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W jaki sposób cukrzyca może manifestować się w jamie ustnej?

Karolina6 785 komentarzy
Ten tekst przeczytasz w 3 min.

Cukrzyca może objawiać się w obrębie jamy ustnej poprzez zmiany w tkankach przyzębia i błony śluzowej, a także zaburzoną funkcję gruczołów ślinowych. Ze względu na upośledzoną odporność u osób chorujących na cukrzycę, istnieje zwiększone ryzyko zakażenia wirusem opryszczki, wystąpienia drożdżycy czy zaniku kości wyrostka zębodołowego.  

Zgodnie z zaleceniami Międzynarodowej Federacji Cukrzycy, klinicyści powinni raz w roku przeprowadzać wywiad z osobą chorą na cukrzycę w kierunku występowania objawów w obrębie jamy ustnej. Szczególną uwagę należy zwrócić na dziąsła, np. czy nie występuje krwawienie, obrzęk lub ich zaczerwienienie. Diabetycy powinni być zachęcani do regularnego badania i leczenia stomatologicznego.

Zmiany w okolicach przyzębia w przebiegu cukrzycy

U pacjentów chorych na cukrzycę najczęstszą manifestacją choroby w jamie ustnej są choroby przyzębia. U niektórych diabetyków obserwowane jest np. zapalenie dziąseł lub zapalenie przyzębia. Zmiany w obrębie tkanek przyzębia objawiają się zaczerwienieniem i obrzękiem dziąseł, krwawieniami z dziąseł w następstwie niewielkich urazów. Może dojść również do obluzowania zębów i zwiększenia się szpar między nimi, a także odsłonięcia korzeni zębów.

Zaawansowane stadium chorób przyzębia może zwiastować powikłania cukrzycy, takie jak nefropatia, udar mózgu, przemijający napad niedokrwienia mózgu, dławica piersiowa, zawał serca i niewydolność serca. U pacjentów ze źle kontrolowaną cukrzycą występuje również większa utrata przyczepu łącznotkankowego w porównaniu do pacjentów zdrowych lub z dobrze kontrolowaną chorobą.

Ryzyko zmian w obrębie błon śluzowych jamy ustnej

U osób zdrowych błona śluzowa jamy ustnej chroniona jest przez odpowiednią ilość i jakość śliny, która zapewnia nawilżenie, oczyszczenie i buforowanie pH, a także jest źródłem białek przeciwbakteryjnych oraz powoduje agregację i eliminację bakterii. Dzięki temu tkanki miękkie jamy ustnej są odporne na uszkodzenia oraz drobnoustroje. Tymczasem cukrzyca negatywnie wpływa na czynność gruczołów ślinowych i układ immunologiczny, dlatego istnieje zwiększone ryzyko zmian w obrębie błon śluzowych.

W przebiegu cukrzycy u niektórych chorych obserwuje się m.in. zanik błony śluzowej lub zapalenie błony śluzowej. W jamie ustnej chorych na cukrzycę niekiedy dochodzi również do niezapalnego powiększenia ślinianek przyusznych. Zaburzenie to występuje częściej u pacjentów ze źle kontrolowaną chorobą. Ponadto chorzy mogą doświadczać uczucia suchości błony śluzowej jamy ustnej, co wiąże się ze zmniejszeniem ilości wydzielanej śliny.

Zapalenie języka w przebiegu cukrzycy

U osób chorych na cukrzycę niejednokrotnie dochodzi również do zmian w obrębie języka. Obserwowany jest m.in. całkowity lub ogniskowy zanik brodawek językowych (zanikowe zapalenie języka), dający wygląd wygładzonej powierzchni języka. Niekiedy dochodzi również do romboidalnego zapalenia języka, który charakteryzuje się zanikiem brodawek językowych w obszarze umiejscowionym w tylnej części grzbietowej powierzchni języka, która jest wówczas płaska i gładka, ale może również dochodzić do zagłębień.

U chorych na cukrzycę może również występować język geograficzny, czyli wędrujące zapalenie języka. Obserwowany jest ogniskowy zanik brodawek językowych, które przybierają nieregularny kształt z białymi lub żółtawymi uniesieniami, które z czasem migrują. Objaw ten często wiąże się z bólem, świądem, pieczeniem błony śluzowej.

Zwiększone ryzyko rozwoju drożdżycy

Zbyt mała ilość śliny oraz zaburzenia układu immunologicznego u cukrzyków znacznie zwiększają ryzyko rozwoju drożdżycy (kandydozy) jamy ustnej. Diabetycy często są nosicielami grzybów z rodzaju Candida. Z badań naukowców wynika, że drożdżyca rozwija się wskutek zmniejszonej ilości immunoglobulin przeciwgrzybiczych w ślinie, a także wskutek zwiększonego stężenia glukozy w ślinie, co sprzyja rozwojowi grzybów.

Drożdżyca u chorych na cukrzycę może przyjmować różne postacie. Jedną z nich jest stomatopatia protetyczna, do której dochodzi wskutek zakażenia przez grzyby porowatej akrylowej struktury protezy. U pacjentów obserwuje się rozlane zaczerwienienie błony śluzowej pod protezami górnych zębów. Ten rodzaj zakażenia najczęściej objawia się uczuciem pieczenia, chociaż u niektórych chorych objawy nie występują. Inne postacie zakażenia to ostra rzekomobłoniasta postać drożdżycy czy zapalenie kątów ust.

Liszaj płaski jamy ustnej manifestacją cukrzycy

Liszaj płaski to przewlekła niezakaźna, swędząca choroba skóry i błon śluzowych, która również może być objawem cukrzycy. Manifestuje się występowaniem plamistych białych zmian na powierzchni zaczerwienionej błony śluzowej. U chorych na cukrzycę obserwuje się również liszajowate reakcje polekowe występujące w obrębie błon śluzowych. Zmiany te to niepożądane działanie leków przepisywanych często chorym na cukrzycę, np. leków hipoglikemizujących czy hipotensyjnych.

Liszaj płaski oraz liszajowate reakcje polekowe mogą wywołać objawy takie jak ból, uczucie pieczenia, nadwrażliwość na kwaśne pokarmy. Wiążą się one również z ryzykiem dysplazji i transformacji nowotworowej.

Źródła:

B. K. Gandara, T. H. Morton Jr., „Objawy cukrzycy w jamie ustnej występujące poza przyzębiem: podstawowe informacje dla personelu medycznego” w Diabetologia po Dyplomie, Tom 9 nr 1, 2012, str. 31-37

W. Leśniak, A. Doboszyńska, „Objawy stomatologiczne chorób ogólnych” w Wybrane Problemy Kliniczne, Via Medica, 2014

mp.pl

 

Przeczytaj także: Owrzodzenia w jamie ustnej a choroby reumatoidalne

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