Caries and salivary status in young adults with type 1 diabetes

The aim of this study was to evaluate the salivary status, prevalence of caries and the status of primary dentition, when primary teeth were exfoliated, in 41 patients, 18-24 years of age, with type 1 diabetes since childhood in comparison with age- and sex-matched non-diabetic controls. The blood glucose and glycosylated haemoglobin concentration (HbA1c), dosage of daily insulin and retinal fundus photography was recorded for the diabetic group. According to the concentration of HbA1c, the diabetic patients were divided into well and poorly controlled groups. The study was based on three intra-oral photos, dental examination including intra-oral radiographs, flow rate and buffering capacity of the saliva and amount of Streptococcus mutans and Lactobacilli. Retrospective data regarding the primary dentition was found in the dental files of each patient, and are based on the last registration for respective tooth before exfoliation. The patients with type 1 diabetes, without any relationship to metabolic control, displayed more initial buccal caries compared to healthy controls (p<0.01). No significant differences concerning the status of saliva (neither flow rate, buffering capacity nor amount of Streptococcus mutans and Lactobacilli), manifest caries or the status of the primary dentition were seen. We conclude that initial, but not manifest caries seems to be overrepresented in young adults with type 1 diabetes. These patients, thus, need more intense efforts regarding dental health care to prevent the development from initial to manifest caries.     

The effect of periodontal therapy on uncontrolled type 2 diabetes mellitus in older subjects

OBJECTIVE: The purpose of this study was to examine the effect of periodontal therapy on glycemic control in older type 2 diabetic patients. METHODS: Fifty-two diabetic patients, age 55-80 years (mean age = 61 years), with glycated hemoglobin (HbA1c) 7.5-11.0% (mean +/- s.d. = 8.98 +/- 0.88) and severe periodontitis were included in the present study. The treatment group received mechanical periodontal treatment combined with systemic doxycycline, 100 mg day(-1) for 14 days. The control group received neither periodontal treatment nor systemic doxycycline. Clinical periodontal parameters, fasting plasma glucose (FPG), and HbA1c levels were measures at baseline and 3 months. RESULTS: Periodontal treatment significantly improved periodontal status of the treatment group (P < 0.05), however the reduction in the level of FPG and HbA1c did not reach significance. In the control group, no significant changes in clinical periodontal parameters, FPG and HbA1c levels were observed, except for significant increase in attachment loss (P < 0.05). Comparing the two groups, although the 3-month level of HbA1c of the treatment group was lower than that of the control group, the difference did not reach significance. CONCLUSIONS: The results of the present study indicate that the periodontal condition of older Thais with uncontrolled diabetes is: (a) significantly improved 3 months after mechanical periodontal therapy with adjunctive systemic antimicrobial treatment, and (b) rapidly deteriorating without periodontal treatment. The effect of periodontal therapy on the glycemic control of older uncontrolled diabetics will require further studies that will have to include much larger sample sizes.     

Association of salivary flow rate with oral function in a sample of community-dwelling older adults in Japan

OBJECTIVE: The purpose of this study was to determine the association of stimulated salivary flow rate with perceived salivary flow and various oral symptoms among a group of independently living elderly persons. STUDY DESIGN: The subjects were 351 persons (189 men and 162 women) with a mean age of 66.7 +/- 4.3 years. Stimulated whole saliva was collected with the mastication method. Self-assessed chewing ability and satisfaction with oral function also were evaluated. A multiple logistic regression analysis was used to determine whether an independent variable was statistically significant. RESULTS: Hyposalivation (< 0.5 mL/min) was significantly associated with gender (odds ratio, 1.67; P < .05). Hyposalivation (odds ratio, 3.40; P <.05) and low perceived salivary flow (odds ratio, 5.35; P <.05) were significantly associated with dissatisfaction with tasting. Low perceived salivary flow was also significantly associated with self-assessed chewing ability (odds ratio, 3.32; P <.01). CONCLUSION: This study suggested that hyposalivation and low perceived salivary flow were related to chewing ability and satisfaction with tasting foods.     

The effect of chewing sorbitol-sweetened gum on salivary flow and cemental plaque pH in subjects with low salivary flow

The purpose of this work was to study the effect of chewing a sorbitol-sweetened gum on whole and parotid salivary flow rates, and on the cemental plaque pH response to a sucrose rinse challenge, in subjects with low salivary flow. The results show that chewing a flavored sugarless gum significantly increases salivary flow rates in individuals with dry mouth. Additionally, chewing the sorbitol-sweetened gum effectively prevents the fall in cemental plaque pH generally seen in response to a sucrose challenge. This indicates that chewing a sorbitol-sweetened gum provides a palliative and possibly a protective benefit for people who suffer from dry mouth.     

Impact of glycemic control on oral health status in type 2 diabetes individuals and its association with salivary and plasma levels of chromogranin A

ObjectiveTo evaluate the effect of glycemic control status in type 2 diabetes mellitus (T2DM) individuals on clinical oral health indicators and to compare the concentrations of plasma and salivary chromogranin A (CHGA) among nondiabetic subjects and T2DM patients, exploring their associations.DesignIn this cross-sectional study, 32 patients with controlled T2DM, 31 with poorly controlled T2DM and 37 nondiabetic subjects underwent a clinical and periodontal examination. CHGA concentrations were determined in saliva and plasma with ELISA.ResultsPoorly controlled T2DM group exhibited significantly higher mean buffering capacity, plaque index and bleeding on probing than other groups (P < 0.05). No difference was found to DMFT (decayed, missed and filled teeth) index between groups. Sites with clinical attachment loss (CAL) of 4 and 5–6 mm were significantly higher in both diabetic groups compared to control group (P < 0.05). Poorly controlled T2DM group had significantly higher sites with CAL ≥ 7 mm than other groups (P = 0.001). Significantly higher plasma and salivary CHGA levels were found in T2DM groups (P < 0.05). In both diabetic groups, probing depths 5–6 mm and CAL 5–6 mm were associated with higher salivary CHGA concentration (P < 0.05).ConclusionsThe findings revealed that T2DM patients were more prone to periodontal tissue damage than to caries risk. The results also provide some evidence that the degree of attachment loss deteriorates significantly with poor glycemic control in T2DM (CAL ≥ 7 mm). Moreover, the results suggest that high concentrations of salivary CHGA are associated with worse periodontal parameters and T2DM, and this could be related to the pathogenesis of both diseases.     

Evaluation of unstimulated and stimulated parotid salivary flow rate in Israeli healthy subjects aged 60 years and older

Saliva plays a critical role in the maintenance oral health. Clinical studies showed that 25% of the elderly population suffers from oral dryness and its related complaints. Studies that measured parotid gland salivary flow rate, both unstimulated and stimulated, in healthy older individuals did not find age-related functional changes. However, histological studies have revealed an age-dependent reduction in the parotid acinar tissue component. To our knowledge there are still no reports of the parotid salivary flow rate in the elderly population in Israel. The goal of this study was to evaluate the rate of the parotid unstimulated and stimulated salivary flow rate among healthy Israeli people aged over 60 years old--the findings may serve as basic standard values to be compared to data collected from patients with complaints of xerostomia and to data reported in other studies. Thirty healthy volunteers aged 60 to 77 years (average 64.7), 23 females and 7 males, were evaluated. Twenty five of the subjects used to live in kibbutzim and 5 lived in a city. The mean unstimulated parotid salivary secretion rate was 0.044+/-0.063 ml/min and the mean stimulated secretion was 0.163+/-0.291 ml/min. Those rates were found to be lower than the unstimulated and stimulated parotid salivary flow rates reported in most other studies. Fourteen (43.3) of the subjects had zero flow rate at rest. This figure was higher then the 20% zero flow at rest that was reported by others among persons with a broader age range. No significant differences were recorded in the parotid salivary flow, both unstimulated and stimulated, between subjects living in the kibbutzim compared to those living in the city. Similar to other studies the differences in the secretion rates between men and women were non significant. The low mean unstimulated and stimulated salivary flow rates, and the high prevalence of no flow at rest can be explained by the fact that saliva collections were done during the very warm Israeli summer and it is speculated that the subjects might be dehydrated. General dehydration can be observed in warm climate areas. No significant differences were found in the parotid salivary flow rates, (unstimulated and stimulated), between the city subjects compared to those from the kibbutzim. Further similar studies in different weather conditions (winter-summer) are needed to establish data of the normal parotid salivary secretion in the over 60 years old Israeli population.     

Root surface and coronal caries in adults with type 2 diabetes mellitus

OBJECTIVES: To determine the effect of type 2 diabetes mellitus (DM) on coronal and root surface caries and to investigate some factors suspected of being related to or interacting with DM, that may be associated with coronal and root surface caries. METHODS: A stratified cross-sectional study was conducted in 105 type 2 diabetic patients and 103 non-diabetic subjects of the same age and gender. Coronal and root surface caries, exposed root surfaces, periodontal status, stimulated salivary functions, oral hygiene status, oral health behaviors, and counts of mutans streptococci and lactobacilli were measured. RESULTS: Type 2 diabetic patients compared with non-diabetic subjects had a higher prevalence of root surface caries (40.0% versus 18.5%; P = 0.001), a higher number of decayed/filled root surfaces (1.2 +/- 0.2 versus 0.5 +/- 0.1; P < 0.01) and a higher percentage of generalized periodontitis (98.1% versus 87.4%; P < 0.01); but the prevalence and decayed/filled surface of coronal caries was not significantly different (83.8% versus 72.8% and 8.0 +/- 9.4 versus 6.3 +/- 7.5 respectively). The factors associated with root surface caries included type 2 DM, a low saliva buffer capacity, more missing teeth, and existing coronal caries; whereas wearing removable dentures, more missing teeth, a high number of lactobacilli, and a low saliva buffer capacity were associated with coronal caries. CONCLUSION: Type 2 DM is a significant risk factor for root surface, but not for coronal caries. Periodontal disease should be treated early in type 2 diabetic subjects to reduce the risk of subsequent root surface caries.     

Association of masticatory performance with age, posterior occlusal contacts, occlusal force, and salivary flow in older adults

PURPOSE: This study aimed to investigate the effect of age, posterior occlusal contacts, occlusal force, and salivary flow on masticatory performance in older adults. MATERIALS AND METHODS: The study sample consisted of 328 independently living people over the age of 60 years. Masticatory performance was determined by the concentration of dissolved glucose obtained from test gummy jellies, which are the standardized food developed for measuring masticatory performance. Bilateral maximal occlusal force in the intercuspal position was measured with pressure-sensitive sheets. Stimulated whole saliva was collected using the mastication method. Subjects were grouped into 3 categories by posterior occlusal contacts according to the Eichner Index. RESULTS: The multiple linear regression analysis showed that, with other variables controlled, masticatory performance was significantly associated with posterior occlusal contacts (beta = -.24, P < .001 for Eichner group B; beta = -.52, P < .001 for Eichner group C), occlusal force (P = .28, P < .001), and hyposalivation (beta = -.08, P < .046) (R(2) = 0.49). Within the groups classified by the Eichner Index, occlusal force was significantly associated with masticatory performance; however, age was not. For salivary flow rate, hyposalivation had a significant relationship with masticatory performance in group C (P = .003) and group B (P = .047), but no significant relationship in group A. CONCLUSION: A decline of posterior occlusal contacts, occlusal force, and hyposalivation appear to be associated with masticatory performance with aging in older adults.     

Relationship between salivary flow rates and Candida counts in subjects with xerostomia

OBJECTIVE: This study evaluated the relationship between salivary flow and Candida colony counts in the saliva of patients with xerostomia. STUDY DESIGN: Sialometry and Candida colony-forming unit (CFU) counts were taken from 112 subjects who reported xerostomia in a questionnaire. Chewing-stimulated whole saliva was collected and streaked in Candida plates and counted in 72 hours. Species identification was accomplished under standard methods. RESULTS: There was a significant inverse relationship between salivary flow and Candida CFU counts (P =.007) when subjects with high colony counts were analyzed (cutoff point of 400 or greater CFU/mL). In addition, the median sialometry of men was significantly greater than that of women (P =.003), even after controlling for confounding variables like underlying disease and medications. Sj?gren's syndrome was associated with low salivary flow rate (P =.007). There was no relationship between the median Candida CFU counts and gender or age. There was a high frequency (28%) of mixed colonization. Candida albicans was the most frequent species, followed by C parapsilosis, C tropicalis, and C krusei. CONCLUSIONS: In subjects with high Candida CFU counts there was an inverse relationship between salivary flow and Candida CFU counts.     

Dietary intake, food preferences, stimulated salivary flow rate, and masticatory ability in older adults with complete dentitions

This study was conducted to determine whether significant relationships exist among the masticatory ability, chewing-stimulated salivary flow rate, food preferences, and dietary intake of older adults with complete natural dentitions. Pearson r correlations revealed that significant relationships existed between: (1) salivary flow rate and eighteen out of the twenty-two nutrients comprising dietary intake; (2) masticatory ability and six out of the twenty-two nutrients comprising dietary intake; and (3) the perceived frequency of ingestion of the thirteen test foods and the dietary intake of thirteen of the nutrients comprising dietary intake. No significant relationships were found among salivary flow rate, masticatory ability, and food preferences. The amount of saliva accumulated in the mouth during the consumption of food may play an important role in food choices and subsequent intake of nutrients by older adults. Masticatory ability may not play as large a role as salivary flow rate in determining the selection and consumption of nutrient-rich foods.     

Association of salivary levels of cortisol and dehydroepiandrosterone with periodontitis in older Japanese adults

BACKGROUND: The relationship between periodontitis and psychoneuroimmunologic variables, such as stress-related hormones, is poorly understood. The purpose of this cross-sectional study was to investigate the associations between two kinds of stress-related hormones, cortisol and dehydroepiandrosterone (DHEA), and periodontitis in healthy community-dwelling elderly subjects aged > or =60 years. METHODS: A total of 171 subjects (85 males and 86 females) participated in this study. The subjects were independently living elderly people with a mean age of 68.4 (+/- 4.46) years. Stimulated whole saliva samples were collected, and hormone levels were determined. A medical questionnaire regarding medical conditions, lifestyle, and psychosocial stress also was administered. The clinical examinations included probing depth (PD), bleeding on probing, and clinical attachment level (CAL). RESULTS: There was a positive correlation between hormone levels and PD and CAL values. When the subjects were divided into two groups based on periodontitis severity, hormone levels were significantly higher in subjects with severe PD or CAL. Multiple regression analysis showed that higher cortisol and DHEA levels were associated significantly with greater numbers of teeth with severe PD or CAL, after adjusting for confounding variables. CONCLUSIONS: These results suggested close relationships between the extent and severity of periodontitis and salivary levels of cortisol and DHEA in healthy elderly subjects. To the best of our knowledge, this is the first report on the association between the levels of DHEA and extensive periodontitis.     

Levels of salivary cystatins in periodontally healthy and diseased older adults.

Cystatins are cysteine protease inhibitors present in a variety of tissues and body fluids, including saliva. One possible function of these molecules may be to modulate tissue destruction in periodontal diseases. To investigate the potential role of salivary cystatins in these events, the levels of cystatins in saliva from periodontally healthy and diseased individuals were measured by enzyme-linked immunosorbent assay. Flow rates and total protein content were determined in all the samples collected, while cysteine protease inhibitory activity was assessed in submandibular-sublingual secretions. Statistical analysis showed no significant differences in the levels and activity of salivary cystatins in periodontally healthy and diseased individuals. These findings suggest that comparing the levels of cystatins in glandular salivas may not be a suitable indicator of periodontal disease status.     

Salivary function and glycemic control in older persons with diabetes

OBJECTIVE: There is no consensus on the possible association between diabetes and salivary dysfunction in older persons with diabetes. This study's purpose was to investigate the effect of diabetes and glycemic control on salivary function in an older population. STUDY DESIGN: Twenty nine persons with type 2 diabetes and 23 nondiabetic control subjects participated (age range, 54-90 years). Diabetic status was determined by a glycosylated hemoglobin (HbA(1c)) test and a 2-hour glucose tolerance test. Poor glycemic control was defined as HbA(1c) >9%. Unstimulated whole saliva, unstimulated parotid, and stimulated parotid flow rates were measured, and subjects completed a standardized xerostomia questionnaire. RESULTS: Persons with poorly controlled diabetes had lower (P =.01) stimulated parotid flow rates than persons with well-controlled diabetes and nondiabetic control subjects. There were no significant differences in xerostomic complaints based on diabetic or glycemic control status or salivary flow rates. CONCLUSIONS: These results provide some evidence that poorly controlled diabetes may be associated with salivary dysfunction in older adults who have no concomitant complaints of xerostomia.     

Oral complaints and stimulated salivary flow rate in 1188 adults

J Oral Pathol Med (2010) 39 : 407–419 Background: Recently, oral sensory complaints (OSC) were proposed as a disease entity to represent idiopathic sensory disturbances of dry mouth, burning mouth, and taste disturbance, even though neither the status of OSC in the general population nor its underlying mechanism has yet been elucidated. Moreover, these three OSC‐related complaints have not been assessed in combination by means of a visual analog scale (VAS) in a large‐scale, community‐dwelling population of a broad age range. Methods: In a 1188‐member community‐dwelling adult population, comprised of 373 males and 815 females, aged 20–90 years, the three OSC‐related complaints and stimulated salivary flow rate (SSFR) were assessed by means of a VAS and modified Saxon test, respectively. Association of each complaint with age, gender, SSFR, and other complaints was analyzed. Results: Increases in both prevalence and intensity of subjective dry mouth and burning mouth were associated closely with decreasing SSFR. Even for taste disturbance, which may be affected less significantly by salivation status than the other two complaints, a significant association was suggested between decreasing SSFR and especially severe taste disturbance. However, these oral complaints were found in considerable prevalence even in the individuals with high SSFR. Often overlapping presentation of these complaints and a close association in intensity between the complaints to each other were also found. Conclusions: Hyposalivation may be a significant and common etiology for the three oral complaints, although the considerable prevalence of complaints without hyposalivation suggests other etiologies, including those related to the OSC.