Periodontal Health, Salivary Status, and Metabolic Control in Children with Type 1 Diabetes Mellitus

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.

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.

Discovering genetic linkage between periodontitis and type 1 diabetes: A bioinformatics study

Background: Relationship between periodontitis (PD) and type 1 diabetes (T1D) has been reported, but the detailed pathogenesis requires further elucidation. This study aimed to reveal the genetic linkage between PD and T1D through bioinformatics analysis, thereby providing novel insights into scientific research and clinical treatment of the two diseases.

Methods: PD-related datasets (GSE10334, GSE16134, GSE23586) and T1D-related datasets(GSE162689)were downloaded from NCBI Gene Expression Omnibus (GEO). Following batch correction and merging of PD-related datasets as one cohort, differential expression analysis was performed (adjusted p-value <0.05 and ∣log2  fold change| > 0.5), and common differentially expressed genes (DEGs) between PD and T1D were extracted. Functional enrichment analysis was conducted via Metascape website. The protein-protein interaction (PPI) network of common DEGs was generated in The Search Tool for the Retrieval of Interacting Genes/Proteins (STRING) database. Hub genes were selected by Cytoscape software and validated by receiver operating characteristic (ROC) curve analysis.

Results: 59 common DEGs of PD and T1D were identified. Among these DEGs, 23 genes were commonly upregulated, and 36 genes were commonly downregulated in both PD- and T1D-related cohorts. Functional enrichment analysis indicated that common DEGs were mainly enriched in tube morphogenesis, supramolecular fiber organization, 9 + 0 non-motile cilium, plasma membrane bounded cell projection assembly, glomerulus development, enzyme-linked receptor protein signaling pathway, endochondral bone morphogenesis, positive regulation of kinase activity, cell projection membrane and regulation of lipid metabolic process. After PPI construction and modules selection, 6 hub genes (CD34, EGR1, BBS7, FMOD, IGF2, TXN) were screened out and expected to be critical in linking PD and T1D. ROC analysis showed that the AUC values of hub genes were all greater than 70% in PD-related cohort and greater than 60% in T1D-related datasets.

Conclusion: Shared molecular mechanisms between PD and T1D were revealed in this study, and 6 hub genes were identified as potential targets in treating PD and T1D.

Assessment of Oral Hygiene, Gingival, and Periodontal Health, and Teeth Eruption among Type 1 Diabetic Saudi Children

Aims and objectives

To determine the differences between type 1 diabetic children and healthy children regarding oral hygiene, gingival and periodontal health, and permanent teeth eruption.Materials and methods: A case-control study was conducted on 80 children (40 type 1 diabetic children and 40 healthy children) aged 6-12-year-old. The groups were further divided into subgroups (early and late mixed dentition). All study aspects were examined clinically using the simplified oral hygiene index, Löe and Silness gingival index, clinical attachment loss (CAL), and Logan and Kronfeld stages for tooth eruption. The data were analyzed using Fisher's exact test, chi-squared test, and logistic regression models. A p-value of ≤0.05 was the threshold for statistical significance.

Results

No significant difference was found between diabetic and healthy children regarding oral hygiene and gingival health. Most children had poor oral hygiene (52.5% in the case group and 60% in the control group), with fair gingival health (70% in the case group and 55% in the control group). Diabetic children had significantly (p = 0.05) more periodontitis than healthy children. Teeth in the advanced stage of the eruption were significantly higher in diabetic than control subjects (p = 0.048 in stage V and p = 0.003 in stage VI). Older diabetic children in late mixed dentition exhibited accelerated eruption.

Conclusion

Periodontitis was significantly more common in diabetic than in healthy children. The advanced stage of the eruption was significantly higher in diabetic than in control subjects.

Clinical significance

Type 1 diabetic children had more periodontal disease and advanced stage of permanent teeth eruption compared to healthy children. Therefore, periodic dental evaluation and a strong preventive plan for diabetic children is crucial.

How to cite this article

Mandura RA, El Meligy OA, Attar MH, et al. Assessment of Oral Hygiene, Gingival, and Periodontal Health, and Teeth Eruption among Type 1 Diabetic Saudi Children. Int J Clin Pediatr Dent 2022;15(6):711-716.

Caries-related salivary parameters and oral microbial flora in patients with type 1 diabetes: A meta-analysis

OBJECTIVES

This study aimed to conduct a meta-analysis by synthesising the outcomes of studies that investigated the relationship between type 1 diabetes (T1D) and salivary flow rate (SFR), salivary pH (SpH), salivary buffer capacity (SBC), streptococcus Mutans (SM), and lactobacillus (LB) counts.

MATERIAL AND METHODS

The PRISMA statement guide was followed for the meta-analysis. Electronic databases were searched, and study selection and data collection processes were performed. The risks of bias in individual studies and across studies were assessed. Mean differences (MD) and Odds Ratio (OR) were used to measure the effect estimates in the comparisons.

RESULTS

29 studies were included in the qualitative and quantitative syntheses. Significantly higher SFR (MD = -0.22, CI: -0.26, -0.18; p < 0.001) and SpH (MD = -0.59, CI: -0.81, -0.36; p < 0.001) were observed in the healthy individuals than T1D individuals. No significant difference was observed among groups in terms of SBC (MD = 0.10, CI: -0.46,0.66; p = 0.73). An increased odds ratio of SM counts were observed regarding the T1D (OR = 3.09, 95% CI: 1.16, 8.20; p = 0.02). No association was found between LB counts and T1D (OR = 2.15, 95% CI: 0.38, 11.98; p = 0.38).

CONCLUSIONS

Subjects with T1D have a significantly lesser SFR and SpH than healthy individuals. But no significant difference is available in terms of SBC. Lower SM counts were observed in individuals with T1D, while no association was observed regarding LB counts. The tendency to dental caries is more likely in subjects with T1D due to lower SFR, SpH, and higher SM.

Periodontal health status of children and adolescents with diabetes mellitus: a systematic review and meta-analysis

Diabetes mellitus (DM) is a complex metabolic disease characterized by hyperglycaemia resulted from defects in insulin secretion or action, or both. Various studies have reported on the bidirectional relationship between DM and periodontal disease. A systematic search of the literature was performed in several databases, EBSCO Medline Complete, PubMed, Science Direct and a manual search for articles from 2000 until 2019. Literature that fulfilled the inclusion criteria were identified, and data measuring plaque index (PI), gingival index (GI), clinical attachment loss (CAL) and periodontal probing depth (PPD) were extracted and subjected to Random-effects meta-analysis. From 947 titles and abstracts screened, 11 articles were included for meta-analysis. It was found that PI, GI, CAL and PPD were significantly higher in DM children than in non-DM children according to the Standardized Mean different (SMD) and 95% confidence intervals (CI) (SMD 0.54, 95% CI 0.20-0.87, P = 0.002; SMD 0.63, 95% CI 0.39-0.87, P < 0.001; SMD 0.79, 95% CI 0.52-1.05, P < 0.001, SMD 0.67, 95% CI 0.23-1.11, P = 0.003, respectively). The meta-analysis showed significant differences in PI, GI, PD and CAL between the two groups, favouring non-DM children. Therefore, early detection of DM children with periodontal disease is crucial to prevent periodontal disease.

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.

Caries Status and Salivary Alterations of Type-1 Diabetes Mellitus in Children and Adolescents: A Systematic Review and Meta-analysis

INTRODUCTION

The association between dental caries, salivary alterations, and type-1 diabetes mellitus (D1TM) remains inconclusive in children and adolescents. This systematic review evaluated the caries status and salivary alterations of children and adolescents suffering from D1TM.

METHODS

Meta-analysis searched from 5 electronic databases was performed considering the decay-missing-filled teeth (DMFT), decay-missing-filled surfaces, and decay-missing-filled primary teeth (dmft) index for caries and the stimulated flow rate, unstimulated flow rate, and buffering capacity for salivary alterations. Quality assessments were performed using the Healthcare Research and Quality Agency.

RESULTS

Eleven studies satisfied the eligibility criteria. The meta-analysis revealed that DMF(T) (0.61; 95% confidence interval [CI], 0.14-1.08, P = .01) and dmft (-0.43; 95% CI, -0.71 to -0.15, P = .002) were significantly higher in D1TM group than the non-D1TM group. Stimulated flow rate (-0.40; 95% CI, -0.57 to -0.23, P < .00001) was significantly lower in D1TM group than in the non-D1TM group. No significant differences in decay-missing-filled surfaces and the buffering capacity were observed between the D1TM and the non-D1TM groups.

CONCLUSIONS

The level of DMF(T) and dmft was higher in children/adolescents with D1TM than that with non-D1TM, and the salivary flow could be considered decreased with D1TM. The strength of the evidence of the studies analyzed, however, was deemed to be moderate and low.

Simultaneously Transplanted Pancreas Improves Salivation and Reduces Oral Fungal Infections Incidence in Type 1 Diabetic Renal Transplant Recipients

BACKGROUND

Long-lasting diabetes mellitus may lead to numerous pathologies in the oral cavity. The aim of the study was to assess the condition of the oral cavity, caries intensity, salivary parameters, and incidence of oral fungal infections in patients with type 1 diabetes (T1D) and end-stage renal disease (ESRD) after kidney transplantation (KTx) or simultaneous kidney and pancreas transplantation (SPK).

METHODS

Twenty-one patients after SPK, 18 T1D patients after KTx, and 14 kidney recipients without diabetes (control group) were included in the study. Donor sources complied with Helsinki Congress and the Declaration of Istanbul.

RESULTS

Approximal plague index in SPK (80% [68%-90%]) was comparable to KTx (80% [37.5%-92.5%]) but higher than in control group (46% [35%-50%]). All 3 groups did not differ in terms of decayed-missing-filled tooth index: 22.3 ± 4.8 vs 22.5 ± 4.5 vs 19.1 ± 4.9, respectively. Normal saliva resting secretion and consistency were more common in SPK (71.4% and 52%, respectively) than in KTx (27.8% and 50.0%, respectively). Stimulated saliva volume in the SPK, KTx and controls, pH value, and buffering capacity were comparable. In KTx higher incidence of Candida albicans infection (55.6%) compared with SPK (23.8%) and controls (no infection) was observed.

CONCLUSIONS

Simultaneously transplanted pancreas improves salivation and reduces the incidence of oral fungal infections in T1D kidney recipients. The severity of caries is higher and oral hygiene is worse in T1D kidney recipients compared with patients after KTx without diabetes.

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 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.

The Effect of Diabetes Mellitus Type I on Periodontal and Dental Status

INTRODUCTION

Diabetes mellitus type I is a chronic metabolic disease with an autoimmune origin. The initial manifestations mainly appear during childhood and its prevalence is on the rise in many countries. Some of the complications of diabetes mellitus are problems related to oro-dental structures and periodontal diseases.

AIM

The present study was undertaken to evaluate the relationship between diabetes mellitus type I and dental and periodontal status in Tehran, Iran.

MATERIALS AND METHODS

This cross-sectional study was carried out on 50 patients with diabetes mellitus type I who were under treatment in the Diabetic Patients' Center in Tehran and 50 healthy individuals who did not have diabetes, all recruited from schools. The subjects were divided into two age groups of 6-12 and 13-18 years. In test group, HbA1c (glycosylated haemoglobin) level of the patients was collected from the medical records of Association of Diabetic Patients. To make sure that the control subjects did not suffer from diabetes mellitus, their blood glucose was measured with the Glucocard 01 blood glucose monitoring kit (GT-1920, Japan). The periodontal and dental status were assessed using dmft/DMFT (Decayed, Missing, Filled Permanent Teeth), GI (Gingival Index), PPD (Periodontal Pocket Depth), PI (Plaque Index) and CI (Calculus Index). The data obtained from each group were compared statistically using the Mann-Whitney test and Kruskal Wallis Test.

RESULTS

There was increase in PPD, GI and DMFT values with aging, with no significant differences between the diabetic and non-diabetic groups. PI and DMFT not only increased with aging but also were higher in both age groups in patients with diabetes compared to healthy subjects (p<0.05). GI was higher only in the 13-18 year age group in diabetic patients (p<0.01). There was no relation between the HbA1c (glycosylated haemoglobin) level, and periodontal indices (p<0.09).

CONCLUSION

It appears that patients with diabetes mellitus type I are more susceptible to periodontal diseases and tooth loss and such problems might be aggravated with aging.

Salivary flow rate, buffer capacity, and urea concentration in adolescents with type 1 diabetes mellitus

BACKGROUND

The objective of the study was to analyze salivary flow rate, urea concentration, and buffer capacity in adolescents with type 1 diabetes mellitus (type 1 DM) in two different stages.

METHODS

This study was performed on adolescents (14-19 years), allocated between two groups: type 1 DM group comprised 32 adolescents with type 1 DM, and non-type 1 DM group comprised 32 nondiabetics. The adolescents in type 1 DM group were evaluated at a baseline (T0) and after 15 months (T1), and those in non-type 1 DM group were only evaluated at T0. Diabetic status was determined by glycosylated hemoglobin (GHb) and capillary glucose tests. Measurement of salivary flow was performed by means of stimulated saliva (SSFR) collection. The buffer capacity (BC) was determined, and analysis of urea salivary concentration was performed using the colorimetric method.

RESULTS

At T0, there were significant differences between diabetics and nondiabetics for SSFR and BC (p<0.05). In diabetics, SSFR was 0.790 mL/min in T0 and 0.881 mL/min in T1 (p>0.05). BC at T0 was 4.8, and at T1, it was 3.9 (p=0.000). Urea concentration mean value had a significant decrease at T1 (28.13) compared with T0 (34.88) (p=0.013). There was a negative correlation between SSFR and urea salivary concentration at both T0 (r=-0.426, p≤0.05) and T1 (r=-0.601, p≤0.01).

CONCLUSIONS

In adolescents with type 1 DM, hyposalivation at T0 was associated with an increase in urea salivary concentration. At T1, hyposalivation was associated with a reduction in BC, and an increase in salivary urea.

Estimation of gingival crevicular blood glucose level for the screening of diabetes mellitus: A simple yet reliable method

AIM

This study was designed to assess the reliability of blood glucose level estimation in gingival crevicular blood(GCB) for screening diabetes mellitus.

MATERIALS AND METHOD

70 patients were included in study. A randomized, double-blind clinical trial was performed. Among these, 39 patients were diabetic (including 4 patients who were diagnosed during the study) and rest 31 patients were non-diabetic. GCB obtained during routine periodontal examination was analyzed by glucometer to know blood glucose level. The same patient underwent for finger stick blood (FSB) glucose level estimation with glucometer and venous blood (VB) glucose level with standardized laboratory method as per American Diabetes Association Guidelines.¹ All the three blood glucose levels were compared. Periodontal parameters were also recorded including gingival index (GI) and probing pocket depth (PPD).

RESULTS

A strong positive correlation (r) was observed between glucose levels of GCB with FSB and VB with the values of 0.986 and 0.972 in diabetic group and 0.820 and 0.721 in non-diabetic group. As well, the mean values of GI and PPD were more in diabetic group than non-diabetic group with the statistically significant difference (p < 0.005).

CONCLUSION

GCB can be reliably used to measure the blood glucose level as the values were closest to glucose levels estimated by VB. The technique is safe, easy to perform and non-invasive to the patient and can increase the frequency of diagnosing diabetes during routine periodontal therapy.

Oral health of children with type 1 diabetes mellitus: A systematic review

AIM

This systematic review investigated the oral health status of children with type 1 diabetes.

METHODS

A systematic search was conducted using PubMed/Medline, Web of Knowledge, SCOPUS and EMBASE. The search included all studies published from inception of database to January 2014. A total of 1179 abstracts were analyzed for selection in 2 phases. The first phase selection was based on the title and abstracts alone. The selected abstracts were then included for second phase, where full articles were obtained. The selection was carried out by 2 independent reviewers (Kappa value=0.809). Only 37 articles were included for final analysis in this review.

RESULTS

There is conflicting evidence in the caries experience between children with type 1 diabetes and healthy children. For periodontal health, most studies reported significantly greater plaque accumulation and higher gingival index in children with type 1 diabetes. Cohort studies reported no significant differences in perioodontal parameters over time.

CONCLUSIONS

There is conflicting evidence regarding the caries experience of children with type 1 diabetes, but they exhibit poorer periodontal health status with greater plaque accumulation compared to healthy children. Further studies are warranted to assess the oral health status of children with type 1 diabetes.

Selected antibacterial factors in the saliva of diabetic patients

OBJECTIVE

Diabetes mellitus leads to many systemic complications, including changes in the morphology, function of the salivary glands, and the composition of saliva.

DESIGN

The study comprised a randomly selected 156 adults, of both genders, aged from 21 to 79, out of which patients with diabetes type 1 and 2, and healthy subjects forming two control age- and gender matched to the ill subjects. In unstimulated mixed saliva, total protein, peroxidase, myeloperoxidase and immunoglobulin A were measured as well as salivary flow rate. The periodontal condition was assessed with the use of GI, mSBI and PSR index. The obtained data were analysed with the use of U Mann-Whitney's test, Spearman's rang correlation and Chi-square test at a significant level of p < 0.05 with use of Statistica 9.0 software.

RESULTS

Type 1 diabetics in comparison to healthy age and gender matched control group had a lower salivary flow rate (p < 0.01), a higher content of total protein (p < 0.01), myeloperoxidase (p < 0.001) and immunoglobulin A (p < 0.001). Similarly, type 2 diabetics in comparison to control subjects had a higher level of total protein concentration (p < 0.01), myeloperoxidase (p < 0.05) and immunoglobulin A (p < 0.001). We also found worse periodontal condition.

CONCLUSION

Within the limitation of the study it may be stated that diabetes type 1 and 2 can cause abnormalities in salivary glands function resulting in the diminishing of salivary flow rate and the increase in total protein content. Higher levels of myeloperoxidase and IgA in the saliva can be linked to worse periodontal condition in the diabetic patients.

Electrochemical corrosion and surface analyses of a ni-cr alloy in bleaching agents

PURPOSE

The aim of this study was to evaluate the corrosion behavior of a Ni-Cr dental casting alloy subjected to 10% hydrogen peroxide (HP) and 10% carbamide peroxide (CP) bleaching solutions and to determine the composition of the surface oxide layer formed on the alloy specimens.

MATERIALS AND METHODS

Ten cylindrical specimens (4 mm in diameter × 25 mm in height) were cast from a Ni-Cr alloy (Wiron 99) and divided into two groups (n = 5). A potentiodynamic polarization test was used to compare the corrosion rates of specimens in HP and CP (pH = 6.5). Before cyclic polarization tests, all alloy specimens were allowed to reach a steady open circuit potential (Ecorr ) for a period of 1 hour. Then tests were initiated at 100 mV versus standard calomel electrode (SCE) below Ecorr and scanned at a rate of 1 mV/s in the anodic direction until reaching 1000 mV over the Ecorr value. The scan then was reversed back to the Ecorr of the specimens. The open circuit potentials (Ecorr ) and the current densities (Icorr ) were determined using the anodic Tafel regions extrapolating from the curves. Differences in Ecorr and Icorr were determined using one-way ANOVA (α = 0.05). In addition, corrosion rates were calculated from these curves. Before and after polarization tests, a scanning electron microscope (SEM) examination accompanied by energy dispersive X-ray spectroscopy (EDS) was used to analyze the surface morphology. The surface characterization of the passive film formed on alloy specimens was also performed by using X-ray photoelectron spectroscopy (XPS).

RESULTS

In this study, bleaching agents had an effect on the anodic process for two groups. Although no statistical difference was identified between the groups for both corrosion parameters, results indicated that the effect of CP on the corrosion behavior was less than that of HP. These results agreed with the SEM observations. XPS data showed that oxide layers formed on all groups contained mainly Cr2 O3 , NiO, and MoO3 , and the amounts of oxides formed on CP-treated specimens were higher than HP treated ones. Also, molybdenum rates were increased with CP application compared to HP.

CONCLUSIONS

The comparison of the effects of the two bleaching agents at 10% showed that the alloy suffered less corrosion with CP than HP. This result was also confirmed by the SEM and XPS data. The presence of Mo on the oxide layer affected the oxide layer, leading to lower corrosion rates.

Electrochemical Behavior of Titanium in Artificial Saliva: Influence of pH

Titanium is the most common material chosen for dental implants because it is highly corrosion resistant because it constantly reforms a protective passive film layer. The formation and composition of the passive film layer is dependent on the environmental conditions. If the stable oxide layer is damaged, the titanium surface underneath can corrode. The purpose of this study was to determine if basic corrosion of commercially pure titanium (CpTi) alloy in artificial saliva was affected by pH and to understand the corrosion kinetics/mechanisms of CpTi as a function of pH. In this study, titanium alloy discs were subjected to corrosion tests. Before the tests, all samples were cleaned and polished using standard metallographic preparation methods. Artificial saliva was used as the testing medium. The following pH values were tested: 3.0, 4.5, 6.0, 6.5, 7.5, and 9.0. Different pH values were achieved by adding lactic acid (acidic) or NaOH (basic) in appropriate amounts. Potentiodynamic curves indicated behavior change at each pH. In addition, the corrosion current density value determined from the potentiodynamic curve exhibited the poorest corrosion resistance for pH 7.5. The Nyquist plot (from the electrochemical impedance spectroscopy results) indicated that pH 7.5 had the poorest resistance. Scanning electron microscopy images indicated that pH levels of 6.5, 7.5, and 9.0 had considerable surface corrosion. The results showed that the media's pH significantly influenced the corrosion behavior of CpTi. The poor corrosion behavior at the neutral pHs invites some concerns and highlights the need for further study.

Salivary innate defense system in type 1 diabetes mellitus in children with mixed and permanent dentition

OBJECTIVE

It should be expected that type 1 diabetes mellitus may disturb innate and acquired immunity. There are no data on type 1 diabetes mellitus-related changes in the salivary flow and the protein output responsible for the innate immunity of saliva depending on the quality of dentition reflecting the age of child. The aim of this work was the evaluation of parameters responsible for the innate immunity of saliva in children and adolescents with type 1 diabetes mellitus.

MATERIALS AND METHODS

In diabetic children, adolescent and healthy volunteers, the salivary flow, the output and the concentration of the activity of peroxidase (colorimetry), lysozyme (radial immunodiffusion) and lactoferrin (ELISA) were determined.

RESULTS

In children with mixed and permanent dentition, type 1 diabetes mellitus significantly decreases (as compared with the appropriate controls) the unstimulated salivary flow, the output, concentration of peroxidase and the output of the lysozyme and lactoferrin.

CONCLUSION

In conclusion, it may be stated that type 1 diabetes mellitus causes functional changes in the salivary glands, resulting in a decrease of the salivary flow and weakening of the salivary innate defense system, thus creating a threat to the oral and general health of type 1 diabetes mellitus children. The results showed that the salivary glands of younger children, when compared to adolescents with type 1 diabetes mellitus, are more susceptible to the injurious effects of the disease.

Periodontal health of children with type 1 diabetes mellitus in Kuwait: a case-control study

OBJECTIVE

The aim of this study was to evaluate periodontal health in children diagnosed with type 1 diabetes mellitus.

SUBJECTS AND METHODS

Periodontal health was clinically examined and compared in 95 children diagnosed with type 1 diabetes and 61 healthy control subjects (4-14 years old). Plaque index, gingival index, clinical attachment loss and bleeding on probing were assessed on the 6 Ramfjord index teeth. Diabetes history was recorded based on information provided by the physician from the medical record of each diabetic child. Diabetes history included date of diagnosis, diabetes duration, age at diagnosis, latest reading for glycosylated hemoglobin and any existing diabetes complications. Data were analyzed using the Statistical Package for Social Science software, version 18. 'Periodontitis' was defined as at least one site with clinical attachment loss >2 mm on at least 2 teeth.

RESULTS

Sixty-two of the diabetic children (65%) had poor compliance with dental care, and 42 of them (44%) had never visited the dentist before. The children with type 1 diabetes mellitus had a significantly higher plaque index and gingival index and more bleeding on probing than control subjects (p < 0.001). In the diabetic group, periodontitis was significantly associated with longer duration of diabetes (odds ratio 2.230, confidence interval 1.308-3.801; p = 0.003) and older age at diagnosis of diabetes (odds ratio 1.838, confidence interval 1.091-3.096; p = 0.022).

CONCLUSIONS

Periodontal disease in young patients with type 1 diabetes was more evident than in those without diabetes. These data showed that diabetes duration may play a significant role in the progression of periodontal disease in diabetic children.

Minor manifestations of periodontal diseases in young adults with type 1 diabetes mellitus. Periodontal and microbiological findings

OBJECTIVE

The aim of this study was to evaluate periodontal status and microbiological conditions in young adults with insulin-dependent diabetes (IDDM) in comparison with age- and sex-matched non-diabetic controls.

MATERIALS AND METHODS

Forty-one patients, 18-24 years of age with IDDM since childhood, were examined and the results were compared to those of a group of 41 sex- and age-matched non-diabetic controls. According to the HbA(1c) %, the group of diabetic patients was divided into two groups, with good or poor metabolic control.

RESULTS

Periodontal health, expressed in probing pocket depths and marginal bone loss, was fairly good in all patients. Fifty per cent of the patients in the study and control groups displayed probing pocket depths ≥4 mm, mostly pocket depths 4 mm. These findings were also equally distributed among the patients with good and poor metabolic control. No significant differences were found between the groups regarding bleeding on probing, but in the number of sites with excessive bleeding the study group exhibited higher scores than the healthy controls. Different microbiological species were equally distributed between the groups.

CONCLUSION

Neither periodontal nor microbiological status in young adults with IDDM differs from that of healthy controls.

Association between carotid intima-media thickness, buccodental status, and glycemic control in pediatric type 1 diabetes

OBJECTIVE

To evaluate the association between carotid intima-media thickness, buccodental status, and glycemic control in patients with type 1 diabetes.

METHODS

Cross-sectional study with consecutive cases attended in an outpatient clinic (n = 69). Medical and clinical dental history, HbA1c, lipid profile, treatment period, and daily insulin dosage were recorded. Sociodemographic data and anthropometrical measurements were obtained by standardized questionnaire. Doppler real-time ultrasound was performed by a single experienced vascular radiologist blinded to the study. Assessment of buccodental status was done by the Maxillofacial Unit of the Pediatrics Hospital, and an oral scrape culture was collected.

RESULTS

The mean age was 11.7 ± 3.0 years, with diabetes 5.1 ± 3.3 years. Mean HbA1c was 8.5 ± 1.7%. Primary teeth were present in 52.2% and bacterial plaque in 94.2%. Buccodental conditions featured caries (63.8%), gingivitis (84%), and enamel demineralization (26.1%): white spot lesions (18.8%) and cavitated lesions (7.3%). Bacteria associated with caries were found in 44.1%. Patients in the highest HbA1c tertile (>8.5%) had greater frequency of buccodental conditions and were positive for Streptococcus mutans and Candida albicans; also, cIMT increased and vessel compliance decreased compared to those in the lowest tertile (<7.0%) (p < 0.05).

CONCLUSIONS

More buccodental conditions and carotid intima-media thickness increase appeared in the patients with HbA1c level > 8.5%, suggesting onset of atherosclerosis. The correlation between buccodental status and HbA1c values may indicate the connection between inflammatory states of atherosclerosis and type 1 diabetes.

Influence of pH on the tribocorrosion behavior of CpTi in the oral environment: synergistic interactions of wear and corrosion

Dental implants made of titanium alloys have been used as a predictable therapy approach to replace missing teeth. The oral environment subjects titanium implants to varying conditions like changes in pH, temperature, and saliva contamination leading to chemical corrosion together with mastication process.

OBJECTIVE

In this study, the combined effect of chemical corrosion and wear (so-called tribocorrosion) in the degradation of dental implant material (CpTi) under varying pH oral environment was investigated.

METHODS

Titanium (CpTi) discs were subjected to sliding tests in artificial saliva at varying pHs: 3.0, 6.0, and 9.0. A custom made tribocorrosion apparatus was used to perform the tests. The tribological system consisted of a ceramic ball of 28 mm diameter articulating against the flat face (titanium).

RESULTS

Electrochemical impedance spectroscopy results indicated an increase in electrochemical double layer capacitance (C(dl)) at pH 3.0 and 6.0 after sliding. Surprisingly, in the presence of tribological stresses, the measured current evolution was highest and fluctuated the most at pH 6.0. In addition, the greatest weight loss was measured at pH 6.0.

CONCLUSIONS

Despite reports of CpTi being electrochemically stable down to pH 2.0, this study suggests degradation peaks at near neutral pH values in the presence of motion. At pH 6.0, the passive film layer, typically protecting the surface of titanium may not be reformed cohesively, resulting in more tribocorrosion products at the surface, which are easily sheared off. These findings elevate concern with regard to dental implants because the average pH of the oral cavity is 6.3.

Associations between periodontal disease and selected risk factors of early complications among youth with type 1 and type 2 diabetes: a pilot study

BACKGROUND

Most studies evaluating the relation between periodontal disease and diabetes in children have not considered diabetes type.

OBJECTIVE

To evaluate the relationship between periodontal damage and risk factors of diabetes complications among youth by diabetes type in a pilot study.

SUBJECTS

155 participants (126 with type 1 diabetes; 29 with type 2 diabetes) from the SEARCH for Diabetes in Youth study in South Carolina who were <20 yr of age at diagnosis.

METHODS

Cross-sectional analysis of periodontal damage (bone loss ≥3 mm on ≥1 permanent tooth site on pre-existing bitewing radiographs) and diabetes type assigned by the provider at diagnosis.

RESULTS

Periodontal damage was observed in 52 individuals (34%) overall, but was more common in type 2 (16/29, 55%) vs. type 1 diabetes (37/126, 29%). Among youth with type 2 diabetes, those with periodontal damage had lower fasting c-peptide (2.3 vs. 3.4 ng/mL, p-value=0.01), and higher triglyceride levels (171.8 vs. 87.2, p-value=0.01) than those without periodontal damage after adjustment for age, sex, race, education level, family income, duration of diabetes, diabetes control, time between study visit and date of radiograph, tooth brushing, and visits to the dentist. Blood pressure, waist circumference, LDL cholesterol and A1c were not associated with periodontal damage.

CONCLUSIONS

The associations between periodontal disease and risk factors for diabetes complications differ by diabetes type. Periodontal damage is associated with impaired beta cell function and metabolic syndrome components in type 2 but not type 1 diabetes. These findings need to be confirmed in larger, prospective studies.

Dental caries and dental care level (restorative index) in children with diabetes mellitus type 1

INTRODUCTION

The aim of the study was to investigate caries experience and dental care index in diabetic children and to determine if correlation exists between caries experience and metabolic control, insulin treatment, and the duration of diabetes.

MATERIALS AND METHODS

The study group consisted of 52 children and adolescents, 3-16 years of age with type 1 diabetes attending the outpatient diabetic clinic at Ghent University Hospital, Belgium. Fifty healthy subjects recruited from the paediatric dental clinic served as the control group. Caries lesions were assessed using DMF-index both at cavity and non-cavity levels. Participants and/or their guardians provided information about oral hygiene habits and dietary habits. Diabetes-related data (type, duration, insulin regimen) were collected from medical records and completed with the lab data on HbAlc.

CONCLUSION

It became clear that, although children with type 1 diabetes mellitus could be expected to run a potential high caries risk taking into account the diabetes-associated biological and behavioural alterations, no significant differences were observed regarding caries experience and dental care between diabetic children and healthy controls. The level of untreated dental decay among the diabetic children is, however, considerably high, which was reflected by a significant lower dental attendance.

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

OBJECTIVES

The aim of this study was to evaluate the association between metabolic control and oral health of adolescents with type 1 diabetes mellitus (DM1).

STUDY DESIGN

A case-control epidemiologic study was performed on adolescents allocated between 2 groups: DM1 group composed of 51 with DM1, and control group composed of 51 without diabetes. In the DM1 group, metabolic control data were observed (glycosylated hemoglobin (GHb) and capillary glucose), whereby GHb < or =8.0% was considered to indicate good metabolic control (DM1-A) and >8.0% poor metabolic control (DM1-B). Oral mucosal abnormalites, Community Periodontal Index (CPI), and decayed, missing, and filled (DMF) index were documented. Salivary flow was evaluated by means of stimulated saliva collection (SSFR).

RESULTS

Glycosylated hemoglobin values of < or =8.0% (DM1-A) were observed in 17 (24%) and >8.0% (DM1-B) in 34 (76%) of the subjects. The average DMF indexes were 1.5 (control) and 3.3 (DM1-group) (P < or = .05). The average CPIs were 0.2 (control), 1.4 (DM1-A), and 2.0 (DM1-B) (P < or = .05). Average SSFRs were 0.997 (DM1-A), 0.903 (DM1-B), and 1.224 (control) mL/min.

CONCLUSIONS

Oral health of adolescents with DM1 was impaired regardless of metabolic control.

Risk factors for oral postoperative infection in patients with diabetes

The prevalence of diabetes mellitus in the general population has been increasing sharply. Currently, much is feared but little is known about postoperative complications of oral surgery among persons with diabetes. Existing dental education and practice guidelines cite excess infectious risk among patients with diabetes; however, empiric evidence to support such concerns is lacking. In fact, dentists commonly prescribe antibiotics when dental surgical procedures involve bone. This practice may contribute to the rising problem of microbial resistance and may increase overall healthcare costs. The growing number of dental patients with diabetes warrants strengthening the evidence base to guide their dental care and prevent possible morbid complications.

Clinical and laboratory evaluations of non-surgical periodontal treatment in subjects with diabetes mellitus

BACKGROUND

The aim of this study was to evaluate the clinical and laboratory changes 3 months after full-mouth scaling and root planing in subjects with and without diabetes mellitus.

METHODS

This study was performed using 10 subjects with type 2 diabetes mellitus who required insulin therapy (DM) and 10 healthy adult control subjects (NDM) with generalized chronic periodontal disease. Both groups were treated with full-mouth scaling and root planing and given oral hygiene instructions. Clinical parameters, including plaque index (PI), gingival index (GI), probing depth (PD), gingival recession (GR), and clinical attachment level (CAL), were measured at four sites per tooth. Subgingival plaque samples were obtained from sites with the deepest PD (> or =5 mm) and with furcations in each subject. Samples were also tested for the presence of Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans), Porphyromonas gingivalis, and Tannerella forsythia (previously T. forsythensis) by polymerase chain reaction. Glycemic control (glycosylated hemoglobin [HbA1c] and fasting glucose levels) and clinical and microbiologic assessments were recorded at baseline and 3 months after periodontal treatment.

RESULTS

Data revealed statistical changes (P < or =0.05; analysis of variance [ANOVA]) in clinical variables (PI, GI, PD, GR, and CAL) between baseline and 3 months in both groups. Conversely, no improvement in the fasting glucose level or glycosylated hemoglobin (P < or =0.05; ANOVA) was found after treatment. Besides some reduction in the bacterial frequency 3 months after treatment, no statistically significant difference was found between the groups.

CONCLUSION

Clinical and laboratory responses were similar in DM and NDM groups 3 months after full-mouth scaling and root planing.

[Pathogenic aspects of the periodontal disease associated to diabetes mellitus]

OBJECTIVE

Systematic review of present knowledge about the association between diabetes mellitus (DM) and periodontal disease (PD) with emphasis on their physiopathogenesis.

DATA SOURCES

Bibliographic search through MEDLINE and LILACS databases, in the last five years, using the following descriptors: "diabetes mellitus", "periodontal disease", and "periodontitis".

SUMMARY OF DATA

Periodontal tissues are the oral structures most affected by DM. DM predisposes to the development of PD, which leads to loss of glycemic control, which emphasizes the importance of the two-way relationship between these two diseases. Several mechanisms are involved in the physiopathology of PD associated with DM: production of advanced glycosilation products, deficient immune response, inheritance of certain genetic polymorphisms, alterations in blood vessels, conjunctive tissue and salivary composition. In the initial phase, gingivitis and periodontitis predominate. If not detected early, these problems can develop into advanced periodontal disease. Puberty, with its hormonal alterations, longer duration of the disease, poor metabolic control and inadequate oral hygiene are factors that contribute to PD progression and aggressiveness.

CONCLUSION

Better knowledge about the mechanisms involved in the physiopathogenesis of PD associated with DM would help to institute early preventive and therapeutic measures. It is important for doctors and dentists to instruct their patients with DM about the need for good glycemic control and adequate oral hygiene, to minimize the risks for the appearance of periodontal disease and consequent loss of glycemic control.

Osmotic pressure and vasculature of gingiva in experimental diabetes mellitus

BACKGROUND

Alterations in tissue osmotic pressure (OP) and vasculature are considered to be the inevitable aspects of an inflammatory process that subsequently alter the fluid dynamics of the tissues involved. The aim of this study was to reveal a profile of OP and vascular changes in periodontally healthy gingival tissues and analyze the relationship between them in diabetes mellitus (DM) to evaluate the possible effects of DM on the fluid dynamics of the periodontium.

METHODS

Experimental DM was created by intraperitoneal streptozotocin injection in 10 periodontally healthy rats. These rats were used as the test group, and 10 systemically and periodontally healthy rats served as the control group. Gingival tissue samples obtained from the groups were used for the test procedures. OP was measured in the supernatants of these samples by a semimicrodigital osmometer. Vasculature was assessed as the alterations in vascularization (vessel number [VN]) and vasodilatation (vessel diameter [VD]) by histomorphometric means.

RESULTS

There was a gross increase in the OP level of the test group (172.7 +/- 59.7 mOsm/kg) compared to the control group (11.4 +/- 4.2 mOsm/kg; P <0.001). VN was found to be significantly larger in the test group (12.7 +/- 2.8) than in the control group (6.8 +/- 1.1; P <0.001). VD was found to be smaller in the test group (10.1 +/- 2.8 microm) than in the control group (15.5 +/- 2.4 microm), and this difference was statistically significant (P <0.001). A positive correlation between OP and VN (r = 0.77; P <0.001) and a negative correlation between OP and VD (r = 0.1; P >0.05) were observed in the test group.

CONCLUSION

Our results reveal that the fluid dynamics of periodontal soft tissues may be affected by the diabetic conditions in this diabetic model because of the increased OP and VN during the pathogenesis of the disease.

Effects of diabetes mellitus, chronic renal failure and hemodialysis on serum and salivary antioxidant status

AIM

To analyze various oxidative stress parameters in the saliva and serum of patients with chronic renal failure (CRF) and/or diabetes mellitus (DM), and to compare them in dialytic vs. pre-dialytic patients.

METHOD

50 consenting patients were divided into five subgroups of patients: severe CRF (dialytic) without DM, severe CRF (dialytic) with DM, mild CRF (pre-dialytic) without DM, mild CRF (pre-dialytic) with DM, and with DM but without CRF (controls). Uric acid (UA), peroxidase and total antioxidant status (TAS) were studied in both saliva and serum; superoxide dismutase (SOD) was evaluated only in saliva. Both saliva collection and serum harvesting were done simultaneously.

RESULTS

In severe-CRF patients without DM, median TAS, UA and SOD levels decreased following dialysis (54, 85, 48%, respectively), and peroxidase levels increased slightly (9%). In severe-CRF patients with DM, median TAS and SOD levels increased following dialysis (33 and 54%, respectively) while median UA and peroxidase levels decreased (68 and 10%, respectively).

CONCLUSIONS

DM, CRF and hemodialysis were found to increase the oxidative stress burden in both serum and saliva. Therefore, antioxidant assessment may be used to monitor baseline oxidative status in these situations though larger randomized studies are in order.

Free radicals related effects and antioxidants in saliva and serum of adolescents with Type 1 diabetes mellitus

OBJECTIVE

The purpose of the current study was to analyze both serum and salivary composition and oxidative stress markers in Type 1 diabetes mellitus (DM) patients.

DESIGN

Twenty consenting patients with DM but otherwise healthy patients aged 13-19 years and 12 healthy controls, matching in age and gender (Group 1), participated in the study. The patients were divided according to those who had controlled diabetes mellitus (Group 2) or uncontrolled diabetes mellitus (Group 3). All were analyzed for saliva composition and antioxidants. Saliva was also analyzed for its levels of superoxide dismutase (SOD) and amylase activity, total IgA and total IgG concentrations and potassium, phosphorus, magnesium and calcium electrolyte concentrations.

RESULTS

A significant correlation was found between the severity of the DM/HbA1c values and the increase in both salivary and/or serum antioxidants (peroxidase, SOD and TAS), and the various TCL parameters (H1, H3, pre-incubation and oxygenation-potential).

CONCLUSIONS

The two most important findings of the current study relate to the role of oxidative stress in the pathogenesis of Type 1 diabetes mellitus and to the involvement of salivary glands in the disease. The profound effects of DM on salivary antioxidant parameters may be also of great importance in respect to the diagnosis and evaluation of the disease. The correlation between altered salivary parameters and the severity of the disease may indicate that evaluation of the salivary status of DM patients as part of the assessment of their disease activity and severity is warranted.

Oral Infections and Glycemic Control in Pregnant Type 2 Diabetics

BACKGROUND

The relationship between diabetes mellitus and infection is bidirectional. Diabetes favors infection, while infections make controlling diabetes much more difficult. The most frequent infections encountered in pregnant diabetics are those of the urinary tract (UTI) and cervicovaginal (CVI) area. Periodontal diseases (PD) and active caries (AC) are infectious diseases frequently found in these cases often remaining as hidden entities of low intensity. The aim of this study was to assess whether there is an association between PD and caries with lack of glycemic control often encountered in pregnant type 2 diabetic women.

METHODS

A single skilled researcher performed the periodontal evaluation of PD and AC cases. Glycated alpha hemoglobin (HbA(1c)) over 6.5% was used to diagnose metabolic glucose disturbances. The controlled variables were UTI, CVI and adherence to treatment. The statistical tests used were chi-square adjusted for continuity, analysis of variance, odds ratio with 95% confidence intervals and logistic regression with a significance level of p < 0.05.

RESULTS

One hundred twenty-seven type 2 diabetic women were seen during the second trimester of their pregnancies. Mean age was 31.3 years; 55% had lack of glycemic control associated with CVI (chi2 21.07, p < 0.000), PD (chi2 5.72, p < 0.005) and UTI (chi2 13.77, p < 0.000) with therapeutic adherence (TA) (chi2 14.80, p < 0.00). No association was found with AC. The logistic regression results showed that UTI, CIV, PD and TA are associated with lack of glycemic control.

CONCLUSIONS

Periodontal diseases may act as "hidden" infections in pregnant diabetics and be associated with lack of glycemic control. This situation should be taken into consideration by healthcare teams in charge of prenatal care.