Introduction:
Diabetes mellitus or type 2 diabetes is known to be the fifth most common chronic condition globally affecting adults. It is the sixth most frequent or leading cause of death amongst the geriatric or the elderly population. Because diabetic patients are often unaware of the oral complications as a result of the disease process, they may tend to ignore their oral health. Oral health education and awareness in individuals affected by diabetes is crucial in sustaining their systemic health. Also, the glycogen content in the patient's mouth or oral cavity can be detected by exfoliative cytology methods, by using modern-day staining protocols.
The detection of blood glucose orally has not exactly been a new-age method or technology. Also, the detection of either hyperglycemia or hypoglycemia in a diabetes patient can be analyzed from the glycogen content present in the oral epithelial cells. However, with the advancement in modern-day technologies, oral detection of diabetes mellitus or type 2 diabetes can play a crucial role in the early detection or diagnosis of this disease in individuals. Diabetes can produce many complications in the oral cavity or the head and neck, just like in the various regions of the body, because of the unregulated insulin metabolism and a spike in blood sugar levels. As a result, oral detection of diabetes is an important aspect of disease prevention.
What Is the Etiology of Oral Complications?
Diabetes mellitus is known to be (as per current research statistics) the fifth most common chronic condition across the globe. Almost an estimated 100 million people are affected by diabetes mellitus as per current world statistics.
Hyperglycemia (higher levels of sugar in the blood) is associated with several oral complications due to the dysfunctional changes in the oral cells in their normal tissue repair process. When this tissue repair is affected, there is an eventual dysfunction of the oral mucosa that occurs because of alterations in the salivary flow and its inorganic or organic constituents. Saliva, the primary immune defense of the oral cavity, contains essential immunoglobulins for protecting the oral cavity from microbial invasion or breach. However, due to the presence of cellular changes saliva secretion is affected.
Some of the common oral manifestations and complications that are related to diabetes are :
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Dry mouth or xerostomia (reduced salivary flow in the mouth).
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Gingivitis or gum disease.
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Periodontal disease.
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Increased tendency to develop oral infections.
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Burning mouth or burning mouth syndrome.
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Taste disturbances or dysgeusia.
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Lowered or poor wound healing.
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Compromised oral immunity.
These oral complications in diabetic patients can be factors that tend to affect the patient’s overall quality of life. There is also currently increasing research evidence that chronic oral complications of diabetes in the affected patients are accompanied by further negative effects on blood glucose control and vice versa. This is the reason why not only the prevention but also the timely detection and management of oral complications are considered extremely important.
What Is the Method of Detecting Glycogen Orally by Exfoliative Cytology?
The major modern method of glycogen staining or detection of glycogen is a cornerstone in detecting diabetes mellitus orally. Glycogen usually fails to be stained with conventional hematoxylin solutions or is weakly stained with eosin stain. The current research focuses on detecting the glycogen content in oral epithelial cells using the diastase enzyme. Diastase is a common digestive enzyme that is easy to use and economical and can be stable in its functions at the temperature of the oral cavity. The effects of diastase enzyme on the glycogen content can easily help in diagnosing diabetes mellitus. This is one of the advantages of exfoliative cytology that can differentiate the normal mucosal epithelial cells from those of diabetic patients.
Apart from the conventional hematoxylin and eosin stains, the Papanicolaou (PAP) stain, Periodic acid Schiff (PAS), and PAS-Diastase (PAS-D) stains can be respectively used in this diastase method of detecting or estimating blood glucose levels. The benefit of this method is to detect both hypoglycemia and hyperglycemia. This can prove easy and economical even for dental surgeons or oral and maxillofacial surgeons to detect diabetes from oral methods.
The principle that is employed in PAS-D stain is that diastase or alpha-amylase, would primarily act on glycogen and create a depolymerization effect. The glycogen would split into smaller sugar units such as maltose and glucose which will be washed out of the specific section. Glycogen will be then usually stained as magenta on the PAS-stained slide or will be absent on the PAS-D stained slide, in case it is digested by the diastase enzyme. If glycogen is detected orally, this can be an excellent method for diagnosis of diabetes mellitus. Exfoliative cytology using the PAS-D stain or PAP stain can also be used for detecting changes like nuclear enlargement, and cytoplasmic-nuclear ratios in oral cells. Hence this method of staining can be an extremely beneficial tool in detecting diabetes mellitus.
What Are the Effects of Diabetes in Oral Structures?
The changes in nutrition or an overall impaired or reduced immune defense in diabetes patients can lead to changes within the microbial oral flora. This may be related to the individual developing a greater chance of bacterial, viral, or oral fungal infections. Ranging from several conditions such as xerostomia, fungal infections like candidiasis, a rise in the incidence of dental caries, gingivitis or periodontal disease or periodontitis, and periapical abscess formation.
Salivary gland involvement such as parotid enlargement, minor salivary gland disorders, and burning mouth syndrome are all possible when hyperglycemia remains consistently prevalent in diabetic patients. Hence detection of these symptoms clinically in patients or the oral manifestations of diabetes plays a major role in clinically confirming diabetes in the individuals.
Also, this is the main reason why the detection and early diagnosis of diabetes mellitus orally is a crucial aspect of the health care system.
Conclusion:
The oral manifestations of diabetes are quite common in diabetic patients. The utilization of exfoliative cytology and PAS-D staining techniques is highly effective in identifying the presence of glycogen in oral mucosal or epithelial cells. This innovative approach is highly effective for dental professionals and oral surgeons in the detection of diabetes mellitus. Above all, any suspected lesion should raise concerns among dental surgeons and prompt them to investigate the possibility of diabetes in the affected individual.
