Revista de Odontologia da UNESP
https://revodontolunesp.com.br/journal/rou/article/doi/10.1590/rou.2014.030
Revista de Odontologia da UNESP
Original Article

Salivary and microbiological parameters of chronic periodontitis subjects with and without type 2 diabetes mellitus: a case-control study

Parâmetros salivares e microbiológicos em indivíduos com periodontite crônica com ou sem diabetes melito tipo 2: estudo caso-controle

Cortelli, José Roberto; Pinheiro, Regina Marcia S.; Costa, Fernando Oliveira; Aquino, Davi Romeiro; Araslan, Suzane; Cortelli, Sheila Cavalca

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Abstract

Background: Several studies have investigated the differences in salivary parameters and microbial composition between diabetic and non-diabetic patients, however, specific differences are still not clear mainly due to the effects of confounder. Aim: The aim of this case-control study was to evaluate the salivary and microbial parameters of chronic periodontitis subjects with and without type 2 diabetes mellitus. Material and method: This case-control study included 60 chronic periodontitis subjects, 30 diabetics (case group) and 30 non-diabetics (control group), paired according to periodontitis severity, gender and age. Stimulated whole saliva was collected from all volunteers to measure the salivary pH and the salivary flow rate. Bacterial samples were collected with paper points from periodontal sites showing the deepest periodontal pocket depth associated with the highest clinical attachment loss. The frequency of A. actinomycetemcomitans, P. intermedia, P. gingivalis, T. forsythia and C. rectus was evaluated by PCR. Data was statistically analyzed by Student’s t, Mann-Whitney and Chi-square (p<0.05). Result: Diabetic subjects showed higher salivary glucose levels and lower stimulated flow rates in comparison to non-diabetic controls. P. gingivalis and T. forsythia were the most frequent pathogens (p<0.05). Bacterial frequency did not differ between case and control groups. Conclusion: Diabetes status influenced salivary glucose levels and flow rate. Within the same severity of chronic periodontitis, diabetic subjects did not show higher frequency of periodontal pathogens in comparison to their paired controls.

Keywords

Saliva, bacteria, chronic periodontitis, diabetes mellitus

Resumo

Introdução: Diversos estudos têm investigado as diferenças dos parâmetros salivares e microbianos entre pacientes diabéticos e não diabéticos, contudo, diferenças específicas ainda não estão claras, principalmente devido aos efeitos de variáveis de confusão. Objetivo: O objetivo deste estudo caso-controle foi avaliar os parâmetros salivares e microbianos de indivíduos com doença periodontal crônica com ou sem diagnóstico de diabetes melito tipo 2. Material e método: Este estudo caso-controle incluiu 60 indivíduos com periodontite crônica, 30 diabéticos (casos) e 30 não diabéticos (controles), pareados pela severidade da doença periodontal, gênero e idade. Saliva total estimulada foi coletada de todos os voluntários para mensuração do pH salivar e fluxo salivar. Amostras bacterianas foram coletadas com pontas de papel absorvente dos sítios periodontais com maior profundidade de sondagem e perda de inserção clínica. A frequência de A. actinomycetemcomitans, P. intermedia, P. gingivalis, T. forsythia e C. rectus foi avaliada por PCR. Os dados foram analisados estatisticamente pelo teste t de Student, Mann -Whitney e Qui-quadrado (p < 0,05). Resultado: Diabéticos apresentaram maior nível de glicose salivar e menor fluxo salivar em comparação aos não diabéticos. P. gingivalis e T. forsythia foram os patógenos mais frequentes (p < 0,05). Frequência bacteriana não diferiu entre os casos e controles. Conclusão: A condição diabetes influenciou o fluxo e os níveis de glicose salivar. Dentro da mesma severidade da periodontite crônica, indivíduos diabéticos não mostraram maior frequência de patógenos periodontais em comparação aos seus controles.

Palavras-chave

Saliva, bactérias, periodontite crônica, diabetes mellitus

References

 


1. American Diabetes Association. Diagnosis and classification of diabetes mellitus: position statement. Diabetes Care. 2012; 35 Suppl 1: 64‑71. PMid:22187472 PMCid:PMC3632174. http://dx.doi.org/10.2337/dc12-s064

2. Rezende KF, Ferraz MB, Malerbi DA, Melo NH, Nunes MP, Pedrosa HC, et al. Predicted annual costs for inpatients with diabetes and foot ulcers in a developing country – a simulation of the current situation in Brazil. Diabet Med. 2010; 27: 109-12. PMid:20121897. http:// dx.doi.org/10.1111/j.1464-5491.2009.02871.x

3. Santos VR, Lima JA, Miranda TS, Feres M, Zimmermann GS, Nogueira-Filho GR, et al. Relationship between glycemic subsets and generalized chronic periodontitis in type 2 diabetic Brazilian subjects. Arch Oral Biol. 2012; 57: 293-9. PMid:21890108. http://dx.doi. org/10.1016/j.archoralbio.2011.08.003

4. Costa FO, Miranda Cota LO, Pereira Lages EJ, Soares Dutra Oliveira AM, Dutra Oliveira PA, Cyrino RM, et al. Progression of periodontitis and tooth loss associated with glycemic control individuals under periodontal maintenance therapy: a 5-year follow-up study. J Periodontol. 2012; 84: 595-605. PMid:22769441. http://dx.doi.org/10.1902/jop.2012.120255

5. World Health Organization. Cause-specific mortality: regional estimates for 2008. Geneva: WHO; 2011. Avaliable from: http://www.who. int/healthinfo/global_burden_disease/estimates_regional/en/index.html

6. Taylor GW, Burt BA, Becker MP, Genco RJ, Shlossman M, Knowler WC, et al. Non-insulin dependent diabetes mellitus and alveolar bone loss progression over 2 years. J Periodontol. 1998; 69: 76-83. PMid:9527565. http://dx.doi.org/10.1902/jop.1998.69.1.76

7. Soskolne WA, Klinger A. The relationship between periodontal diseases and diabetes: an overview. Ann Periodontol. 2001; 6: 91-8. PMid:11887477. http://dx.doi.org/10.1902/annals.2001.6.1.91

8. Lakschevitz F, Aboodi G, Tenenbaum H, Glogauer M. Diabetes and periodontal diseases: interplay and links. Curr Diabetes Rev. 2011; 7: 433-9. PMid:22091748. http://dx.doi.org/10.2174/157339911797579205

9. Preshaw PM, Alba AL, Herrera D, Jepsen S, Konstantinidis A, Makrilakis K, et al. Periodontitis and diabetes: a two-way relationship. Diabetologia. 2012; 55: 21-31. PMid:22057194 PMCid:PMC3228943. http://dx.doi.org/10.1007/s00125-011-2342-y

10. Campus G, Salem A, Uzzau S, Baldoni E, Tonolo G. Diabetes and periodontal disease: a case-control study. J Periodontol. 2005; 76: 418‑25. PMid:15857077. http://dx.doi.org/10.1902/jop.2005.76.3.418

11. Oliver RC, Tervonen T. Diabetes a risk factor for periodontitis in adults? J Periodontol. 1994; 65 (Suppl 5): 530-8. PMid:8046569. http:// dx.doi.org/10.1902/jop.1994.65.5s.530

12. Mealey BL, Ocampo GL. Diabetes mellitus and periodontal disease. Periodontol 2000. 2007; 44: 127-53. PMid:17474930. http://dx.doi. org/10.1111/j.1600-0757.2006.00193.x

13. Sbordone L, Ramaglia L, Barone A, Ciaglia RN, Tenore A, Iacono VJ. Periodontal status and selected cultivable microflora of insulindependent juvenile diabetics. J Periodontol. 1995; 66: 452-61. PMid:7562335. http://dx.doi.org/10.1902/jop.1995.66.6.452

14. Field CA, Gidley MD, Preshaw PM, Jakubovics N. Investigation and quantification of key periodontal pathogens in patients with type 2 diabetes. J Periodontal Res. 2012; 47: 470-8. PMid:22220967. http://dx.doi.org/10.1111/j.1600-0765.2011.01455.x

15. Sardi JC, Duque C, Camargo GA, Hofling JF, Gonçalves RB. Periodontal conditions and prevalence of putative periodontopathogens and Candida spp. in insulin-dependent type 2 diabetic and non-diabetic patients with chronic periodontitis-a pilot study. Arch Oral Biol. 2011; 56: 1098-105. PMid:21529777. http://dx.doi.org/10.1016/j.archoralbio.2011.03.017

16. Dodds MW, Johnson DA, Yeh CK. Health benefits of saliva: a review. J Dent. 2005; 33: 223-33. PMid:15725522. http://dx.doi.org/10.1016/j. jdent.2004.10.009

17. Lasisi TJ, Fasanmade AA. Salivary flow and composition in diabetic and non-diabetic subjects. Niger J Physiol Sci. 2012; 27: 79-82. PMid:23235312.

18. American Academy or Periodontology. International workshop for a classification of periodontal diseases and conditions. Ann Periodontol. 1999; 4: 1-6. PMid:10863370. http://dx.doi.org/10.1902/annals.1999.4.1.1

19. Ainamo J, Bay I. Problems and proposals for recording gingivitis and plaque. Int Dent J. 1975; 25: 229-35. PMid:1058834.

20. Cortelli JR, Aquino DR, Cortelli SC, Fernandes CB, Carvalho-Filho J, Franco GCN, et al. Etiological analysis of initial colonization of periodontal pathogens in oral cavity. J Clin Microbiol. 2008; 46(4): 1322-9. PMid:18287326 PMCid:PMC2292974. http://dx.doi. org/10.1128/JCM.02051-07

21. Navazesh M, Christensen C, Brightman V. Clinical criteria for the diagnosis of salivary gland hypofunction. J Dent Res. 1992; 71: 1363-9. PMid:1629451. http://dx.doi.org/10.1177/00220345920710070301

22. Navazesh M. Methods for collecting saliva. Ann N Y Acad Sci. 1993; 694: 72-7. PMid:8215087. http://dx.doi.org/10.1111/j.1749-6632.1993. tb18343.x

23. Krasse B. Biological factors as indicators of future caries. Int Dent J. 1988; 38: 219-25. PMid:3063665.

24. Frostell G. A colourimetric screening test for evaluation of the buffer capacity of saliva. Swed Dent J. 1980; 4: 81-6. PMid:6933707.

25. Abikshyeet P, Ramesh V, Oza N. Glucose estimation in the salivary secretion of diabetes mellitus patients. Diabetes Metab Syndr Obes. 2012; 5: 149-54. PMid:22923999 PMCid:PMC3422906.

26. Panchbhai AS, Degwekar SS, Bhowte RR. Estimation of salivary glucose, salivary amylase, salivary total protein and salivary flow rate in diabetics in India. J Oral Sci. 2010; 52: 359-68. PMid:20881327. http://dx.doi.org/10.2334/josnusd.52.359

27. Borges BC, Fulco GM, Souza AJ, de Lima KC. Xerostomia and hyposalivation: a preliminary report of their prevalence and associated factors in Brazilian elderly diabetic patients. Oral Health Prev Dent. 2010; 8: 153-8. PMid:20589249.

28. Lalla E. Periodontal infections and diabetes mellitus: when will the puzzle be complete? J Clin Periodontol. 2007; 34: 913-6. PMid:17935499. http://dx.doi.org/10.1111/j.1600-051X.2007.01140.x

29. Ryan CS, Kleinberg I. A comparative study of glucose and galactose uptake in pure cultures of human oral bacteria, salivary sediment and dental plaque. Arch Oral Biol. 1995; 40: 743-52. http://dx.doi.org/10.1016/0003-9969(95)00028-N

 

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