The Influence of Type 1 Diabetes Mellitus on Dental Caries and Salivary Composition

Hindawi International Journal of Dentistry Volume 2018, Article ID 5780916, 7 pages https://doi.org/10.1155/2018/5780916 Research Article The Influence of Type 1 Diabetes Mellitus on Dental Caries and Salivary Composition Lulëjeta Ferizi ,1 Fatmir Dragidella,2 Lidvana Spahiu,3 Agim Begzati ,1 and Vjosa Kotori3 1 Department of Pediatric Dentistry, School of Dentistry, Medical Faculty, University of Prishtina, Prishtina, Kosovo Department of Periodontology and Oral Medicine, School of Dentistry, Medical Faculty, University of Prishtina, Prishtina, Kosovo 3 Department of Endocrinology, Pediatric Clinic, School of Medicine, Medical Faculty, University of Prishtina, Prishtina, Kosovo 2 Correspondence should be addressed to Lulëjeta Ferizi; Received 1 June 2018; Accepted 26 August 2018; Published 2 October 2018 Academic Editor: Izzet Yavuz Copyright © 2018 Lulëjeta Ferizi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Diabetes mellitus is the most common chronic disease that affects the oral health. The aim of the study is to evaluate the dental caries, salivary flow rate, buffer capacity, and Lactobacilli in saliva in children with type 1 diabetes mellitus compared to the control group. Methods. The sample consisted of 160 children of 10 to 15 years divided into two groups: 80 children with type 1 diabetes mellitus and 80 children as a control group. Dental caries was assessed using the DMFT index for permanent dentition. Stimulated saliva was collected among all children. Salivary flow rate and buffer capacity were measured, and the colonies of Lactobacillus in saliva were determined. The observed children have answered a number of questions related to their dental visits and parents’ education. The data obtained from each group were compared statistically using the chi-square test and Mann–Whitney U-test. The significant level was set at p < 0.05. Results. DMFT in children with type 1 diabetes was significantly higher than that in the control group (p < 0.001). Diabetic children have a low level of stimulated salivary flow rate compared to control children (0.86 ± 0.16 and 1.10 ± 0.14). The buffer capacity showed statistically significant differences between children with type 1 diabetes and control group (p < 0.001). Also, children with type 1 diabetes had a higher count and a higher risk of Lactobacillus compared to the control group (p < 0.05 and p < 0.001). Conclusion. The findings we obtained showed that type 1 diabetes mellitus has an important part in children’s oral health. It appears that children with type 1 diabetes are exposed to a higher risk for caries and oral health than nondiabetic children. 1. Introduction Diabetes mellitus (DM) is a common chronic disease that leads to hyperglycemia [1–3]. It is classified into four general categories: type 1, in which the pancreas β-cells lose their capacity to produce insulin; type 2, in which a defect in the β-cells or a reduction in tissue sensitivity to insulin is necessary for disease manifestation; gestational diabetes, defined as any degree of glucose intolerance with onset or first recognition during pregnancy; and specific types of diabetes due to other causes, e.g., monogenic diabetes syndromes (such as neonatal diabetes and maturity-onset diabetes of the young (MODY)), diseases of the exocrine pancreas (such as cystic fibrosis), and drug- or chemical-induced diabetes (such as with glucocorticoid use, in the treatment of HIV/AIDS, or after organ transplantation) [1]. The oral cavity structure can be affected by diabetes, which may result in several complications including dental caries, periodontal disease, oral mucosal diseases, and saliva dysfunction that have a significant effect on the quality of life of diabetic patients. Also, untreated oral diseases may increase the risk of poor metabolic control [4]. The relationship between diabetes and dental caries has received the attention of researchers because both of the diseases are associated with carbohydrates. The insulin deficiency in diabetes may lead to hyposalivation and elevated salivary glucose levels, which may put diabetic patients at a high risk of caries development [5]. Saliva composition is 2 an important factor in determining the prevalence of caries and oral health. It maintains the integrity of oral tissues, provides protection against immunologic bacterial, fungal, and viral infections [6], and controls the equilibrium between demineralization and remineralization in a cariogenic environment. Also, salivary buffers can stabilize pH in plaque, thus preventing demineralization of enamel [7–9]. Patients with diabetes have been reported to complain of dry mouth and salivary dysfunction leading to a reduction of salivary flow rate, lower buffer capacity, increased risk for dental caries, and bacterial infections [10]. Increasing the level of glucose in saliva affects the activity of microorganisms. Streptococcus mutans and Lactobacillus are considered to be related to caries and are the most cariogenic bacteria [11] because they have the ability to create a low pH environment and progression of caries [12]. Research studies show that Streptococcus mutans and Lactobacillus found in stimulated saliva explain better the development of caries than Streptococcus mutans and Lactobacillus found in plaque [13, 14]. For this reason, the combined analysis of dental caries, salivary components, and bacterial pathogens in saliva is a powerful method of following the oral diseases in children with type 1 diabetes mellitus [15]. The parents’ role is very important in relation to oral health because they are the main caregivers of their children’s oral health [16]. The studies show that the parents of children with diabetes are often careless about untreated dental caries in their children and not conscious enough on the importance of their oral health and its influence in diabetes [17, 18]. The aim of the study was to assess the dental caries, salivary flow rate, buffer capacity, and bacterial count of Lactobacillus in saliva between children with type 1 diabetes mellitus and control group. 2. Materials and Methods 2.1. Study Sample. The study was conducted in 160 children, including 80 children with type 1 diabetes mellitus aged 10–15 years, who were attending the Pediatric Clinic at University Medical Centre of Prishtina, Republic of Kosovo. All diabetic children were treated with insulin but not with any other therapy within the last month. The control group aged 10–15 years included 80 healthy children with absence of active diseases and no history of drug therapy within the previous month. 2.2. Clinical and Microbiological Procedures. All children were examined by a researcher at the Department of Pediatric Dentistry, University Dentistry Clinical Centre of Kosovo (UDCCK). Before children’s examin (...truncated)