Oral Health of Portuguese Children with Type 1 Diabetes: A Multiparametric Evaluation

Objective: To perform a multiparametric evaluation of the oral health of 36 children with type 1 diabetes. Study design: A group of type 1 diabetic children and a sex-age-matched control group were formed. Seven parameters were evaluated: probing depth, bleeding on probing, plaque index (O'Laery index), calculus index (according to Ramfjord), dental caries (using ICDAS), salivary pH and unstimulated salivary flow rate. Statistical analysis was performed and the significance level was set at 5%. Results: Both groups consisted of 36 children with a mean age of 13 years. With regard to bleeding on probing, plaque index and calculus index, higher values were obtained in the diabetic group and the differences between groups were statistically significant for all three parameters. Concerning dental caries and salivary parameters, there were no significant differences between groups. However, a statistically significant correlation between salivary parameters and metabolic control was found. Conclusion: This study suggests that type 1 diabetic children are associated with some risk factors related to periodontal disease and dental caries. The proven relationship between diabetes and oral health complications imposes the need for these patients to be integrated into preventive dental programs from a young age.

diabetes, oral health, dental caries, periodontal disease, pediatric dentistry

1. Novotna M, Podzimek S, Broukal Z, Lencova E, Duskova J. Periodontal Diseases and Dental Caries in Children with Type 1 Diabetes Mellitus. Mediators Inflamm; 37;9626.2015.

2. Subramaniam P, Sharma A, Kaje K. Association of salivary triglycerides and cholesterol with dental caries in children with type 1 diabetes mellitus. Spec Care Dentist; 35(3):120-2.2015.

3. (2) Classification and diagnosis of diabetes. Diabetes Care; 38:S8-S16.2015. 4. World Health Organization. Diabetes Fact sheet No. 321. World Health Organization, Geneva, Switzerland. 2008.

5. Orlando VA, Johnson LR, Wilson AR, Maahs DM, Wadwa RP, Bishop FK. Oral Health Knowledge and Behaviors among Adolescents with Type 1 Diabetes. Int J Dent; :942124.2010.

6. Muller HP, Behbehani E. Screening of elevated glucose levels in gingival crevice blood using a novel, sensitive self-monitoring device. Med Princ Pract;13(6):361-5.2004.

7. Patterson C, Guariguata L, Dahlquist G, Soltesz G, Ogle G, Silink M. Diabetes in the young–a global view and worldwide estimates of numbers of children with type 1 diabetes. Diabetes Res Clin Pract;103(2):161-75.2014.

8. Saes Busato IM, Bittencourt MS, Machado MA, Gregio AM, Azevedo-Alanis LR. Association between metabolic control and oral health in adolescents with type 1 diabetes mellitus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod;109(3):e51-6.2010.

9. Aspriello SD, Zizzi A, Tirabassi G, Buldreghini E, Biscotti T, Faloia E. Diabetes mellitus-associated periodontitis: differences between type 1 and type 2 diabetes mellitus. J Periodontal Res;46(2):164-9.2011.

10. Sollecito TP, Sullivan KE, Pinto A, Stewart J, Korostoff J. Systemic conditions associated with periodontitis in childhood and adolescence. A review of diagnostic possibilities. Med Oral Patol Oral Cir Bucal;10(2):142-50.2005.

11. Orbak R, Simsek S, Orbak Z, Kavrut F, Colak M. The influence of type-1 diabetes mellitus on dentition and oral health in children and adolescents.Yonsei Med J;49(3):357-65.2008.

12. Rapp GE, Pineda-Trujillo N, McQuillin A, Tonetti M. Genetic power of a Brazilian three-generation family with generalized aggressive periodontitis. II. Braz Dent J;22(1):68-73.2011.

13. Khader YS, Dauod AS, El-Qaderi SS, Alkafajei A, Batayha WQ. Periodontal status of diabetics compared with nondiabetics: a meta-analysis. J Diabetes Complications;20(1):59-68.2006.

14. Miko S, Ambrus SJ, Sahafian S, Dinya E, Tamas G, Albrecht MG. Dental caries and adolescents with type 1 diabetes. Br Dent J;208(6):E12.2010.

15. Karjalainen KM, Knuuttila ML, Kaar ML. Salivary factors in children and adolescents with insulin-dependent diabetes mellitus. Pediatr Dent;18(4):306-11.1996.

16. Arheiam A, Omar S. Dental caries experience and periodontal treatment needs of 10- to 15-year old children with type 1 diabetes mellitus. Int Dent J;64(3):150-4.2014.

17. Akpata ES, Alomari Q, Mojiminiyi OA, Al-Sanae H. Caries experience among children with type 1 diabetes in Kuwait. Pediatr Dent;34(7):468-72.2012.

18. Lopez del Valle LM, Ocasio-Lopez C. Comparing the oral health status of diabetic and non-diabetic children from Puerto Rico: a case-control pilot study. P R Health Sci J;30(3):123-7.2011.

19. Kirk JM, Kinirons MJ. Dental health of young insulin dependent diabetic subjects in Northern Ireland. Community Dent Health;8(4):335-41.1991.

20. Matsson L, Koch G. Caries frequency in children with controlled diabetes. Scand J Dent Res;83(6):327-32.1975.

21. Amaral FM, Ramos PG, Ferreira SR. Study on the frequency of caries and associated factors in type 1 diabetes mellitus. Arq Bras Endocrinol Metabol;50(3):515-22.2006.

22. Swanljung O, Meurman JH, Torkko H, Sandholm L, Kaprio E, Maenpaa J. Caries and saliva in 12-18-year-old diabetics and controls. Scand J Dent Res;100(6):310-3.1992.

23. Tenovuo J, Alanen P, Larjava H, Viikari J, Lehtonen OP. Oral health of patients with insulin-dependent diabetes mellitus. Scand J Dent Res;94(4):338-46.1986.

24. Tagelsir A, Cauwels R, van Aken S, Vanobbergen J, Martens LC. Dental caries and dental care level (restorative index) in children with diabetes mellitus type 1. Int J Paediatr Dent;21(1):13-22.2011.

25. Bassir L, Amani R, Khaneh Masjedi M, Ahangarpor F. Relationship between dietary patterns and dental health in type I diabetic children compared with healthy controls. Iran Red Crescent Med J;16(1):e9684.2014.

26. Lalla E, Cheng B, Lal S, Kaplan S, Softness B, Greenberg E. Diabetes-related parameters and periodontal conditions in children. J Periodontal Res;42(4):345-9.2007.

27. Botero JE, Bedoya E. Determinants of Periodontal Diagnosis. Rev Clin Periodoncia Implantol Rehabil Oral;3(2):94-9.2010.

28. Farina R, Scapoli C, Carrieri A, Guarnelli ME, Trombelli L. Prevalence of bleeding on probing: a cohort study in a specialist periodontal clinic. Quintessence Int;42(1):57-68.2011.

29. Caton J, Greenstein G, Polson AM. Depth of periodontal probe penetration related to clinical and histologic signs of gingival inflammation. J Periodontol;52(10):626-9.1981.

30. Madeiro A, Bandeira F, Figueiredo C. The interrelationship between inflamatory periodontal disease and diabetes. OdontologiaClín-Científ;4(1):07-12.2005.

31. Lal S, Cheng B, Kaplan S, Softness B, Greenberg E, Goland RS, et al. Gingival bleeding in 6- to 13-year-old children with diabetes mellitus. Pediatr Dent;29(5):426-30.2007.

32. Lalla E, Cheng B, Lal S, Tucker S, Greenberg E, Goland R, et al. Periodontalchanges in children and adolescents with dia betes: a case-control study. Diabetes care;29(2):295-9.2006.

33. Scannapieco FA. Periodontal inflammation: from gingivitis to systemic disease? Compend Contin Educ Dent;25(7 Suppl 1):16-25.2004.

34. Giuca MR, Pasini M, Giuca G, Caruso S, Necozione S, Gatto R. Investigation of periodontal status in type 1 diabetic adolescents. Eur J Paediatr Dent;16(4):319-23.2015.

35. Aren G, Sepet E, Ozdemir D, Dinccag N, Guvener B, Firatli E. Periodontal health, salivary status, and metabolic control in children with type 1 diabetes mellitus. J Periodontol;74(12):1789-95.2003.

36. Manfredi M, McCullough MJ, Vescovi P, Al-Kaarawi ZM, Porter SR. Update on diabetes mellitus and related oral diseases. Oral Dis;10(4):187-200.2004.

37. Lopez ME, Colloca ME, Paez RG, Schallmach JN, Koss MA, Chervonagura A. Salivary characteristics of diabetic children. Braz Dent J;14(1):26-31.2003.

38. Siudikiene J, Maciulskiene V, Dobrovolskiene R, Nedzelskiene I. Oral hygiene in children with type I diabetes mellitus. Stomatologija;7(1):24-7.2005.

39. Sarmamy HM, Saber SM, Majeed VO. The influence of type I diabetes mellitus on dentition and oral health of children and adolescents attending two diabetic centers in Erbil city. Zanco J Med Sci;16(3):204-12.2012.

40. Karjalainen KM, Knuuttila ML, Kaar ML. Relationship between caries and level of metabolic balance in children and adolescents with insulin-dependent diabetes mellitus. Caries Res;31(1):13-8.1997.

41. Twetman S, Johansson I, Birkhed D, Nederfors T. Caries incidence in young type 1 diabetes mellitus patients in relation to metabolic control and caries-associated risk factors. Caries Res;36(1):31-5.2002.

42. Edblad E, Lundin SA, Sjodin B, Aman J. Caries and salivary status in youngadults with type 1 diabetes. Swed Dent J;25(2 ):53-60.2001.

43. Twetman S, Nederfors T, Stahl B, Aronson S. Two-year longitudinal observations of salivary status and dental caries in children with insulin-dependentdiabetes mellitus. Pediatr Dent;14(3):184-8.1992.