2.

1 Association between Xerostomia in Diabetes Mellitus Patient

Many types of systemic disorders cause decreased salivary flow, which
lead to development of dry mouth syndrome or xerostomia. Some diseases such as
autoimmune diseases, diabetes mellitus, hypertension, neurological disorders, and
depression cause progressive destruction of parenchyma often irreversibly.
Xerostomia occurs when salivary glands do not produce enough saliva to
keep the mouth moist. Dryness contributes to cavities and gum disease, because
saliva helps wash away the bacteria that contribute to these conditions.
Common symptoms of xerostomia, such as:
A sticky, dry feeling in the mouth and throat
Frequent thirst
Mouth sores, and sores or split skin at the corners of the mouth
A burning sensation in the mouth, especially on the tongue
Problems speaking
Difficulties in tasting and chewing food and in swallowing
Hoarseness and dry nasal passages
Bad breath (Anonim. 2012. Diabetes and Dry Mouth: How it Adversely?
Accessed at: December 4, 2012. Available from:)
http://www.dentistryfordiabetics.com/consumer/article-diabetes-and-dry-
mouth.pdf
Other times there may be affected nerves or vessels causing temporary
effects and reversibility. Autoimmune diseases, which induce dry mouth or
xerostomia, are Sjgrens syndrome, lupus erythematosus, rheumatoid arthritis,
and scleroderma. Common clinical features in all these diseases can be observed
as oral mucosa dryness as well as dryness of ocular, vaginal, pharyngeal,
laryngeal, and nasal mucous membranes. Out of all these disorders, Sjgren's
syndrome is the one that most affects the mucous membranes. Sjgrens
syndrome is a chronic inflammatory autoimmune disease characterized by
progressive replacement of the parenchyma of the lacrimal glands and salivary by
an inflammatory infiltrate. It can be seen alone as primary Sjgren syndrome or in
association with other autoimmune disorders like lupus erythematosus,
rheumatoid arthritis, scleroderma, primary biliary cirrhosis, and vasculitis.


Figure 2.1 Dry mouth in autoimmune disorders and diabetes.

When a dentist suspects the presence of dry mouth syndrome or
xerostomia, the patient is referred for a biopsy of the salivary glands to be
performed under the lower lip. The patient also undergoes special serological tests
like IgG antibodies, anti Ro/SS-A and anti Ro/SS-B34, and rheumatoid factor.
Another disease that commonly causes xerostomia is diabetes. According
to recent research conducted on diabetic and nondiabetic patients, it has been
found that the total saliva of diabetic patients not controlled is approximately one
third to half the amount of saliva of non-diabetics. The uncontrolled diabetic
patients may have some clinical manifestations of disease namely polydipsia,
polyphagia, polyuria causing the sensation of dry mouth. What occurs in
uncontrolled diabetic patients who have xerostomia is progressive destruction of
parenchyma, which can also sometimes affect blood vessels and nerves.
The above factors modify the secretion of salivary flow by different
mechanisms including the interruption of autonomic nerve function, interference
with ductal cells of salivary glands, cytotoxicity causing indirect effects such as
vasoconstriction or vasodilation, and disturbance of fluid and electrolyte balance.
These can also cause physical trauma to the salivary glands and nerves.
Decrease in salivary flow in diabetic patients is caused by the increase in
diuresis which, in turn, is related to a marked reduction in extracellular fluid
directly affecting salivary production. Multiple physiologic factors can contribute
to the compromise of salivary function in diabetic adults with poor metabolic
control. As a result of metabolic dysregulation, diabetes mellitus often causes
hormonal, microvascular and neuronal alterations which compromise the
functionality of various organs. Microvascular alterations are capable of
compromising the ability of salivary glands to respond to neural or hormonal
stimulation. Besides, as salivary secretion is controlled by the autonomic nervous
system, it is possible that neuropathy can interfere with the ability of an individual
to respond to stimulation of the salivary glands, altering salivary flow and
composition. (Ana Carolina U, et al. 2010. Comparative study of the
concentration of salivary and blood glucose in type 2 diabetic patients. Journal of
Oral Science, Vol. 52, No. 2, 293-298)
In addition to adversely affecting salivary glands, diabetes causes blood
vessels to thicken, which in turn slows down the flow of blood to body tissues,
including the gums and dental bones. Good blood flow is essential to provide
important nutrients and eliminate harmful wastes from body tissues, including
tissues of the mouth. Lowered blood flow causes the gum and bone tissue that
support the teeth to become less healthy and less resistant to infection from the
bacteria found in dental plaque. (Anonim. 2012. Diabetes and Dry Mouth: How it
Adversely? Accessed at: December 4, 2012. Available from:)
http://www.dentistryfordiabetics.com/consumer/article-diabetes-and-dry-
mouth.pdf