Salivary Alkaline Phosphatase as a Noninvasive Marker for Periodontal Disease in Children with Uncontrolled Type 1 Diabetes Mellitus

Imbalance of Myoinositol and D-Chiro-Inositol in Saliva of Children With Type-1 Diabetes Mellitus: A Cross-Sectional Study

OBJECTIVE

Earlier work suggests Myoinositol (MI) and D-chiro- inositol (DCI) imbalance in urine and plasma of diabetic patients, and their potential for monitoring insulin resistance. This study aimed to assess levels of Myoinositol (MI) and D-chiro- inositol (DCI) in saliva of children with type 1 diabetes mellitus (DM-1) and controls, to verify if concentrations of MI and DCI are similarly altered in saliva, exploring their potential for monitoring DM-1.

DESIGN, PATIENTS AND MEASUREMENTS

This cross-sectional clinical study enroled 45 patients (DM-1, n = 25; Controls, n = 20). Children aged 3-12 years with fasting blood glucose levels > 126 mg/dL, and HbA1c levels > 7%. Saliva was collected, and salivary measurements included pH, flow rates and concentrations of MI, DCI and glucose, employing high-performance liquid chromatography. Periodontal health was assessed using bleeding and plaque indices.

RESULTS

Children with DM-1 showed elevated MI (p = 0.001), reduced DCI (p = 0.001), and increased MI-DCI ratio (p = 0.001). The MI-DCI ratio was elevated by 16-fold among diabetic children. Plaque (p = 0.003) and gingival bleeding (p = 0.001) were higher in DM-1 than controls. The MI increased the odds of an outcome of DM-1 by 174%, while DCI reduced the odds by 63%, highlighting their strong and opposing effects on DM-1.

CONCLUSIONS

Children with DM-1 express higher MI and lower DCI levels, while non-diabetic children show an inversion of these concentrations. Inositol imbalance in saliva of diabetic children resembles previous results in urine, and represents a possible venue for monitoring this disease, paving the way for future investigations into salivary inositols.

Adjunctive systemic antibiotic effect on periodontal state, salivary enzyme activity, and glycemia imbalance in type-2 diabetics after non-surgical periodontal management

AIM

The current study aimed at analyzing the effect of non-surgical periodontal treatment accompanied by systemic antibiotics on salivary enzyme activities, periodontal parameters, and glycemic control in type-2 diabetic (T2D) patients with chronic periodontitis.

METHODS

The study included 125 type-2 diabetic patients with chronic periodontitis who had good glycemic control (T2Dc), 125 type-2 diabetics who had bad glycemic control (T2Dpc). The 125 T2Dpc were divided randomly into two groups. The first one enrolled 63 T2Dpc and received a non-surgical periodontal treatment (T2Dpc + NST). The second group enrolled 62 T2Dpc and received the non-surgical treatment accompanied by systemic antibiotics (T2Dpc+NST+A). HbA1c, periodontal indices, and salivary enzyme activities were assessed for all groups. The Glycated hemoglobin (HbA1c) was assessed. The Salivary alkaline phosphatase (ALP), aspartate aminotransferase (AST), alanine aminotransaminase (ALT), lactate dehydrogenase (LDH), and creatine kinase (CK) activities were measured.

RESULTS

The T2Dpc were characterized by the highest probing depth (PPD) and clinical attachment loss (CAL) periodontal scores, as well as ALP, AST, and ALT enzymatic activities. However, BOP did not differ significantly between T2Dc and T2Dpc. Whereas the rest of clinical parameters PI, GI, and OHI-S did not significantly differ between groups. The Pearson's analysis revealed three correlations between ALP-PPD, ALP-CAL, and ALP-BOP (bleeding on probing) in both T2Dc and T2Dpc (P < 0.05). Interestingly, a significant decrease in periodontal indices, salivary enzyme activities, and HbA1c was recorded in T2Dpc+NST+A group.

CONCLUSION

The increase in ALP, AST, and ALT activities reflects the impact of uncontrolled T2D on periodontal tissue alteration. The ALP activity increase was associated with the severity of periodontal status in diabetic patients. In comparison to non-surgical treatment alone, the adjunct use of systemic antibiotics improves periodontal state, enzyme activity, and glycemic control.

Salivary Diagnostics in Pediatrics and the Status of Saliva-Based Biosensors

Salivary biomarkers are increasingly being used as an alternative to diagnose and monitor the progression of various diseases due to their ease of use, on site application, non-invasiveness, and most likely improved patient compliance. Here, we highlight the role of salivary biosensors in the general population, followed by the application of saliva as a diagnostic tool in the pediatric population. We searched the literature for pediatric applications of salivary biomarkers, more specifically, in children from 0 to 18 years old. The use of those biomarkers spans autoimmune, developmental disorders, oncology, neuropsychiatry, respiratory illnesses, gastrointestinal disorders, and oral diseases. Four major applications of salivary proteins as biomarkers are: (1) dental health (caries, stress from orthodontic appliances, and gingivitis); (2) gastrointestinal conditions (eosinophilic esophagitis, acid reflux, appendicitis); (3) metabolic conditions (obesity, diabetes); and (4) respiratory conditions (asthma, allergic rhinitis, small airway inflammation, pneumonia). Genomics, metabolomics, microbiomics, proteomics, and transcriptomics, are various other classifications for biosensing based on the type of biomarkers used and reviewed here. Lastly, we describe the recent advances in pediatric biosensing applications using saliva. This work guides scientists in fabricating saliva-based biosensors by comprehensively overviewing the potential markers and techniques that can be employed.

Evaluation of salivary alkaline phosphatase and glutathione peroxidase levels in diabetic and nondiabetic participants with and without smoking habits: A case–control study

Background:

The majority of the current evidence suggests that tobacco smoking increases the risk of diabetes. Salivary alkaline phosphatase (ALP) and glutathione peroxidase (GSHPx) considered a biomarker to detect various oral diseases. Several studies suggest that smoking habits tend to alter ALP and GSHPx levels. However, at present, there is no much information about these enzymes in smokers with diabetes. Hence, the study aimed to evaluate the status of salivary ALP and GSHPx levels in diabetic and nondiabetic participants with and without smoking habits.

Materials and Methods:

This case–control study was approved by the Institutional Ethical Committee. A total of 60 male participants between the age group 35–50 years were recruited. Informed consent was obtained from participants. Participants were categorized into four groups: Group I – Smokers with diabetes (n = 15), Group II – Smokers without diabetes (n = 15), Group III – Nonsmoker with diabetes (n = 15), and Group IV – Nonsmoker without diabetes (n = 15). Salivary ALP levels and GSHPx activity were measured by colorimetric assay. Data were compared between groups using the one-way analysis of variance, followed by a Bonferroni post-hoc test.

Results:

Nonsmoker diabetic participants demonstrated significantly higher ALP levels as compared to other groups (P < 0.05). We observed significantly lower levels of ALP in smokers with diabetes (P < 0.05). We observed a significant decrease in GSHPx activity in smokers with diabetes compared to all other groups (P < 0.05).

Conclusions:

Salivary ALP can be used as a clinical biomarker to be correlated for evaluating diabetes. GSHPx activity can be used to understand the response of supplementation therapy in smokers with diabetes.

Periodontal risk markers in children and adolescents with type 1 diabetes: A systematic review and meta-analysis

BACKGROUND

Periodontal disease is a frequent complication of diabetes in adults, and both conditions are associated with systemic inflammatory states. This systematic review and meta-analysis was conducted to establish the relative severity of periodontal disease risk markers in children and adolescents with type 1 diabetes (T1D).

METHODS

A systematic search strategy using PubMed and EMBASE databases was performed to identify relevant studies assessing periodontal risk markers in children and adolescents and T1D through to February 2019. Eligible studies were assessed for quality and heterogeneity, and a random effects model was used to estimate differences in selected periodontal risk markers in children with T1D relative to healthy controls.

RESULTS

The search identified 551 studies from which 23 were found to meet the inclusion criteria. Random effects meta-analyses demonstrated that relative to healthy controls, children and adolescents with T1D had higher mean values for plaque index, gingival index, bleeding on probing, pocket depth and clinical attachment loss (all P < .001).

CONCLUSIONS

Risk markers for periodontal disease were found to be more pronounced among children and adolescents with T1D compared to healthy controls. Early referral of these at risk individuals for dental examination is recommended to allow for early intervention.

Detection of Salivary Alkaline Phosphatase Levels in Smokers, Diabetic Patients, Potentially Malignant Diseases and Oral Malignant Tumours

Aim:

Alkaline phosphatase (ALP) is present in human and plays a key role in intracellular destructive processes and cellular damage. It has bicarbonate and phosphate ions, which help in buffering against acids. ALP activity is affected by smoking, which changes pH in oral environment and has harmful effects. Thus, the evaluation of ALP activity of smokers and healthy nonsmoker along with patients who were diabetic, potentially malignant, and malignant was carried out in this study.

Materials and Methods:

The study took place between 2016 and 2017. A total of 150 smokers, non-smokers, and patients who were diabetic, potentially malignant, and malignant were included. Collection of unstimulated whole saliva was done from each participant, and salivary ALP levels were measured by spectrophotometric assay.

Results:

Mean salivary ALP levels were significantly higher in smokers compared to those in nonsmokers. Mean ALP levels were also increased in patients who were diabetic, potentially malignant, and malignant compared to those in controls.

Conclusion:

ALP levels were significantly higher among smokers when compared to a healthy control group. Oral tissue function and side effects among smokers can be evaluated by these salivary enzyme alterations, which can serve as biomarkers for the diagnosis of any disease process. These salivary alterations could potentially be used as biochemical markers for the evaluation and early diagnosis. The higher levels were also found in patients who were diabetic, potentially malignant, and malignant, and ALP levels may also be used as biomarkers for the evaluation of the disease process.

Gingival crevicular fluid levels of interleukin-18 and tumor necrosis factor-alpha in type 1 diabetic children with gingivitis

OBJECTIVE

This study aimed to evaluate the levels of interleukin-18 and tumor necrosis factor-alpha in gingival crevicular fluid of diabetic children with gingivitis.

METHODOLOGY

Eighty-eight children (44 with type 1 diabetes mellitus and 44 systemically healthy) were recruited for the study. The children were divided into four subgroups based on their periodontal and systemic condition: (1) systemically and periodontally healthy children (H), (2) systemically healthy children with gingivitis (G), (3) periodontally healthy children with T1DM (T1DM + H), and (4) children with T1DM and gingivitis (T1DM + G). The plaque index, gingival index, probing pocket depth, and GCF volume were recorded. The IL-18 and TNF-α levels in GCF were determined by ELISA.

RESULTS

The clinical periodontal parameters, GCF IL-18 level, and TNF-α level were similar between diabetic and systemically healthy children (p > 0.05). The gingivitis subgroups had a significantly higher GI, PI, PPD, GCF volume, and TNF-α total amounts than the H subgroups (p < 0.0001). The IL-18 concentrations in the gingivitis subgroups were significantly lower than in the periodontally healthy subgroups.

CONCLUSIONS

In diabetic children with good metabolic control, T1DM did not affect the GCF levels of IL-18 and TNF-α in the presence of gingivitis. However, increased GCF TNF-α levels in children with gingivitis confirm that TNF-α is closely related to gingival inflammation.

CLINICAL RELEVANCE

Type 1 diabetes mellitus is not associated with GCF interleukin-18 and tumor necrosis factor-alpha levels in children with gingivitis.