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Vieira Lima CP, Chagas LFA, Marques RCR, Grisi DC, Salles LP, Guimarães MDCM, Dame-Teixeira N. Can hyperglycemia be associated with caries activity and root caries in adults? Prim Care Diabetes 2023; 17:48-54. [PMID: 36437217 DOI: 10.1016/j.pcd.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/15/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
AIMS A previous meta-analysis showed that individuals with Type 2 diabetes mellitus (T2D) have a greater chance of developing both coronal caries and root caries than systemically healthy ones, which can be influenced by hyperglycemia per se. This study aimed to associate blood and salivary glucose levels with caries. METHODS This research is a subset of a cross-sectional study. N = 39 individuals underwent a dental examination and salivary glucose, fasting blood glucose (FBG) and glycated hemoglobin (A1c) measurements. RESULTS The prevalence of active coronal caries was 10.2%, and that of root caries was 20.5%. A1c and FBG averages were higher in individuals with root caries (9.75 ± 1.71 and 186.3 ± 62.5) than without (7.01 ± 2.23 and 115.1 ± 48.6; p < 0.05). Individuals with T2D showed weak correlation of salivary glucose and number of active coronal caries. Significant correlations were observed between salivary and blood glucose. There was relevance of A1c (0.53; CI=0.124-0.941; p = 0.01) and FBG (0.019; CI=0.006-0.033; p = 0.006) toward the increased number of root caries lesions, even after adjustment for salivary flow and age. CONCLUSION Blood glucose levels are associated with an increased number of root caries in adults with or without T2D. In individuals with T2D, salivary glucose was correlated with active coronal caries. Additional studies are needed to support this association.
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Affiliation(s)
| | | | | | - Daniela Corrêa Grisi
- Department of Dentistry, School of Health Sciences, University of Brasilia, Brazil.
| | - Loise Pedrosa Salles
- Department of Dentistry, School of Health Sciences, University of Brasilia, Brazil.
| | | | - Naile Dame-Teixeira
- Department of Dentistry, School of Health Sciences, University of Brasilia, Brazil; Oral Biology Division, School of Dentistry, University of Leeds, UK.
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Aldosari M, Aldosari M, Aldosari MA, Agrawal P. Diabetes mellitus and its association with dental caries, missing teeth and dental services utilization in the US adult population: Results from the 2015-2018 National Health and Nutrition Examination Survey. Diabet Med 2022; 39:e14826. [PMID: 35262969 DOI: 10.1111/dme.14826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/20/2022] [Accepted: 03/07/2022] [Indexed: 11/28/2022]
Abstract
AIMS This study aimed to evaluate the associations of self-reported diabetic status with clinically assessed dental end points, including teeth with untreated coronal and root caries, missing teeth, complete tooth retention, edentulism and routine dental services utilization among adults aged ≥20 years in the United States. METHODS We pooled data from the 2015-2016 and 2017-2018 cycles of the National Health and Nutrition Examination Survey (NHANES), a nationally representative, cross-sectional, continuous survey of noninstitutionalized US population. The analysed data included all adult participants aged ≥20 years who completed the dental examination and reported their diabetic status. We estimated the prevalence and average outcomes of dental end points by diabetic status. Regression analyses were employed to evaluate the associations between diabetic status and dental outcomes. RESULTS Of 10,249 participants, 1,562 reported having diabetes mellitus, which translates to 11.3% of US adults aged ≥20 years (25.7 million). Compared to non-diabetic individuals, adults with diabetes had 1.49 (95%CI = 1.1-2.0) and 1.46 (95%CI = 1.2-1.8) times higher odds of developing coronal and root caries respectively. Adults with diabetes were 32% less likely to be fully dentate (OR = 0.68; 95%CI = 0.55-0.83) and had a higher average number of missing teeth (mean ratio = 1.35; 95%CI = 1.18-1.55). There was no association between diabetic status and routine dental services utilization. CONCLUSIONS Adults with diabetes exhibited worse dental health; nonetheless, there was no difference in dental services utilization. Multidisciplinary efforts from both medical and dental service providers are required to proactively address the well-being of adults with diabetes in terms of oral health.
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Affiliation(s)
- Maram Aldosari
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Muath Aldosari
- Periodontics and Community Dentistry, King Saud University College of Dentistry, Riyadh, Saudi Arabia
- Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Mohammad A Aldosari
- Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Priyanka Agrawal
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Ribeiro BA, Vieira Lima CP, Alves LS, Damé-Teixeira N. Impact of detection criteria on coronal and root caries estimates in adults with and without type 2 diabetes mellitus. Clin Oral Investig 2022; 26:3687-3695. [DOI: 10.1007/s00784-021-04339-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 12/06/2021] [Indexed: 12/01/2022]
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Diabetes mellitus and poor glycemic control increase the occurrence of coronal and root caries: a systematic review and meta-analysis. Clin Oral Investig 2020; 24:3801-3812. [DOI: 10.1007/s00784-020-03531-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 08/14/2020] [Indexed: 12/22/2022]
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Rawal I, Ghosh S, Hameed SS, Shivashankar R, Ajay VS, Patel SA, Goodman M, Ali MK, Narayan KMV, Tandon N, Prabhakaran D. Association between poor oral health and diabetes among Indian adult population: potential for integration with NCDs. BMC Oral Health 2019; 19:191. [PMID: 31429749 PMCID: PMC6701092 DOI: 10.1186/s12903-019-0884-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/13/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Studies in high-income countries have reported associations between oral health and diabetes. There is however a lack of evidence on this association from low and middle-income countries, especially India. The current study aimed to assess the prevalence of common oral diseases and their association with diabetes. METHODS This cross-sectional study was nested within the second Cardiometabolic Risk Reduction in South Asia Surveillance Study. A subset of study participants residing in Delhi were administered the World Health Organization's Oral Health Assessment Questionnaire and underwent oral examination for caries experience and periodontal health assessment using standard indices. Diabetes status was ascertained by fasting blood glucose, glycosylated hemoglobin values or self-reported medication use. Information was captured on co-variates of interest. The association between oral health and diabetes was investigated using Multivariable Zero-Inflated Poisson (ZIP) regression analysis. RESULTS Out of 2045 participants, 47% were women and the mean age of study participants was 42.17 (12.8) years. The age-standardised prevalence (95% confidence interval) estimates were 78.9% (75.6-81.7) for dental caries, 35.9% (32.3-39.6) for periodontitis. Nearly 85% participants suffered from at least one oral disease. Compared to diabetes-free counterparts, participants with diabetes had more severe caries experience [Mean Count Ratio (MCR) = 1.07 (1.03-1.12)] and attachment loss [MCR = 1.10 (1.04-1.17)]. Also, the adjusted prevalence of periodontitis was significantly higher among participants with diabetes [42.3%(40.0-45.0)] compared to those without diabetes [31.3%(30.3-32.2)]. CONCLUSION We found that eight out of ten participants in urban Delhi suffered from some form of oral disease and participants with diabetes had worse oral health. This highlights the need for public health strategies to integrate oral health within the existing Non-Communicable Disease control programs.
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Affiliation(s)
- Ishita Rawal
- Centre for Chronic Disease Control, C-1/52, 2nd Floor, Safdarjung Development Area, New Delhi, 110016 India
| | - Shreeparna Ghosh
- Immunization Technical Support Unit (ITSU-MoHFW), B-28 Qutub Institutional Area (first floor), New Delhi, India
| | - Safraj Shahul Hameed
- Centre for Chronic Disease Control, C-1/52, 2nd Floor, Safdarjung Development Area, New Delhi, 110016 India
| | - Roopa Shivashankar
- Centre for Chronic Disease Control, C-1/52, 2nd Floor, Safdarjung Development Area, New Delhi, 110016 India
| | - Vamadevan S. Ajay
- Centre for Chronic Disease Control, C-1/52, 2nd Floor, Safdarjung Development Area, New Delhi, 110016 India
| | - Shivani Anil Patel
- Hubert Department of Global Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA USA
| | - Michael Goodman
- Emory University Rollins School of Public Health, 1518 Clifton Road, NE CNR 3021, Atlanta, GA USA
| | - Mohammed K. Ali
- Hubert Department of Global Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA USA
| | - K. M. Venkat Narayan
- Hubert Department of Global Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA USA
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, Ansari Nagar (East), New Delhi, 110029 India
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, C-1/52, 2nd Floor, Safdarjung Development Area, New Delhi, 110016 India
- Public Health Foundation of India, Plot No. 47, Sector 44, Gurgaon, 122002 India
- Department of Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Verhulst MJL, Loos BG, Gerdes VEA, Teeuw WJ. Evaluating All Potential Oral Complications of Diabetes Mellitus. Front Endocrinol (Lausanne) 2019; 10:56. [PMID: 30962800 PMCID: PMC6439528 DOI: 10.3389/fendo.2019.00056] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 01/22/2019] [Indexed: 12/13/2022] Open
Abstract
Diabetes mellitus (DM) is associated with several microvascular and macrovascular complications, such as retinopathy, nephropathy, neuropathy, and cardiovascular diseases. The pathogenesis of these complications is complex, and involves metabolic and hemodynamic disturbances, including hyperglycemia, insulin resistance, dyslipidemia, hypertension, and immune dysfunction. These disturbances initiate several damaging processes, such as increased reactive oxygen species (ROS) production, inflammation, and ischemia. These processes mainly exert their damaging effect on endothelial and nerve cells, hence the susceptibility of densely vascularized and innervated sites, such as the eyes, kidneys, and nerves. Since the oral cavity is also highly vascularized and innervated, oral complications can be expected as well. The relationship between DM and oral diseases has received considerable attention in the past few decades. However, most studies only focus on periodontitis, and still approach DM from the limited perspective of elevated blood glucose levels only. In this review, we will assess other potential oral complications as well, including: dental caries, dry mouth, oral mucosal lesions, oral cancer, taste disturbances, temporomandibular disorders, burning mouth syndrome, apical periodontitis, and peri-implant diseases. Each oral complication will be briefly introduced, followed by an assessment of the literature studying epidemiological associations with DM. We will also elaborate on pathogenic mechanisms that might explain associations between DM and oral complications. To do so, we aim to expand our perspective of DM by not only considering elevated blood glucose levels, but also including literature about the other important pathogenic mechanisms, such as insulin resistance, dyslipidemia, hypertension, and immune dysfunction.
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Affiliation(s)
- Martijn J. L. Verhulst
- Department of Periodontology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, Netherlands
- *Correspondence: Martijn J. L. Verhulst
| | - Bruno G. Loos
- Department of Periodontology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, Netherlands
| | - Victor E. A. Gerdes
- Department of Vascular Medicine, Amsterdam UMC, Amsterdam, Netherlands
- Department of Internal Medicine, Spaarne Gasthuis, Hoofddorp, Netherlands
| | - Wijnand J. Teeuw
- Department of Periodontology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, Netherlands
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Odontal-Periodontal Changes in Patients with Type 1 Diabetes. CURRENT HEALTH SCIENCES JOURNAL 2017; 43:330-334. [PMID: 30595898 PMCID: PMC6286457 DOI: 10.12865/chsj.43.04.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 12/15/2017] [Indexed: 11/29/2022]
Abstract
ABSTRACT: Diabetes mellitus is a complex disease characterized by insufficient insulin secretion and / or an inefficiency of target tissues to its metabolic action. Periodontal disease was recognized as the sixth leading complication of a diabetes. Gingival sulcus bleeding is considered as an important clinical parameter in the diagnosis of periodontal disease. This research is based on comparison of the clinical and paraclinical data between groups of patients with type 1 diabetes and periodontal disease on the one hand and groups of patients with periodontal disease without diabetic disease on the other hand. We can conclude that there is sufficient data to confirm the existence of a bidirectional relationship between metabolic changes in type 1 diabetes and periodontal (odontal-periodontal) disorder of patients, especially in adolescents and young adults. Both diseases can influence each other more or less, so for diabetics there is a predilection to develop periodontal disease as diabetes is a risk factor for severe parodontopathies.
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Soni S, Mehta M, M AD, P R, Pallavi, Kadanakuppe S, Nagashree, B V. Root caries among type 2 diabetes mellitus patients visiting a hospital. SPECIAL CARE IN DENTISTRY 2014; 34:273-7. [DOI: 10.1111/scd.12065] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sugandhi Soni
- JN Kapoor DAV Dental College and Hospital; Yamuna Nagar Haryana India
| | - Mohit Mehta
- MM College of Dental Sciences and Research; Mullana Haryana India
| | - Aruna Devi M
- VS Dental College and Hospital; Bangalore Karnataka India
| | - Radha P
- VS Dental College and Hospital; Bangalore Karnataka India
| | - Pallavi
- VS Dental College and Hospital; Bangalore Karnataka India
| | | | - Nagashree
- VS Dental College and Hospital; Bangalore Karnataka India
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Garton BJ, Ford PJ. Root caries and diabetes: risk assessing to improve oral and systemic health outcomes. Aust Dent J 2012; 57:114-22. [PMID: 22624749 DOI: 10.1111/j.1834-7819.2012.01690.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This report reviews the current understanding of the relationship between diabetes and root caries, and investigates the evidence for dental chairside testing of gingival crevicular blood (GCB) glucose levels to assess risk for type 2 diabetes mellitus. Diabetes is linked with the progression of periodontal disease and a greater number of exposed root surfaces at risk for root caries. The rapidly increasing prevalence of type 2 diabetes coupled with a general trend towards retention of teeth means that the number of patients with increased risk for root caries is expanding significantly. Many patients with diabetes or abnormal blood glucose levels are unaware of their condition or that they are at increased risk for oral disease. Systemic blood glucose concentrations are comparable to those found in GCB and therefore may be a useful adjunctive clinical aid in determining appropriate care for patients and providing timely referrals to general medical practitioners. Use of GCB testing within the dental clinic is described. It is proposed that future studies be undertaken to provide clinicians with improved risk assessment strategies and to evaluate GCB glucose screening models.
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Affiliation(s)
- B J Garton
- School of Dentistry, The University of Queensland, Brisbane
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Lewis D, Fiske J, Dougall A. Access to special care dentistry, part 7. Special care dentistry services: seamless care for people in their middle years – part 1. Br Dent J 2008; 205:305-17. [DOI: 10.1038/sj.bdj.2008.803] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Moynihan PJ. The Relationship Between Diet, Nutrition and Dental Health: an Overview and Update for the 90s. Nutr Res Rev 2007; 8:193-224. [DOI: 10.1079/nrr19950013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bakhshandeh S, Murtomaa H, Vehkalahti M, Mofid R, Suomalainen K. Dental Findings in Diabetic Adults. Caries Res 2007; 42:14-8. [DOI: 10.1159/000111745] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Accepted: 08/31/2007] [Indexed: 11/19/2022] Open
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Hintao J, Teanpaisan R, Chongsuvivatwong V, Dahlen G, Rattarasarn C. Root surface and coronal caries in adults with type 2 diabetes mellitus. Community Dent Oral Epidemiol 2007; 35:302-9. [PMID: 17615017 DOI: 10.1111/j.1600-0528.2007.00325.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine the effect of type 2 diabetes mellitus (DM) on coronal and root surface caries and to investigate some factors suspected of being related to or interacting with DM, that may be associated with coronal and root surface caries. METHODS A stratified cross-sectional study was conducted in 105 type 2 diabetic patients and 103 non-diabetic subjects of the same age and gender. Coronal and root surface caries, exposed root surfaces, periodontal status, stimulated salivary functions, oral hygiene status, oral health behaviors, and counts of mutans streptococci and lactobacilli were measured. RESULTS Type 2 diabetic patients compared with non-diabetic subjects had a higher prevalence of root surface caries (40.0% versus 18.5%; P = 0.001), a higher number of decayed/filled root surfaces (1.2 +/- 0.2 versus 0.5 +/- 0.1; P < 0.01) and a higher percentage of generalized periodontitis (98.1% versus 87.4%; P < 0.01); but the prevalence and decayed/filled surface of coronal caries was not significantly different (83.8% versus 72.8% and 8.0 +/- 9.4 versus 6.3 +/- 7.5 respectively). The factors associated with root surface caries included type 2 DM, a low saliva buffer capacity, more missing teeth, and existing coronal caries; whereas wearing removable dentures, more missing teeth, a high number of lactobacilli, and a low saliva buffer capacity were associated with coronal caries. CONCLUSION Type 2 DM is a significant risk factor for root surface, but not for coronal caries. Periodontal disease should be treated early in type 2 diabetic subjects to reduce the risk of subsequent root surface caries.
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Affiliation(s)
- J Hintao
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand
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Siudikiene J, Machiulskiene V, Nyvad B, Tenovuo J, Nedzelskiene I. Dental caries and salivary status in children with type 1 diabetes mellitus, related to the metabolic control of the disease. Eur J Oral Sci 2006; 114:8-14. [PMID: 16460335 DOI: 10.1111/j.1600-0722.2006.00277.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of this study was to investigate the relationship among type 1 diabetes mellitus, dental caries, and salivary status in children. The study comprised 68, 10-15-yr-old diabetics, and 68, age- and gender-matched non-diabetic controls. Diabetics were categorized into well-to-moderately controlled (HbA1c < 9.0%) and poorly controlled (HbA1c >or= 9.0%) groups. Caries was recorded by assessing lesion activity at non-cavitated and cavity levels. Teeth were examined visually for the presence of dental plaque. Saliva was analyzed for unstimulated and stimulated flow rates, buffer effect, mutans streptococci, lactobacilli, and yeasts. Diabetics had fewer caries and plaque, lower salivary flow rates and buffer effect, and more frequent growth of yeasts than their non-diabetic controls. Well-to-moderately controlled diabetics had fewer decayed surfaces and lower counts of mutans streptococci and yeasts than poorly controlled diabetics, but the level of metabolic control of diabetes had no influence on salivary flow rates and buffer effect. High caries levels in diabetics were significantly associated with age, plaque score, and decreased unstimulated salivary flow rate, but were not associated with the level of metabolic control of diabetes. High caries experience in this study population could be related to plaque accumulation and/or to changes in saliva induced by diabetes mellitus.
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Affiliation(s)
- Jolanta Siudikiene
- Faculty of Odontology, Clinic of Denatl and Oral Diseases, Kaunas University of Medicine, Kaunas, Lithuania.
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Abstract
OBJECTIVE To determine the magnitude of diabetes mellitus among Ohio nursing home residents and the comorbid conditions affecting residents with diabetes. RESEARCH DESIGN, METHOD, AND SETTINGS: In certified Ohio nursing homes during 1999, 161,723 residents were eligible for this study because they had been admitted for at least 1 day that year, had been assessed using the Centers for Medicaid and Medicare's Minimum Data Set instrument, were 21 years old or older, and had a known sex and race. Eligible residents with diabetes were compared with those without diabetes with respect to comorbidity. RESULTS The 25% of residents diagnosed with diabetes were younger, more often male, and more often black than residents without this disorder. Residents with diabetes were also more likely to have cardiovascular diseases; visual problems; foot conditions, including missing limbs; and kidney failure. Residents with diabetes were less likely to have oral problems than residents without diabetes. CONCLUSION The Minimum Data Set instrument identifies important comorbidities among nursing home residents with diabetes and allows their disease course to be followed longitudinally. Nursing home residents in Ohio, and presumably in other states, bear a heavy burden from diabetes and significant comorbidities.
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Mealey BL, Moritz AJ. Hormonal influences: effects of diabetes mellitus and endogenous female sex steroid hormones on the periodontium. Periodontol 2000 2003; 32:59-81. [PMID: 12756034 DOI: 10.1046/j.0906-6713.2002.03206.x] [Citation(s) in RCA: 117] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Brian L Mealey
- Chairman, Department of Periodontics and Program Director, US Air Force Periodontics Residency, Wilford Hall Medical Center, Lackland Air Force Base San Antonio, Texas, USA
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Collin HL, Uusitupa M, Niskanen L, Koivisto AM, Markkanen H, Meurman JH. Caries in patients with non-insulin-dependent diabetes mellitus. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1998; 85:680-5. [PMID: 9638701 DOI: 10.1016/s1079-2104(98)90035-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
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.
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Affiliation(s)
- H L Collin
- Department of Oral and Dental Diseases, University of Kuopio, Finland
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Abstract
The presence of systemic disease in patients requiring periodontal therapy creates challenges for management. Alteration of treatment plans, with emphasis on physician consultation and preventive periodontal care, is frequently needed to minimize the impact of periodontal disease on the systemic condition. Conversely, detection and treatment of systemic disorders may impact upon the status of the periodontium and the success of periodontal therapy. The goal of holistic patient management is facilitated by a free flow of information between the patients and their medical and dental health care providers.
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Affiliation(s)
- B L Mealey
- Department of Periodontology, Wilford Hall Medical Center, Lackland Air Force Base, Texas, USA
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20
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Bridges RB, Anderson JW, Saxe SR, Gregory K, Bridges SR. Periodontal status of diabetic and non-diabetic men: effects of smoking, glycemic control, and socioeconomic factors. J Periodontol 1996; 67:1185-92. [PMID: 8959568 DOI: 10.1902/jop.1996.67.11.1185] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Periodontal disease is more prevalent and more severe in diabetic than in non-diabetic individuals but the magnitude of this increase is still being debated. This prospective, cross-sectional study compared the periodontal status of 118 diabetic men and 115 age-matched non-diabetic men. Plaque and gingival indices, bleeding scores, probing depth, loss of attachment, and number of missing teeth were measured in a blinded manner. Smoking status, glycemic control, socioeconomic status, and previous dental care were also assessed. These parameters were significantly higher in diabetic than non-diabetic men: plaque index, P < 0.0001; gingival index, P < 0.0002; bleeding score, P < 0.0001; probing depth, P = 0.0059; loss of attachment, P < 0.0001; and missing teeth, P < 0.005. These parameters were significantly higher in smokers than non-smokers: gingival index, probing depth, and loss of attachment. The duration of diabetes was not significantly related to the periodontal measures. Glycemic control as assessed by fasting plasma glucose and glycohemoglobin values was not significantly correlated to periodontal status. These studies indicate, for this study group, that diabetes significantly affects all measured parameters of periodontal status.
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Affiliation(s)
- R B Bridges
- Department of Oral Health Science, College of Dentistry, University of Kentucky, Lexington, USA
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Ringelberg ML, Gilbert GH, Antonson DE, Dolan TA, Legler DW, Foerster U, Heft MW. Root caries and root defects in urban and rural adults: the Florida Dental Care Study. J Am Dent Assoc 1996; 127:885-91. [PMID: 8754463 DOI: 10.14219/jada.archive.1996.0388] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
As part of the Florida Dental Care Study--a longitudinal study of risk factors for changes in dental health--the authors examined and interviewed 873 adults aged 45 years and older. During the examination, clinicians noted the number of teeth present and the participant's dental condition, including presence of root caries and fillings or noncarious defects on the roots. The interview was conducted to collect demographic and other information such as the adults' perceptions about dental care and their perceptions about their own dental health. The authors found that men, African-Americans, adults living in rural areas and those living in poverty were significantly more likely to have root caries than other participants. The data reported in this article will serve as baseline information for subsequent research.
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Affiliation(s)
- M L Ringelberg
- Public Health Dental Program, State Health Office, Tallahassee, Fla. 32301, USA
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22
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Katz RV. The RCI revisited after 15 years: used, reinvented, modified, debated, and natural logged. J Public Health Dent 1996; 56:28-34. [PMID: 8667314 DOI: 10.1111/j.1752-7325.1996.tb02391.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES The purpose of this article is to review the status of the Root Caries Index (RCI) 15 years after it was first introduced in the dental literature as a method for the reporting of supragingival root lesions. This review focuses on the extent to which the RCI has been used by epidemiologic researchers, as well as on the issues concerning the RCI as a useful index that have been raised and debated in the literature by those epidemiologic researchers. METHODS The debated points are categorized into six issues, including whether: (1) the RCI underestimates the prevalence of root caries by omitting subgingival root caries lesions; (2) the RCI overestimates the prevalence of root caries by using too rigid a definition of when recession can be visualized; (3) the RCI makes the assumption that there is a linear relationship between root caries lesions and the occurrence of at-risk surfaces, i.e., surfaces with recession; (4) the RCI, by ignoring missing teeth, distorts the descriptive epidemiologic picture of root caries; (5) recession is a predictor of root caries versus merely being an antecedent state; and (6) the imprecision of diagnosing gingival recession renders the RCI useless. RESULTS Given both the evidence from recent studies and the professional interest in subgingival root caries, as addressed in the first debated point, it seems reasonable to modify the RCI to include a separate reporting of subgingival root caries. Of the remaining debated points over the past 15 years, three of these (points #2, #4, and #5 above) seemingly serve to clarify specific aspects of the RCI that were intended as inherent elements of the RCI as originally presented. The question as to whether there is an assumption of a linear relationship between root caries lesions and the occurrence of at-risk surfaces (point #3) is answered in the negative. The final debated point (#6), while addressing a fundamental periodontal tissue measurement issue--namely the reliability of identifying gingival recession--and while theoretically interesting, should not undermine the current use, or utility, of the RCI, but rather suggests the need for improved periodontal diagnostic techniques for the condition of recession. CONCLUSIONS After 15 years, the RCI appears to be one of the two most common methods of reporting root caries in the epidemiologic literature (along with DFS counts). In fact, the best overall descriptive picture of root caries is achieved when those two reporting methods are presented in the same study accompanied by descriptive presentations of missing teeth and at-risk surfaces. Of all the debated points in the literature, the suggested modification of including subgingival lesions in the RCI leads now to the recommendation to collect subgingival data, but to do so in a manner that allows for separate presentation of supra- and subgingival root caries findings.
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Affiliation(s)
- R V Katz
- Department of Behavioral Sciences and Community Health, University of Connecticut Health Center, Farmington, 06030 USA.
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Scheinin A, Pienihäkkinen K, Tiekso J, Holmberg S, Fukuda M, Suzuki A. Multifactorial modeling for root caries prediction: 3-year follow-up results. Community Dent Oral Epidemiol 1994; 22:126-9. [PMID: 8205779 DOI: 10.1111/j.1600-0528.1994.tb01587.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The study was part of a series aiming at the development of caries tests. The initial material (n = 104, age range 47-79 yr, mean 62 yr) was reduced to 96, who were observed for 3 yr. During the follow-up four subjects died, all due to myocardial infarction, and four refused to participate. Thorough oral examinations were conducted at the baseline, 1- and 3-yr registrations; coronal and root surface caries were registered separately according to WHO classification. The tests included salivary mutans streptococci, lactobacilli, candida/yeasts, secretion rate, buffer effect and sucrase activity, and quantitation of visible plaque. The association between prospective root caries increment and several tests was significant. Multifactorial modeling resulted in the combination of Past Root Caries Experience (OR 12.8), Lactobacilli (OR 8.6) and Candida (OR 2.8). At screening, the criterion "two or three positive tests" of these yielded acceptable accuracy (77.1) and a relative risk of 3.3.
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Affiliation(s)
- A Scheinin
- Department of Cariology, University of Turku, Finland
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Abstract
Outcome measures are necessary for assessment of the appropriateness, quality, necessity for, and effectiveness of oral health care. With the growing number of older adults in the United States, it is appropriate to reflect on the unique characteristics of this segment of our society and how these characteristics may influence the identification of appropriate outcome measures. Older people often demonstrate multiple acute or chronic oral diseases with interrelated symptoms and clinical findings. Older persons are more likely to take medications with potentially adverse oral health effects. Patients experience a variety of disease processes over many years and have variable access to and experiences with the dental care system. These characteristics make the selection and interpretation of outcomes complex. Limitations of existing measures and considerations for the development of new outcomes measures specifically for older populations are reviewed.
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Affiliation(s)
- T A Dolan
- Department of Community Dentistry, University of Florida School of Dentistry, Gainesville 32610-0404
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Swanljung O, Meurman JH, Torkko H, Sandholm L, Kaprio E, Mäenpää J. Caries and saliva in 12-18-year-old diabetics and controls. SCANDINAVIAN JOURNAL OF DENTAL RESEARCH 1992; 100:310-3. [PMID: 1465562 DOI: 10.1111/j.1600-0722.1992.tb01077.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Eighty-five 12-18-yr-old adolescents suffering from insulin-dependent diabetes mellitus (IDDM) and their healthy age- and sex-matched controls were investigated with respect to dental caries, salivary flow rate, pH and buffering capacity of saliva, counts for lactobacilli and mutans streptococci, and salivary glucose content. The diabetics had their disease well controlled according to the HbA1 levels. The results showed no statistically significant difference between diabetics and controls in DMF and DMFS indexes and the number of initial caries lesions. Mean number of initial caries lesions was 3.2 in diabetics, 2.3 in controls. Mean stimulated salivary flow rate was 1.2 ml/min in the patients, 1.4 ml/min in the controls. The pH and buffering capacity values were 7.3 and 4.8 in the patients, 7.4 and 5.1 in the controls, respectively. High counts of mutans streptococci (> 10(6) CFU/ml) and lactobacilli (> 10(5) CFU/ml) were observed more often, but not significantly so, among the patients than in the controls. The mean concentration of glucose in saliva was 10.3 micrograms/ml in the patients, 9.7 1 microgram/ml in the controls. Thus, if the patients' IDDM is well controlled, their salivary and caries data does not differ from that of healthy controls.
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Affiliation(s)
- O Swanljung
- Department of Cariology, University of Helsinki, Finland
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