Manifestações bucais em pacientes portadores de Diabetes Mellitus: uma revisão sistemática

Enrichment of Acid-Associated Microbiota in the Saliva of Type 2 Diabetes Mellitus Adults: A Systematic Review

It could conceivably be hypothesized that a link exists between an altered microbiota due to local hyperglycemia and the increased risk of caries in diabetes mellitus (DM). This systematic review aimed to perform a cross-study comparison into the salivary microbiota of adults with type 2 diabetes mellitus (T2D) compared to adults without T2D, particularly focusing on the abundance of acid-associated bacteria. This report follows PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Studies using next-generation sequencing and other molecular techniques are included. The methodological quality of individual studies was assessed using appropriate Joanna Briggs Institute tools. The certainty of the evidence considering the effect direction was evaluated using the GRADE approach. From 2060 titles retrieved, 12 were included in the data synthesis, totalling 873 individuals with T2D and controls evaluated across the literature. Weighted averages of blood glucose levels (HbA1c—fasting blood glucose) were 8.21%—172.14 mg/dL and 5.12%—84.53 mg/dL for T2D and controls, respectively. In most studies, the relative abundance of acidogenic and aciduric bacteria was higher in diabetics when compared to their normoglycaemic controls. Whilst the evidence certainty was very low, there was a consistent Proteobacteria depletion and Firmicutes enrichment in T2D. As for the acid-associated genera, there was consistent enrichment of Lactobacillus and Veillonela for T2D. Tannerella/T. forsythia was enriched in T2D saliva, but the certainty is low. Further well-designed cohorts are needed to clarify the distribution of acid-associated microorganisms in the saliva of adults with T2D and how this can be clinically manifested (PROSPERO = CRD42021264350).

The Complex Interrelationship between Diabetes Mellitus, Oral Diseases and General Health

There is emerging evidence that several oral diseases and conditions can be associated with DM. Dental caries, hyposalivation, fungal diseases and endodontics lesions may represent potential oral complications that can be aggravated by chronic hyperglycemia. Individuals with DM have a low perception of oral diseases which can lead to clinically important oral and systemic complications. This review aims to provide data on the most common oral signs and symptoms related to DM and to explore the mechanisms that might explain associations between DM and oral diseases in order to clarify the risks posed by poor oral health in DM. Since the linkage between oral diseases and DM is part of multifactorial aspects related to chronic hyperglycemic status and several common conditions affecting the whole body, both require rigorous self-control from patients and attention from medical and dental professionals.

Association between dental visits at primary care and glycated hemoglobin level in patients with type 2 diabetes: a cohort study

OBJECTIVE

To evaluate the association between dental visits and variation in the glycated hemoglobin index (A1C) of patients with type 2 diabetes (T2DM) with well or not well glycemic control over time.

METHODS

Patients with T2DM, A1C ≥ 7% (not well-controlled) and < 7% (well-controlled), who attended a primary care service and were followed up from January 2010 to May 2018. The outcome was the variation of A1C obtained from reference laboratories. At the beginning of the study, a questionnaire with behavioral, clinical, and socioeconomic information was carried out. Multiple linear regression analyses tested interaction terms of all variables with the initial glycemic level (not well-controlled or well-controlled).

RESULTS

The sample consisted of 507 people, 65% women, and 66% individuals 55 to 74 years old, followed on average for 5.4 years. There was an interaction (p = 0.01) between dental visits and initial A1C. Patients not well-controlled with at least one dental visit had an average reduction in A1C of -0.56 percentage point (95%CI -1.06 - -0.56), whereas the well-controlled group who also had at least one dental visit had an increase of 0.34 percentage point (95%CI -0.18 - 0.87).

CONCLUSION

Dental visits were associated with an improvement in A1C of approximately a half-percentage point in patients who had the initial A1C considered as not well-controlled.

Accuracy of a questionnaire on xerostomia as a screening tool for hyposalivation

OBJECTIVE

Determine the accuracy of a questionnaire on xerostomia as a screening tool for hyposalivation.

METHODS

A total of 402 adults awaiting dental care at a public healthcare service answered an eight-item questionnaire addressing xerostomia and were submitted to stimulated sialometry, with ≤ 0.7 mL/min considered indicative of hyposalivation. Reproducibility and internal consistency of the questionnaire were evaluated. The correlation between the score and salivary flow was investigated. The total score was also compared between groups with and without hyposalivation and diagnostic precision measures were calculated.

RESULTS

Hyposalivation was identified in 162 participants (40.3%) and a total of 229 (57.0%) answered affirmatively to at least one question. The responses to each question revealed variable reproducibility (κ = 0.450-0.785) and satisfactory internal consistency (Cronbach's α = 0.70). Individuals with a larger number of positive answers had lower salivary flow (Spearman's ρ = -0.193; P < 0.001). The mean number of positive answers was greater in the group with a clinical diagnosis of hyposalivation compared to those without low salivary flow. The sensitivity of the screening tool was 64.8%, with an area under the ROC curve of 0.60 (95% confidence interval: 0.547-0.645; P < 0.001).

CONCLUSION

The questionnaire proved to be useful for the epidemiological screening of individuals with possible hyposalivation.

Oral health complications in Brazilian and French diabetic older people: A comparative study

INTRODUCTION

Diabetes mellitus (DM) is a risk factor for periodontitis for over 40 years and novel evidence suggests that periodontitis has an impact on glycemic control in patients with diabetes. This study aimed to compare oral health complications in diabetic older patients from Brazil and France.

METHODS

This cross-sectional study included 120 patients aged 65 and over diagnosed with type 2 diabetes. Sixty patients were admitted to a center for diabetes and hypertension care in Brazil and 60 patients were admitted to the Rouen University hospital. Dental conditions were assessed through the decayed, missing and filled teeth index and periodontal condition was assessed using the Community Periodontal Index. The significance threshold was p < 0.05.

RESULTS

Decayed teeth differed statistically between the groups (p = 0.001). The French group presented more tooth mobility, gingival recession and furcation involvement (p < 0.001). Tooth brushing frequency differed significantly between the groups (p < 0.030). The main cause of missing teeth was periodontitis in the French group and caries and periodontitis in the Brazilian group (p < 0.001). Statistical significance was found for use of fixed upper (p = 0.013) and lower (p = 0.013) dentures in the French group. The French group needed upper denture rehabilitation (p = 0.010) while the Brazilian group needed lower denture rehabilitation (p = 0.003).

CONCLUSION

Edentulism was prevalent in diabetic older people in both countries. However, the French participants presented with better oral health.

FACTORS RELATED TO ORAL CANDIDIASIS IN ELDERLY USERS AND NON-USERS OF REMOVABLE DENTAL PROSTHESES

This study examined the association between oral candidiasis in elderly users and nonusers of prosthesis and its predisposing factors. To this end, we performed a cross-sectional study where saliva samples from 48 patients were collected they used prosthesis and 43 patients (control group) who did not use. Among the 91 patients, Candida spp were isolated in 40 (83.3%) who used prosthesis and in 23 (53.5%) in the control group. A statistically significant association was determined between the two groups, the isolation of yeasts and dental prosthesis (p < 0.05, OR = 4.3). The most common etiological agent was Candida albicans (37 isolates), with 23 (62.2%) in the denture group and 14 (37.8%) (control group). Among patients who presented clinical manifestations of oral candidiasis (n = 24), 83.3% (n = 20) belonged to the group that wore dentures, while only 16.7% (n = 4) belonged to the control group. Elderly patients with diabetes had 4.4 times higher estimated risk of developing oral candidiasis when compared with individuals without this condition. There was no statistically significant association between being user prostheses and have diabetes with the onset of candidiasis. No statistically significant association was determined between xerostomia, use of prosthesis and oral candidiasis. The use of prosthetics and poor oral hygiene in elderly patients predisposes to the development of oral candidiasis.

Perfil e percepção de diabéticos sobre a relação entre diabetes e doença periodontal

INTRODUÇÃO: A periodontite é considerada um dos principais problemas de saúde em pacientes com diabetes e sua presença pode induzir resistência à insulina.OBJETIVO: avaliar o perfil e a percepção de pacientes com diabetes sobre a relação bidirecional entre diabetes e doença periodontal, assim como a integralidade da atenção primária à saúde destes pacientes.MÉTODO: Foi realizado um estudo epidemiológico de corte transversal, com 154 usuários cadastrados no programa HIPERDIA, em Unidades de Saúde da Família (USF), utilizando-se um questionário estruturado. Os dados foram registrados no SPSS e analisados por meio de estatística descritiva e inferencial, considerando-se um nível de significância de 5%.RESULTADO: A maioria dos pacientes pertencia ao gênero feminino (71,1%), apresentava baixa renda (73,2%) e escolaridade (42,5%), era não fumante (87,6%), com mais de 12 dentes perdidos (73,2%), escovavam os dentes duas vezes por dia (54,9%) e não utilizavam o fio dental (79,1%). Verificou-se associação estatisticamente significativa entre: gênero e número de escovações (pCONCLUSÃO: Os pacientes com diabetes apresentam elevada prevalência de dentes perdidos, carência de informações sobre os cuidados de higiene bucal e acerca da relação entre a doença periodontal e diabetes, o que evidencia a necessidade uma maior integração entre o Cirurgião-Dentista e a equipe médica.