Oral inflammatory conditions and diabetes mellitus

Abstract

The association between periodontal inflammation and diabetes mellitus has been reported. However, the influence of hyperglycemia and gender in oral inflammation is still unclear. In this thesis, periodontal conditions (plaque index [PI], bleeding on probing [BOP], probing pocket depth [PD] [4mm < 6mm and ≥ 6mm]), marginal bone levels on panoramic radiographs, oral yeast colonization, salivary protein concentrations and perceived oral symptoms were investigated in individuals with and without diabetes mellitus. Other variables that have been assessed include socioeconomic status (SES), education, gender, smoking, and gutka-chewing. Individuals aged between 45-64 years (Studies I, II and IV) and 10-19 years (Study II) were included in the research project.

Study I aimed to compare periodontal condition and socioeconomic status between subjects with and without type 2 diabetes (T2D). Study II investigated the self-perceived oral health and the levels of salivary proteins in children with and without type 1 diabetes (T1D). Study III aimed to investigate the periodontal conditions and oral symptoms in gutka-chewers with and without T2D. Study IV evaluated the association between periodontal conditions, oral Candida albicans (C. albicans) colonization and salivary proteins in subjects with T2D.

In study I, PI, BOP, PD (4mm < 6mm) and marginal bone loss were increased in subjects with poorly-controlled T2D compared with well-controlled T2D. Individuals with poorly controlled T2D had a lower SES compared to patients with well-controlled T2D. In study II, self-perceived gingival bleeding (GB), bad breath and dry mouth were higher in children with T1D compared with controls. Children with poorlycontrolled T1D more often perceived GB and bad breath compared to those with wellcontrolled T1D. Salivary IgG/mg protein and total protein concentrations were higher in children with T1D compared with controls. Salivary IgG/mg protein levels were also elevated in children with poorly-controlled T1D compared to those with wellcontrolled T1D. In study III, periodontal conditions (PI, BOP, PD [4mm < 6mm]) and oral symptoms were severe in gutka-chewers compared to non-chewers in non-diabetic subjects. In subjects with T2D, there was no difference in these variables between gutka-chewers and non-chewers. In study IV, periodontal and salivary markers of inflammation (BOP and IgG/mg protein) were increased in type 2 diabetic females with C. albicans colonization compared with males.

In conclusion, this thesis shows that radiological and clinical parameters of periodontal destruction are increased in subjects with poorly-controlled T2D, and a poor SES aggravates the periodontal conditions in these subjects. Self-perceived GB and salivary IgG/mg protein levels are higher in children with T1D compared with controls. In subjects without T2D, gutka-chewing is associated with severe periodontal conditions and oral symptoms; however, in subjects with T2D, the severity of these variables is related to glycemic levels rather than gutka consumption. Periodontal and salivary markers of inflammation, BOP and IgG/mg protein, are increased in type 2 diabetic females with C. albicans colonization compared with males.