Metabolic control and periodontal treatment decreases elevated oxidative stress in the early phases of type 1 diabetes onset

Investigating the Interplay: Periodontal Disease and Type 1 Diabetes Mellitus-A Comprehensive Review of Clinical Studies

Diabetes mellitus (DM) poses a significant challenge to global health, with its prevalence projected to rise dramatically by 2045. This narrative review explores the bidirectional relationship between periodontitis (PD) and type 1 diabetes mellitus (T1DM), focusing on cellular and molecular mechanisms derived from the interplay between oral microbiota and the host immune response. A comprehensive search of studies published between 2008 and 2023 was conducted to elucidate the association between these two diseases. Preclinical and clinical evidence suggests a bidirectional relationship, with individuals with T1DM exhibiting heightened susceptibility to periodontitis, and vice versa. The review includes recent findings from human clinical studies, revealing variations in oral microbiota composition in T1DM patients, including increases in certain pathogenic species such as Porphyromonas gingivalis, Prevotella intermedia, and Aggregatibacter actinomycetemcomitans, along with shifts in microbial diversity and abundance. Molecular mechanisms underlying this association involve oxidative stress and dysregulated host immune responses, mediated by inflammatory cytokines such as IL-6, IL-8, and MMPs. Furthermore, disruptions in bone turnover markers, such as RANKL and OPG, contribute to periodontal complications in T1DM patients. While preventive measures to manage periodontal complications in T1DM patients may improve overall health outcomes, further research is needed to understand the intricate interactions between oral microbiota, host response, periodontal disease, and systemic health in this population.

Salivary Oxidative Stress Biomarkers in Thai Adolescents and Young Adults with Type 1 Diabetes Mellitus: A Cross-Sectional Study

Aims and Objectives

The primary objectives of this study were to compare salivary oxidative stress (OS) biomarker levels in patients with type 1 diabetes mellitus (T1DM) and without T1DM (non-T1DM) and evaluate the relationships between diabetes, periodontal status, and OS biomarker levels.

Materials and Methods

Twenty patients with T1DM and 20 age-matched patients without T1DM were enrolled. All participants were 15-23 years of age and had permanent dentition. Unstimulated whole saliva was collected in a sterile test tube before examination of clinical periodontal parameters, including bleeding on probing (BOP). Salivary levels of OS biomarkers-malondialdehyde, protein carbonyl, total oxidant status (TOS), and total antioxidant capacity-were determined using oxidative and antioxidative assays followed by spectrophotometric measurement at 375-532 nm. The relationships between diabetes, periodontal status, and OS biomarkers were analyzed using multiple linear regression.

Results

TOS was significantly lower in the T1DM group compared with the non-T1DM group (5.06 ± 0.39 vs. 6.44 ± 0.51 µmol H2O2 Eq/l, P = 0.035). After adjusting for confounding factors (age, gender, BMI, clinical periodontal parameters, BOP, or diabetes status accordingly), the multiple linear regression showed that T1DM was significantly associated with a reduction of TOS level (P = 0.008). The BOP > 30% group showed a significant correlation with increased TOS levels compared with the BOP ≤ 30% group (P = 0.002). No relationship was found between OS biomarkers and HbA1c levels.

Conclusion

Salivary TOS levels were related to both diabetes status and the extent of gingival inflammation. Further studies to elucidate the role of OS in relation of periodontal disease and T1DM are required.

Salivary Diagnostics in Pediatrics and the Status of Saliva-Based Biosensors

Salivary biomarkers are increasingly being used as an alternative to diagnose and monitor the progression of various diseases due to their ease of use, on site application, non-invasiveness, and most likely improved patient compliance. Here, we highlight the role of salivary biosensors in the general population, followed by the application of saliva as a diagnostic tool in the pediatric population. We searched the literature for pediatric applications of salivary biomarkers, more specifically, in children from 0 to 18 years old. The use of those biomarkers spans autoimmune, developmental disorders, oncology, neuropsychiatry, respiratory illnesses, gastrointestinal disorders, and oral diseases. Four major applications of salivary proteins as biomarkers are: (1) dental health (caries, stress from orthodontic appliances, and gingivitis); (2) gastrointestinal conditions (eosinophilic esophagitis, acid reflux, appendicitis); (3) metabolic conditions (obesity, diabetes); and (4) respiratory conditions (asthma, allergic rhinitis, small airway inflammation, pneumonia). Genomics, metabolomics, microbiomics, proteomics, and transcriptomics, are various other classifications for biosensing based on the type of biomarkers used and reviewed here. Lastly, we describe the recent advances in pediatric biosensing applications using saliva. This work guides scientists in fabricating saliva-based biosensors by comprehensively overviewing the potential markers and techniques that can be employed.

Analysis of dental status in children with type I diabetes mellitus: a literature review

Relevance. Diabetes mellitus is one of the most complex metabolic chronic diseases. Severe forms of type I diabetes mellitus are more common in children and adolescents, and its prevalence is increasing in many countries. Type I diabetes mellitus in children and adolescents remains an essential health issue in many countries despite the achieved scientific and practical results and progress in diabetology. Therefore, its early detection in children is still relevant and is associated with the early diagnosis of endocrinolog ical pathologies.

Materials and methods. The study searched the publications in PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), Medline (www.elibrary.ru, www.ncbi.nlm.nih.gov/pubmed) by the specific keywords.

Results. In children with diabetes mellitus, vascular changes in periodontal tissues appear earlier than in other organs. On oral examination of children with diabetes mellitus, 50% of cases reveal periodontal lesions, and the lesions are often in the areas of the lower molars. If not treated, the following perio-dontitis signs are present in diabetic children: bleeding of the gingival papillae and the bright red colour of the gingival margin. There may be bulging of granulations from pathological gingival pockets. In most patients with type I diabetes mellitus, cytology of the periodontal pockets and gingival sulci demonstrated inflammatory cytologic responses, changes in the stratified squamous epithelium, and mixed bacterial microflora with leukocytes and erythrocytes.

Conclusion. The study of type I diabetes mellitus impact on pathological changes in the oral cavity of children and the development of therapeutic and preventive measures is a relevant issue in pediatric dentistry, which justifies the need to continue research in this area.

Oral Health Implications and Dental Management of Diabetic Children

Aim

To review the effect of diabetes mellitus (DM) on the oral health status of children.

Background

Diabetes mellitus (DM) is one of the most severe chronic diseases in children and adolescents. It appears as type 1 DM and type 2 DM. Children are mainly diagnosed with type 1 DM. Genetic, as well as environmental factors, contribute to disease risk, indicating a multifactorial etiology. Early symptoms may vary from polyuria to anxiety or depression disorders.

Review results

A variety of signs and symptoms have been reported regarding the oral health of DM children. Both dental and periodontal health is compromised. Qualitative and quantitative changes in saliva have also been reported. Moreover, there is a direct effect of type 1 DM on oral microflora and increased sensitivity to infections. A variety of protocols have been developed regarding the dental treatment of diabetic children.

Conclusion

Children with diabetes, due to the increased risk of periodontal disease and dental caries, are recommended to follow an intensive prevention program and a diet with strict instructions.

Clinical significance

The dental care provided to children with DM should be personalized, and all patients should follow a strict program of reexaminations. Moreover, the dentist may evaluate oral signs and symptoms of inadequately controlled diabetes and, in coordination with the patient's physician, can play a crucial role in maintaining oral and general health.

How to cite this article

Davidopoulou S, Bitzeni-Nigdeli A, Archaki C, et al. Oral Health Implications and Dental Management of Diabetic Children. Int J Clin Pediatr Dent 2022;15(5):631-635.

A Comparative Study of Antioxidative Activity of Saliva in Children and Young Teenagers with and without Gingivitis

Objectives: The aim of this study was to compare the values of total antioxidant capacity (TAC), catalase (CAT) and glutathione peroxidase (GPX) in the saliva of children and young teenagers with and without gingivitis. Materials and Methods: A total of 120 children and young teenagers of the mean age of 12.2 participated in the research. Gingival condition was assessed using the Löe and Silness Gingival Index. The subjects were divided into groups of those without gingivitis and those with gingivitis. Samples of unstimulated saliva were collected, and TAC, CAT and GPX were determined spectrophotometrically. Results: By comparing the values of TAC, CAT and GPX in subjects with and without gingivitis, significantly lower values of TAC (p < 0.001) and CAT (p < 0.001) were observed in the group of subjects with gingivitis. The correlation analysis of these values showed a positive correlation in groups of subjects not suffering from gingival inflammation and those with gingival inflammation. Conclusions: The study showed significantly lower values of TAC and CAT in the saliva of subjects with gingivitis. This indicates their possible role as a potential biomarker in the early diagnosis and expression of periodontal disease in children and young teenagers.

Evaluation of the Relationship between Salivary Lipids, Proteins and Total Antioxidant Capacity with Gingival Health Status in Type-1 Diabetic Children

STATEMENT OF THE PROBLEM

Alteration in salivary composition and its effect on the oral cavity in diabetic child patients remains equivocal.

PURPOSE

This study was performed to assess the relationship between salivary factors and gingival status in children with type-1 diabetes mellitus (DM).

MATERIAL AND METHOD

In this cross-sectional study, 120 subjects aged 6-16 years (60 well-controlled and poorly-controlled diabetics and 60 healthy individuals) were examined to determine the gingival index (GI) and plaque index (PI). The unstimulated saliva samples were collected to measure the salivary triglyceride, cholesterol, albumin, α-amylase, total protein levels by the laboratory kits. Total antioxidant capacity and the free radicals scavenger index were measured by the Ferric Reducing Ability Of Plasma (FRAP) and 1,1-Diphenyl-2-picryl-hydrazyl (DPPH) assays, respectively. Data were analyzed by parametric and non-parametric, Pearson correlation, and t tests at a 5% error level.

RESULTS

GI of diabetics was significantly higher than that of healthy individuals (1.51± 0.71 and 0.9±0.81, respectively, p< 0.001). No significant difference was found between the PI of diabetics compared to healthy volunteers (1.59±0.69, 1.63±0.74, respectively). The levels of salivary triglyceride and cholesterol, albumin and total proteins in healthy subjects were significantly higher than that in people with DM (p< 0.001). A significantly more salivary α-amylase activity was found in diabetics compared to non-diabetics (p< 0.001). No significant differences were found between diabetic and non-diabetic subjects in terms of DPPH (95.5, 95.9%, respectively) and FRAP (9.77±0.13, 9.78±0.12 (µmol/mL), respectively).

CONCLUSION

More gingival inflammation and salivary α-amylase activity and lower level of salivary lipids, albumin, and total proteins were found in diabetic patients, but there was no association between the level of lipids, proteins, and the total antioxidant capacity of saliva with periodontal health indicators in patients with DM and healthy individuals.

Bidirectional Association between Metabolic Control in Type-2 Diabetes Mellitus and Periodontitis Inflammatory Burden: A Cross-Sectional Study in an Italian Population

This study assessed the periodontal conditions of type 2 diabetes (T2DM) patients attending an Outpatient Center in North Italy and explored the associations between metabolic control and periodontitis. Periodontal health of 104 T2DM patients (61 men and 43 women, mean age of 65.3 ± 10.1 years) was assessed according to CDC/AAP periodontitis case definitions and Periodontal Inflamed Surface Area (PISA) Index. Data on sociodemographic factors, lifestyle behaviors, laboratory tests, and glycated hemoglobin (HbA1c) levels were collected by interview and medical records. Poor glycemic control (HbA1c ≥ 7%), family history of T2DM, and C-reactive protein levels were predictors of severe periodontitis. An increase in HbA1c of 1% was associated with a rise in PISA of 89.6 mm². On the other hand, predictors of poor glycemic control were severe periodontitis, waist circumference, unbalanced diet, and sedentary lifestyle. A rise in PISA of 10 mm² increased the odds of having HbA1c ≥ 7% by 2%. There is a strong bidirectional connection between periodontitis and poor glycemic control. The inflammatory burden posed by periodontitis represents the strongest predictor of poor glycemic control.

Gingival crevicular fluid biomarkers in type 1 diabetes mellitus: A case-control study

OBJECTIVE

The aim of the study is to compare the levels of Gingival Crevicular Fluid (GCF) interleukin 8 (IL-8), matrix metalloproteinase 8 (MMP-8) and advanced glycated-end products (AGEs) in a cohort of type 1 diabetic (T1D) subjects and healthy controls.

MATERIAL AND METHODS

GCF samples and periodontal examination were assessed in 50 subjects with T1D (30 males and 20 females; mean age: 35.2 years) recruited from the Diabetology Unit of the Geneva University Hospitals and in 50 control subjects matched for gender, age and smoking status. Samples were assessed for IL-8 and MMP-8 using a bead array multianalyte detection system and for AGEs the ELISA. The two groups were compared using the Wilcoxon signed rank test.

RESULTS

The mean HbA1c differed significantly between the groups (8.3% for the T1D group vs. 5.2% for the control group, p < 0.001). T1D subjects had significantly more plaque and gingival inflammation and presented more sites with bleeding on probing compared to the controls. The GCF levels of IL-8, MMP-8 and AGEs did not differ significantly between the groups. Further analysis of the GCF markers in younger (<40 years) and older (≥40 years) cohorts, revealed no significant differences between younger diabetics and controls or between older diabetics and controls. When the groups were divided according to their glycemic status (HbA1c 6.1-8, and > 8%), again no significant differences could be identified for any of the biochemical markers.

CONCLUSIONS

T1D subjects, particularly the younger ones, exhibited more inflammation compared to the matched healthy controls. Results on the GCF expression of IL-8, MMP-8 and AGEs did not differ between the groups. The diabetic population of our cohort was for the most part fairly-controlled, with little if any complications and with presence of only mild type of periodontal disease, as 68% had gingivitis.

Evaluation of Salivary and Serum Total Antioxidant Capacity and Lipid Peroxidation in Postmenopausal Women

Objective

In menopause, reduction of estrogen hormone affects oxidative stress process in serum. Oxidative stress in saliva plays a significant role in the pathogenesis of oral diseases. The aim of this study was to investigate the total antioxidant capacity and lipid peroxidation in the serum and saliva of premenopausal and postmenopausal women.

Methods

In this case control study, 50 postmenopausal women (case group) and 48 premenopausal women (control group) were selected. The unstimulated whole saliva and serum of the postmenopausal and premenopausal women were collected. The total antioxidant capacity (TAC) of the saliva and serum was measured by ferric reducing antioxidant power (FRAP). Also, malondialdehyde (MDA) was measured by thiobarbituric acid reactive substance (TBARS) method for serum and saliva. Then, the obtained data were analyzed by SPSS 17, whereby Mann–Whitney test and Spearman's correlation test were used. P < 0.05 was considered statistically significant.

Results

The postmenopausal group had significantly lower mean serum TAC and higher mean serum MDA than the control group (P < 0 < 001 and P < 0.01, respectively). The mean salivary TAC and MDA, however, did not differ significantly between the case and control group (P = 0.64 and P = 0.08, respectively).

Conclusion

In postmenopausal women, with elevation of serum MDA and reduction of serum TAC, the extent of serum oxidative stress grows, but MDA and TAC levels of saliva do not change.

Oxidative stress, neutrophil elastase and IGFBP7 levels in patients with oropharyngeal cancer and chronic periodontitis

OBJECTIVE

The present study focused on investigating levels of oxidative stress, neutrophil elastase (NE), and insulin-like growth factor-binding protein 7 (IGFBP7) in oropharyngeal cancers (OC) with the presence and absence of periodontitis.

MATERIALS AND METHODS

A healthy non-periodontitis group (H-NP; n = 20), a systemically healthy chronic periodontitis group (H-P; n = 20), a non-periodontitis group with OC (OC-NP; n = 12), and a chronic periodontitis group with OC (OC-P; n = 16) formed the study groups. The levels of NE and IGFBP7 were measured in gingival crevicular fluid (GCF) and saliva. In addition, oxidative status was determined by evaluating total oxidant status (TOS), total antioxidant status (TAS), and OSI (TOS/TAS).

RESULTS

Gingival crevicular fluid NE was higher in all the groups compared with the H-NP group (p < .01). Salivary NE was higher in the OC-P and H-P groups compared with the H-NP and OC-NP groups (p < .05). Salivary IGFBP7 was significantly higher in the OC-NP and OC-P groups compared with the H-NP and H-P groups (p < .001). GCF TOS and OSI levels were significantly higher in all groups compared with the H-NP group (p < .05).

CONCLUSIONS

Gingival crevicular fluid NE levels were lower in healthy conditions compared with periodontal disease and OC. Salivary NE levels were higher in periodontal disease compared to states with no periodontal disease. Salivary IGFBP7 levels were higher in OC. Further analyses may help determine whether high salivary IGFBP7 levels distinguish OC from healthy conditions.

Topical oral 1-tetradecanol complex in the treatment of periodontal diseases in cats

OBJECTIVES

The aim of this study was to evaluate the outcomes of the treatment of chronic periodontal disease with an oral application of tetradecanol complex (1-TDC) in cats.

METHODS

The test group (n = 9) received 1-TDC (525 mg per gel capsule/day) and the placebo group (n = 4) received olive oil (0.25 ml per gel capsule/day) for 6 weeks.

RESULTS

Oral treatment with 1-TDC resulted in significant reductions in all parameters of clinical periodontal disease except tooth mobility at 6 weeks. The 1-TDC group exhibited a statistically significant reduction in pocket depth, clinical attachment loss, gingival index and bleeding on probing after treatment at 6 weeks, whereas the placebo group did not show any significant change.

CONCLUSIONS AND RELEVANCE

Chronic inflammation associated with periodontal diseases leads to periodontal tissue destruction. As a result, modulation of the host response has been included in the treatment protocol for periodontal diseases. Fatty acids present anti-inflammatory properties and are being investigated for use in the treatment and prevention of progressive periodontal diseases.

Oxidative Stress and Antioxidants in the Diagnosis and Therapy of Periodontitis

Oxidative stress has been implicated in the pathogenesis of numerous diseases. However, large interventional studies with antioxidants failed to show benefits in the prevention or treatment of cardiovascular diseases, cancer, or diabetes mellitus. Numerous clinical studies have confirmed the association of oxidative stress markers and periodontitis. Technical and biological variability is high for most of the analyzed markers and none of them seems to be optimal for routine clinical use. In a research setting, analysis of a palette of oxidative stress markers is needed to cover lipid peroxidation, protein oxidation, and the antioxidant status. The source of reactive oxygen species and their role in the pathogenesis of periodontitis remains unclear. Interventional experiments indicate that oxidative stress might be more than just a simple consequence of the inflammation. Small studies have confirmed that some antioxidants could have therapeutic value at least as an addition to the standard non-surgical treatment of periodontitis. A clear evidence for the efficiency of antioxidant treatment in large patient cohorts is lacking. Potentially, because lowering of oxidative stress markers might be a secondary effect of anti-inflammatory or antibacterial agents. As the field of research of oxidative stress in periodontitis gains attraction and the number of relevant published papers is increasing a systematic overview of the conducted observational and interventional studies is needed. This review summarizes the currently available literature linking oxidative stress and periodontitis and points toward the potential of adjuvant antioxidant treatment, especially in cases where standard treatment fails to improve the periodontal status.