Saudi Cultural Missions Theses & Dissertations
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Item Restricted Dental Caries in Individuals living with Type 2 Diabetes: Exploring Severity, Risk Factors, and Salivary Metabolic Profiling for Comprehensive Insights(Queen Mary University of London, 2024-03-31) Alkahtani, Ashwaq; Baysan, Aylin; Anderson, PaulDiabetes mellitus is a well-known disease that is associated with several of general and oral health issues. However, evidence related to the association between type 2 diabetes mellitus (T2DM) and dental caries is controversial. Aim This study aimed to investigate the impact of type 2 diabetes mellites (T2DM) on severity of dental caries and evaluate the relative protective and risk factors for the development of dental caries. Material and method Firstly, a laboratory study evaluated the SoproLIFE fluorescence system for detecting dental caries on 56 extracted teeth. Subsequently, a case-control study was conducted with 182 participants, with 91 nondiabetics (ND) and 91 participants. A questionnaire including demographic and oral health and dietary for each participant were recorded. Clinical assessments including dental plaque, periodontal health, dental caries score using ICDAS and root caries, SoproLIFE and dental caries risk assessment using caries management by risk assessment (CAMBRA) were carried out. Unstimulated whole saliva was collected to measure the saliva properties and stimulated saliva for metabolic profiling using 1H-Nuclear Magnetic Resonance Spectroscopy. Results Results from laboratory study showed SoproLIFE had 90% sensitivity and 95.8% specificity for sound-initial caries, 100% sensitivity and 53.8% specificity for dentine caries. The case- control study reported that participants with diabetes showed higher British Asian representation (38%) compared to non-diabetes (12%). 98% of the participants had no dental insurance, with 31.8% on benefits and 39.5% of diabetes participants retired. Diabetes participants had significantly lower juice consumption (34%) compared to non-diabetes (27%). No significant associations were found in oral health behaviours except the presence of removable prosthesis. Significant differences were observed in juice and sweetened juice consumption between diabetes and non-diabetes groups. Saliva pH was slightly low in T2DM (6.65±1.12) vs. ND group (6.88±0.49), but not statistically significant (p=0.065). Saliva buffer capacity showed no significant difference, with values of 7.38 ± 3.2 in T2DM and 7.37±2.83 in ND (p=0.973). Saliva spinnbarkeit was slightly higher in T2DM (4.57±4.34) than ND (3.69±3.6), but not statistically significant (p=0.141). T2DM individuals were more likely to have very low or low saliva flow rates compared to non-diabetic individuals (18% vs. 5.5%, respectively). The plaque index was slightly high in T2DM (p>0.05). Overall ICDAS scores were significantly high with T2DM. ICDAS scores 3 and 6 were significantly high in in T2DM (2.7±2.66, 0.86 ±2.61) compared to ND (2.10±2.00, 0.26±0.96) respectively. SWS 1H-NMR spectroscopy profile for T2DM revealed significant upregulation of organic acid anions, specifically lactate and formate (lactic and formic acids), when compared to the non-diabetic group. Conclusion: The light fluorescence evaluator (SoproLIFE) reported promising performance in distinguishing early enamel carious lesions from sound surfaces in the laboratory study. The case-control study showed the mean age at diagnosis of 43±10 years, a gender disparity with more males (67.7%) in the T2DM group, and a notable representation of Asian British individuals (38.4%). T2DM participants had a significantly high reliance on medications (92.3%) and distinct oral health practices when compared to the non-diabetic group. There were differences in the presence of removable prostheses, as well as juice and sweetened juice consumption between the two groups. In addition, this case-control study revealed differences in severity of dental caries with high moderate and severe lesions in T2DM group. The study also provided valuable insights into metabolic changes in saliva among individuals with diabetes, demonstrated that the organic acid anions lactate and formate were significantly upregulated in the T2DM group. These bacterial catabolites have been previously implicated in the pathogenesis of dental caries. This highlights the significant differences in salivary metabolites between individuals with T2DM and healthy controls.9 0