D AMANJ 95-109

(KAJ) Kurdistan Academicians Journal, March 2006, 4(1) part A (1) ذ4 ,بةرط2006 ئازارى2706 نةوروزى كوردستان ئةكاديميانى طؤظارى

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Oral Manifestations of Type Two Diabetes Mellitus

Amanj Abobakir khaznadar and Bakhtiar Mahmmoud

Department of Medicine, College of Medicine Kurdistan Region / Iraq.

Faiq M.Ameen,College of Dentistry University of Sulaimani, Kurdistan Region / Iraq.

Abstract Oral manifestations studied in 257 diabetic patients; (137) admitted to hospital for various illnesses & (120 patients) visiting consultation clinic for follow up examination.Among the patients 240 were type II & 17 were type I, which were excluded from the study.Oral manifestation observed in these patients includes: Periodontal disease (82.75%), xerostomia or dry mouth (75%), oral soreness or burning mouth syndrome (32.5%), taste alteration (53.33%), oral candidiasis (58.33%), dental caries (4.96 teeth per patient), tooth loss (12.5 teeth per patient ), lichen planus (1.25%) tempromandibular joint dysfunction (19.16%) , other oral lesions (15%) , varicositis (19.16%). Oral manifestations of the diabetic patients ( 240 ), were compared to oral diseases in non-diabetic ( control group ) individuals ( 240 ) , which showed statistically significantly higher prevalence in patients with diabetes. Diabetes mellitus is one of major risk factor for orodental diseases in this country. Diabetes mellitus may be diagnosed for the first time in the dental clinic from these oral manifestations.

Keywords: -Diabetes mellitus, periodontal disease, Dental caries .

Introduction

It is the third leading cause of death after heart disease & cancer. Characterized by: hyperglycemia & increase urine output leading to dehydration ,increased thirst & water consumption, inability to utilize glucose energy eventually leads to weight loss despite an increase in appetite, Disturbances of carbohydrate, fat and protein metabolism, associated with absolute or relative deficiency in the secretion and/or action of insulin [1].

Diabetes mellitus is classified to two main types: Class one insulin-dependent or, juvenile-onset diabetes (IDDM).

Class two non-insulin-dependents, adult-onset diabetes (NIDDM). Risk factors are: family history, pregnancy, insulin resistance, obesity , certain drugs, infection,& trauma[2] . There are increasing reports in recent litreture on the prevalne of dental & periodontal complications in both NIDDM & IDDM.The aims of this study are: 1- Prevalence of oral manifestations of diabetes mellitus type two in Sulaimani region. 2- To put into consideration the possibility of early diagnosing diabetes mellitus from oral manifestations in dental clinics.

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3-To compare the extent of oral manifestations between diabetic patients and non diabetic individuals.

4-To compare the prevalence of oral manifestations in various diabetic status such as:a- Hospitalized and non hospitalized diabetic patientsb- Patients and duration of diseasec- Smokers and diabetic non smokers.d- Dentulous and edentulous diabetic patients.e- Poor controlled and diabetic good controlled.f- Patient and different age groups.

Material and Methods: Two hundred fifty seven diabetic patients seen in this study. Twelve of them detected from their oral manifestations. Two hundred forty five (245) of them detected by their physicians. Seventeen with type one diabetes mellitus, and they were excluded from the study. Two hundred forty (240) type two diabetes mellitus entered the study, (168 female and 72 males, and their ages ranging from 29-87 years). The patients were divided in to two groups:

(1) - One hundred twenty (120) hospitalized diabetic patients.Who were admitted to Sulaimani general hospital for various diseases and complications of diabetes mellitus.

(2) - One hundred twenty (120) non hospitalized diabetic patients these included:

One hundred eight (108) non hospitalized patients attending Ali Kamal primary health care center, for follow up examination. Twelve (12) non hospitalized diabetic patient diagnosed from their oral manifestations during searching for non diabetic individuals (control group), and from (Specialist consultation clinic of Sulaimani) when patients asking for management of various medical needs. Two hundred forty 240 non-diabetic patients are the control group included (168 female and 72 males, their ages ranged from 29-87 years), attending hospital for other diseases.Patients subjected to random single oral examinations. The statistical significance of the differences between these groups of subjects was tested by (categorical data contingency tables). The significance of the differences in the distribution of categorical variables between groups was tested using the chi-square test.

Results: Categorizations: Intraoral examination of the diabetes mellitus patients (257) revealed that the patients could be categorized, for the purpose of comparison of the prevalence and severity of their oral manifestation, according to the followings: 1- Non diabetics (240 individuals).2- Type one diabetics (17 patients).3- Type two diabetics (240 patients). Type two diabetics subdivided in to: (A-) 1- Hospitalized diabetic patients (120 patients)

2- Non-hospitalized diabetic patients (120 patients, 12 of them detected from their oral manifestations). (B-) 1- Poorly controlled diabetic patients (48 patients).

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2-Well controlled diabetic patients (48 patients).(C-) 1- Duration of the disease for ≤ 5 years (115 patients). 2- Duration of the disease for more than 5 years (115 patients).(D-) 1- Smoker diabetic patients (50 patients). 2- Non-smoker diabetic patients (50 patients).(E-) 1- Edentulous diabetic patients (66 patients). 2- Dentulous diabetic patients (50 patients). (F-) Diabetic Age groups: 1- (29-45) years (24 patients) 2- (46-65) years (24 patients) 3- (66-87) years (24 patients). (G-) Sex prevalence: One hundred sixty eight patients out of 240 diabetic patients were female and the rest were male. The prevalence and intensity of the following oral manifestations were analyzed for comparison in each of the above mentioned categories individually: periodontitis, dry mouth, mouth soreness ,taste disturbance, oral candidiasis, dental caries and fillings, tooth loss and replacement ,oral lesions, lichen planus, and varicosities.

Investigations used for diagnosis of oral diseases

1- Dental X-ray. 2- Direct microbiological examination of sputum using gram stain technique. Investigations used for diagnosis and management of diabetes mellitus: 1- Symptoms of diabetes mellitus + casual plasma glucose concentration.

2- Fasting plasma glucose more or = 126mg\dl. 3- Postprandial blood sugar =200 mg\dl. Oral manifestations of diabetic patients type two: From 240 diabetic patients (168 females and 72 males) and 240 non diabetic persons (168 female and 72 males).we found the following oral manifestations and oral findings :

Discussion As long as periodontal problems are rare before age of twenty, which is the age of type one diabetes mellitus, so we excluded in our study patients with type one diabetes mellitus. DM detected by oral manifestations:

In our study 12 patients were detected from their oral manifestations.

Oral health care workers are often the first to detect undiagnosed or untreateddiabetes mellitus because of its oral manifestations .The oral manifestations of diabetes mellitus include periodontal disease, burning mouth syndrome, candidiasis, and xerostomia[3The oral signs and symptoms of glossodynia and xerostomia present a diagnostic problem for the clinicians, one of the etiologic considerations in the differential diagnosis should be diabetes mellitus.We found more decayed teeth in diabetic patients. Increased caries incidence in diabetic patients has been attributed partially to decreased salivary flow and increased level of carbohydrates in the parotid saliva.

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Table 1: Oral manifestations and findings of diabetic patients and non diabetic persons:

Oral manifestations

non diabetic persons %

diabeticpatients %

p value

Periodontitis

57.83 82.75% 0.0019 Sig.

Oral candidiasis

28.33 58.33 0.001 Sig.

Dry mouth 56.66 75 0.0012 Sig.

Burning mouth

18.33 32.5 0.0019 Sig.

Taste disturbance

28.23 53.33 0.001 Sig.

TMJ dysfunction

4.58 19.16 0.0098 Sig.

Other oral lesions

9.58 23 0.07 Sig.

Varicosities 12.5 19.16 0.045 Sig.

Lichen planus

-------- 1.25 Non Sig.

No. of teeth/patient

No. of dental caries per

patient

4 5

No. of teeth loss per patient

11 13

Fillings 22.89% 17.24%

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Teeth replacement

16.85 11.49%

The following are pictures of our patients with some oral manifestations.

Table 2 : Percentages and significance of oral manifestations of diabetics, control group in our study and diabetics in other studies:

Oral manifestations and findings

Control group % Diabetic patients %

Our results

Other results

Periodontitis 57.83% 82.75% 85.1%[4]70 %[5]

Oral candidiasis 28.33% 58.33% 49%[6] 75%[7]

Dry mouth: 56.66% 75% 76%[8] 40% -80%[9]

Burning mouth: 18.33% 32.5% 37%[10]28.6%[11]

Taste disturbance:

28.23% 53.33% 42.8%[11]

Dental caries: 4.2 teeth per patient

4.96 teeth per

patient

Teeth loss 10.71 teeth per person.

12.5 teeth per

patient.

(12.3)[17] teeth per patient

Tempromandibular joint dysfunction:

4.58%. 19.16%. 27%[15]

Lichen planus: (not present) 1.25% 2.83%[17]

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Varicosities: 12.5% 19.16% 27.1%[18]

Other oral lesions:

Discoloration (white,blue,red,black patches )

9.58% %15 More[16] .

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( Table 3 ): General Comparisons of our diabetic patients according to age, hospitalization, smoking , dental health:

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1- Periodontitis: control our study other studies 57.83% 82.75% 85.1% [5], 70 % [5]

Advanced periodontal diseases and tooth mobility occur in 70% of diabetic patients.

2- Oral candidiasis: control our study other studies 28.33% 58.33% 49% [6] 75%

Other study also reported that diabetic people have an increased predisposition for oral candidiasis including median rhomboid glossitis, denture stomatitis and angular cheilitis.

3- Dry mouth: control our study Other studies found

6.66% 75% 76%[8] 40% -80%[9]

Oral dryness in diabetic patients is due to hyperglycemia, which leads to polyuria and can result in dehydration like saliva (changes in composition of saliva, decrease salivary flow rates and increase salivary glucose level).

4- Burning mouth: control our study Other studies found

18.33% 32.5% 37%[10]

28.6%[11]

Diabetic patients are more susceptible to candidial infection, and vascular changes occur in diabetic, cause changes of small blood vessels in the mouth and there by lower pain threshold.

5- Taste disturbance: control our study other studies found

28.23% 53.33% 42.8%[11]

6- Dental caries: control ( 4.2 teeth per patient) our study (4.96 teeth per

patient)

Fillings 22.89% 17.24%

Elevated salivary glucose level changes in saliva formation and

composition and xerostomia may predispose to dental caries.

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High concentration of salivary calcium and glucose, hyperglycemia and a lower resistant to infections are main factor contributing to dental caries.7- Tooth loss and replacement: A-Partial tooth loss: 10.71 teeth per

person. 12.5 teeth per patient.

Other studies found (12.3) [12] teeth per patient. High concentrations of salivary calcium and glucose, hyperglycemia and a lower resistance to infections, are main factors contributing to periodontal disease and dental caries, so prevalence of caries and periodontal disease among diabetes mellitus were increased, and because dental caries and periodontal disease are main reason for tooth extraction, so diabetes mellitus is a risk factor for teeth loss. B-Complete teeth loss: Other studies, they found that edentulism showed to be significantly related to diabetes mellitus [13] . Other studies also found that the percentage of tooth lost significantly greater in diabetic patients than in non diabetic one[14], this may be due to increasing desire for wearing dentures among our non diabetic population, or may be due to diabetic patients have fears regarding dental procedures, or a good number of dentists have fear in treating diabetic patients (uncontrolled bleeding and delayed healing) and these are due to a poor understanding of the pathophysiology of diabetes.8-Tempromandibular joint dysfunction:

Control 4.58% our study 19.16%. Other studies found 27%[15] Abnormalities in the alignment of teeth due to teeth loss (if not replaced) that is

more common in diabetic patients, lead to unbalanced biting surfaces, that are causing tempro mandibular joint problems.9-Other oral lesions: control 9.58% our study %15 Other studies found that no oral mucosal differences existed between the diabetes and control groups [16]. Oral lesions may be due to hyposalivation and deficient hygiene.10-Lichen planus: (control) our study other studies(notpresent) 1.25% 2.83%[17] Some antidiabetic drugs can produce lesions clinically similar to lichen planus, the so-called lichenoid reaction. Lichen planus may be a side effect of oral hypoglycemic agents or antihypertensive medications, immunological defect and deficient leukocyte functions.11-Varicosities:

Control our study other studies 12.5% 19.16% 27.1% [18].

During evaluating oral manifestations of geriatric patients, observed the main lesions to be varicosities of the tongue and Fordyce granules. These alterations were not associated to other systemic problems, as also observed in our study [19]. The diabetic statuses are multifactorial and most evidently, not all diabetic patients are at equal risk for oral diseases, and more attention has recently been paid to possible diabetes-related risk factors to identify subjects who are more prone to oral manifestations. These factors are: a- The duration of diabetes. b- Age at diagnosis of diabetes. c- The presence of diabetic organ complications.

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d- The level of metabolic control. The results of these studies, however, have still been inconsistent, possibly because of methodological differences and differences in the characteristics of the study populations, such as the type of diabetes, the level of metabolic control, the duration of diabetes and the age range of the subjects. Comparison: 1- Diabetic patients and non diabetic individualsAs already pointed out, comparisons between patients with diabetes and control support that diabetes is a risk factor with respect to oral manifestations. 2- Hospitalized and non-hospitalized diabetic patients. We found prevalence of percentage of all oral manifestations in hospitalized patients in comparison with non-hospitalized patients, although they are statistically not significant, and this may be due to presence of all hospitalized diabetic patients with systemic complications that may reflect poor control of the disease. Our result is similar to other studies done by (Dean Schillinger ) he found that diabetic patients with low literacy and low outcome, are twice as likely as patients with higher literacy and higher outcome, to have poorly controlled blood sugar and serious long-term diabetes complications. 3- Poor and well controlled diabetics: Diabetes mellitus especially when poorly controlled increases the risk of periodontitis[20][21]. Increasing in the prevalence and extent of periodontitis with poorer control of diabetes was observed [22] . Periodontitis also progresses more rapidly in poorly controlled diabetics [23]. Diabetics with poor metabolic control and calculus also had more periodontitis[24].

Dry mouth in controlled diabetic patients 68.6% and in uncontrolled 82.8%[25]. Taste alteration in controlled 28.6% uncontrolled 42.8%[25] . Taste alterations may be more common in people with uncontrolled diabetes mellitus [9].Poorly controlled diabetics have high risk for oral candidiasis[23]. In poorly controlled diabetics, the rate of candida growth found high[24]. 4- Long-duration diabetics: Long-duration diabetics have more periodontitis and tooth loss than well controlled or non-diabetics [25]. Patients with long duration of diabetes had more manifest caries lesions (p=0.05)[26]. But other studies found that there is no any difference found in the periodontal condition related to the duration and control of diabetes [27]. Dental caries among diabetes mellitus was found in 79% with no significant relation to age of patient or duration of illness [28]. There was no difference in the caries experience regarding duration of diabetes, diabetic control, or diabetic complications [21]. No differences in candidial status could be detected according to the degree of control of diabetes, mode of treatment, duration of diabetes and the patient's age [28]. 5- Smoker and non smoker diabetics: Risk factors, such as smoking, have a profound effect on the predisposition to periodontal disease. There is now a clear association between smoking and periodontal diseases, independent of oral hygiene, age, or any other risk factor[10]. Among smokers definitely have more periodontal problems than non-smokers[25]. People with diabetes who smoke reported more symptoms of dry

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mouth[31], candidiasis in diabetic smokers is more than non-diabetic smokers[29]. Cigarette smoking is a risk factor for adult periodontitis and tooth loss[30]. Smoking was associated with an increased prevalence of the yeast in diabetes mellitus[28]. Smoking exerts an effect on the vasculature. Smokers usually present with relatively severe and widespread disease, smokers have been reported to have less bleeding and inflammation than nonsmokers. Tobacco smoke contains cytotoxic and vasoactive substances, including nicotine that has been shown to mediate these local effects. The systemic effects of cigarette smoking are well documented and include inhibition of peripheral blood and oral neutrophil function, reduced antibody production, and alteration of peripheral blood immunoregulatory T-cells. Conclusions 1- It is hoped that from oral manifestations more patients with diabetes mellitus may be diagnosed for the first time in the dental clinic.

2- Diabetic status effect on the severity and prevalence of oral manifestations, more prevalence of many of the oral manifestations were observed in: a- Complicated diabetic hospitalized patients. b- Poorly controlled diabetic patients. c- Long standing diabetic patients. d- smoker diabetic patients. e- Edentulous diabetic patients.

Recommendations: 1- Needs for promotion of appropriate dental preventive and dental services. 2-All patients with diabetes mellitus

should be fully informed of the risks of oral infections.

3- It is important for dentists to be familiar with the medical management of patients with diabetes mellitus and to recognize the sign and symptoms of undiagnosed or poorly controlled disease.

References 1- McCance DR, Hanson RL, Pettitt DJ, Bennett PH, Hadden DR, Knowler WC.

Diagnosing diabetes mellitus:do we need new criteria? Diabetologia 1997; 40: 247-55.

2- Dr. Jaime S. Rubin Assistant Dean Research Administration college of physicians and Surgeons Health Sciences campus Columbia University college of P & S Complete Home Medical Guide diabetes and other Endocrine Disorders

http:// www. Diabetic- lifestyle. Com/ articles/ nov 98- whats- 1.html#top3- Garg, A.K.; Duarte, F.; Lopez, E. Journal of Practical Hygiene. 7(5): 49-54.

1998.4- Ackerman BH, Kasbekar N. Disturbances of taste and smell induced by drugs.

Pharmacotherapy 1997; 17:482- 96.5- Deems DA, Doty RL, Settle RG, Moore- Gillon V, Shaman P, Mester AF, et al.

Smell and taste disorders, a study of 750 patients from the University of

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Pennsylvania Smell and Taste Center. Arch Otolaryngol Head Neck Surg 1991; 117: 519- 28.

6- Schiffman SS. Taste and smell losses in normal aging and disease. JAMA 1997; 278: 1357- 62.7- Seppala B, Seppala M, Ainamo J. A longitudinal study on insulin dependent

diabetes mellitus and periodontal disease. J Clin Periodontal 1993; 20:161-165

8- Schiffman SS, Wedral E. Contribution of taste smell losses to the wasting syndrome. Age Nutr 1996 ; 7:106-20.

9- Ackerman BH, Kasbekar N. Disturbances taste and smell induced by drugs. Pharmacotherapy 1997; 17:482-96.

10- Ship JA,Grushka M, Lipton JA, et al.Burning mouth syndrome: An update. J Am Dent Association 1995 ; 843: 126-35.

11- Wilkins EM: Clinical practice of the Dental hygienist,1999,8th ed.12- Bacic M, Ciglar I, Granic M, Plancak D, General Virology 1995; 76 : 2801 ...

134. J. Sutalo, Patologija i terapija tvrdnih zubnih .13- Edentulism and diabetes mellitus in the Japanese-Brazilian population in Bauru,

SP – Brazil 2002.14- J Dent Hyg 1994 Nov- Dec ; 68 (6): 287- 93. PIDM: 8962998 [PubMed-

indexedfor MEDLINE] HTMLCONTROL forms. HTML :Checkbox. 1"http:// www.ncbi.nlm.nih.gov;80/entrez/query.fcgi?Dp=PubMed&cmd=Display& dopt= pumed pubmed & fromuid=8962998 & DP=PubMed.15- Falk H, Hugoson A, Thorstensson H. Number of teeth, prevalence of caries andperiapical lesions in insulin- dependent diabetics. Scand J Dent Res1989; 97:198- 20616- Cherry- Peppers G, Ship JA. Epidemiology and Oral Disease Prevention

Program, National Institute of Dental Research, Bethesda, Maryland 20892. Diabetes Care, Vol 16, Issue 4 638-641, Copyright © 1993 by American Diabetes Association

17- Van Dis ML parks ET. Prevalence of oral lichen planus in patients with diabetes mellitus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995;79:696-700.

18- Guggenheimer J, Moore PA, Rossi K, et al. Insulin- dependent diabetes mellitusand oral soft tissue pathologies, II: prevalence and characteristics of candida andcandidal lesion. Oral surg Oral Med Oral Pathol Oral Radiol Endod 2000; 89:570-6.19- Birman EG, Silveira FRX, Sampaio MCC: Study of oral mucosal lesion ingeriatric patients. Rev Fac Odontol FZL1991; 3: 17-25,20- ampbell, Neil A., Biology, 4th edition (Menlo Park, California: The Benjamin/Cummings Publishing Company, Inc., 1996), p. 930.21- Collin hL , Uusitupa M, Niskanen L, Koivisto AM, Markkanen H, Meurma JH,

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Caries in patients with non- insulin- dependent diabetes mellitus.Oral Sugar Oral Med Oral pathol Oral Radiol Endod 1998; 85:680-5.22- Rees TD.Periodontal management of the patients with diabetes

mellitus.Periodontal 2000; 23(1):63-72.www.ncbi.nlm.nih.gov/entrez/query.fcbi? CMD=Display&db=PubMed23- Petrou- Amerikanou C, Markopoulos AK, Belezi M, Karamitsos D,

PapanayotouP.Prevalence of oral lichen planus in diabetes mellitus according to the type ofDiabetes. Oral Dis 1998; 4:37-40.24- Westfelt E, Raylander H,Blohme G, Jonasson P, Lindhe J. The effect of

periodontal therapy in diabetics. Results after 5 years. J Clinical Periodontal 1996; 23 (2):92-100.

25- Scully C, ElKom M. Lichen planus: review and update on pathogenesis. Jpathogenesis. J oral pathol 1985 : 431- 45826- Rees TD. Periodontal management of the patient with diabetesmellitus.Periodontal 2000;23 (1) :63-72.27- Firattli E.The relationship between clinical periodontal status and insulin-

dependant diabetes mellitus.Results after 5 years.J periodontal 1997; 68 (2):136-40

28- Tapper- Jones LM, Aldred MJ, Walker DM, HayesTM. Related Articles, Books, LinkOut Candidal infections and populations of candida albicans in mouths of diabetics. J Clin Pathol 1981 ; 34(7):706-11.

29- Maria Rozeli S. QUIRINO [1] Esther G. BIRMAN [2] Claudete R.PAULA [3]BrazDentJ (1995) 6(2):131-136 ISSN 0103-6440

http;//www.forp.usp.br / bdj/ t0962.html30- Harold Rubin, MS,ABD,CRC,Guest Lecturer posted 2002,8http: //www.therubins.com/E-mail: rehabstrat @ aol.com or rubin @ brainlink.com31- Grinspan D, Fernandez Blanco G, Allevato MA, Stengel FM. Burning mouth

syndrome. Int J Dermatol 1995;34:483-87.

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دووةم جؤرى شـــةكرةى نةخؤشى كى ما و نيشانةكاندا ددان و دةم لة

.محمود بختيارمحمد و خةزنةدار ئامانج&مانى , زانكؤى ثزيشكى كولي&جى سلي

امين محمد فائق&مانى , زانكؤى ددان ثزيشكى كولي&جى سلي

&مي عيراق – كوردستان هةري

ثوختة

&كؤلينةوةية ئةم &تةوة،كة ( نةخؤش257) لي بة نةخؤشخانة لة ( نةخؤشيان137) دةطري&نراون جؤرةوة جؤراو نةخؤشى هؤى داضوونى بةدوا بؤ تةنيا ( نةخؤشيان120) خةوي

(240) نةخؤشانةدا ئةم كردوة،لةناو نةخؤشخانةيان سةردانى يةكةيان نةخؤشي نةخرانة كة نةخؤشيان17 ، شةكرةن نةخؤشى دووةمى جؤرى لة نةخؤشيان

&كؤلينةكةوة شةكرةبوون. نةخؤشى يةكةمى جؤرى لة لي&ذةى نةخؤشانةدا لةم (, ئازارةكانى%82.75) ثووك يةكانى نةخؤشي بة بوون تووش ري( ,دةم%32.5) دةم ناو

&وانى%75) بوون ووشك &كرFاى ددان ( , كلؤربوونى%53.33) تام ( , شي كلؤر ددانى5 )تي&كدا لة &كراى كةوتن (,ددان نةخؤشي &كدا( هةوى لة كةوتوو ددانى13 )تي ) ناودةم نةخؤشي

.بةراوردكردنى كراون نيشان دةست%19,16)) شةويلطة جومطةكانى ( , ئازارى15%Lوان لة كراوة نيشانانةش ئةم &ز ئةوانةى ني &ز ئةوانةى و دةكةن ثاري كي&ش ،جطةرة ناكةن ثاري

&ذخايةن يةكةيان نةخؤشي ، جطةرةنةكي&شن و , كةوتووى بي&ت خايةن كورت يان بي&ت دري ددانى يان داية دةم لة تاقميان ، نةخؤشخانةن دةرةوةى لة ئةوانةى نةخؤشخانةو

ثيروطةنجةكان. هةروةها خؤيانة،وة ئةو بتواني&ت ، باسكرا نيشانانةى ئةم ناسينةوةى ى ري&ى لة دان د ثزيشكى هيوايةى بةو

. نةزانيوة خؤيان بة و هةية شةكرةيان كة بكات دةستنيشان نةخؤشانة108


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نوع من الداءاالسكرى لمرضى للفم المرضية الظواهرالثانى

خزندار محمود و امانج فائق بختيار محمدامين

طب كلية السليمانية الطب,جامعة كلية السليمانية االسنان- جامعة

كوردستان- العراق اقليم

الخالصة قد السكرى بالداء مصاب مريض275 شمل الذى الفم المرضية الظواهر دراسة خالل

مbbريض120 وان مختلفbbة المbbراض المستشفى ادخلو المرضى هؤالء من137 ان لوحظالطبية. واالستشارات العام للفحص المستشفى بزيارة يقوم منهم 17و الثbbانى النوع من السكرى بداء مصابين اكانو مريض240 المرضى هؤالء بين من وان

البحث. عن ابعادهم تم والذين االول نوع من السكرى بداء مصاب مريض: مايلى فتشمل المرضى هؤالء عند الفم فى المالحظة المرضية الظواهر اما

, 72) لسbbن ابbb المحيbbط الغشbbاء التهbbاب الريbbق( )نشbbفان او الفم %( , جفbbاف82 , 33 المbذاق % ,تغbير32,5 الفم وقرحbة التقbرح % ,متالزمة75 الفم % , فطريbات53

,58الفم( )مبضات المبسbوط الخbرز مbرض( ,داء لكbل سن4,96السن) % ,تسوس33 %, داء15 اخbbرى فمbbوى %,اضbbرار19,16 الفكين مفصلل الوضيفى %,االضطرابات125

%19,16 الدوالى بbداء المصbابين المرضbى عند للفم المرضية الظواهر انتشار نسبة ارتفاع احصائيا ثبت وقد

ونفس240 عbbددهم يبلbbغ والbbذى السbbكرى داء مرضbbى بين المقارنbbة اجراء بعد السكرىباالمراض. المصابين غير االشخاص من العدد

المbbراض خطbbورة االكbbثر عوامbbل احد هو السكرى داء مرض ان وجدنا الدراسة هذه ونتيجةمنطقتنا. فى واالسنان الفم

المرضbbية واهرظال هذه نتيجة االولى الوهلة من تشخيصه يمكن ربما السكرى داء مرض اناالسنان. طب عيادة فى الفم تصيب التى

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Received on 15/12/2004, Accepted on 31/8/200531/8/2005 لة ثةسندكراوة ،15/12/2004 لة وةرطيراوة

D AMANJ 95-109

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