International Journal of Clinical Pediatric Dentistry

Register      Login

VOLUME 15 , ISSUE 6 ( November-December, 2022 ) > List of Articles


Assessment of Oral Hygiene, Gingival, and Periodontal Health, and Teeth Eruption among Type 1 Diabetic Saudi Children

Rafif A Mandura, Omar AES El Meligy, Moaz H Attar, Rana A Alamoudi, Amal O Dafar, Mona T Rajeh, Rayyan A Kayal, Najat M Farsi

Keywords : Case-control study, Children, Dental health, Diabetes mellitus, Periodontal health, Tooth eruption

Citation Information : Mandura RA, El Meligy OA, Attar MH, Alamoudi RA, Dafar AO, Rajeh MT, Kayal RA, Farsi NM. Assessment of Oral Hygiene, Gingival, and Periodontal Health, and Teeth Eruption among Type 1 Diabetic Saudi Children. Int J Clin Pediatr Dent 2022; 15 (6):711-716.

DOI: 10.5005/jp-journals-10005-2462

License: CC BY-NC 4.0

Published Online: 14-02-2023

Copyright Statement:  Copyright © 2022; The Author(s).


Aims and objectives: To determine the differences between type 1 diabetic children and healthy children regarding oral hygiene, gingival and periodontal health, and permanent teeth eruption. Materials and methods: A case-control study was conducted on 80 children (40 type 1 diabetic children and 40 healthy children) aged 6–12-year-old. The groups were further divided into subgroups (early and late mixed dentition). All study aspects were examined clinically using the simplified oral hygiene index, Löe and Silness gingival index, clinical attachment loss (CAL), and Logan and Kronfeld stages for tooth eruption. The data were analyzed using Fisher's exact test, chi-squared test, and logistic regression models. A p-value of ≤0.05 was the threshold for statistical significance. Results: No significant difference was found between diabetic and healthy children regarding oral hygiene and gingival health. Most children had poor oral hygiene (52.5% in the case group and 60% in the control group), with fair gingival health (70% in the case group and 55% in the control group). Diabetic children had significantly (p = 0.05) more periodontitis than healthy children. Teeth in the advanced stage of the eruption were significantly higher in diabetic than control subjects (p = 0.048 in stage V and p = 0.003 in stage VI). Older diabetic children in late mixed dentition exhibited accelerated eruption. Conclusion: Periodontitis was significantly more common in diabetic than in healthy children. The advanced stage of the eruption was significantly higher in diabetic than in control subjects. Clinical significance: Type 1 diabetic children had more periodontal disease and advanced stage of permanent teeth eruption compared to healthy children. Therefore, periodic dental evaluation and a strong preventive plan for diabetic children is crucial.

PDF Share
  1. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2014;37(Suppl 1):S81–S90. DOI: 10.2337/dc14-S081
  2. Atkinson MA, Eisenbarth GS, Michels AW. Type 1 diabetes. Lancet 2014;383(9911):69–82. DOI: 10.1016/S0140-6736(13)60591-7
  3. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee, Goldenberg R, Punthakee Z. Definition, classification and diagnosis of diabetes, prediabetes and metabolic syndrome. Can J Diabetes 2013;37(Suppl 1):S8–S11. DOI: 10.1016/j.jcjd.2013.01.011
  4. Cherian MP, Al-Kanani KA, Al Qahtani SS, et al. The rising incidence of type 1 diabetes mellitus and the role of environmental factors–three decade experience in a primary care health center in Saudi Arabia. J Pediatr Endocrinol Metab 2010;23(7):685–695. DOI: 10.1515/jpem.2010.23.7.685
  5. LaPorte RE, Tuomilehto J, King H. WHO multinational project for childhood diabetes. Diabetes Care 1990;13(10):1062–1068. DOI: 10.2337/diacare.13.10.1062
  6. Rask-Madsen C, King GL. Vascular complications of diabetes: mechanisms of injury and protective factors. Cell Metab 2013;17(1): 20–33. DOI: 10.1016/j.cmet.2012.11.012
  7. Ship JA. Diabetes and oral health: an overview. J Am Dent Assoc 2003;134(Spec No):4S–10S. DOI: 10.14219/jada.archive.2003.0367
  8. Adler P, Wegner H, Bohatka L. Influence of age and duration of diabetes on dental development in diabetic children. J Dent Res 1973;52(3):535–537. DOI: 10.1177/00220345730520032601
  9. Bremenkamp RM, Caris AR, Jorge AO, et al. Prevalence and antifungal resistance profile of Candida spp. oral isolates from patients with type 1 and 2 diabetes mellitus. Arch Oral Biol 2011;56(6):549–555. DOI: 10.1016/j.archoralbio.2010.11.018
  10. Edblad E, Lundin SA, Sjödin B, et al. Caries and salivary status in young adults with type 1 diabetes. Swed Dent J 2001;25(2):53–60.
  11. Wyne AH, Chohan AN, Al-sharari R. Caries, oral hygiene and gingival health status in type I diabetic Saudi children. Pakistan Oral Dent J 2016;36(3):421–426.
  12. Greene JG, VermilIion JR. The simplified oral hygiene index. J Am Dent Assoc 1964;68(1):7–13. DOI: 10.14219/jada.archive.1964.0034
  13. Marwah Nikhil. Textbook of pediatric dentistry. 3rd ed. New Delhi: Jaypee Brothers Medical Pub 2013;53:1689–1699 p.
  14. Rodrigues CR, Ando T, Guimarães LO. Simplified oral hygiene index for ages 4 to 6 and 7 to 10 (deciduous and mixed dentition). Rev Odontol Univ Sao Paulo 1990;4(1):20–24.
  15. Löe H. The gingival index, the plaque index and the retention index systems. J Periodontol 1967;38(6):610–616. DOI: 10.1902/jop.1967.38.6.610
  16. Poulsen S. Epidemiology and indices of gingival and periodontal disease. Pediatr Dent 1981;3(Special issue):82–88.
  17. Rodrigues CR, Ando T, Guimarães LO. Simplified gingival index for ages 4 to 6 and 7 to 10. (Deciduous and mixed dentition). Rev Odontol Univ Sao Paulo 1989;3(3):414–419.
  18. Genco RJ, Grossi SG, Ho A, et al. A proposed model linking inflammation to obesity, diabetes, and periodontal infections. J Periodontol 2005;76(11 Suppl):2075–2084. DOI: 10.1902/jop.2005.76.11-S.2075
  19. Logan WHG, Kronfeld R. Development of the human jaws and surrounding structures from birth to the age of fifteen years. J Am Dent Assoc 1933;20(3):379–427. DOI: 10.14219/jada.archive.1933.0080
  20. Steiner DF, Chan SJ, Welsh JM, et al. Structure and evolution of the insulin gene. Annu Rev Genet 1985;19(1):463–484. DOI: 10.1146/
  21. Qaid MM, Abdelrahman MM. Role of insulin and other related hormones in energy metabolism—a review. Cogent Food Agric 2016;2(1):1267691.
  22. Obradović RR, Kesić GL, Pejčić AN, et al. Diabetes mellitus and oral candidiasis. Acta Stomatol Naissi 2011;27(63):1025–1034. DOI: 10.5937/asn1163025O
  23. Gupta S, Koirala J, Khardori R, et al. Infections in diabetes mellitus and hyperglycemia. Infect Dis Clin North Am 2007;21(3):617–638. DOI: 10.1016/j.idc.2007.07.003
  24. Khovidhunkit SO, Suwantuntula T, Thaweboon S, et al. Xerostomia, hyposalivation, and oral microbiota in type 2 diabetic patients: a preliminary study. J Med Assoc Thai 2009;92(9):1220–1228.
  25. Muzyka BC, Glick M. A review of oral fungal infections and appropriate therapy. J Am Dent Assoc 1995;126(1):63–72. DOI: 10.14219/jada.archive.1995.0025
  26. Ferizi L, Dragidella F, Spahiu L, et al. Oral health and salivary status in children with type 1 diabetes mellitus. J Int Dent Med Res 2018;11(3):931–937.
  27. Hugoson A, Thorstensson H, Falk H, et al. Periodontal conditions in insulin-dependent diabetics. J Clin Periodontol 1989;16(4):215–223. DOI: 10.1111/j.1600-051x.1989.tb01644.x
  28. Aren G, Sepet E, Ozdemir D, et al. Periodontal health, salivary status, and metabolic control in children with type 1 diabetes mellitus. J Periodontol 2003;74(12):1789–1795. DOI: 10.1902/jop.2003.74.12.1789
  29. Lalla E, Cheng B, Lal S, et al. Periodontal changes in children and adolescents with diabetes: a case-control study. Diabetes Care 2006;29(2):295–299. DOI: 10.2337/diacare.29.02.06.dc05-1355
  30. Oliver RC, Tervonen T. Diabetes-a risk factor for periodontitis in adults? J Periodontol 1994;65(Suppl 5S):530–538. DOI: 10.1902/jop.1994.65.5s.530
  31. Seppälä B, Seppälä M, Ainamo J. A longitudinal study on insulin-dependent diabetes mellitus and periodontal disease. J Clin Periodontol 1993;20(3):161–165. DOI: 10.1111/j.1600-051x.1993.tb00338.x
  32. Tervonen T, Oliver RC. Long-term control of diabetes mellitus and periodontitis. J Clin Periodontol 1993;20(6):431–435. DOI: 10.1111/j.1600-051x.1993.tb00384.x
  33. Dakovic D, Pavlovic MD. Periodontal disease in children and adolescents with type 1 diabetes in Serbia. J Periodontol 2008;79(6):987–992. DOI: 10.1902/jop.2008.070549
  34. Shroff B, Kashner JE, Keyser JD, et al. Epidermal growth factor and epidermal growth factor-receptor expression in the mouse dental follicle during tooth eruption. Arch Oral Biol 1996;41(6):613–617. DOI: 10.1016/0003-9969(96)00147-1
  35. Shroff B, Siegel SM. Molecular basis for tooth eruption and its clinical implications in orthodontic tooth movement. Semin Orthod 2000;6(3):155–172. DOI: 10.1053/sodo.2000.8082
  36. Lal S, Cheng B, Kaplan S, et al. Accelerated tooth eruption in children with diabetes mellitus. Pediatrics 2008;121(5):e1139–1143. DOI: 10.1542/peds.2007-1486
  37. 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. DOI: 10.3349/ymj.2008.49.3.357
  38. Bohátka L, Wegner H, Adler P. Parameters of the mixed dentition in diabetic children. J Dent Res 1973;52(1):131–135. DOI: 10.1177/00220345730520010601
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.