Volume 21, number 1
 Views: (Visited 140 times, 1 visits today)    PDF Downloads: 94

Deka K. A, Gayathri K, Ravishankar P. L, Soury G. S. S. Effect of Non-Surgical Periodontal Therapy on Salivary Glucose Levels in Chronic Periodontitis Patients with Type 2 Diabetes. A Pilot Study. Biotech Res Asia 2024;21(1).
Manuscript received on : 25-08-2023
Manuscript accepted on : 30-01-2024
Published online on:  28-02-2024

Plagiarism Check: Yes

Reviewed by: Dr. Hind Shakir Ahmed

Second Review by: Dr Revathi P Shenoy

Final Approval by: Dr. Susana Rodriguez-Couto

How to Cite    |   Publication History    |   PlumX Article Matrix

Effect of Non-Surgical Periodontal Therapy on Salivary Glucose Levels in Chronic Periodontitis Patients with Type 2 Diabetes. A Pilot Study

Kristi Ananya Deka , Gayathri. K, P. L. Ravishankar and Sai Sri Soury. G

Department of Periodontology, SRM Kattankulathur Dental College and hospital, SRM Institute of science and technology, SRM Nagar, Kattankulathur 603203, Chengalpattu, Tamil Nadu, India.

Corresponding Author E-mail:kd9341@srmist.edu.in

DOI : http://dx.doi.org/10.13005/bbra/3222

ABSTRACT: Aim: To assess whether nonsurgical periodontal therapy lowers salivary glucose levels in diabetic patients and healthy individuals with chronic periodontitis patients. Materials and methods: 20 individuals with and without type 2 diabetes with widespread periodontitis were involved in this study. Subjects were designated into two groups based on their systemic status. Group I consisted of ten systemically healthy periodontitis patients. Group II consisted of ten diabetic patients with periodontitis. Glucose levels in saliva along with the periodontal parameters were recorded in all the subjects preoperatively at baseline and 3months after periodontal therapy. Results: At baseline, when the clinical parameters were compared among the groups, no statistically discernible difference was found. At baseline, mean salivary glucose levels in group 1 and group 2 were 0.76±0.34mg/dl and 6.02±2.55mg/dl respectively. At 3 months post-operatively, mean salivary glucose levels in group 1 and group 2 were 0.67±.0.30 mg/dl and 5.71±2.27mg/dl.At 3-months follow-up, clinical parameters and salivary glucose reduced in both groups. Conclusion: The considerable reduction in salivary glucose levels following therapy raises the possibility that it could be used as a target inflammatory marker in periodontal diseases. Keywords: Chronic periodontitis, Non-surgical periodontal therapy, salivary glucose, Type2 diabetes mellitus

KEYWORDS: Chronic periodontitis; Non-surgical periodontal therapy; salivary glucose; Type2 diabetes mellitus

Download this article as: 
Copy the following to cite this article:

Deka K. A, Gayathri K, Ravishankar P. L, Soury G. S. S. Effect of Non-Surgical Periodontal Therapy on Salivary Glucose Levels in Chronic Periodontitis Patients with Type 2 Diabetes. A Pilot Study. Biotech Res Asia 2024;21(1).

Copy the following to cite this URL:

Deka K. A, Gayathri K, Ravishankar P. L, Soury G. S. S. Effect of Non-Surgical Periodontal Therapy on Salivary Glucose Levels in Chronic Periodontitis Patients with Type 2 Diabetes. A Pilot Study. Biotech Res Asia 2024;21(1). Available from: https://bit.ly/3TiIPfa

Introduction 

Diabetes and periodontal disease are inflammatory diseases that possess a two-way interaction. Periodontal disease was ranked as the sixth diabetes consequence by Löe in 1993. Production of pro-inflammatory mediators in periodontitis can lead to insulin resistance and change how lipids and glucose are metabolized. As a result, periodontal disease can impair diabetics’ ability to control the blood sugar1.

Compared with individuals with a healthy periodontal condition, diabetics have two to three times higher chance of acquiring periodontitis, and one of the most important indicators of risk is the level of glycemic control. In diabetic patients, having periodontitis is associated to an elevated higher HbA1c levels and may further worsen diabetes complications due to increase in the inflammatory burden2. Thus the association between periodontitis and diabetes shows a link between systemic illness and oral infection.

Over the past two to three decades, numerous studies have looked into how periodontal therapy affects diabetic patients’ ability to control their blood sugar levels. In general, these research’ findings have consistently shown that periodontal therapy lowers blood glucose and HbA1c levels.3 Currently, there are three main methods for diagnosing diabetes: the random blood sugar test (RBS), the glucose tolerance test (GTT), and the glycated hemoglobin (HbA1c) test. Diabetes is confirmed by an HbA1c of 6%, and the severity of the score is correlated with diabetic complications.4

A far easier and non-invasive method for diabetes diagnosis and monitoring is advisable because regular blood glucose testing creates unneeded discomfort and mental trauma for patients. Recently, there has been a rise in interest in using saliva as a diagnostic fluid since it can be collected non-invasively, with less training and technique sensitivity.5 Since collecting saliva is associated with fewer compliance issues than collecting blood, its more reliable to use saliva as a potent diagnostic tool.6

Due to the small size and ease of diffusion via semi permeable membranes, glucose can be found in saliva, especially when blood sugar levels are high. Norma salivary glucose levels range from Previous study has reported elevated salivary glucose levels in diabetics7. However, no prior research have compared salivary glucose levels in type 2 diabetes mellitus (T2DM) who had chronic periodontitis before and after non- surgical periodontal therapy. The glucose concentration was measured in the current study using saliva, making self-measurement of glucose a non-invasive process. Hence, the purpose of this pilot study was to evaluate whether nonsurgical periodontal treatment (NSPT) lowers salivary glucose levels in type 2 diabetics with periodontitis.

Materials and Methods 

This pilot study was carried out in Department of Periodontology, SRM Kattankulathur Dental College & Hospital, Potheri, Tamil Nadu, India. The current study was approved by institutional ethical board. This pilot study included 20 generalized chronic periodontitis patients (13 males and 7 females) with and without T2DM.. The selected subjects were categorized into 2 groups, Group I consisted  10 patients  (8 males and 2 females) with persistent periodontitis who were in overall good health and Group 2 contained10 patients (5 males and 5 females )with type 2 diabetes and chronic periodontitis. In group 2 the participants with T2DM with average blood glucose level of 130-200mg/dl were included

In both groups generalized chronic periodontitis patients within age group 30-60 years, with presence of minimum of≥10 teeth per dental arch, exhibiting pocket depth≥5mmwithCALof

≥3mm with > 30% sites involved (AAP 1999) were included in the study. In group2 Patients exhibiting random blood glucose concentration within range of 130-200mg/dl were also included.

Pregnant women, people with systemic diseases that could affect the course of periodontal disease in the blood, people who had taken anti-inflammatory medicines for 4 weeks before to the trial, smokers or had quit smoking within the last 5years, and those with these conditions were excluded from the study. The entire study procedure was elaborated to the selected patients and their consent was obtained in written format.

Periodontal parameters including plaque index (PI), gingival index (GI), probing pocket depth (PPD) were recorded and documented before the periodontal therapy. Nonsurgical periodontal therapy that comprises of scaling and root planing (SRP) was performed in all patients. Oral hygiene instructions were reinforced for all the patients as home care regimen (brushing technique and interdental cleaning) following SRP. All patients were re-evaluated after three months after the initial examination, and clinical parameters were assessed and compared with the baseline values.

Salivary glucose analysis: Evaluation of salivary glucose level in the saliva sample was done before therapy and 3 months. Quantitative evaluation of salivary glucose was performed using a commercially available glucose oxidase-peroxidase assay kit (GOD-POD method)8and the values were attained. Individuals were instructed not to have anything for atleast two hours before saliva collection. Between 11:00 am and 12:00 pm, 5 ml of whole, un-stimulated saliva from each individual was collected using the spitting technique. Until the experiment started, saliva was obtained in sterile tubes and immediately frozen at 80°C.Each saliva sample weighed 5 ml and was pipetted into a completely fresh microcap tube and clarified by centrifuging at10,000rpm for 1 minute. In order to conduct an analysis, a clean microcap tube was used to quickly transfer the supernatant9.

Statistical Analysis

Data were analyzed using IBM SPSS version 20 software (IBM SPSS, IBM Corp., Armonk, NY, USA). Independent samples t tests, paired t tests were done to analyze the study data.

Results

Total of 20 participants among were included in the present study. In the current study, the baseline periodontal parameters and salivary glucose levels were recorded at baseline and after SRP since saliva has proven to be good indicator for measuring the glucose levels in the diabetic patients. The observed results were reported as mean ±SD with P-values indicating their level of significance. When the clinical parameters were compared among the groups, no statistically discernible difference was found at baseline however after SRP there was reduction in both periodontal parameters and salivary glucose (Table 1 and Table 2). At baseline, mean salivary glucose levels in group 1 and group 2 were 0.76±0.34mg/dl and 6.02±2.55mg/dl respectively (Table 1). At 3 months postoperatively, mean salivary glucose levels in group 1 and group 2 were 0.67±.0.30 mg/dl and 5.71±2.27mg/dl. In comparison to normal salivary glucose levels (0.5mg/dl-1.0mg/dl)9 group 2 showed elevated salivary glucose values at baseline (Table 2). After scaling and root planing there was significant reduction (p=<0.001) in salivary glucose levels to 5.71 mg/dl in group 2 at three month follow up (Table 3). Intra-group comparisons revealed significant reduction of periodontal parameters and salivary glucose levels from baseline to post SRP.

Table 1: Comparison of baseline clinical parameters between the study groups A

 Variable Group N Mean ± SD P value
GI 1 10 2.44±0.35 0.587
2 10 2.35±0.35
PI 1 10 2.57±0.18 0.11
2 10 2.43±0.18
PPD 1 10 4.90±0.48 0.711
2 10 4.80±0.75
Salivary Glucose 1 10 0.76±0.34 <0.001*
2 10 6.02±2.55

Independent samples t test; p≤0.05 considered statistically significant; * denotes significance

Table 2: Comparison of clinical parameters post SRP between the study groups.

 Variable Group N Mean ± SD P value
GI 1 10 1.75±.0.37 0.688
2 10 1.83±.0.44
PI 1 10 1.95±.0.29 0.136
2 10 2.11±.0.17
PPD 1 10 4.44±.0.51 0.639
2 10 4.31±.0.66
Salivary Glucose 1 10 0.67±.0.30 <0.001*
2 10 5.71±2.27

Independent samples t test; p≤0.05 considered statistically significant; * denotes significance

Table 3: Intragroup comparison of clinical parameters from baseline to post SRP

Group Parameter N Mean ± SD Mean diff. P value
1 GI BL 10 2.44±0.34 0.691 <0.001*
GI Post 10 1.75±0.36
PI BL 10 2.53±0.18 0.623 0.001*
PI Post 10 1.95±0.28
PPD BL 10 4.91±0.47 0.47 <0.001*
PPD Post 10 4.43±0.50
SG BL 10 0.76±0.34 0.09 0.108
SG Post 10 0.67±0.30
2 GI BL 10 2.35±0.35 0.53 <0.001*
GI Post 10 1.82±0.43
PI BL 10 2.43±0.18 0.319 <0.001*
PI Post 10 2.12±0.17
PPD BL 10 4.80±0.75 0.49 <0.001*
PPD Post 10 4.31±0.66
SG BL 10 6.02±2.54 0.317 0.046*
SG Post 10 5.71±2.27

Paired t test; p≤0.05 considered statistically significant; * denotes significance

Discussion 

In the current study,20 generalized chronic periodontitis (CP) patients presenting with and without T2DM were assessed for salivary glucose levels prior to non-surgical periodontal therapy and after 3 months of periodontal intervention. The relationship between diabetes and periodontal health has receive lot of focus in the dental literature. According to reports, periodontitis is considered as sixth consequence of diabetes.1 Non-surgical periodontal therapy employed for management of generalized chronic periodontitis has been proved to improve the glycaemic status in T2DM patients.4 We measured the concentration of salivary glucose and its response to NSPT in this study since there are few studies that assess the concentration of glucose in saliva and because there is disagreement over the association between salivary glucose and glycaemia.

In diabetic patients, saliva has been shown to be are liable indication of glucose levels.10 Although we understand that saliva contains glucose, the mechanism by which it is secreted is still unknown. Despite both paracellular and intercellular pathways have been put forth, this is still just a hypothesis and not a proven theory. According to López et al., salivary glands change their function as blood glucose filters in response to hormonal or neurological regulation.11 Persistent hyperglycemia changes the salivary glands’ basement membrane and causes micro vascular abnormalities in the blood vessels. Due to increased glucose leakage from ductal cells of the salivary glands as a result, the amount of glucose in saliva increases12. The non-invasive nature of salivary evaluation and its affordability for mass population screening have benefits. Periodontal parameters like plaque index, gingival index and probing depth were evaluated at baseline and after 3months post non-surgical periodontal therapy since it takes around 3 months to completely resolve gingival inflammation and improve tissue healing 13.

In the current study, at baseline there is no statistical difference in periodontal parameters between the study groups, since all the study participants exhibited similar periodontal status during the recruitment for the study. However, baseline salivary glucose level was significant between the groups since group 1 consists of systemically healthy patients with CP and group 2 consists of T2DM patients with CP. At 3 months, the study findings revealed statistically significant improvement periodontal parameters in both groups, intergroup comparison of salivary glucose level showed significant difference. These results are in accordance with Vedavalli Subramanian et al.14

Intra group comparison of clinical parameter and salivary glucose levels from baseline showed significantreductionpostnon-surgicalperiodontaltherapy.Theseresultsare comparable to those of a meta-analysis by Quanlietal which concluded that nonsurgical periodontal care was helpful in improving glycaemic control in patients with CP and T2 DM.15 The average concentration of salivary glucose for the T2DM patients in current study was 6.02mg/dl, which is in accordance with results obtained by Di Gioia et al 16 SGL =5.57 mg/dl and Maria Sueli et al 17 SGL =5.94 mg/dl. However, our results were in contrast to the results obtained byVidyakadashettietal10 and Sivakumar et al 18. Periodontal treatment improved clinical measures of chronic periodontitis in patients with diabetes, supporting use of non-surgical periodontal treatment for lowering salivary glucose level19. Selection of a particular study design, as well as the variety of techniques and criteria used in collection of samples, may be one explanation for these differences. Also in the current study we selected diabetic patients with average blood glucose level130-200mg/dl which might have contributed to lower salivary glucose values when compared to above studies. The finding of this pilot study depicts saliva as a useful diagnostic tool for the early identification of diabetes mellitus. To determine the diagnostic efficacy of salivary glucose level in the early diagnosis of diabetes 2 mellitus randomized control trails with large sample sizes and long term follow up should be done.

Conclusion

There are numerous analytes in saliva that can be employed as biomarkers for clinical and translational purposes, including DM. Saliva is easily accessible. Thus, the study shows that salivary glucose be used as a diagnostic parameter to assess glycaemic control in T2DM.

Acknowledgements

None

Conflict of Interest

There are no conflict of interest.

Funding sources

There is no funding sources.

References

  1. LöeH. Periodontal disease: the sixth complication of diabetes mellitus. Diabetes care. 1993 Jan 1;16(1):329-34.
    CrossRef
  2. Thorstensson H, Hugoson A. Periodontal disease experience in adult long‐duration insulin‐dependent diabetics. Journal of clinical periodontology.1993May;20(5):352-8.
    CrossRef
  3. PreshawPM, BissettSM. Periodontitis and diabetes. British dental journal.2019 Oct;227(7):577-84.
    CrossRef
  4. ChenYF,ZhanQ,WuCZ,YuanYH,ChenW,BaselineHbA1clevelinfluences the effect of periodontal therapy on glycemic control in people with type 2 diabetes and periodontitis: a systematic review on randomized controlled trails. Diabetes Therapy. 2021 May;12:1249-78.
    CrossRef
  5. Yeh CK, Christodoulides NJ, Floriano PN, Miller CS, Ebersole JL, Weigum SE, McDevittJ, ReddingSW. Current development of saliva/oral fluid-based diagnostics. Texas dental journal. 2010 Jul;127(7):651.
  6. Madalli VB, Basavaraddi SM, BurdeK, HorattiP. Saliva-A diagnostic tool. IOSRJ Dent Med Sci. 2013 Nov;11(6):96-9.
    CrossRef
  7. Panchbhai AS, Degwekar SS, Bhowte RR. Estimation of salivary glucose, salivary amylase, salivary total protein and salivary flow rate in diabetics in India. Journal of oral science. 2010;52(3):359-68.
    CrossRef
  8. KadashettiV, BaadR, MalikN, Shivakuma KM, VibhuteN, BelgaumiU, GugawadS, Pramod RC. Glucose level estimation in diabetes mellitus by saliva: a bloodless revolution. Romanian Journal of Internal Medicine. 2015 Jul 1;53(3):248-52.
    CrossRef
  9. GuptaV, KaurA. Salivary glucose levels in diabetes mellitus patients: A case–control study. Journal of Oral and Maxillofacial Pathology. 2020 Jan;24(1):187.
    CrossRef
  10. KoA, LiaoC. Salivary glucose measurement: A holy ground for next generation of non- invasive diabetic monitoring. Hybrid Advances. 2023 Jun 9:100052.
    CrossRef
  11. LópezME, CollocaME, PáezRG, SchallmachJN, KossMA, ChervonaguraA. Salivary characteristics of diabetic children. Braz Dent J. 2003;14:26–31
    CrossRef
  12. AbikshyeetP, RameshV, OzaN. Glucose estimation in the salivary secretion of diabetes mellitus patients. Diabetes, metabolic syndrome and obesity: targets and therapy. 2012 Jul 12:149-54.
  13. Mauri‐ObradorsE, MerlosA, Estrugo‐DevesaA, Jané‐SalasE, Benefits of non‐surgical periodontal treatment in patients with type2 diabetes mellitus and chronic periodontitis: A randomized controlled trial. Journal of clinical periodontology. 2018 Mar;45(3):345-52.
  14. VedavalliSubramanian1, Muthukumar Santhanakrishnan, NizarAhmed1, M Ganesh2, P Kennedy Kumar Relationship between Serum and Salivary Estimation of Glucose and TNF-α in Patients with Type-II Diabetes–A Correlative Study Journal of Research in Medical and Dental Science.2020
  15. Li Q, Hao S, Fang J, Xie J, Kong XH, Yang JX. Effect of non-surgical periodontal treatment on glycemic control of patients with diabetes: a meta-analysis of randomized controlled trials. Trials. 2015 Dec;16:1-8.
    CrossRef
  16. Di Gioia ML, Leggio A, Le Pera A, Liguori A, Napoli A, Siciliano C, Sindona G. Quantitative analysis of human salivary glucose by gas chromatography–mass spectrometry. Journal of Chromatography B. 2004 Mar 5;801(2):355-8.
    CrossRef
  17. Soares MS, Batista Filho MM, Pimentel MJ, Passos IA, ChimenosKüstner E. Determination of salivary glucose in healthy adults. Medicina Oral, Patología Oraly Cirugia Bucal, 2009, vol. 14, num. 10, p. 510-513. 2009
    CrossRef
  18. Sivakumar M, Deepthi A, Sasidharan P. A Case Control Study To Evaluate The SensitivityOfSalivaryOverSerumGlucoseLevelsInPatientsWithControlledType2 Diabetes Mellitus. Journal of Pharmaceutical Negative Results. 2022 Nov 12:1557-61.
    CrossRef
  19. Prasad R, Raj A, Khan SF, Agarwal S, Shalini B, HS C. Effect of non-surgical periodontal therapy on glycemic control of patients with chronic periodontitis and type-2 diabetes mellitus: A 3 month follow-up intervention study. Intern at J Applied Dental Sci. 2021;7(2):05-8.
    CrossRef
(Visited 140 times, 1 visits today)

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.