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Hygiene Tribune Middle East & Africa Edition No.3, 2017

C4 HYGIENE TRIBUNE Dental Tribune Middle East & Africa Edition | 3/2017 Prevalence of Diabetes Mellitus in Odontogenic Infection and Oral Candidiasis By Dr. Aparna Sharma, UAE Diabetes Mellitus Diabetes mellitus (DM) is a group of complex multi-system metabolic disorders resulting from a deficiency in insulin secretion caused by pan- creatic β-cell dysfunction and/or in- sulin resistance in liver and muscles. Diabetes affects more than 9% of the adult population and has a dramatic impact on the healthcare system be- cause of high morbidity and mortal- ity among affected individuals. Type 1 diabetes results from cellular- mediated autoimmune destruction of pancreatic β-cells, which usually leads to total loss of insulin secretion; in contrast, type 2 diabetes is caused by resistance to insulin combined with a failure to produce enough additional insulin to compensate for the resistance. Type 2 diabetes is commonly linked to obesity, which contributes to insulin resistance through elevation of circulating lev- els of free fatty acids derived from the adipocytes; these free fatty ac- ids inhibit glucose uptake, glycogen synthesis and glycolysis. In many obese individuals, insulin resistance is compensated for by increased in- sulin production. However, in one third of obese individuals, β-cell mass is reduced by a marked increase in β-cell apoptosis, which results inadequate production of insulin. in The prevalence of dia- betes mellitus (DM) in odontogenic infections and oral candidiasis is influenced by neutro- phil functions, allowing microbial invasion and multiplication. During the period of infection, a high blood sugar level usually complicates both odontogenic infections and candidiasis. All white blood counts, C-reactive protein levels and eryth- rocyte sedimentation rates show increased lev- el in DM (+ve) patients than in DM (-ve) patients. The polymorphonuclear leukocytes from diabetic patients, especially those with candidiasis, pro- duced fewer free oxygen radicals and exhibited reduced phagocytosis and intracellular killing of Candida cells associated with the reduced O2−gen- eration during the infection. These suppressed neutrophil functions increase after treatment but do not reach control levels. These studies indicate that DM is a predisposing condition for odontogenic infections and oral candidiasis, that DM-com- plicated infections become severe because of neutrophil suppression, and that examination of blood sugar level should be essential for patients with oral infections. It has generally been assumed that oral candidiasis occurs with in- creased frequency in patients with diabetes mellitus. Several research studies have been done on this and it has been concluded that in the diabetic group, no relationship was found between recent use of anti- biotics, total or differential white blood cell count, serum glucose, presence of diabetic retinopathy, or glycosylated haemoglobin values in Insulin Dependent Diabetes Mellitus (IDDM). In IDDM there is a predispo- sition to oral candidiasis and it has been shown that this predisposition is independent of glucose control. In patients with type 2 DM i.e. Non- Insulin Dependent Diabetes Mellitus (NIDDM), the degree of disease con- trol, as measured by fasting sugar and urinary glucose concentration, is unrelated to oral candidiasis. Howev- er, a glycosylated haemoglobin con- centration above 12% is significantly associated with oral yeast infection, which suggests that fungal infection of mucous membranes may only be significantly associated with diabe- tes in patients with a longer history of hyperglycemia. Tobacco smoking and wearing den- tures continuously day and night have been found to be important local factors in chronic oral hyper- plastic candidiasis. As per the recent studies, the presence of dentures and glycosylated haemoglobin concen- tration are independent predictors of the risk of developing candidiasis. This finding suggests that diabetics are more susceptible to fungal infec- tion in areas of moisture and trauma, but, in the absence of dentures, high glycosylated haemoglobin concen- tration is the most important risk factor. Conclusion Being a Diabetic may not place a person at increased risk of fungal infection / other odontogenic infec- tions, unless diabetes control is very poor as evidenced by a glycosylated haemoglobin concentration of more than 12% and, particularly, if the per- son maintains a very low level of oral hygiene.

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