Benign migratory glossitis in patients with juvenile diabetes

The prevalence of tissue type HLA-B15 has been shown to be higher in atopic patients with benign migratory glossitis and in patients with insulin-dependent diabetes mellitus than it is in the general population. Despite this apparent link, the possible relationship between benign migratory glossitis and insulin-dependent diabetes mellitus does not appear to have been investigated previously. This study of 87 diabetic patients and 105 age- and sex-matched nondiabetic control subjects revealed a fourfold increase in the prevalence of benign migratory glossitis in the diabetic group. These results suggest that benign migratory glossitis may be linked to diabetes mellitus and that further investigation of this association is warranted.     

Periodontal and caries experience in children with insulin-dependent diabetes mellitus

This study compared the periodontal and caries experience of young patients with insulin-dependent diabetes mellitus (IDDM) with a nondiabetic population of the same age. The plaque scores of children with IDDM were statistically higher. The caries experience of a child with closely monitored IDDM and a family history of diabetes was significantly lower than that of a child with IDDM and no such family history, even though the gingival and plaque indexes of both children were the same.     

The onset of diabetes and poor metabolic control increases gingival bleeding in children and adolescents with insulin-dependent diabetes mellitus

Abstract Gingival health (bleeding on probing) and oral hygiene (plaque percent) were assessed in 2 groups of children and adolescents with insulin-dependent diabetes mellitus (IDDM). 1st study group included 12 newly diagnosed diabetic children and adolescents (age range 6.3-14.0 years, 5 boys and 7 girls). They were examined on the 3rd day after initial hospital admission and at 2 weeks and 6 weeks after initiation of insulin treatment. Gingival bleeding decreased after 2 weeks of insulin treatment (37.8% versus 19.0%. p < 0.001. paired t-test). and remained at the same level when examined 1 month later while glucose balance was excellent. Another group (n=80) of insulin-dependent diabetic children and adolescents (age range 11.7 - 18.4 years, 44 boys and 36 girls) with a mean duration of diabetes 6.0 years (range 0.3-15.0 years) were examined 2× at 3-month intervals. Subjects with poor blood glucose control (glycosylated haemoglobin, HbA₁, values over 13%) had more gingival bleeding (46.3% on examination 1, 41.7% on examination 2) than subjects with HbA₁ values less than 10% (mean gingival bleeding 35.2% and 26.9%, respectively) or subjects with HbA₁ values between 10 to 13% (mean gingival bleeding 35.6% and 33.4%, respectively). Differences were significant on both examinations (p < 0.05, Anova). and remained significant after controlling the groups for differences in age, age at the onset of diabetes, duration of diabetes and pubertal stage (Ancova). Results were not related to differences or changes in dental plaque status, supporting the concept that imbalance of glucose metabolism associated with diabetes predisposes to gingival inflammation. An increase in gingival bleeding in association with hyperglycaemia suggests that hyperglycaemia-associated biological alterations, which lower host resistance toward plaque, have apparently taken place. Consequently, although not all gingivitis proceeds into a destructive periodontal disease, prevention of plaque-induced gingival inflammation should be emphasised, particularly in children and adolescents with poorly controlled diabetes.     

The relationship between clinical attachment loss and the duration of insulin-dependent diabetes mellitus (IDDM) in children and adolescents

Abstract The periodontal status of 77 diabetic children and adolescents, and 77 paired, systemically-healthy, sex- and age-matched control subjects, was clinical examined. Fasting blood glucose, fructosamine and glycosylated haemoglobin (HbAl) values were determined. The mean periodontal pocket depths, clinical attachment levels and the parameters to assess diabetes mellitus from the diabetic group were significantly higher than those of the controls. We found a positive correlation between the duration of diabetes and clinical attachment loss, but not with periodontal probing depth, plaque index and gingival index in the diabetic group. A positive correlation was also assessed between the present serum fructosamine and gingival index in the diabetic group, but not in controls.     

Periodontal conditions in insulin-dependent diabetes mellitus.

In the present investigation, the frequency and severity of periodontal disease was assessed in a group of 71 patients with a mean duration of 16.5 years of insulin-dependent diabetes mellitus (IDD). The diabetics, aged 17-63 years, were under treatment at the diabetic outpatient clinic of the III Department of Medicine, University Central Hospital of Helsinki and at two clinics of the Helsinki Health Centre. Based upon their long-term medical records, 44 individuals were assessed to have a poorly controlled insulin-dependent diabetes mellitus (PIDD). At baseline of the present study, the PIDD group had a mean blood glucose level of 11.8 mmol/l and a mean glycosylated hemoglobin (HBA1) level of 10.7%. 27 subjects were classified as having a controlled insulin-dependent diabetes mellitus (CIDD). For each individual, site-specific recordings were made for the plaque index, gingival index, pocket depth, loss of attachment, bleeding after probing, gingival recession and radiographic loss of alveolar bone. Under similar plaque conditions, adult subjects with a long-term PIDD were found to have lost more approximal attachment and bone than subjects with a CIDD (P = 0.046, P = 0.019). These differences were not equally obvious when the subjects were classified according to the history of medical complications, such as retinopathies, neuropathies and nephropathies.     

口腔扁平苔藓患者空腹血糖测定及评价

对１０２例口腔扁平苔藓进行空腹血糖测定，发现９例糖尿病，患病率８．８％，显著高于年龄、性别配对的正常组（３．１％）（Ｐ＜０．０１）；进一步的分析表明，扁平苔藓患者血糖偏高者（ｎ＝２３）的口腔念珠菌感染率（７３．９％）高于血糖正常者（４６．８％），差别具有显著性（Ｐ＜０．０５）。对９例伴发糖尿病的扁平苔藓患者予以糠尿病治疗与口腔抗真菌治疗，７例口腔损害消失或改善。结果揭示，高糖血症、糖尿病在扁平苔藓致病中具有一定作用。     

The relationship of inflammatory periodontal disease to diabetic status in insulin-dependent diabetes mellitus patients

This study was designed to evaluate the relationship of inflammatory periodontal disease to the diabetic status of the insulin-dependent diabetes mellitus (IDDM) patient. 52 IDDM patients, ages 11-22 years, were evaluated. These patients were closely monitored at regular intervals in the University of Kentucky pediatric diabetic clinic. A periodontal examination was carried out for each patient. The patients were then assigned to a periodontitis or non-periodontitis group. Moderate to advanced periodontitis was found in 5.8% of the subjects. The gingival index and sulcular bleeding index were significantly higher in the periodontitis group (P less than 0.05). There was no significant difference between groups for plaque index, age of diabetic onset, duration of diabetes, present age, insulin dosage/weight, or serum glucose (P greater than 0.05). There was a greater % of ketoacidosis, retinopathy and neuropathy in the periodontitis group. IDDM patients with neurological complications or a history of chronic infections had a significantly higher gingival index score than those without the complication (P less than 0.05).     

Recent advances in diabetes mellitus of interest to dentistry

Significant changes were made in 1997 by The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus of the American Association of Diabetes regarding the diagnosis and classification of diabetes mellitus. The terms "insulin-dependent diabetes mellitus" (IDDM) and "non-insulin-dependent diabetes mellitus" (NIDDM) were dropped. The new classification is, in general, based on etiology rather than on treatment and includes four groups: Type I (autoimmune), Type 2 (non-autoimmune), Other specific types, and Gestational diabetes. The fasting blood glucose level for diagnosis was lowered from 140 mg/dL to 126 mg/dL A random blood glucose of 200 mg/dL or greater in a patient with symptoms of diabetes is diagnostic. Each of these diagnostic tests needs to be repeated on a separate day. The glucose tolerance test is no longer recommended for routine diagnostic use. Recommendations for the screening of diabetes mellitus in presumably healthy individuals are presented. New advances in insulin and its delivery to the diabetic patient are discussed. The impact of diabetes mellitus on the oral cavity is updated.     

Elevated blood glucose levels in patients with severe periodontal disease

Background, aims: The rôle of diabetes mellitus in various forms of periodontal disease was investigated intensively in the past; some studies have also indicated an impact of periodontal inflammation on diabetic balance. The purpose of this study was to evaluate the reciprocal relationship between abnormal serum glucose levels and elevated CPITN scores in non‐diabetic patients. Material and Methods: 10,590 subjects were analyzed for normal and abnormal (higher than 120 mg/dl) serum glucose levels, their periodontal status reflected as CPITN was correlated with their glucose level category. Results: The results of the present study reflect a significant association between elevated blood glucose levels (higher than 120 mg/dl) and CPITN scores of 4.5 with an odds ratio of 2.46. Conclusion: A strong association exists between abnormal serum glucose level and periodontal disease as manifested by CPITN score.     

Mutans streptococci and lactobacilli in saliva from children with insulin-dependent diabetes mellitus

The quantitative distribution of mutans streptococci and lactobacilli in saliva of insulin-dependent diabetic children was compared with a group of healthy children and related to the metabolic control of the disease. The study group, consisting of 94 boys and girls (age 4-19) with type 1 diabetes was matched by sex and age with a non-diabetic control group. Stimulated whole saliva was collected and flow rate, buffer capacity and the levels of mutans streptococci and lactobacilli were analysed in all children. In the diabetic group, total salivary proteins and glucose content of saliva were determined. Data on caries experience were recorded from the dental cards of all children. There were no difference in the distribution or number of mutans streptococci between the groups, but significantly (p less than 0.05) lower levels of lactobacilli were found among the diabetic children. The number of lactobacilli was positively correlated (p less than 0.05) to glucose concentration in saliva. There was no difference in the prevalence of caries between the groups. The present findings suggest that the dietary treatment of young insulin dependent diabetics gives rise to a reduced number of lactobacilli in saliva but does not affect the mutans streptococci.     

A site-by-site follow-up study on the effect of controlled versus poorly controlled insulin-dependent diabetes mellitus

Abstract In the present site-by-site follow-up study, the change in amount of approximal alveolar bone was assessed after 1 year from the baseline examination in 38 and after 2 years in 22 dentate subjects all with insulin-dependent diabetes mellitus. The diabetics, aged 35 lo 56 years at baseline, had a history of a mean duration of 18 years of insulin-dependent diabetes mellitus and were under medical treatment at the outpatient clinic of the III Department of Medicine, University Central Hospital of Helsinki as well as at 2 diabetic clinics of the Helsinki Health Centre. Based upon their Song-term medical records, 26 subjects were after 1 year, and 16 subjects after 2 years from the baseline, identified as having poorly controlled insulin-dependent diabetes (PIDD). At the 1-year examination, 12 subjects were classified as having controlled insulin-dependent diabetes (CIDD) as compared to 6 subjects at the 2-year examination. After 1 and 2 years, from baseline, site-by-site measurements were recorded for plaque index scores, bleeding after probing, loss of attachment, and radiographic loss of alveolar bone. After 1 and 1 years from baseline, the PIDD subjects exhibited higher mean %s of sites with improved bleeding scores (p < 0.01, x³-test) than the CIDD subjects. At the 2-year examination, the mean % of sites with loss of approximal alveolar bone was greater in the PIDD than in the CIDD group (P < 0.05, X³-test). The greatest differences between PIDD and CIDD subjects were found when recordings for only canines were analyzed at the 1 - and 2-year examinations (p<0.05, X²-test). The results of our current 2–year longitudinal site-by-site examinations confirm earlier, results that poorly controlled insulin-dependent diabetes mellitus is strongly related to the amount of alveolar bone loss.     

Effect of insulin on naturally occurring gingivitis rats with diabetes

It is well known that diabetes mellitus aggravates both the severity and progression of periodontal disease. We sought to further explore biologic mechanisms of this relationship using naturally occurring gingivitis rats (ODUS/Odu) rendered diabetic by 65 mg/kg intravenous injection of streptozotocin (STZ). Insulin was administered daily to one group of the rats beginning 4 weeks after STZ injection (STZ-insulin group). Others received no insulin (STZ group). A third group that received no STZ was kept as controls. Eight weeks after STZ injection, sterilized liquid paraffin was injected peritoneally into all three groups, and peritoneal macrophages were collected 4 days later. Macrophage chemotaxis was measured by the membrane filter method using a 48-well microchemotaxis chamber with zymosan activated serum used as a chemotactic stimulant. Blood glucose levels, body weight, plaque indices, pocket depths, serum triglyceride and hemoglobin A1C levels were also determined. We found that blood glucose levels, body weight and triglycerides recovered to normal values in the STZ-insulin group. Further, control of blood glucose resulted in diminished plaque indices, and pocket depths returned to values seen in the controls. Chemotaxis and phagocytosis of peritoneal macrophages improved slightly in the STZ-insulin group, but did not return to levels seen in the pretreatment state. Although insulin resulted in some improvement in leukocyte function damaged by induced diabetes mellitus, recovery was incomplete.     

A prevalence study of denture stomatitis in subjects with diabetes mellitus or elevated plasma glucose levels

The purpose of this study was to determine if a relation between diabetes mellitus and denture stomatitis could be supported by observing an increased prevalence of denture stomatitis in subjects with either diagnosed diabetes mellitus or elevated plasma glucose levels. The study involved 301 subjects wearing either complete or partial maxillary dentures. Medical history information, oral examination records, and laboratory data were used for the study. No significant increase in the prevalence of denture stomatitis was found in those subjects with either previously diagnosed diabetes mellitus or elevated plasma glucose levels when compared with subjects with normal glucose metabolism.     

Salivary alterations in insulin-dependent diabetes mellitus

Objectives. To examine the flow rate and composition of unstimulated whole saliva and of serum in children with newly diagnosed insulin-dependent diabetes mellitus (IDDM) and to compare these with values for a group of healthy controls.
Design. Cross-sectional.
Setting. Diabetic Department of a University Hospital in Thessaloniki, Greece.
Subjects and methods. The test group was made up of 10 recently diagnosed child patients with IDDM, aged 4–15 years and free of other systemic disease. Ten healthy children aged 5–17 years served as controls. Children were clinically examined before unstimulated saliva was collected over a 5 minute period and blood samples taken. Saliva and serum measurements included glucose, total proteins, albumin and immunoglobulins (IgA, IgG).
Results. No significant difference was seen in salivary flow rate between the two groups. Significantly greater concentrations of glucose were seen in saliva and serum in children with IDDM. Neither total protein nor albumin differed significantly between the two groups. Salivary IgA concentration was higher in the test group as was serum IgG.
Conclusions. Findings in this sample suggest that changes in salivary composition may, together with estimated glucose levels, play a helpful diagnostic role in the early stages of IDDM in some children.     

局部含漱治疗患糖尿病老年人义齿性口炎的疗效观察

目的：探讨仅局部应用含漱液治疗老年Ⅱ型糖尿病患者义齿性口炎的疗效。方法：将63例患有义齿性口炎的老年糖尿患者根据糖尿病控制情况分成控制较好组（31例）和控制不良组（32例）及无全身系统性疾病的义齿性口炎患者组成的对照组（20例）,3组均采取局部使用0.1%西吡氯铵含漱液和5%碳酸氢钠溶液交替含漱的治疗方法,对临床疗效进行观察比较。结果：控制较好组临床有效率（90.32%）明显高于控制不良组（50%）,稍低于对照组（95%）,P〈0.01。结论：老年Ⅱ型糖尿病患者义齿性口炎使用局部含漱液治疗完全可以控制病情,此外还需控制好血糖,保持口腔和义齿清洁,才能达到治愈的目的。     

Periodontal status of Finnish adolescents with insulin-dependent diabetes mellitus

Abstract The periodontal status of 85 12–18 year-old Finnish adolescents with insulin-dependent diabetes mellitus (IDDM) and their paired, age- and sex-matched healthy controls was assessed clinically and radiographically. The clinical examination consisted of plaque index, gingival index (GI), retentive calculus index, WHO community periodontal index of treatment needs, number of pockets ≥4 mm and number of surfaces bleeding after probing. Alveolar bone loss was measured interproximally from the first molars in bite-wing radiographs (all subjects) and from the first incisors in periapical X-rays (patients only). The results show that in spite of similar plaque scores, the patients had higher GI scores and more surfaces bleeding after probing. No differences were found in the number of ≥4 mm pockets or radiographical bone loss in the first molars.     

Enamel hypoplasia in a litter of rats with alloxan-induced diabetes mellitus

Enamel hypoplasia is an important clinical problem commonly seen in children born to diabetic women. We aimed to characterize the enamel hypoplasia in Wistar rats born to alloxan-induced diabetes mellitus rats. Groups consisted of pregnant rats supplemented (ISDR) or not (NISDR) with insulin and controls, in which sterile saline solution was administered instead of alloxan or insulin. The mandibular incisors of one-month-old rats born to these mothers were analyzed. Whitish defective enamel was found macroscopically in both experimental groups (ISDR = 37.5%, NISDR = 33.3%) but not in the control group. Mild to severe enamel hypoplasia was observed by scanning electron microscopy (ISDR = 93.8%; NISDR = 100%, control = 4.2%). The severity of hypoplasia correlated positively with the maternal level of blood glucose. In conclusion, the intensity of enamel hypoplasia in the teeth of the litter born to alloxan-induced diabetic rats was variable and was dependent on the glycemic level of the pregnant rat.     

Diabetes mellitus: medical and dental considerations

Diabetes mellitus is challenging to the clinician, researcher, and patient because of its complex pathogenesis, questionable cause, and often frustrating course of treatment. The two relatively distinct forms, adult-onset and juvenile-onset diabetes, can be considered separately because their cause, clinical course, and treatment is often radically different. Adult-onset diabetes is most commonly seen in middle-aged, overweight individuals and is generally easily managed by diet control and weight reduction. The chronic complications are rare, and patients experience a normal lifespan. Juvenile-onset diabetes affects younger individuals and is associated with the classic triad of diabetes: polydipsia, polyuria, and polyphagia. Its course is more acute and associated with greater swings in blood glucose. Although insulin is the treatment of choice, maintenance of normoglycemia is often difficult. The chronic complications of diabetic neuropathologic, retinopathologic, and angiopathologic conditions, relatively constant features of juvenile-onset diabetes, are somewhat independent of insulin control. The fasting blood glucose and oral glucose tolerance tests are used to diagnose diabetes, and the level of urine sugar is used as a measure of control. Specific oral problems have been noted with higher frequency in the diabetic population. The caries pattern seen in diabetics is related to xerostomia and results in rapidly advancing decay, affecting smooth and interdental surfaces. Periodontal disease is more common in diabetics, especially poorly controlled insulin-dependent diabetics. These patients are more prone to the development of acute periodontal problems such as abscesses and the chronic, often rapidly progressive, destruction of the periodontal support apparatus. Dental treatment is directed toward the prevention of caries and periodontal disease through periodic dental care, daily use of topical fluoride, and meticulous oral hygiene.     

Occurrence of oral leukoplakia and lichen planus in diabetes mellitus

The occurrence of oral leukoplakia and lichen planus in 1600 patients with diabetes mellitus (815 type 1: insulin-dependent, 761 type 2: non-insulin-dependent)-under care at the International Medicine Department-was studied. Precancerous lesions and conditions were diagnosed and grouped according to internationally accepted criteria. The prevalence of oral leukoplakia in diabetic patients was 6.2%, as compared to 2.2% in the healthy controls, that of oral lichen was 1.0% in the test-, and 0.0% in the control group. Leukoplakia and lichen both showed the highest occurrence in the second year of established diabetes, and their prevalence was higher among insulin-treated diabetics. Smokers were more often affected, by both kind of lesions, oral lichen showed a more frequent association with candidiasis. The prevalence of oral leukoplakia and lichen in diabetes mellitus patients was higher, than average ratios in population samples from the same country.     

Atrophic lesions of the tongue: A prevalence study among 175 diabetic patients

Central papillary atrophy and other anomalies of the tongue were studied among 175 diabetic outpatients attending the Tygerberg Hospital. Atrophic lesions of the tongue were found in 26.9 % of the patients and 61.7 % of these lesions were central papillary atrophy. The degree of control of the diabetes as measured by plasma glucose and urine analyses was not related to the frequency of central papillary atrophy. The prevalence of central papillary atrophy in diabetics was found to be much higher than that of central papillary atrophy and median rhomboid glossitis found in previous investigations among other populations. It is suggested that patients with central papillary atrophy should be screened to rule out diabetes mellitus as the underlying cause. Double central fissures, producing well demarcated triangular areas with their bases at the “sulcus terminalis”, were seen in nine instances (5.1 %). Four of these areas were associated with central papillary atrophy; the remaining five were covered by non-atrophic mucosa with filiform and fungiform papillae.