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Oral Complications
Dental Caries
Individuals who do not exhibit good glycemic control often experience an increased rate of dental caries. This is due to increased glucose levels in saliva and crevicular fluid. However, controlled diabetics may show a normal or reduced incidence of dental caries due to better glucose control, reduced carbohydrate consumption, better oral hygiene practices and frequent dental appointments. (35-37)
Periodontitis
Often referred to as "the sixth complication of diabetes", (39) periodontitis is the most common oral complication of diabetes. Studies (36) suggest that there is a higher prevalence of periodontal disease among diabetic individuals than in the general population. Similar studies (39,40) found Pima Indians with Type 2 were 2.5 times more likely to have periodontal disease. A greater prevalence of periodontal disease among Type 1 diabetics has also been shown. (39) Severity of periodontal disease in Type 1 diabetics appears to be related to the duration of diabetes. In Type 1 diabetics who present with retinal changes, periodontal loss of attachment was greater than in those without any retinal alteration. (36)
Research into the relationship between diabetes and periodontal disease is incomplete and not fully understood. Patients with poor glycemic control may have more calculus compared to nondiabetics with the same plaque control. There also appears to be a greater number of missing teeth and greater pocket depth associated with diabetic individuals. (27)
Persons at Risk
Diabetic individuals with a long history of diabetes, other systemic complications, pregnancy, poorly controlled blood glucose levels and poor oral hygiene are at high risk for periodontal disease. (37) Clearly, many factors contribute to the prevalence and severity of periodontal disease in diabetic individuals.
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Pathogenesis of Factors
