Page 72 - GALENIKA MEDICAL JOURNAL

from dentists and require careful pre-procedural evaluation individuals with diabetes, and they are more frequent and
because they are a particularly sensitive group of patients severe in younger age groups . Due to a deficiency in vita-
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in terms of the possibility of developing acute complicati- min B, stomatodynia and stomatopyrosis may be present,
ons. Dentists must be familiar with the basic characteristics which can be further aggravated by candidiasis .
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of diabetes to be able to react promptly and adequately if
hyperglycemic or hypoglycemic crises occur in the dental The pathophysiology of oral manifestations of diabetes
office. In such cases, it is necessary to act following the re- is not fully elucidated, but there is a known association with
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commendations of the National Guideline for the Diagnosis the occurrence of dental caries . In individuals with diabe-
and Treatment of Diabetes Mellitus issued by the Ministry of tes, there is an elevated glucose level in saliva (glycosylati-
Health of the Republic of Serbia . on), and saliva pH is decreased (acidosis). Additionally, there
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is reduced saliva secretion (xerostomia), which complicates
chewing and swallowing food and prevents adequate self-c-
Specific forms of hyperglycemia leaning of the oral cavity, creating favorable conditions for
the development of microorganisms and infections. It has
Stress hyperglycemia (SHG) is defined as hyperglycemia been demonstrated that periodontal disease and oral disor-
in previously euglycemic patients, with blood glucose levels ders are more common in individuals with diabetes compa-
≥ 7.0 mmol/L in two successive measurements or blood red to healthy individuals 11, 12 .
glucose levels ≥ 11.1 mmol/L in random measurements in
previously normoglycemic patients. SHG most commonly In individuals with diabetes, oral blood vessels exhibit
occurs concerning an acute process, such as trauma or ano- increased permeability due to microangiopathy, leading to
ther acute illness, including situations in the dental office . the deposition of mucopolysaccharides and glycoproteins in
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According to various reports, the frequency of SHG ranges oral tissues. Gingival blood vessels are affected by atherosc-
from 3% to 80% of cases among hospitalized patients. This lerosis and atheromatous changes, resulting in narrowed
wide variability is explained by the imprecise definition of lumens. Microthromboses and microangiopathies are pre-
stress hyperglycemia and the fact that in a large number of sent, leading to stasis, disturbances in the nourishment and
cases, diabetes mellitus already existed but was unrecogni- oxygenation of oral tissues, as well as impaired elimination
zed and untreated . of harmful metabolic byproducts. Alveolar bone undergo-
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es significant resorption and the formation of pockets that
Insulin resistance represents the inability to effectively suppurate, thus predisposing to the development of absce-
utilize insulin, despite sufficient levels present in the body, sses . In the periodontium, there is progressive destruction
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which can result in hyperglycemia. This resistance may be of all components, increased collagenolysis, and reduced
influenced by genetic factors or caused by certain medica- synthesis of new collagen .
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tions (such as corticosteroids). However, it most commonly
occurs within the context of stressful conditions, such as Periodontitis is a chronic inflammation of the gums
infection, sepsis, critical illness, and others . It also occurs caused by an inflammatory disease, which can not only
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during pregnancy, in obese individuals, and in those with lead to tooth loss but also is considered a modifying factor
high blood pressure, as part of hyperlipidemia (elevated that affects overall systemic health 14, 15 . Recent studies have
cholesterol and/or triglycerides), etc . The release of stress shown an association between periodontitis and chronic
1
hormones and cytokines plays an important role in redu- diseases such as Alzheimer's disease, cancer, rheumatoid
cing the insulin/glucose ratio. Insulin stimulates glucose up- arthritis, and others 13, 16 . In addition to the known impact of
take in insulin-sensitive tissues (liver, skeletal muscles, and DM on the occurrence and outcome of treatment in patients
adipose tissue), thereby reducing glucose release from the with the coronavirus, studies by Santana and other authors
liver . have shown that the combination of diabetes and perio-
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dontal diseases increases the risk of COVID-19 infection 17- 21 .
Numerous studies indicate a connection between diabetes
Oral manifestations of diabetes mellitus and the outcome of dental implants 22, 23 . Also, many studies
have examined the impact of local anesthesia on glycemic
Numerous studies have demonstrated an association levels in individuals with diabetes during dental procedures
between diabetes mellitus (DM) and periodontal diseases . (lidocaine with epinephrine 1:100.000). However, there is no
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Patients with diabetes often experience a burning sensation evidence that a local anesthetic with the addition of adrena-
and discomfort in the oral cavity, as well as bad breath (fetor line significantly alters glycemic levels 24, 25 .
ex ore). The oral mucosa may appear swollen, and darker
in color, and ulcerations in the oral cavity are possible. The From the aforementioned, it unequivocally emerges
tongue may also appear swollen, red, with atrophic papillae that dentists often encounter patients with diabetes becau-
(lingua geografica). The gingiva tends to bleed easily and se they constitute a vulnerable population concerning oral
is prone to infections (especially candidiasis), while the sa- and dental diseases. Although the association between dia-
livary glands are prone to calculus formation. Periodontal betes and increased prevalence of oral and dental diseases
disease and periodontal abscesses are common findings in is well-known, unfortunately, there are no specific protocols

70 DOI: 10.5937/Galmed2409080D