CHAPTER I

INTRODUCTION

1.1 Background
Diabetes Mellitus (DM) 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 -cell dysfunction or resistance to the action of insulin in liver
and muscles, or both (Indurkar et al,. 2016). DM has become a global epidemic, the
complications of which significantly impact on the quality of life and longevity of
the sufferers, as well as healthcare costs (Obradors et al., 2017).
The number of people with diabetes has increased from 108 million in
1980 to 422 million in 2014. The overall prevalence of diabetes among adults over
18 years of age has increased from 4.7% in 1980 to 8.5% in 2014 and the World
Health Organization (WHO) predicts this will increase to 439 million, almost 10%
of adults in 2030 (WHO, 2011).
There are two types of diabetes, type 1 insulin dependent diabetes and type
2 non-insulin dependent diabetes. Additional sets of diabetics include gestational
diabetes mellitus which affects approximately 3% to 5% of the pregnancies and the
other conditions. Type 2 diabetes is most prevalent compared to type 1.
Approximately 90 to 95% of the people affected by the type 2 diabetes. Prevalence
of type 2 diabetes is positively associated with the age and minority status. Among
the people 65 years or older diabetes prevalence is 3.5 times more greater than the
prevalence of the all people of all ages (Nandakumar, 2015).
Diabetes is characterized by hyperglycemia, insulin resistance, absolute or
relative insulin deficiency, hyperglucagonemia, increased hepatic glucose
production and frequently accelerated gastric emptying and obesity (Nandakumar,
2015). Patients with diabetes present impaired function of polymorphonuclear
leukocytes (leukocyte adhesion, chemotaxis, and phagocytosis), impaired
bactericidal activity, altered response to exposure to antigens, and alteration to the
function of T lymphocytes. Many studies have shown a clear link between chronic
inflammation and the development of type 2 diabetes (Duncan et al., 2003;
Shoelson et al., 2006).
Both type 1 and type 2 diabetes present numerous possible long-term
complications. Epidemiological studies indicate that the severity of diabetic
complications is generally proportional to the degree and duration of hyperglycemia
(Tandon et al., 2012). The effects of diabetes on oral health have been studied
extensively. Diminished salivary flow is a common oral feature of diabetes and may
or may not include symptoms of a burning sensation in the mouth or tongue and
concomitant enlargement of the parotid salivary glands (Gandara & Morton, 2011).
Other oral manifestations related to DM described are: dry mouth, tooth decay,
periodontal disease and gingivitis, oral candidiasis, burning mouth syndrome
(BMS), taste disorders, rhinocerebral zygomycosis (mucormycosis), aspergillosis,
oral lichen planus, geographic tongue and fissured tongue, delayed wound healing,
and increased incidence of infection, salivary dysfunction, altered taste and other
neurosensory disorders, impaired tooth eruption, and benign parotid hypertrophy
(Albert et al., 2012).
Understanding the two-way relationship between diabetes and oral health
is important for health care professionals who treat either condition. Medical
management of patients of diabetes should include consideration of possible oral
conditions. Similarly, treatment of oral diseases should include systemic evaluation
of patients for diabetes. To achieve successful results, both diseases should be
controlled and treated properly when they occur as comorbid conditions.

1.2 Scenario
A 55 years old women come to RSGM-P FKG UNAIR with dry mouth
complaints, burning sensation and hard to swallow since 1 month ago, there are
tooth mobility found in upper and lower teeth and tooth loss without retraction or
trauma in anterior region. Patients have never seen a doctor or a dentist. Family
history mentioned that his father had diabetes mellitus.
1.3 Purpose
To understand case management according to condition priority of clinical
case in dental treatment, specifically in identifying oral soft tissue disorder,
periodontal disease treatment, advance treatment in prosthodontic, use of
radiographic photo as diagnosis support, and choosing drugs in specific case.

1.4 Benefit
To allow reader to understand about diabetes mellitus, its oral
manifestation and management according to the systemic and oral condition.

REFERENCES
Indurkar MS, Maurya AS, Indurkar S. 2016. Oral Manifestations of Diabetes. Clinical
Diabetes Journal; 34(1): 54-57.

Obradors EM, Devesa AE, Salas EJ, Vinas M, Lopes JL. 2017. Oral manifestations of
Diabetes Mellitus. A systematic review. Med Oral Patol Oral Cir Bucal; 22 (5):
586-94.

World Health Organization. 2011. Fact Sheet No. 312. Diabetes. Available at:
http://www.who.int/mediacentre/factsh.

Nandakumar E. 2015. Dental Manifestations in Diabetic and Non Diabetic Patients: A

Review. J. Pharm. Sci. & Res; 7(7): 482-484.

Duncan BB, Schmidt MI, Pankow JS, Ballantyne CM, Couper D, Vigo A. 2003. Low-
Grade Systemic Inflammation and the Development of Type 2 Diabetes: The
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Shoelson SE, Lee J, Goldfine AB. 2006. Review series Inflammation and insulin resistance.
J Clin Invest;116:1793-801.

Tandon N, Ali MK, Narayan KMV. 2012. Pharmacologic prevention of microvascular and
macrovascular complications in diabetes mellitus: implications of the results of
recent clinical trials in type 2 diabetes. Am J Cardiovasc Drugs;12:7-22.

Gandara BK, Morton TH Jr. 2011. Nonperiodontal oral manifestations of diabetes: a

framework for medical care providers. Diabetes Spectrum; 24:19905.

Albert DA, Ward A, Allweiss P, Graves DT, Knowler WC, Kunzel C. 2012. Diabetes and
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