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Dental Caries and Diabetes Mellitusthough salivary constituents are changed in diabetesbut what is its impact on caries is not clearly explained. 6Dental caries and salivary factors have attractedless interest, and the results are divergent as towhether caries risk is different or salivary factors areaffected in diabetic patients compared to controls.Equal caries rates in diabetic patients and controlshave been reported in many studies1. 7,8 A higher cariesrisk among diabetic patients than healthy controls hasalso been demonstrated 9,10 , but in contrast, some studieshave found even less caries in diabetic patients thanin controls. 9In Pakistan no studies on changes in salivaryconstituents in diabetic patients were available onsearch of literature. Thus there is need for an investigationfocused on the assessment of salivary glucoseand calcium levels in diabetics. Thus the present studyhas been aimed at assessing the salivary glucose &calcium levels in diabetic patients and their linkagewith dental caries.METHODOLOGYThe study was conducted on 60 patients, out ofwhom 30 were diabetics (Fasting Blood Sugar Level>120mg/dl, HbA1c level > 7.0%), who were registeredin the endocrinology department of Shaikh ZayedMedical Complex, Lahore and 30 were normal nondiabetics(Fasting Blood Sugar Level between 70-120mg/dl, HbA1c level < 7.0%), who were under treatmentin dental / orthodontic department of Faculty ofDentistry, The University of Lahore. Un-cooperativepatients, patients with any active systemic disease andpatients with missing teeth were excluded from thestudy.the hexokinase-glucose-6-phosphate dehydrogenasemethod. The calcium method used on the dimension®clinical chemistry system is an in vitro diagnostic test.The calcium method is the modification of the calciumo-cresolphthalein complexone (OCPC) reaction.Intra-oral examination was performed to assessthe DFT in normal & diabetic patients with the aimthat whether caries incidence was more in diabeticsand whether there was any association of caries withsalivary glucose and calcium levels.SPSS 16.0 was used for statistical evaluation.Mean, Standard Deviation, Variance, Minimum &Maximum value and Range were calculated for eachvariable for each subject. Salivary Glucose & Calciumlevel for normal & diabetics was assessed and corelationwith caries incidence was establishedRESULTSTABLE 1: COMPARISON OF SALIVARY GLUCOSELEVELS AMONG STUDY GROUPSStudy Groups Salivary Glucose (mg/dl)Mini- Maxi Mean ± SDmum mumControls (n=30) 3.0 9.0 7.33 1.36Diabetic Patients 10.50 19.50 15.60 2.48(n=30)Glucose concentration (mg/dl) in saliva in patients withdiabetes mellitus was compared with healthy population.Glucose concentration in saliva of diabetic patientswas significantly higher as compared to healthypopulation (p = 0.001 < 0.05).Un-stimulated whole saliva from diabetic and controlgroup was collected in sterilized plastic jars throughspitting method and stored in freezer at -20degreecentigrade and then brought to the laboratory in a icechilled box. Saliva samples were defrosted, centrifugedand its supernatant portion was used for analysis whichwas carried out by using auto analyzer (DimensionClinical Chemistry System). Salivary glucose & Calciumlevels were analyzed by using Dimension ClinicalChemistry System. The glucose method used on theDimension® clinical chemistry system is an in vitrodiagnostic test. The Glucose method is an adaptation ofPakistan Oral & Dental Journal Vol 31, No. 1 (June 2011)Fig 1:Comparison of Salivary Glucose levels (minimum& maximum) among study groups61
Dental Caries and Diabetes MellitusTABLE 2: COMPARISON OF SALIVARY CALCIUMLEVELS AMONG STUDY GROUPSStudy Groups Salivary Calcium (mg/dl)Mini- Maxi Mean ± SDmum mumControls (n=30) 8.50 12.50 10.40 1.14Diabetic Patients 1.80 5.70 3.73 1.01(n=30)Calcium levels (mg/dl) in saliva of patients with diabetesmellitus were compared with healthy controls and it wasshown that their level was significantly low in cases ascompared to the normal controls. (p = 0.001< 0.05).TABLE 4: CO-RELATION BETWEEN SALIVARYGLUCOSE LEVEL AND DFT AMONG DIABETICPATIENTSTeeth Decayed /FilledSalivary Glucose mg/dl 0.385 *Salivary glucose level was correlated with the destructionof permanent teeth among diabetics and it wasshown that mean glucose level increased with theincrease in number of decayed teeth.TABLE 5: CO-RELATION BETWEEN SALIVARYCALCIUM LEVEL AND DFT AMONG DIABETICPATIENTSTeeth Decayed /FilledSalivary Calcium mg/dl -0.287 *Mean salivary calcium level was calculated in alldiabetic subjects having permanent/ decayed teeth.Statistically significant co-relation was found betweensalivary calcium level and the number of permanentteeth decayed / filled.Fig 2:Comparison of Salivary Calcium levels (minimum& maximum) among study groupsTABLE 3: DECAYED FILLED PERMANENTDENTITIOND (decayed)F (filled) DFTControl 0.4 0.13 .53Diabetic Patients 2.31 0.14 2.49It can be observed that in diabetic patients DFT scorewas higher (2.49) as compared to control group (0.53).DISCUSSIONPresent study revealed that glucose levels in theun-stimulated whole saliva of IDDM group were higherthan in healthy subjects. The mean salivary glucoselevel in diabetic patients was 15.60 ± 2.48 and that ofcontrol was 7.33 ± 1.36mg/dl., so glucose concentrationin saliva of diabetic patients was significantly higher ascompared to healthy population (p = 0.001 < 0.05).These results are in agreement with reports of otherresearchers who found the same increased correlatedlevels of glucose in the saliva. 11,12 In one of the studymean and standard deviation of glucose level in diabeticchildren was found to be 2.05±1.63 where as innon-diabetic children was 1.03±1.03, indicating thatsalivary glucose level was higher in diabetics. 5 Kjellman 13and Thorstensson et al 14 reported significantly highervalues of glucose in whole saliva in diabetics than inhealthy controls. In contrast, other studies of diabeticsand healthy individuals indicate that no such relationshipsexist. 15,16Fig 3:Comparison of decayed filled permanent dentitionin Control group & diabetic patientsCalcium levels in the present study were low indiabetics as compared to controls. Mean calcium levelin controls was 10.40 mg/dl and that of diabetics were3.73 mg/dl. (p = 0.001< 0.05). Previous study by MariaPakistan Oral & Dental Journal Vol 31, No. 1 (June 2011)62
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