Assessment of Oral Health Status among Children with Type I Diabetes Mellitus: A Cross-sectional Study
T Nishna, Vennila Chandran, Malini Venugopal, Greeshmaja Sharma Nirmala, Fathima M Najeeb, Fini Raj Ajith Radha, Niveditha Kartha
Keywords :
Dental calculus, Dental caries, Dental plaque, Gingival bleeding, Gingival inflammation, Oral health, Pediatric diabetology, Type I diabetes mellitus
Citation Information :
Nishna T, Chandran V, Venugopal M, Nirmala GS, Najeeb FM, Radha FR, Kartha N. Assessment of Oral Health Status among Children with Type I Diabetes Mellitus: A Cross-sectional Study. Int J Clin Pediatr Dent 2024; 17 (10):1124-1128.
Objectives: Diabetes mellitus (DM) is among the four noncommunicable diseases. There are two types—type I and type II. The prevalence of type I DM in India is 0.26/1,000 population (1992). This study was carried out to assess dental caries status and gingival status. The study group was compared with the nondiabetic control group to find any association with metabolic control of the disease.
Methodology: A total sample size of 200 subjects was selected out of 100 patients referred to treat their poorly controlled type I diabetes mellitus at the tertiary hospital. Another 100 nondiabetic subjects were selected as controls. An oral clinical examination used a mouth mirror, dental explorer, visible light source, and cotton gauze. Decayed, missing, and filled teeth (DMFT), gingival index, plaque index, and calculus index were evaluated.
Results: Comparison of the gingival index between cases and control was found to be significant, where the p-value is <0.001. This points out that type I diabetic patients have more chance of gingival problems than others. The increased plaque index indicates the need to give more importance to oral health as it may lead to an increased calculus index in the future, leading to periodontal problems. It was found that glycosylated hemoglobin (HbA1c) is directly proportional to the gingival index.
Conclusion: Maintaining good oral health through regular check-ups with dental experts and motivating and educating type I diabetic patients as they are more prone to dental issues.
Robinson T, Linklater S, Wang F, et al. Global incidence, prevalence, and mortality of type 1 diabetes in 2021 with projection to 2040: a modelling study. Lancet Diabetes Endocrinol 2022;10:741–760.
Ogle GD, James S, Dabelea D, et al. Global estimates of incidence of type 1 diabetes in children and adolescents: results from the International Diabetes Federation Atlas, 10th edition. Diabetes Res Clin Pract 2022;183:109083.
Kumar KMP. Incidence trends for childhood type 1 diabetes in India. Indian J Endocrinol Metab 2015;19(Suppl 1):S34–S35.
Das AK. Type 1 diabetes in India: overall insights. Indian J Endocrinol Metab 2015;19(Suppl 1):S31–S33.
Menon VU, Kumar KV, Gilchrist A, et al. Prevalence of known and undetected diabetes and associated risk factors in central Kerala—ADEPS. Diabetes Res Clin Pract 2006;74(3):289–294.
Filippi CM, von Herrath MG. Viral trigger for type 1 diabetes. Diabetes 2008;57(11):2863–2871.
Vilarrasa N, San Jose P, Rubio MÁ, et al. Obesity in patients with type 1 diabetes: links, risks and management challenges. Diabetes Metab Syndr Obes Targets Ther 2021;14:2807–2827.
Zhang R, Li Y, Zhang S, et al. The association of retinopathy and plasma glucose and HbA1c: a validation of diabetes diagnostic criteria in a Chinese population. J Diabetes Res 2016;2016:4034129.
Verhulst MJL, Loos BG, Gerdes VEA, et al. Evaluating all potential oral complications of diabetes mellitus. Front Endocrinol 2019;10:56.
Dakovic D, Pavlovic MD. Periodontal disease in children and adolescents with type 1 diabetes in Serbia. J Periodontol 2008;79(6):987–992.
Lalla E, Lamster IB, Schmidt AM. Enhanced interaction of advanced glycation end products with their cellular receptor RAGE: implications for the pathogenesis of accelerated periodontal disease in diabetes. Ann Periodontol 1998;3(1):13–19.
Pinson M, Hoffman WH, Garnick JJ, et al. Periodontal disease and type I diabetes mellitus in children and adolescents. J Clin Periodontol 1995;22(2):118–123.
Cicmil S, Mladenović I, Krunić J, et al. Oral alterations in diabetes mellitus. Balk J Dent Med 2018;22:7–14.
Orbak R, Simsek S, Orbak Z, et al. The influence of type-1 diabetes mellitus on dentition and oral health in children and adolescents. Yonsei Med J 2008;49(3):357–365.
Brownlee M. The pathobiology of diabetic complications: a unifying mechanism. Diabetes 2005;54(6):1615–1625.
Kaiser N, Sasson S, Feener EP, et al. Differential regulation of glucose transport and transporters by glucose in vascular endothelial and smooth muscle cells. Diabetes 1993;42(1):80–89.
Zizzi A, Tirabassi G, Aspriello SD, et al. Gingival advanced glycation end-products in diabetes mellitus-associated chronic periodontitis: an immunohistochemical study. J Periodontal Res 2013;48(3):293–301.
Yoon MS, Jankowski V, Montag S, et al. Characterisation of advanced glycation endproducts in saliva from patients with diabetes mellitus. Biochem Biophys Res Commun 2004;323(2):377–381.
Schmidt AM, Weidman E, Lalla E, et al. Advanced glycation endproducts (AGEs) induce oxidant stress in the gingiva: a potential mechanism underlying accelerated periodontal disease associated with diabetes. J Periodontal Res 1996;31(7):508–515.
Babu KLG, Subramaniam P, Kaje K. Assessment of dental caries and gingival status among a group of type 1 diabetes mellitus and healthy children of South India—a comparative study. J Pediatr Endocrinol Metab JPEM 2018;31(12):1305–1310.
Ramfjord SP. The periodontal disease index (PDI). J Periodontol 1967;38(6):602–610.
Sinjari B, Feragalli B, Cornelli U, et al. Artificial saliva in diabetic xerostomia (ASDIX): double blind trial of Aldiamed® versus Placebo. J Clin Med 2020;9(7):2196.
Bernaud FSR, Beretta MV, do Nascimento C, et al. Fiber intake and inflammation in type 1 diabetes. Diabetol Metab Syndr 2014;6(1):66.
Esmaillzadeh A, Kimiagar M, Mehrabi Y, et al. Fruit and vegetable intakes, C-reactive protein, and the metabolic syndrome. Am J Clin Nutr 2006;84(6):1489–1497.
Ferrazzano GF, Amato I, Ingenito A, et al. Plant polyphenols and their anti-cariogenic properties: a review. Molecules 2011;16(2):1486–1507.
Nielsen SJ, Trak-Fellermeier MA, Joshipura K, et al. Dietary fiber intake is inversely associated with periodontal disease among US adults. J Nutr 2016;146(12):2530–2536.
Sadeghi R, Taleghani F, Mohammadi S, et al. The effect of diabetes mellitus type I on periodontal and dental status. J Clin Diagn Res JCDR 2017;11(7):ZC14–ZC17.
Kokane N, Kokane V, Uttarwar V, et al. Patients awareness, perception, and willingness toward dental treatment during COVID-19 pandemic in India. J Glob Oral Health 2022;5(1):25–31.
Olak J, Nguyen MS, Nguyen TT, et al. The influence of mothers’ oral health behaviour and perception thereof on the dental health of their children. EPMA J 2018;9(2):187–193.
Mueller M, Schorle S, Vach K, et al. Relationship between dental experiences, oral hygiene education and self-reported oral hygiene behaviour. PLoS One 2022;17(2):e0264306.
Ismail AF, McGrath CP, Yiu CKY. Oral health status of children with type 1 diabetes: a comparative study. J Pediatr Endocrinol Metab JPEM 2017;30(11):1155–1159.
Babatzia A, Papaioannou W, Stavropoulou A, et al. Clinical and microbial oral health status in children and adolescents with type 1 diabetes mellitus. Int Dent J 2020;70(2):136–144.
Twetman S, Johansson I, Birkhed D, et al. Caries incidence in young type 1 diabetes mellitus patients in relation to metabolic control and caries-associated risk factors. Caries Res 2002;36(1):31–35.
Tchobroutsky G. Relation of diabetic control to development of microvascular complications. Diabetologia 1978;15(3):143–152.
Vidya K, Shetty P, Anandakrishna L. Oral health and glycosylated hemoglobin among type 1 diabetes children in South India. J Indian Soc Pedod Prev Dent 2018;36(1):38–42.
McCarter RJ, Hempe JM, Chalew SA. Mean blood glucose and biological variation have greater influence on HbA1c levels than glucose instability: an analysis of data from the Diabetes Control and Complications Trial. Diabetes Care 2006;29(2):352–355.
Meenawat A, Punn K, Srivastava V, et al. Periodontal disease and type I diabetes mellitus: associations with glycemic control and complications. J Indian Soc Periodontol 2013;17(5):597–600.
Lalla E, Cheng B, Lal S, et al. Diabetes mellitus promotes periodontal destruction in children. J Clin Periodontol 2007;34(4):294–298.
Gislen G, Nilsson KO, Matsson L. Gingival inflammation in diabetic children related to degree of metabolic control. Acta Odontol Scand 1980;38(4):241–246.
Carelli M, Maguolo A, Zusi C, et al. Oral microbiota in children and adolescents with type 1 diabetes mellitus: novel insights into the pathogenesis of dental and periodontal disease. Microorganisms 2023;11(3):668.