Diabetes and Oral Health: An Endocrine Disorder

The human endocrine system plays an important role in the regulation of the oral cavity. Hormone secretion and regulation can vastly alter the status of bacteria, cells, and other microscopic organisms which exist in the mouth. One endocrine disorder which has a tremendous impact on oral health is that of diabetes. This article focuses on diabetes and its negative effect on the oral cavity.

Diabetes is characterized by chronic hyperglycemia which results in diminished insulin production and/or impaired insulin action resulting in inability of glucose transportation into tissues. Over 15.7 million individuals are affected. Diabetes can be classified into two categories. Type I has a child onset, destroys beta cells of islets of Langerhans in pancreas and most individuals are insulin dependant. Type II exhibits an adult onset, peripheral resistance to insulin action, impaired secretion, increased glucose production. This is the most common form (90-95%) and is best controlled with diet and exercise.

The status of diabetic patients is determined by a simple blood test. This test measures the amount of glucose in the blood. Normal values for a fasting adult individual ranges from 90 - 130 mg/dL. Recently, a newer test called the hemoglobin A1C (HbA1C) has given diabetics a more accurate representation of their status. An HbA1C can give a long term evaluation of the amount of glucose on the hemoglobin molecule. A normal value is generally under 6.3% and can measure a history as far as 30 days old.

Oral changes associated with diabetes include cheilosis, mucosal drying, burning mouth and tongue, diminished salivary flow, alterations in the flora of the oral cavity and increased rate of dental caries. Periodontal changes include enlarged gingiva, sessile or pedunculated gingival polyps, polypoid gingival proliferations, abscess formation, periodontitis, and loosened teeth. Periodontal disease in diabetics follows no consistent or distinct pattern.