Oral manifestations of Diabetes Mellitus. A systematic review

Association between dietary fiber to carbohydrate ratio and risk of dental caries in diabetic patients: an analysis of the National Health and Nutrition Examination Survey 2015-2020

Aim

People with diabetes mellitus have a higher risk of dental caries than the general population. Diet is one of the most important factors affecting the risk of dental caries. This study aimed to evaluate the effect of dietary fiber to carbohydrate ratio (FCR) on the risk of dental caries in diabetic patients.

Methods

Data of this cross-sectional study were extracted from the 2015-2020 cycle of the National Health and Nutrition Examination Survey (NHANES) database. FCR levels were divided into two categories based on the median (0.13). The outcomes were untreated dental caries and dental caries experience. The associations of FCR with untreated dental caries and dental caries experience were assessed using multivariable logistic regression analysis and reported as odds ratio (OR) and 95% confidence interval (CI). Stratified analyses were performed according to age (<65 and ≥ 65 years), gender (female and male), hypertension (yes and no), and the ratio of family income to poverty (PIR, <1 and ≥ 1).

Results

A total of 2,412 patients diagnosed with diabetes were included, of whom 728 (30.18%) had untreated dental caries and 2,104 (87.23%) had dental caries experience. Patients with FCR ≥0.13 were correlated with lower odds of untreated dental caries (OR = 0.72, 95%CI: 0.52-0.99) and dental caries experience (OR = 0.63, 95%CI: 0.42-0.93) compared to patients with FCR <0.13. Stratified analyses demonstrated that patients with FCR ≥0.13 were found to be related to lower odds of untreated dental caries in those aged <65 years (OR = 0.64, 95%CI: 0.42-0.97), female (OR = 0.57, 95%CI: 0.35-0.93), with hypertension (OR = 0.66, 95%CI: 0.45-0.96), and PIR ≥1 (OR = 0.64, 95%CI: 0.42-0.99). Similar results to untreated dental caries were observed in the analysis of dental caries experience (p < 0.05).

Conclusion

High levels of FCR may be associated with a lower risk of dental caries in patients with diabetes. Increasing the proportion of dietary fiber intake among diabetic patients may help prevent the occurrence of dental caries.

Poor glycemic control impairs oral health in children with type 1 diabetes mellitus - a systematic review and meta-analysis

OBJECTIVE

There are more than one million children and adolescents living with type 1 diabetes mellitus, and their number is steadily increasing. Diabetes affects oral health through numerous channels, including hyposalivation, immune suppression, and the inflammatory effect of glycation end-products. However, patients with type 1 diabetes must follow a strict sugar free diet that is proven to be carioprotective. Therefore, the aim of this systematic review and meta-analysis is to investigate whether children with type 1 diabetes have a difference in Decayed, Missing, Filled Teeth index (DMFT), salivary function, and periodontal status than children without diabetes, with an emphasis on glycemic control.

MATERIALS AND METHODS

PubMed, Embase and Cochrane libraries were screened for articles, using predefined search keys without any language or date restrictions. Two independent authors performed the selection procedure, extracted data from the eligible articles, carried out a manual search of the reference lists, and assessed the risk of bias using the Newcastle-Ottawa scale. Meta-analysis was performed in R using the random-effects model. Effect sizes were mean differences; subgroup analysis was performed on glycemic control.

RESULTS

33 studies satisfied the eligibility criteria. 22 studies did not show a significant difference regarding the DMFT index between the diabetes and non-diabetes groups; six studies found that children living with diabetes had higher DMFT scores, compared to five studies that found significantly lower scores. Meta-analysis found no statistically significant differences in plaque, gingival, and calculus indexes, however it found significant differences in pooled DMFT indexes, and salivary flow rate. Subgroup analysis on glycemic control using DMFT values found significant differences in children with good and poor glycemic control with results of 0.26 (CI95%=-0.50; 1.03) and 1.46 (CI95%=0.57; 2.35), respectively.

CONCLUSIONS

Children with poor glycemic control face higher risk of developing caries compared to good control and non-diabetes children. Regular dental check-ups and strict control of glycemic levels are highly advised for children living with type 1 diabetes, further emphasizing the importance of cooperation between dentists and diabetologists.

The interplay between gingival crevicular fluid microbiome and metabolomic profile in intensively treated people with type 1 diabetes - a combined metagenomic/metabolomic approach cross-sectional study

Aims

This study aimed to assess the gingival crevicular fluid (GCF) microbiome and metabolome of adults with type 1 diabetes (T1D) treated with continuous subcutaneous insulin infusion (CSII).

Methods

In this cross-sectional study, the GCF of adults with T1D treated with CSII and non-diabetic controls were sampled, and metagenomic/metabolomic analyses were performed.

Results

In total, 65 participants with T1D and 45 healthy controls with a mean age of 27.05 ± 5.95 years were investigated. There were 22 cases of mild gingivitis (G) in the T1D group. There were no differences considering the Shannon and Chao indices and β-diversity between people with T1D and G, with T1D without G, and healthy controls. Differential taxa were identified, which were mainly enriched in people with T1D and G. Acetic acid concentration was higher in people with T1D, regardless of the presence of G, than in healthy controls. Propionic acid was higher in people with T1D and G than in healthy controls. Isobutyric and isovaleric acid levels were higher in individuals with T1D and G than in the other two subgroups. The concentration of valeric acid was lower and that of caproic acid was higher in people with T1D (regardless of gingival status) than in healthy controls.

Conclusions

The identification of early changes in periodontal tissues by targeting the microbiome and metabolome could potentially enable effective prevention and initial treatment of periodontal disease in people with T1D.

[Knowledge level of periodontal health in students of health sciences. a cross-sectional study]

Introduction

Periodontal disease is a multifactorial chronic inflammatory disease, so knowledge about this disease is important for health professionals for an assertive and early diagnosis.

Objective

Determine the level of knowledge about periodontal health in Health Sciences students at a private university in Lima-Perú.

Materials and Methods

Through a descriptive and cross-sectional study, 200 students from the Faculty of Health Sciences were evaluated. The sample size was obtained using a proportion estimation formula. The level of knowledge about periodontal health was measured using a specific virtual and self-applicable questionnaire, which was fully validated. University students of legal age and who signed the informed consent were included. This consisted of 16 questions about the causes, signs, prevention habits and relationship with systemic diseases related to periodontal disease. The data were analyzed using descriptive statistics (absolute and relative frequencies) and means and averages for age.

Results

The level of knowledge was medium in 38%, high in 32.5% and low in 29.5% of the students surveyed. 96.5% knew that periodontal disease is preventable; However, 91.5% do not know what its main clinical sign is.

Conclusions

The use of a self-applicable and specific questionnaire is beneficial to evaluate and measure knowledge about periodontal health, and the Health Sciences students evaluated have a medium level of knowledge about periodontal health.

The relationship with and effect of oral microbiota on NLRP3 inflammatory pathway in type 2 diabetes mellitus

OBJECTIVE

The aim of this study was to explore the correlation between oral microbiota and NLRP3 inflammasome in type 2 diabetes, and to preliminarily explore their possible impact on type 2 diabetes.

DESIGN

The 16S rDNA sequencing technique was used to analyze the microbial composition in the saliva of patients with T2DM and healthy people. Real-time quantitative PCR (RT-qPCR) was used to detect the expression levels of T2DM-related inflammatory cytokines in the blood of two groups.

RESULTS

The relative abundances of Fusobacteriota and Campilobacterota in the saliva of patients with T2DM were lower than those of healthy people (P < 0.05), whereas the relative abundance of Proteobacteria in patients with T2DM was higher than that of healthy people (P < 0.05). In addition, real-time quantitative PCR results showed changes in inflammasome-associated factors in the blood of patients with T2DM and healthy people. Compared with healthy individuals, the relative expression levels of lipopolysaccharide (LPS), apoptosis-associated point-like protein (ASC), Caspase-1, Caspase-11, nucleotide-binding oligomerization domain-like receptor family pyrin domain containing 3 (NLRP3), and interleukin (IL)-1β were significantly higher in the blood of patients with T2DM, whereas the expression level of insulin receptor substrate-1 (IRS-1) was reduced (P < 0.05).

CONCLUSIONS

Our research suggested that changes in the ratio of oral microbial taxa might increase the expression levels of inflammatory and T2DM-related factors by activating the NLRP3 inflammasome pathway. This discovery indicated the imbalance in oral microbiota might have a certain influence on diabetes by triggering an inflammatory response, and provided a new idea for the relationship between T2DM and oral microbiota.

Teeth Rehabilitation and Nutritional Influence on Diabetic Patients: A Review

Diabetes mellitus (DM) is a globally prevalent endocrine and metabolic disorder characterized by hyperglycemia. Its complications significantly impact both the quality and longevity of the patient's life with a substantial burden on the healthcare system. Missing teeth make individuals more susceptible to malnutrition compared to those with functional teeth. This is especially true for people with diabetes, as the condition is closely linked to both oral health and food intake. Natural teeth loss can significantly reduce an individual's ability to chew food, leading to a decrease in the quality and quantity of their nutrition. Prosthodontics is a dental specialty that replaces missing teeth with artificial ones. Replacing missing teeth may prevent the risk of malnutrition due to decreased ability to chew. Good oral health is important for overall health, especially for those with conditions such as diabetes. Artificial teeth replacement may improve nutrition intake by improving chewing ability. Therefore, the ultimate objective of rehabilitating a patient's oral cavity is to replace the shape and function in terms of chewing performance to a degree that is as close to normal as feasible. The purpose of this review is to explore the literature showing the link between natural teeth loss and nutrition in individuals with DM, with a special focus on prosthodontic management. Several oral complications occur in diabetic patients specifically teeth loss, which in turn affects mastication function. This in turn cause malnutrition and affect glucose level. It is imperative for healthcare providers to take an interdisciplinary approach in order to improve the dental and nutritional status and overall well-being of DM patients.

Epigenetic changes underlie the association between diabetes mellitus and oral diseases

Patients with diabetes mellitus (DM) suffer from oral complications related to oral infections, periodontal diseases, and endodontic lesions. Emerging evidence has revealed the contribution of the epigenetic process as the underlying mechanism of DM complications. DNA methylation, histone modifications, and non-coding RNAs are epigenetic regulators that directly affect gene expression. The present review elaborated on the role of epigenetic dysregulation in the etiology of diabetes-related periodontal and endodontic diseases. The narrative review study was prepared using databases such as PubMed, Google Scholar, Science Direct, and Scopus. The formation of glycation products as a result of hyperglycemic condition increases oxidative stress, and elevates chronic inflammatory mediators that could in turn adversely change the cellular environment and alter the epigenetic status. This process contributes to the alteration of regulatory genes expression, leading to the development of diabetes-induced bone complications and impaired odontogenic capacity of pulp. Indeed, epigenetic mechanisms mediate the interaction between gene expression and DM cellular environment. Further investigations on epigenetic factors involved in DM oral complications may provide novel therapeutic targets.

The Associations of Auto-Brewery Syndrome and Diabetes Mellitus: A Literature Review and Clinical Perspective

Endogenous production of alcohol without the external intake of alcohol is called auto-brewery syndrome (ABS), and to get its levels to rise to a level that it has physical symptoms of alcohol intake is rare. The most common cause of ABS is the metabolism of ingested carbohydrates by intestinal microflora. This occurrence does not happen in all normal individuals but only in some high-risk individuals. Patients with diabetes mellitus (DM) have been hypothesized to be at high risk for ABS. We searched databases, such as PubMed, Medline, and PubMed Central, to search for existing literature with relevant keywords. In the finalized review, we have included 30 relevant articles. Alcohol formed in the gut gets absorbed in the bloodstream and immediately gets metabolized, so usually it does not achieve a level in blood high enough to cause symptoms. In high-risk patients, there is an increase in the level of bloodstream alcohol above a certain level, so it shows symptoms. Because there is higher blood glucose in DM, the patients have been shown to be at increased risk for developing ABS. Similarly, obesity is also a risk factor for DM, making it a high-risk condition for ABS. The most involved pathogens are Candida and Saccharomyces.

Oral Manifestations of Type II Diabetes Mellitus and Comparison of Blood and Salivary Glucose Levels

Background and introduction Diabetes mellitus is a common systemic disease in nearly all countries. Its prevalence has been increasing. Thus, early detection and control of this disorder are urgent tasks. The average blood glucose, salivary glucose, and glycosylated hemoglobin (HbA1c) levels must be estimated. Aim and objective This study aimed to assess oral manifestations of type 2 diabetes mellitus in relation to HbA1c and compare glucose levels in the saliva and blood. Materials and methods This study examined 60 patients with diabetes who were visiting the Department of Oral Medicine and Radiology as well as the Department of Medicine at Vinayaka Mission's Sankarachariyar Dental College, Salem, Tamil Nadu, India. In all patients, the blood glucose, saliva glucose, and HbA1c levels were estimated. Results and statistical analysis The patients (aged 40-60 years) have type 2 diabetes mellitus; among them, patients aged 56-60 years were predominant. In the Pearson correlation analysis, a positive correlation was obtained in random blood glucose, salivary glucose, and HbA1c levels. The p-value was 0.001**, which indicated significance. Conclusion This study revealed a clear-cut correlation between blood and salivary glucose levels. Thus, salivary glucose levels can very well become a substitute for blood glucose levels. If the estimated salivary glucose level is used in practice to estimate glucose levels in patients with diabetes, the use of any invasive procedures may be avoided.

Impact of oral intervention on the oral and overall health of children living with HIV in Cambodia: a randomized controlled trial

BACKGROUND

Maintaining oral health is essential for improving overall health of children living with HIV. Therefore, we evaluated the effectiveness of an oral health intervention for improving their oral and overall health. In addition, we examined their longitudinal association between changes in oral and overall health.

METHODS

We conducted a 2-year randomized controlled trial involving children living with HIV in Cambodia. Children aged 3-15 years and their caregivers were randomly allocated either to the intervention (group A) or control (group B) arm. A second control arm (group C) included children without HIV. The group A children received oral health education sessions and practiced home-based daily care.

RESULTS

In the baseline survey, 482 children participated (group A: n = 160, group B: n = 168, group C: n = 154), and 350 completed the endline survey. An interaction effect in teeth brushing duration was observed in children in group A relative to group B (AOR = 2.69, 95% CI: 1.37-5.31) and group C (AOR = 3.78, 95% CI: 1.70-8.40). Longitudinal associations were observed between changes in oral hygiene and overall health, as presented by alterations in dental caries in permanent teeth with viral load detection (adjusted odds ratio = 3.58, 95% CI: 1.10 - 11.73), in salivary flow quantity with the overall quality of life (β = 0.07, 95% CI: < 0.01 - 0.13), as well as in dental caries, salivary pH, debris index with body mass index for age among group A children.

CONCLUSIONS

Oral health intervention may improve oral care behaviors and potentially enhance overall health among children living with HIV in antiretroviral therapy in a resource-constrained setting.

TRIAL REGISTRATION

ISRCTN 15177479.

Feasibility of a nursing guide for the oral management of outpatients with diabetes mellitus

Support for nurses is necessary to enable them to practice the oral management of patients with diabetes; however, no support for nurses in this context has been reported. The objective of this study was to verify the feasibility of a nursing guide for the oral management of outpatients with type 2 diabetes, aimed at giving nurses the ability to independently practice oral management for patients with diabetes in an outpatient department. Questionnaires were administered to 25 certified diabetes educator nurses from 54 medical facilities. The evaluation and degree of understanding of the guide were assessed using items in the nursing guide. In addition, opinions and impressions about the guide in the form of free responses were requested. Descriptive statistics were calculated for all measured variables, and data gathered from the free responses were divided into categories based on their similarities and differences. The feasibility of the nursing guide was confirmed, and nurses confidently provided education regarding oral management to patients with diabetes using the guide. These results suggest that a guide may improve nurses' knowledge, skills, and confidence in providing patient education and improve the overall practice of oral management. Further improvements based on the opinions of nurses, such as the expression of terms, implementation of checklists for oral assessment, and identification of devices that can be utilized in a shorter time, are needed to facilitate the implementation of the guide into practice by nurses.

Preoperative HbA1c and Blood Glucose Measurements in Diabetes Mellitus before Oral Surgery and Implantology Treatments

Diabetes mellitus has become a worldwide epidemic and is frequently accompanied by a number of complications proportional to the duration of hyperglycemia. The aim of this narrative review is to assess the most up-to-date guidelines on DM provided by both diabetes and dental associations. Furthermore, to gather evidence on the uni/bidirectional relationships of elevated HbA1c levels on dental surgery, implantology, bone augmentation, and periodontology and to demonstrate the importance of measuring HbA1c levels before invasive dental treatments. HbA1c and blood glucose measurements are a minimally invasive method for preventing complications in diabetes mellitus. The authors conducted a literature review to determine which oral conditions are affected by diabetes mellitus. MEDLINE served as a source with the use of a specific search key. Regarding oral complications of diabetes, prevention is the most vital factor. With this publication, we hope to assist physicians and dentists to make prompt diagnoses and to help in recognizing various oral manifestations of diabetes and follow the existing guidelines.

Dysbiosis of Oral Microbiota and Metabolite Profiles Associated with Type 2 Diabetes Mellitus

Several previous studies have shown that oral microbial disorders may be closely related to the occurrence and development of type 2 diabetes mellitus (T2DM). However, whether the function of oral microorganisms and their metabolites have changed in patients with T2DM who have not suffered from any oral diseases has not been reported. We performed metagenomic analyses and nontargeted metabolic analysis of saliva and supragingival plaque samples from patients with T2DM who have not suffered any oral diseases and normal controls. We found that periodontal pathogens such as Porphyromonas gingivalis and Prevotella melaninogenica were significantly enriched, while the abundances of dental caries pathogens such as Streptococcus mutans and Streptococcus sobrinus were not significantly different in patients with T2DM compared to those in normal controls. Metabolomic analyses showed that the salivary levels of cadaverine and L-(+)-leucine of patients with T2DM were significantly higher than those of normal controls, while the supragingival plaque levels of N-acetyldopamine and 3,4-dimethylbenzoic acid in patients with T2DM were significantly higher than those in the normal controls. Additionally, we identified the types of oral microorganisms related to the changes in the levels of circulating metabolites, and the oral microorganisms were involved in the dysregulation of harmful metabolites such as cadaverine and n, n-dimethylarginine. Overall, our study first described the changes in the composition of oral microorganisms and their metabolites in patients with T2DM who have not suffered any oral diseases, which will provide a direct basis for finding oral biomarkers for early warning of oral diseases in T2DM. IMPORTANCE The incidence of oral diseases in type 2 diabetic patients might increase, and the severity might also be more serious. At present, the relationship between oral microorganisms and type 2 diabetes mellitus (T2DM) has become a hot topic in systemic health research. However, whether the function of oral microorganisms and their metabolites have changed in patients with T2DM who have not suffered from any oral diseases has not been reported. We found that even if the oral condition of T2DM is healthy, their oral microbes and metabolites have changed, thus increasing the risk of periodontal disease. Our study first described the changes in the composition of oral microorganisms and their metabolites in T2DM who have not suffered any oral diseases and revealed the correlation between oral microorganisms and their metabolites, which will provide a direct basis for finding oral biomarkers for early warning of oral diseases in patients with T2DM.

Proinflammatory Cytokine Expression in Apical Periodontitis from Diabetic Patients

Diabetes mellitus has been regarded as a condition capable of influencing the evolution of periapical lesions. Therefore, this study evaluated the immunoexpression of IL-1β, TNF-α, and IL-17 in apical periodontitis from type 2 diabetic patients through immunohistochemistry. Twenty-six periapical lesions were selected, and the images obtained through immunohistochemistry reactions were analyzed. The statistical significance was set at p < 0.05. IL-1β expression was considered focal (54%), weak to moderate (38%), and strong (8%) in diabetics, and focal (46%), weak to moderate (31%), and strong (23%), in controls. TNF-α was focal (85%) and weak to moderate (15%) in diabetics, and focal (92%) and weak to moderate (8%), in controls. IL-17 was focal (8%), weak to moderate (46%), and strong (46%) in diabetics, and focal (62%), weak to moderate (8%), and strong (30%), in controls. The quantitative analysis revealed greater expression of IL-17, with a significant difference between IL-17 × IL-1β × TNF-α(p=0.0009) in the diabetic group. The cytokines IL-1β and TNF-α did not express statistical differences between the tested groups. The IL-17 showed higher immunoexpression in the diabetic group (p=0.047), which may suggest higher bone resorption activity in chronic apical periodontitis in this group of patients.

Diabetes linked oral complications in south Indian cohorts

Diabetes is characterized by elevated blood sugar and insulin resistance. In poorly controlled or uncontrolled diabetes, persistent hyperglycemia causes oral and systemic problems. Therefore, it is of interest to evaluate biochemical indicators for oral health and diabetes using a fully automatic biochemistry analyzer which separates patient serum from blood samples. Data shows that diabetic oral complex patients showed high RBS, HbA1c, FBS, and PBSS. Thus, dental condition is linked to diabetes.

Oral Microbiota-One Habitat or Diverse Niches? A Pilot Study of Sampling and Identification of Oral Bacterial and Fungal Biota in Patients with Type I Diabetes Mellitus Treated with Insulin Pump

OBJECTIVE

The oral microbiota is a very complex and dynamic microbial ecosystem. Alterations of its balance can result in oral and systemic diseases. We aimed to characterize the microbiota in particular niches of the oral cavity in adult type 1 diabetes patients treated with continuous infusion of insulin with insulin pump (IP). In addition, we aimed to determine optimal sites of oral microbiota sampling in studies of large research groups of patients with DM I.

DESIGN

In this pilot study, we sampled the buccal and soft palate mucosa, tongue, palatal and buccal dental surfaces and gingival pockets of adult DM I patients treated with IP.

RESULTS

In total, 23 patients were recruited. The oral microbiota was dominated by Streptococus and Neisseria, with a low incidence of cariogenic S. mutans and Lactobacillus, as well as periodontal pathogens such as Prevotella. There were significant differences in overall CFU counts of all strains, Gram-positive, Staphylococci, Streptococci and S. oralis strains between mucosal and dental surface sites. The overall CFU counts of all strains and Gram-positive strains were higher in dental sites vs. mucosal sites (both p < 0.001). CFU counts of S. oralis were significantly higher in dental sites vs. gingival pocket sites (p = 0.013). Candida species were rare. The mucosal sites on the buccae presented lower diversity and bacterial counts.

CONCLUSIONS

In the study group of adult DM I patients treated with IP, the microbiota in particular niches of the oral cavity was significantly different. Three distinct and optimally appropriate sampling sites for oral microflora were identified: buccal and palatal mucosa, dental surface and gingival pockets. The results of this study may be the basis for further studies of large groups of patients with DM I.

Reduced Number of Remaining or Healthy Teeth in Patients with Type 2 Diabetes Mellitus: A Cross-sectional Study Assessed by Dentists or Dental Hygienists in Japan

Objective This study assessed the relationships between oral health (number of remaining and healthy teeth and periodontal disease) and type 2 diabetes mellitus (T2DM) to contribute to improved patient care. Patients We conducted a cross-sectional cohort study of consecutive patients being regularly treated for chronic diseases (T2DM, hypertension, and dyslipidemia). A dentist or dental hygienist accurately evaluated the oral environment. Patients with fewer than 20 teeth were classified as having reduced remaining teeth (RRT). Results A total of 267 patients were enrolled, including 153 patients (57%) with T2DM and 114 without (43%). Patients with T2DM had 3 fewer remaining teeth on average than those without DM [median: 22 (interquartile range (IQR): 11-27) vs. median: 25 (IQR: 17.3-28), p=0.02]. In addition, patients with T2DM had 4 fewer healthy teeth on average than those without DM [median: 8 (IQR: 2.8-15) vs. median: 12 (IQR: 6-16), p=0.02]. The frequency of RRT was higher in the T2DM group (n=63; 41%) than in the non-DM group (n=31; 27%, p=0.02). Multivariable logistic regression for the presence of RRT in the T2DM group found that age [odds ratio (OR), 1.08; 95% confidence interval (CI), 1.03-1.13; p<0.01] and regular dental consultations (OR, 0.28; 95% CI, 0.10-0.76; p=0.01) were independently and significantly associated. Conclusion The number of remaining or healthy teeth was significantly lower in patients with T2DM than in those without T2DM in current Japanese clinical practice. Regular dental consultation is recommended to preserve remaining teeth in patients with T2DM.

Association between Apical Periodontitis and Chronic Diseases: An Umbrella Review

Introduction

To assess the methodological quality of systematic reviews (SRs) that evaluated the association between apical periodontitis (AP) and chronic diseases.

Materials and Methods

A systematic search was performed in the databases PubMed, Virtual Health Library, Scopus, Cochrane Library, Embase, Web of Science and Open Grey. SRs that evaluated the association between any chronic disease and AP, and that had performed a valid risk of bias assessment were included. The AMSTAR-2 tool was used for quality assessment and each included systematic review received a final categorization as having "high", "moderate", "low", or "critically low" quality.

Results

Nine studies that met the eligibility criteria were included. The diseases investigated were cardiovascular diseases, diabetes mellitus, HIV, osteoporosis, chronic liver disease, blood disorders and autoimmune diseases. The systematic reviews included in this umbrella review showed a 'low' to 'high' quality of evidence.

Conclusion

There are substantial heterogeneity and several methodological concerns in the included studies. It was observed a positive association between diabetes mellitus and apical periodontitis with limited evidence, no association between HIV and apical periodontitis and a positive association between apical periodontitis and cardiovascular disease, blood disorders, chronic liver disease, osteoporosis and autoimmune diseases with moderate evidence.

Progress in salivary glands: Endocrine glands with immune functions

The production and secretion of saliva is an essential function of the salivary glands. Saliva is a complicated liquid with different functions, including moistening, digestion, mineralization, lubrication, and mucosal protection. This review focuses on the mechanism and neural regulation of salivary secretion, and saliva is secreted in response to various stimuli, including odor, taste, vision, and mastication. The chemical and physical properties of saliva change dynamically during physiological and pathophysiological processes. Moreover, the central nervous system modulates salivary secretion and function via various neurotransmitters and neuroreceptors. Smell, vision, and taste have been investigated for the connection between salivation and brain function. The immune and endocrine functions of the salivary glands have been explored recently. Salivary glands play an essential role in innate and adaptive immunity and protection. Various immune cells such as B cells, T cells, macrophages, and dendritic cells, as well as immunoglobins like IgA and IgG have been found in salivary glands. Evidence supports the synthesis of corticosterone, testosterone, and melatonin in salivary glands. Saliva contains many potential biomarkers derived from epithelial cells, gingival crevicular fluid, and serum. High level of matrix metalloproteinases and cytokines are potential markers for oral carcinoma, infectious disease in the oral cavity, and systemic disease. Further research is required to monitor and predict potential salivary biomarkers for health and disease in clinical practice and precision medicine.

Factors Influencing the Survival Rate of Teeth and Implants in Patients after Tumor Therapy to the Head and Neck Region-Part 1: Tooth Survival

We aimed to evaluate possible factors influencing the long-term survival of teeth after tumor therapy (TT) to the head and neck region with and without radiation. Between January 2019 and January 2020, patients who underwent TT for head and neck cancer and received dental treatment before and after TT at the Department of Prosthetic Dentistry of the Martin Luther University Halle-Wittenberg were enrolled in the study. Clinical examination with assessment of dental status and stimulated salivary flow rate (SFR) was performed and information about disease progression and therapy was retrieved from medical records. Of 118 patients (male: 70.3%; mean age: 63.2 ± 12.4 years), 95 received radiotherapy (RT), and 47 were administered radio-chemotherapy (RCT). The teeth of irradiated patients exhibited a lower 5-year survival probability (74.2%) than those of non-irradiated patients (89.4%). The risk of loss (RL) after RT increased with nicotine use, presence of intraoral defects, reduced SFR, RCT and regarding mandibular teeth, and decreased with crowning following TT. Lower SFR increased the RL even without RT. Consideration of patient's treatment history, individual risk profile, and clinical findings during the prosthetic planning phase could enable earlier, more targeted dental treatment after TT (e.g., timely crowning).

Impact of hyperglycemia on the expression of GLUT1 during oral carcinogenesis in rats

BACKGROUND

On the background of the epidemiological link between diabetes and oral cancer, the present study aimed to analyze the potential involvement of selected glucose transporters (GLUT1/GLUT3/GLUT4), if any, in such putative association.

METHODS AND RESULTS

Oral carcinogenesis was induced by 4-nitroquinoline N-oxide in 10 non-diabetic and 10 diabetic rats; 8 non-diabetic and 7 diabetic rats served as controls. Expressions of selected GLUTs at mRNA and protein levels were analyzed in oral tissue (normal/lesion) by quantitative real-time PCR and immunohistochemistry respectively. Premalignant lesions (hyperplasia/dysplasia/carcinoma-in-situ) appeared on tongues of carcinogen-treated animals. Significant increase of GLUT1mRNA level was seen from normal to lesion tongues, along increasing lesion grades (from hyperplasia/mild dysplasia to moderate/severe dysplasia) and in lesions induced under hyperglycemic condition than that induced under normoglycemic one; a similar trend was found in transcript variant-1 of GLUT1, but not in variant-2. GLUT3 and GLUT4 mRNA levels were comparable among lesions irrespective of grades and glycemic status. Concordant to mRNA level, overall expression of GLUT1 protein was higher in tongue lesions in presence of hyperglycemia than in absence of such condition; non-lesion portions of tongues exposed to carcinogen showed a similar trend. Moreover in carcinogen-treated groups, non-lesion and lesion portions of tongues under hyperglycemic condition showed predominantly membranous expression for GLUT1 which was again significantly higher than equivalent portions of tongue under normoglycemic condition.

CONCLUSION

Hyperglycemia seemed to favor GLUT1 over-expression and membrane localization of the protein during oral carcinogenesis. GLUT1 transcript variant-1 appeared to be more important than variant-2 in disease pathogenesis.

Genetic Cross-Talk between Oral Squamous Cell Carcinoma and Type 2 Diabetes: The Potential Role of Immunity

Background. This bioinformatics study was aimed at evaluating type 2 diabetes (T2D) and oral squamous cell carcinoma (OSCC) with regard to related immune cells and prognosis. Methods. We downloaded the data on OSCC from TCGA and for T2D from GEO database. Differentially expressed genes were analyzed, i.e., for OSCC genes with $p\text{value}<0.01$ , $\left|\log 2\left(\text{FC}\right)\right|>0$ ; and for T2D, genes with $p\text{value}<0.05$ , $\left|\log 2\left(\text{FC}\right)\right|>0$ . The intersected genes between OSCC and T2D were cross-talk genes. The expression values of immune-related genes in case samples in OSCC and T2D were assessed and underwent multivariate and univariate analysis (Cox-PH model). The intersection between the immune genes and cross-talk genes was taken and further analyzed by recursive feature elimination (RFE), survival analysis, and ROC analysis. Results. 1008 cross-talk genes were acquired, including 28 common upregulated, 440 common downregulated, and 540 differently regulated DEGs. We extracted the gene expression value of 782 immune-related genes, of which seven increased immune cells were obtained. From the results, plasmacytoid dendritic cells and effector memory CD8 T cells were highly negatively correlated in both OSCC and T2D. After estimating a low- and high-risk model for survival, we found that activated dendritic cell was significantly different between high and low groups ( $p=0.0095$ ), followed by plasmacytoid dendritic cell. We integrated DE_Immune genes set 1 and DE_Immune genes set 2 and eight key immune-related cross-talk genes (C1QC, ABCD1, NOS2, PDIA4, IL1RN, ALOX15, CSE1L, and PSMC4) were evaluated. After ROC analysis, we obtained that ABCD1, C1QC, CSE1L, and PSMC4 had higher classification and prediction effects on OSCC and T2D. Conclusion. This study revealed a close relationship between T2D and OSCC. Thereby, plasmacytoid dendritic cell and activated dendritic cell-related genes were associated with the survival of T2D-related OSCC, while ABCD1, C1QC, CSE1L, and PSMC4 were the most important immune-related cross-talk genes.

Effect of Morbidities, Depression, Anxiety, and Stress on Oral Health-Related Quality of Life among Migrant Elderly Following Children in Weifang, China

This study explored the relationship between depression, anxiety, stress, morbidity, and oral health-related quality of life (OHRQoL) in the migrant elderly following children (MEFC) in Weifang, China. A total of 613 MEFC were selected using multistage cluster random sampling. The GOHAI scale was used to evaluate oral health-related quality of life. The DASS-21 scale was used to assess levels of depression, anxiety, and stress. Univariate analysis and binary logistic regression were used to analyze the correlation between these indicators and oral health-related quality of life, of which 43.9% were classified as having poor oral health. Logistic regression analysis showed that the MEFC who were of older age (OR = 0.965, p = 0.039), with hypertension (OR = 0.567, p = 0.004), with gastroenteropathy (OR = 0.263, p = 0.007), had received an outpatient service in the past year (OR = 0.669, p = 0.048), were depressed (OR = 0.338, p = 0.012), and anxious (OR = 0.414, p = 0.026) were less likely to report good oral health status. On the other hand, the MEFC with a high school education or above (OR = 1.872, p = 0.020) were more likely to report good oral health than those with primary school education and below. In conclusion, with regard to depression, anxiety, and stress: the results indicated that the fewer morbidities, the lower the level of depression and anxiety and the better the OHRQoL of MEFC. Targeted measures for government, communities, and family members were given to improve the OHRQoL of MEFC.

Platycodin D Alleviates High-Glucose-Aggravated Inflammatory Responses in Oral Mucosal Cells by PI3K/mTOR Pathway

Oral mucosal diseases account for an increasing proportion of hμMan diseases. Among the many common risk factors that cause oral diseases and systemic diseases, dietary factors, especially high sugar, are particularly prominent. Exhibiting therapeutic potential in treating certain inflammation-related diseases, platycodin D (PD) has been known to possess anti-inflammatory benefits in cases of cytokine-induced inflammation, a fact that has been widely docμMented. However, there are few studies about PD in the oral mucosal disease. Investigating the effect of PD on high-glucose (HG)-induced inflammatory responses in oral mucosal cells was the endeavor of this study. The results revealed that HG induced cell mortality, promoted activity of inflammatory factor (TNF-α, IL-1β, IL-6, and IL-8), and increased ROS production in oral mucosal cells. Interestingly, PD obviously alleviated HG-induced oral mucosal cells inflammatory response. Simultaneously, the expressions of PI3K and mTOR were inhibited by PD. In addition, the activation of PI3K and mTOR decreased the protective effect of PD on oral mucosal cells. To conclude, the PI3K/mTOR signaling pathway was found to be inactivated, thereby restraining the activation of the full immune cell by inhibition of the pro-inflammatory cytokines, as revealed by the results indicating the prevention of the HG-induced inflammation response by PD.

A validated instrument to assess dentists’ knowledge about diabetes

Aim: To elaborate and validate an instrument for Brazilian Portuguese speakers, to assess dentists’ knowledge about care of patients with diabetes mellitus (Dental-Diabetes). Methods: Methodological study comprising four stages: a) Elaboration of instrument; b) Content validation (computing Content Validity Index - CVI) based on Expert Committee assessment; c) Pre-test with 30 dentists, followed by assessment of suggestions by Expert Committee; d) Psychometric validation through instrument application in a sample of 127 dentists by means of the web tool e-Surv. Cronbach’s alpha and intraclass correlation coefficients were used to evaluate, respectively, internal consistency and reproducibility. Results: The final version of the instrument consists of 22 questions (7 on sociodemographic data and 15 querying dentists’ knowledge) and those submitted for validation attained a CVI of 0.95 [95% CI 0.916-0,981], showing satisfactory internal consistency, with 0.794 Cronbach’s alpha [95% CI 0.741-0.842] and an intraclass correlation coefficient of 0.799 [95% CI: 0.746-0.846] between the test and retest scores. Conclusions: Dental-Diabetes is a comprehensive instrument, culturally adequate and validated to assess dentists’ knowledge about care of patients with diabetes.

Glycyrrhizic acid ameliorates submandibular gland oxidative stress, autophagy and vascular dysfunction in rat model of type 1 diabetes

The burden of diabetes mellitus (DM) and associated complications is increasing worldwide, affecting many organ functionalities including submandibular glands (SMG). The present study aims to investigate the potential ameliorative effect of glycyrrhizic acid (GA) on diabetes-induced SMG damage. Experimental evaluation of GA treatment was conducted on a rat model of type I diabetes. Animals were assigned to three groups; control, diabetic and GA treated diabetic groups. After 8 weeks, the SMG was processed for assessment of oxidative stress markers, autophagy related proteins; LC3, Beclin-1 and P62, vascular regulator ET-1, aquaporins (AQPs 1.4 and 5), SIRT1 protein expressions in addition to LC3 and AQP5 mRNA expressions. Also, parenchymal structures of the SMG were examined. GA alleviated the diabetes-induced SMG damage via restoring the SMG levels of oxidative stress markers and ET-1 almost near to the normal levels most probably via regulation of SIRT1, AQPs and accordingly LC-3, P62 and Beclin-1levels. GA could be a promising candidate for the treatment of diabetes-induced SMG damage via regulating oxidative stress, autophagy and angiogenesis.

Artesunate Combined With Metformin Ameliorate on Diabetes-Induced Xerostomia by Mitigating Superior Salivatory Nucleus and Salivary Glands Injury in Type 2 Diabetic Rats via the PI3K/AKT Pathway

Polydipsia and xerostomia are the most common complications that seriously affect oral health in patients with diabetes. However, to date, there is no effective treatment for diabetic xerostomia. Recent studies have reported that artesunate (ART) and metformin (Met) improve salivary gland (SG) hypofunction in murine Sjögren's syndrome. Therefore, aim of this study was to investigate the effect and underlying mechanism of artesunate (ART) alone and in combination with metformin (Met) on hyposalivation in type 2 diabetes mellitus (T2DM) rats. T2DM rats were induced using a high-fat diet and streptozotocin. SPF male Sprague-Dawley rats were divided into the following five groups: normal control group, untreated diabetic group, ART-treated diabetic group (50 mg/kg), Met-treated diabetic group (150 mg/kg), and ART/Met co-treated diabetic group (50 mg/kg ART and 150 mg/kg Met). ART and Met were intragastrically administered daily for 4 weeks. The general conditions, diabetes parameters and serum lipids were evaluated after drug treatment. Furthermore, we observed changes in the central superior salivatory nucleus (SSN) and SG, and changes in the AQP5 expression, parasympathetic innervation (AChE and BDNF expression), and PI3K/AKT pathway- (p-AKT, and p-PI3K), apoptosis- (Bax, Bcl-2, and Caspase3), and autophagy- (LC3 and P62) related markers expression in T2DM rats after treatment. Our results showed that ART or Met alone and ART/Met combination attenuated a range of diabetic symptoms, including weight loss, urine volume increase, water consumption increase, hyperglycemia, insulin resistance, glucose intolerance and dyslipidemia. More importantly, we found that these three treatments, especially ART/Met combination, mitigated hyposalivation in the T2DM rats via improving the central SSN and SGs damage in hyperglycemia. Our data also indicated that ART/Met attenuated SG damage though regulating the PI3K/Akt pathway to inhibit apoptosis and autophagy of SGs in the T2DM rats. Moreover, ART/Met preserved parasympathetic innervation (AChE and BDNF expression) in SGs to alleviate diabetes-induced hyposalivation likely through rescuing central SSN damage. Taken together, these findings might provide a novel rationale and treatment strategy for future treatment of diabetes-induced xerostomia in the clinic.

Oral Health among Adult Residents in Vilnius, Lithuania

According to the World Health Organization (WHO) oral conditions may be determined by social, biological, behavioral, and psychosocial factors. The study assessed oral health status and its determinants associated with oral health conditions among adult residents in Vilnius, Lithuania. A total of 453 of 35–74-year-olds participated (response rate 63%). A self-reported questionnaire was administered. Dental caries experience (D₃MFS score), periodontal probing depth (PPD), andnumber of missing teeth were assessed clinically. Data were analyzed using χ² test, independent samples t-test, and multivariable linear regression. The mean (sd) of D₃MFS scores was 67.3 (33.5), the mean (sd) number of teeth with PPD 4+ mm was 5.9 (5.3), prevalence of periodontitis was 33%, the mean (sd) number of missing teeth was 6.9 (6.8), and prevalence of total edentulism was 3.8%. Medication use was associated with all oral health conditions, while age was associated with caries experience, and missing teeth. Sugar-containing diet was associated with caries experience, and missing teeth, and smoking with caries experience and periodontal status. Systemic diseases were associated with periodontal status, while behavioral determinants, last dental visit, and use of fluoridated toothpaste were associated with missing teeth. Oral health status among adult Vilnius residents was poor. Oral conditions were associated with both biological and behavioral determinants. Oral health promotion should focus on modifying behavioral determinants.

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

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

THE IMPACT OF THE DIABETES ON ORAL HEALTH - AN OBSERVATIONAL STUDY

OBJECTIVE

The aim: To evaluate the impact of diabetes mellitus on the oral health.

PATIENTS AND METHODS

Materials and methods: This is an observational study. In the present research were taken into consideration 300 patients. The study sample consisted of 191 males, respectively (63.7%) of them and 109 females (36.3%) of the participants.

RESULTS

Results: In the current study, we analyzed the oral health of diabetic patients within the age class of 11-80 years. We divided them into seven age groups: 11-20, 21-30, 31-40, 41-50, 51-60, 61-70, and 71-80 years. Based on the results of the current study it was observed that 83.7% of patients were affected by gingivitis. The results of our study show that dental caries prevalence was 68.7 % and the prevalence of missing teeth among patients with diabetes mellitus was 78.7%. According to the ANOVA test, high blood sugar values had a direct impact on the manifestation of gingivitis and there it was a strong correlation between them P-value = .000. Males with diabetes mellitus were more affected by dental caries and this was indicated by the P-value= .02, in comparison to females who recorded a P-value = .03. The relation between gender males and missing teeth was highly significant P-value = .001.

CONCLUSION

Conclusions: The present study proved that diabetes mellitus is risk factor for oral health. The authors studied this group of patients exposed to high blood glucose levels and found out that oral diseases were high in these patients.

Impact of the Glycemic Level on the Salivary Proteome of Middle-Aged and Elderly People With Type 2 Diabetes Mellitus: An Observational Study

Type 2 diabetes mellitus (T2DM) is an increasing global public health concern, but its impact on the salivary proteome is still unclear. To evaluate the effect of glycemic levels in middle-aged and elderly individuals with T2DM on salivary proteomics, we compared the differences by liquid chromatography tandem mass spectrometry (LC–MS/MS). Unstimulated whole saliva samples from 8 T2DM patients with good glycemic control (G group, HbA1c <6.5%) and 16 patients with poor control (P group, HbA1c ≥6.5%) were analyzed by LC–MS/MS in the data-independent acquisition mode (Clinical register number: ChiCTR1900023582.). After functional annotation, cluster analysis and receiver operating characteristic (ROC) curve analysis were carried out to screen and evaluate candidate proteins. A total of 5,721 proteins were quantified, while 40 proteins differed significantly. In the P group, proteins involved in oxidative stress-related processes were upregulated, whereas proteins related to salivary secretion were downregulated. The combination of thioredoxin domain-containing protein 17, zymogen granule protein 16B, and FAM3 metabolism regulating signaling molecule D yielded an area under the curve of 0.917 which showed a robust ability to distinguish the P and G groups. In conclusion, poorly controlled hyperglycemia may affect salivary proteins through various pathways, including oxidative stress and glandular secretion. Furthermore, the differentially expressed proteins, especially the three proteins with the best differentiation, might serve as an anchor point for the further study of hyperglycemia and oral diseases.

A Cross-Sectional Study of the Association Between Chronic Oral Disease Burden and Serum Biomarkers in Kidney Transplant Recipients

INTRODUCTION

Poor oral health can negatively affect general health and quality of life of kidney transplant recipients. The study aimed to investigate the association between chronic oral disease burden, serum biomarkers, and comorbidities in kidney transplant recipients.

DESIGN

A cross-sectional comparative study was conducted with 44 patients after kidney transplant. The burden of chronic oral disease was composed of the following observable variables: moderate periodontitis and presence of dental caries. Serum biomarkers and comorbidities data were collected. The chi-square or Fisher's exact tests for categorical variables and Student's t-test or Mann-Whitney test for continuous variables were used. Robust Poisson regression was used to model the association.

RESULTS

Higher levels of mean uric acid (P = .01) and creatinine (P = .03) were observed in the group of patients with oral disease burden, while the highest level of high-density lipoprotein was observed in the group without oral disease. Higher values of uric acid were associated with the occurrence of chronic oral disease burden (Adjusted PR = 1.24, 95% CI: 1.03-1.48, P = .019). There was no statistical difference between the groups with and without oral disease burden in comorbidities present.

CONCLUSION

The findings suggest that chronic oral diseases burden can be associated with uric acid and creatinine levels in kidney transplant recipients.

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.

Association between Smokeless Tobacco Use and Risk of Periodontitis in Asian Countries: A Systematic Review and Meta-Analysis

BACKGROUND

Individual studies conducted in Asian countries have reported higher risk of periodontitis among smokeless tobacco (SLT) users in comparison to non-users. Therefore, a systematic review was conducted to summarize the available evidence on this topic.

METHODS

Prominent electronic databases were searched using pre-decided MeSH terms and keywords. Screening of titles and abstracts, full text reading, quality assessment and data extraction was done by two investigators independently. The Newcastle-Ottawa scale was used for risk of bias assessment of eligible studies. Meta-analysis was performed for four periodontal outcomes (periodontal pocket depth, loss of attachment, clinical attachment level and gingival recession). A sensitivity analysis was also performed.

RESULTS

Of the 546 citations, 367 were screened for eligibility. Finally, 89 studies were shortlisted for full text reading, of which, 36 were found eligible for qualitative analysis. Most of the studies were conducted in India (n=22), were of cross-sectional design (n=33), utilized purposive sampling and 24 studies were included for meta-analysis (n=28) and done on hospital-based population (n=26). Only 13 (37.1%) studies achieved a score of more than 50% (5/10 stars) on quality assessment scale. SLT users had higher odds of greater periodontal pocket depth greater than 4 mm (OR=3.64), gingival recession (OR=1.71) and loss of attachment 4-5 mm (OR=2.83) and mean difference of 1.7 mm for Clinical Attachment Level compared to non-users.

CONCLUSION

The studies included in this review suggests that SLT users have poorer periodontal health in comparison to non-users. But most of this evidence comes from cross-sectional studies. Longitudinal studies with rigorous methodology are required to support this elucidation. Registration: This systematic review protocol has been registered in PROSPERO (CRD42019122964).

Methylmercury-Induced Toxicopathologic Findings in Salivary Glands of Offspring Rats After Gestational and Lactational Exposure

Methylmercury (MeHg) is one of the main global pollutants. The vulnerability of fetus and newborn to MeHg-induced changes is extensively reported, making relevant investigation possible for alternative sample matrix for human biological monitoring for at this stage of life. This study aimed to characterize tissue change effects of environmental-experimental MeHg on salivary glands of offspring rats after pre- and postnatal exposure. For this, pregnant Wistar rats were orally exposed to MeHg (40 μg/kg BW/day) or only vehicle (control group), from the gestational period to the end of the lactation period. Salivary glands (SG) were collected from the offspring to analyze possible Hg levels and main findings by histopathological evaluations and CK19 and α-SMA immunostaining. The results indicated that Hg levels in SG of intoxicated offspring were associated with histologic abnormalities, such as acinar atrophy and an increase in the intercellular matrix among the acini, as well as damages in the architecture of epithelium and myoepithelial cells, evidenced by a decrease in immunostaining area. Thus, this is the first study to show in the literature the toxicopathologic findings on SG of offspring after pre- and postnatal exposure to MeHg. Moreover, it presents the SG as an attractive target to futures studies, mainly in children exposed to environmentally relevant doses.

Analysis of Healthy Lifestyle Habits and Oral Health in a Patient Sample at the Dental Hospital of the University of Barcelona

The association between general health and oral health has been studied over recent years. In order to evaluate the lifestyle and the presence of healthy habits, a descriptive observational study was conducted from December 2018 to April 2019 with 230 patients, aged from 18 to 65 years old, that attended the Dental Hospital of the University of Barcelona for the first time. A total of 230 participants were considered, 98 (43%) were men and 132 (57%) were women, with a mean age of 37 years old. Our hypothesis was that patients with healthy habits had a better oral status in comparison with patients with bad lifestyle habits. No statistically significant results were found regarding oral hygiene between gender, smokers and patients with systemic pathology. Regarding a healthy lifestyle (High adherence to dietary intake), no statistically significant results were found. No significant differences were found regarding physical activity between male and female patients. Our hypothesis wasn't confirmed; therefore, we cannot conclude that patients with healthy habits have better oral status in comparison with patients with bad lifestyle habits. Consequently, more prospective longitudinal studies should be carried out.

Comparison of the effect of ginger and aloe vera mouthwashes on xerostomia in patients with type 2 diabetes: A clinical trial, triple-blind

BACKGROUND

Ginger and aloe vera are two medicinal herbs mostly used to produce mouthwash. This study aimed to compare the effects of ginger and aloe vera mouthwashes on the xerostomia in patients referred to Bandar Abbas diabetes clinic (Iran).

MATERIAL AND METHODS

In this triple-blind clinical trial, three groups (n=35 patients in each group) were studied. One group was given aloe vera mouthwash, the other group used ginger mouthwash, and the control group was only given normal saline. All the mouthwashes were used 20 ccs three times daily for 14 consecutive days. The symptoms and severity of xerostomia were measured before and after the intervention by the questionnaire proposed by Fox et al. as well as VAS scale, respectively. Statistical analysis, including the Shapiro-Wilk test used to measure the normality of variables, and Chi-square and McNemar used to compare the scores questionnaire proposed by Fox et al., were also applied. Scores of VAS were analyzed using a one-way ANOVA test. P<0.05 was considered as statistically significant in all these tests.

RESULTS

The mean age of the participants included in the normal saline group was 58.13±14.75 years old, 54.14±9.35 years old in the ginger group, and 53.37±11.57 years old in the aloe vera group. The difference between the scores of xerostomia before and after performing the intervention (The amount of reduction in xerostomia) in the ginger group was 6.12±2.004 cm, in the aloe vera group it was 4.08±2.09 cm, and in the normal saline group it was 2.45±2.09 cm. Finally, the ginger and aloe vera mouthwashes significantly reduced all symptoms and severity related to xerostomia, respectively(p<0.001).

CONCLUSIONS

The use of mouthwash is an effective measure to reduce xerostomia under chronic conditions. Aloe vera, ginger, and normal saline are known as effective mouthwashes on controlling this complication. According to the results of this study, ginger and aloe vera mouthwashes could significantly decrease xerostomia and promote oral health in patients with diabetes.

Type 2 diabetes and its characteristics are associated with poor oral health: findings from 60,590 senior women from the E3N study

BACKGROUND

Type 2 diabetes (T2D) has been identified as a risk factor for poor oral health, however, a limited number of oral health and T2D characteristics have been studied so far. We sought to assess T2D status, age at diagnosis, duration since diagnosis and treatment in relation to a variety of oral diseases.

METHODS

Cross-sectional data were analyzed from the E3N (Etude Epidémiologique auprès de femmes de l'Education Nationale) cohort study which enrolled 60,590 women. Participants self-reported oral health status, and T2D cases were identified using diabetes-specific questionnaires and drug reimbursement insurance databases. Multivariable-adjusted ORs and 95% CIs were estimated using logistic regression models.

RESULTS

The mean age (SD) of the women was 70 years (7.2), and 4.7% (n = 2857) had T2D. Compared to women without T2D, women with T2D were more likely to report a poor perceived oral health (OR 1.37 [95% CI 1.18, 1.60]), wearing dental prostheses (1.26 [1.14, 1.39]) and having problems of biting and chewing food (1.19 [1.07, 1.33]). In addition, for women with T2D the age at diagnosis (inversely) and the duration (positively) were associated with the likelihood to report poor oral health.

CONCLUSIONS

For women with T2D, duration and age at diagnosis are associated with wearing prostheses, problems of biting and chewing, periodontitis and gingivitis.

Impact of COVID-19 Pandemic on Quality of Life of Type II Diabetes Patients With Periodontitis

Background: Confinement due to the COVID-19 pandemic has made dental treatments impossible in Chile and many other countries, including diabetic patients with periodontitis. The aim of the present study was to evaluate the impact of periodontal therapy in terms of oral health-related quality of life (OHRQoL) during the COVID-19 pandemic in a cohort of diabetic patients with periodontitis. Material and Methods: Thirty-eight diabetic patients with stage III-IV periodontitis, enrolled for periodontal therapy, were screened. Periodontal clinical parameters including clinical attachment loss (CAL), probing pocket depth (PPD) and bleeding on probing (BOP) as well as glycated hemoglobin (HbA1c) were evaluated at baseline and 3 months follow-up prior the pandemic. The OHRQoL changes by means of Oral Health Impact Profile (OHIP-14) and a self-reported oral health questionnaire were assessed at baseline (prior pandemic) and during the pandemic via telemonitoring. Results: Thirty-one patients received non-surgical periodontal therapy prior to the pandemic. Out of the 31 patients, four died due to COVID-19 resulting in 27 patients available for telemonitoring at the time of the pandemic. Periodontal therapy significantly improved CAL, PPD and BOP (p < 0.05) but not HbA1c (p > 0.05) between baseline and 3 months follow-up pior to the pandemic. Total OHIP-14 scores significantly improved between baseline and the middle of pandemic (intragroup comparison p = 0.00411). In particular, OHIP-14 scores related to the "Physical pain" (intragroup comparison p = 0.04) and "Psychological disability" (intragroup comparison p = 0.00) significantly improved between baseline and the middle of pandemic. Conclusions: In diabetic type II patients with periodontitis periodontal therapy tends to improve the oral health-related quality of life despite the COVID-19 pandemic.

Potential Pathogenicity of Candida Species Isolated from Oral Cavity of Patients with Diabetes Mellitus

INTRODUCTION

In the recent decade, the increased immunocompromised population such as diabetic patients makes a high incidence of invasive Candida infections. Diabetes mellitus is the most common endocrine metabolic disorder, and diabetic patients are more susceptible to oral candidiasis infection. Candidiasis is an opportunistic fungal infection caused by many species of Candida. Secretion of exoenzymes plays an important role in the virulence and pathogenesis of Candida species. The aim of this study was to evaluate the potential role of phospholipase, esterase, and hemolytic activity of Candida species isolated from oral cavity lesions of diabetic patients.

METHODS

A total of 108 Candida species including 75 Candida albicans and 33 non-Candida albicans species were recovered from the oral cavity of diabetic patients included in our study. Egg yolk agar, Tween 80 opacity medium, and blood agar plate assays were used for determining phospholipase, esterase, and hemolytic activities, respectively.

RESULTS

Candida albicans species had the most exoenzyme activity in comparison to non-albicans isolates. Candida albicans isolates showed 97.3%, 100%, and 77.3% phospholipase, hemolysin, and esterase activities, respectively. The difference between Candida albicans and non-Candida albicans was significant in phospholipase (P < 0.001) and hemolytic activity (P = 0.027), but not significant in esterase activity (P = 0.076).

CONCLUSION

This study showed that most of the isolates had different enzymatic patterns, and Candida albicans isolates had the most exoenzyme activity. So due to the potential effects of these enzymes in pathogenesis and virulence effects of Candida species, we can conclude that the severity of extracellular enzymes may play a role in the severity of signs and symptoms of Candida oral cavity infections in diabetic patients.

Maintaining Digestive Health in Diabetes: The Role of the Gut Microbiome and the Challenge of Functional Foods

Over the last decades, the incidence of diabetes has increased in developed countries and beyond the genetic impact, environmental factors, which can trigger the activation of the gut immune system, seem to affect the induction of the disease process. Since the composition of the gut microbiome might disturb the normal interaction with the immune system and contribute to altered immune responses, the restoration of normal microbiota composition constitutes a new target for the prevention and treatment of diabetes. Thus, the interaction of gut microbiome and diabetes, focusing on mechanisms connecting gut microbiota with the occurrence of the disorder, is discussed in the present review. Finally, the challenge of functional food diet on maintaining intestinal health and microbial flora diversity and functionality, as a potential tool for the onset inhibition and management of the disease, is highlighted by reporting key animal studies and clinical trials. Early onset of the disease in the oral cavity is an important factor for the incorporation of a functional food diet in daily routine.

Computed tomography texture analysis of mandibular condylar bone marrow in diabetes mellitus patients

OBJECTIVES

Diabetes mellitus (DM) is associated with a broad range of complications, such as retinopathy, nephropathy, neuropathy, and cardiovascular disease. Therefore, predicting DM from head and neck images is a challenge for clinicians. The purpose of this study was to assess the mandibular condylar bone marrow in DM patients using computed tomography (CT) texture analysis.

METHODS

This retrospective study included 16 DM and age and sex matched 16 control patients (11 men, 5 women; mean age, 56.8 ± 14.4 years; range 31-78 years). Patients with Type I DM, prior history of taking bisphosphonates, osteoarthritis of the temporomandibular joint, and CT images with metal artifacts were excluded from this study. Bilateral mandibular condylar bone marrow was manually contoured on axial CT images. The presence or absence of DM is the primary predictor variable. Texture features of the region of interest was the outcome variable, that were analyzed using an open-access software, MaZda Ver.3.3. For each group, 20 features out of 279 parameters were selected with Fisher, probability of error and average correlation coefficient methods in MaZda. Bivariate statistics were computed with the Mann-Whitney U test and the P value was set at .05.

RESULTS

One histogram feature, 15 Gy level co-occurrence matrix features, and four gray level run length matrix features showed differences between the DM patients and non-DM patients (P < 0.05).

CONCLUSIONS

Several texture features of the condyle demonstrated differences between the DM and non-DM patients. CT texture analysis may potentially detect DM from the condylar bone marrow.

Sex Differences in Oral Health and the Consumption of Sugary Diets in a Saudi Arabian Population

BACKGROUND AND PURPOSE

Adolescence is a crucial period for developing healthy lifestyle and dietary habits. The growing consumption of high-sugar foods and beverages constitutes a serious public health concern. The aim of this study was to evaluate sex differences in the consumption of a sugary diet and oral health among Saudi adolescents.

SUBJECTS AND METHODS

This cross-sectional study was conducted in the Eastern Province of the Kingdom of Saudi Arabia between January and February 2019. A multistage sampling technique was used to recruit 2265 middle-school children aged 12-16 years. Data were collected via the Food Frequency Questionnaire and via an oral health examination, using the WHO criteria. The chi-squared test, Student's t-test, and Mann-Whitney U-test were used to investigate the associations between the study variables.

RESULTS

The most consumed foods and beverages reported were water, juices, and biscuits (90%), while the least consumed were energy drinks and jams. A significant difference was found between males and females in the frequency of consumed sugary foods (P=0.01) and the quantity of consumed sugary beverages (P=0.000); males over all consumption were greater than their counterpart. However, no differences were found between sexes in the frequency of sugary drink consumption (P=0.2). The decayed-missing-filled index score was significantly higher in females (4.29 ± 3.44) than in males (3.61 ± 3.14; P=0.001). The mean plaque index among males and females was 1.72 (±0.79) and 1.20 (±0.78), respectively, while the mean gingival index was 1.31 (±0.77) in males and 0.69 (±0.73) in females-a statistically significant difference (P=0.001).

CONCLUSION

Sex differences were found in sugary diet consumption and oral health status. Thus, policy makers are encouraged to consider sex-based differences when planning preventative programs and initiatives. Nevertheless, further research is needed on the dietary intake patterns of young adults.

Oral Health Messiers: Diabetes Mellitus Relevance

This article aims to narrate the various oral complications in individuals suffering from diabetes mellitus. Google search for "diabetes mellitus and oral complications" was done. The search was also carried out for "diabetes mellitus" and its oral complications individually. Diabetes mellitus is a chronic metabolic disorder that is a global epidemic and a common cause of morbidity and mortality in the world today. Currently, there are about 422 million cases of diabetes mellitus worldwide. Diabetic patients can develop different complications in the body such as retinopathy, neuropathy, nephropathy, cardiovascular disease. Complications in the oral cavity have been observed in individuals suffering from diabetes mellitus. A study noted that more than 90% of diabetic patients suffered from oral complications. Another research has shown a greater prevalence of oral mucosal disorders in patients with diabetes mellitus than non-diabetic population: 45-88% in patients with type 2 diabetes compared to 38.3-45% in non-diabetic subjects and 44.7% in type 1 diabetic individuals compared to 25% in the non-diabetic population. Oral complications in people with diabetes are periodontal disease, dental caries, oral infections, salivary dysfunction, taste dysfunction, delayed wound healing, tongue abnormalities, halitosis, and lichen planus. The high glucose level in saliva, poor neutrophil function, neuropathy, and small vessel damage contribute to oral complications in individuals with uncontrolled diabetes. Good oral health is imperative for healthy living. Oral complications cause deterioration to the quality of life in diabetic patients. Complications like periodontal disease having a bidirectional relationship with diabetes mellitus even contribute to increased blood glucose levels in people with diabetes. This article intends to promote awareness regarding the oral health of diabetics and to stress the importance of maintaining proper oral hygiene, taking preventive measures, early detection, and appropriate management of oral complications of these patients through a multidisciplinary approach.

Ultrastructural analysis of bone formation around dental implants in nondiabetic rats, severe diabetics not controlled and controlled with insulin

Purpose:

To evaluate bone formation through ultrastructural analysis around titanium implants in severe alloxanic uncontrolled diabetic rats, and controlled with insulin, in comparison with nondiabetic rats.

Methods:

Thirty-six male Wistar rats, weighing between 200 and 300 g, divided into three experimental groups: normal control group (G1), a diabetic group without treatment (G2), and a diabetic group treated with insulin (G3). The animals received titanium implants in the right femur, and osseointegration was evaluated at 7, 14, and 21 days after surgery, through ultrastructural analysis using scanning electron microscopy.

Results:

The ultrastructural analysis showed a dense bone structure in the G1, few empty spaces and a small number of proteoglycans; G2 presented bone matrix with a loose aspect, irregular arrangement, thin trabeculae, empty spaces and a large number of proteoglycans; G3 obtained similar results to G1, however with a higher number of proteoglycans.

Conclusion:

Severe diabetes caused ultrastructural changes in bone formation, and insulin therapy allowed an improvement in osseointegration, but it was not possible to reach the results obtained in the control group.

Evaluation of Dental Health in Terminally Ill Patients

Dental health plays an imperative role in the general health and well-being of an individual. Terminally ill patients due to a compromised immune response are susceptible to a wide array of oral complications, which may affect their ability to speak and chew, leading to malnutrition. The present study was conducted to evaluate dental health and various oral manifestations in terminally ill patients. One hundred twenty terminally ill patients hospitalized with diseases of the respiratory tract, gastrointestinal tract, circulatory system, liver, and endocrinal disorders were included in the study. The evaluation of oral manifestations and their prevalence was done by a single examiner. The oral health was evaluated according to symptoms exhibited by the patients and clinical presentation. Of the patients included in the study, 78 were male, and 42 were female. All the individuals were adults between 25 to 55 years of age. Out of 120 admitted terminally ill patients, 27 subjects had respiratory diseases, 17 had gastrointestinal disorders, 5 had disorders of the circulatory system, 39 had liver disorders, and 32 had endocrine disorders. A need for added comprehension is mandatory to link the inter-relationships between dentistry and medicine to further perk up the management of the overall health of patients, which will further reinforce the partnership between dental and medical communities.

Estimation and correlation of serum and salivary glucose and immunoglobulin A levels and salivary candidal carriage in diabetic and non-diabetic patients

Background. A correlation has been noted between diabetes mellitus (DM) and changes in the oral cavity. The present study aimed to estimate, compare, and correlate serum and salivary glucose and IgA levels and salivary candidal carriage in diabetic and non-diabetic individuals. Methods. Eighty-eight subjects were categorized into three groups: group 1 (controlled DM; n=27), group 2 (uncontrolled DM; n=32) and group 3 (non-diabetics; n=29). Serum and salivary glucose levels were estimated by glucose oxidase/peroxidase method, serum and salivary IgA by a diagnostic kit, and candidal colonization by inoculating samples into Sabouraud dextrose agar plate. Statistical analyses were carried out by one-way ANOVA, post hoc Tukey tests, and Pearson's correlation coefficient. Results. Significant elevation of serum IgA levels was observed in group 2 compared to group 3 and significant decreases in salivary IgA levels in groups 1 and 2. The candidal carriage was significantly higher in group 2 compared to group 3. Serum glucose and salivary IgA levels showed a significant correlation in group 1. There was a positive correlation between serum/ salivary glucose and serum/salivary IgA levels in group 2. In addition, there was a significant correlation between serum glucose and serum IgA levels in group 3. Conclusion. Saliva could be a potential, non-invasive diagnostic tool to estimate glucose levels. The evaluation of salivary components, like IgA, might be useful in diagnosing and managing oral manifestations in diabetic individuals. Elevated salivary glucose levels contribute to elevated candidal carriage, making individuals susceptible to oral candidiasis.