Research Journal of Recent Sciences _________________________________________________ ISSN 2277-2502 Vol. 3(ISC-2013), 224-226 (2014) Res. J. Recent. Sci. International Science Congress Association 224 Evaluation of correlation between Salivary pH and prevalence of Dental Caries in subjects with and without Diabetes MellitusArul A Sri Kennath J, R Sanjay and Palanivelu Peramachi1 Department of Molecular Microbiology, School of Biotechnology, Madurai Kamaraj University, Madurai, Tamil Nadu, INDIA Department of Botany, the American College, Madurai, Tamil Nadu, INDIAAvailable online at: www.isca.in, www.isca.me Received 29th November 2013, revised 25th January 2014, accepted 31st March 2014 AbstractThe relationship between diabetes mellitus and dental caries, particularly among adults has received far less attention. However, a consistent relationship between diabetes mellitus, dental caries and salivary pH is lacking. Therefore, the correlation between salivary pH and caries prevalence in non-diabetics and diabetics was evaluated.Fasting blood glucose level and salivary pH for each subject were measured and caries index was recorded as DMFT index. The results show that a decreased salivary pH and an increased incidence of dental caries in subjects with uncontrolled diabetes as compared to control group and those with controlled diabetes. Decreased salivary pH and increased dental caries rate was observed in subjects with controlled diabetes as compared to control group. Thus, diabetes mellitus may have a direct effect on salivary pH, reducing it from normal levels irrespective of diet. Keywords: Dental caries, diabetes mellitus, diet, DMFT, salivary pH. Introduction Diabetes mellitus (DM) characterized bysustained hyperglycemia affects multiple organ system together with the oral cavity1,2. The oral manifestations include xerostomia, gingivitis, periodontitis, odontogenic abscess, dental caries and opportunistic infections of tongue and oral mucosa. DM has also been related to increased carriage of pathogens in saliva4,5. The link between diabetes and dental caries, particularly among adults has received far less attention. Some studies have demonstrated increased caries incidence in diabetics; while other have shown similar or decreased caries rate7,8. However, the literature lacks unswerving relationship between the two. Similarly its relation to salivary pH is not clearly understood. With this aforementioned problem in mind, the correlation between salivary pH and caries prevalence in non-diabetics and diabetics was evaluated. Material and Methods The study was approved by the Institutional Review Board of Madurai Kamaraj University at Madurai, Tamil Nadu (India) on activities involving human subjects. Sample Collection: A total of 150 subjects (45-70 years) were enrolled in the study with their informed consent and were categorized as per WHO Criteria into: Group I: 50 subjects with no known history of diabetes mellitus and a fasting plasma glucose level less than 100 mg/dl (Control group). Group II: 50 subjects who had a known history of type 2 diabetes mellitus with fasting plasma glucose levels less than 126 mg/dl and were under medication (Controlled Diabetic Group). Group III 50 subjects with a known history of type 2 diabetes mellitus with fasting plasma glucose levels greater than 126 mg/dl and were under medication (Uncontrolled Diabetic Group). Morning blood and salivary samples were collected from each subject. Glucose levels were estimated by blood glucose monitoring system (Johnson and Johnson; One Touch). The subjects were asked to abstain from any oral hygiene method prior to saliva collection. Unstimulated saliva was collected in a dappen glass and immediately following that, HiIndicator pH paper (HiMedia LA318-1PX) was used to measure salivary pH, in to avoid any time-related changes in the pH value. World Health Organization (WHO) probe and a mouth mirror were utilized for the dental examination. To calculate DMFT caries index, the examiner recorded the teeth as decayed (D), missing (M), and filled (F) as per the WHO criteria. The sum of decayed, missing, and filled teeth for each patient gave the overall DMFT value. Mean of salivary pH scores and DMFT scores were taken individually for each group and the data for all the values were skewed and non parametric tests were applied. Research Journal of Recent Sciences ______________________________________________________________ ISSN 2277-2502Vol. 3(ISC-2013), 224-226 (2014) Res. J. Recent. Sci. International Science Congress Association 225 Results and Discussion Results: The fasting blood glucose of subjects in the group I ranged from 76-98 mg/dl with a mean of 88.88 ± 5.63 mg/dl, in group II ranged from 114-125 mg/dl with a mean of 120.98 ± 2.20 mg/dl; while in group III ranged, it from 186-225 mg/dl with a mean of 215.24 ± 9.67 mg/dl. The salivary pH values of subjects in group I ranged from 7.0 to 7.5 with a mean of 7.4 ± 0.20. Similarly, salivary pH values of subjects in group II ranged from 6.5 to 7.0 with a mean of 6.7 ± 0.24 and salivary pH values of subjects in group III ranged from 5.5 to 6.0 with a mean of 5.7 ± 0.24. The DMFT score of subjects in group I ranged from 1 to 4 with a mean of 2.74 ± 0.96. Similarly, DMFT score of subjects in group II ranged from 4 to 6 with a mean of 4.86 ± 0.75 and that in group III ranged from 6 to 10 with a mean of 7.76 ± 1.02 (table 1). Mean salivary pH value was 6.7 for group II and 7.4 for cases in group I. The difference in mean pH value between Group II and Group I was significant (t = 15.50, p 0.01). The mean pH value, 5.7 for Group III was significantly less than that of Group I (t = 37.6, p 0.01) and Group II (t = 20.2, p 0.01). Thus salivary pH value was significantly at much lower level for the uncontrolled diabetic patients. Mean DMFT score was 4.86 for Group II and 2.74 for cases in Group I. The difference in mean DMFT score between Group II and Group I was significant (t = 12.23, p 0.01). The mean DMFT score, 7.76 for Group III was significantly more when compared to that of control, Group I (t = 16.1, p 0.01) and Group II (t = 16.14, p 0.01). Thus, the DMFT score was significantly higher for uncontrolled diabetic patients. Therefore, as per the results, dental caries prevalence is more in patients with uncontrolled diabetes; and salivary pH value became acidic as disease state progressed from non-diabetics to uncontrolled diabetics. Discussion: Diabetes has emerged as a major health care problem in the world, with high degree of morbidity and mortality related to multiple organ systems involvement. Like other organs; the oral cavity show changes related to the disease; and oral infections may adversely affect metabolic control of the diabetic state. The intimate relationship between the oral health and diabetes suggests a need for assessment of oral clinical parameters in such patients. Therefore, in the present study salivary pH was determined in non diabetics and diabetics; and the possible difference in the occurrence of dental caries was evaluated. To avoid the effect of diet, blood samples were obtained during fasting state and unstimulated saliva of subjects was collected for monitoring salivary pH. DMFT index was selected so to measure the dental caries rate in these subjects. The present study demonstrated that when the uncontrolled diabetics were compared with the control group and those with controlled diabetes in terms of the clinical parameters assessed; the uncontrolled diabetics had decreased salivary pH values and increased DMFT score. This may be attributed to the changes in the metabolic processes of the uncontrolled diabetics due to higher glucose levels, resulting in a more acidic environment and thus increased incidence of dental caries. In agreement to the present study results, a study reported significantly lower salivary pH and significantly higher DMFT index in patients with type 1 and type 2 DM as compared to the normal subjects. The effect could be secondary to decreased salivary flow rates and pH value that leads a series of caries risk factors especially if the disease is inadequately controlled and uncontrolled10. Association of dental caries and poor control of DM has been reported and in such individuals, the presence of yeasts may be a caries risk indicator11. As per the study comparing the salivary flow rate, pH and its buffering capacity between subjects with type 2 DM and control concluded that, the metabolic control of hyperglycemia was not sufficient to improve the salivary flow rate or the salivary glucose concentration12. Another study on type 1 DM supported the view that, evaluation of salivary flow rate and buffer capacity is recommended when assisting diabetic children13. Table-1 Mean and standard deviation values of the clinical parametersobtained in all the three groups Group Mean fasting blood glucose levels (mg/dl) + S.D Mean salivary pH values + S.D Mean DMFT score + S.D Group I (Control) 88.88 ± 5.63 7.4 ± 0.20 2.74 ± 0.96 Group II (Controlled Diabetics) 120.98 ± 2.20 6.7 ± 0.24 4.86 ± 0.75 Group III (Uncontrolled Diabetics) 215.24 ± 9.67 5.7 ± 0.24 7.76 ± 1.02 Research Journal of Recent Sciences ______________________________________________________________ ISSN 2277-2502Vol. 3(ISC-2013), 224-226 (2014) Res. J. Recent. Sci. International Science Congress Association 226 In contrast, a study reported that, patients with DM had fewer caries and plaque, lower salivary flow rates and buffering effect and more frequent growth of yeasts than the control group. Patients with well-to-moderately controlled diabetes had fewer decayed surfaces and lower mutans streptococci counts than those with poorly controlled disease14. Further, no difference in salivary flow rates, organic composition of saliva, acidogenic bacteria counts in saliva, or coronal and root caries rates was seen when comparing control group with type 2 DM individuals. Such findings suggest that individuals with diabetes as a group are similar to healthy subjects in regard to these oral conditions15,16. Since both controlled and uncontrolled diabetics showed a significant decrease in salivary pH, the present study suggests that diabetes may have a direct effect on salivary pH reducing it from normal levels irrespective of diet thus influencing the oral environment. ConclusionSince the insidious nature of the type 2 diabetes mellitus allow prolonged periods of hyperglycemia to begin exerting negative effects on various organ system including oral cavity; adequate measures to prevent the dental caries in these patients at early stage are necessary. 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