International Journal of Orofacial Research

: 2017  |  Volume : 2  |  Issue : 1  |  Page : 28--31

Awareness on oral disorders in diabetes mellitus among general population in Chennai

Gayathri Devi Kumaresan1, M Subha2,  
1 CRI, Saveetha Dental College and Hospital, Chennai, Tamil Nadu, India
2 Department of Oral Medicine and Radiology, Saveetha Dental College, Saveetha University, Chennai, Tamil Nadu, India

Correspondence Address:
Gayathri Devi Kumaresan
Saveetha Dental College and Hospital, Chennai, Tamil Nadu


Objective: To evaluate the awareness on oral manifestation of diabetes in general population in Chennai. Background: Diabetes mellitus (DM), according to the World Health Organization is a silent epidemic which affects large number of people around the world and is directly related to the oral health status of the patients. DM is a metabolic disorder of multiple etiologies due to disturbances of carbohydrate, fat, and protein metabolism. It is characterized by chronic hyperglycemia, and it is associated with oral disorders, cardiovascular, and renal complications. These complications result in diminished quality of life and reduced life expectancy. Although dental caries was comparatively low in diabetics, periodontal status was compromised. Awareness on diabetes and increase risk of oral disorders in diabetic patient is comparatively less than awareness on systemic diseases in general population. Hence, this study was conducted to evaluate awareness and educate them by reinforcing the importance of oral health care in diabetes. Methodology: A total of 159 self-completion questionnaires were distributed to assess the main objectives of the study. Results: The awareness of public toward increased risk for oral diseases in diabetes is low compared to their awareness of systemic diseases. On average, only 41.8% people is aware of an oral complication of DM, which is very low and 58.2% of population is unaware of a complication of DM. Conclusion: People were found to have little knowledge on oral manifestation of DM. To promote proper oral health and to reduce the risk of oral diseases, health professionals in both the dental and medical fields need to take the responsibility to develop programs to educate the public about the oral manifestations of diabetes and its complications on oral health.

How to cite this article:
Kumaresan GD, Subha M. Awareness on oral disorders in diabetes mellitus among general population in Chennai.Int J Orofac Res 2017;2:28-31

How to cite this URL:
Kumaresan GD, Subha M. Awareness on oral disorders in diabetes mellitus among general population in Chennai. Int J Orofac Res [serial online] 2017 [cited 2021 Dec 9 ];2:28-31
Available from:

Full Text


Diabetes mellitus (DM) is chronic metabolic disorders characterized by incompatible blood hyperglycemia, due to the failure of the pancreatic beta cells to produce insulin and/or inability of the body to use the insulin produced because of insulin resistance in the body cells. DM is a growing problem worldwide, it affects 5% of the world's population, and the number of cases is doubling every generation.[1] In fact, the prevalence of DM has been increasing worldwide at such a rate that recently the World Health Organization (WHO) declared the disease an epidemic. Worldwide, the number of estimated cases of DM has increased from 30 million in 1985 to 135 million in 1995.[2] Furthermore, the WHO reported that by the year 2030 the number of estimated cases of DM is jutting to increase to 366 million. In most part of the world, this increase is directly attributed to a genetic predisposition to the disease and also to lifestyle changes that modern development has brought on, such as a high-sugar diet, physical inactivity, obesity, as well as other etiological factors.

Uncontrolled diabetic patients will be at high risk of systemic and oral complications. The most common chronic manifestations are vascular diseases that include coronary artery, peripheral vascular and cerebrovascular diseases. In addition, microvascular complications manifest as retinopathy, neuropathy, and nephropathy among others. Examples of acute complications are diabetic ketoacidosis, hyperosmolar hyperglycemia, as well as other acute infections.[3] In terms of its oral consequences, diabetes manifests itself in several ways. When DM is left uncontrolled for an extended period, for example, it negatively affects the salivary glands and results in xerostomia or sialosis.[4],[5],[6],[7],[8] When not enough saliva is produced to wash and cleanse the oral cavity, plaque, and debris accumulate at a much faster rate.[9],[10]

In addition to periodontitis, persistent poor glycemic control has been associated with increased incidence and progression of gingivitis and alveolar bone loss,[11],[12] salivary gland dysfunction,[13],[14] taste disturbances,[15] and orofacial neurosensory disorders (e.g., burning mouth syndrome [BMS]).[16] People with diabetes have also been shown to be at greater risk of developing certain oral mucosal disorders such as lichen planus, recurrent aphthous stomatitis, and oral fungal infections.[17] There is also evidence that people with diabetes have an increased risk of oral cancer and oral premalignancies.[18] Awareness on diabetes and increase risk of oral disorders in a diabetic patient is comparatively less than awareness on systemic diseases in general population. Hence, this study was conducted to create awareness and educate them by reinforcing the importance of oral health care in diabetes.


A cross-sectional study was conducted among the general population of Chennai. A total of 200 people in the age group 16–75 years were selected using random sampling technique Informed consent was obtained from each person. A self-completion questionnaire was utilized to assess the main aims of the study [Figure 1].{Figure 1}

The questionnaire included information related to the patient's name, age, gender, occupation, and residential area. It was further categorized to evaluate their awareness on oral complications associated with diabetes. The completed questionnaires were then analyzed statistically to obtain the results in terms of percentages.


A total of 149 patients out of 200 fulfilling the inclusion and exclusion criteria were enrolled into the study. Sixty-nine (46.3%) were males and 80 (53.7%) were females. The median age of the included patients was 55.00. Regarding people's knowledge and awareness of oral complications associated with diabetes; results were represented as bar diagram [Figure 2], [Figure 3], [Figure 4].{Figure 2}{Figure 3}{Figure 4}

More than half of the included patients (55.7%) were not aware that diabetic patients are more prone to oral diseases. Only less than half of them (37.6%) and (44.9%) knew that diabetes cause gingivitis and affect periodontium consequently.

More than half of the included patients (56.4%) did not know that diabetes cause dry mouth. Only less than half of the people (38.2%) knew that diabetes cause halitosis. The study showed that most of the patients (85.2%) were not aware that diabetes cause BMS.

More than half of the included patients (65.8%) did not know that diabetes cause oral fungal infection. Only less than half of the people (38.2%) knew that diabetes cause dental caries. The study showed that most of the patients (96.6%) were aware that diabetes cause delayed wound healing. Results were represented in [Table 1].{Table 1}


Increasing amount of evidences indicate that patient education is one of the most effective ways to decrease the complications of diabetes.[19] The results of this study vividly highlight that patients' lack knowledge about the relationship of diabetes and oral health. This statement is in agreement with Sandberg et al., Kamel et al., Masood Mirza et al., and Awartani.[20],[21],[22],[23]

According to this study, 44% of the members were aware that diabetes can lead to oral complications. This is in accordance with the study reported by Faten MR et al., on the other hand, 47.7% showed positivity toward awareness of oral diseases caused by diabetes Jayanthi et al. reported about 58% awareness among the residents of Bengaluru which is comparatively higher than the study conducted by us.[24],[25],[26],[27],[28],[29]

Thirty-eight percent of people are acquainted with the knowledge that gingivitis is a manifestation of DM, which is similar to the study by Faten et al. Fatin et al. stated that 30% of diabetic patients having bleeding on brushing. This study also proved that diabetic patients are at high risk of developing periodontal diseases. About 44.9% of participants have adequate knowledge that diabetes could cause periodontitis.

About 65% of attendants were familiar that xerostomia is caused by DM. Fifty-seven percent of the contributors were aware halitosis occurs in diabetes. Ninety-seven percent of the population is aware of delayed wound healing which is probably because they do know any ulcer in their body/feet will take the time to heal. Among the study group, more than half 51% of participants were acquainted with knowledge that diabetics are prone to infection and 57% of people were familiar that dendritic cell occurs in diabetes. This was inconsistence with study conducted by Ismaei and Ali that only 39.2% of participants know that diabetes can cause oral fungal infection and 46.1% of participants aware of diabetes can cause dental caries.[30]


People are less informed the risk for dental diseases in comparison with their knowledge of their increased risk for systemic diseases in DM. Thus, it is necessary for dental professionals and related government medical agencies to promote awareness of the relationship between DM and oral heath to prevent harmful complications. Education programs to increase public awareness as a first step to prevent the disease and long-term complications. Health professionals in both the dental and medical fields and as well as the nutritionists need to take the responsibility to develop programs to educate the public about DM and the serious oral and systemic complications of the disease.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


1King H, Aubert RE, Herman WH. Global burden of diabetes, 1995-2025: Prevalence, numerical estimates, and projections. Diabetes Care 1998;21:1414-31.
2Smyth S, Heron A. Diabetes and obesity: The twin epidemics. Nat Med 2006;12:75-80.
3Skamagas M, Breen TL, LeRoith D. Update on diabetes mellitus: Prevention, treatment, and association with oral diseases. Oral Dis 2008;14:105-14.
4Sheppard IM. Oral manifestation of diabetes mellitus: A study of one hundred cases. J Am Dent Assoc 1942;29:1188-92.
5Lamey PJ, Darwazeh AM, Frier BM. Oral disorders associated with diabetes mellitus. Diabet Med 1992;9:410-6.
6Russotto SB. Asymptomatic parotid gland enlargement in diabetes mellitus. Oral Surg Oral Med Oral Pathol 1981;52:594-8.
7Murrah VA. Diabetes mellitus and associated oral manifestations: A review. J Oral Pathol 1985;14:271-81.
8Greenspan D. Xerostomia: Diagnosis and management. Oncology (Williston Park) 1996;10 3 Suppl:7-11.
9Rees TD. The diabetic dental patient. Dent Clin North Am 1994;38:447-63.
10Finney LS, Finney MO, Gonzalez-Campoy JM. What the mouth has to say about diabetes. Careful examinations can avert serious complications. Postgrad Med 1997;102:117-26.
11Taylor GW, Burt BA, Becker MP, Genco RJ, Shlossman M. Glycemic control and alveolar bone loss progression in type 2 diabetes. Ann Periodontol 1998;3:30-9.
12Grossi SG. Treatment of periodontal disease and control of diabetes: An assessment of the evidence and need for future research. Ann Periodontol 2001;6:138-45.
13Chavez EM, Borrell LN, Taylor GW, Ship JA. A longitudinal analysis of salivary flow in control subjects and older adults with type 2 diabetes. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;91:166-73.
14Gilbert GH, Heft MW, Duncan RP. Mouth dryness as reported by older Floridians. Community Dent Oral Epidemiol. 1993;21:390-7.
15Settle RG. The chemical senses in diabetes mellitus. In: Getchell TV, Doty RL, Bartoshuk LM, Snow JB Jr., editors. Smell and Taste in Health and Disease. New York: Raven Press; 1991. p. 829-44.
16Moore PA, Guggenheimer J, Orchard T. Burning mouth syndrome and peripheral neuropathy in patients with type 1 diabetes mellitus. J Diabetes Complications 2007;21:397-402.
17Guggenheimer J, Moore PA, Rossie K, Myers D, Mongelluzzo MB, Block HM, et al. Insulin-dependent diabetes mellitus and oral soft tissue pathologies: II. Prevalence and characteristics of Candida and candidal lesions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;89:570-6.
18Auluck A. Diabetes mellitus: An emerging risk factor for oral cancer? J Can Dent Assoc 2007;73:501-3.
19Shah VN, Kamdar PK, Shah N. Assessing the knowledge, attitudes and practice of type 2 diabetes among patients of saurashtra region, Gujarat. Int J Diabetes Dev Ctrie 2009;29:118-22.
20Sandberg GE, Sundberg HE, Wikblad KF. A controlled study of oral self-care and self-perceived oral health in type 2 diabetic patients. Acta Odontol Scand 2001;59:28-33.
21Kamel NM, Badawy YA, el-Zeiny NA, Merdan LA. Sociodemographic deteminants of management behaviour of diabetic patients. II. Diabetics' knowledge of the disease and their management behavior. East Mediterr Health J 1999;5:974-983.
22Kamran M, Ayyaz A, Munawarm and Saima Ch. Oral health knowledge, attitude, practices and sources of information for Diabetic Patients in Lahore Pakistan. Diabetes Care 2007:30:3046-47.
23Allen EM, Ziada HM, O'halloran D, Clerehugh V, Allen PF. Attitudes, awareness and oral health-related quality of life in patients with diabetes. J Oral Rehabil 2008;35:218-23.
24Greenstein. Princible of Practical periodontics: A review of core periodontal treatment. Dent Today 2008; 27;66, 70-73.
25Moore PA, Orchard T, Guggenheimer J, Weyant RJ. Diabetes and oral health promotion: A survey of disease prevention behaviors. Jada 2000;131:1333-41.
26Dinesh DK, Palaian S, Shankar R, Mishra P. Knowledge, attitude and practice about diabetes among diabetes patients in Western Nepal. Rawal Med J 2008;33:1.
27Awartani F. Oral health knowledge and practices in Saudi diabetic female patients. Pakistan Oral & Dental Journal 2009;29:1.
28Al Habasneh R, Khader Y, Hammad, Mm, Almuradi M. Knowledge and awareness about diabetes and periodontal health among jordanians. Journal of Diabetes and its Complications 2010;24:409-14.
29Jayanthi D, Bajaj P, Srivastava N, Prakash N, Karanjkar A, Prathima B. Evaluation of awareness regarding diabetes mellitus and its association with periodontal health: A cross sectional study. Journal of International Oral Health 2016;8:508-11.
30Faten MR. Ismaei, Ali N. Diabetic Patients Knowledge, Attitude and Practice toward Oral Health. Journal of Education and Practice 2013;4:20.