amputations that are almost always preceded by ulcers ascribable to neuropathy and/or vasculopathy. Videocapillaroscopy (VCS) can be a valuable aid in order to uncover morpho-structural anomalies in the vascular bed, both at the level of the oral mucosa and at the level of the terminal vessels of the lower limb. Materials and methods: Sixty subjects divided into 4 groups were enrolled: 15 healthy subjects; 15 patients with diabetes for more than 10 years without ulcerative foot lesions; 15 patients with neuropathic diabetic foot (clinical diagnosis, MDNS); 15 patients with ischemic diabetic foot (clinical diagnosis, ABI, lower limb doppler). A complete videocapillaroscopic mapping of the oral mucosa was carried out on each patient. The areas investigated were: labial mucosa, the retro-commissural region of the buccal mucosa, and the vestibular masticatory mucosa (II and V sextant). Results: The analysis of the morphological and densitometric characteristics of the capillaries revealed the following: a significant reduction in capillary density in neuropathic (mean ± SD 7.32 ± 2.1) and ischemic patients (mean ± SD 4.32 ± 3.2) compared to the control group of patients (both diabetic mean ± SD 12.98 ± 3.1 and healthy mean ± SD 19.04 ± 3.16) (ANOVA test and Bonferroni t test p < 0.05); a reduction in the average length of the capillaries and a significant increase in tortuosity (ANOVA test and Bonferroni t test p < 0.05). In the neuropathic patients, a recurrent capillaroscopic pattern that we defined as “sun” was found, with capillaries arranged radially around an avascular area. Conclusions: The data obtained from this preliminary study suggest a potential diagnostic role of oral capillaroscopy in the early and subclinical identification of microangiopathic damage in patients with diabetic foot.

Orofacial Manifestation of Systemic Sclerosis: A Cross-Sectional Study and Future Prospects of Oral Capillaroscopy

“…Similar results were evaluated in labial capillaroscopy, where loop visibility was significantly lower, and lip ectasia and tortuosity labial loops were significantly higher in SSc patients. After this result, we agree with other authors on the predictability of oral videocapillaroscopy as a diagnostic helpful tool to study peripheral microcirculation in healthy people and their pattern changes during systemic disease [59,60,63,64].…”

“…It is evident that this examination can also be performed in many research topics of dentistry within the mucosal surface of the oral cavity. Currently, oral capillaroscopy can be used for several diseases, such as Behçet Syndrome, Sjogren Syndrome, diabetic microangiopathy, periodontitis, COVID-19, and SSc [14,[58][59][60][61]. The evaluation of vascular involvement in the oral cavity is crucial in the management of SSc patients.…”

Potential Utility of Oral Mucosal Capillaroscopy as an Indicator of Microvascular Damage in Behçet Disease: A Preliminary Study

“…In a study conducted on patients with diabetic foot, a reduction in capillary density and length; and an enhancement in capillary curling were observed. The authors emphasized that oral mucosa capillaroscopy has an important diagnostic role in the early detection of microangiopathic damage [36].…”