Scintigraphic evidence of poor salivary function in type 2 diabetes

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.

Relationship between Mortality and Oral Function of Older People Requiring Long-Term Care in Rural Areas of Japan: A Four-Year Prospective Cohort Study

Oral ingestion influences the life sustenance, quality of life, and dignity of older adults. Thus, it is an important issue in medical care and the welfare of older adults. The purpose of this four-year prospective cohort study was to investigate the relationship between mortality and oral function among older adults who required long-term care and were living in different settings in a rural area of Japan. This study included 289 participants aged 65 and older who required long-term care and lived in the former Omorimachi area in Yokote City, Akita Prefecture, located in northern Japan. Following the baseline survey, mortality data were collected over four years; 102 participants (35.3%) died during that time. A significant difference was noted in the overall survival rates between the groups with good and deterioration of oral function such as oral dryness, rinsing ability, swallowing function, and articulation, based on Log-rank test results. After adjusting for various potential confounders using Cox proportional-hazards regression, oral dryness (HR: 1.83, 95% confidence interval: 1.12−3.00) was significantly associated with mortality within four years. This study revealed that oral dryness influences the life prognosis of older adults who receive long-term care in different settings.

Oxidative stress and the antioxidant system in salivary glands of rats with experimental chronic kidney disease

OBJECTIVE

This study aims to analyze the presence of oxidative stress and activity of the antioxidant system in the parotid and submandibular salivary glands of rats with Chronic Kidney Disease (CKD).

DESIGN

Sixteen male wistar rats were divided into two groups (n = 8, each): control rats and rats with CKD. CKD was induced by 5/6 nephrectomy. Blood urea nitrogen and serum creatinine clearance were quantified. Malondialdehyde, superoxide dismutase, glutathione peroxidase, glutathione reductase, catalase, total antioxidant status, ascorbic acid, α-tocopherol, superoxide anion, and hydrogen peroxide concentrations were assessed.

RESULTS

In CKD rats, blood urea nitrogen, serum creatinine, and proteinuria concentrations were increased, while creatinine clearance was reduced. In the submandibular gland, superoxide anion concentration was increased significantly (p < 0.05). Hydrogen peroxide and superoxide anion concentrations were reduced in the parotid gland. CKD rats presented increased malondialdehyde concentration, total antioxidant status, superoxide dismutase, and glutathione reductase activities only in the parotid gland (p < 0.05).

CONCLUSION

Oxidative stress and changes in the antioxidant system were found in the parotid and submandibular salivary glands in an experimental model of CKD induced by 5/6 nephrectomy.

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.

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.

An Incidental Finding of Subcutaneous Hemangioma During 99mTcO4 Salivary Gland Scintigraphy

A 43-year-old woman with papillary thyroid cancer prepared for I ablation after total thyroidectomy. With a history of type 2 diabetes for 10 years, she recently presented with periodontitis, candidiasis, and mouth dryness. TcO4 scintigraphy was ordered to evaluate function of the salivary glands. The scintigraphy incidentally found a focal TcO4 uptake in the left supraclavicular region. The subsequent neck ultrasonography showed a hypoechoic soft tissue mass with heterogeneous hypervascularity, suggestive of hemangioma.

Salivary lactate dehydrogenase and aminotransferases in diabetic patients

Diabetes mellitus (DM) is a group of metabolic diseases resulting from impaired insulin secretion and/or action. DM is characterized by hyperglycemia that can lead to the dysfunction or damage of organs, including the salivary glands.The aim of this study was to compare the levels of salivary lactate dehydrogenase (LDH), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) in diabetic patients.The study was approved by the Bioethics Committee of Wroclaw Medical University (Poland). The study comprised 90 adults of both sexes, aged 21 to 57 years. The patients were divided into 3 groups: type 1 diabetics (D1), type 2 diabetics (D2), and a healthy control group (C). Each group consisted of 30 age- and sex-matched subjects. Total protein (P, by Lowry method), LDH, AST, ALT (with Alpha Diagnostics kits), and salivary flow rate were measured in unstimulated mixed saliva. The level of glycosylated hemoglobin (HbA1c) was measured with DCA 2000 Reagent Kit. The obtained data were analyzed using the Mann-Whitney U test and the Spearman rank at a significance level of P < 0.05 with the use of STATISTICA 9.0 software.In comparison with C, D1 presented a significantly higher activity of LDH (P < 0.001), AST (P < 0.001), and ALT (P < 0.01), whereas D2 indicated higher levels of LDH (P < 0.001) and ALT (P < 0.05) compared with C. Comparing D1 to D2, approximately 3-fold higher activity of AST (P < 0.01) and approximately 4.5-fold higher activity of ALT (P < 0.01) was observed.Higher levels of salivary LDH, AST, and ALT in D1 compared with D2 and C confirm that salivary glands of D1 might be attributed to autoimmunological damage associated with the pathomechanism of DM.

Xerostomia in geriatric patients: a burgeoning global concern

Saliva plays a key role in maintaining oral homeostasis, function, and health. The prevalence of xerostomia and its consequences are rising due to the increasing aging population, the effects of some systemic diseases, medical management, and commonly-prescribed medications that reduce saliva production. When salivary function is diminished, patients are at a greater risk of developing caries, discomfort in wearing dentures, and opportunistic diseases, such as candidiasis. The psychosocial aspects of xerostomia can range from a mild effect on self-rated oral health to frustration, embarrassment, unhappiness, or substantial disruptions in quality of life. This article reviews the clinical features, diagnosis, and prevalence of dry mouth, as well as its treatment strategies.

The Role of Salivary Gland Scintigraphy in the Evaluation of Salivary Gland Dysfunction in Uncontrolled Type II Diabetic Patients

The aim of the present study was to evaluate the salivary gland dysfunction in patients with uncontrolled type II diabetes using salivary gland scintigraphy and then to compare these ratios with quantitative whole salivary secretion rates. Using a gamma camera (siemens-diacam) equipped with a low energy all-purpose collimator, 32 uncontrolled type II diabetic patients and 30 normal healthy patients were studied by injecting a radio isotope (technetium 99m pertechnetate) about 5 mCi was injected intravenously in to anticubital vein and the activity was measured for the 1(st), 20(th) and 40(th) min. At 20 min after injection, vitamin C chewable tablet was given to stimulate the secretion and continued until the end of the study period (40 min). Before scintigraphy, salivary sampling was carried out in both diabetic and normal individuals in a quiet room, saliva was allowed to accumulate and was expectorated into the collecting vessel approximately once a minute for 15 min and the volume was recorded as Unstimulated salivary flow rate and after 5 min break vitamin C chewable tablet was given to stimulate the secretion and the patient was asked to expectorate the saliva in the collecting vessel for 5 min. The expectorated volume was recorded as stimulated salivary flow rate. The mean of the measurements of scintigraphic ratio and salivary secretion rates were compared using the paired Student's t-test. The scintigraphic mean uptake and excretory ratio (ER) and the salivary flow rates were correlated. The result shows that there was a significant correlation between salivary flow rate and scintigraphic uptake and ER. However, statistically significant result could not be derived as it may be due to smaller sample size and marginal difference in the scintigraphic values between the groups. Salivary gland scintigraphy plays a significant role in the evaluation of salivary gland dysfunction. However, its role as an independent investigative procedure in the evaluation of salivary gland dysfunction requires a study with a larger sample size, may yield a statistical significant result and it can also act as an adjunct along with salivary flow rate procedure.

The role of salivary gland scintigraphy in detection of salivary gland dysfunction in type 2 diabetic patients

Objective:

The aim of the study was to evaluate the salivary gland dysfunction in a patient with uncontrolled type 2 diabetes using salivary gland scintigraphy.

Materials and Methods:

patients included in the study were 32 uncontrolled type 2 diabetic and 30 normal healthy individuals. Patients having any other systemic(or) nervous illness(or) taking medications that could affect the normal functioning of the salivary gland were excluded from the study. The salivary gland scintigraphy was performed, with radioactivity measured at 1^st, 20^th, and 40^th minutes. Twenty minutes after the injection, vitamin C chewable tablet was given to stimulate the secretion and continued until the end of the study period (40min). The data were replayed and regions of interest were chosen over four salivary glands to obtain the uptake ratio (UR) and excretory ratio(ER) of the salivary glands. Result: The scintigraphic total URand ER in diabetic and control groups was compared. The values in these two categories showed decrease in both UR and ER in diabetic patients, when compared to control patients.

Conclusion and Significance:

The result of this study suggests that salivary gland scintigraphy plays a significant role in the evaluation of salivary gland dysfunction in type 2 diabetic patients.

Oral health knowledge and behavior among adults with diabetes

The purpose of this study was to determine levels of oral health knowledge and factors associated with adequate oral health knowledge in adults with diabetes. A convenience sample of 253 adult US residents with diabetes completed an oral health survey to assess their knowledge. Results showed that only 47% of the participants answered five or more (out of a maximum of seven) oral health knowledge items related to diabetes correctly. Participants who received oral health information related to diabetes have 2.9 times the odds of possessing adequate oral health knowledge (i.e., answered five or more items correctly) compared to participants who did not received that information controlling for education and race (OR=2.86, 95% CI 1.31-6.24, P=0.008). Given that oral health information provided by health professionals (dental and/or medical) contributes to improve oral health knowledge among adults with diabetes, health professionals should take the opportunity to educate patients with diabetes about the oral manifestations (e.g., dry mouth) and complications (e.g., periodontitis and oral candidiasis) of diabetes and to promote proper oral health behaviors.

Diabetes and oral health: an overview

BACKGROUND

Diabetes is a common disease with concomitant oral manifestations that impact dental care. The purpose of this review is to summarize the prevalence, signs, symptoms, diagnosis and treatment of diabetes, as well as dental treatment considerations for the patient with diabetes.

CONCLUSIONS

Safely managing the patient with diabetes requires effective communication among multiple health care providers. Dentists must be familiar with techniques to diagnose, treat and prevent stomatological disorders in patients with diabetes.

PRACTICE IMPLICATIONS

Dental practitioners will be treating more patients with diabetes in the future, and this article provides an overview of the systemic and oral aspects of the disease that impact dental treatment.

Dental management of patients with diabetes

Diabetes is a disease of metabolism resulting from impaired insulin secretion, varying degrees of insulin resistance, or both. Management of the diabetic dental patients must take into consideration the impact of dental disease and dental treatment on the management of diabetes as well as an appreciation for the comorbidities that accompany long-standing diabetes. Those comorbidities include obesity, hypertension, and dyslipidemia. Central to the management of diabetes is the intensive regulation of plasma glucose along with management of comorbidities comprising the "metabolic syndrome." Management of the diabetic dental patient should focus on periodontal health and the delivery of comprehensive dental care with minimal disruption of metabolic homeostasis and recognition of diabetic comorbidities.

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.

Evaluation of the concordance of sialometry and salivary glands scintigraphy in dry mouth patients

Introduction

Many diagnostic tests are used to evaluate dry mouth patients, especially the ones with Sjögren's Syndrome, to whom these tests are part of classification criteria for scientific studies.

Aim

Thus, the concordance between results of sialometry and salivary glands scintigraphy was evaluated; if positive, it would enable the choice of one or the other for diagnosis.

Patients and Method

Seventy-two dry mouth patients were divided into non-Sjögren's Syndrome group, primary Sjögren's Syndrome group and secondary Sjögren's Syndrome group. The concordance among sialometry and scintigraphy results was evaluated by Kappa test.

Results

It was observed that their concordance was equal or near to zero.

Conclusion

It is not possible to make a choice between these tests and both should be performed.

Dysgeusia related to urinary obstruction from benign prostatic disease: a case control and qualitative study

Anecdotal reports suggest that dysgeusia may be related to a variety of systemic factors, including bladder outflow obstruction. This is a hospital-based case-controlled study involving 111 patients who were admitted to urological wards for transurethral resection of the prostate for benign prostatic disease with age- and sex-matched control of 137 subjects. We used a semi-structured questionnaire by a trained interviewer at admission (preoperative), at the postoperative period and at follow-up between 4-6 months (median 5 months). Analysis used unpaired t-test and chi(2) test. The incidence of dysgeusia was 22% in the study group and 13% in the control group (P=N.S.). However, strikingly, the dysgeusia in the study group was relieved promptly by relief of urinary obstruction in 100% of cases and did not return within the follow-up period. The mechanism of the dysgeusia associated with dysuria in benign prostatic disease is unknown, but we suggest that the dysgeusia could be from the stress of dysuria or due to a release of an unknown chemical from the urinary tract or an overflow of neural impulse from pontine/cortical micturition centres to the taste centres. An association between dysgeusia and dysuria has not been described before.

Radiation-induced xerostomia in patients with head and neck cancer: pathogenesis, impact on quality of life, and management

BACKGROUND

Xerostomia is a common, debilitating complication of radiation therapy (RT) for head and neck cancer. This article reviews the pathogenesis of radiation-induced xerostomia, its impact on quality of life (QOL), and treatment options.

METHODS

Virtually all patients undergoing RT for head and neck cancers have xerostomia, which causes oral discomfort and pain, increased dental caries and oral infection, and difficulty speaking and swallowing. This significantly impairs QOL and can compromise nutritional intake and continuity of cancer therapy. The literature describing pathogenesis, impact on QOL of radiation-induced xerostomia, and preventive and interventional therapies was reviewed.

RESULTS

Current management strategies include stringent dental and oral hygiene; parotid-sparing radiation techniques to prevent or minimize xerostomia; and pharmacotherapies, such as salivary substitutes and sialogogues. Future strategies may include advanced three-dimensional intensity-modulated RT techniques, salivary gland transfer, newer sialogogues, and gene therapy.

CONCLUSIONS

New treatment approaches to xerostomia from RT for head and neck cancer may result in significant improvement in patient QOL.

Impaired salivary function in patients with noninsulin-dependent diabetes mellitus with xerostomia

To test this hypothesis, salivary function was measured by quantitative salivary scintigraphy in noninsulin-dependent diabetes mellitus (NIDDM) patients, as well as in age- and sex-matched controls for comparison. Seventy-two patients with NIDDM history of over 10 years and 36 healthy age- and sex-matched controls were enrolled in the study. All of the 72 NIDDM patients had good blood sugar control. None presented with autonomic neuropathy. These 72 NIDDM patients were separated into two subgroups. Group 1: 36 patients with xerostomia and Group 2: 36 patients without xerostomia. After intravenous injection of 5mCi Tc-99m pertechnetate, sequential images at 1 min/frame were acquired for 30 min. The 1st and 15th minute uptake ratios (UR) were calculated from the tracer uptakes in the four major salivary glands over the background regions of interest. Saliva excretion was stimulated by one tablet of 200 mg ascorbic acid given orally 15-min postinjection of the tracer. Then, the maximal excretion ratios (ER) of the four major salivary glands after sialagogue stimulation were calculated. Significantly poorer salivary function was found, represented by significantly decreased UR and ER values, in 36 NIDDM patients with xerostomia, when compared with 36 NIDDM patients without xerostomia and 36 healthy controls, via objective and quantitative salivary scintigraphy. It has been speculated that impaired salivary function contributes to NIDDM with xerostomia. However, further studies with a larger series of NIDDM patients are necessary to confirm our findings.