Dentistry and Diabetes: The Influence of Diabetes in Oral Diseases and Dental Treatments

THE IMPACT OF THE DIABETES ON ORAL HEALTH - AN OBSERVATIONAL STUDY

OBJECTIVE

The aim: To evaluate the impact of diabetes mellitus on the oral health.

PATIENTS AND METHODS

Materials and methods: This is an observational study. In the present research were taken into consideration 300 patients. The study sample consisted of 191 males, respectively (63.7%) of them and 109 females (36.3%) of the participants.

RESULTS

Results: In the current study, we analyzed the oral health of diabetic patients within the age class of 11-80 years. We divided them into seven age groups: 11-20, 21-30, 31-40, 41-50, 51-60, 61-70, and 71-80 years. Based on the results of the current study it was observed that 83.7% of patients were affected by gingivitis. The results of our study show that dental caries prevalence was 68.7 % and the prevalence of missing teeth among patients with diabetes mellitus was 78.7%. According to the ANOVA test, high blood sugar values had a direct impact on the manifestation of gingivitis and there it was a strong correlation between them P-value = .000. Males with diabetes mellitus were more affected by dental caries and this was indicated by the P-value= .02, in comparison to females who recorded a P-value = .03. The relation between gender males and missing teeth was highly significant P-value = .001.

CONCLUSION

Conclusions: The present study proved that diabetes mellitus is risk factor for oral health. The authors studied this group of patients exposed to high blood glucose levels and found out that oral diseases were high in these patients.

OUP accepted manuscript

This proof-of-principle study aims to find commensal oral bacteria that can produce extracellular polymeric substances (EPS), which have similar lubrication properties to saliva and could serve as saliva substitutes. Saliva and plaque samples were collected from 21 generally healthy individuals. Primary screening was done by conventional culturing and Gram-staining; all species selected for further analysis were identified by MALDI-TOF and deposited in DSMZ. Lactobacillus gasseri (DSM32453 and DSM32455), Lactobacillus rhamnosus (DSM32452), Lactobacillus paracasei (DSM32454), and Streptococcus sanguinis (DSM32456) produced 413.6, 415.7, 431.1, 426.8, and 877.6 µg/ml of EPS, respectively. At the same time calcium dissolution could not be detected for both L. gasseri strains, minimal dissolution for the other three: S. sanguinis 0.3 mm, and 3.7 mm for L. rhamnosus and L. paracasei. There were no differences found between the EPS samples and the saliva for the effect of shear rate on the viscosity and for the effect of sliding speed on lubrication properties. In conclusion, five commensal bacterial strains have been isolated, all able to produce EPS and lead to no or to low calcium dissolution. EPS produced exhibits rheological and tribological properties comparable to human saliva. A total of four out of five selected strains are probiotic and, therefore, may exhibit additional beneficial influence within the oral cavity.

Impact of the Glycemic Level on the Salivary Proteome of Middle-Aged and Elderly People With Type 2 Diabetes Mellitus: An Observational Study

Type 2 diabetes mellitus (T2DM) is an increasing global public health concern, but its impact on the salivary proteome is still unclear. To evaluate the effect of glycemic levels in middle-aged and elderly individuals with T2DM on salivary proteomics, we compared the differences by liquid chromatography tandem mass spectrometry (LC–MS/MS). Unstimulated whole saliva samples from 8 T2DM patients with good glycemic control (G group, HbA1c <6.5%) and 16 patients with poor control (P group, HbA1c ≥6.5%) were analyzed by LC–MS/MS in the data-independent acquisition mode (Clinical register number: ChiCTR1900023582.). After functional annotation, cluster analysis and receiver operating characteristic (ROC) curve analysis were carried out to screen and evaluate candidate proteins. A total of 5,721 proteins were quantified, while 40 proteins differed significantly. In the P group, proteins involved in oxidative stress-related processes were upregulated, whereas proteins related to salivary secretion were downregulated. The combination of thioredoxin domain-containing protein 17, zymogen granule protein 16B, and FAM3 metabolism regulating signaling molecule D yielded an area under the curve of 0.917 which showed a robust ability to distinguish the P and G groups. In conclusion, poorly controlled hyperglycemia may affect salivary proteins through various pathways, including oxidative stress and glandular secretion. Furthermore, the differentially expressed proteins, especially the three proteins with the best differentiation, might serve as an anchor point for the further study of hyperglycemia and oral diseases.

Correlation between diabetes mellitus and number of restored, carious lesions and missing teeth: A retrospective radiographic evaluation

Aim

This study aimed to evaluate the prevalence of carious, restored, and missing teeth among diabetic and non-diabetic patients who visited dental clinics in Dammam, Saudi Arabia.

Method

This retrospective study was conducted between April and November 2018. The data collection procedure was conducted in two steps: (1) review of patient records for the demographic variables and (2) screening of digital panoramic radiographs (OPGs). The patients who visited the restorative and prosthetic clinics in the period of 2016–2017 were included in the study.

Results

A total of 1186 patient records and OPGs were reviewed to extract the data. The average age of the patients in the study sample was 40.96 (±16.29). The sample included 751 (63.3%) female and 435 (36.7%) male patients. Among the patients, 192 (16.2%) had diabetes mellitus and 994 (83.8%) were non-diabetic. The average numbers of fixed partial dentures and missing teeth were significantly high among diabetic patients (P < 0.001). Conversely, the average numbers of carious lesions and restored teeth were higher among the non-diabetic patients. Only the number of restored teeth was found to be significant (P < 0.001).

Conclusion

The diabetic patients were found to be at high risk of losing teeth compared with the non-diabetic patients. The prevalence of fixed partial dentures was also higher among diabetic patients. The oral health status of dental patients with diabetes needs urgent attention to prevent these patients from having teeth loss, and it can be done by improving their oral health.

Oral Health and Nutritional Characteristics of Adults With Morbid Obesity: A Multivariate Analysis

The relationship between oral health and nutritional aspects are complex, especially in individuals with chronic diseases and comorbidities, such as morbid obesity. Thus, the aim of the present study was to identify oral health and nutritional-related patterns in 113 individuals, aged 19–68 years (92 females), seeking treatment for morbid obesity. Sociodemographic variables and medical records were examined, in addition to the consumption of fruit, vegetables, candies, and processed foods. Measures of body mass index, neck, waist and hip, caries experience (DMFT index), Community Periodontal Index (CPI index), and salivary physicochemical aspects were gathered. Aspects of oral health-related quality of life and symptoms of dry mouth were evaluated by means of Oral Health Impact Profile (OHIP-14) and Xerostomia Inventory-XI questionnaires. K-means cluster analysis and, subsequently, comparisons between clusters (one-way ANOVA) were performed (α = 5%). Three clusters were generated: Cluster 1 (labeled “Young”; n = 77) was characterized by younger participants with higher BMI, who reported the use of distractors while eating, the smallest number of meals/day, and who consumed sweetened drinks and processed food the day before. Cluster 2 (labeled “Diabetic individuals”; n = 12) was characterized by older participants with the highest proportion of diabetic participants (100% were diabetic; 73% insulin users), lower BMI, higher DMFT index and OHIP-14 and xerostomia scores, and who reported having consumed fruit and vegetables the day before. Finally, Cluster 3 (labeled “Poor periodontal health”; n = 24) was characterized by participants with the worse periodontal condition (higher CPI), and lower salivary flow, pH, and buffer capacity. Cluster 1 and 2 were the groups that showed higher demand for nutritional and dietetic counseling, because of the poor eating behavior and higher serum glucose levels, respectively. On the other hand, Cluster 2 and 3 showed the higher demand for oral rehabilitation and dental treatment because of the loss of teeth and worse periodontal condition, respectively, besides the need for dietetic counseling. This sample of individuals with morbid obesity showed very unique oral-health and nutritional characteristics and special needs patterns that should be identified to adjust or change unhealthy habits, thus improving the assistance of this condition.

Artificial Saliva in Diabetic Xerostomia (ASDIX): Double Blind Trial of Aldiamed® Versus Placebo

Xerostomia is a symptom frequently present in patients with type 1 (T1DM) and type 2 diabetes mellitus (T2DM). In the present trial, the activity of an artificial saliva (aldiamed^® spray) in comparison to a placebo spray were used to evaluate the xerostomia and the saliva antioxidant capacity (SAT). Sixty patients of both genders with T1DM or T2DM were randomized into two groups of 30 subjects each. The experiment was a double-blind study approved by the Ethics Committee of the “G. d’Annunzio University” of Chieti and Pescara. Moreover, measurements of the stimulated saliva flow rate and the ultrasonography of the submandibular and parotid glands were performed at both the study time points. The results demonstrated statistically significant differences between the treatments in terms of the xerostomia average score. Specifically, the values were at baseline and after 30 days 2.9 ± 1.31 and 3.0 ± 1.44 and 1.4 ± 1.48 and 2.4 ± 0.99 for aldiamed^® spray and the placebo, respectively. Meanwhile, no statistically significant differences were shown between the two groups for the other variables, such as the salivary flow rate, the antioxidant capacity of the saliva, and the ultrasonography of the major salivary glands.

Trace elements in saliva and plasma of patients with type 2 diabetes: Association to metabolic control and complications

AIM

An analysis is made of the saliva and plasma levels of trace elements in patients with type 2 diabetes mellitus and their association to metabolic control and the presence of chronic complications.

METHODS

A cross-sectional observational clinical study was carried out in 74 patients with type 2 diabetes mellitus. Mass spectrometry (ICP-MS) was used to determine the following trace elements in plasma and unstimulated basal saliva: ¹³Al, ¹⁶S, ⁴Be, ⁵B, ²⁰Ca, ²⁷Co, ²⁹Cu, ²⁴Cr, ³⁸Sr, ¹⁵P, ³Li, ¹²Mg, ²⁵Mn, ²⁸Ni, ⁸²Pb, ³⁷Rb, ²²Ti, ²³V and ³⁰Zn.

RESULTS

The levels of cobalt (p = 0.048) in saliva and of strontium (p = 0.001) in plasma were related to the presence of chronic complications. Significant differences with respect to metabolic control were observed for beryllium (p = 0.038), boron (p = 0.023) and phosphorus in saliva (p = 0.046), and for rubidium (p = 0.005), titanium (p = 0.016) and zinc in plasma (p = 0.013). A significant correlation (p < 0.001) was found between boron in plasma and boron in unstimulated basal saliva.

CONCLUSIONS

The determination of trace elements in plasma and saliva constitutes a complementary tool for the assessment of metabolic control and for predicting chronic complications associated to type 2 diabetes mellitus. Further studies involving the biomonitoring of trace elements in saliva and plasma are needed.