Periodontal changes in children and adolescents with diabetes: a case-control study

Delivery of dietary messages for type 2 diabetic patients by dental practitioners: A scoping review protocol

Objective

The objective of this scoping review is to identify and understand the available evidence on the delivery of dietary messages to patients with type 2 diabetes in a dental setting. The outcome of a scoping review in this area will inform the development of a clinical intervention for dietary counseling at the chairside.

Introduction

Diabetics are at a higher risk for developing periodontal disease, and the severity of periodontal disease can impact the ability to control glucose levels. Considering the prevalence of diabetes within the community, dental practitioners are well placed to provide dietary messages to support this cohort during the management of periodontal disease.

Inclusion Criteria

Studies that consider the population affected by type 2 diabetes and a dietary intervention in the context of a dental setting will be included.

Methods

The databases selected for sources of studies are MEDLINE, EMBASE, CINAHL and SCOPUS. The scoping review will be conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews. Only English language studies are eligible for inclusion in this review. Terms relating to dietary advice, diabetes, dental practitioner and health education will be used to search for related studies. Screening based on abstract, and titles will be followed by full text screening with results supplied in PRISMA-SCR diagram. A data extraction tool will be used to chart the details of selected studies then presented in a venn diagram and word map along with a narrative synthesis of results.

Tooth- and implant-related prognostic factors in treatment planning

Following a comprehensive patient examination, including the assessment of periodontal and peri-implant diseases as well as considering the patient's needs, a pretherapeutic prognosis for each tooth and implant is given. Teeth and implants with a secure pretherapeutic prognosis require simple procedures and may be regarded as secure abutments for function and with a doubtful pretherapeutic prognosis usually need a comprehensive therapy. Such teeth and implants must be brought into the category with a secure prognosis by means of additional therapy such as endodontic, restorative, and surgical procedures. Teeth and implants with a hopeless pretherapeutic prognosis should be extracted/explanted during the initial phase of cause-related therapy (i.e., infection control). For example, teeth with vertical root fracture or unrestorable caries and implants with mobility or unrestorable malposition fall into the category of hopeless units. The primary goal of periodontal and peri-implant therapy should be to arrest disease progression. The latest consensus statement highlights that periodontitis can be successfully controlled and treated teeth can be retained for life. Nevertheless, for patients with uncontrolled contributing factors, the endpoints might not always be achievable, and low disease activity may be an acceptable therapeutic goal. Similarly, the management of peri-implantitis frequently requires surgical intervention following nonsurgical therapy due to incomplete treatment outcomes. Different surgical modalities can be effective and lead to significant improvement; however, achieving complete resolution of peri-implantitis is challenging, not always predictable, and can depend on multiple baseline factors. Therefore, this review aims at summarising available evidence on the rationale for incorporating systemic, lifestyle-related, clinical, and radiographic prognostic factors into treatment planning of patients diagnosed with periodontal and peri-implant diseases.

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.

Effects of Nonsurgical Periodontal Therapy on Glycemic Control in Diabetic Patients under Systemic Administration of Antidiabetic Ayurvedic Drug

AIM

This study aimed to monitor the metabolic response of nonsurgical periodontal therapy in type-2 diabetic patients with chronic periodontitis under systemic administration of antidiabetic ayurvedic drug.

MATERIALS AND METHODS

About 90 newly diagnosed mild-to-moderate forms of type-2 diabetes mellitus (DM) subjects with generalized chronic periodontitis were selected according to the inclusion and exclusion criteria and were randomly divided into group A and group B with 45 patients in each group. Clinical parameters, including plaque index, probing pocket depth, clinical attachment level, and glycemic status, were assessed at baseline. Following initial periodontal clinical examination, the drug Nishamalaki (NA) 2 gm twice daily for 3 months was prescribed after food by an Ayurvedic physician to all the patients enrolled in group A and group B, and scaling and root planing were completed only for group B patients. Patients were recalled for review, and all the parameters were reassessed at the end of the 1st, 2nd, and 3rd months following interventions.

RESULTS

Regarding clinical and metabolic parameters at baseline, no statistically significant differences were displayed between the two groups. However, at the 3-months follow-up period, the patients in group B demonstrated significantly better clinical and metabolic outcomes than patients in group A.

CONCLUSION

Periodontal therapy improved glycemic control in patients with type-2 DM in both groups; however, the reduction in FBS values reached statistical significance only in the group receiving scaling and root planing alone.

CLINICAL SIGNIFICANCE

Nonsurgical periodontal therapy may have a beneficial effect on the periodontal clinical and glycemic levels in type-2 diabetic patients with chronic periodontitis.

Impact of puberty, sex determinants and chronic inflammation on cardiovascular risk in young people

Worrying trends of increased cardiovascular disease (CVD) risk in children, adolescents and young people in the Modern Era have channelled research and public health strategies to tackle this growing epidemic. However, there are still controversies related to the dynamic of the impact of sex, age and puberty on this risk and on cardiovascular health outcomes later in life. In this comprehensive review of current literature, we examine the relationship between puberty, sex determinants and various traditional CVD-risk factors, as well as subclinical atherosclerosis in young people in general population. In addition, we evaluate the role of chronic inflammation, sex hormone therapy and health-risk behaviours on augmenting traditional CVD-risk factors and health outcomes, ultimately aiming to determine whether tailored management strategies for this age group are justified.

High prevalence of periodontitis in children and adolescents with type 2 diabetes

BACKGROUND

The aim of the present study was to determine the prevalence of periodontitis in children and adolescents with type 2 diabetes, and if poor glycemic control is associated with increasing prevalence of the disease.

METHODS

This is a cross-sectional study involving children and adolescents with type 2 diabetes. A questionnaire related to oral health care history and oral health behaviors was administered to each participant and they then underwent a full-mouth oral evaluation. In addition, clinical and metabolic parameters were extracted from the clinical chart.

RESULTS

One hundred and twenty one children and adolescents (8-17 years, 11 months) participated. Overall, 45.5% presented some degree of periodontitis, with 10 (8.3%) mild, 36 (29.8%) moderate, and nine (7.4%) severe. The periodontitis group (PD-group) had higher mean gingival and plaque indexes, periodontal probing depth, and clinical attachment loss than the group without periodontitis (NoPD-group) (p<0.05). A statistically significant relationship between the prevalence of periodontitis and glycosylated hemoglobin (HbA1c) was verified in the bivariate (odds ratio [OR] 1.31 [95% CI, 1.13-1.53], p = 0.001) and multivariate (OR, 1.29 [95% CI, 1.03-1.61], p = 0.03) analysis. For the adjustment variables, associations were verified for duration of diabetes, age, body mass index z-score, lack of running water, insulin use, and acanthosis nigricans.

CONCLUSIONS

Children and adolescents with type 2 diabetes presented high rates of periodontitis comparable with that seen in previous studies in youth with diabetes. Uncontrolled HbA1c influences prevalence of periodontal disease. The lack of matched control group and radiographs are limitations of the study. Comprehensive periodontal examination is essential for children and adolescents with type 2 diabetes to prevent, identify, and treat periodontitis early.

The effect of antibiotics on the periodontal treatment of diabetic patients with periodontitis: A systematic review and meta-analysis

Background: The aim of this meta-analysis was to compare the effects of periodontal treatment with or without adjunctive antibiotic on periodontal status and blood glucose level in diabetic patients with periodontitis. Methods: A search using electronic database (MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials) and a manual search were performed up to July 2022. Eligible 13 RCTs were included according to inclusion and exclusion criteria. Reviewers independently performed data screening, data selection, data extraction, and risk of bias. Quality assessment was performed according to the Cochrane Handbook for Systematic Reviews of Interventions. Weighted mean differences and 95% confidence intervals (CIs) for continuous outcomes were calculated using random or fixed-effects models. This review is registered in the PROSPERO database (CRD42022347803). Results: Of the 13 included articles, eight were on the use of systemic antibiotics and five on topical antibiotics. The results showed statistically significant improvement in periodontal status (probing depth, clinical attachment loss and bleeding on probing) at 6 months with systematic antibiotics use (PD-6M p = 0.04, BOP-6M p < 0.0001, CAL-6M p = 0.002). The improvement in PD with topical antibiotics was statistically significant at 1 month (p = 0.0006). However, there was no statistically significant improvement in periodontal status at 3 months with adjuvant systemic antibiotics. Conclusion: Antibiotics can improve the periodontal condition of diabetic patients with periodontitis to a certain extent. In clinical practice, it is necessary to comprehensively consider the balance of benefits and risks before deciding whether to use antibiotics. Systematic Review Registration: Identifier CRD42022347803, https://www.crd.york.ac.uk/PROSPERO/.

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

Background

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

Methods

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

Results

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

Conclusion

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

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.

Periodontitis induced by Porphyromonas gingivalis drives impaired glucose metabolism in mice

Periodontitis has been demonstrated to be bidirectionally associated with diabetes and has been recognized as a complication of diabetes. As a periodontal pathogen, Porphyromonas gingivalis is a possible pathogen linking periodontal disease and systemic diseases. It has also been found to be involved in the occurrence and development of diabetes. In this study, 6-week-old male C57BL/6 mice were orally administered the P. gingivalis strain ATCC381 for 22 weeks. Histological analysis of the gingival tissue and quantified analysis of alveolar bone loss were performed to evaluate periodontal destruction. Body weight, fasting glucose, glucose tolerance test (GTT), and insulin tolerance test (ITT) were used to evaluate glucose metabolism disorder. We then analyzed the expression profiles of inflammatory cytokines and chemokines in gingival tissue, the liver, and adipose tissue, as well as in serum. The results showed that mice in the P. gingivalis-administered group developed apparent gingival inflammation and more alveolar bone loss compared to the control group. After 22 weeks of P. gingivalis infection, significant differences were observed at 30 and 60 min for the GTT and at 15 min for the ITT. P. gingivalis-administered mice showed an increase in the mRNA expression levels of the pro-inflammatory cytokines (TNF-α, IL-6, IL-17, and IL-23) and chemokines (CCL2, CCL8, and CXCL10) in the gingiva and serum. The expression levels of the glucose metabolism-related genes were also changed in the liver and adipose tissue. Our results indicate that oral administration of P. gingivalis can induce changes in the inflammatory cytokines and chemokines in the gingiva and blood, can lead to alveolar bone loss and to inflammatory changes in the liver and adipose tissues, and can promote glucose metabolism disorder in mice.

Periodontitis and implant complications in diabetes

Epidemiologic evidence indicates that periodontitis is more frequent in patients with uncontrolled diabetes mellitus than in healthy controls, suggesting that it could be considered the "sixth complication" of diabetes. Actually, diabetes mellitus and periodontitis are two extraordinarily prevalent chronic diseases that share a number of comorbidities all converging toward an increased risk of cardiovascular disease. Periodontal treatment has recently been shown to have the potential to improve the metabolic control of diabetes, although long-term studies are lacking. Uncontrolled diabetes also seems to affect the response to periodontal treatment, as well as the risk to develop peri-implant diseases. Mechanisms of associations between diabetes mellitus and periodontal disease include the release of advanced glycation end products as a result of hyperglycemia and a range of shared predisposing factors of genetic, microbial, and lifestyle nature. This review discusses the evidence for the risk of periodontal and peri-implant disease in diabetic patients and the potential role of the dental professional in the diabetes-periodontal interface.

Periodontal disease and a poor response to periodontal treatment were associated with an increased risk of incident diabetes: A longitudinal cohort study in Sweden

AIM

To investigate whether periodontal disease or the response to periodontal treatment could influence the risk of future diabetes.

MATERIALS AND METHODS

The eligible population consisted of 8983 individuals referred for periodontal treatment between 1980 and 2015. Diabetes incidence was obtained from the Swedish registers for cause of death, hospital discharge, and national diabetes registers. Data concerning treatment outcome 1 year after treatment were available for 5258 individuals. Poor response to treatment was defined as having >10% sites with probing pocket depth ≥5 mm and bleeding on probing (BOP) at ≥20% of the sites.

RESULTS

Among the 8983 individuals during a median follow-up of 21.3 years, 1117 cases of diabetes occurred. The number of teeth and BOP at baseline were significantly associated with incident diabetes in a dose-dependent manner after adjusting for age, sex, smoking, education level, and civil status [incident rate ratio (IRR) = 0.88 (95% confidence interval [CI] 0.84-0.93), p < .001 and IRR = 1.06 (95% CI 1.02-1.11), p = .003, respectively]. Poor response to treatment (14%) was associated with an increased risk (37%) for future diabetes (95% CI 1.12-1.68, p = .002) compared with good responders.

CONCLUSIONS

Periodontal disease with increased tooth loss and BOP, as well as poor response to treatment, was associated with an increased risk for diabetes.

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

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

Consensus report of the joint workshop of the Italian Society of Diabetology, Italian Society of Periodontology and Implantology, Italian Association of Clinical Diabetologists (SID-SIdP-AMD)

Periodontitis has been defined as the Sixth complication of Diabetes Mellitus. Since both diabetes mellitus and periodontitis have a high prevalence in the general population, the Italian Society of Diabetology, the Italian Society of Periodontology and Implantology and the Italian Association of Clinical Diabetologists revised the present scientific literature in the present consensus report. A bi-directional interaction was demonstrated: Patients affected by type 1 and type 2 diabetes have a higher prevalence of periodontitis than the general population, due to several metabolic factors (e.g. chronic hyperglycemia, autoimmunity, dietary and life-style factors); similarly, periodontitis predisposes to type 2 diabetes mellitus mainly via the increase of systemic cytokines release. Conversely, improvement of metabolic control of diabetic patients delay the progression of periodontitis as well as periodontitis treatment reduces glycosylated hemoglobin levels in blood. Due to the bi-directional causal interaction between periodontitis and diabetes mellitus, a strict collaboration among dentists and diabetologists is required and strongly recommended. The inter-societies consensus proposes specific flow-diagrams to improve the treatment of patients and management of the general population regarding the issue of periodontitis and diabetes.

Evaluation of the Relationship between Salivary Lipids, Proteins and Total Antioxidant Capacity with Gingival Health Status in Type-1 Diabetic Children

STATEMENT OF THE PROBLEM

Alteration in salivary composition and its effect on the oral cavity in diabetic child patients remains equivocal.

PURPOSE

This study was performed to assess the relationship between salivary factors and gingival status in children with type-1 diabetes mellitus (DM).

MATERIAL AND METHOD

In this cross-sectional study, 120 subjects aged 6-16 years (60 well-controlled and poorly-controlled diabetics and 60 healthy individuals) were examined to determine the gingival index (GI) and plaque index (PI). The unstimulated saliva samples were collected to measure the salivary triglyceride, cholesterol, albumin, α-amylase, total protein levels by the laboratory kits. Total antioxidant capacity and the free radicals scavenger index were measured by the Ferric Reducing Ability Of Plasma (FRAP) and 1,1-Diphenyl-2-picryl-hydrazyl (DPPH) assays, respectively. Data were analyzed by parametric and non-parametric, Pearson correlation, and t tests at a 5% error level.

RESULTS

GI of diabetics was significantly higher than that of healthy individuals (1.51± 0.71 and 0.9±0.81, respectively, p< 0.001). No significant difference was found between the PI of diabetics compared to healthy volunteers (1.59±0.69, 1.63±0.74, respectively). The levels of salivary triglyceride and cholesterol, albumin and total proteins in healthy subjects were significantly higher than that in people with DM (p< 0.001). A significantly more salivary α-amylase activity was found in diabetics compared to non-diabetics (p< 0.001). No significant differences were found between diabetic and non-diabetic subjects in terms of DPPH (95.5, 95.9%, respectively) and FRAP (9.77±0.13, 9.78±0.12 (µmol/mL), respectively).

CONCLUSION

More gingival inflammation and salivary α-amylase activity and lower level of salivary lipids, albumin, and total proteins were found in diabetic patients, but there was no association between the level of lipids, proteins, and the total antioxidant capacity of saliva with periodontal health indicators in patients with DM and healthy individuals.

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 Disease in Type 1 Diabetes Mellitus: Influence of Pubertal Stage and Glycemic Control

OBJECTIVE

Though gingivitis is common in children with type 1 diabetes mellitus (T1DM), the overall periodontal health in T1DM during the pubertal stage is less well-characterized. The study was undertaken to explore the possible influence of puberty and metabolic derangement on periodontal health in T1DM.

METHODS

In this cross-sectional study, 110 subjects between 10-18 years with T1DM and 52 healthy siblings of similar age were evaluated for pubertal stage, glycosylated hemoglobin (HbA1c), and periodontal health. Simplified oral hygiene index (OHIS), gingival index (GI), plaque index (PI), bleeding on probing (BOP), and probing depth (PPD) were evaluated at 4 sites per tooth as per 6 Ramfjord index teeth used to assess periodontal disease (PD).

RESULTS

PD not merely gingivitis was significantly higher in T1DM (84/110, 76.36%) than the control group (28/52, 53.8%) (P = .004). Irrespective of pubertal status, children with T1DM had worse GI, PI, BOP, and PPD than nondiabetic subjects, although OHIS was better in diabetes. In both T1DM and nondiabetic subjects, pubertal subjects showed significantly worse OHIS, PPD, BOP, and GI than prepubertal subjects. PD was correlated with pubertal stage, age, and HbA1c, although less strongly with the duration of diabetes. In logistic regression, pubertal stage was a stronger predictor of PD (OR = 14.26) than age (OR = 2.22), and HbA1c (OR = 1.5) rather than the presence of diabetes and its duration.

CONCLUSIONS

Though pubertal status, age, and poor glycemic control rather than the presence of diabetes and its duration are associated with gingivitis and other forms of PD, puberty had a more profound effect in the pathogenesis of PD in T1DM.

Bridging Oral and Systemic Health in Children with Prader-Willi Syndrome: Case Reports and Dental Treatment Recommendations

BACKGROUND

Prader-Willi Syndrome (PWS) is a complex neurodevelopmental disorder caused by gene alterations on chromosome 15q11-q13, resulting in hyperphagia and neuroendocrine deficits. A comprehensive guide for dental treatment for PWS is lacking despite numerous case reports. The objective of this report was to develop a problem-focused list of the interrelationship between oral and systemic parameters of PWS and enable dentists in anticipating the unique treatment needs of children and individuals with PWS.

METHODS

Four pediatric patients with PWS presenting to an academic dental clinic were evaluated. A literature review spanning the last twenty years was performed to identify the pathophysiological impact of systemic problems on dental health and treatment.

RESULTS

The four cases along with cases from the literature were used to enumerate salient oro-dental and systemic features influencing treatment decisions in dentistry. They formed the basis for collective recommendations and precautions for rendering dental treatment in patients with PWS.

CONCLUSION

Sedation for dental treatment is contraindicated due to obesity (BMI over 95th percentile), hypotonia, obstructive sleep apnea (OSA), and respiratory limitations (restricted ventilation due to weight on thoracic cage). Prolonged recovery from general anesthesia, OSA, and temperature dysregulation necessitate extended monitoring after dental rehabilitation under general anesthesia. Orthopedic problems and respiratory limitations exclude protective stabilization. Xerostomia and acidic saliva necessitate recommendations for oral rehydrating products. Periodontal assessment is necessary due to poor oral hygiene and diabetes mellitus. Early establishment of a dental home and risk-based frequency of dental care should address caries prevention and restorative needs.

Are diabetes and dental care providers in the Republic of Mauritius advising patients about the importance of oral health in diabetes management?

Diabetes and dental care providers may greatly contribute in the early detection of oral diseases and diabetes, respectively, and in the prevention of complications of diabetes. However, there is limited collaboration and referrals between these two groups of health professionals.

OBJECTIVE

To investigate whether diabetic providers are addressing the importance of oral care in the management of diabetes and whether dental care providers are advising their patients with diabetes about the importance of glycaemic control.

METHOD

Descriptive statistics was used to report data collected from 720 patients with diabetes using a closed-end questionnaire. Logistic regression analysis revealed the factors significantly impacting whether participants received advice from healthcare providers.

RESULTS

The majority of participants did not receive advice from either diabetes (84%) or dental (75%) care providers regarding the reciprocal nature of diabetes and periodontitis. The factors significantly affecting receiving advice from diabetes care providers were place of residence (p = 0.003), self-reported type of diabetes (p = 0.000) receiving advice from dental care providers (p = 0.000); from dental care providers - education (p = 0.020), place of residence (p = 0.004), the number of years since diagnosis of diabetes (p = 0.002), frequency of dental visits (p = 0.000) and receiving advice from diabetes care providers (p = 0.000).

CONCLUSION

Diabetes and dental care providers in Mauritius are not addressing oral health care as an essential component of diabetes care. Patients with diabetes are neither being advised about the importance of regular dental visits by their treating doctor, nor about the importance of glycaemic control in the prevention of oral complications by their dentist.

Management of periodontal disease in patients with diabetes- good clinical practice guidelines: A joint statement by Indian Society of Periodontology and Research Society for the Study of Diabetes in India

There is a huge body of literature suggesting an association and a bidirectional relationship between periodontal disease and diabetes. Diabetes and periodontal diseases are both chronic diseases with a high prevalence. Dentists/periodontists, in their daily clinical practice, very often attend to diabetes patients with diverse oral health conditions and cater to their dental treatment needs. Safe and effective periodontal therapy in this population requires a broad understanding of diabetes, medical management of diabetes, and essential modifications to dental/periodontal therapy that may be required. This paper describes a joint statement put forth by the Indian Society of Periodontology and the Research Society for the Study of Diabetes in India aiming to provide expert consensus and evidence-based guidelines for optimal clinical management of periodontal conditions in diabetes patients or patients at risk for diabetes. Although this paper is not envisioned to be a comprehensive review of this topic, it intends to provide the guidelines for dental professionals and periodontists.

Oral health and halitosis among type 1 diabetic and healthy children

AIM

To evaluate the oral health status, oral health related habits and halitosis of children with and without type 1 diabetes.

MATERIALS AND METHODS

In this study the oral health status of children with and without type 1 diabetes were evaluated by using different indices (dmft/DMFT, International Caries Detection and Assessment System(ICDAS) II, pufa, gingival and periodontal indices). Halitosis was determined by organoleptic assessment and sulfur monitoring.

RESULTS

One hundred children with the age range between 6-13 years, 50 type 1 diabetics (24 boys,26 girls) with mean age (±sd) of 10.3 ± 2.1 years and 50 healthy (30 boys, 20 girls) with mean age (±sd) of 9.9 ± 1.5 years, participated in the study. The median values of dmft and dmfs was lower in children with type 1 diabetes, while for DMFT and DMFS indices were similar with the healthy group. Cavitated caries lesions were observed in 60.0% of children with diabetes and in 58.0% of healthy children. According to the ICDAS II index, 42.0% of children with diabetes and 56.0% of healthy children had severe decay. The mean plaque index was statistically significantly less in diabetic children (p = 0.04). In 12.0% of children with type 1 diabetes and in 18.0% of healthy children, volatile sulfur compounds (VSC) were determined to be ≥150 ppb and the most diagnosed score was 1 in both groups. In diabetic children with the cut off value of 7.5% HbA1c, there was no statistically significant difference in oral health indices results and VSC scores.

CONCLUSION

Findings of the present study are insufficient to support a significant effect of diabetes on increasing the risk of oral and periodontal diseases. Nonetheless, it is important to emphasize the importance of oral and dental health, regular oral care and dental visits both to the patients with type 1 diabetes and their parents.

Oral health status and impact on the oral health-related quality of life of Egyptian children and early adolescents with type-1 diabetes: a case-control study

OBJECTIVES

The purpose of the present study is to (1) evaluate the oral health-related quality of life (OHRQoL) among a group of Egyptian children and early adolescents with type-1 diabetes mellitus (T₁DM) aged from 8 to 14 years and the impact of individual, environmental, oral health care and biological independent predictors (2) assess oral health status (OHS) in terms of oral hygiene, caries experience, untreated carious cavities and gingival condition.

MATERIALS AND METHODS

A case-control investigation conducted on eligible 444 participants who have been assigned into four groups (two case groups included 125 children and 97 early adolescents with T₁DM and two matched control groups). The OHRQoL was measured using a validated structured CPQ_8-10 for children and CPQ_11-14 short-form questionnaires for early adolescents. The questionnaire comprised of four parts that represented the study independent variables. Descriptive data were analysed using Mann-Whitney U test for the non-parametric data. Pearson's correlations have been calculated to inspect the interrelation between metabolic disease control and study of different OHS representatives. Log-linear Poisson model regression analyses performed to determine associations between the OHRQoL and independent predictors.

RESULTS

The prevalence of dental caries (DT ≥ 1) in children with diabetes was 49.6% (75.3%). The worse GI mean and median scores were recorded among early adolescents with T₁DM [mean (SD) = 2.24 ± 0.61; median (IQR) = 2.3(1)]. The social well-being of CPQ domains was a prominent concern that negatively affected children and early adolescents' life aspects. A strong correlation between OHRQoL and the level of HbA_1c in the two diabetic groups (r = 0.69 for children's group and 0.74 for the early adolescent group) was observed. The final model of log-linear Poisson regression analysis demonstrated that the odds ratio (OR) of poor OHRQoL among children and early adolescents with poor metabolic control was 1.30 [95% CI 1.18-1.47] and 1.22 [95% CI 1.11-1.38] times more than those with good metabolic control do.

CONCLUSIONS

The overall self-reported OHRQL appears to be adversely affected by T₁DM especially among children and early adolescents with poor metabolic control. Socioeconomic status and oral health care demonstrate a significant impact on the OHRQoL; however, the effect was obvious in the diabetic and non-diabetic groups.

CLINICAL RELEVANCE

1. In Egypt, the number of new cases rises progressively in a retrospective survey to figure out the prevalence of T1DM among children and adolescents. The available data is limited regarding the incidence and prevalence of dental caries and gingival condition among Egyptian children and early adolescents. 2. The present study is a premier study that assesses the OHRQoL and studies the impact of the individual, environmental, biological and oral health care variables. 3. This study highlights the urgent need for improving the oral health status of diabetic children and adolescents and the necessity for qualified oral health education programs for children and parents. There is an intense need to reinforce the role of preventive oral hygiene measures.

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

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

Does Periodontal Inflammation Affect Type 1 Diabetes in Childhood and Adolescence? A Meta-Analysis

The emergence of link between periodontal disease and diabetes has created conditions for analyzing new interdisciplinary approach making toward tackling oral health and systemic issues. As periodontal disease is a readily modifiable risk factor this association has potential clinical implications. The aim of this paper was systematically review the extant literature related to analytics data in order to identify the association between type 1 diabetes (T1DM) in childhood and adolescence with periodontal inflammation. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a database search between 2004 and 2019. A manual search of the literature was conducted as an additional phase of the search process, with the aim of identifying studies that were missed in the primary search. One hundred and thirty-nine records were screened and 10 fulfilled the inclusion criteria. Most studies were of moderate methodological quality. Outcomes included assessments of diabetes and periodontal status. In diabetic populations, compared to healthy subjects, interindividual differences in periodontal status are reflected in higher severity of periodontal inflammation. The most reported barriers to evidence uptake were the intrinsic limits of cross-sectional report data and relevant research, and lack of timely research output. Based on the evidence presented within the literature, the aforementioned biomarkers correlate with poor periodontal status in type 1 diabetic patients. Whilst the corpus of the evidence suggests that there may be an association between periodontal status and type 1 diabetes, study designs and methodological limitations hinder interpretation of the current research.

Clinical and microbial oral health status in children and adolescents with type 1 diabetes mellitus

OBJECTIVES

To study the oral health of young individuals with controlled and uncontrolled type 1 diabetes mellitus (T1DM) and compare the results with those for healthy counterparts.

MATERIALS AND METHODS

One-hundred and forty-four youngsters (6-15 years of age) were assigned, according to glycaemic control, to three study groups: (i) diabetic patients with poor glycaemic control [glycated haemoglobin (HbA1c ≥7.5%)] (n = 35); (ii) diabetic patients with good glycaemic control (HbA1c <7.5%) (n = 39); and (iii) healthy individuals (n = 70). Plaque, gingival inflammation, calculus and decayed, missing and filled surfaces (DMFS) indices were recorded. Salivary parameters were determined, and stimulated saliva was collected to allow detection and determination of the levels of oral Candida albicans and Streptococcus mutans by real-time polymerase chain reaction (PCR).

RESULTS

Significantly different amounts of plaque were found among the study groups (P = 0.024): youngsters with poor glycaemic control had significantly more plaque than youngsters in the other two groups. The gingival, calculus and DMFS indices were not significantly different among groups (P > 0.05). Candida albicans levels were not statistically significant different among groups, but the group with poor glycemic control showed an elevated frequency of detection. Streptococcus mutans was isolated from the oral cavity of 96 of the 144 individuals. A statistically significant difference in the level of S. mutans was found between the group with poor glycaemic control and the healthy control group (P = 0.032).

CONCLUSIONS

The results imply that youngsters with T1DM have a lower level of oral hygiene and are potentially at a higher risk of future oral disease, particularly when their metabolic disorder is uncontrolled. However, factors outside the oral cavity may also have a considerable impact on the initiation and progression of oral diseases.

A review of the influence of periodontal treatment in systemic diseases

The effects and consequences of periodontal diseases might not be confined to the oral cavity. A great body of evidence has arisen supporting the claim demonstrating an association with several systemic conditions and diseases. With different levels of evidence, an association between periodontal disease and cardiovascular disease, diabetes, psoriasis, rheumatoid arthritis, pregnancy outcomes and respiratory diseases has been established. However, the true nature of this association, if it is causal, still remains elusive. For a better understanding of the complex relationships linking different conditions, interventional studies now begin to focus on the possible outcomes of periodontal treatment in relation to the events, symptoms and biomarkers of several systemic disorders, assessing if periodontal treatment has any impact on them, hopefully reducing their severity or prevalence. Therefore, we proceeded to review the recent literature on the subject, attempting to present a brief explanation of the systemic condition or disease, what proposed mechanisms might give biological plausibility to its association with periodontal disease, and finally and more importantly, what data are currently available pertaining to the effects periodontal treatment may have. Raising awareness and discussing the possible benefits of periodontal treatment on overall systemic health is important, in order to change the perception that periodontal diseases are only limited to the oral cavity, and ultimately providing better and comprehensive care to patients.

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.

The effect of periodontal and prosthodontic therapy on glycemic control in patients with diabetes

PURPOSE

To evaluate the effect of periodontal and prosthodontic therapy on glycated hemoglobin A(HbA1c) level in patients with diabetes.

MATERIALS AND METHODS

This is a retrospective study of 70 patients suffering from diabetes who visited the Kyungpook National University Hospital between January 2016 and May 2018. Patients underwent medical evaluation for their routine check-up, which includes laboratory test for HbA1c levels. Among the 70 patients, 35 patients also visited Kyungpook National University Dental Hospital during the same period to receive periodontal and prosthodontic therapy, while the other 35 patients did not receive such therapy. The HbA1c levels were compared before and after periodontal and prosthodontic therapy. Comparisons between groups and within groups were performed using independent t-test.

RESULTS

The HbA1c levels in the group who have received periodontal and prosthodontic therapy decreased from 7.2 to 6.7 (P=.001). The HbA1c levels in the control group decreased from 7.2 to 7.1 (P=.580). The difference in changes between the two patient groups was statistically significant (P=.011).

CONCLUSION

Periodontal and prosthodontic therapy can be effective on glycemic control in patients with diabetes.

Comparison of Salivary Cortisol Level in Type 2 Diabetic Patients and Pre-Diabetics with Healthy People

BACKGROUND:

Cortisol is one of the important enzymes of saliva. Control of this hormone is an effective way to adjust the glucose level in diabetic patients.

AIM:

The aim of this research is to compare the salivary cortisol level in type 2 diabetic patients and pre-diabetics with healthy people.

METHODS:

In this case-control study (2018), the unstimulated salivary samples were collected from 44 patients with type 2 diabetes, 44 pre-diabetic people (case group), and 44 healthy subjects (control group), matched for age and gender. The samples were transferred to the laboratory, and salivary cortisol level was measured using ELISA. Data were analysed using SPSS 22 and Chi 2 tests.

RESULTS:

The mean salivary cortisol level in type 2 diabetic patients was 3.14 ± 1.17, in pre-diabetic cases was 1.83 ± 0.68, and in healthy controls was 0.86 ± 0.43 (P < 0.001). The mean DMFT in type 2 diabetic patients was 19.6 ± 6.5, in the pre-diabetic group was 13.43 ± 4.5, and in healthy controls was 9.38 ± 3.72 (P < 0.001).

CONCLUSION:

With regards to the results, salivary cortisol level in type 2 diabetic patients is more than pre-diabetic people, and in pre-diabetic people is more than healthy people. Also, there was a significant relation between salivary cortisol level and DMFT index.

Frequency of putative periodontal pathogens among type 1 diabetes mellitus: a case-control study

Objective

The aim of the present study is to compare and assess the risk of periodontitis due to the presence of four putative periodontopathic bacteria viz., Eikenella corrodens, Campylobacter rectus, Prevotella intermedia and Prevotella nigrescens. To fulfil the above objective, polymerase Chain reaction using the primers targeting 16S rRNA gene of the bacterial species was performed with the subgingival plaque collected from the permanent first molars of type 1 diabetic children and age matched healthy children.

Results

The prevalence of periodontal pathogens in diabetic and healthy children was 6% and 16% for E. corrodens, 18% and 36% for C. rectus, 2% and 2% for P. intermedia, 4% and 0%, for P. nigrescens respectively. Statistically, significant difference was not observed for the prevalence of all the four periodontal pathogens between type 1 diabetic and healthy children (P = 1.00). The results of the present study thus reveal a negative correlation of type I diabetes to periodontitis in association to Eikenella corrodens, Campylobacter rectus, Prevotella intermedia and Prevotella nigrescens.

Does Diabetes Influence Oral Health in Children?

Background and aims: Diabetes has a high prevalence in both pediatric as well as adult populations in present times. Dental caries represents also a very serious problem form the health point of view in all population. Our study wishes to emphasize the relation between diabetes and oral health status in pediatric patients, also inquiring upon their awareness of the link between the two.

Material and method: 15 diabetic patients were compared with 15 non-diabetic matching patients.

Results: The study concluded in showing the importance of a correct oral hygiene in all patients with emphasize in cases of diabetic patients.

Conclusions: Awareness of the link between diabetes and oral health status should be promoted not only by dentists but also by their general medicine practitioner as well as diabetes specialists and nutrition specialist.

Periodontal, metabolic, and cardiovascular disease: Exploring the role of inflammation and mental health

Previous evidence connects periodontal disease, a modifiable condition affecting a majority of Americans, with metabolic and cardiovascular morbidity and mortality. This review focuses on the likely mediation of these associations by immune activation and their potential interactions with mental illness. Future longitudinal, and ideally interventional studies, should focus on reciprocal interactions and cascading effects, as well as points for effective preventative and therapeutic interventions across diagnostic domains to reduce morbidity, mortality and improve quality of life.

The association between Type 1 diabetes mellitus and periodontal diseases

BACKGROUND/PURPOSE

Type 1 diabetes mellitus (T1DM) is a chronic autoimmune disease affecting oral health. Evidence shows possible association between T1DM and periodontal diseases (PDs). We conducted a nationwide population-based study in Taiwan, with a 14-year follow-up to investigate the risk of PDs in T1DM patients.

METHODS

We used data from the National Health Insurance Research Database in Taiwan. The T1DM cohort was identified with newly diagnosed T1DM from 1998 to 2011. The non-T1DM cohort was frequency matched with the T1DM cohort. Participants comprised 4248 patients in the T1DM cohort and 16992 persons in the non-T1DM cohort.

RESULTS

The T1DM patients showed an increased risk of PDs compared to non-T1DM individuals [adjusted hazard ratio (aHR) = 1.45]. T1DM patients who visited the emergency room more than twice per year had a higher aHR of 13.0 for developing PDs. The aHR for PDs was 13.2 in the T1DM patients who had been hospitalized more than twice per year.

CONCLUSION

T1DM patients are at higher risk of developing PDs than non-T1DM individuals. Our results further showed that the number of T1DM interventions; that is, annual emergency visits and hospitalizations were associated with increased the risk of developing PDs.

Oral Health of Portuguese Children with Type 1 Diabetes: A Multiparametric Evaluation

OBJECTIVE

To perform a multiparametric evaluation of the oral health of 36 children with type 1 diabetes.

STUDY DESIGN

A group of type 1 diabetic children and a sex-age-matched control group were formed. Seven parameters were evaluated: probing depth, bleeding on probing, plaque index (O'Laery index), calculus index (according to Ramfjord), dental caries (using ICDAS), salivary pH and unstimulated salivary flow rate. Statistical analysis was performed and the significance level was set at 5%.

RESULTS

Both groups consisted of 36 children with a mean age of 13 years. With regard to bleeding on probing, plaque index and calculus index, higher values were obtained in the diabetic group and the differences between groups were statistically significant for all three parameters. Concerning dental caries and salivary parameters, there were no significant differences between groups. However, a statistically significant correlation between salivary parameters and metabolic control was found.

CONCLUSION

This study suggests that type 1 diabetic children are associated with some risk factors related to periodontal disease and dental caries. The proven relationship between diabetes and oral health complications imposes the need for these patients to be integrated into preventive dental programs from a young age.

Efficacy of systemic antibiotics in nonsurgical periodontal therapy for diabetic subjects: a systematic review and meta-analysis

OBJECTIVES

To evaluate the effects of systemic antibiotics as adjuncts to nonsurgical periodontal treatment (NSPT), as opposed to using NSPT alone, on periodontal clinical parameters of diabetic patients with periodontitis.

MATERIALS AND METHODS

Randomised controlled trials with a follow-up of 3 months or more, assessing the effects of NSPT in combination with antibiotics, in diabetic patients with periodontitis were included. Trials published up to August 2016 were identified from MEDLINE, EMBASE and LILACS databases. Meta-analyses were conducted to determine changes in clinical attachment level (CAL), probing pocket depth (PPD), bleeding on probing (BOP) and gingival index (GI). Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in this review.

RESULTS

Of the 164 papers potentially admissible to this systematic review, 15 articles on 11 randomised clinical trials were considered as eligible. The results of the meta-analyses presented a modest additional benefit of 0.14 mm (95% confidence interval: 0.08-0.20) in reducing PPD but no further benefit in CAL gain.

CONCLUSION

When the data for all antibiotic protocols were considered together for the treatment of periodontitis patients with DM, a significant, albeit small, reduction of PPD and no improvement in CAL gain was observed. When the antibiotic protocols were analysed separately, the combination of amoxicillin plus metronidazole yielded the best results for PPD.

Is overweight/obesity a risk factor for periodontitis in young adults and adolescents?: a systematic review

BACKGROUND

Obesity in young adults and adolescents is associated with chronic co-morbidities. This project investigated whether being overweight or obese is a risk factor for periodontitis in adolescents (13-17 years) and young adults (18-34 years).

METHODS

A search of 12 databases was conducted using Medical Subject Headings/Index and Emtree terms. Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, articles published between 2003 and 2016 were screened that reported periodontal and anthropometric measures. The Newcastle-Ottawa Scale was used to appraise the quality of studies.

RESULTS

Of 25 eligible studies from 12 countries, 17 showed an association between obesity and periodontitis (odds ratios ranged from 1.1 to 4.5). The obesity indicators of body mass index, waist circumference, waist-hip ratio and body fat percentage were significantly associated with measures of periodontitis of bleeding on probing, plaque index, probing depths, clinical attachment loss, calculus, oral hygiene index and community periodontal index. Two prospective cohort studies in the review showed no significant association between obesity and periodontitis, but these studies had limitations of study design and used inappropriate epidemiological diagnostic measures of periodontitis.

CONCLUSION

There was evidence to suggest that obesity is associated with periodontitis in adolescents and young adults. Systematic Review Registration: PROSPERO Registration Number: CRD42016046507.

Impact of General and Oral Complications of Diabetes Mellitus Type I on Lebanese Children's Quality of Life

Introduction

Diabetes mellitus type I (DM1) has been increasing at an alarming rate worldwide. Children suffering from this chronic disease are subject to a high risk of systemic and oral complications, due to their young age and the lack of awareness of the relation between diabetes and oral health.

Objective

The aim of this study is to evaluate the impact of oral and general complications of DM1 on the Lebanese children's quality of life. The goal was to assess the child's behavioral issues on the one hand and the oral issues on the other.

Materials and methods

About 37 diabetic Lebanese children aged between 6 and 12 years, recruited from the Chronic Care Center (CCC), answered two questionnaires, one related to the disease and the second related to the oral complications.

Results

A majority of the participants (81.1%) are aware of their disease, 73% know the importance of their treatment and 54.1% are able to control their glycemia; 45.9% are not annoyed with constantly carrying a monitor and 67.5% are bothered by their restricted diet. Only 5.4% of children isolate themselves.

Concerning the oral complications

About 83.8% of the children do not suffer from oral ulcers, 56.8% are caries-free, and 64.9% have completed their dental treatment; 89.2% do not complain while eating and 94.6% are not able to brush their teeth properly.

Conclusion

Diabetic patients are found to have good knowledge of the disease and its systemic complications but a little on their increased risk for oral diseases. In order to ensure a good quality of life for the diabetic children and their families, optimal control of diabetes, appropriate oral hygiene, and regular visits to the dentist must be respected.How to cite this article: Noueiri B, Nassif N, Ollek A. Impact of General and Oral Complications of Diabetes Mellitus Type I on Lebanese Children's Quality of Life. Int J Clin Pediatr Dent 2018;11(1):40-45.

EB 2017 Article: Changes in advanced glycation end products, beta-defensin-3, and interleukin-17 during diabetic periodontitis development in rhesus monkeys

The bidirectional relationship between diabetes mellitus (DM) and periodontal disease has drawn great attention; however, the mechanisms underlying their association remain unclear. In this study, we aimed to develop a rhesus monkey model of diabetic periodontitis and explore the potential mechanisms by which DM affects the progression of periodontal disease. Three healthy rhesus monkeys were selected as the control group. Five streptozotocin-induced diabetic rhesus monkeys were chosen as the experimental group. Ligature placement was used to induce periodontitis. The changes in the levels of advanced glycation end products (AGEs), beta-defensin-3 (BD-3), and interleukin-17 (IL-17) were measured using enzyme-linked immunosorbent assays (ELISA) and real-time reverse transcription polymerase chain reaction (RT-PCR) at different stages during disease progression. Periodontitis was confirmed by clinical assessment, radiographic images, and histological examination. Significant changes in the levels of AGEs and BD-3 in serum were observed at the periodontitis stage in diabetic rhesus monkeys ( P < 0.05). The expression of BD-3 mRNA in the gingiva of diabetic group at baseline was significantly high ( P < 0.05). Diabetic monkeys exhibited significantly enhanced IL-17 mRNA expression at the periodontitis stage ( P < 0.05). Our findings indicated that the rhesus monkey can serve as an ideal model for exploring the pathogenesis of diabetic periodontitis, and the hyperglycemic environment may accelerate inflammatory response and weaken the defense system in periodontal tissues. Impact statement The mechanism underlying the association between diabetes mellitus (DM) and periodontal disease is not yet fully understood. Hence, there is a need to establish animal models to reveal the effect of DM on the pathogenesis of periodontitis. In this study, we explored the appropriate methods for inducing periodontitis and shortening the modeling time in rhesus monkeys, to investigate the pathogenesis of diabetic periodontitis and develop innovative therapies. Our results suggest that a hyperglycemic environment might lead to the destruction of periodontal tissues by accelerating inflammatory response and weakening the defense system in periodontal tissues. Therefore, this study has significant treatment implications regarding the regulation of the immune response against periodontal diseases in patients with DM.

Green tea prevents vascular disturbs and attenuates periodontal breakdown in long-term hyperglycaemia in T1D rats

AIM

The effects of green tea on the modulation of vascularization during the progression of spontaneous periodontitis in long-term hyperglycaemia in streptozotocin-induced type 1 diabetic (T1D) rats were evaluated.

MATERIALS AND METHODS

Wistar rats normoglycaemic (NG) and T1D were divided into two control groups, which received water (NG-W and T1D-W) and two experimental groups that received green tea (NG-GT and T1D-GT). Periodontal structures were evaluated by microtomographic and histological analyses. Number of immunostained cells for VEGF (NcVEGF+/mm² ) and CD31 (NcCD31+/mm² ), as well microvessel density (MVD) in the periodontal ligament (PDL) were evaluated.

RESULTS

Long-term hyperglycaemia in T1D-W rats induced vascular alterations in PDL with a reduction of 36% in MVD, a decrease of 33% in NcCD31+/mm² and an increase of 53% in NcVEGF+/mm² . Concomitantly, a severe degree of periodontitis with higher reduction in bone volume and periodontal bone level was observed. In T1D-GT, green tea maintained the MVD, NcCD31+/mm² and NcVEGF+/mm² in the PDL similar to normoglycaemic groups. Clinically, in T1D-GT rats, green tea reduced dental plaque accumulation and the degree of periodontitis when compared to T1D-W.

CONCLUSION

Daily green tea consumption has a therapeutic effect on the diabetic vascular disorder in PDL and the progression of periodontitis in long-term hyperglycaemia in T1D rats.

Scientific evidence on the links between periodontal diseases and diabetes: Consensus report and guidelines of the joint workshop on periodontal diseases and diabetes by the International diabetes Federation and the European Federation of Periodontology

BACKGROUND

Diabetes and periodontitis are chronic non-communicable diseases independently associated with mortality and have a bidirectional relationship.

AIMS

To update the evidence for their epidemiological and mechanistic associations and re-examine the impact of effective periodontal therapy upon metabolic control (glycated haemoglobin, HbA1C).

EPIDEMIOLOGY

There is strong evidence that people with periodontitis have elevated risk for dysglycaemia and insulin resistance. Cohort studies among people with diabetes demonstrate significantly higher HbA1C levels in patients with periodontitis (versus periodontally healthy patients), but there are insufficient data among people with type 1 diabetes. Periodontitis is also associated with an increased risk of incident type 2 diabetes.

MECHANISMS

Mechanistic links between periodontitis and diabetes involve elevations in interleukin (IL)-1-β, tumour necrosis factor-α, IL-6, receptor activator of nuclear factor-kappa B ligand/osteoprotegerin ratio, oxidative stress and Toll-like receptor (TLR) 2/4 expression.

INTERVENTIONS

Periodontal therapy is safe and effective in people with diabetes, and it is associated with reductions in HbA1C of 0.27-0.48% after 3 months, although studies involving longer-term follow-up are inconclusive.

CONCLUSIONS

The European Federation of Periodontology (EFP) and the International Diabetes Federation (IDF) report consensus guidelines for physicians, oral healthcare professionals and patients to improve early diagnosis, prevention and comanagement of diabetes and periodontitis.

Odontal-Periodontal Changes in Patients with Type 1 Diabetes

ABSTRACT: Diabetes mellitus is a complex disease characterized by insufficient insulin secretion and / or an inefficiency of target tissues to its metabolic action. Periodontal disease was recognized as the sixth leading complication of a diabetes. Gingival sulcus bleeding is considered as an important clinical parameter in the diagnosis of periodontal disease. This research is based on comparison of the clinical and paraclinical data between groups of patients with type 1 diabetes and periodontal disease on the one hand and groups of patients with periodontal disease without diabetic disease on the other hand. We can conclude that there is sufficient data to confirm the existence of a bidirectional relationship between metabolic changes in type 1 diabetes and periodontal (odontal-periodontal) disorder of patients, especially in adolescents and young adults. Both diseases can influence each other more or less, so for diabetics there is a predilection to develop periodontal disease as diabetes is a risk factor for severe parodontopathies.

Scientific evidence on the links between periodontal diseases and diabetes: Consensus report and guidelines of the joint workshop on periodontal diseases and diabetes by the International Diabetes Federation and the European Federation of Periodontology

BACKGROUND

Diabetes and periodontitis are chronic non-communicable diseases independently associated with mortality and have a bidirectional relationship.

AIMS

To update the evidence for their epidemiological and mechanistic associations and re-examine the impact of effective periodontal therapy upon metabolic control (glycated haemoglobin, HbA1C).

EPIDEMIOLOGY

There is strong evidence that people with periodontitis have elevated risk for dysglycaemia and insulin resistance. Cohort studies among people with diabetes demonstrate significantly higher HbA1C levels in patients with periodontitis (versus periodontally healthy patients), but there are insufficient data among people with type 1 diabetes. Periodontitis is also associated with an increased risk of incident type 2 diabetes.

MECHANISMS

Mechanistic links between periodontitis and diabetes involve elevations in interleukin (IL)-1-β, tumour necrosis factor-α, IL-6, receptor activator of nuclear factor-kappa B ligand/osteoprotegerin ratio, oxidative stress and Toll-like receptor (TLR) 2/4 expression.

INTERVENTIONS

Periodontal therapy is safe and effective in people with diabetes, and it is associated with reductions in HbA1C of 0.27-0.48% after 3 months, although studies involving longer-term follow-up are inconclusive.

CONCLUSIONS

The European Federation of Periodontology (EFP) and the International Diabetes Federation (IDF) report consensus guidelines for physicians, oral healthcare professionals and patients to improve early diagnosis, prevention and comanagement of diabetes and periodontitis.

Oral health status of children with type 1 diabetes: a comparative study

BACKGROUND

The aim of this study was to compare the oral health status of children with type 1 diabetes and healthy controls.

METHODS

This comparative study involved 64 children, 32 children with type 1 diabetes and 32 age- and gender-matched controls. Oral health examination was conducted using WHO criteria. Dental caries experience was recorded using DMFT/dmft index and periodontal parameters were assessed using plaque, gingivitis, gingival bleeding and calculus indexes. Dental caries and periodontal parameters between the two groups were compared using the Mann-Whitney U-test.

RESULTS

Children with diabetes exhibited significantly greater plaque deposits (p=0.01) and a higher mean plaque index (p<0.01), when compared to healthy subjects. No significant difference in DMFT and dmft scores, mean bleeding index, calculus index and gingival index was found between the two groups.

CONCLUSIONS

Children with type 1 diabetes had a poor oral health status with greater plaque accumulation than children without diabetes.

Association between numbers of decayed teeth and HbA1c in Japanese patients with type 2 diabetes mellitus

BACKGROUND

Dental caries (DC) are more prevalent in individuals with diabetes than in healthy individuals. However, the association between glycaemic control and DC has not been well characterized in patients with type 2 diabetes mellitus (T2DM). We therefore assessed the association between glycated haemoglobin (HbA1c) serum concentrations and the prevalence of DC in patients with T2DM.

METHODS

Retrospective analyses of data pertaining to 108 Japanese patients with T2DM hospitalized because of poor or worsened glycaemic control were included. We divided the patients based on HbA1c into two groups: HbA1c level ≥75 mmol/mol (9.0%) as poorly controlled T2DM, and HbA1c level <75 mmol/mol (9.0%) as a control group. We compared the association of lifestyle factors, dental caries, and periodontal health between patients with poorly controlled T2DM and controls. Stepwise multiple regression analyses were performed to evaluate the association between HbA1c, the absolute number of decayed teeth (DT), the sum of decayed, missing, and filled teeth, and the Met Need Index (MNI).

RESULTS

DT was higher and MNI was lower in patients with poorly controlled T2DM as compared to that in controls (P = 0.006 and P = 0.004, respectively). Multiple regression analyses revealed a significant association between HbA1c levels and DT (adjusted β = 0.039, 95% confidence interval [CI], 0.005 to 0.072, P = 0.025) and the MNI (adjusted β = -0.216, 95% CI -0.374 to -0.058, P = 0.008).

CONCLUSIONS

DT and MNI were associated with HbA1c in T2DM patients.