Oral Manifestations of Diabetes

Diabetes is a clinically and genetically heterogeneous group of metabolic disorders manifested by abnormally high levels of glucose in the blood. This hyperglycemia results from either a deficiency of insulin secretion caused by pancreatic β-cell dysfunction or resistance to the action of insulin in liver and muscles, or both (1). Periodontal disease is one of the most common chronic inflammatory diseases and is characterized by gradual destruction of connective tissue surrounding the teeth, eventually leading to tooth loss. Periodontitis occurs primarily in adults, and its incidence increases with age (2). Type 2 diabetes and chronic periodontitis are both common in older age-groups. The relationship between both these diseases has been extensively studied. The prevalence of type 2 diabetes is increasing rapidly. According to World Health Organization estimates, the number of adults with diabetes worldwide will increase from 171 million in 2000 to 366 million by 2030 (3). India has been called “the diabetes capital of the world” because of its high diabetes rates; ∼41 million Indians have diabetes, accounting for one-fifth of all diabetes cases worldwide (4). The prevalence of periodontal disease in India is also alarming, with incidences of 296 million in 2000, 319 million in 2005, 341 million in 2010, and an estimated 363 million in 2015 (5). Both diabetes and periodontitis are more severe and progress more rapidly when these conditions occur simultaneously. Many studies have reported correlations between periodontal health and various diabetes-related factors such as A1C and duration of diabetes. In the U.S. Third National Health and Nutrition Examination Survey (2), adults with an A1C >9% had a significantly higher rate of severe periodontitis than those without diabetes. Periodontitis is considered a “sixth complication of diabetes” (6). A study by Williams and Mahan (7) involving 2,273 people with diabetes found a 60% prevalence of periodontal …