Oral complications of diabetes mellitus and their underlying pathogenic mechanisms: a narrative review

Authors

  • Hamad Abdulsalam Hamad Alfarisi Department of Fundamental and Dental Medical Sciences, Kulliyyah of Dentistry, International Islamic University Malaysia, Kuantan, Pahang.
  • Samiullah Dowlath Saheb Department of Fundamental and Dental Medical Sciences, Kulliyyah of Dentistry, International Islamic University Malaysia, Kuantan, Pahang.

DOI:

https://doi.org/10.31436/ijohs.v7i1.395

Keywords:

diabetes mellitus, oral complications, pathogenic mechanisms

Abstract

Diabetes mellitus (DM) is a syndrome of abnormal carbohydrate metabolism causing tremendous mortality and morbidly worldwide. To date, there is no permanent curative treatment for diabetes and the patients have to rely on modification of their lifestyle and on the available timely medication. Understanding pathophysiology and complications of DM is crucial for clinicians and dental care providers in order to provide a proper management. Complications of DM are multisystemic with inevitable involvement of oral cavity. Diabetic patients have increased frequency of periodontitis, xerostomia, tooth loss, delay in wound healing, and impaired response to infection. Dental complications of DM exert medical, psychological, economical and national burden. This narrative review aims to outline the oral complications of DM and their underlying pathogenic mechanisms in the recent literature. The review concluded that; the commonest oral complications of DM are xerostomia, tooth decay, periodontal disease and gingivitis, oral candidiasis, altered taste sensation, oral mucosa alterations, and delayed wound healing. The important underlying pathogenic mechanisms include oxidative stress, alterations in salivary amylase protein, high level of sodium-glucose cotransporter 1 (SGLT1) protein, impaired neural structure and function, use of sodium glucose transporter 2 (SGLT2) inhibitor, the influence of the IL-23R gene polymorphism, and formation of advanced glycation end products (AGEP).

References

Akhtar, S., Nasir, J. A., Ali, A., Asghar, M., Majeed, R., & Sarwar, A. (2022). Prevalence of type-2 diabetes and prediabetes in Malaysia: a systematic review and meta-analysis. PLoS ONE, 17(1 January). https://doi.org/10.1371/journal.pone.0263139

Akil, A. A. S., Yassin, E., Al-Maraghi, A., Aliyev, E., Al-Malki, K., & Fakhro, K. A. (2021). Diagnosis and treatment of type 1 diabetes at the dawn of the personalized medicine era. Journal of Translational Medicine, 19(1). https://doi.org/10.1186/s12967-021-02778-6

Alawya, A., Catartika, V.R. (2024). Fungal infection characteristic in type 2 diabetic mellitus: narrative review. SAGO: Gizi dan Kesehatan, 5(3). http://dx.doi.org/10.30867/gikes.v5i3.1790

Bellou, V., Belbasis, L., Tzoulaki, I., & Evangelou, E. (2018). Risk factors for type 2 diabetes mellitus: An exposure-wide umbrella review of meta-analyses. PLoS ONE, 13(3). https://doi.org/10.1371/journal.pone.0194127

Bhat, A. R., Meghana, I. S. S., Thomas, B., Shenoy, N., Bhandary, R., & Sai Sreeja, S. (2021). Diabetes mellitus and potential oral complications – a review. Romanian Journal of Diabetes, Nutrition and Metabolic Diseases, 28(4), 453–462. https://doi.org/10.46389/rjd-2021-1066

Busa, P., Kuthati, Y., Huang, N., & Wong, C.-S. (2022). New advances on pathophysiology of diabetes neuropathy and pain management: potential role of melatonin and DPP-4 inhibitors. Frontiers in Pharmacology, 13. https://doi.org/10.3389/fphar.2022.864088

Chiang, J. L., Kirkman, M. S., Laffel, L. M. B., & Peters, A. L. (2014). Type 1 diabetes through the life span: a position statement of the American Diabetes Association. Diabetes Care, 37(7), 2034–2054. https://doi.org/10.2337/dc14-1140

Cui, Y., Zhang, H., Zhu, J., Liao, Z., Wang, S., & Liu, W. (2022). Correlations of salivary and blood glucose levels among six saliva collection methods. International Journal of Environmental Research and Public Health, 19(7). https://doi.org/10.3390/ijerph19074122

Dipalma, G., Inchingolo, F., Patano, A., Guglielmo, M., Palumbo, I., Campanelli, M., et al. (2023). Dental erosion and the role of saliva: a systematic review. European Review for Medical and Pharmacological Sciences, 27, 10651–10660.

Elsayed, N. A., Aleppo, G., Aroda, V. R., Bannuru, R. R., Brown, F. M., Bruemmer, D., et al. (2023). 2. classification and diagnosis of diabetes: standards of care in diabetes—2023. Diabetes Care, 46, S19–S40. https://doi.org/10.2337/dc23-S002

Fouani, M., Basset, C. A., Jurjus, A. R., Leone, L. G., Tomasello, G., & Leone, A. (2021). Salivary gland proteins alterations in the diabetic milieu. Journal of Molecular Histology, 52(5), 893–904. https://doi.org/10.1007/s10735-021-09999-5

Genco, R. J., & Borgnakke, W. S. (2020). Diabetes as a potential risk for periodontitis: association studies. Periodontology 2000, 83(1), 40–45. https://doi.org/10.1111/prd.12270

Gürsoy, U. K., Yilmaz, N., Yilmaz, D., Grönroos, S., & Gürsoy, M. (2024). Type 1 diabetes mellitus and host–bacterial interactions in the oral cavity. Current Opinion in Endocrine and Metabolic Research, 36. https://doi.org/10.1016/j.coemr.2024.100536

Ismail, L., Materwala, H., & Al Kaabi, J. (2021). Association of risk factors with type 2 diabetes: a systematic review. Computational and Structural Biotechnology Journal, 19, 1759–1785. https://doi.org/10.1016/j.csbj.2021.03.003

Kataria, R., Ishita, R., Anas, A., Pallavi, L., Chakraborty, P., Ajay, M., et al. (2019). Diabetes & dental health – a review. Saudi Journal of Medicine, 4(4), 313–316.

Kim, Y. J. (2023). Xerostomia and Its Cellular Targets. International Journal of Molecular Sciences, 24(6). https://doi.org/10.3390/ijms24065358

Kushwaha, J. S., Gupta, V. K., Singh, A., & Giri, R. (2022). Significant correlation between taste dysfunction and HbA1C level and blood sugar fasting level in type 2 diabetes mellitus patients in at a tertiary care center in north India. Diabetes Epidemiology and Management, 8. https://doi.org/10.1016/j.deman.2022.100092

Mainas, G., Nibali, L., Ide, M., Mahmeed, W. Al, Al-Rasadi, K., Al-Alawi, K., et al. (2023). Associations between periodontitis, COVID-19, and cardiometabolic complications: molecular mechanisms and clinical evidence. Metabolites, 13(1). https://doi.org/10.3390/metabo13010040

Mbembela, O., Ngarashi, D., & Nyamuryekung’e, K. K. (2023). Biochemical changes in salivary pH and its correlation to hemoglobin levels, calcium and phosphate ion concentrations among pregnant women, tanzania: a cross-sectional study. Oral, 3(3), 325–336. https://doi.org/10.3390/oral3030027

Ministry of Health Malaysia. (2020). National Diabetes Registry Report, 2013-2019. Available from: www.moh.gov.my

Nazir, M. A., Alghamdi, L., Alkadi, M., Albeajan, N., Alrashoudi, L., & Alhussan, M. (2018). The burden of diabetes, its oral complications and their prevention and management. Open Access Macedonian Journal of Medical Sciences, 6(8), 1545–1553. https://doi.org/10.3889/oamjms.2018.294

Nettore, I. C., Palatucci, G., Ungaro, P., Scidà, G., Corrado, A., De Vito, R., et al. (2024). Flavor and taste recognition impairments in people with type 1 diabetes. Nutrition and Diabetes, 14(1). https://doi.org/10.1038/s41387-024-00322-1

Rohani, B. (2019). Oral manifestations in patients with diabetes mellitus. World Journal of Diabetes, 10(9), 485–489. https://doi.org/10.4239/wjd.v10.i9.485

Santonocito, S., Polizzi, A., Marchetti, E., Dalessandri, D., Migliorati, M., Lupi, et al. (2022). Impact of periodontitis on glycemic control and metabolic status in diabetes patients: current knowledge on early disease markers and therapeutic perspectives. Mediators of Inflammation, 2022. https://doi.org/10.1155/2022/4955277

Sjöstrand, A. E., Sjödin, P., Hegay, T., Nikolaeva, A., Shayimkulov, F., Blum, M. G. B., et al. (2021). Taste perception and lifestyle: insights from phenotype and genome data among Africans and Asians. European Journal of Human Genetics, 29(2), 325–337. https://doi.org/10.1038/s41431-020-00736-2

Smith, S., Normahani, P., Lane, T., Hohenschurz-Schmidt, D., Oliver, N., et al. (2022). Prevention and management strategies for diabetic neuropathy. Life, 12(8). https://doi.org/10.3390/life12081185

Teeuw, W. J., F Kosho, M. X., W Poland, D. C., A Gerdes, V. E., & Loos, B. G. (2017). Periodontitis as a possible early sign of diabetes mellitus. BMJ Open Diabetes Research and Care, 5, 326. https://doi.org/10.1136/bmjdrc-2016

Tomic, D., Shaw, J. E., & Magliano, D. J. (2022). The burden and risks of emerging complications of diabetes mellitus. Nature Reviews Endocrinology, 18(9), 525–539. https://doi.org/10.1038/s41574-022-00690-7

Turner, C., & Bouloux, P.-M. (2023). Diabetes mellitus and periodontal disease: education, collaboration and information sharing between doctors, dentists and patients. British Journal of Diabetes, 23(1), 35–38. https://doi.org/10.15277/bjd.2023.403

Velasco-Ortega, E., Delgado-Ruiz, R. A., & López-López, J. (2016). Dentistry and diabetes: the influence of diabetes in oral diseases and dental treatments. Journal of Diabetes Research, 2016. https://doi.org/10.1155/2016/6073190

WHO (2023). World Health Statistics 2023 Monitoring health for the SDGs Sustainable Development Goals Health for All. Retrieved from, https://www.who.int/publications/i/item/9789240074323

Downloads

Published

2026-02-28

How to Cite

Alfarisi, H., & Saheb, S. D. . (2026). Oral complications of diabetes mellitus and their underlying pathogenic mechanisms: a narrative review. IIUM Journal of Orofacial and Health Sciences, 7(1), 62–69. https://doi.org/10.31436/ijohs.v7i1.395