Supervisors info:
Χρήστος Ραχιώτης, Αναπληρωτής Καθηγητής, Τμήμα Οδοντιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ
Αφροδίτη Κακάμπουρα, Καθηγήτρια και Διευθύντρια, Τμήμα Οδοντιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ
Νικόλαος Τεντολούρης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Summary:
Introduction
Type 2 Diabetes Mellitus (DM2) is a growing threat to global health. It is a complex metabolic disorder, characterized by tissue resistance to insulin action combined, in another extent each time, with impaired insulin secretion (delayed or inadequate secretion to meet the metabolic needs). There have been reported various oral manifestations of DM. The most important of them are xerostomia, gingivitis and periodontitis, lesions of the oral mucosa and tongue, increased incidence of candidiasis, increased incidence of dental caries and poor wound healing. On the contrary, there is no consensus to research data, which examine the relation of diabetes with caries in both children and adolescents, as in adult patients, while recently factors such as the effect of metabolic control of diabetes in caries incidence and also the year the disease first appeared are investigated. In an attempt to identify the mechanism by which caries incidence of diabetic patients is probably affected, the research interest has focused on investigating the effect of the DM control level in saliva characteristics such as resting and stimulating saliva flow and the concentration of glucose in saliva.
Aim
The aim of this study was to investigate the correlation between factors such as metabolic control of type 2 diabetes (fasting glucose and glycosylated hemoglobin), duration of the disease and age of the patient, with quantitative characteristics of saliva (pH, flow, consistency, buffering capacity), and caries in adults with type 2 diabetes. The null hypothesis of the study was that patients with type 2 diabetes will not show differences in the characteristics of saliva and caries’ incidence a) compared with the control group b) according to their metabolic control.
Materials and Methods
23 adults with diagnosed Type 2 diabetes between 18- 65 years of age and 18 healthy adults, who composed the control group, took part in the clinical trial. Patients came from the diabetic clinic of the University Hospital "Attikon" and the private practise of mrs. Mitrou, who is an internist- diabetologist. A pilot study with 10 subjects took place, followed by statistical analysis to confirm that the sample size is adequate. Patients with type 2 DM divided into two groups depending on their metabolic control (well- controlled: HbA1c <7%, poorly- controlled: HbA1c> 7%). Patients had at least 15 natural teeth. The exclusion criteria were: 1) presence of orthodontic appliances, 2) diseases and drugs that affect the salivary function 3) systematic use of antibiotics affecting microbial oral flora in the last 3 months, 4) use of diuretics or other drugs causing loss or retention of water, 5) disabilities that prevent oral hygiene. The clinical parameters which were recorded and evaluated in each participant were: 1) number of natural teeth, 2) the clinical index of coronal caries ICDAS II –DMFT, 3) saliva pH 4) salivary flow and buffering capacity of saliva-based on GC Saliva Check Buffer (3M ESPE). 5) check of the subjective feeling of xerostomia with a questionnaire completed by patients. For the group of patients with type 2 diabetes, the fasting glucose and glycosylated hemoglobin (HbA1c) were recorded additionally to calculate the control level of DM 2 and also the time of DM diagnosis to calculate the duration of the disease.
Results
41 adults participated in thiw clinical trial. 18 of them belonged to the healthy control group, 13 in the group of the well cotrolled (w.c.) diabetic adults and 10 in the group of the poorly controlled (p.c.) diabetic adults. Caries incidence was significantly higher in the p.c. group compared to the control group and also in the w.c. compared to the control group. The saliva flow rate was significantrly lower in the w.c. compared to the control and also to the p.c. compared to the control. Statistically signicant differences were also recorded in the saliva pH between the groups of the control and p.c. patients and in the buffering capacity between the control and p.c. and also between the control and w.c. In addition, the duration of the DM was significantly related to the pH, while the HbA1C was significantly related to the saliva flow rate and the buffering capacity. Xerostomia was significantly affected by the duration of the DM whilst was not affected by the saliva fow rate.
Conclusion
Statistically significant differences were found between the control and the p.c. groups in the saliva flow rate, the buffering capacity and the DMFT. The control group and the w.c. patients significanty differed in the saliva flow rate, buffering capacity, pH, DMFT and D3MFT. W.c. and p.c. patients differed in the saliva flow rate and D3MFT.
Keywords:
Diabetes mellitus, Saliva, Caries, Glycemic control
