Diabetes Impacts Oral Conditions in Patients With Chronic Kidney Disease

Objectives: Chronic kidney disease (CKD) and diabetes mellitus (DM) are chronic diseases characterized by increased blood levels of pro-inflammatory mediators. At an individual level, CKD and DM are associated with the increased prevalence of intraoral conditions compared with the respective healthy controls. Since many patients with CKD are also diagnosed with DM, the present work aimed to review the current body of evidence on the impact of DM on the prevalence and severity of intraoral signs and symptoms in patients with CKD.
Methods: MEDLINE/PubMed, Embase, and Cochrane library databases were searched to identify original human studies published prior to September 1, 2022, which examined the prevalence of oral symptoms and signs in patients with CKD and both CKD and DM (CKD/DM).
Results: A total of 24 publications met the inclusion criteria. Patients with CKD/DM displayed a significantly increased prevalence of oral symptoms and signs, including xerostomia (32-48 vs. 11-42%, respectively), dental caries (64.6-98 vs. 46.4-83%, respectively), carious teeth (5.1 vs. 3.1 teeth, respectively), oral mucosa petechiae (32 vs. 10%, respectively), medication-induced gingival enlargements (27.3 vs. 7.1%, respectively), yeast infection (35-72.7 vs. 17-36%, respectively), and the prevalence of patients with severe periodontitis (43.3 vs. 27%, respectively) compared with non-diabetic controls. Limited evidence suggests that patients with CKD/DM had (i) a lower prevalence of halitosis (76 vs. 91%, respectively) and biofilm-induced gingivitis (13 vs. 19%, respectively) and (ii) no significant differences in the number of remaining teeth (21-26 vs. 23-24 teeth, respectively) and the prevalence of periodontal pockets ≥6mm (45 vs. 34%, respectively) and sites with clinical attachment loss ≥4mm (28.3 vs. 21.3%, respectively) compared with non-diabetic controls.
Conclusions: Patients with CKD/DM are reported to have a greater prevalence and/or severity of various oral conditions compared with patients with CKD alone. A better understanding of the mechanisms underlying these increases will improve the dental management of these patients.