Chair-side saliva diagnostic tests: An evaluation tool for xerostomia and caries risk assessment in children with type 1 diabetes

Poor glycemic control impairs oral health in children with type 1 diabetes mellitus - a systematic review and meta-analysis

OBJECTIVE

There are more than one million children and adolescents living with type 1 diabetes mellitus, and their number is steadily increasing. Diabetes affects oral health through numerous channels, including hyposalivation, immune suppression, and the inflammatory effect of glycation end-products. However, patients with type 1 diabetes must follow a strict sugar free diet that is proven to be carioprotective. Therefore, the aim of this systematic review and meta-analysis is to investigate whether children with type 1 diabetes have a difference in Decayed, Missing, Filled Teeth index (DMFT), salivary function, and periodontal status than children without diabetes, with an emphasis on glycemic control.

MATERIALS AND METHODS

PubMed, Embase and Cochrane libraries were screened for articles, using predefined search keys without any language or date restrictions. Two independent authors performed the selection procedure, extracted data from the eligible articles, carried out a manual search of the reference lists, and assessed the risk of bias using the Newcastle-Ottawa scale. Meta-analysis was performed in R using the random-effects model. Effect sizes were mean differences; subgroup analysis was performed on glycemic control.

RESULTS

33 studies satisfied the eligibility criteria. 22 studies did not show a significant difference regarding the DMFT index between the diabetes and non-diabetes groups; six studies found that children living with diabetes had higher DMFT scores, compared to five studies that found significantly lower scores. Meta-analysis found no statistically significant differences in plaque, gingival, and calculus indexes, however it found significant differences in pooled DMFT indexes, and salivary flow rate. Subgroup analysis on glycemic control using DMFT values found significant differences in children with good and poor glycemic control with results of 0.26 (CI95%=-0.50; 1.03) and 1.46 (CI95%=0.57; 2.35), respectively.

CONCLUSIONS

Children with poor glycemic control face higher risk of developing caries compared to good control and non-diabetes children. Regular dental check-ups and strict control of glycemic levels are highly advised for children living with type 1 diabetes, further emphasizing the importance of cooperation between dentists and diabetologists.

A suggested universal protocol for dental examination in sports

The athletes of any sport and level submit their bodies to constant exercise. Any given pathology can increase the risk of injury, illness, or even reduced performance. The medical examination is valuable in diagnosing existing health problems and preventing medical issues that might compromise the athlete's overall health when exercising. The stomatognathic system is not an exemption, as oral pathologies, including dental caries and periodontal diseases, are found in high incidence in sports. The need for accurate and detailed dental examination in sports leaded dentists from the European Association for Sports Dentistry and the Academy for Sports Dentistry to elaborate a universal dental examination in sports protocol that can record the overall oral health of the athlete, including the teeth, periodontium, and musculoskeletal screening, for all athletes. The outcome of this stomatognathic examination allows sports physicians and professionals other than dentists to have a complete image of the individual oral health condition of any given athlete, and it allows the dentists to efficiently screen and prevent pathologies, as well as to advise on the eligibility to practice sports from the oral health perspective.

Salivary levels of hBDs in children and adolescents with type 1 diabetes mellitus and gingivitis

OBJECTIVES

Type 1 diabetes mellitus (T1DM), a chronic autoimmune disease characterized by insulin deficiency, is related to periodontal diseases in children and adolescents. Our aim was to profile salivary human beta-defensin (hBD)-2 and hBD-3 concentrations in relation to periodontal and T1DM status in children and adolescent populations.

MATERIAL AND METHODS

Unstimulated saliva samples were collected from 66 participants including periodontally healthy T1DM patients (T1DM + C; n = 18), T1DM patients with gingivitis (T1DM + G; n = 20), systemically and periodontally healthy individuals (SH + C: n = 15), and systemically healthy gingivitis patients (SH + G; n = 13). Full mouth plaque index (PI), bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL) were recorded. Salivary hBD-2 and hBD-3 concentrations were evaluated by sandwich ELISA method. A p value of < 0.05 was considered statistically significant.

RESULTS

Salivary hBD-3 concentrations were lower in T1DM groups in comparison to systemically healthy counterparts (SH + G vs. T1DM + G; p < 0.001 and SH + C vs. T1DM + C; p < 0.001). Salivary hBD-2 levels did not differ between related groups. The difference in hBD-3 concentrations between T1DM and control groups was still significant (p = 0.008) after being adjusted for PI%, BOP%, and age.

CONCLUSION

In the limits of study, T1DM patients were found to have decreased salivary hBD-3 concentrations, regardless of their gingival inflammatory status.

CLINICAL RELEVANCE

Altered salivary hBD-3 concentration can partly explain why diabetic children are more prone to periodontal diseases.

Interplay Among the Oral Microbiome, Oral Cavity Conditions, the Host Immune Response, Diabetes Mellitus, and Its Associated-Risk Factors-An Overview

This comprehensive review of the literature aimed to investigate the interplay between the oral microbiome, oral cavity conditions, and host immune response in Diabetes mellitus (DM). Moreover, this review also aimed to investigate how DM related risk factors, such as advanced age, hyperglycemia, hyperlipidemia, obesity, hypertension and polycystic ovary syndrome (PCOS), act in promoting or modifying specific mechanisms that could potentially perpetuate both altered systemic and oral conditions. We found that poorly controlled glycemic index may exert a negative effect on the immune system of affected individuals, leading to a deficient immune response or to an exacerbation of the inflammatory response exacerbating DM-related complications. Hyperglycemia induces alterations in the oral microbiome since poor glycemic control is associated with increased levels and frequencies of periodontal pathogens in the subgingival biofilm of individuals with DM. A bidirectional relationship between periodontal diseases and DM has been suggested: DM patients may have an exaggerated inflammatory response, poor repair and bone resorption that aggravates periodontal disease whereas the increased levels of systemic pro-inflammatory mediators found in individuals affected with periodontal disease exacerbates insulin resistance. SARS-CoV-2 infection may represent an aggravating factor for individuals with DM. Individuals with DM tend to have low salivary flow and a high prevalence of xerostomia, but the association between prevalence/experience of dental caries and DM is still unclear. DM has also been associated to the development of lesions in the oral mucosa, especially potentially malignant ones and those associated with fungal infections. Obesity plays an important role in the induction and progression of DM. Co-affected obese and DM individuals tend to present worse oral health conditions. A decrease in HDL and, an increase in triglycerides bloodstream levels seem to be associated with an increase on the load of periodontopathogens on oral cavity. Moreover, DM may increase the likelihood of halitosis. Prevalence of impaired taste perception and impaired smell recognition tend to be greater in DM patients. An important interplay among oral cavity microbiome, DM, obesity and hypertension has been proposed as the reduction of nitrate into nitrite, in addition to contribute to lowering of blood pressure, reduces oxidative stress and increases insulin secretion, being these effects desirable for the control of obesity and DM. Women with PCOS tend to present a distinct oral microbial composition and an elevated systemic response to selective members of this microbial community, but the association between oral microbiome, PCOS are DM is still unknown. The results of the studies presented in this review suggest the interplay among the oral microbiome, oral cavity conditions, host immune response and DM and some of the DM associated risk factors exist. DM individuals need to be encouraged and motivated for an adequate oral health care. In addition, these results show the importance of adopting multidisciplinary management of DM and of strengthening physicians-dentists relationship focusing on both systemic and on oral cavity conditions of DM patients.

Unstimulated Parotid Saliva Is a Better Method for Blood Glucose Prediction

Objective: Saliva glucose has been widely used in diagnosing and monitoring diabetes, but the saliva collection method will affect saliva glucose concentration. So, this study aims to identify the ideal saliva collection method. Method: A total amount of six saliva collection methods were employed in 80 healthy participants in the morning. Besides, three unstimulated saliva methods were employed in another 30 healthy participants in the morning; in the meantime the blood glucose of these 30 participants was detected with a Roche blood glucose meter. The glucose oxidase method with 2, 4, 6-tribromo-3-hydroxybenzoic acid (TBHBA) as the chromogen has been improved to be suitable for healthy people, through the selection of the optimal pH value and ionic strength of the reaction system. This method was used for the detection of saliva glucose. Results: The improved method obtained absorbance at the wavelength of 520 nm, and the optimized parameter combination was pH 6.5 and 5 mg/dL NaCl. The lower limit of glucose detection was 0.1 mg/dL. Unstimulated saliva glucose concentration was higher than stimulated saliva glucose concentration. Unstimulated parotid saliva glucose concentration was the highest. Besides, unstimulated saliva glucose has a better normal distribution effect. Meantime, it was found that unstimulated parotid saliva was the most highly correlated with blood glucose (R2 = 0.707). Conclusions: the saliva collection method was an important factor that affected saliva glucose concentration. Unstimulated parotid saliva was the most highly correlated with blood glucose, which provided a reference for prediction of diabetes mellitus.

Potential of Salivary Biomarkers in Autism Research: A Systematic Review

The diagnostic process for autism spectrum disorders (ASD) is based on a behavioral analysis of the suspected individual. Despite intensive research, no specific and valid biomarker has been identified for ASD, but saliva, with its advantages such as non-invasive collection, could serve as a suitable alternative to other body fluids. As a source of nucleic acid of both human and microbial origin, protein and non-protein molecules, saliva offers a complex view on the current state of the organism. Additionally, the use of salivary markers seems to be less complicated not only for ASD screening but also for revealing the etiopathogenesis of ASD, since enrolling neurotypical counterparts willing to participate in studies may be more feasible. The aim of the presented review is to provide an overview of the current research performed on saliva in relation to ASD, mutual complementing, and discrepancies that result in difficulties applying the observed markers in clinical practice. We emphasize the methodological limitations of saliva collection and processing as well as the lack of information regarding ASD diagnosis, which is critically discussed.

Predicting dental caries increment using salivary biomarkers in a remote Indigenous Australian child population

BACKGROUND

The burden of childhood dental caries amongst Indigenous Australians is higher than in other Australians. Because of differences in lifestyle and the evolutionary history of the oral microbiota, associated risk indicators may differ. Here, we evaluate associations between caries increment, salivary biomarkers and baseline caries among children aged 5-17 years residing in a remote rural Indigenous community.

METHODS

This study was part of a trial assessing cost-effectiveness of an intervention to prevent dental caries among children. Baseline epidemiology and application of topical caries-preventive measures was conducted in 2015, followed-up in 2016 and 2017. Children who did not consent or failed to attend the prevention visits but did attend for follow-up epidemiology constituted a natural comparison group for evaluating the intervention. Saliva flow, pH, buffering and bacterial loads were measured at all visits. Caries was scored by the International Caries Detection and Assessment system. Outcome was caries increment. Explanatory variables were sex, being in experimental or comparison group, baseline caries, saliva flowrate and buffering, pH, and salivary loads of mutans streptococci (MS), Lactobacilli (LB), and yeast. Chi Square tests compared caries incidence in relation to explanatory variables and Generalised Linear Models explored associations between explanatory and outcome variables.

RESULTS

Of 408 participants at baseline, only 208 presented at 2-year follow-up. Of caries-free children at baseline, significantly fewer had incipient (p = 0.01) and advanced (p = 0.04) caries after two years. Children in the experimental group experienced fewer tooth surfaces with advanced caries (p = 0.02) than comparison children. Having caries at baseline (p = 0.02) and low salivary flow-rates (p < 0.001) saw a significant increase in advanced caries after two years. Children with high salivary loads of MS (p = 0.03) and LB (p = 0.004) experienced more advanced carious surfaces. Multivariable analysis revealed 58% reduction (p = 0.001) in advanced caries among children with high salivary flow rates. Caries increment was 61% (p = 0.03) more for incipient and 121% (p = 0.007) more for advanced caries among children who harboured higher loads of MS.

CONCLUSION

As with other ethnicities, children with low salivary flow and those with high MS had higher incipient and advanced caries increments after two years. Such risk assessments facilitate targeted preventive interventions for such communities.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ANZCTR), No: ACTRN12615000693527: 3 July 2015.

Downregulation of Salivary Proteins, Protective against Dental Caries, in Type 1 Diabetes

Saliva, an essential oral secretion involved in protecting the oral cavity’s hard and soft tissues, is readily available and straightforward to collect. Recent studies have analyzed the salivary proteome in children and adolescents with extensive carious lesions to identify diagnostic and prognostic biomarkers. The current study aimed to investigate saliva’s diagnostic ability through proteomics to detect the potential differential expression of proteins specific for the occurrence of carious lesions. For this study, we performed bioinformatics and functional analysis of proteomic datasets, previously examined by our group, from samples of adolescents with regulated and unregulated type 1 diabetes, as they compare with healthy controls. Among the differentially expressed proteins relevant to caries pathology, alpha-amylase 2B, beta-defensin 4A, BPI fold containing family B member 2, protein S100-A7, mucin 5B, statherin, salivary proline-rich protein 2, and interleukin 36 gamma were significantly downregulated in poorly-controlled patients compared to healthy subjects. In addition, significant biological pathways (defense response to the bacterium, beta-defensin activity, proline-rich protein activity, oxygen binding, calcium binding, and glycosylation) were deregulated in this comparison, highlighting specific molecular characteristics in the cariogenic process. This analysis contributes to a better understanding of the mechanisms involved in caries vulnerability in adolescents with unregulated diabetes.

Comparative Evaluation of Chair-Side Saliva Tests According to Current Dental Status in Adult Patient

Background: this cross-sectional study evaluated the correlation of commercial chair-side saliva tests with caries status in adults. Methods: teeth in 87 adults (20–40 years old) were clinically examined for carious lesions according to International Caries Detection and Assessment System (ICDAS) criteria. The Decayed-Missing-Filling-Tooth (DMFT) and Decayed-Missing-Filling-Surface (DMFS) indexes at D1 (lesions 1–6 according to ICDAS criteria) and D3 (lesions 4–6 according to ICDAS criteria threshold and the number of active lesions, according to the Lesion Activity Assessment (LAA)) criteria were measured. The saliva parameters measured by chair-side tests were stimulated and non-stimulated saliva flow rate, saliva consistency, saliva pH, saliva buffer capacity, and lactic acid production. The statistical analyses performed were Student t-test and Mann–Whitney U test at a = 0.05 significant level. Results: the low resting saliva pH was related to a high value of DMFT (D1) index (p = 0.007). Conclusions: among the saliva parameters measured, the values of low resting pH are associated with increased DMFT at threshold D1. None of the chair-side available saliva tests evaluated can accurately underline the tooth carious status.

Salivary immunoglobulins (A, G, and M) in type 1 diabetes mellitus patients: A PROSPERO-registered systematic review and meta-analysis

OBJECTIVE

To assess the difference in the salivary levels of immunoglobulins between patients with type 1 diabetes mellitus (DM1) and healthy controls.

DESIGN

This systematic review was registered on the PROSPERO (CRD42020159198) database. All references were cross-checked and the risk of bias assessment was conducted using the Newcastle-Ottawa Scale. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used to appraise the quality of evidence. The standardized mean difference and Cohen's d as the effect size were used in the meta-analysis. I-square statistics was used to estimate heterogeneity. Analysis was performed using the RevMan® software (p < 0.05) with a 95 % confidence interval.

RESULTS

Of the total 92 articles, 9 were selected for this study. The meta-analysis included 333 DM1 patients and 325 healthy controls. DM1 patients showed a significant reduction in salivary flow (p = 0.0008; Cohen's d= -0.19, CI 95 %= -0.33, -0.05), although not significant enough to modify the IgA concentration (p = 0.120; Cohen's d = 0.58, CI 95 %= -0.15, 1.32). However, DM1 increased IgA concentration by reducing salivary flow (Cohen's d = 0.84; CI 95 % = 0.36, 1.32), with a strong estimate of effect (p = 0.0006). Regarding IgG, no significant change was noted with DM1 in the patient's saliva (p = 0.420). Furthermore, there was no significant variation in the salivary IgM levels (p = 0.300).

CONCLUSIONS

The data suggest that the salivary levels of the evaluated immunoglobulins do not seem to be altered in DM1 patients when compared to that in healthy controls. However, the increase in IgA salivary concentration was dependent on total protein estimation.