Original Article


Analysis of Oral and Dental Manifestations in Diabetic and Non-Diabetic Patients

Rakesh Sutariya, Bhari Sharanesha Manjunatha, Bhavik Dholia


Background: Diabetes mellitus is a metabolic disorder characterized by abnormal secretion and action of insulin on metabolism of carbohydrate, protein and lipids. Diabetes mellitus alters the cellular microenvironment in multiple organ systems and oral cavity is not an exception. It alters the oral health to a great extent and periodontitis most common oral complication of this disease. Aim: To evaluate the interrelationship between diabetes mellitus and dental health status such as the prevalence of caries, periodontal condition of teeth and any endodontic/restorative treatment of teeth. Materials and Methods: A total of one hundred type 2 DM patients (68 Uncontrolled diabetics and 32 controlled diabetics) among the age group of 35-60 years were included in the study. Relevant information regarding age, oral hygiene habits and personal habits was obtained from patients reporting to our hospital. Results: Gingivitis and Periodontitis were most frequent oral signs and symptoms observed in both controlled and uncontrolled diabetic patients. No statistically significant differences are found between control and uncontrolled diabetic patients for number of teeth, prevalence of caries, endodontically treated teeth, periapical lesions and restorations. Conclusion: Growing evidence of complications of diabetes on oral structures especially periodontium, demands dental care as one of main health care in these patients. The objective of treatment is to encourage a good oral health in patients with diabetes.


Keywords: Diabetes Mellitus; Periodontal Disease; DMFT Index; Oral health.


Rakesh Sutariya, Bhari Sharanesha Manjunatha, Bhavik Dholia. Analysis of Oral and Dental Manifestations in Diabetic and Non-Diabetic Patients. International Journal of Oral & Maxillofacial Pathology; 2019:10(1):06-09. ©International Journal of Oral and Maxillofacial Pathology. Published by Publishing Division, Celesta Software Private Limited. All Rights Reserved.



Diabetes mellitus (DM), a common metabolic disorder of carbohydrate and lipid metabolism, caused by either an impaired insulin secretion or function causing a rise in glycemic levels.1 DM poses a major threat to global public health and the biggest impact is on adults of working age in developing countries. The World Health Organization (WHO) estimates that the proportions of annual health budgets spent on DM related illnesses range from 2.5 to 15%.1 Common medical complications associated are renal disease, retinopathy, neuropathy, peripheral vascular disease and coronary heart disease.2 It can manifest many oral symptoms and periodontal disease is the most consistent finding. Few published epidemiological and clinical studies related to the dental status of diabetic patients are available in the literature. The association between diabetes and dental caries has received little attention and the results have been controversial. It has been reported that diabetes may influence local factors, causing the periapical reaction, interfering with the healing potential or even producing a periapical lesion that is unrelated to pulp pathology.3,4 The dental patients with diabetes should be aware of dental care and visit to dentist for prophylaxis and mainly to prevent periodontitis. Hence this study was undertaken to examine Oral health status of diabetic patients.


Materials and Method

This study was conducted among individuals attending Department of Oral Pathology, for any routine hematological investigations. All patients were screened for diabetes using glycated haemoglobin (HbA1c) to get an overall picture of average blood sugar levels have been over a period of 8-12 weeks. A total of 100 patients with known diabetics (68 Uncontrolled diabetics and 32 controlled diabetics were evaluated having permanent dentition with age range from 35 to 60 years. The study was conducted in full accordance with the World Medical Association Declaration of Helsinki. An Institutional Ethics Committee approval was obtained before commencing the study. A written informed consent was obtained from all participants. Patients with the following criteria are excluded from the study:

į       Edentulous patients,

į       Undergoing orthodontic treatment,

į       Extensive crown restoration and bridge work,

į       Full mouth periodontal surgery and

į       Patients with other systemic diseases.


The Oral health status was measured by noting DMFT (Decayed-Missing-Filled Teeth) index and CPI (Community Periodontal) Index. The number of endodontically treated teeth and periapical lesions were recorded by examining periapical radiographs. All radiographs are taken by a dental X-ray unit with 70kv, 10mA using paralleling technique. All teeth were grouped into three categories as anterior, premolars, and molars. Teeth were recorded as endodontically treated if they had been filled with a radiopaque material in the pulp chamber and/or in the root canal(s). A clear and locally widened periodontal membrane, loss of lamina dura or destruction of bone adjacent to the root were recorded as a lesion. A comprehensive analysis was done on the data collected and Independent sample tŠtests and ChiŠsquare tests were used for statistical analysis.



Controlled group comprised of 22 (68.75%) males and 10 (31.25%) females and the uncontrolled group, had 46 (67.65%) males and 22 (32.35%) females. (Figure 1) Gingivitis and periodontitis are most frequent oral signs and symptoms observed in both controlled and uncontrolled diabetic patients (Table 1). No statistically significant differences were found between control and uncontrolled diabetic patients (Table 2) for number of teeth, prevalence of caries, endodontically treated teeth, periapical lesions and restorations (Figure 2).

Study Groups



Uncontrolled patients (68)

47 (69.12%)

58 (85.3%)

Controlled  patients (32)

5 (15.6%)

9 (28.2%)

Student-t test

p-value: 0.40


Table 1: Distribution of patients according to gingivitis and periodontitis



Diabetes is a far reaching epidemic that creates morbidity and mortality for millions of people in both developed and developing countries. According to WHO estimates, there were 422 million, nearly 8.5% of the total adult population in the world with diabetes in the year 2014. In 2012, Diabetes caused 1.5 million deaths and an additional 2.2 million deaths, by increasing the risks of cardiovascular and other diseases throughout the world.5

Study Groups

Periapical  lesions

Endodontically treated teeth







Uncontrolled patients







Controlled patients







Chi-square test

p-value; 0.40 (Non-Significant)

p-value : 0.30 (Non-Significant)

Table 2: Comparison of periapical lesion and endodontically treated teeth


Study Groups

Decayed Teeth (mean± SD)

Missing Teeth (mean± SD)

Filled Teeth (mean± SD)

DMFT (mean± SD)

Uncontrolled patients





Controlled patients





Table 3: DMFT indices among Controlled and Uncontrolled diabetic patients


Based on data from the US National Health Interview Survey, the estimated lifetime risk of developing diabetes for a person born in 2000 is a staggering 33% for males and 38.5% for females.6 Diabetes may involve and affect several organs of the body, resulting in many complications.7 Skamagas M, et al8 described various complication of diabetes. A number of oral disorders such as gingivitis, periodontitis, candidiasis, Oral lichen planus, Leukoplakia to Oral Cancer, have been associated with diabetes mellitus. Several authors have studied the relationship of diabetes and periodontal disease, with a majority of the studies done throughout the world suggesting that diabetics are at increased risk for periodontitis and also highlight the need for comprehensive periodontal treatment in patients suffering from diabetic individuals.9-11 The association of diabetes mellitus and periodontal diseases (such as gingivitis and periodontitis) has received the greatest attention. In addition to gingivitis and periodontitis, Oral health differences were found between patients with diabetes and non-diabetes in both in periodontal health as well as in caries indicators. With reference to periodontal health differences, our results showed that patients with uncontrolled diabetes had a higher rate of gingivitis and periodontitis compared to patients without diabetes (Figure 3).

Figure 1: Bar diagram showing Gender distribution of controlled and uncontrolled Diabetic patients.

Figure 2: Bar diagram showing periapical lesions and endodontically treated teeth in controlled and uncontrolled Diabetic patients.


In contrast to other reported oral manifestations of diabetes mellitus, periodontal disease is a recognized and well-documented complication of diabetes. The evidence supporting this relationship is based on epidemiologic data and animal model studies that help explain the pathophysiology of periodontal disease as a complication of diabetes mellitus.12,13 Data suggest that periodontal disease may increase the risk of experiencing poor metabolic control.14


Quirino MS et al.,15 studied the oral manifestations of a sample of 70 diabetic patients, divided in controlled and uncontrolled patients. The data was analyzed and main observed symptoms were hyposalivation, taste alterations and burning mouth, with the main sign being parotid enlargement. The lesions observed were candidiasis of the erythematous type and proliferative lesions both associated to the use of total prosthesis. Bacic M et al.,16 determined the prevalence of dental caries, DMFT score and treatment needs in a group of diabetic patients and revealed no difference in the prevalence of caries between the group of diabetics and the control group. Neither was any difference found in the mean numbers of teeth with fillings, but the number of extracted teeth per subject was significantly higher in the group of diabetics than in the control group. Ilguy M et al.,17 investigated the number of existing teeth, prevalence of endodontically treated teeth, periapical lesions, caries and restorations in diabetic patients by taking periapical radiographs. Forty-six patients with Type I diabetes and 40 patients with Type II diabetes participated in the study. The control group consisted of 50 patients. There were significant differences between patients with Type I and Type II diabetes in the mean number of missing teeth surfaces and existing teeth.

Figure 3: Photograph showing periodontitis in uncontrolled Diabetic patients.


Bakhshandeh S et al.,18 recorded the dental status of diabetic adults (n=299) and its associations with diabetes-related factors in Tehran, Iran. Presence of diabetes-related complications made no difference in mean values of DMFT, but was associated with a higher number of decayed and missing teeth, and fewer filled teeth. Higher level of HbA 1c was associated with higher DMFT for men, but not for women and these results suggests a possible association between the level of metabolic control of diabetes mellitus and cumulative caries experience.


A study related oral health behavior in patients with diabetes showed a higher rate of mobile teeth as well as periodontal problem. They also had more DMFT index and concluded that educating such patients the importance of good self-oral health care needs to become a priority for oral health care providers.19 Another study showed that the prevalence of oral health problems was higher among subjects who had diabetes, compared with those who were non diabetic and dental care utilization was reported to be less among diabetic versus those who were non diabetic subjects.20



Very few epidemiological and clinical studies related to the oral and dental status of diabetic patients exists. Individuals with diabetes may be using less of oral health care services, particularly as it relates to periodontal health. Dentists and other oral health care providers at community level should explain the links between diabetes and periodontitis. In addition, dental screening examinations to diabetes may be conducted frequently so that they know risk of gingivitis and periodontitis.



We would like to acknowledge all the staff members of Oral Pathology Department for their support and guidance.


Author Affiliations

1.Dr.Rakesh Sutariya, Reader, Vaidik Dental College & Research Centre, Daman, 2.Dr.Bhari Sharanesha Manjunatha, Associate Professor, Dept. of Oral Biology, Faculty of Dentistry, University of Taif, Kingdom of Saudi Arabia, 3.Dr.Bhavik Dholia, Senior Lecturer, Vaidik Dental College & Research Centre, Daman,(UT) India.



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Corresponding Author

Dr. Manjunatha BS,

Associate Professor

Faculty of Dentistry, University of Taif,

Al-Hawiyah, Taif-21944, KSA.

E- mail:  drmanju26@hotmail.com


Source of Support: Nil, Conflict of Interest: None Declared.


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