Salivary alterations in relation to metabolic control in children and adolescents with type 1 diabetes

Doctoral Dissertation uoadl:2867316 95 Read counter

Department of Dentistry
Βιβλιοθήκη Οδοντιατρικής
Deposit date:
Pappa Eftychia
Dissertation committee:
Ελένη Βασταρδή, Επίκουρη Καθηγήτρια, Τμήμα Οδοντιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ
Κωνσταντίνος Βουγάς, Ερευνητής Β’ Ιδρύματος Ιατροβιολογικών Ερευνών, Ακαδημία Αθηνών
Ευθυμία Κιτράκη, Καθηγήτρια, Τμήμα Οδοντιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ
Αντωνία Βλάχου, Ειδική Λειτουργική Επιστήμονας Α’ Ιδρύματος Ιατροβιολογικών Ερευνών, Ακαδημία Αθηνών
Αθανάσιος Αρμακόλας, Αναπληρωτής Καθηγητής, Τμήμα Ιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ
Αντώνης Σταματάκης, Αναπληρωτής Καθηγητής, Τμήμα Νοσηλευτικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ
Χρίστος Ραχιώτης, Αναπληρωτής Καθηγητής, Τμήμα Οδοντιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ
Original Title:
Μεταβολές των ποιοτικών και βιοχημικών χαρακτηριστικών του σάλιου σε συσχέτιση με τη μεταβολική ρύθμιση σε παιδιά και εφήβους με διαβήτη τύπου 1
Translated title:
Salivary alterations in relation to metabolic control in children and adolescents with type 1 diabetes
This thesis focuses on the salivary characteristics of children and adolescents with type 1 diabetes in relation to the level of glycemic control, with the aim to investigate their oral health status and at a further level of analysis, explore the salivary proteome of this study group.

The thesis consists of two separate parts

Part I: The aim of this cross-sectional study was to investigate the possible association between salivary dysfunction, xerostomia prevalence and incidence of caries, in relation to the level of metabolic control, in children and adolescents with type 1 diabetes. For the purpose of this study, a total of 150 children and adolescents (10-18 years old) were examined and allocated among 3 groups: 50 patients poorly-controlled (HbA1c≥7.5%), 50 well-controlled (HbA1c<7.5%) and 50 age- and sex-matched healthy controls. The study was approved by the Research Ethics Committee of the National and Kapodistrian University of Athens and the parents signed written informed consent. All subjects were examined for dental caries, oral hygiene and salivary factors. Assessments of salivary characteristics included self-reported xerostomia, quantification of resting and stimulated whole saliva flow rates, pH values, buffering capacity and saliva’s viscosity. A questionnaire and a chair-side saliva testing kit were used for the evaluation of salivary function. Caries incidence was recorded using DMFT index. Plaque index and gingival index were additionally evaluated. Data were analysed by Chi-square and Kruskal-Wallis tests. Higher caries levels, higher prevalence of xerostomia and a decreased unstimulated salivary flow rate were recorded in poorly-controlled diabetics. The average caries indexes were DMFT(poor c) 3.6, DMFT(well c)1.2, DMFT(healthy) 1.5, p < 0.05). Salivary status and caries index were not found to be significantly different between well-controlled patients and healthy controls. The results of this study indicated that chair-side salivary tests provide the practitioners with an easy-to use and quick method for the evaluation of salivary function and caries risk assessment in young patients with diabetes.

Part II: In this part of our study we investigated the proteomic profile of whole saliva by high resolution mass spectrometry in type 1 diabetic patients. The aim of this research was to characterize the salivary proteome of type 1 diabetes patients in order to identify differentially expressed proteins compared to control subjects, infer deregulated biological pathways, and evaluate the relevance of the findings in the context of diabetes pathophysiology. We analyzed by high resolution mass spectrometry approaches saliva samples collected from 32 children and adolescents: 12 with poorly controlled type 1 diabetes (G1) (HbA1c≥7.5%), 12 with well controlled type 1 diabetes (G2) (HbA1c<7.5%) and 12 healthy controls (Ctrl). According to the results of this study, the composition of the salivary proteome is affected by pathological conditions. The list of more than 2000 high confidence protein identifications constitutes a comprehensive characterization of the salivary proteome. Patients with good glycemic regulation and healthy individuals have comparable proteomic profiles. In contrast, a significant number of differentially expressed proteins were identified in the saliva of patients with poor glycemic regulation compared to patients with good glycemic control and healthy children. These proteins are involved in biological processes relevant to diabetic pathology such as endothelial damage and inflammation. Moreover, a putative preventive therapeutic approach was identified based on bioinformatic analysis of the deregulated salivary proteins. Thus, thorough characterization of saliva proteins in diabetic pediatric patients established a connection between molecular changes and disease pathology. This proteomic and bioinformatic approach highlights the potential of salivary diagnostics in diabetes pathology and opens the way for preventive treatment of the disease.
Main subject category:
Health Sciences
Saliva, Xerostomia, Diabetes, Caries, Proteomics
Number of index pages:
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