Original article: Comparative evaluation of stimulated salivary flow in between diabetic and non diabetic subjects wearing complete denture

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1 Original article: Comparative evaluation of stimulated salivary flow in between diabetic and non diabetic subjects wearing complete denture Dr.Apurwa Madhup, Dr.S.R.Godbole, Dr. Shubhangi Meshram Department of Prosthodontics, Sharad Pawar Dental College,Sawangi. Wardha. India Corresponding author : Dr.Apurwa Madhup Abstract: Diabetes mellitus is a complex polygenic disorder in which common genetic variants interacts with environmental factors to unmask the disease and is commonly found in dental patient. Patients with a diagnosis of diabetes mellitus present a higher susceptibility to infections due to a deficiency in polymorphonuclear leukocytes, as a result of vascular alterations and neuropathies. An increased risk of infections has been observed with reduced salivary flow commonly report specific symptoms such as a sensation of dry mouth and burning, mastication and speech difficulties, dry lips, altered taste, and a lack of adaptation to the complete denture. The aim of the present study was to compare diabetic and nondiabetic subjects wearing complete dentures regarding salivary flow of different age group.thirty subjects, 15 with and 15 without a diagnosis of diabetes, were matched for gender, race, and age. Keywords: Diabetes mellitus, Salivary flow, Stimulated saliva, Xerostomia I. Introduction Diabetes mellitus is a chronic metabolic disorder characterized by hyperglycemia, associated with irregularities in the metabolism of carbohydrates, lipids, and proteins, and susceptibility to the development of specific forms of premature renal, occular, neurological, and cardiovascular diseases. Diabetes mellitus is one of the most prevalent diseases worldwide and is commonly found in older individual. It is one of the main reason due to which early tooth loss occur. It was found that the direct correlation exist between diabetes mellitus and edentulism. Patients with a diagnosed diabetes mellitus present a higher susceptibility to infections due to a deficiency in polymorphonuclear leukocytes, due to peripheralvascular alterations and peripheral neuropathies 1. Which increases the risk of infection in oral cavity and inadequate maintenance of oral hygiene and hygiene of existing complete dentures. Special care and great attention on the part of the dentist in terms of anamnesis and clinical examination is necessary, since these subjects commonly report specific symptoms such as a sensation of dry mouth and burning sensation, difficulty in mastication and speech difficulties, dry lips, altered taste, and a lack of adaptation to the complete denture. Diabetes mellitus increases the susceptibility to erosion and ulceration of the mucosa where it comes in contact with the tissue surface of the complete denture 1. Bergdahl and Bergdahl showed that psychological factors play an important role in xerostomia. Hyposalivation is significantly associated with depression and anxiety. Wettability, surface tension, viscosity, and muscle control are factors that enhance denture retention 1. Sreebny and Schwartz reported that the use of medications may alter the salivary gland secretion, with the most influential drugs being antidepressant 35

2 , antihypertensive, and diuretic agents. Most of the diabetic people are under continuous medication and psychological treatment which affects the denture tolerance so the aim of the study is to evaluate and compare the stimulated salivay flow in diabetic and non diabetic subjects wearing complete denture. The aim of the present study was to compare diabetic and nondiabetic subjects wearing complete dentures regarding salivary flow of different age group. The research hypotheses were:oral mucosal lesions are more frequent in complete denturewearing subjects with diabetes which may be due to reduced salivary flow and also causes subjective feelings of denture instability in patients with diabetes so this study is aimed to relate the change in stimulated salivary flow and diabetes mellitus. II. Material and methods : 30 subjects were selected in Department of Prosthodontics, Sharad Pawar Dental College,Sawangi ( Meghe ) Wardha out of which 15 subjects were diagnosed with type 2 diabetes and considered as experimental group. Another 15 subjects were healthy individuals and were considered as control group. No selection was made on the basis of gender, race, and age. Control group Inclusion criteria: All the selected individuals should be healthy No TMJ problem. No systemic diseases Denture should be in proper condition. No hormonal disturbances Exclusion criteria: Patient having faulty denture should not be included in the study Experimental group Inclusion criteria: 1. Only patient with type2 diabetes Exclusion criteria patient with type2 diabetes with systemic diseases like hypertension, cardiovascular disease, neurological disorder. Patient with type1 diabetes mellitus Patient on medication other than medication for type2 diabetes mellitus Patient with systemic disease Method Patient is instructed to chew chewing tablets {sugar free}for one minute and sample is collected in a graduated test tube after one minute the process is repeated o nce a day on alternate day for three days with each individual. [ Saliva collector ] 36

3 III. Result Table 1: Comparison of mean saliva in both the groups Group N Mean Std. Deviation Std. Mean Error t-value p-value Control Experimental ,S,p< Mean Saliva and SD Control 0.48 Experimental Group [ Comparison of the 2 groups revealed significant difference in mean (SD) salivary flow between the control group (1.38(0.21) ml/min) and the diabetic group (0.48(0.16) ml/min) t=12.68 (p<0.05). ] IV. Discussion The salivary flow rate differs between the groups, and feelings of denture instability were reported. The results support the research hypothesis that salivary flow is decreased in complete denturewearing subjects with diabetes compared to controls. The data supports the research hypothesis that oral mucosal lesions are more frequent in complete denture- wearing subjects with diabetes. Wu AJ and Ship JA 1 observed that xerostomia and salivary gland hypofunction are associated with sundry local and systemic conditions. Advancing age, selected medical disorders, polypharmacy, smoking, and recreational drug usage have all been shown to be associated with salivary gland hypofunction and/or xerostomia. The chewingstimulated whole salivary flow rate was <_0.7 ml/min Navazesh et al 2 observed that parotid glands contribute mostly to stimulated saliva, whereas 37 36

4 submandibular glands predominantly affect the unstimulated whole saliva flow rates.. Salivary gland hypofunction can lead to dental caries, dental erosion, tooth demineralization, oral candidiasis and altered oral sensation. V. Conclusion Within the limitations of this study, significant differences were observed in salivary flow, selfreported denture retention, or oral mucosal lesions when comparing diabetic and nondiabetic subjects. References 1. Fumihiko Mori., Noriko H., Masayuki O., Junji T. Effects of Masticastion On Flow And Properties Of Saliva. Asian Pac Dent 2012;12: Danielle C.L, Gislaine C.N., Ivan B, Janete D.A Oral Manifestations of Diabetes Mellitus in Complete Denture Wearers. The Journal of Prosthetic Dentistry 2008 ;99(1): Mahvash N., Roseann M., Yolanda B., Maryann R., Deborah G., Mario A., Joan P., 4-year longitudinal evalution of xerostomia and salivary gland in the women s interagency HIV study s 4. Wu AJ and Ship JA. A characterization of major salivary gland flow rates in the presence of medications and systemic diseases. Oral Surg Oral Med Oral Pathol ;6: Awatif Y. Al- Maskari, Masoud Y. Al- Maskari, Salem Al-Sudairy. Oral Manifestation and Complications of Diabetes mellitus. SQU Medical Journal May 2011 Volume11, Issue 2 6. Bergdahl M, Bergdahl J. Low unstimulated salivary flow and subjective oral dryness: association with medication, anxiety, depression, and stress. J Dent Res 2000;79: Belazi MA, Galli-Tsinopoulou A, Drakoulakos D, Fleva A, Papanayiotou PH. Salivary alterations in insulin -dependent diabetes mellitus. Int J Paediatr Dent 1998;8: Abbas NA, Moussa MM, Nada MA. Ultrastructural, histological and histochemical study of the denture bearing mucosa of complete dentures with soft liner in diabetic patients, Egypt Dent J 1987;33: Vernillo AT. Diabetes mellitus: Relevance to dental treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;91: Chavez EM, Borrell LN, Taylor GW, Ship JA. A longitudinal analysis of salivary flow in control subjects and older adults with type 2 diabetes. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;91: Papapanou PN. Periodontal diseases: epidemiology. Ann Periodontol 1996;1: Zielinski MB, Fedele D, Forman LJ, Pomerantz SC. Oral health in the elderly with noninsulindependent diabetes mellitus. Spec Care Dentist 2002;22: Morrato EH, Hill JO, Wyatt HR, Ghushchyan V, Sullivan PW. Physical activity in U.S. adults with diabetes and at risk for developing diabetes, Diabetes Care 2007;30: Owen KR, McCarthy MI. Genetics of type 2 diabetes. Curr Opin Genet Dev 2007;17: Sykes LM, Sukha A. Potential risk of serious oral infections in the diabetic patient: a clinical report. J Prosthet Dent 2001;86: Astor FC, Hanft KL, Ciocon JO. Xerostomia: a prevalent condition in the elderly, Ear Nose Throat J 1999;78: Darvell BW, Clark RK. The physical mechanisms of complete denture retention. Br Dent J 2000;189:

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