Frequencies and association of oral mucosal alterations and periodontal conditions with type 2 diabetes mellitus in Pakistani individuals

Abstract

Diabetes mellitus is a growing public health concern and a chronic metabolic disease worldwide. It is recognized as a group of metabolic disorder characterized by chronic hyperglycemia and glucose intolerance, due to insulin deficiency, impaired effectiveness of insulin action or both. A number of oral health complications are frequently associated with diabetes mellitus. These include various inflammatory diseases like gingivitis, periodontitis and oral soft tissue pathologies. This study was done to explore an association between oral mucosal lesions and type 2 Diabetes mellitus with reference to clinical periodontal status, self-reported oral symptoms, oral yeast colonization, smoking, as well as tobacco-chewing habits. A total of 800 individuals’ i.e 395 patients with type 2 diabetes mellitus and 405 normal individuals were enrolled in this study. Previously diagnosed type 2 diabetic subjects were recruited from Baqai institute of diabetology and endocrinology and normal individuals from Baqai Medical University (from January 2010 to September 2012). Patients with type 1 diabetes were not included in this study. Four hundred and five systemically healthy subjects without diabetes and other illness with oral diseases were similar in socio-economic level and age recruited as control subjects after checking their fasting blood glucose level. These patients were selected from the department of periodontology and oral medicine, Baqai Medical University at the same time as the type 2 diabetes mellitus group. All clinical examinations were carried out by research scholar with the aid of a plane mouth mirror, gauze and a WHO CPITN probe. Radiography was not applied. Moreover, in cases requiring further confirmation, biopsies were obtained to establish an accurate diagnosis. The oral mucosal alterations were classified in two types’ oral mucosal lesions (OML) and potentially malignant disorders (PMDs), and periodontal disease was classified into Gingivitis and Periodontitis. In this study oral mucosal lesion was highly significant with a p value of < 0.0001 (odd ratio 2.601, CI 1.929-3.509) in type 2 diabetic as compared to non-diabetic. With respect to specific oral mucosal lesions we observed a highly significant association p<0.0001 (Odds ratio4.275, CI 7 2.798-6.534) of coated tongue (26.8%) with type 2 diabetes mellitus patients.Concerning potentially malignant disorder our study did not find any association between diabetes mellitus and potentially malignant disorder. We found a highly significant association of potentially malignant disorder p<0.001(odd ratio15.164, CI 5.119-44.921) and mixed lesions p<0.0001(odd ratio 8.571,CI 2.731-26.896) in individual using smokeless tobacco. In addition another relationship exists between periodontal disease and smokeless tobacco use. It shows that the smokeless tobacco caused a higher prevalence of gingivitis (76.4%) and periodontitis (77.4%) in the study population. Concerning oral hygiene habits, almost 87% of the total sample population surveyed reported daily oral hygiene habits. Brushing was the most frequent technique used (48.1%). Periodontitis was more frequent in diabetics than in non-diabetics. In our study we found a highly significant p<0.0001 association of periodontitis with type 2 diabetes mellitus. This is in agreement with many previous studies which pose diabetes as a risk factor for periodontal disease. With respect to glycemic control this study showed that there was a high percentage of periodontitis in patients with poor glycemic control, however statistical analysis disclosed no association between glycemic control and periodontal disease (odd ratio 1.621, CI 0.768-3.420). The cut-off point for Hemoglobin A1c (7%) used to distinguish those who were poorly controlled from those with better control. This study showed that the prevalence of oral mucosal lesions tends to be higher in diabetic than non-diabetics patients, however no association was observed between potentially malignant disorder and type 2 diabetes mellitus. A highly significant association of periodontitis with type 2 diabetes mellitus has been observed. In addition a highly significant association of potentially malignant disorder and mixed lesions in individual using smokeless tobacco was found. This study provides evidence that diabetes has a strong negative influence on oral health.