Buccal alterations in diabetes mellitus

Abstract

Long standing hyperglycaemia besides damaging the kidneys, eyes, nerves, blood vessels, heart, can also impair the function of the salivary glands leading to a reduction in the salivary flow. When salivary flow decreases, as a consequence of an acute hyperglycaemia, many buccal or oral alterations can occur such as: a) increased concentration of mucin and glucose; b) impaired production and/or action of many antimicrobial factors; c) absence of a metalloprotein called gustin, that contains zinc and is responsible for the constant maturation of taste papillae; d) bad taste; e) oral candidiasis f) increased cells exfoliation after contact, because of poor lubrication; g) increased proliferation of pathogenic microorganisms; h) coated tongue; i) halitosis; and many others may occur as a consequence of chronic hyperglycaemia: a) tongue alterations, generally a burning mouth; b) periodontal disease; c) white spots due to demineralization in the teeth; d) caries; e) delayed healing of wounds; f) greater tendency to infections; g) lichen planus; h) mucosa ulcerations. Buccal alterations found in diabetic patients, although not specific of this disease, have its incidence and progression increased when an inadequate glycaemic control is present.

Figure 1

Sialosis - growth of both parotid glands.

Figure 2

a - Severe xerostomia with alterations in tongue's taste papillae. b - Less severe degree of xerostomia than that shown in picture 2 a.

Figure 3

a - Saliva collected in resting state with a very low flux, almost undetectable. Aside, saliva collected through mechanical stimulus with also very low flow (0.08 ml/min). b - Saliva collected in resting state that can be classified as: Normal salivary flux (0.42 ml/min), high viscosity (with a great amount of foam on top of the saliva) and high turbidity that means the presence of epithelial cells (beyond the physiological). c - saliva collected through mechanical stimulus, with a normal salivary flux (1.70 ml/min), high viscosity, turbidity and redness indicating the presence of gingival bleeding. d - Saliva collected through mechanical stimulus, with a normal salivary flux (1.60 ml/min), low viscosity (absence of foam on top of the saliva) and high turbidity. e - Kit for sialometry composed by a silicone piece used to be chewed and so stimulate the mechanical production of saliva, a small bottle to keep the collected saliva and a 5 ml syringe used to measure the volume of saliva collected after 5 minutes chewing.

Figure 4

Oral candidiasis - white plaques and reddened regions of tongue.

Figure 5

Titanium implant to be used as support for the dental crown.

Figure 6

Inferior dental arcade where it can be seen a sequence of decays in progressive degrees of severity: (1) healthy surface; (2) white spot injury that is the beginning phase of the decay; (3) Decay injury with an initial cavity; (4) relapse of the initial decay around a restoration; (5) Decay injury (a more advanced stage) around a restoration; (6) Decay injury that led to dental crown destruction.

Figure 7

Coated tongue before and after cleaning with a tongue scraper.

Figure 8

Correct use of a tongue scraper.