Clinico-cytological Lesions of Oral Mucosa in Type 2 Diabetes Mellitus

Objectives: Oral manifestations of Diabetes Mellitus (DM) include xerostomia, increased susceptibility to infections, delayed wound healing, ulcerations and periodontal destruction along with many subclinical changes. This study was therefore designed to determine the cytopathological changes in oral epithelial cells in patients with type 2 DM.
Methods: Oral smears were prepared from n=100 patients diagnosed of having type 2 DM for at least 5 years duration. A detailed oral examination was carried out and latest random blood sugar (RBS) levels were collected from clinical record. Smears were examined microscopically using routine and special stains (Haematoxylin & Eosin, Papanicolaou, Periodic Acid Schiff’s and Gomori`s methenamine sliver).

Results: Mean age of the patients was 52.21±8.39 years with a male to female ratio being 1:1.8. Oral lesions were present in 77% patients including chronic periodontitis (37%), xerostomia (25%), mobility of teeth (13%) and traumatic ulcers (2%). Family history was positive in 53% patients. The RBS levels of >200 and ˂200 were found in 88% and 12% patients respectively. On cytological examination, micronuclei (94%) and atypia (68%) with pleomorphism (61%) and prominent nucleoli (45%) within oral squamous epithelial cells were seen. Dysplastic changes with nuclear hyperchromasia and atypical mitoses were found in 2% of smears (50% grade 1, 50% grade 2). Inflammation was seen in 31% smears (acute: 97%, chronic: 3%) with candida albicans hyphae detected in 1% of smears only. When clinico-cytological variables were compared, micronuclei (p=0.01) nuclear pleomorphism (p=0.02) and prominent nucleoli (p=0.01) were significantly associated with xerostomia. While RBS and other studied variables did not yield significant associations among them.
Conclusions: Type 2 DM may produce many subclinical pathological changes in the otherwise normal appearing oral mucosa. Routine screening and early detection of such changes through exfoliative cytology may help to improve oral health, compliance to drug therapy and prevent complications in these patients.