Oral manifestation of Systemic Diseases

THIS week we will look at a very common disease of the endocrine system, Diabetes Mellitus.

According to the International Diabetes Federation, 415 million people have diabetes in the world.

There were 209 800 cases of diabetes in Zimbabwe in 2015. An alarming rate for a country with a population of approximately 15,5 million.

A few key terms that will be used in the article and their definitions:

Insulin: a protein pancreatic hormone secreted by the beta cells of the islets of Langerrhans that is essential especially for the metabolism of carbohydrates and the regulation of glucose levels in the blood, thereby promoting a decrease in the sugar content of the blood.

Gucagon: a protein hormone that is produced especially by the islets of Langerrhans and that promotes an increase in the sugar content of the blood by increasing the rate of glycogen breakdown in the liver.

Pancreas: a large lobulated gland that secretes digestive enzymes and the hormones insulin and glucagon.

Beta cells: any of the insulin-secreting pancreatic cells in the islets of Langerrhans.

Islets of Langerrhans: any of the groups of small slightly granular endocrine cells of the pancreas and secrete insulin and glucagon.

Hyperglycemia: excess sugar in the blood (above the normal level)

There are 2 main types of Diabetes Mellitus,Type 1 and Type 2.

Diabetes Mellitus Type 1 A long term illness characterised by the body’s inability to produce insulin due to auto-immune destruction of the beta cells in the pancreas, its onset often occurs in childhood, but can also occur in adults between the ages of 30 and 40.

Genetic predisposition Viral infections e.g Cytomegalovirus type 2 Dietary factors: exposure to cow milks protein before the age of 3 months Diabetes Mellitus Type 2 An array of dysfunctions characterised by hyperglycemia and resulting from the combination of i) resistance to insulin action ii) inadequate insulin secretion iii) excessive glucagon secretion Many patients may be as symptomatic and remain undiagnosed for many years.

Risk Factors Sedentary lifestyle (no physical activity) Relative with Diabetes Mellitus type 2 Women who deliver a baby>4,5 kg or who were diagnosed with gestational Diabetes Mellitus High blood cholesterol levels Hypertension (High Blood Pressure) Abdominal obesity Diet high in animal fat and sugar Heart disease history Among many other systemic symptoms the oral manifestations of both types of Diabetes Mellitus are:

Periodontitis (gum disease): inflammation of the tissue around the teeth, often causing shrinkage of the gums and loosening of the teeth. Dental caries(cavities) Xerostomia (dry mouth): due to reduced function of the saliva and increased salivary sugar content.

Burning mouth syndrome: painful and frustrating condition, it is often described as the feeling of having burnt one’s mouth with hot coffee.

The burning sensation may affect the tongue, the roof of the mouth (palate), the gums, inside of the cheeks, and the back of the mouth or throat. Glossodynia: burning tongue sensation Stomatodynia: burning sensation of the whole mouth Constant bitter and metallic taste Fungal infections: such as candidiasis (oral thrush)

Below is an explanation of only the complications of Diabetes Mellitus with distinctive oral manifestations. Complication of Diabetes Mellitus Type 1 Diabetic Ketoacidosis: this occurs due to inadequate blood sugar due to lack of insulin, the body then uses fat as an energy source, when fat is metabolised in the body, ketones are released into the blood making it acidic, this produces a distinctive fruity smell of the breath, frequent urination, cold and pale skin, abdominal pain, confusion, weakness, and abnormally great thirst. Complication of Diabetes Mellitus Type 2 Hyperosmolar Hyperglycemic Non Ketotic Syndrome (HHNS): when blood sugar levels rise very high and may be lethal, occurs most often in the elderly and the sick, this condition also produces a distinctive fruity smell of the breath, frequent urination, cold and pale skin, abdominal pain, confusion, weakness, and abnormally great thirst.

Type 1 Diabetes Mellitus can’t be prevented. However, the same healthy lifestyle choices that help treat type 2 Diabetes Mellitus help prevent it:

Eat healthy foods. Choose foods lower in fat and sugar and higher in fiber. Focus on fruits, vegetables and whole grains.

Get more physical activity. Aim for 30 minutes of moderate physical activity a day.

Lose excess weight. If you’re overweight, losing even 7% of your body weight — for example, 6,4 kg if you weigh 90,9 kg— can reduce the risk of diabetes.

To keep your weight in a healthy range, focus on permanent changes to your eating and exercise habits.

Sometimes medication is an option as well. Oral diabetes drugs such as metformin may reduce the risk of type 2 Diabetes Mellitus — but healthy lifestyle choices remain essential.

Have your blood sugar checked at least once a year to check that you haven’t developed type 2 diabetes. Role of the Dentist

A dentist can only treat the oral manifestations of Diabetes Mellitus, if your dentist suspects that you may have any of the above mentioned oral manifestations as result of any type of Diabetes Mellitus you will be referred to a physician for further evaluation and possible treatment.

Patients living with diabetes are advised to ensure that they take their medication before visiting the dentist and are also advised to check their blood sugar level before their dental check up,

In the unlikely event of any of the above mentioned complications occuring in the dental office, dentists are trained to handle and manage the patient until an ambulance arrives.

Bi-annual dental check ups even if you think your teeth are in great health many systemic diseases can be detected just by inspection of the mouth because the mouth is the mirror of the body. A healthy you is a happy you. Kimberley Eve Nyathi is a Final year BDS (Bachelor of Dental Surgery) student

Lviv National Medical University.