State of Evidence on Oral Health Problems in Diabetic Patients: A Critical Review of the Literature

Abstract

Diabetes mellitus (DM) is a global health problem, having recognized that in the next 20 years the number of diabetic patients in the world will increase to 642 million. DM exerts enormous repercussions on general health diabetic (especially derived from vascular, cardiac, renal, ocular, or neurological affectation). It entails in addition a high number of deaths directly related to the disease, as well as a high health care cost, estimated at $673 billion annually. Oral cavity is found among all the organs and systems affected in the course of DM. Important pathologies are developed with higher prevalence, such as periodontitis (PD), alterations in salivary flow, fungal infections, oral cancer, and oral potentially malignant disorders (OPMD). It has been proven that PD hinders the metabolic control of DM and that the presence of PD increases the possibility for developing diabetes. Despite the relevance of these oral pathologies, the knowledge of primary care physicians and diabetes specialists about the importance of oral health in diabetics, as well as the knowledge of dentists about the importance of DM for oral health of patients is scarce or non-existent. It is accepted that the correct management of diabetic patients requires interdisciplinary teams, including dentists. In this critical review, the existing knowledge and evidence-degree on the preventive, clinical, diagnosis, prognosis, and therapeutic aspects of oral diseases that occur with a significant frequency in the diabetic population are developed in extension.

Keywords: dental caries; diabetes mellitus; oral cancer; oral health; oral medicine; oral pathology; periodontitis.

Figure 1

Diabetes Mellitus with a poor control generates sustained hyperglycemia, which in turn induces an increase in the inflammatory response in the periodontal tissue; this in turn stimulates the RANK/RANKL axis with an increase in osteoclastogenesis and destruction of the alveolar bone, which will conclude with the loss of teeth—one of the hallmarks in periodontitis. The increase in the number of periodontal pathogens, the increase in reactive oxygen species (ROS), and the increase in the expression of role of advanced glycation end products (AGE) and its receptor (RAGE) also activate the inflammatory response in the periodontal tissue. The receptor activator of nuclear factor κB (RANK)/RANK-Ligand (RANKL)-RANK/osteoprotegerin (OPG) balance will be important in maintaining periodontal bone homeostasis.