Oral disorders associated with diabetes mellitus

Suppression of sweet taste-related responses by plant-derived bioactive compounds and eating. Part I: A systematic review in humans

The taste of food plays a crucial role in determining what and how much we eat. Thus, interventions that temporarily block sweet taste receptors offer a promising approach to addressing unhealthy behaviours associated with sugary foods. However, the relationship between reduced sweet taste response and food consumption remains unclear, with contradictory findings. Certain studies suggest that a diminished perception of sweetness leads to a sense of fullness and results in reduced food intake, while others suggest the opposite effect. To shed some light, our systematic review looked into the relationship between diminished sweet taste response and food consumption by examining the effects of bioactive compounds that experimentally inhibit sweetness in healthy individuals. This review was registered in the International Prospective Register of Systematic Reviews and conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Scottish Intercollegiate Guidelines Network, and covered original papers included in Web of Science, PubMed, Scopus, Food Science Source and Food Science and technology abstracts. We identified 33 peer-reviewed English-language studies that fit the topic and met the inclusion criteria. The current literature predominantly focuses on the immediate impact of oral gymnemic acids, failing to provide preliminary evidence in support of the specific threshold hypothesis, above which food consumption decreases and below which the opposite effect occurs. Additionally, there was inconsistency in the findings regarding the short-term desire to eat following sweetness inhibition. Considering the downstream effects on energy intake and their clinical applications, further research is needed to clarify both the acute within-session effects (i.e., not wanting any more now) and the longer-term effects (i.e., deciding not to start eating) linked to oral sweet-taste-suppressing compounds.

The neuropeptide substance P/neurokinin-1 receptor system and diabetes: From mechanism to therapy

Diabetes is a significant public health issue known as the world's fastest-growing disease condition. It is characterized by persistent hyperglycemia and subsequent chronic complications leading to organ dysfunction and, ultimately, the failure of target organs. Substance P (SP) is an undecapeptide that belongs to the family of tachykinin (TK) peptides. The SP-mediated activation of the neurokinin 1 receptor (NK1R) regulates many pathophysiological processes in the body. There is also a relation between the SP/NK1R system and diabetic processes. Importantly, deregulated expression of SP has been reported in diabetes and diabetes-associated chronic complications. SP can induce both diabetogenic and antidiabetogenic effects and thus affect the pathology of diabetes destructively or protectively. Here, we review the current knowledge of the functional relevance of the SP/NK1R system in diabetes pathogenesis and its exploitation for diabetes therapy. A comprehensive understanding of the role of the SP/NK1R system in diabetes is expected to shed further light on developing new therapeutic possibilities for diabetes and its associated chronic conditions.

Diabetes mellitus risk among Jordanians in a dental setting: a cross-sectional study

BACKGROUND

Dental offices can be useful to screen and identify patients at risk of developing diabetes mellitus (DM) using risk prediction tools. The Finnish Diabetes Risk Score (FINDRISC) is a validated, questionnaire-based tool used to predict the 10-year risk of developing type II DM.

OBJECTIVES

To determine the 10-year DM risk among Jordanians using the FINDRISC questionnaire in a dental setting.

MATERIALS AND METHODS

Participants attending two university dental teaching centres between March 2017 and February 2018 were interviewed using an Arabic translated version of the FINDRISC questionnaire. Anthropometrics including weight, height, waist circumference (WC) and body mass index (BMI) were recorded. Random capillary blood glucose level was measured for each participant. Statistical analysis was done using Chi-square and independent t-tests.

RESULTS

A total of 1,247 (436 males and 811 females) participants were included. As defined by BMI, 1,012 (81.2%) participants were either overweight or obese. Abdominal adiposity as determined by WC was seen in 738 (59.2%) participants. The mean (± SD) FINDRISC score for females (11.3 ± 4.3) was significantly higher (P = 0.001) than males (10.4 ± 4.9). After age adjustment, more females were in the high-risk categories (FINDRISC ≥ 15) compared with males. This trend was seen among all age groups, but was statistically significant in the older age groups; 55-64 years (P = 0.037) and ≥ 65 years (P = 0.004).

CONCLUSION

In a developing Middle Eastern country such as Jordan, almost half of Jordanians attending university dental clinics are at a moderate to high risk of developing type II DM in 10 years. The risk of DM should be considered in dental patients, particularly older females.

Oral health of cystic fibrosis patients at a north american center: A pilot study

Background

The objective of this study was to describe the oral health status of Cystic Fibrosis (CF) children in a US facility.

Material and Methods

Twenty CF children ages 6-18 were recruited from Children’s Hospital of Wisconsin Pulmonary Clinic. Parents completed a health questionnaire. Clinical examinations checked dental caries using the dmft/DMFT index, dental hygiene using the Simplified Greene-Vermillion Index (DI-S), gingival inflammation using the Community Periodontal Index of Treatment Needs, and enamel defects using the modified Developmental Defects of Enamel Index.

Results

The majority (90%) brush twice a day, 65% consume sugary snacks, and 70% visit the dentist every 6 months. Clinically, they presented DMFT 0.25 and dmft 0.90, fair oral hygiene with DI-S 1.02, 75% had mild gingivitis and 50% had enamel defects. The more antibiotics they took, significantly more frequent (p=0.007) and more severe (p=0.017) enamel defects were noted. Similar trend was found between the number of surgeries and the presence of enamel defects (p=0.076) and dental caries (p=0.028).

Conclusions

Within the limitations of this study, CF patients were found to be at oral health risk due to the high prevalence of dental enamel defects. Oral health for CF children should be part of the multidisciplinary care.

Key words:Cystic fibrosis, oral health, teeth, United States.

Characteristics of lingual papillae in diabetic rats

Diabetes mellitus (DM) is a metabolic disorder resulting with many different complications including soft tissue abnormalities in the oral cavity such as periodontitis and salivary and taste dysfunction. Previous studies also reported fungal and bacterial infections in oral cavity in these patients. This study aims to represent three dimentional morphologic ultrastructural changes of the diabetic rat tongue via scanning electron microscopy. Twenty-four (24) adult male Spraque-Dawley rats, (weight ranging between 200-250g) included in the study were randomly assigned into two groups: control rats were injected with intraperitoneally saline alone, experimental diabetes group received streptozotocin (STZ) (80mg/kg) administrated intraperitoneally. On month four, by the end of experimental period, all animals of each group were anesthetised. All tongues were dissected totally, postfixed in 2% osmium tetroxide and then dried by critical point drying before SEM analysis. Finally, superficial epithelial configurations of the lingual papillae in experimental diabetic rats were examined by scanning electron microscopy. Diabetes mellitus caused thickness, hyperceratosis and different epithelial changes, We observed yeast-like structures and bacterial colonisations on the papillar and epithelial structure of the tongue. The morphological atrophic changes of lingual mucosa and the median rhomboid glossitis (which is primary finding of candidal infection) are characteristic observations on the lingual mucosa of the streptozotocin treated rats.

Effect of streptozotocin-induced diabetes on lipids metabolism in the salivary glands

BACKGROUND

Diabetes is one of the most common metabolic diseases. Moreover, previous studies indicate that diabetes may cause changes in the salivary glands phenotype and in the composition of saliva itself. Therefore, the main objective of this study was to determine the effects of streptozotocin induced diabetes on lipid profile of the rat salivary glands.

METHODS

Male Wistar rats were divided into two groups: control and STZ-induced diabetes. At the end of the experiment all animals were sacrificed and samples of the parotid and submandibular salivary glands were excised. Major lipid fractions concentrations were determined by means of chromatography (TLC and GC).

RESULTS

We observed a significant increase (∼3.5 fold) in the level of triacylglycerol in both the parotid and submandibular salivary glands of diabetic rats. The abovementioned changes were accompanied by significant, although less dramatic (i.e. from -60% to -90%), decrements in the levels of other lipid classes (phospholipids, free fatty acids and diacylglycerol).

CONCLUSIONS

In our study we have showed, presumably for the first time, that streptozotocin induced diabetes causes decrement in PH content with subsequent atrophy and malfunction in both parotid and submandibular salivary glands. Another novel finding of our research is that diabetic rats were characterized by an increased TG accumulation in both parotid and submandibular salivary glands. The later one could be a clinical manifestation of diabetes.

Effects of dextrose and lipopolysaccharide on the corrosion behavior of a Ti-6Al-4V alloy with a smooth surface or treated with double-acid-etching

Diabetes and infections are associated with a high risk of implant failure. However, the effects of such conditions on the electrochemical stability of titanium materials remain unclear. This study evaluated the corrosion behavior of a Ti-6Al-4V alloy, with a smooth surface or conditioned by double-acid-etching, in simulated body fluid with different concentrations of dextrose and lipopolysaccharide. For the electrochemical assay, the open-circuit-potential, electrochemical impedance spectroscopy, and potentiodynamic test were used. The disc surfaces were characterized by scanning electron microscopy and atomic force microscopy. Their surface roughness and Vickers microhardness were also tested. The quantitative data were analyzed by Pearson's correlation and independent t-tests (α = 0.05). In the corrosion parameters, there was a strong lipopolysaccharide correlation with the Ipass (passivation current density), Cdl (double-layer capacitance), and Rp (polarization resistance) values (p<0.05) for the Ti-6Al-4V alloy with surface treatment by double-acid-etching. The combination of dextrose and lipopolysaccharide was correlated with the Icorr (corrosion current density) and Ipass (p<0.05). The acid-treated groups showed a significant increase in Cdl values and reduced Rp values (p<0.05, t-test). According to the topography, there was an increase in surface roughness (R2 = 0.726, p<0.0001 for the smooth surface; R2 = 0.405, p = 0.036 for the double-acid-etching-treated surface). The microhardness of the smooth Ti-6Al-4V alloy decreased (p<0.05) and that of the treated Ti-6Al-4V alloy increased (p<0.0001). Atomic force microscopy showed changes in the microstructure of the Ti-6Al-4V alloy by increasing the surface thickness mainly in the group associated with dextrose and lipopolysaccharide. The combination of dextrose and lipopolysaccharide affected the corrosion behavior of the Ti-6Al-4V alloy surface treated with double-acid-etching. However, no dose-response corrosion behavior could be observed. These results suggest a greater susceptibility to corrosion of titanium implants in diabetic patients with associated infections.

Dietary behaviors and oral-systemic health in women

The impact of dietary behaviors and food consumption and their relation to oral health are significant public health issues. Women and men exhibit different dietary behaviors. Understanding the influences of dietary behaviors on oral health from the perspective of gender disparities, however, is limited. This article provides the intersections of dietary factors and oral-systemic health for which women are at greater risk than men. Topics include the effect of dietary choices on oral health disparities seen in female patients. Interventional strategies at the local and community level that are designed to influence the balance between dietary habits and oral-systemic health are discussed.

[Changes in the innervation of the taste buds in diabetic rats]

INTRODUCTION

Abnormal sensations such as pain and impairment of taste are symptoms of approximately 10% of patients having diabetes mellitus.

AIM

The aim of the study was to investigate and quantify the different neuropeptide containing nerve fibres in the vallate papilla of the diabetic rat.

METHODS

Immunohistochemical methods were used to study the changes of the number of different neuropeptide containing nerve terminals located in the vallate papillae in diabetic rats. Diabetes was induced in the rats with streptozotocin.

RESULTS

Two weeks after streptozotocin treatment the number of the substance P, galanin, vasoactive intestinal polypeptide and neuropeptide Y immunoreactive nerve terminals was significantly increased (p<0.05) in the tunica mucosa of the tongue. The number of the lymphocytes and mast cells was also increased significantly. Some of the immunoreactive nerve terminals were located in the lingual epithelium both intragemmally and extragemmally and were seen to comprise dense bundles in the lamina propria just beneath the epithelium. No taste cells were immunoreactive for any of the investigated peptides. Vasoactive intestinal polypeptide and neuropeptide Y immunoreactive nerve fibres were not detected in the taste buds. For weeks after streptozotocin administration the number of the substance P, calcitonin gene related peptide and galanin immunoreactive nerve terminals was decreased both intragemmally and intergemmally. In case of immediate insulin treatment, the number of the immunoreactive nerve terminals was similar to that of the controls, however, insulin treatment given 1 week later to diabetic rats produced a decreased number of nerve fibers. Morphometry revealed no significant difference in papilla size between the control and diabetic groups, but there were fewer taste buds (per papilla).

CONCLUSIONS

Increased number of immunoreactive nerve terminals and mast cells 2 weeks after the development of diabetes was the consequence of neurogenic inflammation which might cause vasoconstriction and lesions of the oral mucosa. Taste impairment, which developed 4 weeks after streptozotocin treatment could be caused by neuropathic defects and degeneration or morphological changes in the taste buds and nerve fibres.

Breaking paradigms: a new definition for halitosis in the context of pseudo-halitosis and halitophobia

It is known that almost one-third of patients who seeks treatment for bad breath do not have genuine halitosis. Halitosis can occur even in cases when the malodor is not perceived by those around the patient and can neither be confirmed by organoleptic tests, nor by sulfur portable monitor readings. In such cases, these patients have been considered as halitophobic or have pseudo-halitosis. The complaint might signal the existence of a chemosensory dysfunction. Factors associated with taste and smell perception can be potentially connected to the occurrence of oral malodor. The threshold values of volatile sulfur compounds that have been used to establish the diagnosis of genuine halitosis do not take into account that the patient may perceive low levels of these and of other volatile compounds through retronasal olfaction. The current concept of halitosis requires the presence of a signal that has been based on equipment results, from the olfactory perception of the examiners and of those who interact with the patient. Nevertheless, the concept does not encompass the symptoms of halitosis. This paper addresses some of the possible causes of chemosensory dysfunction and proposes a new definition for halitosis.

Effect of 980-nm GaAlAs diode laser irradiation on healing of extraction sockets in streptozotocin-induced diabetic rats: a pilot study

Low-level laser irradiation can promote the healing process in soft and hard tissue but the precise mechanisms are unclear. In this study, we examined the effect of LLLT (low-level laser therapy) on the healing of extraction sockets in diabetic and healthy rats. Forty-eight Sprague-Dawley rats were divided into normal (n = 24) and diabetic (n = 24) rats, and streptozotocin (STZ) injection was used to induce diabetes in the latter. The left and right maxillary first molars of all the rats were extracted. In the non-diabetic rats, the left extraction sockets were not irradiated (group 1) and the right ones were irradiated daily for 3, 5, 7, and 14 days after extraction with a galium-aluminum-arsenide (GaAlAs) diode laser (group 2), and in the diabetic rats, similarly the left ones were not irradiated (group 3) and the right ones were irradiated (group 4). Specimens acquired at these intervals were examined by hematoxylin and eosin (H&E) staining and reverse transcription polymerase chain reaction (RT-PCR). Histological observations and gene expression analyses revealed that groups 2 (normal rats with LLLT) and 4 (diabetic rats with LLLT) showed faster initial healing and more new alveolar bone formation than group 1 (normal rats without LLLT) and group 3 (diabetic rats without LLLT), respectively. We conclude that 980-nm GaAlAs low-intensity diode laser irradiation is beneficial for the initial stages of alveolar bone healing and for further calcification in both diabetic and normal rats when applied every day at a dose of 13.95 J/cm(2) for 60 s.

Diabetic patients: their knowledge and perception of oral health

Objectives

The objectives of the study were to: (1) assess the knowledge and awareness of diabetic patients of their risk for systemic and oral diseases as complications associated with diabetes, (2) to assess their attitudes toward sustaining good oral health through proper oral hygiene and regular dental check-ups, and (3) to the extent that they are aware, to determine how they became aware.

Methods

Two hundred self-administered questionnaires were distributed to assess the main objectives of the study. Only completed questionnaires were used in the current study data analysis.

Results

A majority of the participants had Type 2 diabetes (58%). The awareness of diabetic patients of their increased risk for oral diseases is low compared to their awareness of systemic diseases. Their attitude toward maintaining good oral health was also not to desired standard. Of the participants, 50% brushed their teeth once daily and 66% never used dental floss. Regarding participants’ sources of awareness, 37% learned from dentists and 45% through other media sources.

Conclusions

Diabetic patients are found to have little knowledge of their increased risk for oral diseases. In order to promote proper oral health and to reduce the risk of oral diseases, health professionals in both the dental and medical fields need to take the responsibility to develop programs to educate the public about the oral manifestations of diabetes and its complications on oral health.

Prevalence and antifungal resistance profile of Candida spp. oral isolates from patients with type 1 and 2 diabetes mellitus

OBJECTIVE

The goal of the study was to measure the prevalence of Candida spp. in the oral cavity of patients with diabetes types 1 and 2 when compared to healthy individuals and to study antifungal resistance profile of the isolates.

DESIGN

There were 162 subjects in the study: diabetes type 1 (n=39); control group 1 (n=50): healthy individuals matched in gender, age, and oral conditions to diabetes type 1 patients; diabetes type 2 (n=37); control group 2 (n=36) who were matched to each patient of the diabetes type 2 group. Stimulated saliva was collected and isolates were identified with phenotypic tests. The presence of C. dubliniensis was determined by multiplex PCR.

RESULTS

There were no statistically significant differences in Candida spp. frequency between the diabetes 1 group and its control (p=0.443) nor between the diabetes 2 group and its control (p=0.429). C. albicans was the most frequently isolated yeast in all groups. In the diabetes groups, C. stellatoidea, C. parapsilosis, C. tropicalis, C. lipolytica, C. glabrata, and C. krusei were also identified. Additionally, in control groups, C. kefyr was also detected. None of the isolates were resistant to amphotericin B and flucytosine. A low percentage of the isolates were resistant to ketoconazole.

CONCLUSIONS

No differences were detected in colonization of Candida spp. oral isolates from type 1 and type 2 diabetes when compared to matched controls. The antifungal resistance of Candida spp. isolates for ketoconazole from type 1 diabetes patients was significantly higher than that of its matched control.

Effects of saliva substitutes on oral status in patients with Type 2 diabetes

AIMS

To assess oral status in a sample of Type 2 diabetic patients before and after therapy with saliva substitutes and oral status in a control group of diabetic patients who were not given saliva substitutes.

METHODS

Salivary flow rate was determined in 134 patients (mean age 47.9 ± 2.9 years) with Type 2 diabetes. Mean salivary rate was significantly low compared with a healthy control group. The sample of 134 patients was randomly divided into two groups of 67 people each. One group was given immunologically active salivary substitutes for 6 months, the other group was given nothing. Each patient of the two groups underwent a dental and periodontal examination at the beginning of the study and 6 months later.

RESULTS

As regards carious teeth and teeth loss, there was no statistical difference between the first group after 6 months of treatment with salivary substitutes and the control group (P>0.01). Salivary substitutes did not significantly reduce the periodontal disease (P>0.01). In the group treated with salivary substitutes, after 6 months of therapy, the average dental plaque index decreased from 2.3 ± 0.73 to 1.6 ± 0.56, patients with gingivitis decreased from 66 to 43% and patients with positive yeast counts decreased from 60 to 37%. These differences were statistically significant (P<0.01).

CONCLUSIONS

In Type 2 diabetes, in the case of hyposalivation, a therapy with immunologically active saliva substitutes can be of help in reducing the amount of plaque, gingivitis and positive yeast counts.

Parotid sialosis: morphometrical analysis of the glandular parenchyme and stroma among diabetic and alcoholic patients

BACKGROUND

Among the agents that cause parotid sialosis, diabetes mellitus type 2 and chronic alcoholism are included. In this study, the morphometrical modifications in the diabetic parotid sialosis were determined to compare them with the histopathological characteristics of alcoholic parotid sialosis.

METHODS

Five parotid biopsy samples obtained from patients with diabetic sialosis, 12 samples from patients with alcoholic sialosis and seven from individuals without these pathologies (control group) were analyzed. A morphometrical study of parotid parenchyme and stroma, using a digital image analyzer attached to an optical microscope, was carried out. Dimensions of serous acini and striated ducts, the area occupied by the fatty tissue, and the number of ducts were recorded. Mean values were compared using the Mann-Whitney U-test (P <or= 0.05).

RESULTS

The variables analyzed in diabetic patients did not show significant differences with respect to the control group. However, when diabetics were compared with alcoholics, the alcoholics exhibited a noticeable reduction in the proportion of fatty tissue of stroma and a significant development of ductal epithelium that contributed to increase the caliber of the striated ducts.

CONCLUSIONS

These results indicate that the glandular hypertrophy in the diabetic parotid sialosis is not directly associated with the ductal and acinar size, amount of fatty tissue and ductal hyperplasy. Nevertheless, these findings show that the ductal dimensions and the proportion of adipose tissue are variables that allow us to establish histopathological differences between diabetic and alcoholic sialosis.

Alteration of Ca(2+)-ATPase activity in the homogenate, plasma membrane and microsomes of the salivary glands of streptozotocin-induced diabetic rats

Diabetes has been implicated in the dryness of the mouth, loss of taste sensation, sialosis, and other disorders of the oral cavity, by impairment of the salivary glands. The aim of the present study was to examine the plasma membrane, microsomal, and homogenate Ca(2+)-ATPase activity in the rat submandibular and parotid salivary glands of streptozotocin-induced diabetes. We have also examined the influence of the acidosis state on this parameter. Diabetes was induced by an intraperitoneal injection of streptozotocin and acidosis was induced by daily injection of NH(4)Cl. At 15 and 30 days after diabetes induction, the animals were euthanized and the submandibular and parotid salivary glands were removed and analyzed. Ca(2+)-ATPase (total, independent, and dependent) was determined in the homogenate, microsomal, and plasma membranes of the salivary glands of diabetic and control rats. Calcium concentration was also determined in the glands and showed to be higher in the diabetic animals. Ca(2+)-ATPase activity was found to be reduced in all cell fractions studied in the diabetic animals compared with control. Similar results were obtained for the submandibular salivary glands of acidotic animals; however in the parotid salivary glands it was found an increase in the enzyme activity.

GAD and IA-2 autoantibody detection in type 1 diabetic patient saliva

Some attempts have been made in assaying glutamic-acid decarboxylase autoantibodies (GADA) in type 1 diabetic patient (T1DM) saliva. However, these salivary assays did not show sufficient sensitivity and specificity in comparison to serum assays. In this study we evaluated the ability of a fluid-phase (35)S-radioimmunoassay to detect GADA and tyrosine phosphatase 2 autoantibodies (IA-2A) in 70 T1DM, 24 T1DM first degree relatives (FDR) and 76 healthy subject saliva. Paired saliva and serum samples were collected from each subject and analyzed. GADA were detected in 45/70 (64.3%) sera and 43/70 (61.4%) T1DM saliva, respectively. IA-2A were detected in 33/70 (47.1%) sera and 30/70 (42.9%) T1DM saliva, respectively. All FDR serum/saliva samples were autoantibody negative. In conclusion, we here report that GADA and IA-2A are detectable with high sensitivity and specificity in human saliva, a specimen which can be easily collected by non-invasive procedures and may represent a reliable tool for the study of T1DM autoimmunity.

Effects of streptozotocin-induced diabetes on taste buds in rat vallate papillae

Some studies have documented taste changes in patients with diabetes mellitus (DM). In order to understand the relationships between taste disorders caused by DM and the innervation and morphologic changes in the taste buds, we studied the vallate papillae and their taste buds in rats with DM. DM was induced in these rats with streptozotocin (STZ), which causes the death of beta cells of the pancreas. The rats were sacrificed and the vallate papillae were dissected for morphometric and quantitative immunohistochemical analyses. The innervations of the vallate papillae and taste buds in diabetic and control rats were detected using immunohistochemistry employing antibodies directed against protein gene product 9.5 (PGP 9.5) and calcitonin gene-related peptide (CGRP). The results showed that PGP 9.5- and CGRP-immunoreactive nerve fibers in the trench wall of diabetic vallate papillae, as well as taste cells in the taste buds, gradually decreased both intragemmally and intergemmally. The morphometry revealed no significant difference in papilla size between the control and diabetic groups, but there were fewer taste buds per papilla (per animal). The quantification of innervation in taste buds of the diabetic rats supported the visual assessment of immunohistochemical labeling, that the innervation of taste cells was significantly reduced in diabetic animals. These findings suggest that taste impairment in diabetic subjects may be caused by neuropathy defects and/or morphological changes in the taste buds.

In vivo observation of papillae of the human tongue using confocal laser scanning microscopy

The aim of this investigation was to visualize the epithelial structures of the tongue using confocal laser scanning microscopy (LSM). The human tongue epithelium of 28 healthy subjects, aged 21-67 years, mean age 38 years, 14 women and 14 men, was examined in vivo by LSM. Using LSM, a combination of the Heidelberg Retina Tomograph HRT II and the Rostock Cornea Module, up to 800-fold magnifications were obtained. On the tongue surface both filiform and fungiform papillae and their taste pores were easily identified. The epithelium of the tongue with its subcellular structures could be observed up to a depth of 50 microm, cellular structures up to 150 microm and subepithelial vessels up to 300 microm. Additionally the papillary crests and blood flow were visible. Confocal LSM seems suitable for noninvasive in vivo examination of the tongue. The hydraulic z scan, the manual start setting and the measurement of the depth allow a clear classification of the observed structures.

Candidal overgrowth in diabetic patients: potential predisposing factors

This study was designed to investigate the potential factors that influence the prevalence of the oral carriage of Candida species in patients with type II diabetes mellitus. One hundred and twenty-eight diabetic patients (68 males and 60 females, mean age 54 +/- 7 years) were sequentially enrolled along with 84 (44 males and 40 females mean age 52 +/- 8 years) healthy subjects. Samples were obtained by swabbing the oral mucosa of all participants. Yeast isolates were identified by germ tube test, with API 32 ID system, and by chlamydospore production on 'cornmeal' Tween-80 agar. Candida spp. was recovered from the oral cavity of 64% of the diabetic group, in contrast to 40% of the control group. Candida albicans was the most frequently isolated species in both groups. Potential etiologic factors such as xerostomia, dentures, age, gender and diabetes on oral carriage of Candida spp. were evaluated. The oral carriage of Candida spp. was significantly higher in 'diabetic' patients compared with the healthy subjects but it seems that parameters such as xerostomia, dentures, age, gender and glycemic control cannot be directly associated with Candida growth in the oral cavity in the presence of diabetes.

Altered glycogen metabolism in the submandibular and parotid salivary glands of rats with streptozotocin-induced diabetes

Experimental animal models of diabetes induced either by alloxan or streptozotocin have been used to study aspects of the pathophysiology of this disease. The purpose of this study was to examine the metabolism of glycogen in the submandibular and parotid salivary glands of diabetic rats. Diabetes was induced by an intraperitoneal injection of streptozotocin. Eight weeks after the induction of diabetes, the animals were sacrificed and the submandibular and parotid salivary glands were removed. The glands were analyzed for glycogen concentration, and activities of glycogen synthase and phosphorylase. Although the diabetic rats consumed more food than controls, they had a lower body weight eight weeks after diabetes induction. Glycogen concentration in the submandibular and parotid glands increased by about 27% and 130%, respectively. Glycogen phosphorylase a in the submandibular gland of diabetic rats showed a reduction of between 75% and 68% compared with controls. In parotid glands, phosphorylase a was reduced by between 84% and 79% compared with controls. The increase in the activity of glycogen synthase a (active) varied from 64% to 130% for the submandibular glands and from 75% to 110% for the parotid compared with controls. These results suggest that the diabetic state influences glycogen metabolism in the submandibular and parotid salivary glands of rats.

A Framework for Studying the Nutritional Health of Community-Dwelling Elders

BACKGROUND

Ensuring nutritional health for elders has been shown to reduce healthcare costs and enhance quality of life. Studies, however, have shown that malnutrition is present in 2% to 51% of community-dwelling elders, depending on the definition used and the population studied. An empirically tested framework for studying nutritional health in community-dwelling elders is not yet available.

OBJECTIVE

To test the goodness-of-fit exhibited by the framework of nutritional health among community-dwelling elders based on the Roy Adaptation Model using structural equation modeling (SEM).

METHODS

A population-based study investigated 243 elders dwelling in public housing. Demographics, polypharmacy, chronic illness, oral health, depressive symptoms, functional status, and satisfaction with social support were assessed to test their relation with nutritional health according to the propositions of the Roy Adaptation Model and scientific evidence.

RESULTS

The SEM analysis indicated that functional status, oral health, depressive symptoms, and satisfaction with social support affect nutritional health directly. Oral health, depressive symptoms, functional status, and satisfaction with support mediated the effects of age, ethnicity, education, and number of medications and chronic illnesses on nutritional health. The model accounted for 35% of the variance in nutritional health and demonstrated a good fit with the data and with the values for Bentler's Comparative Fit Index (0.94) and chi (1.76).

CONCLUSIONS

The propositions of the Roy Adaptation Model were supported, and the findings showed that this framework of nutritional health among community-dwelling elders could serve as a theoretical and empirical base for future inquiry.

Plasticity of the different neuropeptide-containing nerve fibres in the tongue of the diabetic rat

Common oral complications of diabetes mellitus are xerostomia, impairment of taste, atrophic lesions of the tongue, leukoplakia, lichen oris planus, and tumours, which might be the consequence of chronic inflammation and changes in innervation. In this work, we examined the density of different neuropeptide-containing nerve fibres immunohisto- and immunocytochemically in the root of the control and diabetic rat's tongue. Quantitative analysis showed that the number of immunoreactive (IR) nerve fibres was decreased after 1 week of the streptozotocin treatment, which was prevented by immediate insulin treatment. However, after 4 weeks duration of diabetes, the number of all investigated IR nerve fibres increased significantly (p<0.05), which was further enhanced by the delayed insulin treatment. The numbers of substance P (SP) and vasoactive intestinal polypeptide IR perikarya were also increased by insulin treatment. The electron-microscopic investigations showed that some of the nerve terminals from diabetic animals were found in degeneration. After 4 weeks duration of diabetes, the number of inflammatory cells as well as the mast cell/nerve fibre contacts was also increased. The immunocells also showed IR for SP and neuropeptide Y in the diabetic rats. The insulin treatment decreased both the number and the immunoreactivity of these cells. The increased synthesis and/or regeneration of neuropeptide-containing nerves might indicate the plasticity of nerve fibres in diabetes mellitus, which might happen as a consequence of the changes in the level of neurotrophic factors released by increased number of inflammatory cells or as an effect of insulin.

Update on diabetes mellitus and related oral diseases

Diabetes mellitus (DM) is a group of complex multisystem metabolic disorders characterized by a relative or absolute insufficiency of insulin secretion and/or concomitant resistance to the metabolic action of insulin on target tissues. The chronic hyperglycaemia of diabetes is associated with long-term systemic dysfunction. The present article summarizes current knowledge of DM and details the oral and dental implications of this common endocrine disorder.

Impaired salivary function in patients with noninsulin-dependent diabetes mellitus with xerostomia

To test this hypothesis, salivary function was measured by quantitative salivary scintigraphy in noninsulin-dependent diabetes mellitus (NIDDM) patients, as well as in age- and sex-matched controls for comparison. Seventy-two patients with NIDDM history of over 10 years and 36 healthy age- and sex-matched controls were enrolled in the study. All of the 72 NIDDM patients had good blood sugar control. None presented with autonomic neuropathy. These 72 NIDDM patients were separated into two subgroups. Group 1: 36 patients with xerostomia and Group 2: 36 patients without xerostomia. After intravenous injection of 5mCi Tc-99m pertechnetate, sequential images at 1 min/frame were acquired for 30 min. The 1st and 15th minute uptake ratios (UR) were calculated from the tracer uptakes in the four major salivary glands over the background regions of interest. Saliva excretion was stimulated by one tablet of 200 mg ascorbic acid given orally 15-min postinjection of the tracer. Then, the maximal excretion ratios (ER) of the four major salivary glands after sialagogue stimulation were calculated. Significantly poorer salivary function was found, represented by significantly decreased UR and ER values, in 36 NIDDM patients with xerostomia, when compared with 36 NIDDM patients without xerostomia and 36 healthy controls, via objective and quantitative salivary scintigraphy. It has been speculated that impaired salivary function contributes to NIDDM with xerostomia. However, further studies with a larger series of NIDDM patients are necessary to confirm our findings.

Diabetic neuropathy masquerading as glossodynia

BACKGROUND

Diabetic neuropathy, or DN, occurs in approximately 50 percent of patients who have type 2 diabetes mellitus, or DM. Oral burning and symptoms consistent with glossodynia (burning mouth syndrome) may occur secondary to DN.

CASE DESCRIPTION

A 54-year-old woman reported to a university dental clinic with a chief complaint of oral burning. No clinical signs were evident. Her medical history was positive for type 2 DM. The initial diagnosis was glossodynia, and she was evaluated with relevant blood studies, which indicated that her diabetes was not well-controlled. The patient was referred back to her physician, and her symptoms abated once her diabetic condition was under control.

CLINICAL IMPLICATIONS

It is important to consider DN within the differential diagnoses of patients who have symptoms consistent with glossodynia but have no clinical signs. Dentists are invaluable in ascertaining underlying systemic disease considerations in patients with oral symptomatology. Cooperation between dentists and physicians often is helpful and necessary in caring for patients who have uncontrolled type 2 DM and oral symptoms.

Type 1 diabetes mellitus, xerostomia, and salivary flow rates

OBJECTIVE

The Oral Health Science Institute at the University of Pittsburgh has completed a cross-sectional epidemiologic study of 406 subjects with type 1 diabetes and 268 control subjects without diabetes that assessed the associations between oral health and diabetes. This report describes the prevalence of dry-mouth symptoms (xerostomia), the prevalence of hyposalivation in this population, and the possible interrelationships between salivary dysfunction and diabetic complications.

STUDY DESIGN

The subjects with diabetes were participants in the Pittsburgh Epidemiology of Diabetes Complications study who were enrolled in an oral health substudy. Control subjects were spouses or best friends of participants or persons recruited from the community through advertisements in local newspapers. Assessments of salivary function included self-reported xerostomia measures and quantification of resting and stimulated whole saliva flow rates.

RESULTS

Subjects with diabetes reported symptoms of dry mouth more frequently than did control subjects. Salivary flow rates were also impaired in the subjects with diabetes. Regression models of potential predictor variables were created for the 3 self-reported xerostomia measures and 4 salivary flow rate variables. Of the medical diabetic complications studied (ie, retinopathy, peripheral and autonomic neuropathy, nephropathy, and peripheral vascular disease), only neuropathy was found to be associated with xerostomia and decreased salivary flow measures. A report of dry-mouth symptoms was associated with current use of cigarettes, dysgeusia (report of a bad taste), and more frequent snacking behavior. Xerogenic medications and elevated fasting blood glucose concentrations were significantly associated with decreased salivary flow. Resting salivary flow rates less than 0.01 mL/min were associated with a slightly higher prevalence of dental caries. Subjects who reported higher levels of alcohol consumption were less likely to have lower rates of stimulated salivary flow.

CONCLUSIONS

Subjects with type 1 diabetes who had developed neuropathy more often reported symptoms of dry mouth as well as symptoms of decreased salivary flow rates. Because of the importance of saliva in the maintenance and the preservation of oral health, management of oral diseases in diabetic patients should include a comprehensive evaluation of salivary function.

Oral symptoms and signs in elderly patients with type 2 diabetes mellitus. A focus on diabetic neuropathy

OBJECTIVE

We investigated oral disorders and compared the findings with the occurrence of neuropathy in type 2 diabetes mellitus.

STUDY DESIGN

Mucosal diseases, tooth loss, and temporomandibular joint dysfunction were examined in 45 patients with long-term type 2 diabetes mellitus and in 77 control subjects. The occurrence of neuropathy was evaluated by neurophysiologic tests.

RESULTS

Of patients with diabetes, 56% suffered from dry mouth and 18% from glossodynia; of controls, correspondingly, 36% and 7% (P <.05); 2 or more mucosal lesions were detected in 42% and 20%, respectively (P =. 008). Temporomandibular joint dysfunction was found in 27% of subjects with diabetes and in 16% of control subjects. Peripheral neuropathy was present in 42% of patients with diabetes and in none of the controls (P <.01), and autonomic parasympathetic neuropathy in 54% and 31%, respectively (P =.02). Peripheral and autonomic parasympathetic neuropathies were independent risk factors for tooth loss and temporomandibular dysfunction.

CONCLUSIONS

Diabetic neuropathy was found to be associated with tooth loss and temporomandibular joint dysfunction.

Caries in patients with non-insulin-dependent diabetes mellitus

OBJECTIVE

The purpose of this study was to investigate the prevalence and risk factors of dental caries in patients with non-insulin-dependent diabetes mellitus and to determine whether these factors are associated with metabolic control and vascular complications of the disease.

STUDY DESIGN

Both the occurrence of caries, acidogenic oral bacteria, and yeasts and salivary flow were studied in 25 patients with non-insulin-dependent diabetes mellitus whose diagnosis had been set 13 to 14 years earlier and in whom the metabolic evolution of the disease was well established. The patients' glycemic control was determined by means of analysis of the blood hemoglobin A1C concentration at the time of dental examination. The control group consisted of 40 nondiabetic subjects in the same age group. Decayed, missing, and filled teeth indices and numbers of surfaces with caries, filled surfaces, and root caries were determined by means of clinical dental caries examination. Stimulated salivary flow was measured, and levels of Streptococcus mutans, lactobacilli, and yeasts were analyzed.

RESULTS

The median hemoglobin A1C concentration of the patients was 8.6%, which indicates poor metabolic control of diabetes. No association was found between the metabolic control of disease and dental caries. The occurrence of dental caries was not increased in the patients with non-insulin-dependent diabetes mellitus in comparison with the control subjects. The counts of acidogenic microbes and yeasts did not differ statistically significantly between the groups. There was no association of caries with the prevalence of coronary artery disease or hypertension in either the patients or the control subjects. In a stepwise logistic regression model, a salivary flow of at least 0.8 ml/min was related to the occurrence of dental caries in patients with non-insulin-dependent diabetes mellitus, whereas negligence with respect to dental care was the most important risk predictor in the control group.

CONCLUSION

Our results showed no effect of diabetes on the prevalence of caries. However, the caries-protective effect of saliva was partly lost in patients with non-insulin-dependent diabetes mellitus.

Inflammatory mediator response as a potential risk marker for periodontal diseases in insulin-dependent diabetes mellitus patients

The gingival crevicular fluid (GCF) and monocytic secretion of prostaglandin E2 (PGE2) and interleukin 1 beta (IL-1 beta) were measured in a group of 39 insulin-dependent diabetes mellitus (IDDM) patients and 64 systemically healthy individuals. Diabetics were divided into Group A (gingivitis or mild periodontal disease) and Group B (moderate or severe periodontal disease). Diabetics had significantly higher GCF levels of both PGE2 and IL-1 beta as compared to non-diabetic controls who were matched with regard to periodontal disease severity (P < 0.00001 and P = 0.0005, respectively). Within the diabetic population, the GCF levels of these inflammatory mediators were almost 2-fold higher in Group B as compared to Group A (P = 0.01, P = 0.006, respectively for GCF-PGE2 and IL-1 beta). Furthermore, diabetics as a group had a significantly higher monocytic PGE2 and IL-1 beta production in response to various concentrations of both Escherichia coli and Prophyromonas gingivalis lipopolysaccharide (LPS) as compared to non-diabetic patients with adult periodontitis (P = 0.0001). LPS dose-response curves demonstrated that monocytes from Group B diabetics produced approximately 3 times more PGE2 than Group A monocytes; however, there was no significant difference in monocytic IL-1 beta secretion within the IDDM patients. The levels of GCF or monocytic mediators did not correlate with age, race, or glycosylated hemoglobin (HbA1C) levels. Our data suggest that the high GCF and monocytic secretion of PGE2 and IL-1 beta in IDDM patients may be a consequence of a systemic response trait and that the presence of Gram-negative infections such as periodontal diseases may interact synergistically to yield high local levels of these mediators and a more severe periodontal condition.

Long-term complications of diabetes mellitus, Part II: Gastrointestinal and infectious

Numerous gastrointestinal and infectious diseases are associated with long-standing and often poorly controlled DM in humans. Although not as well documented in veterinary patients, the veterinary practitioner must always have an index of suspicion for the possibility of these complications. Because the clinical signs of a number of these problems are identical, proper diagnostic procedures need to be used to differentiate among the gastrointestinal and even infectious problems. In all cases, stringent blood glucose control is the common denominator in effective treatment. Other agents can be used both to assist in short-term control and for long-term therapy.