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Weijdijk LPM, Van der Weijden GA, Slot DE. DMF scores in patients with diabetes mellitus: A systematic review and meta-analysis of observational studies. J Dent 2023; 136:104628. [PMID: 37490966 DOI: 10.1016/j.jdent.2023.104628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/10/2023] [Accepted: 07/19/2023] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVE The aim of this systematic review(SR) is to comprehensively and critically summarise and synthesise the available scientific evidence from observational studies that use the decayed-missed-filled(DMF) index to determine caries experiences among adult patients with diabetes mellitus (DM) as compared to individuals without DM(non-DM). DATA Indices that present examinations of decayed-filled-surfaces(DFS), decayed-missed-filled-surfaces(DMFS), and decayed-missed-filled-teeth(DMFT) established from observational studies were considered. SOURCES MEDLINE-PubMed and Cochrane Central databases were searched through 1 February 2023 to identify studies that evaluate DMF indices for adult patients with DM compared to non-DM. The reference lists of the selected studies were reviewed to identify additional potentially relevant studies. STUDY SELECTION All studies were independently screened by two reviewers. Included papers were critically appraised using pre-designed forms, and the risk of bias was assessed. Data as means and standard deviations were extracted. A descriptive data presentation was used for all studies. If quantitative methods were feasible, then a meta-analysis was performed. It was decided 'a priori' to perform a sub-analysis on type of DM(I or II). The quality of the studies was assessed. RESULTS Initially 932 studies were found, and screening resulted in 13 eligible observational studies. The total number of subjects included in this SR is 21,220. A descriptive analysis of the comparisons demonstrated that eight studies provided data and demonstrated higher DFS (1/2), DMFS (2/3) and DMFT (5/8). This was confirmed by the meta-analysis difference of means(DiffM), which was 3.01([95%CI:1.47,4.54],p=0.0001) for DMFT and 10.30([95% CI:8.50,12.11],p<0.00001) for DMFS. Subgroup analysis showed that this difference is irrespective to the type of DM(DiffM=3.09;[95%CI:2.09,4.09],p<0.00001). CONCLUSION There is moderate certainty for a higher DMF index score in DM patients as compared to those without DM disease. CLINICAL SIGNIFICANCE This SR indicates a higher DMF index in DM patients. Oral disease prevention should be the focus of the dental care practitioner in this patient category.
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Affiliation(s)
- L P M Weijdijk
- Department of Periodontology Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands(1); Department of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), Gustav Mahlerlaan 30041081 LA Amsterdam, The Netherlands(1)
| | - G A Van der Weijden
- Department of Periodontology Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands(1)
| | - D E Slot
- Department of Periodontology Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands(1).
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Rahim A, Hassan S, Ullah N, Noor N, Rafique R, Khattak FA, Afaq S. Association and comparison of periodontal and oral hygiene status with serum HbA1c levels: a cross-sectional study. BMC Oral Health 2023; 23:442. [PMID: 37394484 DOI: 10.1186/s12903-023-03042-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/13/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND Diabetes Mellitus and periodontitis are chronic diseases with known reciprocal association. Studies have shown that uncontrolled diabetes increases the risk of development and progression of periodontal disease. This study aimed to explore the association and severity of periodontal clinical parameters and oral hygiene with HbA1c levels in non-diabetics and T2DM patients. MATERIALS AND METHODS In this cross-sectional study, the periodontal status of 144 participants, categorized into non-diabetics, controlled T2DM, and uncontrolled T2DM and were assessed via the Community Periodontal Index (CPI), Loss of Attachment Index (LOA index), and the number of missing teeth, while oral hygiene was measured by utilizing the Oral Hygiene Index Simplified (OHI-S). SPSS was used for data analysis. Chi-square test was used to find out the association of different independent variables with HbA1c groups, while ANOVA and post-hoc tests were run for inter-group and intra-group comparison respectively. RESULTS Out of 144 participants, the missing dentition was prevalent in uncontrolled T2DM with mean 2.64 ± 1.97 (95% CI 2.07-3.21; p = 0.01) followed by controlled T2DM 1.70 ± 1.79 (95% CI 1.18-2.23; p = 0.01) and non-diabetics 1.35 ± 1.63 (95% CI 0.88-1.82; p = 0.01) respectively. Furthermore, non-diabetics had a higher proportion of CPI score 0 (Healthy) [30 (20.8%); p = 0.001] as compared to uncontrolled T2DM [6 (4.2%); p = 0.001], while CPI score 3 was more prevalent in uncontrolled T2DM in comparison to non-diabetics. Loss of attachment (codes-2,3 and 4) was also frequently observed in uncontrolled T2DM compared to non-diabetics (p = 0.001). Similarly, based on Oral Hygiene Index- Simplified (OHI-S), the result showed that poor oral hygiene was most commonly observed in uncontrolled T2DM 29 (20.1%) followed by controlled T2DM patients 22 (15.3%) and non-diabetic [14 (9.7%); p = 0.03]. CONCLUSION This study showed that periodontal status and oral hygiene status were deteriorated in uncontrolled T2DM patients compared to non-diabetic participants and controlled T2DM.
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Affiliation(s)
- Abid Rahim
- Sardar Begum Dental College, Gandhara University, Peshawar, Pakistan
- Dental Surgery Department, Qazi Hussain Ahmed Medical Complex (MTI), Nowshera, Pakistan
| | - Sabreen Hassan
- Department of Oral Pathology, Saidu College of Dentistry, Swat, Pakistan
| | - Naeem Ullah
- Department of Community Medicine, Saidu Medical College, Swat, Pakistan
| | - Nawal Noor
- Sardar Begum Dental College, Gandhara University, Peshawar, Pakistan
| | | | - Farhad Ali Khattak
- Research & Development Cell, Khyber College of Dentistry, Peshawar, Pakistan.
| | - Saima Afaq
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan.
- School of Public Health Faculty of Medicine, Imperial College London, London, UK.
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Vieira Lima CP, Chagas LFA, Marques RCR, Grisi DC, Salles LP, Guimarães MDCM, Dame-Teixeira N. Can hyperglycemia be associated with caries activity and root caries in adults? Prim Care Diabetes 2023; 17:48-54. [PMID: 36437217 DOI: 10.1016/j.pcd.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/15/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
AIMS A previous meta-analysis showed that individuals with Type 2 diabetes mellitus (T2D) have a greater chance of developing both coronal caries and root caries than systemically healthy ones, which can be influenced by hyperglycemia per se. This study aimed to associate blood and salivary glucose levels with caries. METHODS This research is a subset of a cross-sectional study. N = 39 individuals underwent a dental examination and salivary glucose, fasting blood glucose (FBG) and glycated hemoglobin (A1c) measurements. RESULTS The prevalence of active coronal caries was 10.2%, and that of root caries was 20.5%. A1c and FBG averages were higher in individuals with root caries (9.75 ± 1.71 and 186.3 ± 62.5) than without (7.01 ± 2.23 and 115.1 ± 48.6; p < 0.05). Individuals with T2D showed weak correlation of salivary glucose and number of active coronal caries. Significant correlations were observed between salivary and blood glucose. There was relevance of A1c (0.53; CI=0.124-0.941; p = 0.01) and FBG (0.019; CI=0.006-0.033; p = 0.006) toward the increased number of root caries lesions, even after adjustment for salivary flow and age. CONCLUSION Blood glucose levels are associated with an increased number of root caries in adults with or without T2D. In individuals with T2D, salivary glucose was correlated with active coronal caries. Additional studies are needed to support this association.
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Affiliation(s)
| | | | | | - Daniela Corrêa Grisi
- Department of Dentistry, School of Health Sciences, University of Brasilia, Brazil.
| | - Loise Pedrosa Salles
- Department of Dentistry, School of Health Sciences, University of Brasilia, Brazil.
| | | | - Naile Dame-Teixeira
- Department of Dentistry, School of Health Sciences, University of Brasilia, Brazil; Oral Biology Division, School of Dentistry, University of Leeds, UK.
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Varughese A, Kavitha R, Sravan Kumar Y, Venkitachalam R, Menon AS, Francis PT, Haridas K. Prevalence and severity of coronal and radicular caries among patients with type 2 diabetes mellitus: A cross sectional study. Med J Armed Forces India 2022; 78:S179-S185. [PMID: 36147423 PMCID: PMC9485771 DOI: 10.1016/j.mjafi.2020.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 09/29/2020] [Indexed: 11/22/2022] Open
Abstract
Background Studies among type 2 diabetes mellitus patients have reported total caries experience; however the severity and clinical consequences of untreated dental caries are often ignored. Methods For this study, 150 well (I) and poorly controlled (II) diabetic participants were recruited. The spectrum of caries was evaluated using DMFT (Decayed, Missing and Filled Tooth) index, Dental Caries Severity Classification Scale, PUFA (Pulpal involvement, Ulceration, Fistula and Abscess) index, RCI (Root Caries Index) and the severity of radicular caries by Root Surface Caries Severity Index. Results The prevalence of coronal and root caries was 90.7% and 23.3%, respectively. There was significant difference among caries experiences for D, M and DMFT. In group II, severity of coronal caries and mean rank of P, F, A and PUFA scores were higher, so were prevalence of root caries and severity of RD2, RD3 and RD4. HbA1c level had positive correlation with DMFT and PUFA scores (r = 0.458 and 0.522), so was the duration of diabetes with coronal caries, DMFT, PUFA score, root caries and RCI score (r = 0.235, 0.320, 0.273, 0.308 and 0.323). Conclusion This is probably the first study to examine the severity of coronal caries, prevalence of untreated dental caries and severity of radicular caries in diabetic patients. Uncontrolled diabetes causes substantial increase in prevalence and severity of coronal and radicular caries.
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Affiliation(s)
- Anju Varughese
- Assistant Professor (Conservative Dentistry & Endodontics), Amrita School of Dentistry, Amrita Vishwa Vidyapeetam, AIMS, Kochi, Kerala, India
| | - R. Kavitha
- Assistant Professor (Conservative Dentistry & Endodontics), Amrita School of Dentistry, Amrita Vishwa Vidyapeetam, AIMS, Kochi, Kerala, India
| | - Y. Sravan Kumar
- Assistant Professor (Public Health Dentistry), Amrita School of Dentistry, Amrita Vishwa Vidyapeetam, AIMS, Kochi, Kerala, India
| | - R. Venkitachalam
- Assistant Professor (Public Health Dentistry), Amrita School of Dentistry, Amrita Vishwa Vidyapeetam, AIMS, Kochi, Kerala, India
| | - Arun S. Menon
- Professor (Endocrinology), Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetam, AIMS, Kochi, Kerala, India
| | - Paul T. Francis
- Associate Professor (Community Medicine), Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetam, AIMS, Kochi, Kerala, India
| | - Kaushik Haridas
- Assistant Professor (Conservative Dentistry & Endodontics), Amrita School of Dentistry, Amrita Vishwa Vidyapeetam, AIMS, Kochi, Kerala, India
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Aldosari M, Aldosari M, Aldosari MA, Agrawal P. Diabetes mellitus and its association with dental caries, missing teeth and dental services utilization in the US adult population: Results from the 2015-2018 National Health and Nutrition Examination Survey. Diabet Med 2022; 39:e14826. [PMID: 35262969 DOI: 10.1111/dme.14826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/20/2022] [Accepted: 03/07/2022] [Indexed: 11/28/2022]
Abstract
AIMS This study aimed to evaluate the associations of self-reported diabetic status with clinically assessed dental end points, including teeth with untreated coronal and root caries, missing teeth, complete tooth retention, edentulism and routine dental services utilization among adults aged ≥20 years in the United States. METHODS We pooled data from the 2015-2016 and 2017-2018 cycles of the National Health and Nutrition Examination Survey (NHANES), a nationally representative, cross-sectional, continuous survey of noninstitutionalized US population. The analysed data included all adult participants aged ≥20 years who completed the dental examination and reported their diabetic status. We estimated the prevalence and average outcomes of dental end points by diabetic status. Regression analyses were employed to evaluate the associations between diabetic status and dental outcomes. RESULTS Of 10,249 participants, 1,562 reported having diabetes mellitus, which translates to 11.3% of US adults aged ≥20 years (25.7 million). Compared to non-diabetic individuals, adults with diabetes had 1.49 (95%CI = 1.1-2.0) and 1.46 (95%CI = 1.2-1.8) times higher odds of developing coronal and root caries respectively. Adults with diabetes were 32% less likely to be fully dentate (OR = 0.68; 95%CI = 0.55-0.83) and had a higher average number of missing teeth (mean ratio = 1.35; 95%CI = 1.18-1.55). There was no association between diabetic status and routine dental services utilization. CONCLUSIONS Adults with diabetes exhibited worse dental health; nonetheless, there was no difference in dental services utilization. Multidisciplinary efforts from both medical and dental service providers are required to proactively address the well-being of adults with diabetes in terms of oral health.
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Affiliation(s)
- Maram Aldosari
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Muath Aldosari
- Periodontics and Community Dentistry, King Saud University College of Dentistry, Riyadh, Saudi Arabia
- Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Mohammad A Aldosari
- Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Priyanka Agrawal
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Gupta R, Das D, Menon I, Sharma A, Arora V, Ahsan I. Oral health status among type 2 diabetic versus nondiabetic adult population of muradnagar: A cross-sectional comparative study. ASIAN JOURNAL OF PHARMACEUTICAL RESEARCH AND HEALTH CARE 2022. [DOI: 10.4103/ajprhc.ajprhc_1_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Madhuri M, Kulkarni S, Doshi D, Reddy S, Adepu S, Reddy S. Oral health status and self- assessment of oral health risk factors among South Indian diabetic patients. Indian J Dent Res 2021; 32:140-146. [PMID: 34810379 DOI: 10.4103/ijdr.ijdr_508_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background The disease profile of the world is changing at an astonishingly fast rate. It is essential that the impending nature of chronic disease is recognized and acted on urgently. India leads the world with the largest number of diabetics earning the dubious distinction of being termed the "diabetic capital" of the world. Aim To assess and compare the oral health status and related oral health risk factors among diabetic patients in Hyderabad and Secunderabad. Settings A cross sectional study was carried out in various diagnostic centers among 801 patients aged 30 years and above. Methods and Materials Oral health status and self-assessed data on related oral risk factors were measured using modified World Health Organization (WHO) assessment form and oral health questionnaire for adults 2013. Statistical Analysis Comparison of mean scores of the variables based on gender was assessed using ANOVA. Statistical significance was set at p < 0.05. Results Females had higher proportion of untreated caries (362; 85%) and DMFT (Decayed, Missing and Filled Teeth; 375; 88%) compared to males. On the basis of loss of attachment, the mean number of sextants with no loss of attachment was mostly noted among female subjects. Conclusion In the present study, though gingivitis was seen in higher percentage (82%), the presence of periodontal disease was relatively low (68.3%). It can be concluded that diabetic subjects may have poor oral health.
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Affiliation(s)
- Mukkavilli Madhuri
- Department of Public Health Dentistry, Panineeya Institute of Dental Sciences and Research Centre, Hyderabad, Telangana, India
| | - Suhas Kulkarni
- Department of Public Health Dentistry, Panineeya Institute of Dental Sciences and Research Centre, Hyderabad, Telangana, India
| | - Dolar Doshi
- Department of Public Health Dentistry, Panineeya Institute of Dental Sciences and Research Centre, Hyderabad, Telangana, India
| | - Srikanth Reddy
- Department of Public Health Dentistry, Panineeya Institute of Dental Sciences and Research Centre, Hyderabad, Telangana, India
| | - Srilatha Adepu
- Department of Public Health Dentistry, Panineeya Institute of Dental Sciences and Research Centre, Hyderabad, Telangana, India
| | - Sahithi Reddy
- Department of Public Health Dentistry, Panineeya Institute of Dental Sciences and Research Centre, Hyderabad, Telangana, India
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State of Evidence on Oral Health Problems in Diabetic Patients: A Critical Review of the Literature. J Clin Med 2021; 10:5383. [PMID: 34830663 PMCID: PMC8618619 DOI: 10.3390/jcm10225383&set/a 912874875+940716348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Diabetes mellitus (DM) is a global health problem, having recognized that in the next 20 years the number of diabetic patients in the world will increase to 642 million. DM exerts enormous repercussions on general health diabetic (especially derived from vascular, cardiac, renal, ocular, or neurological affectation). It entails in addition a high number of deaths directly related to the disease, as well as a high health care cost, estimated at $673 billion annually. Oral cavity is found among all the organs and systems affected in the course of DM. Important pathologies are developed with higher prevalence, such as periodontitis (PD), alterations in salivary flow, fungal infections, oral cancer, and oral potentially malignant disorders (OPMD). It has been proven that PD hinders the metabolic control of DM and that the presence of PD increases the possibility for developing diabetes. Despite the relevance of these oral pathologies, the knowledge of primary care physicians and diabetes specialists about the importance of oral health in diabetics, as well as the knowledge of dentists about the importance of DM for oral health of patients is scarce or non-existent. It is accepted that the correct management of diabetic patients requires interdisciplinary teams, including dentists. In this critical review, the existing knowledge and evidence-degree on the preventive, clinical, diagnosis, prognosis, and therapeutic aspects of oral diseases that occur with a significant frequency in the diabetic population are developed in extension.
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State of Evidence on Oral Health Problems in Diabetic Patients: A Critical Review of the Literature. J Clin Med 2021. [DOI: 10.3390/jcm10225383
expr 893869204 + 932072443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Diabetes mellitus (DM) is a global health problem, having recognized that in the next 20 years the number of diabetic patients in the world will increase to 642 million. DM exerts enormous repercussions on general health diabetic (especially derived from vascular, cardiac, renal, ocular, or neurological affectation). It entails in addition a high number of deaths directly related to the disease, as well as a high health care cost, estimated at $673 billion annually. Oral cavity is found among all the organs and systems affected in the course of DM. Important pathologies are developed with higher prevalence, such as periodontitis (PD), alterations in salivary flow, fungal infections, oral cancer, and oral potentially malignant disorders (OPMD). It has been proven that PD hinders the metabolic control of DM and that the presence of PD increases the possibility for developing diabetes. Despite the relevance of these oral pathologies, the knowledge of primary care physicians and diabetes specialists about the importance of oral health in diabetics, as well as the knowledge of dentists about the importance of DM for oral health of patients is scarce or non-existent. It is accepted that the correct management of diabetic patients requires interdisciplinary teams, including dentists. In this critical review, the existing knowledge and evidence-degree on the preventive, clinical, diagnosis, prognosis, and therapeutic aspects of oral diseases that occur with a significant frequency in the diabetic population are developed in extension.
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González-Moles MÁ, Ramos-García P. State of Evidence on Oral Health Problems in Diabetic Patients: A Critical Review of the Literature. J Clin Med 2021; 10:5383. [PMID: 34830663 PMCID: PMC8618619 DOI: 10.3390/jcm10225383] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/09/2021] [Accepted: 11/13/2021] [Indexed: 12/24/2022] Open
Abstract
Diabetes mellitus (DM) is a global health problem, having recognized that in the next 20 years the number of diabetic patients in the world will increase to 642 million. DM exerts enormous repercussions on general health diabetic (especially derived from vascular, cardiac, renal, ocular, or neurological affectation). It entails in addition a high number of deaths directly related to the disease, as well as a high health care cost, estimated at $673 billion annually. Oral cavity is found among all the organs and systems affected in the course of DM. Important pathologies are developed with higher prevalence, such as periodontitis (PD), alterations in salivary flow, fungal infections, oral cancer, and oral potentially malignant disorders (OPMD). It has been proven that PD hinders the metabolic control of DM and that the presence of PD increases the possibility for developing diabetes. Despite the relevance of these oral pathologies, the knowledge of primary care physicians and diabetes specialists about the importance of oral health in diabetics, as well as the knowledge of dentists about the importance of DM for oral health of patients is scarce or non-existent. It is accepted that the correct management of diabetic patients requires interdisciplinary teams, including dentists. In this critical review, the existing knowledge and evidence-degree on the preventive, clinical, diagnosis, prognosis, and therapeutic aspects of oral diseases that occur with a significant frequency in the diabetic population are developed in extension.
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Affiliation(s)
- Miguel Ángel González-Moles
- School of Dentistry, University of Granada, 18010 Granada, Spain;
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
| | - Pablo Ramos-García
- School of Dentistry, University of Granada, 18010 Granada, Spain;
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
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Zheng M, Wang C, Ali A, Shih YA, Xie Q, Guo C. Prevalence of periodontitis in people clinically diagnosed with diabetes mellitus: a meta-analysis of epidemiologic studies. Acta Diabetol 2021; 58:1307-1327. [PMID: 34028620 DOI: 10.1007/s00592-021-01738-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/06/2021] [Indexed: 12/19/2022]
Abstract
AIMS The relationship between diabetes mellitus and periodontitis has long been discussed, but the conclusion of this relationship was controversial. We conducted this meta-analysis to explore the association between diabetes mellitus and the prevalence of periodontitis. METHODS PubMed, Embase, Web of Science, and the Cochrane Library were searched for studies reporting associations of periodontitis with diabetes. Gray literature was integrated from the Open-Gray database. Prevalence estimates and odds ratios were extracted by two independent reviewers and synthesized through meta-analyses. RESULTS Twenty-seven papers met the inclusion criteria involving 3092 diabetic patients and 23,494 controls. Overall prevalence of periodontitis was 67.8% in diabetics (combined types) and 35.5% in patients without diabetes (OR, 1.85; 95%CI, 1.61-2.11). Probing depth (MD 0.23; 95% CI, 0.17-0.29; I2 = 25%) and plaque index (MD, 0.20; 95% CI, 0.18-0.23; P = 0.59; I2 = 0%) severity scores were significantly greater among the diabetic group. CONCLUSIONS The prevalence and severity of periodontitis are greater in patients with diabetes than in non-diabetic populations.
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Affiliation(s)
- Mengwen Zheng
- Department of Stomatology, School of Medicine, The First Affiliated Hospital, Shihezi University, Shihezi, Xinjiang, China
| | - Cheng Wang
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ali Ali
- Sheffield Teaching Hospitals NIHR Biomedical Research Centre, Glossop Rd, Sheffield, S10 2JF, UK
| | - Yi An Shih
- School of Nursing, Peking University, Beijing, China
| | - Qinqin Xie
- Department of Stomatology, The Second Affiliated Hospital, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Chao Guo
- Department of Stomatology, School of Medicine, The First Affiliated Hospital, Shihezi University, Shihezi, Xinjiang, China.
- The Affiliated Hospital of Qingdao University, Qingdao,Shangdong, China.
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Glycemic control and number of natural teeth: analysis of cross-sectional Japanese employment-based dental insurance claims and medical check-up data. Diabetol Int 2021; 13:244-252. [DOI: 10.1007/s13340-021-00533-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/16/2021] [Indexed: 02/08/2023]
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Horbach AL, Baldisserotto J, Celeste RK. Association between dental visits at primary care and glycated hemoglobin level in patients with type 2 diabetes: a cohort study. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2021; 24:e210032. [PMID: 34105595 DOI: 10.1590/1980-549720210032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/17/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the association between dental visits and variation in the glycated hemoglobin index (A1C) of patients with type 2 diabetes (T2DM) with well or not well glycemic control over time. METHODS Patients with T2DM, A1C ≥ 7% (not well-controlled) and < 7% (well-controlled), who attended a primary care service and were followed up from January 2010 to May 2018. The outcome was the variation of A1C obtained from reference laboratories. At the beginning of the study, a questionnaire with behavioral, clinical, and socioeconomic information was carried out. Multiple linear regression analyses tested interaction terms of all variables with the initial glycemic level (not well-controlled or well-controlled). RESULTS The sample consisted of 507 people, 65% women, and 66% individuals 55 to 74 years old, followed on average for 5.4 years. There was an interaction (p = 0.01) between dental visits and initial A1C. Patients not well-controlled with at least one dental visit had an average reduction in A1C of -0.56 percentage point (95%CI -1.06 - -0.56), whereas the well-controlled group who also had at least one dental visit had an increase of 0.34 percentage point (95%CI -0.18 - 0.87). CONCLUSION Dental visits were associated with an improvement in A1C of approximately a half-percentage point in patients who had the initial A1C considered as not well-controlled.
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Affiliation(s)
| | - Julio Baldisserotto
- Conceição Hospital Group - Porto Alegre (RS), Brazil.,Department of Preventive and Social Dentistry, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil
| | - Roger Keller Celeste
- Department of Preventive and Social Dentistry, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil
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Paurobally N, Kruger E, Tennant M. Oral Health Behaviour and Predictors of Oral Health Behaviour Among Patients With Diabetes in the Republic of Mauritius. Int Dent J 2021; 72:106-115. [PMID: 33875276 PMCID: PMC9275285 DOI: 10.1016/j.identj.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To investigate the oral care habits and assess the determinants of oral care behaviour among people with diabetes in the Republic of Mauritius. METHODS The present study draws on data collected from 589 dentate persons with diabetes by means of a close-ended questionnaire. Multivariate logistic regression analyses were used to estimate the association of different demographic and clinical factors with recommended dental hygiene practices. RESULTS The majority of the participants brushed at least twice daily (84.2%), never flossed (88.6%), attended dental clinics on need only (87.1%), and did not monitor their blood glucose levels regularly (69.9%). Neither awareness about the increased risk of periodontal disease and xerostomia nor receiving advice from diabetes care providers was found to be associated with good oral hygiene or increased service utilisation. The experience of oral diseases did not encourage recommended oral health practice, with participants without experience with periodontal disease being 3 times more likely to floss (odds ratio [OR], 2.9; P = .045). Regular dental visits were strongly associated with self-reported type 1 diabetes (OR, 7.8; P = .025). Participants from urban areas were more than twice as likely to visit their dental care provider at least once annually (OR, 2.3; P = .006). Regular dental attendance (OR, 3.7; P = .011) and flossing (OR, 4.5; P = .012) were strongly associated with one another. CONCLUSION There is widespread noncompliance with regular flossing and dental service utilisation. Our findings highlight the need for an emphasis on preventive care through the provision of integrated medical and dental interventions to high-risk individuals suffering from both diabetes and chronic periodontitis.
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Affiliation(s)
- Nesha Paurobally
- International Research Collaborative - Oral Health and Equity, School of Human Sciences, University of Western Australia, Crawley, Australia.
| | - Estie Kruger
- International Research Collaborative - Oral Health and Equity, School of Human Sciences, University of Western Australia, Crawley, Australia
| | - Marc Tennant
- International Research Collaborative - Oral Health and Equity, School of Human Sciences, University of Western Australia, Crawley, Australia
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15
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Rahiotis C, Petraki V, Mitrou P. Changes in saliva characteristics and carious status related to metabolic control in patients with type 2 diabetes mellitus. J Dent 2021; 108:103629. [PMID: 33684464 DOI: 10.1016/j.jdent.2021.103629] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES This cross-sectional study aimed: 1) to compare the saliva characteristics and the occurrence of caries in patients with type 2 diabetes mellitus (T2DM) and patients without T2DM, 2) to study the impact of inadequate glycemic control on saliva and caries prevalence. METHODS 23 adults with T2DM and 18 controls participated. Patients with T2DM were divided depending on their metabolic control: a) well-controlled (W.C.): HbA1c≤7 %, and b) poorly-controlled (P.C.): HbA1c> 7 %). The examined clinical parameters were: 1) number of natural teeth, 2) DMFT index of coronal caries, 3) saliva pH, 4) saliva flow and buffering capacity, and 5) subjective feeling of dry mouth. RESULTS The groups W.C and P.C showed significant differences in the number of teeth, the saliva flow, and DMFT. The C and P.C groups presented differences in pH, saliva flow, buffer capacity, and DMFT. Finally, the W.C and C groups indicated differences in the buffer capacity, saliva flow, and DMFT. The subjective feeling of dry mouth is related to the duration of the disease. The DMFT value correlated negatively with the status of metabolic regulation. Multiple linear regression revealed that the DMFT value was positively associated with serum HbA1c levels. CONCLUSIONS 1) Adults with T2DM present a lower saliva flow rate and buffering capacity, as well as higher caries prevalence than controls; 2) The metabolic control of T2DM is essential for the maintenance of saliva flow rate and buffering capacity, and caries prevalence; 3) The duration of T2DM is of importance for the subjective sense of dry mouth. CLINICAL SIGNIFICANCE The duration and metabolic control of T2DM are important clinical parameters for oral complications. Awareness and co-operation of diabetologists and dentists are needed to detect oral lesions in patients with diabetes and be treated timely and effectively.
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Affiliation(s)
- Christos Rahiotis
- School of Dentistry, National and Kapodistrian University of Athens, Thivon 2, Goudi, 11527, Greece.
| | - Vasilia Petraki
- School of Dentistry, National and Kapodistrian University of Athens, Thivon 2, Goudi, 11527, Greece
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16
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Wu CZ, Yuan YH, Liu HH, Li SS, Zhang BW, Chen W, An ZJ, Chen SY, Wu YZ, Han B, Li CJ, Li LJ. Epidemiologic relationship between periodontitis and type 2 diabetes mellitus. BMC Oral Health 2020; 20:204. [PMID: 32652980 PMCID: PMC7353775 DOI: 10.1186/s12903-020-01180-w] [Citation(s) in RCA: 123] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 06/29/2020] [Indexed: 02/05/2023] Open
Abstract
Background To systematically review the epidemiologic relationship between periodontitis and type 2 diabetes mellitus (T2DM). Methods Four electronic databases were searched up until December 2018. The manual search included the reference lists of the included studies and relevant journals. Observational studies evaluating the relationship between T2DM and periodontitis were included. Meta-analyses were conducted using STATA. Results A total of 53 observational studies were included. The Adjusted T2DM prevalence was significantly higher in periodontitis patients (OR = 4.04, p = 0.000), and vice versa (OR = 1.58, p = 0.000). T2DM patients had significantly worse periodontal status, as reflected in a 0.61 mm deeper periodontal pocket, a 0.89 mm higher attachment loss and approximately 2 more lost teeth (all p = 0.000), than those without T2DM. The results of the cohort studies found that T2DM could elevate the risk of developing periodontitis by 34% (p = 0.002). The glycemic control of T2DM patients might result in different periodontitis outcomes. Severe periodontitis increased the incidence of T2DM by 53% (p = 0.000), and this result was stable. In contrast, the impact of mild periodontitis on T2DM incidence (RR = 1.28, p = 0.007) was less robust. Conclusions There is an evident bidirectional relationship between T2DM and periodontitis. Further well-designed cohort studies are needed to confirm this finding. Our results suggest that both dentists and physicians need to be aware of the strong connection between periodontitis and T2DM. Controlling these two diseases might help prevent each other’s incidence.
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Affiliation(s)
- Chen-Zhou Wu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Number 14, Unit 3, Renmin Nan Road, Chengdu City, 610041, Sichuan, China
| | - Yi-Hang Yuan
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Number 14, Unit 3, Renmin Nan Road, Chengdu City, 610041, Sichuan, China
| | - Hang-Hang Liu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Orthognathic and Temporomandibular Joint Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Shen-Sui Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Number 14, Unit 3, Renmin Nan Road, Chengdu City, 610041, Sichuan, China
| | - Bo-Wen Zhang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Number 14, Unit 3, Renmin Nan Road, Chengdu City, 610041, Sichuan, China
| | - Wen Chen
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Number 14, Unit 3, Renmin Nan Road, Chengdu City, 610041, Sichuan, China
| | - Zi-Jian An
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Number 14, Unit 3, Renmin Nan Road, Chengdu City, 610041, Sichuan, China
| | - Si-Yu Chen
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Number 14, Unit 3, Renmin Nan Road, Chengdu City, 610041, Sichuan, China
| | - Yong-Zhi Wu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Number 14, Unit 3, Renmin Nan Road, Chengdu City, 610041, Sichuan, China
| | - Bo Han
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Number 14, Unit 3, Renmin Nan Road, Chengdu City, 610041, Sichuan, China
| | - Chun-Jie Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Number 14, Unit 3, Renmin Nan Road, Chengdu City, 610041, Sichuan, China
| | - Long-Jiang Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Number 14, Unit 3, Renmin Nan Road, Chengdu City, 610041, Sichuan, China.
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17
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Almusawi MA, Gosadi I, Abidia R, Almasawi M, Alrashood ST, Ekhzaimy A, Alhomida AS, Khan HA. Association between salivary factors and cariogenic bacteria in type-2 diabetes patients. JOURNAL OF KING SAUD UNIVERSITY - SCIENCE 2020. [DOI: 10.1016/j.jksus.2020.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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18
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Sen S, Kumar S, Chakraborty R, Srivastava S, Mishra G, Choudhary A. Prevalence and risk factors of root caries in the geriatric population in the rural sector. J Family Med Prim Care 2020; 9:771-776. [PMID: 32318418 PMCID: PMC7114028 DOI: 10.4103/jfmpc.jfmpc_1053_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 01/10/2020] [Accepted: 01/22/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction Increasing age, long-term deleterious habits, and increased bone resorption leading to the gingival recession have become a significant reason for poor geriatric oral health among which root caries are the most prevalent ones among the Indian population. Methodology A cross-sectional study was conducted among the geriatric population above 60 years of age and those who gave voluntary consent for participating in the study were included in the study and were briefed about the questionnaire. The self-administered questionnaire was given and complete oral examination was done. Results were analyzed using the SPSS 22 version using descriptive analysis and Chi-square test. Result Percentage of deleterious habits amongst males was higher than that of females i.e. 56%. Thus, males were reported with root caries more than females. The percentage of married people suffering from root caries was 85%. The most prevalent occupation among the geriatric population was found to be the farmers with 37%. Religion with maximum percentage and frequency was found to be Hinduism with 84%. Educational statuses with 6th to 12th standards were reported with maximum root caries, i.e. 55%. Conclusion The study showed that criteria including income, gender, marital status, occupation, religion, and educational status were significant in assessing the prevalence of root caries. Whereas the risk factors such as habits, methods of cleaning, and brushing techniques influenced the root caries among the geriatric population.
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Affiliation(s)
- Sourav Sen
- Department of Public Health Dentistry, Maharishi Markandeshwar College of Dental Sciences and Research, Maharishi Markandeshwar (Deemed to be University), Ambala, Haryana, India
| | - Sumit Kumar
- Department of Public Health Dentistry, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Rakashree Chakraborty
- Department of Oral Medicine and Radiology, Maharishi Markandeshwar College of Dental Sciences and Research, Maharishi Markandeshwar (Deemed to be University), Ambala, Haryana, India
| | - Sumedha Srivastava
- Department of Periodontology, People College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
| | - Gaurav Mishra
- Department of Public Health Dentistry, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Ashish Choudhary
- Department of Public Health Dentistry, Kusum Devi Sunderlal Dugar Jain Dental College and Hospital, Kolkata, West Bengal, India
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19
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Coelho AS, Amaro IF, Caramelo F, Paula A, Marto CM, Ferreira MM, Botelho MF, Carrilho EV. Dental caries, diabetes mellitus, metabolic control and diabetes duration: A systematic review and meta-analysis. J ESTHET RESTOR DENT 2020; 32:291-309. [PMID: 31912978 DOI: 10.1111/jerd.12562] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/04/2019] [Accepted: 12/17/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To analyze articles aimed at evaluating the association between diabetes, metabolic control, diabetes duration, and dental caries. OVERVIEW A systematic search in PubMed, Cochrane Library, Embase, and Web of Science was conducted to retrieve papers in English, Portuguese, and Spanish, up to April 2019. The research strategy was constructed considering the "PECO" strategy. Only quantitative observational studies were analyzed. The risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale. The meta-analyses were performed based on random-effects models using the statistical platform R. A total of 69 articles was included in the systematic review and 40 in the meta-analysis. Type 1 diabetics have a significantly higher DMFT compared to controls. No significant differences were found between type 2 diabetics and controls and between well-controlled and poorly controlled diabetics. Concerning diabetes duration, all authors failed to find differences between groups. CONCLUSION Although there is still a need for longitudinal studies, the meta-analysis proved that type 1 diabetics have a high dental caries risk. CLINICAL SIGNIFICANCE It is necessary to be aware of all risk factors for dental caries that may be associated with these patients, making it possible to include them into an individualized prevention program.
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Affiliation(s)
- Ana Sofia Coelho
- Faculty of Medicine, Institute of Integrated Clinical Practice, University of Coimbra, Coimbra, Portugal.,Faculty of Medicine, Coimbra Institute for Clinical and Biomedical Research (iCBR), University of Coimbra, Coimbra, Portugal.,Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal.,Faculty of Medicine, CIMAGO-Center of Investigation on Environment, Genetics and Oncobiology, University of Coimbra, Coimbra, Portugal.,CNC.IBILI, University of Coimbra, Coimbra, Portugal
| | - Inês Flores Amaro
- Faculty of Medicine, Institute of Integrated Clinical Practice, University of Coimbra, Coimbra, Portugal
| | - Francisco Caramelo
- Faculty of Medicine, Coimbra Institute for Clinical and Biomedical Research (iCBR), University of Coimbra, Coimbra, Portugal.,Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal.,Faculty of Medicine, CIMAGO-Center of Investigation on Environment, Genetics and Oncobiology, University of Coimbra, Coimbra, Portugal.,CNC.IBILI, University of Coimbra, Coimbra, Portugal.,Faculty of Medicine, Laboratory of Biostatistics and Medical Informatics, University of Coimbra, Coimbra, Portugal
| | - Anabela Paula
- Faculty of Medicine, Institute of Integrated Clinical Practice, University of Coimbra, Coimbra, Portugal.,Faculty of Medicine, Coimbra Institute for Clinical and Biomedical Research (iCBR), University of Coimbra, Coimbra, Portugal.,Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal.,Faculty of Medicine, CIMAGO-Center of Investigation on Environment, Genetics and Oncobiology, University of Coimbra, Coimbra, Portugal.,CNC.IBILI, University of Coimbra, Coimbra, Portugal
| | - Carlos Miguel Marto
- Faculty of Medicine, Institute of Integrated Clinical Practice, University of Coimbra, Coimbra, Portugal.,Faculty of Medicine, Coimbra Institute for Clinical and Biomedical Research (iCBR), University of Coimbra, Coimbra, Portugal.,Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal.,Faculty of Medicine, CIMAGO-Center of Investigation on Environment, Genetics and Oncobiology, University of Coimbra, Coimbra, Portugal.,CNC.IBILI, University of Coimbra, Coimbra, Portugal.,Faculty of Medicine, Experimental Pathology Institute, University of Coimbra, Coimbra, Portugal
| | - Manuel Marques Ferreira
- Faculty of Medicine, Coimbra Institute for Clinical and Biomedical Research (iCBR), University of Coimbra, Coimbra, Portugal.,Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal.,Faculty of Medicine, CIMAGO-Center of Investigation on Environment, Genetics and Oncobiology, University of Coimbra, Coimbra, Portugal.,CNC.IBILI, University of Coimbra, Coimbra, Portugal.,Faculty of Medicine, Institute of Endodontics, University of Coimbra, Coimbra, Portugal
| | - Maria Filomena Botelho
- Faculty of Medicine, Coimbra Institute for Clinical and Biomedical Research (iCBR), University of Coimbra, Coimbra, Portugal.,Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal.,Faculty of Medicine, CIMAGO-Center of Investigation on Environment, Genetics and Oncobiology, University of Coimbra, Coimbra, Portugal.,CNC.IBILI, University of Coimbra, Coimbra, Portugal
| | - Eunice Virgínia Carrilho
- Faculty of Medicine, Institute of Integrated Clinical Practice, University of Coimbra, Coimbra, Portugal.,Faculty of Medicine, Coimbra Institute for Clinical and Biomedical Research (iCBR), University of Coimbra, Coimbra, Portugal.,Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal.,Faculty of Medicine, CIMAGO-Center of Investigation on Environment, Genetics and Oncobiology, University of Coimbra, Coimbra, Portugal.,CNC.IBILI, University of Coimbra, Coimbra, Portugal
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20
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Majbauddin A, Tanimura C, Aoto H, Otani S, Parrenas MCE, Kobayashi N, Morita T, Inoue K, Masumoto T, Kurozawa Y. Association between dental caries indicators and serum glycated hemoglobin-levels among patients with type 2 diabetes mellitus. J Oral Sci 2019; 61:335-342. [PMID: 31217384 DOI: 10.2334/josnusd.18-0156] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Diabetes mellitus (DM) with poor glycemic control is often linked to oral manifestations. This study aimed to investigate the association between dental caries (DC) and glycated hemoglobin (HbA1c) among patients with type 2 DM (T2DM). A health center-based cross-sectional study was conducted comprising 91 eligible patients with T2DM (21 males and 70 females) with a mean age (± standard deviation) of 61.49 ± 9.71 years. A structured interview, screening for DM-related factors, and oral examination were performed. Serum HbA1c levels were used as an index for glycemic control. A comparison between patients with controlled T2DM, i.e., HbA1c ≤7.0% (n = 46), and uncontrolled T2DM, i.e., HbA1c >7.0% (n = 45), showed significant differences in mean values of decayed teeth (DT) (P = 0.045); missing teeth (P = 0.002); and decayed, missing, and filled teeth (DMFT) index (P < 0.001). Results of multiple linear regression analysis revealed that the number of DT was significantly correlated with serum HbA1c levels (95% confidence interval [CI] 0.173 to 0.972, P = 0.005). Furthermore, DMFT index values and serum HbA1c levels (95% CI 0.532 to 1.658, P < 0.001) showed a significant association. This study provides substantial evidence on the association between DC indicators and serum HbA1c levels.
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Affiliation(s)
- Abir Majbauddin
- International Platform for Dryland Research and Education, Tottori University
| | - Chika Tanimura
- Department of Adult and Elderly Nursing, School of Health Science, Faculty of Medicine, Tottori University
| | - Haruka Aoto
- Department of Fundamental Nursing, School of Health Science, Faculty of Medicine, Tottori University
| | - Shinji Otani
- International Platform for Dryland Research and Education, Tottori University
| | | | | | | | - Kazuoki Inoue
- Department of Community-based Family Medicine, Faculty of Medicine, Tottori University
| | - Toshio Masumoto
- Division of Health Administration and Promotion, Faculty of Medicine, Tottori University
| | - Youichi Kurozawa
- Division of Health Administration and Promotion, Faculty of Medicine, Tottori University
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Schmolinsky J, Kocher T, Rathmann W, Völzke H, Pink C, Holtfreter B. Diabetes status affects long-term changes in coronal caries - The SHIP Study. Sci Rep 2019; 9:15685. [PMID: 31666549 PMCID: PMC6821733 DOI: 10.1038/s41598-019-51086-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 09/25/2019] [Indexed: 01/19/2023] Open
Abstract
We estimated effects of diabetes mellitus and metabolic control on long-term change in coronal caries and restorative status using 11-year-follow-up data from the population-based Study of Health in Pomerania. Data of 3731 participants with baseline and 5- and 11-year follow-up information were included. Diabetes was defined via self-reported physician´s diagnosis or intake of glucose-lowering drugs or hemoglobin A1c (HbA1c) ≥6.5% or fasting blood glucose levels ≥11.1 mmol/l. The diabetes status was defined as no diabetes (HbA1c < 6.5% or non-fasting blood glucose <11.1 mmol/l), subjects with known or undetected diabetes mellitus and HbA1c ≤ 7% (well-controlled diabetes), and subjects with known or undetected diabetes mellitus and HbA1c > 7% (poorly-controlled diabetes). The caries status was clinically assessed using the half-mouth method and the Decayed Missing Filled Surfaces (DMFS) index and its component scores were determined. Covariate-adjusted linear mixed models were evaluated. Rates in change in DMFS were significantly higher in subjects with poorly-controlled diabetes compared to subjects without diabetes. Subjects with poorly- and well-controlled diabetes had significantly higher rates in change in Missing Surfaces (MS) compared to subjects without diabetes. For the DFS, rates in change were significantly lower for subjects with well-controlled diabetes and higher for subjects with poorly-controlled diabetes as compared to subjects without diabetes. Concordantly, all rates in change increased proportional to HbA1c levels. Effects were even more pronounced in subjects with diabetes duration of ≥5 years. Subjects with poorly-controlled diabetes are at higher risk for caries progression compared to subjects without diabetes, especially in case of longer disease duration.
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Affiliation(s)
- Julia Schmolinsky
- Unit of Periodontology, Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - Thomas Kocher
- Unit of Periodontology, Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - Wolfgang Rathmann
- German Diabetes Center, Institute for Biometrics and Epidemiology, Düsseldorf, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.,German Centre of Diabetes Research, site Greifswald, Greifswald, Germany
| | - Christiane Pink
- Unit of Periodontology, Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - Birte Holtfreter
- Unit of Periodontology, Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany.
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22
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Verhulst MJL, Loos BG, Gerdes VEA, Teeuw WJ. Evaluating All Potential Oral Complications of Diabetes Mellitus. Front Endocrinol (Lausanne) 2019; 10:56. [PMID: 30962800 PMCID: PMC6439528 DOI: 10.3389/fendo.2019.00056] [Citation(s) in RCA: 125] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 01/22/2019] [Indexed: 12/13/2022] Open
Abstract
Diabetes mellitus (DM) is associated with several microvascular and macrovascular complications, such as retinopathy, nephropathy, neuropathy, and cardiovascular diseases. The pathogenesis of these complications is complex, and involves metabolic and hemodynamic disturbances, including hyperglycemia, insulin resistance, dyslipidemia, hypertension, and immune dysfunction. These disturbances initiate several damaging processes, such as increased reactive oxygen species (ROS) production, inflammation, and ischemia. These processes mainly exert their damaging effect on endothelial and nerve cells, hence the susceptibility of densely vascularized and innervated sites, such as the eyes, kidneys, and nerves. Since the oral cavity is also highly vascularized and innervated, oral complications can be expected as well. The relationship between DM and oral diseases has received considerable attention in the past few decades. However, most studies only focus on periodontitis, and still approach DM from the limited perspective of elevated blood glucose levels only. In this review, we will assess other potential oral complications as well, including: dental caries, dry mouth, oral mucosal lesions, oral cancer, taste disturbances, temporomandibular disorders, burning mouth syndrome, apical periodontitis, and peri-implant diseases. Each oral complication will be briefly introduced, followed by an assessment of the literature studying epidemiological associations with DM. We will also elaborate on pathogenic mechanisms that might explain associations between DM and oral complications. To do so, we aim to expand our perspective of DM by not only considering elevated blood glucose levels, but also including literature about the other important pathogenic mechanisms, such as insulin resistance, dyslipidemia, hypertension, and immune dysfunction.
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Affiliation(s)
- Martijn J. L. Verhulst
- Department of Periodontology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, Netherlands
- *Correspondence: Martijn J. L. Verhulst
| | - Bruno G. Loos
- Department of Periodontology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, Netherlands
| | - Victor E. A. Gerdes
- Department of Vascular Medicine, Amsterdam UMC, Amsterdam, Netherlands
- Department of Internal Medicine, Spaarne Gasthuis, Hoofddorp, Netherlands
| | - Wijnand J. Teeuw
- Department of Periodontology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, Netherlands
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23
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Pentapati KC, Siddiq H, Yeturu SK. Global and regional estimates of the prevalence of root caries - Systematic review and meta-analysis. Saudi Dent J 2018; 31:3-15. [PMID: 30705564 PMCID: PMC6349959 DOI: 10.1016/j.sdentj.2018.11.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/26/2018] [Accepted: 11/26/2018] [Indexed: 01/04/2023] Open
Abstract
Aim To evaluate the pooled prevalence of root caries through a systematic review and meta-analysis. Methods A keyword search was done in Scopus, Pubmed and CINAHL databases using all the synonyms of root caries in the published literature (till January 1st, 2018). The search was supplemented with standard Boolean operators and other keywords like prevalence, epidemiology in the title, abstract and MeSH terms. Data was extracted and exported to Covidence software for screening and removal of duplicates. Results The search revealed a total of 492 documents from Scopus (n = 95), Pubmed (n = 220) and CINAHL (n = 177). Random effects model was used as there was a high degree of heterogeneity was seen among the studies published (I2 = 99.62%). A total of 74 publications were included in the analysis of the pooled prevalence of root caries which yielded a prevalence of 41.5 (36.9–46.1). Conclusion Root caries is a significant problem, and four out of ten adults might be affected.
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Affiliation(s)
- Kalyana Chakravarthy Pentapati
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Hanan Siddiq
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Sravan Kumar Yeturu
- Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Viswavidya Peetham, Kochi, India
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Almusawi MA, Gosadi I, Abidia R, Almasawi M, Khan HA. Potential risk factors for dental caries in Type 2 diabetic patients. Int J Dent Hyg 2018; 16:467-475. [PMID: 29749033 DOI: 10.1111/idh.12346] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Diabetic patients are known to be at higher risk for dental caries. However, the role of potential risk factors such as blood glucose, salivary glucose and glycaemic control in the occurrence of dental caries in type 2 diabetes (T2D) is not clearly understood so far, and therefore, it was evaluated in this study. MATERIALS AND METHODS This cross-sectional study was conducted on 100 T2D patients from Saudi Arabia. The caries risk assessment was evaluated using the guidelines of Caries Management by Risk Assessment (CAMBRA). Cariogenic bacteria load in saliva was determined by a chair-side test kit. The levels of fasting blood glucose (FBG), salivary glucose and HbA1c were analysed. RESULTS Majority of the patients had dental caries (84%), exposed root surfaces (92%) and heavy plaque (73%), whereas 66% of patients suffered from xerostomia. The frequency of patients with high counts of Streptococcus mutans and Lactobacilli (LB) were 78% and 42%, respectively. There were significant associations between dental caries risk and FBG, HbA1c and salivary glucose. After categorizing the patients into 3 categories of glycaemic control, we observed a significant association between glycaemic control and dental caries risk. CONCLUSION Type 2 diabetes patients are at high risk for dental caries, which is directly associated with FBG, HbA1c and salivary glucose. This is the first study measuring dental caries and its risk factors in T2D patients from Saudi Arabia.
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Affiliation(s)
- M A Almusawi
- Department of Family and Community Medicine, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - I Gosadi
- Department of Family and Community Medicine, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - R Abidia
- College of Dentistry, Dar Al Uloom University, Riyadh, Saudi Arabia
| | - M Almasawi
- Dr. Abdulaziz Al Ajaji Dental Polyclinics, Riyadh, Saudi Arabia
| | - H A Khan
- Department of Biochemistry, College of Science, King Saud University, Riyadh, Saudi Arabia
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Buysschaert M, Buysschaert B, Jamart J. Dental caries and diabetes: A Belgian survey of patients with type 1 and type 2 diabetes. DIABETES & METABOLISM 2018; 46:248-249. [PMID: 29934226 DOI: 10.1016/j.diabet.2018.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 06/06/2018] [Accepted: 06/06/2018] [Indexed: 11/24/2022]
Affiliation(s)
- M Buysschaert
- Department of Endocrinology and Nutrition, cliniques universitaires UCL Saint-Luc, avenue Hippocrate 10, 1200 Brussels, Belgium.
| | - B Buysschaert
- Department of Internal Medicine, CHR de Huy, rue des Trois-Ponts 2, 4500 Huy, Belgium
| | - J Jamart
- Scientific Support Unit, CHU UCL Namur, Site Godinne, avenue G.-Thérasse 1, 5530 Yvoir, Belgium
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Affiliation(s)
- Vinson Yeung
- Dental Core Trainee, University Dental Hospital Cardiff/Cardiff and Vale University Health Board, Cardiff CF14 4XY
| | - Joht Chandan
- Academic Foundation Doctor, City Hospital, Dudley Road, Birmingham B18 7QH, UK
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Suzuki S, Yoshino K, Takayanagi A, Ishizuka Y, Satou R, Nara N, Kamijo H, Sugihara N. Relationship between Blood HbA1c Level and Decayed Teeth in Patients with Type 2 Diabetes: A Cross-sectional Study. THE BULLETIN OF TOKYO DENTAL COLLEGE 2018; 60:89-96. [DOI: 10.2209/tdcpublication.2018-0039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Seitaro Suzuki
- Department of Epidemiology and Public Health, Tokyo Dental College
| | - Koichi Yoshino
- Department of Epidemiology and Public Health, Tokyo Dental College
| | | | - Yoichi Ishizuka
- Department of Epidemiology and Public Health, Tokyo Dental College
| | - Ryouichi Satou
- Department of Epidemiology and Public Health, Tokyo Dental College
| | | | - Hideyuki Kamijo
- Department of Social Security for Dentistry, Tokyo Dental College
| | - Naoki Sugihara
- Department of Epidemiology and Public Health, Tokyo Dental College
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Yonekura S, Usui M, Murano S. Association between numbers of decayed teeth and HbA1c in Japanese patients with type 2 diabetes mellitus. Ups J Med Sci 2017; 122:108-113. [PMID: 28276781 PMCID: PMC5441370 DOI: 10.1080/03009734.2017.1285838] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 12/03/2016] [Accepted: 01/19/2017] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Dental caries (DC) are more prevalent in individuals with diabetes than in healthy individuals. However, the association between glycaemic control and DC has not been well characterized in patients with type 2 diabetes mellitus (T2DM). We therefore assessed the association between glycated haemoglobin (HbA1c) serum concentrations and the prevalence of DC in patients with T2DM. METHODS Retrospective analyses of data pertaining to 108 Japanese patients with T2DM hospitalized because of poor or worsened glycaemic control were included. We divided the patients based on HbA1c into two groups: HbA1c level ≥75 mmol/mol (9.0%) as poorly controlled T2DM, and HbA1c level <75 mmol/mol (9.0%) as a control group. We compared the association of lifestyle factors, dental caries, and periodontal health between patients with poorly controlled T2DM and controls. Stepwise multiple regression analyses were performed to evaluate the association between HbA1c, the absolute number of decayed teeth (DT), the sum of decayed, missing, and filled teeth, and the Met Need Index (MNI). RESULTS DT was higher and MNI was lower in patients with poorly controlled T2DM as compared to that in controls (P = 0.006 and P = 0.004, respectively). Multiple regression analyses revealed a significant association between HbA1c levels and DT (adjusted β = 0.039, 95% confidence interval [CI], 0.005 to 0.072, P = 0.025) and the MNI (adjusted β = -0.216, 95% CI -0.374 to -0.058, P = 0.008). CONCLUSIONS DT and MNI were associated with HbA1c in T2DM patients.
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Affiliation(s)
- Satoru Yonekura
- Department of Endocrinology, Tochigi Medical Center, Shimotsuga, Ohira-machi Kawatsure 420-1, Tochigi City, Tochigi, Japan
| | - Masato Usui
- Usui Dental Office, 12-14 Numawada-machi, Tochigi City, Tochigi, Japan
| | - Shunichi Murano
- Department of Endocrinology, Tochigi Medical Center, Shimotsuga, Ohira-machi Kawatsure 420-1, Tochigi City, Tochigi, Japan
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Risk indicators associated with root caries in independently living older adults. J Dent 2016; 51:8-14. [DOI: 10.1016/j.jdent.2016.05.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 05/15/2016] [Accepted: 05/17/2016] [Indexed: 01/03/2023] Open
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Kumara-Raja B, Radha G. Prevalence of root caries among elders living in residential homes of Bengaluru city, India. J Clin Exp Dent 2016; 8:e260-7. [PMID: 27398175 PMCID: PMC4930634 DOI: 10.4317/jced.52682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 10/21/2015] [Indexed: 12/12/2022] Open
Abstract
Background Among the various oral ailments which have been observed in elderly, root caries is a significant one. Tooth loss is chief oral health-related negative variable to the quality of life in elderly and root caries is the major cause of tooth loss in them. It has been reported about a third of older population bears most of the root caries burden, so the present study aimed to assess the prevalence of root caries among older individuals residing in residential homes of Bengaluru city India. Material and Methods Elderly individuals aged 60 and above, residing in residential homes of Bangalore city, were included in the study. The study participants filled a questionnaire regarding their demographic details and oral health habits. Root surface caries was recorded according to criteria described by Banting et al. and root caries was expressed in terms of the root caries index (RCI). The statistical analysis was performed using descriptive statistics and chi-square test. P < 0.05 was considered as statistically significant. Results The prevalence of root caries was 46.4%. The root caries index was 15%. Statistically significant differences (P < 0.05) observed across gender, marital status, diet, socio-economic status, medication, method of cleaning and frequency of cleaning and were identified as significant predictors of root caries. Conclusions The prevalence of root caries among institutionalized older people was high. Oral health policies and preventive measures are needed focusing on the special needs of this neglected and socioeconomically deprived population to improve their quality of life. Key words:Elders, residential home, root caries.
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Affiliation(s)
- Balasubramanian Kumara-Raja
- BDS, Post Graduate Student. Department of Public Health Dentistry, V.S Dental College & Hospital, Bengaluru 560004
| | - Gubbihal Radha
- MDS, Reader. Department of Public Health Dentistry, V.S Dental College & Hospital, Bengaluru 560004
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Holm NCR, Belstrøm D, Østergaard JA, Schou S, Holmstrup P, Grauballe MB. Identification of Individuals With Undiagnosed Diabetes and Pre-Diabetes in a Danish Cohort Attending Dental Treatment. J Periodontol 2016; 87:395-402. [DOI: 10.1902/jop.2016.150266] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Malvania EA, Sheth SA, Sharma AS, Mansuri S, Shaikh F, Sahani S. Dental caries prevalence among type II diabetic and nondiabetic adults attending a hospital. J Int Soc Prev Community Dent 2016; 6:S232-S236. [PMID: 28217542 PMCID: PMC5285600 DOI: 10.4103/2231-0762.197202] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objectives: Diabetes mellitus (DM) is a common chronic metabolic disorder which affects millions of people. At present, India has the highest incidence of diabetes worldwide. Several oral lesions and conditions are associated with diabetes. However, there is a lack of consensus among researchers regarding the relationship between DM and dental caries. Hence, the present study was carried out to assess the dental caries prevalence among type II diabetic and nondiabetic adults attending a hospital in Ahmedabad city. Materials and Methods: A hospital-based cross-sectional study was conducted. One hundred and twenty diabetics individuals attending the diabetic Outpatient Department (OPD) and age and sex-matched 120 nondiabetic individuals from general OPD were included in the study. The data were gathered through semi-close-ended questionnaire and clinical examination. Dental caries was assessed by using the World Health Organization's 2013 proforma. Data was analyzed by applying Student's independent t-test or one-way analysis of variance. Results: Dental caries prevalence among the diabetic group was 73.33% and 33.33% among the nondiabetic group. Dental caries prevalence and mean dental caries was significantly higher among uncontrolled diabetic individuals than that among controlled diabetic individuals. Duration of the disease and dental caries prevalence did not show any significant difference. Conclusion: Dental caries prevalence was significantly high among diabetic individuals compared with nondiabetic individuals. Close collaboration between the patients, healthcare units, and oral health professionals could be a way of improving diabetic patients' general and oral health.
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Affiliation(s)
- Ekta A Malvania
- Department of Public Health Dentistry, AMC Dental College and Hospital, Ahmedabad, Gujarat, India
| | - Sona A Sheth
- Department of Public Health Dentistry, AMC Dental College and Hospital, Ahmedabad, Gujarat, India
| | - Ashish S Sharma
- Department of Public Health Dentistry, AMC Dental College and Hospital, Ahmedabad, Gujarat, India
| | - Saloni Mansuri
- Department of Public Health Dentistry, AMC Dental College and Hospital, Ahmedabad, Gujarat, India
| | - Faizan Shaikh
- Department of Public Health Dentistry, AMC Dental College and Hospital, Ahmedabad, Gujarat, India
| | - Saloni Sahani
- Department of Public Health Dentistry, AMC Dental College and Hospital, Ahmedabad, Gujarat, India
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Impact of glycemic control on oral health status in type 2 diabetes individuals and its association with salivary and plasma levels of chromogranin A. Arch Oral Biol 2015; 62:10-9. [PMID: 26605682 DOI: 10.1016/j.archoralbio.2015.11.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 11/05/2015] [Accepted: 11/08/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the effect of glycemic control status in type 2 diabetes mellitus (T2DM) individuals on clinical oral health indicators and to compare the concentrations of plasma and salivary chromogranin A (CHGA) among nondiabetic subjects and T2DM patients, exploring their associations. DESIGN In this cross-sectional study, 32 patients with controlled T2DM, 31 with poorly controlled T2DM and 37 nondiabetic subjects underwent a clinical and periodontal examination. CHGA concentrations were determined in saliva and plasma with ELISA. RESULTS Poorly controlled T2DM group exhibited significantly higher mean buffering capacity, plaque index and bleeding on probing than other groups (P<0.05). No difference was found to DMFT (decayed, missed and filled teeth) index between groups. Sites with clinical attachment loss (CAL) of 4 and 5-6mm were significantly higher in both diabetic groups compared to control group (P<0.05). Poorly controlled T2DM group had significantly higher sites with CAL ≥ 7 mm than other groups (P=0.001). Significantly higher plasma and salivary CHGA levels were found in T2DM groups (P<0.05). In both diabetic groups, probing depths 5-6mm and CAL 5-6mm were associated with higher salivary CHGA concentration (P<0.05). CONCLUSIONS The findings revealed that T2DM patients were more prone to periodontal tissue damage than to caries risk. The results also provide some evidence that the degree of attachment loss deteriorates significantly with poor glycemic control in T2DM (CAL ≥ 7 mm). Moreover, the results suggest that high concentrations of salivary CHGA are associated with worse periodontal parameters and T2DM, and this could be related to the pathogenesis of both diseases.
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Soni S, Mehta M, M AD, P R, Pallavi, Kadanakuppe S, Nagashree, B V. Root caries among type 2 diabetes mellitus patients visiting a hospital. SPECIAL CARE IN DENTISTRY 2014; 34:273-7. [DOI: 10.1111/scd.12065] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sugandhi Soni
- JN Kapoor DAV Dental College and Hospital; Yamuna Nagar Haryana India
| | - Mohit Mehta
- MM College of Dental Sciences and Research; Mullana Haryana India
| | - Aruna Devi M
- VS Dental College and Hospital; Bangalore Karnataka India
| | - Radha P
- VS Dental College and Hospital; Bangalore Karnataka India
| | - Pallavi
- VS Dental College and Hospital; Bangalore Karnataka India
| | | | - Nagashree
- VS Dental College and Hospital; Bangalore Karnataka India
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Mohamed HG, Idris SB, Ahmed MF, Bøe OE, Mustafa K, Ibrahim SO, Astrøm AN. Association between oral health status and type 2 diabetes mellitus among Sudanese adults: a matched case-control study. PLoS One 2013; 8:e82158. [PMID: 24349205 PMCID: PMC3859584 DOI: 10.1371/journal.pone.0082158] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 10/21/2013] [Indexed: 12/17/2022] Open
Abstract
AIM The purpose of this study was to compare the clinical and subjective oral health indicators of type 2 diabetic patients (T2DM) with age and gender matched non-diabetic controls. A second aim was to identify clinical and subjective oral health indicators that discriminate between well-controlled and poorly controlled T2DM patients as well as between patients with long and short duration of the disease. METHODS A total of 457 individuals participated in the study (154 T2DM cases and 303 non-diabetic controls). The T2DM group was sub-divided according to metabolic control [(well-controlled: glycosylated haemoglobin test 8%), (poorly controlled: glycosylated haemoglobin test > 8%)] and according to duration of T2DM [(long duration: >10 years), (short duration: 10 years)]. Participants were interviewed using a structured questionnaire including socio-demographics, lifestyle and oral health related quality of life factors. The clinical examination comprised full mouth probing depths, plaque index, tooth mobility index, furcation involvement and coronal and root surface caries. RESULTS The T2DM patients presented with more probing depths 4 mm, furcation involvement, tooth mobility, missing teeth, and oral impacts on daily performance (OIDP). The corresponding adjusted odds ratios and their 95% confidence intervals were 4.07 (1.74-9.49), 2.96 (1.36-6.45), 5.90 (2.26-15.39), 0.23 (0.08-0.63) and 3.46 (1.61-7.42), respectively. Moreover, the odds ratio was 2.60 (1.21-5.55) for the poorly controlled T2DM patients to have high levels of mobility index and 2.94 (1.24-6.94) for those with long duration of T2DM to have high decayed, missed and filled teeth (DMFT) values. CONCLUSION This study revealed that chronic periodontitis, tooth mobility, furcation involvement and OIDP were more prevalent among T2DM patients compared to their non-diabetic controls.
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Affiliation(s)
- Hasaan G Mohamed
- Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway ; Department of Oral Rehabilitation, Faculty of Dentistry, University of Khartoum, Khartoum, Sudan
| | - Shaza B Idris
- Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Mutaz F Ahmed
- Senior Consultant in Endodontics/Restorative Dentistry, Hamad Medical Corporation, Doha, Qatar
| | - Olav E Bøe
- Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Kamal Mustafa
- Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Salah O Ibrahim
- Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Anne N Astrøm
- Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
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Oral bacterial communities in individuals with type 2 diabetes who live in southern Thailand. Appl Environ Microbiol 2013; 80:662-71. [PMID: 24242241 DOI: 10.1128/aem.02821-13] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Type 2 diabetes mellitus is increasingly common in Thailand and elsewhere. In the present investigation, the bacteriological composition of saliva and supragingival plaque in Thai diabetics with and without active dental caries and in nondiabetics was determined by differential culture and eubacterial DNA profiling. Potential associations between fasting blood sugar and glycosylated hemoglobin (biomarkers of current and historical glucose control, respectively) with decayed, missing, and filled teeth and with salivary Streptococcus and Lactobacillus counts were also investigated. The incidence of active dental caries was greater in the Thai diabetics than in nondiabetics, and the numbers of total streptococci and lactobacilli were significantly higher in supragingival plaque from diabetics than in nondiabetics. Lactobacillus counts in the saliva and supragingival plaque of diabetics with active caries were significantly higher than those in diabetics without active caries. Oral eubacterial DNA profiles of diabetic versus nondiabetic individuals and of diabetics with active caries versus those without active caries could not be readily differentiated through cluster analysis or multidimensional scaling. The elevated caries incidence in the Thai diabetics was positively associated with numbers of bacteria of the acidogenic/acid-tolerant genera Streptococcus and Lactobacillus. Lactobacillus bacterial numbers were further elevated in diabetics with active caries, although salivary eubacterial DNA profiles were not significantly altered.
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Garton BJ, Ford PJ. Root caries: a survey of Queensland dentists. Int J Dent Hyg 2013; 11:216-25. [PMID: 23433394 DOI: 10.1111/idh.12018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Root caries stands to be a significant burden for Australia's ageing population. The objective of this study was to describe Queensland dental practitioners' perceptions of root caries prevalence, presentation and predisposing factors as well as diagnosis and recording practices. METHODS Using the Queensland Dental Board register, all 2,515 dentists and dental specialists practising in Queensland were invited to participate in a questionnaire-based postal survey. RESULTS Of the 660 responses received, 638 were included for final analysis. Use of diagnostic measures such as surface elasticity and contour were reported frequently. A majority of respondents (77%) reported not recording root caries in a way that could be distinguished from coronal caries. Dietary analysis was the most commonly reported adjunctive aid for risk assessment. Recommendations for use of remineralizing agents were frequently reported (home use 90%; in office use 71%). Salivary impairment was reported to be an important risk factor for root caries by 93% of respondents, but only 18% reported performing salivary analysis. A large proportion of respondents (32%) considered patients with diabetes to be of low or no risk of root caries. CONCLUSIONS While the Queensland dental practitioners who participated in this survey demonstrated an awareness of root caries and its predisposing factors, clinical risk assessment particularly for patients with diabetes should be further examined.
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Affiliation(s)
- B J Garton
- The University of Queensland, School of Dentistry, Brisbane, Qld, Australia
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Wang X, Shaffer JR, Zeng Z, Begum F, Vieira AR, Noel J, Anjomshoaa I, Cuenco KT, Lee MK, Beck J, Boerwinkle E, Cornelis MC, Hu FB, Crosslin DR, Laurie CC, Nelson SC, Doheny KF, Pugh EW, Polk DE, Weyant RJ, Crout R, McNeil DW, Weeks DE, Feingold E, Marazita ML. Genome-wide association scan of dental caries in the permanent dentition. BMC Oral Health 2012; 12:57. [PMID: 23259602 PMCID: PMC3574042 DOI: 10.1186/1472-6831-12-57] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 11/28/2012] [Indexed: 01/05/2023] Open
Abstract
UNLABELLED BACKGROUND Over 90% of adults aged 20 years or older with permanent teeth have suffered from dental caries leading to pain, infection, or even tooth loss. Although caries prevalence has decreased over the past decade, there are still about 23% of dentate adults who have untreated carious lesions in the US. Dental caries is a complex disorder affected by both individual susceptibility and environmental factors. Approximately 35-55% of caries phenotypic variation in the permanent dentition is attributable to genes, though few specific caries genes have been identified. Therefore, we conducted the first genome-wide association study (GWAS) to identify genes affecting susceptibility to caries in adults. METHODS Five independent cohorts were included in this study, totaling more than 7000 participants. For each participant, dental caries was assessed and genetic markers (single nucleotide polymorphisms, SNPs) were genotyped or imputed across the entire genome. Due to the heterogeneity among the five cohorts regarding age, genotyping platform, quality of dental caries assessment, and study design, we first conducted genome-wide association (GWA) analyses on each of the five independent cohorts separately. We then performed three meta-analyses to combine results for: (i) the comparatively younger, Appalachian cohorts (N = 1483) with well-assessed caries phenotype, (ii) the comparatively older, non-Appalachian cohorts (N = 5960) with inferior caries phenotypes, and (iii) all five cohorts (N = 7443). Top ranking genetic loci within and across meta-analyses were scrutinized for biologically plausible roles on caries. RESULTS Different sets of genes were nominated across the three meta-analyses, especially between the younger and older age cohorts. In general, we identified several suggestive loci (P-value ≤ 10E-05) within or near genes with plausible biological roles for dental caries, including RPS6KA2 and PTK2B, involved in p38-depenedent MAPK signaling, and RHOU and FZD1, involved in the Wnt signaling cascade. Both of these pathways have been implicated in dental caries. ADMTS3 and ISL1 are involved in tooth development, and TLR2 is involved in immune response to oral pathogens. CONCLUSIONS As the first GWAS for dental caries in adults, this study nominated several novel caries genes for future study, which may lead to better understanding of cariogenesis, and ultimately, to improved disease predictions, prevention, and/or treatment.
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Affiliation(s)
- Xiaojing Wang
- Center for Craniofacial and Dental Genetics, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, 15219, USA.
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Ritter AV, Preisser JS, Chung Y, Bader JD, Shugars DA, Amaechi BT, Makhija SK, Funkhouser KA, Vollmer WM. Risk indicators for the presence and extent of root caries among caries-active adults enrolled in the Xylitol for Adult Caries Trial (X-ACT). Clin Oral Investig 2012; 16:1647-57. [PMID: 22198596 DOI: 10.1007/s00784-011-0656-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 11/29/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVE This paper uses baseline data from a randomized clinical trial to evaluate cross-sectional indicators of root caries in caries-active adults. MATERIALS AND METHODS Adults (21-80 years) having at least 12 erupted teeth and between one and ten caries lesions were enrolled. Participants (n = 437) received caries exams by trained, calibrated examiners and responded to baseline demographic and medical-dental questionnaires. We examined associations between baseline characteristics and (1) the presence of any root caries using Mantel-Haenszel hypothesis tests and odds ratio (OR) estimators and (2) the number of root surfaces with caries among study participants with exposed root surfaces (n = 349) using Mantel-Haenszel mean score tests and Mann-Whitney estimators. RESULTS/CONCLUSIONS Adjusting for study site and age, male gender [OR, 1.72; 95% confidence interval (CI), 1.08, 2.78], white race (OR, 2.39; 95% CI, 1.43, 3.98), recent dental visit (OR, 1.98; 95% CI, 1.07, 3.66), poor self-described oral health (OR, 2.65; 95% CI, 1.10, 6.39), and recent professional fluoride treatment (OR, 1.85; 95% CI, 1.06, 3.25) were significantly associated with increased odds to have any root caries, and study participants with exposed root surfaces characterized by male gender [Mann-Whitney probability estimate (MW) = 0.57; 95% CI, 0.51, 0.63), white race (MW, 0.61; 0.55, 0.68), recent dental visit (MW, 0.58; 0.50, 0.67), poor self-described oral health (MW, 0.61; 0.53, 0.69), and flossing at least once per day (MW, 0.57; 95% CI, 0.51, 0.62) were significantly more likely to have a greater number of root surfaces with caries than a randomly selected study participant from their respective complementary subgroups (female gender, non-white, etc.). CLINICAL RELEVANCE Our findings may help identify individuals at higher root caries risk.
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Affiliation(s)
- André V Ritter
- University of North Carolina at Chapel Hill School of Dentistry, 433 Brauer Hall, CB#7450, Chapel Hill, NC 27599-7450, USA.
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Garton BJ, Ford PJ. Root caries and diabetes: risk assessing to improve oral and systemic health outcomes. Aust Dent J 2012; 57:114-22. [PMID: 22624749 DOI: 10.1111/j.1834-7819.2012.01690.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This report reviews the current understanding of the relationship between diabetes and root caries, and investigates the evidence for dental chairside testing of gingival crevicular blood (GCB) glucose levels to assess risk for type 2 diabetes mellitus. Diabetes is linked with the progression of periodontal disease and a greater number of exposed root surfaces at risk for root caries. The rapidly increasing prevalence of type 2 diabetes coupled with a general trend towards retention of teeth means that the number of patients with increased risk for root caries is expanding significantly. Many patients with diabetes or abnormal blood glucose levels are unaware of their condition or that they are at increased risk for oral disease. Systemic blood glucose concentrations are comparable to those found in GCB and therefore may be a useful adjunctive clinical aid in determining appropriate care for patients and providing timely referrals to general medical practitioners. Use of GCB testing within the dental clinic is described. It is proposed that future studies be undertaken to provide clinicians with improved risk assessment strategies and to evaluate GCB glucose screening models.
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Affiliation(s)
- B J Garton
- School of Dentistry, The University of Queensland, Brisbane
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Isola M, Cossu M, Diana M, Isola R, Loy F, Solinas P, Lantini MS. Diabetes reduces statherin in human parotid: immunogold study and comparison with submandibular gland. Oral Dis 2011; 18:360-4. [DOI: 10.1111/j.1601-0825.2011.01884.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Marlow NM, Slate EH, Bandyopadhyay D, Fernandes JK, Salinas CF. An evaluation of serum albumin, root caries, and other covariates in Gullah African Americans with type-2 diabetes. Community Dent Oral Epidemiol 2010; 39:186-92. [PMID: 21070320 DOI: 10.1111/j.1600-0528.2010.00586.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Associations between dental conditions and overall health have been previously reported. Investigators have also shown significant inverse relationships between serum albumin (a general health status marker) and root caries. This relationship was explored among a study population of Gullah African Americans (who have a considerably lower level of non-African genetic admixture when compared to other African American populations) with type-2 diabetes (T2DM) and self-reported history of normal kidney function (N=280). METHODS Root caries indices were defined as total decayed and/or filled root surfaces. The coronal caries index [total decayed, missing, and/or filled coronal surfaces (DMFS)], level of glycemic control, total number of teeth, and other covariates were also evaluated. Logistic regression models were used to evaluate the associations between these factors and hypoalbuminemia (serum albumin concentrations <4 g/dl). RESULTS Serum albumin concentrations ranged 2.4-4.5 g/dl (mean=3.8, SD=0.3), with 70.4% exhibiting hypoalbuminemia. Root caries totals ranged 0-38 (mean=1.3, SD=4.5) surfaces decayed/filled, while total teeth ranged 1-28 (mean=19.4, SD=6.2). DMFS totals ranged 2-116 (mean=55.2, SD=28.0). We failed to detect significant associations for root caries; however, the final multivariable logistic regression models showed significant associations between hypoalbuminemia and total teeth [odds ratio (OR)=0.93, P=0.01], poor glycemic control (OR=2.49, P<0.01), elevated C-reactive protein (OR=1.57, P<0.01), glomerular filtration rates ≥60 (OR=0.31, P=0.03), and age (OR=0.97, P=0.03). CONCLUSIONS Previously reported inverse relationships between serum albumin and root caries were not evident in our study population. We propose that these null findings are because of the considerably lower level of root caries as well as other differing characteristics (including oral health status, the chronic presence of T2DM, and predominantly younger age) within our study population compared to these previously assessed groups.
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Affiliation(s)
- Nicole M Marlow
- Biostatistics and Epidemiology, College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA.
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Sano T, Matsuura T, Ozaki K, Narama I. Dental caries and caries-related periodontitis in type 2 diabetic mice. Vet Pathol 2010; 48:506-12. [PMID: 20817890 DOI: 10.1177/0300985810380394] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Diabetic patients are predisposed to periodontal disease as well as dental caries; however, there are contradictory reports about the possible association between dental caries and diabetes. Thus, the authors set out to determine whether diabetes affects onset of dental caries and periodontal disease and to clarify whether dental caries and periodontal disease are associated with each other in diabetic db/db mice. Oral tissue was examined from 68 male mice (diabetic db/db and nondiabetic db/+; aged 20, 30, 40, and 50 weeks) and 20 female mice (db/db and db/+; aged 50 weeks). Macroscopically, caries were seen developing in the diabetic mice by 20 weeks of age. The number of teeth with dental lesions increased with age in the db/db mice at a significantly higher incidence than that of db/+ mice. Histologically, dental caries were detected in 30 of 120 molars in 17 of 20 db/db mice at 50 weeks of age and in 4 of 108 molars in 4 of 18 db/+ mice of the same age. The severity of dental caries in db/db mice was significantly higher than it was in db/+ mice. Dental caries were a primary change that led to bacterial gingivitis and pulpitis. These lesions spread to the dental root and periodontal connective tissue through the apical foramen. Apical periodontitis was more frequent and severe when occurring in close association with dental caries. In conclusion, there is a strong relationship between diabetes and dental caries, but in this model, it is highly probable that the onset of periodontal disease was a secondary change resulting from dental caries.
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Affiliation(s)
- T Sano
- Department of Pathology, Setsunan University, Hirakata, Osaka 573-0101, Japan
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Teanpaisan R, Hintao J, Dahlén G. Oral Lactobacillus species in type 2 diabetic patients living in southern Thailand. Anaerobe 2009; 15:160-3. [PMID: 19655427 DOI: 10.1016/j.anaerobe.2009.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Although lactobacilli are part of normal oral, gastrointestinal and genitourinary flora, they are an uncommon cause of infections in human. Lactobacillus-associated infections have generally occurred in patients with serious underlying conditions e.g. diabetes and cancer that might favour certain microorganisms. The aim of this study was to characterize species and genotypes of lactobacilli isolated from diabetic patients and non-diabetic subjects. One hundred and five type 2 diabetic patients and 103 non-diabetic subjects were recruited in this study. A total of 170 isolates of Lactobacillus were identified using 16S rRNA gene PCR-RFLP and genotyping were performed using AP-PCR by ERIC primers. It was found that type 2 diabetic patients had a significantly higher prevalence (p = 0.008) and level of lactobacilli than non-diabetic controls (p = 0.030). The most frequently isolated Lactobacillus spp. were L. casei/paracasei and L. fermentum in both the diabetic and non-diabetic groups. Strains of L. casei/paracasei and L. fermentum from between and within individuals were genotyped, and the genotyping of Lactobacillus strains showed diversity between individuals. One up to three genotypes of these two species could be found in the same subject. Interestingly, fewer genotypes were found in the diabetic patients than in the non-diabetic subjects.
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Affiliation(s)
- R Teanpaisan
- Department of Stomatology, Prince of Songkla University, Hat-Yai, Songkhla 90112, Thailand.
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Donovan TE, Becker W, Brodine AH, Burgess JO, Cagna DR, Summitt JB. Annual review of selected dental literature: report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 2008; 100:110-41. [PMID: 18672128 DOI: 10.1016/s0022-3913(08)60159-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Terence E Donovan
- Department of Operative Dentistry, University of North Carolina, Chapel Hill, NC 27599-7450, USA. Terry_Donovan @dentistry.unc.edu
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Lewis D, Fiske J, Dougall A. Access to special care dentistry, part 7. Special care dentistry services: seamless care for people in their middle years – part 1. Br Dent J 2008; 205:305-17. [DOI: 10.1038/sj.bdj.2008.803] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Root surface and coronal caries in adults with type 2 diabetes mellitus. Br Dent J 2008. [DOI: 10.1038/bdj.2007.1200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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