Salivary characteristics of diabetic children

Prevalence and Severity of Periodontal Disease in Diabetic Patients in South Jordan: A Cross-Sectional Study

INTRODUCTION

Poorly managed diabetes mellitus can elevate oral glucose levels, fostering gum disease. Conversely, untreated periodontal disease may worsen diabetes control. This study aims to assess the prevalence of periodontal disease and its association with diabetes characteristics in South Jordan.

METHODS

This cross-sectional study enrolled 249 type 2 diabetic patients from Prince Hashim Bin Abdullah II Clinic in Aqaba, Jordan. Demographics, clinical history, and periodontal indices were recorded, with glycemic control measured via HbA1c. Statistical analyses utilized SPSS.

RESULTS

Predominantly female (58%) and married (90%) participants had a mean age of 49.0 years, with uncontrolled diabetes prevalent in 86% (mean HbA1c: 9.16). Dyslipidemia (73%), hypertension (49%), and diabetic neuropathy (21%) were common. Periodontal indices indicated moderate to high scores, reflecting significant plaque accumulation (plaque index score (PIS) = 3: 20%), severe gingival inflammation (gingival index score (GIS) = 3: 22%), and notable bleeding upon probing (papillary bleeding index score (PBIS) = 3-4: 22%). Moreover, a considerable percentage exhibited advanced periodontal disease (community periodontal index score (CPIS) = 3-4: 19%).

CONCLUSION

A high prevalence of periodontal disease among diabetic patients in South Jordan underscores the need for integrated diabetes and periodontal care strategies. These findings emphasize the interplay between diabetes control and periodontal health, warranting further investigation into effective intervention strategies.

Dental caries in children and adolescents with poorly-controlled diabetes: a case-control study

The relationship between diabetes and dental caries remains uncertain. The main objective of this study was to quantify dental caries in children and adolescents with and without poorly-controlled diabetes to examine whether poorly-controlled diabetes influences caries prevalence and severity. This was a case-control study of children and adolescents with poorly-controlled diabetes and age-matched controls attending paediatric clinics at Sheikh Shakhbout Medical City, Abu Dhabi, UAE in August 2022. Dental caries was diagnosed by visual examination and dental probing to derive total number of decayed, missing, and filled tooth or surface (DMFT/DMFS) indices. Differences in caries metrics between subjects with diabetes and controls were assessed using chi-squared or Mann Whitney U-tests. Fifty-seven children and adolescents without diabetes and 42 with poorly-controlled (HbA1c ≥ 7.5) diabetes were recruited. The median (interquartile range, IQR) DMFT index was 4 (5) and the DMFS index was 4 (11). There were no significant differences in DMFT % [14.0 (21.5) vs.13.0 (20.0); p = 0.602], DMFT index [4 (5) vs. 3 (6); p = 0.749], nor DMFS index [5 (12) vs. 4 (11); p = 0.484] between patients and controls. Diabetes either has no effect on caries risk or its effect is so small that it is masked by dominant risk factors such as diet and obesity that require addressing through robust public health measures. While poor glycaemic control does not appear to influence caries risk, diet and obesity remain serious and addressable risk factors affecting oral health.

Evidence-Based Practice for the Use of pH Indicator Paper Strip in Oral Medicine: A Literature Review

The objective of our article is to review the literature and collect the advice of specialists for the evaluation of the reliabilityand appropriate indications of the use of pH paper in oral medicine practice. The literature pertaining to the use of pH paper in oral medicine practice was reviewed, and appropriate indications were suggested by a French multidisciplinary working group of specialists and validated by a lecture committee. By screening PubMed/MEDLINE from 1911 to March 2024, we found 621 articles. All abstracts were read, 22 articles were selected for full-text reading, and 12 were ultimately included in the review. Three more articles from other sources were included. Thus, 15 articles constituted the literature review; seven papers from PubMed/MEDLINE focusing on how to restore the salivary pH balance in cases of periodontitis and early childhood caries (ECC) completed the review. It is concluded that the lack of sensitivity of pH paper must be underlined. A low pH is a cofactor leading to oral pathologies, and the use of pH paper constitutes an easy diagnostic instrument in patients with pH variations correlated to leukemia, diabetic mellitus, or orofacial radiotherapy. The evaluation of salivary pH using pH paper may be used as a quick chairside test, specifically in cases of ECC and uncontrolled severe periodontitis. Early diagnosis of salivary low pH range in children as well as periodontitis with deep pocket associated with a low pH range in adults should lead to the supply of fluoride and prescript sodium bicarbonate-containing dentifrices, respectively. In children, the use of a chewable toothbrush may help reduce plaque and elevate salivary pH.

A Determination of Salivary and Serum Glucose Levels in Patients With Type II Diabetes Mellitus

AIM

The aim of this work was to determine and compare serum and salivary glucose levels in patients with type II diabetes mellitus (DM).

MATERIAL AND METHODS

This study had an overall sample size of 100, which consisted of male and female volunteers aged 30-67 years. Both in-depth interviews and physical tests were conducted. Blood and saliva were collected from the participants while fasting, which were analyzed to determine the levels of salivary alpha-amylase (α-amylase). Both the subjects and the controls were instructed to test their blood glucose levels while fasting and it was suggested that HbA1c values will be used for diagnosing diabetes following the guidelines of the American Diabetes Association, Centers for Disease Control, and World Health Organization.

RESULTS

The average age of the control group (Category A) was noted as 47.52±6.28 years, and that of the study group (Category B) was 49.17±7.25 years. In Category A, female (n=23) were 46%, and 54% were male (n=27); and 40% of the people in Category B were female (n=20), and 60% were male (n=30). The majority of patients (54%) in Category B displayed an average level of DM control (n=27), followed by poor control (24%. n=12), well-controlled (20%, n=10), and uncontrolled DM (2%, n=1). Category A had an average salivary α-amylase concentration of 3.1±0.88 U/L, whereas that of Category B was 12.06±2.36 U/L. Thus, the mean salivary α-amylase level of Category B was found to be much higher than that of Category A, and this difference was statistically significant (p<0.001).

CONCLUSION

The determination of α-amylase levels in the saliva of individuals suspected of having type II DM has been suggested as a potential diagnostic method. Screenings conducted at healthcare institutions and community health fairs, as well as epidemiological studies, might benefit from this method. We believe that normal clinical practice should include the use of saliva in a broad variety of diagnostic tests.

A spectroscopy based prototype for the noninvasive detection of diabetes from human saliva using nanohybrids acting as nanozyme

The recent prediction of diabetes to be a global pandemic invites a detection strategy preferably non-invasive, and bloodless to manage the disease and the associated complications. Here, we have synthesized chitosan polymer functionalized, organic-inorganic bio-compatible nano-hybrids of Mn3O4 nanoparticles, and characterized it by utilizing several optical methodologies for the structural characterization which shows the Michaelis Menten (MM) kinetics for glucose and alpha-amylase protein (well-known diabetes biomarkers). We have also studied the potentiality for the detection of alpha-amylase in human salivary secretion which is reported to be strongly correlated with uncontrolled hyperglycemia. Finally, we have developed a prototype for the measurement of glucose (LOD of 0.38 mg/dL, LOQ of 1.15 mg/dL) and HbA1c (LOD of 0.15% and LOQ of 0.45%) utilizing the basic knowledge in the study for the detection of uncontrolled hyperglycemia at the point-of-care. With the limited number of clinical trials, we have explored the potential of our work in combating the diabetic pandemic across the globe in near future.

Comparison of the Oral Hygiene Status in Children With and Without Juvenile Diabetes - A Comparative Study

BACKGROUND

The rise in awareness programs with regard to the maintenance of oral hygiene in children with diabetes has led to a hypothetical question if children with juvenile diabetes are still under the risk of developing dental caries and having poor oral hygiene.

AIM

To compare the oral hygiene status of the children with and without juvenile diabetes.

MATERIALS AND METHOD

The study was conducted as age and sex matched case-control study. Sixty-six children diagnosed with juvenile diabetes were compared with the age and sex matched 66 healthy controls with respect to the oral hygiene index, gingival index and DMFT/def index. Mean of the obtained scores of the variables were compared between the groups using Mann-Whitney test with significance level set at 5%.

RESULTS AND CONCLUSION

No statistically significant differences were noted in the gingival condition and dental caries experience between the children with and without juvenile diabetes (P = 0.820; 0.504; 0.422). However, the overall oral hygiene status was found to be poor in children with juvenile diabetes (P = 0.003). No significant differences were observed in the gingival status and the dental caries prevalence between the two groups.

Association between metabolic control and oral health in children with type 1 diabetes mellitus

Background

Type 1 diabetes mellitus is the most common chronic disease and can be reflected in the oral cavity. The aim of this study was to analyze the impact of metabolic control on saliva, dental caries, dental plaque, gingival inflammation, and cariogenic bacteria in saliva.

Methods

A case–control epidemiologic study was performed on children with type 1 diabetes (ages 10–15 years) separated into two groups: 34 children with good metabolic control of glycated hemoglobin (HbA1c < 7.5%) and 46 children with poor metabolic control of glycated hemoglobin (HbA1c > 7.5%). Oral status was assessed using the Decay, Missing, and Filled Teeth index for permanent teeth (DMFT), plaque index and gingival index. The stimulated salivary flow rate was measured, and the colonies of Streptococcus mutans and Lactobacillus in saliva were determined. The observed children answered questions related to their frequency of brushing habits, dental visits and parents’ education. Mann–Whitney U Test, Chi-Square test and Fisher’s exact test were used in the statistical analyses. The significance level was set at p < 0.05.

Results

The children with diabetes with poor metabolic control had significantly higher values of the DMFT index, plaque index, and gingival index, more colonies, and a higher risk of Streptococcus mutans and Lactobacillus than the children with diabetes with good metabolic control (p < 0.001). The level of metabolic control of diabetes had no influence on salivary flow rates (p > 0.05). The majority of both groups with good and poor metabolic control brushed their teeth once per day, and they visited the dentist only when necessary (61.3%). However, the parents of children in both groups had medium to low levels of education, without any significant difference between groups (p > 0.05).

Conclusion

The results indicate that children with diabetes have a lower level of oral hygiene and are potentially to dental caries and periodontal diseases, mainly when their metabolic disorder is uncontrolled.

Validation of salivary glucose as a screening tool of diabetes mellitus

Background: Improved prognosis and delay of clinical complications in diabetes mellitus can be ensured by early screening and regular monitoring after diagnosis. This requires venipuncture at regular intervals of time causing anxiety and discomfort to the patient. Hence, development of a painless, non-invasive procedure is desirable for which saliva is a potential tool. Also, this would provide easy and cost-effective means for large scale screening and epidemiological intervention.

Aim: To measure fasting plasma glucose (FPG) and compare and correlate with salivary glucose levels in normal and diabetic individuals. Also, the correlation between glycated hemoglobin (HbA1c) and salivary glucose is studied in the diabetics and controls.

Methods: Blood and salivary glucose was estimated by GOD-POD method and glycated hemoglobin by HPLC. Statistical analysis was done on SPSS 16. Mean, Standard deviation, independent t test, ANOVA (f test), Pearson’s correlation coefficient along with regression analysis was carried out and comparison was done between the control and diabetic groups and the different subgroups within the diabetic group.

Results: A significant difference between the salivary glucose levels in subjects indicating that a deranged glycemic status is reflected in saliva. Also, salivary glucose increases in proportion to an increase in the FPG and HbA1C of the diabetics. The regression coefficient was calculated and a formula was derived for prediction of FPG and HbA1c using salivary glucose.

Conclusion: Saliva can be used as a screening tool for diabetes. Standardization of the technique and setting up a reference range will also make it useful in diagnosing diabetes mellitus.

Effectiveness of Salivary Glucose as a Reliable Alternative in Diagnosis of Type 1 Diabetes Mellitus: A Cross-Sectional Study

Aims and Objective

The aim of the present study was to ascertain the reliability of using salivary glucose in diagnosing and monitoring the blood glucose levels in type 1 diabetic patients and also to evaluate the salivary glucose in fasting and postprandial states and correlate with the blood glucose levels and hemoglobin A1c values.

Materials and Methods

The study was conducted on 79 Type 1 diabetic patients and 100 healthy controls. The blood and salivary glucose levels were evaluated in both study and control groups using glucose-oxidase peroxidase method.

Results

There was significantly higher level of salivary glucose in diabetics than in controls. There was a positive moderate-to-strong correlation between stimulated and unstimulated salivary glucose to blood glucose in both fasting and postprandial states. The cutoff values for stimulated and unstimulated fasting salivary glucose was 5.8 mg/dl and 5.6 mg/dl, respectively. The cutoff value for stimulated and unstimulated salivary glucose in postprandial state was 10.3 mg/dl and 9.5 mg/dl, respectively.

Conclusion

Salivary glucose appears to be a reliable biofluid to assess the blood glucose levels and can be a reliable alternative to blood glucose in Type 1 diabetes mellitus patients.

Evaluation of Salivary Components and Dental Plaque in Relation to Dental Caries Status in Type 1 Diabetes Mellitus

Purpose

Methods

Results

Conclusion

Clinical significance

How to cite this article

Review of paediatric gastrointestinal physiology relevant to the absorption of orally administered medicines

Despite much progress in regulations to improve paediatric drug development, there remains a significant need to develop better medications for children. For the design of oral dosage forms, a detailed understanding of the specific gastrointestinal (GI) conditions in children of different age categories and how they differ from GI conditions in adults is essential. Several review articles have been published addressing the ontogeny of GI characteristics, including luminal conditions in the GI tract of children. However, the data reported in most of these reviews are of limited quality because (1) information was cited from very old publications and sometimes low quality sources, (2) data gaps in the original data were filled with textbook knowledge, (3) data obtained on healthy and sick children were mixed, (4) average data obtained on groups of patients were mixed with data obtained on individual patients, and (5) results obtained using investigative techniques that may have altered the outcome of the respective studies were considered. Consequently, many of these reviews draw conclusions that may be incorrect. The aim of the present review was to provide a comprehensive and updated overview of the available original data on the ontogeny of GI luminal conditions relevant to oral drug absorption in the paediatric population. To this end, the PubMed and Web of Science metadatabases were searched for appropriate studies that examined age-related conditions in the oral cavity, esophagus, stomach, small intestine, and colon. Maturation was observed for several GI parameters, and corresponding data sets were identified for each paediatric age group. However, it also became clear that the ontogeny of several GI traits in the paediatric population is not yet known. The review article provides a robust and valuable data set for the development of paediatric in vitro and in silico biopharmaceutical tools to support the development of age-appropriate dosage forms. In addition, it provides important information on existing data gaps and should provide impetus for further systematic and well-designed in vivo studies on GI physiology in children of specific age groups in order to close existing knowledge gaps and to sustainably improve oral drug therapy in children.

State of Evidence on Oral Health Problems in Diabetic Patients: A Critical Review of the Literature

Diabetes mellitus (DM) is a global health problem, having recognized that in the next 20 years the number of diabetic patients in the world will increase to 642 million. DM exerts enormous repercussions on general health diabetic (especially derived from vascular, cardiac, renal, ocular, or neurological affectation). It entails in addition a high number of deaths directly related to the disease, as well as a high health care cost, estimated at $673 billion annually. Oral cavity is found among all the organs and systems affected in the course of DM. Important pathologies are developed with higher prevalence, such as periodontitis (PD), alterations in salivary flow, fungal infections, oral cancer, and oral potentially malignant disorders (OPMD). It has been proven that PD hinders the metabolic control of DM and that the presence of PD increases the possibility for developing diabetes. Despite the relevance of these oral pathologies, the knowledge of primary care physicians and diabetes specialists about the importance of oral health in diabetics, as well as the knowledge of dentists about the importance of DM for oral health of patients is scarce or non-existent. It is accepted that the correct management of diabetic patients requires interdisciplinary teams, including dentists. In this critical review, the existing knowledge and evidence-degree on the preventive, clinical, diagnosis, prognosis, and therapeutic aspects of oral diseases that occur with a significant frequency in the diabetic population are developed in extension.

State of Evidence on Oral Health Problems in Diabetic Patients: A Critical Review of the Literature

Diabetes mellitus (DM) is a global health problem, having recognized that in the next 20 years the number of diabetic patients in the world will increase to 642 million. DM exerts enormous repercussions on general health diabetic (especially derived from vascular, cardiac, renal, ocular, or neurological affectation). It entails in addition a high number of deaths directly related to the disease, as well as a high health care cost, estimated at $673 billion annually. Oral cavity is found among all the organs and systems affected in the course of DM. Important pathologies are developed with higher prevalence, such as periodontitis (PD), alterations in salivary flow, fungal infections, oral cancer, and oral potentially malignant disorders (OPMD). It has been proven that PD hinders the metabolic control of DM and that the presence of PD increases the possibility for developing diabetes. Despite the relevance of these oral pathologies, the knowledge of primary care physicians and diabetes specialists about the importance of oral health in diabetics, as well as the knowledge of dentists about the importance of DM for oral health of patients is scarce or non-existent. It is accepted that the correct management of diabetic patients requires interdisciplinary teams, including dentists. In this critical review, the existing knowledge and evidence-degree on the preventive, clinical, diagnosis, prognosis, and therapeutic aspects of oral diseases that occur with a significant frequency in the diabetic population are developed in extension.

State of Evidence on Oral Health Problems in Diabetic Patients: A Critical Review of the Literature

Diabetes mellitus (DM) is a global health problem, having recognized that in the next 20 years the number of diabetic patients in the world will increase to 642 million. DM exerts enormous repercussions on general health diabetic (especially derived from vascular, cardiac, renal, ocular, or neurological affectation). It entails in addition a high number of deaths directly related to the disease, as well as a high health care cost, estimated at $673 billion annually. Oral cavity is found among all the organs and systems affected in the course of DM. Important pathologies are developed with higher prevalence, such as periodontitis (PD), alterations in salivary flow, fungal infections, oral cancer, and oral potentially malignant disorders (OPMD). It has been proven that PD hinders the metabolic control of DM and that the presence of PD increases the possibility for developing diabetes. Despite the relevance of these oral pathologies, the knowledge of primary care physicians and diabetes specialists about the importance of oral health in diabetics, as well as the knowledge of dentists about the importance of DM for oral health of patients is scarce or non-existent. It is accepted that the correct management of diabetic patients requires interdisciplinary teams, including dentists. In this critical review, the existing knowledge and evidence-degree on the preventive, clinical, diagnosis, prognosis, and therapeutic aspects of oral diseases that occur with a significant frequency in the diabetic population are developed in extension.

Effectiveness of Salivary Glucose in Diagnosing Gestational Diabetes Mellitus

Context:

Frequent monitoring of glucose is important in the management of diabetes. A noninvasive painless technique was used to detect glucose levels with the use of saliva as a diagnostic fluid.

Aims:

The aim of our study was to correlate the blood glucose levels with stimulated and unstimulated salivary samples and also to assess the reliability of using salivary glucose in diagnosing and monitoring the blood glucose levels in gestational diabetic patients.

Settings and Design:

The study was conducted among 100 clinically healthy nondiabetic individuals and 99 individuals suffering from gestational diabetes mellitus (GDM).

Subjects and Methods:

Fasting blood glucose estimation and postprandial salivary glucose estimation were done in stimulated and unstimulated salivary samples using glucose oxidase/peroxidase method.

Statistical Analysis Used:

Data obtained were subjected to normality test, and P ≤ 0.05 was considered to be statistically significant. The correlation between blood and salivary glucose levels was evaluated using Pearson's correlation test.

Results:

A positive correlation was obtained for stimulated and unstimulated salivary samples in fasting and postprandial conditions. Linear regression analysis and receiver operating characteristic curve were plotted, and the optimal cutoff value for unstimulated and stimulated salivary glucose under fasting conditions was 5.1 mg/dl and 5.4 mg/dl, respectively. The optimal cutoff value for unstimulated and stimulated salivary glucose was 8.8 mg/dl and 9.3 mg/dl, respectively, in postprandial conditions.

Conclusions:

Saliva appears to be a reliable biofluid to assess the blood glucose levels and can definitely be a reliable alternative to blood glucose in GDM patients.

Characterization of the Oral Microbiome Among Children With Type 1 Diabetes Compared With Healthy Children

Aim: Current microbiome profiling of type 1 diabetes mellitus (T1D) patients is mostly limited to gut microbiome. We characterized the oral microbiome associated with T1D in children after the onset of the disease and explored its relationship with oral physiological factors and dental status. Methods: This cohort study comprised 37 children aged 5-15 years with T1D and 29 healthy children matched in age and gender. Unstimulated whole saliva was collected from diabetic and non-diabetic children, in the morning after brushing their teeth and a fasting period of at least 1 h before sampling. 16S rRNA gene-based analysis was performed by Powersoil Pro kit by Qiagen and Phusion High-Fidelity PCR Master Mix. Oral physiological and dental parameters studied included decayed, missing, and filled teeth index, salivary flow rate, and salivary pH, glucose, calcium, phosphate, and urea levels. Results: Of the identified 105 different genera and 211 different species, the most abundant genera were Streptococcus, Prevotella, Veillonella, Haemophilus, and Neisseria. Streptococcus was more abundant in T1D children. The diabetes group had 22 taxa at the genus level and 33 taxa at the species level that were not present in the control group and the control group exhibited 6 taxa at the genus level and 9 taxa at the species level that did not exist in the diabetes group. In addition, Catonella, Fusobacterium, and Mogibacterium differed between healthy and T1D subjects. Eight species and eight subspecies were significantly more abundant among healthy children than in T1D children. Porphyromonas and Mogibacterium genera were significantly correlated with salivary parameters. We found similarities between taxa revealed in the present study and those found in gut microbiome in type 1 diabetes mellitus according to gutMDisorder database. Conclusions: Salivary microbiome analysis revealed unique microbial taxa that differed between T1D children and healthy subjects. Several genera found in the saliva of T1D children were associated with gut microbiome in T1D individuals.

The potential of salivary biomarkers of nutritional status and dietary intake: A Systematic Review

OBJECTIVES

To explore whether nutritional salivary biomarkers could be used to aid nutritional status assessment and/or support traditional dietary assessment methods for patients.

DATA AND SOURCES

Searches were performed using four electronic databases; MEDLINE, EMBASE, Scopus and Web of Science. Trial registers (i.e. Cochrane), grey literature and reference lists were searched.

STUDY SELECTION

Studies which measured nutritional salivary biomarkers related to nutritional status and/or dietary intake outcome were included. No restrictions on participants' age, study design, publication date, setting or health status. Animal studies, non-English language studies, commentaries, and conference abstracts were excluded.

RESULTS

Study titles and abstracts were screened (n = 7982), full-texts assessed (n = 176) and 85 studies were included in a narrative synthesis. The most promising salivary biomarkers for nutritional status included: glucose, where saliva and serum levels were positively correlated in those with type 2 diabetes (T2D), higher salivary calcium levels in post-menopausal women in general and specifically those with lower bone mineral density (BMD), and salivary vitamin D to assess vitamin D status in healthy volunteers. Higher salivary total antioxidant capacity (TAC), nitrate/nitrite and fluoride were observed with increased antioxidant, nitrate/nitrite and fluoride dietary intake, respectively. A meta-analysis found significantly higher mean salivary glucose (n = 12) in T2D compared with healthy controls, but there was substantial heterogeneity (I²=94%) and evidence of publication bias.

CONCLUSIONS

The most promising salivary biomarkers identified in this systematic review were, glucose, vitamin D, calcium, TAC, nitrate/nitrite and fluoride. However, this was based on a small number of studies of varying quality, with many lacking a salivary assay performance assessment.

CLINICAL SIGNIFICANCE

At present, nutritional salivary biomarkers cannot be used alone to assess nutritional status or dietary intake. Further research into the most promising nutritional salivary biomarkers is required.

Noninvasive Glucose Monitor Using Dielectric Spectroscopy

OBJECTIVE

The Alertgy noninvasive continuous glucose monitor (ANICGM) is a novel wristband device that reports glucose levels without entailing skin puncture. This study evaluated the performance of the ANICGM compared to a Food and Drug Administration-approved glucose meter in patients with type 2 diabetes.

METHODS

The ANICGM device measures changes in the electromagnetic field generated by its sensor to produce a dielectric spectrum. The data contained within this spectrum are used in tandem with machine learning algorithms to estimate blood glucose levels. Values from the ANICGM were collected, sent to the Alertgy lab, formatted, and compared with fingerstick blood glucose levels, which were measured using the Accuchek Inform II glucometer. Fifteen patients completed three 120-minute sessions. The mean absolute relative difference (MARD) was calculated.

RESULTS

MARD values were compared between study days 2 and 3. The MARD for day 2 was 18.5% (95% CI, 12.8-42.2%), and the MARD for day 3 was 15.3% (95% CI, 12.3-18.4%). The difference in the MARD between days 2 and 3 was not statistically significant (P = .210).

CONCLUSION

The resulting MARDs suggest that further investigation into the use of dielectric spectroscopy for glucose monitoring should be explored.

Exploring the Interplay Between Oral Diseases, Microbiome, and Chronic Diseases Driven by Metabolic Dysfunction in Childhood

Oral childhood diseases, such as caries and gingivitis, have much more than a local impact on the dentition and tooth surrounding tissues, which can affect systemic conditions. While the mouth is frequently exposed to microbial stressors that can contribute to an inflammatory state in the entire body, chronic disorders can also interfere with oral health. Sharing common risk factors, a dynamic interplay can be driven between 1. dental caries, gingivitis, and type I diabetes mellitus, 2. early childhood caries and obesity, and 3. caries and cardiovascular diseases. Considering that there are ~2.2 billion children worldwide and that childhood provides unique opportunities for intervention targeting future health promotion, this review is of prime importance and aimed to explore the relationship between the oral microbiome and oral chronic diseases driven by metabolic dysfunction in childhood.

Salivary gland proteins alterations in the diabetic milieu

Salivary glands are considered the chief exocrine glands of the mouth and physiologically contribute to the maintenance of the homeostasis of the oral cavity. They consist of the parotid, submandibular and sublingual glands, which come in pairs and are collectively called the major glands, and the minor glands, which are much smaller and are dispersed throughout the buccal cavity. Salivary glands are distinguished by their size, amount of saliva secretion and their location in the oral cavity. Salivary glands pathophysiology has been a subject of interest in various worldwide metabolic disorders, including diabetes mellitus. Diabetes mellitus (DM), a global health concern, with a pathological imprint involved in vasculature, promotes microvascular and macrovascular complications among which periodontitis ranks sixth. Indeed, DM has also been directly associated with oral health lesions. Specifically, salivary glands in the context of diabetes have been a focal point of study and emphasis in the research field. There is evidence that relates salivary secretion content and diabetes progression. In this review, we present all the reported evidence of the deregulation of specific salivary proteins associated with the progression of diabetes in parallel with changes in salivary gland morphology, cellular architecture, and salivary secretion and composition more generally.

Resilience of the oral microbiome

The human mouth harbors a complex microbiota, the composition of which is potentially influenced by a wide range of factors, including the intake of food and drink, the availability of endogenous nutrients, the host immune system, drug treatments, and systemic diseases. Despite these possible influences, the oral microbiota is remarkably resilient, particularly in comparison with the microbiota of the large intestine. Diet, with the exception of excessive and/or frequent consumption of fermentable carbohydrate or supplementation with nitrate, has minimal impact on the composition of the oral bacterial community. The common oral diseases dental caries and the periodontal diseases is associated with modification of the oral microbiota primarily as a result of the ecological changes induced by excessive acid production and inflammation, respectively. Systemically-administered antimicrobials have only a small effect on the composition of the oral bacterial community, and while locally delivered antimicrobials can have some clinical benefits, the biofilm lifestyle of oral bacteria lends them substantial resistance to the agents used. Saliva plays an important role in oral microbial ecology, by supplying nutrients and providing protection against colonization by nonoral organisms. Dry mouth is one condition that has a major effect on the microbiota, resulting in increased colonization by opportunistic pathogens. Some systemic diseases do affect the oral microbiome, notably diabetes, in which raised levels of glucose in saliva and tissue impact on bacterial nutrition.

Changes in Salivary Amylase and Glucose in Diabetes: A Scoping Review

BACKGROUND AND OBJECTIVE

Diabetes mellitus (DM) is a common long-term disease which can be related with salivary amylase levels. DM has recently been associated with salivary amylase diagnostics that could further impair diagnoses in the diabetic population, as well as being an interesting alternative to traditional methods of determine glucose levels. The main advantage of this method is related to the fact that it is a fast diagnostic method. The DM population experiences changes to their metabolism which affects their salivary parameters, making this an alternative procedure for diagnosis and follow-up of the illness due to the non-invasive nature of salivary analyzes. The objective of this review is to summarize the evidence regarding the changes in salivary amylase and glucose levels, and their relationship with blood markers of glycemic control used in clinical settings such as blood glucose and glycated hemoglobin. The differences in salivary amylase levels depending on the method of saliva collection under fasting or non-fasting conditions. The changes in salivary amylase depends on the type of diabetes, the type of insulin treatment or the quality of glycemic control.

CONCLUSIONS

Salivary amylase concentration is increased in diabetic patients in most of the studies and salivary glucose concentration in all studies in both fasting and non-fasting (post-prandial) conditions. Salivary amylase and glucose concentration represent potential non-invasive biomarkers to evaluate glycemic control and clinical management of diabetic patients, although it is necessary to evaluate the influence of potential modulating factors such as age, duration diseases, sex and the effects of pharmacological treatments in these outcomes which remained to be elucidated.

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.

Comparison of decayed, missing, filled teeth index between thalassemia major patients and control group in Iran: a systematic review and meta-analysis

Introduction

Scientific evidence of the association between Decayed, Missing, and Filled Teeth (DMFT) and thalassemia are conflicting and difficult to establish conclusions. Therefore, this study aimed to determine the relationship between dental caries (using the DMFT index) and thalassemia major using meta-analysis.

Methods

Databases were searched using such keywords as “Thalassemia,” “Caries,” “decay,” “DMFT,” “Iran,” and OR operators, AND, and NOT. After the elimination of duplicate documentation, the articles which met the inclusion criteria were selected. Quality assessment was performed based on the Newcastle-Ottawa Quality Checklist. Thereafter, the standardized mean difference of the DMFT index was estimated.

Results

In eight studies, the mean DMFT was compared between patients with thalassemia major and the control group. In six studies, the mean of this index was higher in patients with thalassemia major than in the control group and in all six of the studies, the differences were statistically significant. The mean standardized difference of DMFT, D, M, and F were reported as 1.36 (0.41, 2.30), 2.63 (0.42, 4.84), 1.65 (−0.14, 3.45), and 0.02 (−1.67, 1.72), respectively.

Conclusion

The results of this meta-analysis indicated that DMFT index was more inappropriate in patients with thalassemia, as compared to the control group which represents the higher incidence of dental caries among patients with thalassemia compared to the control group.

Salivary and Serum Glucose Levels in Diabetes Mellitus Patients versus Control - A Randomised Control Trial

Oral fluids provide a readily available and non-invasive medium for the diagnosis of a wide range of diseases and clinical situations. Diabetes mellitus is a common chronic metabolic disorder that affects millions of people. Our objective was to compare the salivary and serum glucose levels in patients with diabetes mellitus and healthy individuals. Two ml of unstimulated whole saliva was collected by the spitting method. Also, 2 ml of the patient’s intravenous blood was obtained from the forearm’s median cephalic vein. Both the samples were centrifuged at 2000 rpm for 2-3 minutes. Ten μl of both saliva and serum were taken out and added to glucose reagent. These were kept in a temperature-controlled water bath at 37°C for 10 minutes. The color change was noted, and the optical density was measured in a semi-auto analyzer.

The presence of glucose was detected in both groups; however, the levels were raised in people with diabetes compared to healthy individuals. The present study indicated a substantial increase in salivary and serum glucose levels in diabetic patients compared to healthy controls. The concentration of glucose in saliva increases with the increase in serum glucose concentration.

Salivary glucose levels in diabetes mellitus patients: A case-control study

Aim:

The aim of the present study was undertaken to correlate the glucose levels in saliva and blood of diabetic and healthy nondiabetic individuals and to determine the efficacy of saliva as a diagnostic tool.

Setting and Design:

This was a case–control study.

Materials and Methods:

Forty-five patients previously diagnosed with diabetes mellitus and 45 healthy controls were included in the study. The patients and controls were asked to come to the clinic in the morning, after 8–10 h fasting. At that time, 5 ml of venous blood and unstimulated saliva was collected from both the groups, and 2 h after meal, again, venous blood and unstimulated saliva were collected. The saliva and sera from blood samples were subjected to glucose estimation. Saliva was collected in sterilized vials, and blood was collected in test tubes. Glucose estimation was done by oxidase–peroxidase method.

Statistical Analysis:

Pearson's correlation coefficient, Student's t-test and paired t-test were used for statistical analysis.

Results:

Correlation coefficient values show that there is a significant positive correlation between fasting blood and fasting salivary glucose levels and postprandial blood and postprandial salivary glucose levels.

Conclusion:

Salivary glucose level estimation can be used as a potential indicator in screening, diagnosis and monitoring of diabetes mellitus. Furthermore, it is an easy and noninvasive method.

Dental caries prevalence among Type 1 diabetes mellitus (T1DM) 6- to 12-year-old children in Riyadh, Kingdom of Saudi Arabia compared to non-diabetic children

Objective

The aim of this study was to compare the prevalence of dental caries among groups of 6–12-year-old children with and without Type 1 diabetes mellitus (T1DM) in Riyadh, Saudi Arabia, taking into account oral health behaviour, diet, and salivary parameters.

Methods

The study was designed as a comparable study of dental caries experience between T1DM and non-diabetic groups of children. The total sample size of 209 participants consisted of 69 diabetic and 140 non-diabetic children. Oral hygiene, diet and socio-economic status were collected using a pre-tested questionnaire. Caries was recorded in terms of decayed and filled permanent and primary teeth (DFT/dft). Salivary microbial counts and pH levels were recorded using Caries Risk Test (CRT) kit. Student's t-test, the chi-squared test, linear regression and one-way analysis of variance were performed P-value of 0.05 considered significant.

Results

The mean dft scores for the diabetic and non-diabetic groups were 3.32 ± 0.78 and 3.28 ± 0.71 (mean ± SD), respectively (p = 0.458). The mean DFT scores for the diabetic and non-diabetic groups were 1.62 ± 0.65 and 1.96 ± 0.65, respectively (p = 0.681). Diabetic children visited dentists more often than non-diabetic children did (p = 0.04), and had lower consumption of both sweets (p = 0.003) and flavoured milk (p = 0.002) than the non-diabetic group. Furthermore, analysis showed that the diabetic children had medium oral pH levels (pH = 4.5–5.5), whereas the non-diabetic children tended to have high (pH ≥ 6.0) oral pH; this difference was statistically significant (p = 0.01). In addition, the diabetic group had higher Lactobacillus levels than the non-diabetic group (p = 0.04).

Conclusion

The difference in caries prevalence between the diabetic and non-diabetic children was not statistically significant. The CRT analysis revealed a higher frequency of “critical” pH values (pH = 4.5–5.5) and higher Lactobacillus counts in diabetic children than in non-diabetic children, which indicated a higher caries risk in the former group.

A Bibliometric Analysis of Articles Published in Brazilian Dental Journal over 30 years

This study assessed bibliometric characteristics of all articles published in Brazilian Dental Journal (BDJ) in its 30 years of existence (1990-2019) and factors associated with citation rates. A document search was carried out in Scopus in December, 2019 and information about the articles were exported, including citations. Type of study and main subject in each article were categorized. Number of citations was categorized in tertiles. Logistic regression models were used to assess the association between variables related to articles' characteristics and number of citations. In 30 years, 1705 articles were published and 18507 citations received, with average 57 articles and 334 pages published yearly and 10.9 cites/doc. The most frequent types of study were laboratorial (63%), clinical (18.5%), and case reports (11%); the main subjects were dental materials (21.6%), endodontics (19.3%), and oral pathology/stomatology (13.1%). Most articles had origin in Brazil (90%), followed by USA (4.6%) and UK (1.5%). Aside from BDJ, Journal of Endodontics (3.5%) and International Endodontic Journal (2.2%) were journals that most often cited BDJ. Main origins of citations were Brazil (36.7%), USA (10.6%), and India (9%). Older articles had higher odds to be highly cited (12% increase/year), longer articles had lower odds (9% decrease/page). Narrative reviews and epidemiological studies were associated with more citations and systematic reviews with less citations. In conclusion, BDJ covered many subjects and study types in 30 years, showing increased growth in international audience. The journal may be regarded as one of the leading Brazilian journals in dentistry published in English.

The Contribution of the Brazilian Dental Journal to the Brazilian Scientific Research over 30 Years

The Brazilian Dental Journal (BDJ) was officially launched in 1990, stimulated by the courage and boldness of researchers dedicated to teaching and research in dentistry. The journal was conceived in a worldwide coverage and universal language to allow publication of the results of Brazilian studies, which otherwise would not be accessible to the scientific dental community. In the year we celebrate the thirtieth anniversary of BDJ, this article presents a brief overview of Brazilian dental research and a bibliometric analysis of the articles published in this journal as a contribution to our readers and fellow researchers. The purpose was to identify the mot frequent categories of study, the most published areas of dentistry and BDJ's top 50 most-cited articles in the Scopus and Google Scholar databases. A search was performed on all BDJ online issues published from 1990 to 2019. In this period, BDJ published 1,710 articles. Based on their distribution by category of study, 557 articles were in the basic research/dental materials area, 527 in the basic research/biology area and 280 in the clinical research area. Eight articles were cited more than 100 times in the Scopus database and 266 times in the Google Scholar database. Endodontics was the most published area. This overview of BDJ production over those 30 years allows establishing a profile of the characteristics, impact and trends of the published studies, as well as the journal's contribution to the top 50 most-cited articles in the Scopus and Google Scholar databases.

Periodontal parameters and oral hygiene in diabetic and nondiabetic adolescents in Zanjan

Background: Periodontal disease and diabetes mellitus are 2 most common encountered chronic diseases. The occurrence, appearance, and severity of the periodontium tissue conditions vary during adolescence. Also, there is controversy about the relationship between diabetes mellitus and increased periodontal disease breakdown during puberty. This study aimed to assess the periodontal parameters and oral hygiene in diabetic and nondiabetic adolescents in city of Zanjan. Methods: In this case and controls study, 140 diabetic (case) and 140 nondiabetic (control) adolescents were compared. The participants were matched by age, sex, and socioeconomic status using the group matching method. Clinical attachment loss, periodontal pocket depth, gingival index, periodontal index, and bleeding on probing were measured for the 6 Ramfjord index teeth. Data were analysed using descriptive statistics, chi-square test, t test, and one-way ANOVA using SPSS version 18. Results: The mean age of the diabetic and nondiabetic group was 16.7±1.6 and 17.1±0.30 years, respectively. Duration of diabetes was 2.15 ±0.86 years. Mean clinical attachment loss, periodontal pocket depth, gingival index, and bleeding on probing in the patient group were 7.4, 1.68, 12.9, and 97.7%, respectively. All these indices in diabetic adolescents were significantly greater than in nondiabetics. Only the PI was poor in both groups and no significant difference was noted in this respect between the 2 groups. Conclusion: Both diabetic and nondiabetic adolescents had equally poor oral hygiene. Gingivitis and periodontitis indices were significantly poorer in diabetic patients.

Dental caries, diabetes mellitus, metabolic control and diabetes duration: A systematic review and meta-analysis

OBJECTIVE

To analyze articles aimed at evaluating the association between diabetes, metabolic control, diabetes duration, and dental caries.

OVERVIEW

A systematic search in PubMed, Cochrane Library, Embase, and Web of Science was conducted to retrieve papers in English, Portuguese, and Spanish, up to April 2019. The research strategy was constructed considering the "PECO" strategy. Only quantitative observational studies were analyzed. The risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale. The meta-analyses were performed based on random-effects models using the statistical platform R. A total of 69 articles was included in the systematic review and 40 in the meta-analysis. Type 1 diabetics have a significantly higher DMFT compared to controls. No significant differences were found between type 2 diabetics and controls and between well-controlled and poorly controlled diabetics. Concerning diabetes duration, all authors failed to find differences between groups.

CONCLUSION

Although there is still a need for longitudinal studies, the meta-analysis proved that type 1 diabetics have a high dental caries risk.

CLINICAL SIGNIFICANCE

It is necessary to be aware of all risk factors for dental caries that may be associated with these patients, making it possible to include them into an individualized prevention program.

Saliva as a non-invasive tool for assessment of metabolic and inflammatory biomarkers in children

BACKGROUND & AIMS

Epidemiological studies in school-age children are challenging, particularly those that aim to analyse metabolic markers on blood samples obtained via invasive and stressful procedures. The objective of this paper is to evaluate the use of saliva, as a non-invasive tool in epidemiological studies performed in school-age children, to capture metabolic changes associated with body mass index (BMI), dietary characteristics and physical activity in both boys and girls.

METHODS

This is an observational study in which healthy children of ages between 8 and 12 years (n = 129, 60 girls and 69 boys) from three schools in a Mediterranean area of Spain were included. A panel of biomarkers was measured in serum and saliva and correlated with BMI, dietary characteristics and physical activity.

RESULTS

Significant positive correlation between serum and salivary levels were detected for CRP (r = 0.770) in all included children, and boys (r = 0.805) and girls (r = 0.775) separately (P < 0.001, in all cases) and for insulin in girls (r = 0.442; P < 0.05). Among all studied salivary biomarkers, insulin was significantly correlated with the three factors studied: positively with BMI and negatively with dietary characteristics (intake and composition) and physical activity (P < 0.05). Obesity and diet composition were both positively associated to pro-inflammatory biomarkers, CRP and IL1b; while diet composition shared with physical activity levels the correlation with IL6 (positive with energy, fat, carbohydrate and saturated fatty acid intake, and negative with cholesterol intake and average physical activity in boys), NGF and glucose (in both cases correlations were negative with diet composition and physical activity variables) (P < 0.05, in all cases). Sex differences were detected in serum glucose and TNFα.

CONCLUSIONS

Biomarkers in saliva are able to capture differences in BMI, dietary characteristics and physical activity levels in school-age children. Saliva may potentially constitute a useful non-invasive and stress-free tool to evaluate metabolic markers of inflammation and/or metabolism related to BMI and lifestyle in a sex-dependent manner.

Noninvasive glucose detection in exhaled breath condensate

Two-thirds of patients with diabetes avoid regularly monitoring their blood glucose levels because of the painful and invasive nature of current blood glucose detection. As an alternative to blood sample collection, exhaled breath condensate (EBC) has emerged as a promising noninvasive sample from which to monitor glucose levels. However, this dilute sample matrix requires sensors capable of detecting glucose with high resolution at nanomolar and micromolar concentrations. Recent developments in EBC collection methods and highly sensitive glucose biosensors provide a path toward enabling robust and sensitive glucose detection in EBC. This review addresses current and emerging EBC collection and glucose sensing modalities capable of quantifying glucose in EBC samples. We highlight the opportunities and challenges for development and integration of EBC glucose detection systems that will enable clinically robust and accurate EBC glucose measurements for improved glycemic control.

Type 1 Diabetes Mellitus (Juvenile Diabetes) - A Review for the Pediatric Oral Health Provider

Objective: To describe the significance of type 1 diabetes mellitus (juvenile diabetes) to the pediatric oral health provider. Relevance: The oral health provider must be aware of type 1 diabetes mellitus (T1DM) characteristics, influence of on oral health, each patient pre-operative diabetic management, symptoms and treatment of hypo and hyper-glycemia, and the clinical implications before, during and after treatment of children with T1DM. Study design: A review of the scientific literature about the T1DM influence on dental development, caries prevalence, gingival and periodontal diseases, wound healing, salivary and taste dysfunction, oral infections, and the factors that must be taken in consideration before, during and after oral treatment of children with T1DM is presented. Conclusion: The increasing prevalence of T1DB in children strongly emphasizes the need for oral health providers to be aware of the complicacy of the treatment aimed to obtain and maintain acceptable blood glucose levels in diabetic children, the effect of diabetes on the oral cavity, the possible serious complications due to hypo- or hyper glycemia before, during and after oral treatments, the effect of stress on blood glucose levels, and the special behavioral interaction between the diabetic child, his/her family and the oral health providers.

Estimation of salivary glucose, amylase, calcium, and phosphorus among non-diabetics and diabetics: Potential identification of non-invasive diagnostic markers

AIMS

Diabetes Mellitus (DM) continues to burden millions of people worldwide. Early detection and effective diagnosis of DM are essential key strategies to reduce the impeding incidence of the disease and its complications. Thus, this study determined the potential utility of salivary glucose, amylase, calcium, and phosphorus as non-invasive diagnostic markers of DM.

MATERIALS AND METHODS

A total of 80 participants were recruited and divided into two groups (non-diabetics and diabetics). Fasting blood samples and unstimulated saliva samples were collected and tested for glucose, amylase, calcium, and phosphorus.

RESULTS

Mann-Whitney U test shows that salivary glucose and salivary amylase were significantly higher among diabetics than non-diabetics. In addition to this, the receiver operations characteristics (ROC) curve showed that salivary glucose (AUC = 0.811, p < 0.001) and amylase (AUC = 0.649, p = 0.03) has significant association with DM.

CONCLUSION

Overall, only salivary glucose and amylase showed good potential in discriminating patients with diabetes from those without.

Accuracy of salivary glucose assessment in diagnosis of diabetes and prediabestes

AIMS

to assess salivary glucose correlation with blood glucose and its accuracy in diagnosis of diabetes and prediabetes.

MATERIALS AND METHODS

A comparative study including 204 adults in 3 groups (104 type 2 diabetics, 50 prediabetics, 50 non-diabetic controls) aging 18-65 years. The participants were interviewed about their socio-demographic, comorbidities, & drug treatment using a predesigned questionnaire. Salivary & blood samples were collected and analyzed.

RESULTS

Mean salivary glucose was observed to be 23.40 ± 12.755 mg/dl in control group, 42.68 ± 20.830 mg/dl in prediabetic group and 59.32 ± 19.147 mg/dl in diabetic group with significant difference between the 3 groups (P value < 0.001). Salivary glucose was significantly correlated to FBS with strong positive association (r = 0.67, P value < 0.001 in control group, r = 0.56, P value < 0.001in diabetic group and r = 0.36, P value 0.01 in pre-diabetic group). Salivary glucose could differentiate non-diabetics from diabetics (AUC: 0.928, P value < 0.001) with sensitivity (94.2%) and specificity (62%) & differentiate non-diabetics from prediabetics (AUC: 0.928, P value < 0.001) with sensitivity (94.2%) and specificity (62%).

CONCLUSIONS

Salivary glucose estimation can serve as valid and non-invasive test for screening and diagnosis of diabetes & prediabetes.

Evaluating All Potential Oral Complications of Diabetes Mellitus

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.

Glucose, fructosamine, and insulin measurements in saliva of dogs: variations after an experimental glucose administration

The aim of this study was to evaluate if glucose, fructosamine, and insulin levels can be measured in saliva of dogs and assess the changes in these compounds after an experimental glucose administration. Automated spectrophotometric assays for glucose and fructosamine and an ELISA assay for insulin measurements were validated in saliva of dogs, by evaluating precision, accuracy, and limits of detection. In addition, an intravenous glucose bolus was administrated to 10 beagles and fasting serum and saliva samples were obtained immediately before and 5, 10, 20, 30, and 45 min after glucose infusion. The results of the between-run imprecision gave mean CVs of 6.16, 9.40, and 3.10% for glucose, fructosamine, and insulin, respectively. Linearity under dilution showed coefficient of correlation of 0.999, 0.994, and 0.990 for glucose, fructosamine, and insulin, respectively. The LDs were 0.04 mg/dL, 4.08 μmol/L, and 0.02 μg/mL for glucose, fructosamine, and insulin, respectively. The glucose administration caused an increase in serum and salivary levels of glucose with a peak in salivary levels at 30 min and of insulin with a peak in salivary levels at 45 min, while fructosamine did not change. No correlations between serum and salivary concentrations were found for any compound. It is concluded that glucose, fructosamine, and insulin can be measured in saliva of dogs, and an experimental administration of glucose in this species can lead to increases in glucose and insulin in saliva.

Assessment of dental caries and gingival status among a group of type 1 diabetes mellitus and healthy children of South India - a comparative study

Background Diabetes mellitus is a metabolic disorder. However, dental caries and periodontal health have not attracted much interest in diabetic patients. This study was carried out to assess the dental caries status and gingival health status in children with type 1 diabetes mellitus (T1DM). Methods The study group consisted of 80 children, aged 6-18 years, with T1DM. The dental caries status was recorded using the World Health Organisation (WHO) criteria. Gingival health was assessed using the Loe and Silness gingival index (GI). Data obtained were subjected to statistical analysis. Results The mean dental caries status for primary (decayed, extracted, filled teeth [deft]) and permanent dentition (decayed, missing, filled teeth [DMFT]) scores in diabetic children were 0.44±1.28 and 1.26±2.49, respectively. The GI scores of diabetic children were 0.33±0.48. GI in the study group significantly correlated with DMFT (p<0.001) and deft (p≤0.05). Conclusions Dental caries in primary dentition was lower in diabetic children but was not statistically significant, whereas dental caries in permanent dentition was significantly higher. The gingival condition of diabetic children was healthy.

Eight-Week Consumption of High-Sucrose Diet Has a Pro-Oxidant Effect and Alters the Function of the Salivary Glands of Rats

A high-sucrose diet (HSD) is widely known for its cariogenic effects and promotion of obesity, insulin resistance, type 2 diabetes, and cancer. However, the impact of the HSD diet on the salivary gland function as well as the level of salivary oxidative stress is still unknown and requires evaluation. Our study is the first to determine both redox balance and oxidative injury in the parotid and submandibular glands of rats fed the HSD diet compared to the control group. We have demonstrated that uric acid concentration and the activity of superoxide dismutase and peroxidase varied significantly in both the submandibular and parotid glands of HSD rats vs. the control group. However, enhanced oxidative damage to proteins, lipids, and DNA (increase in advanced glycation end products, advanced oxidation protein products, 4-hydroxynonenal, and 8-hydroxy-2'-deoxyguanosine) was observed only in the parotid glands of HSD rats. Moreover, the HSD diet also reduced the total protein content and amylase activity in both types of salivary glands and decreased the stimulated salivary flow rate. To sum up, an HSD diet reduces salivary gland function and disturbs the redox balance of the parotid as well as submandibular salivary glands. However, the parotid glands are more vulnerable to both antioxidant disturbances and oxidative damage.

Salivary glucose levels and oral candidal carriage in Type 2 diabetics

Background

To assess the correlation between salivary glucose and blood glucose levels in diabetics and non diabetics and to study the association between salivary glucose levels and oral candidal carriage in patients with Type 2 diabetes mellitus.

Material and method

The study sample was divided into two groups, control and study group. The study group was again divided into two separate groups controlled diabetics and uncontrolled diabetics. Blood and saliva samples (for fasting and postprandial) were taken from each individual.

Results

The salivary glucose levels, highly correlated with blood glucose levels in both diabetic as well as non diabetics subjects. Salivary candidal carriage was more in oral cavity of Type 2 diabetic subjects than control subjects.

Conclusion

Saliva has the potential to be used as a noninvasive tool to monitor glycemic status of diabetic patients.

Salivary glucose as a non-invasive biomarker of type 2 diabetes mellitus

Background

Every year, millions of people are diagnosed with Diabetes mellitus (DM) and the number of new and undiagnosed cases continue to rise. Diagnosis of diabetes is usually performed by blood glucose analysis after fasting for a certain period. However, this method uses an invasive technique that can cause discomfort and even trauma to some patients which could eventually lead to behavioral changes such as avoidance of healthcare and laboratory testing. Studies that explore the diagnostic value of salivary glucose are promising due to the non-invasiveness of the test procedures and its potential correlation with blood results.

Material and Methods

The study conducted aimed to determine if salivary glucose can be utilized as an alternative to blood glucose in the screening, diagnosis, and monitoring of type 2 diabetes mellitus (T2DM). A total of 75 participants were recruited and equally divided into 3 groups (normal fasting glucose, impaired fasting glucose, and provisional DM) based on their fasting blood glucose (FBG) level. Blood and unstimulated saliva were collected from each participant and were subjected to glucose analysis using the routine glucose oxidase-peroxidase method.

Results

Using Pearson's correlation and linear regression, a high degree and significant correlation was observed between blood and salivary glucose (r = 0.715, p<0.001). Further analysis showed that salivary glucose is 88.5% sensitive and 61.5% specific with a positive predictive value of 45.8%, and a negative predictive value of 97.1%.

Conclusions

Salivary glucose is comparable to blood glucose in diagnosing and monitoring T2DM and is considered more advantageous than blood due to its non-invasive nature. Key words:Saliva, glucose, non-invasive, diabetes.

Ixeris dentata Extract Increases Salivary Secretion through the Regulation of Endoplasmic Reticulum Stress in a Diabetes-Induced Xerostomia Rat Model

This study aimed to investigate the molecular mechanism of diabetes mellitus (DM)-induced dry mouth and an application of natural products from Ixeris dentata (IXD), a recently suggested regulator of amylase secretion in salivary cells. Vehicle-treated or diabetic rats were orally treated with either water or an IXD extract for 10 days to observe the effect on salivary flow. We found that the IXD extract increased aquaporin 5 (AQP5) and alpha-amylase protein expression in the submandibular gland along with salivary flow rate. Similarly, the IXD extract and its purified compound increased amylase secretion in high glucose-exposed human salivary gland cells. Furthermore, increased endoplasmic reticulum stress response in the submandibular gland of diabetic rats was inhibited by treatment with the IXD extract, suggesting that IXD extract treatment improves the ER environment by increasing the protein folding capacity. Thus, pharmacological treatment with the IXD extract is suggested to relieve DM-induced dry mouth symptoms.

In vitro dynamic model simulating the digestive tract of 6-month-old infants

Background

In vivo assays cannot always be conducted because of ethical reasons, technical constraints or costs, but a better understanding of the digestive process, especially in infants, could be of great help in preventing food-related pathologies and in developing new formulas with health benefits. In this context, in vitro dynamic systems to simulate human digestion and, in particular, infant digestion could become increasingly valuable.

Objective

To simulate the digestive process through the use of a dynamic model of the infant gastroenteric apparatus to study the digestibility of starch-based infant foods.

Design

Using M.I.D.A (Model of an Infant Digestive Apparatus), the oral, gastric and intestinal digestibility of two starch-based products were measured: 1) rice starch mixed with distilled water and treated using two different sterilization methods (the classical method with a holding temperature of 121°C for 37 min and the HTST method with a holding temperature of 137°C for 70 sec) and 2) a rice cream with (premium product) or without (basic product) an aliquot of rice flour fermented by Lactobacillus paracasei CBA L74. After the digestion the foods were analyzed for the starch concentration, the amount of D-glucose released and the percentage of hydrolyzed starch.

Results

An in vitro dynamic system, which was referred to as M.I.D.A., was obtained. Using this system, the starch digestion occurred only during the oral and intestinal phase, as expected. The D-glucose released during the intestinal phase was different between the classical and HTST methods (0.795 grams for the HTST versus 0.512 for the classical product). The same analysis was performed for the basic and premium products. In this case, the premium product had a significant difference in terms of the starch hydrolysis percentage during the entire process.

Conclusions

The M.I.D.A. system was able to digest simple starches and a more complex food in the correct compartments. In this study, better digestibility of the premium product was revealed.

Oral dysbacteriosis in type 2 diabetes and its role in the progression to cardiovascular disease

Background

Salivary changes and proliferation of specific bacterial communities are known to result in oral disease which may adversely impact on systemic conditions like diabetes and cardiovascular diseases.

Objectives

This study reports on the changes in oral ecology of healthy and diseased adults and the possible role in disease causation.

Methods

The study comprised 150 participants divided into control (healthy), diabetic and cardiac groups. After dental examination for (Decayed Missing Filled Teeth (DMFT) and Oral Rating Index (ORI), stimulated saliva was sampled to determine flow rate and buffering capacity. Salivary microbial load of Streptococcus mutans and Lactobacilli were subsequently quantified.

Results

DMFT, ORI, buffering capacity and flow rate were inferior for both diabetic and cardiac patients, who had higher bacterial counts (p<0.05). Long standing diabetics harboured a higher load of Streptococcus mutans. The microbial load of Streptococcus mutans in cardiac patients was double that of diabetics.

Conclusion

Disruption in the salivary environment and changes in microbial ecology with increased load of cariogenic bacteria were found in diabetic and cardiac patients. This study brings forward new evidence of a markedly higher load of Streptococcus mutans in cardiac patients which may underlie the progression of diabetes to cardiovascular disease in this population.

Evaluation of the difference in caries experience in diabetic and non-diabetic children-A case control study

Aim

To evaluate the caries prevalence and related variables in Type 1 diabetic and non-diabetic children and among the diabetic children according to their metabolic status.

Methods

Sixty-eight diabetic and 136 non-diabetic children, matching by gender and age (4–14 years) were enrolled. The diabetic children were divided: a) 20 children in good metabolic control (Hb1ac≤7.5) and b) 48 children in bad metabolic control (Hb1ac>7.5). Dietary and oral hygiene habits were investigated. Caries status was registered using the International Caries Detection and Assessment System. Oral microflora was analysed using the checkerboard DNA-DNA hybridisation method. Plaque acidogenicity was recorded after a sucrose rinse.

Results

Sugared beverage and snack intake was higher in diabetic group compared to non-diabetic group (p = 0.03 and p = 0.04, respectively) and in subjects in bad metabolic control (p = 0.03 and p<0.01, respectively). Oral hygiene habits were similar, except for the use of fluoridated adjuvants, higher in non-diabetic children (p = 0.04). No statistically significant differences were observed regarding caries figures, but a higher number of caries free subjects was found in diabetic subjects in good metabolic control (p<0.01). Significant difference for the main cariogenic bacteria was found between diabetic and non-diabetic subjects (p<0.05). The pH values showed statistically significant differences between diabetic and non-diabetic subjects and between diabetic subjects in good and bad metabolic control (p<0.01).

Conclusions

Diabetic children in good metabolic control might even be considered at low caries risk, while those in bad metabolic control showed an oral environment prone to a high caries risk.

The effects of storage time and temperature on the stability of salivary phosphatases, transaminases and dehydrogenase

OBJECTIVES

To investigate the influence of temperature and storage time on salivary acid phosphatase (ACP), tartrate-resistant acid phosphatase (TRAP), alkaline phosphatase (ALP), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) and lactate dehydrogenase (LDH).

DESIGN

Unstimulated whole expectorated saliva was collected from healthy men and women subjects (n=26) between 8 and 10a.m. The saliva samples were centrifuged, and the supernatants were measured for ACP, TRAP, ALP, AST, ALT and LDH activities immediately (without freezing) [baseline values] and after time intervals of 3, 7, 14 and 28days (d) of storage at -20°C and -80°C using spectrophotometric methods The influence of storage time was analyzed by one-way ANOVA followed by the Dunnett post-test, while the paired Student's-t-test was used to compare the differences between the temperature (p<0.05).

RESULTS

There was significant decline in the activities of all enzymes at -20°C with increasing storage time. This decrease was relevant from day 14 onward for the majority of the enzymes, with the exception of AST. After day 28, the more sensitive enzymes were ALP and LDH, which showed residual activity of 39% and 16%, respectively, compared with baseline values. There were considerable, but insignificant changes, in the activities of all enzymes after storage at -80°C for 28days.

CONCLUSIONS

Frozen samples should be kept at -80°C to preserve these activities, but there are restrictions for the enzymes ALP, ALT and LDH. Storage of samples at -20°C could introduce high error variance in measured activities.

Salivary protective factors in patients suffering from decompensated type 2 diabetes

PURPOSE

Defining the level of protective factors in saliva of patients suffering from decompensated type 2 diabetes.

MATERIAL AND METHODS

50 Patients with diagnosis of decompensated type 2 diabetes, including 32 women and 18 men at the age of 57.9±9.2 years. The control group consisted of 50 people among whom there were 38 women and 12 men whose average age was estimated at 51.2±9.9 years.

RESULTS

It was stated the increased concentration of total protein by 60% and decreased concentration of IgA by 70%, of lysozyme by 27% and of lactoferrin by 40% in resting saliva of patients with type 2 diabetes if compared to the control group. These outcomes were really statistically meaningful. The evaluation of dependences between the analyzed protective factors and the indicator of oral cavity condition proved the positive correlation between the concentration of total protein and the number of DMFT (i.e. the rate of caries intensity). The remaining coefficients of correlation being evaluated proved to be negative and statistically meaningless.

CONCLUSION

The obtained outcomes prove a high influence of proteins included in saliva on the prevalence and development of caries at patients with decompensated type 2 diabetes.

Estimation of clinical parameters of chronic kidney disease by exhaled breath full-scan mass spectrometry data and iterative PCA with intensity screening algorithm

Breath mass spectrometry is a useful tool for identifying important compounds associated with health. However, there have been few studies that have explored human exhaled breath by full-scan mass spectrometry as a non-invasive method for medical diagnosis, which may be attributed to the difficulties resulting from multicollinearity and small sample sizes relative to a large number of product ions. In this study, breath samples from 54 chronic kidney disease patients were analyzed by selected ion flow tube mass spectrometry in the full-scan mode. With the signal intensities of product ions, we developed a novel and robust algorithm, iterative PCA with intensity screening (IPS), to build linear models for estimating important clinical parameters of chronic kidney disease. It has been shown that IPS provided good estimations in cross-validated samples, and furthermore the identified product ions could have direct medical relevance to the disease. The study demonstrated the potential of quantitative breath analysis using mass spectrometry for medical diagnosis, and the importance of applying appropriate statistical tools to unveil the rich information in this type of data.