PRACA ORYGINALNA / ORIGINAL ARTICLE

Wpływ cukrzycy na zdrowie jamy ustnej

Оlexandr S. Barylo, Тetiana М. Kanishyna, Liudmila I. Shkilniak

National Pirogov Memorial Medical University, Vinnytsya, Ukraine

ABSTRACT

Introduction: According to the World Health Organization (WHO), the International Diabetic Federation (IDF) and the European Association for the Study of Diabetes (EASD), there is an annual increase in the number of diabetes mellitus patients. At the same time, the incidence and prevalence rate of major dental diseases in Ukraine remains high. Oral health is one of the direct measures indicators of the population’s health.

The aim: To study the features of the oral health status of diabetes mellitus patients, incidence and prevalence of dental caries, the extracted teeth rate; to assess the effect of oral health on quality of life.

Materials and methods: A standard oral health survey of 220 female and male patients with diabetes mellitus aged 40 to 60 was conducted. The patients are under dispensary observation at the Vinnytsia Regional Endocrine Dispensary. Dental caries incidence and prevalence indices were calculated. A questionnaire survey of the patients was conducted to collect the information about the self-rating of oral health status, quality of life and social status. The statistical data were processed using Microsoft Excel. The assessment of significance of the surveyed indices difference was carried out using Student’s test. Dynamics of morbidity in the surveyed group of patients was studied.

Results: The caries incidence rate by the DMFT Index for all the surveyed patients was high. Within the DMFT Index structure, in all age groups, conspicuous is a high percentage of extracted teeth. Dental caries prevalence comes to 100% in all surveyed groups; 78 % of the surveyed reported a pain-induced quality of life deterioration, discomfort or other oral problems.

Conclusions: Diabetes mellitus has a direct effect on oral health. The level of medical and preventive dental care for diabetes patients must be raised.

Key words:

Wiad Lek 2018, 71, 5, -1031

 

Introduction

According to the data of the WHO, the International Diabetic Federation (IDF) and the European Association for the Study of Diabetes (EASD), there is an annual increase in the number of diabetes mellitus patients. In Ukraine, 1.2 million diabetes patients are registered, with 85-90% of type 2 diabetes mellitus, mostly people of productive age (40 to 59 y.o.). In the Vinnytsia Region, diabetes mellitus incidence increases every year. Thus, in 2008 the number of patients reached 38 763 people, in 2009 – 40 325, in 2010 – 41 697, in 2011 – 43 491, in 2012 – 45 182, in 2013 – 46 796, in 2014 – 48 257, in 2015 – 49 927 people.

The 2008-2015 growth rates of the number of diabetes mellitus patients in the Vinnytsia Region is shown in Figure 1.

According to the 2015 data, the proportion of diabetes mellitus patients among the region’s population made 3%, with a similar rate countrywide.

Oral health is one of the direct measures indicators of the population’s health [1].

Equally, the incidence and prevalence rates of major dental disorders in Ukraine remains high [2]. Thus, dental caries prevalence among different cohorts varies from 80% to 98%.

Analyzing the etiological agents and risk factors for the genesis of diabetes mellitus and dental caries and its complications, we note common factors. In particular, diet and dietary pattern contribute considerably to these pathologies genesis.

Over the last 50-60 years, in the majority of countries there have been fundamental changes in people’s lifestyles. Food stuffs have become more affordable. The acceleration of the pace of life has increased the need for fast food and frequent quick snacks. Rough food is used more and more seldom. Sweet carbonated drinks have become widespread, especially among the youths. The regular use of sugary drinks has proved to increase the risk of adiposis and type 2 diabetes. Also, it has a specific effect on metabolic processes in the oral cavity. Simple carbohydrates enter metabolism just in the oral cavity, in contrast to proteins, fats and complex carbohydrates. The conditions for carbohydrates uptake by the oral cavity microflora are close to ideal, which consequently affects dental caries incidence and prevalence.

Unfortunately, the population’s awareness of the types and methods of diseases and risk factors prevention, the mental set on a healthy lifestyle and its principles is very low [3]. Just when diabetes emerges, its first manifestations change the oral health status. Lack of saliva (xerostomia) leads to a decrease in nonspecific and cellular immunity and is a cariogenic factor. Paradontal tissues microcirculation disorders lead to decreasing of perfusion and tissues’ hypoxy [4], which adds to the development of generalized paradontitis.

Thus, there is an evident association in the genesis of diabetes and oral cavity diseases[5], along with the process of their mutual burdening, when diabetes-associated oral health status of a person changes . Similarly, dental and paradontal diseases can aggravate the course of diabetes mellitus. Therefore, the study of the oral health status of diabetes mellitus patients is an urgent issue.

The Aim

To study the features of the oral health status of diabetes mellitus patients, dental caries incidence and prevalence and extracted teeth rates. To analyze how often diabetes patients undergo a tooth extraction operation and to assess the effect of oral health on quality of life of such patients.

Materials and methods

A standard oral health survey of 220 female and male patients with diabetes mellitus aged 40 to 60 was conducted. The patients are under dispensary observation at the Vinnytsia Regional Endocrine Dispensary.

All the patients gave their consent to the participation in the study. For the survey, the epidemiologic methods recommended by the WHO (2013) for evaluation of oral health were used. The collected data were recorded in the WHO card for the adult oral health status evaluation. According to the obtained results caries incidence and prevalence indices were calculated. Caries prevalence index in the group of examined patients was calculated in the following way:

the number of patients who had caries x 100

the number of examined patients

I.e. the number of patients with different types of caries is divided by number of all examined patients in the group and multiplied by 100.

For the evaluation of caries incidence the DMFT index was calculated for every person out of examined ones (where D – is the number of teeth with caries, M – missing teeth, F – filled teeth in one examined person) and the caries incidence was determined for all the group according to the following formula:

total number of DMFT indices

number of persons who have caries

A questionnaire survey of all patients was conducted. The survey used the Oral Health Assessment Form for Adults (2013) proposed by the World Health Organization. This questionnaire includes the questions for collection of the information about the self-rating of oral health status, quality of life and social status.

Females constituted 57%, males 43% (Figure 2). To study the dynamics of dental morbidity the patients were divided into following age groups: 40 to 45 years – 58 people, 45 to 50 years – 57 people, 50 to 55 years – 54 people, and 55 to 60 years – 51 people (Figure 3).

The statistical data were processed using Microsoft Excel (biostatistical method of evaluation). The data in the text and charts show the average value and standard deviation. The assessment of significance of the surveyed indices difference was carried out using Student’s test.

Results and discussion

None of the 220 surveyed patients had all teeth intact. Thus, the prevalence of caries was 100% in all groups. 208 out of 220 examined patients had their teeth extracted, their number ranging from 1 to a complete edentulism of 3 patients. The DMFT Index of caries incidence for all subjects was high – 15,85 (according to the WHO estimation criteria, the DMFT Index of caries incidence for adults is rated as Very low (<5.0), Low (5.0 to 8.9), Moderate (9.0-13.9), High (> 13.9) .

We compared the age-dependent caries incidence variation in the patients examined, dividing them into 4 age groups: 40-44, 45-49, 50-54, 55-59 y.o. In the 40 to 44 y.o. group, the caries incidence was moderate (13.69), in the other groups – high (16.3; 16.7; 16.9 respectively). The Table I shows the DMFT indices for every age group and caries incidence index for all examined patients. The structure of DMFT index is indicated, where D – includes decayed teeth, M – extracted teeth, F – filled teeth. The data in the Chart 1 make possible to evaluate the dynamics of dental morbidity: there is an increase of DMFT indices with aging in examined patients and besides the increase of index appears because of the increase of “M” component (extracted teeth).

The indices did not differ by sex.

The generalized structure of the DMFT Index by age groups is shown in Figure 4. The stable increase of component “M” pays attention: from 5.0 in the group of 40-44 y.o. to 8.61 in the group of 55-59 y.o. The component “D” (number of decayed teeth) is conversely decreased in older age groups: from 1.86 in 40-44 y.o. to 1.0 in 55-59 y.o. examined patients. The component “F” is the lowest in the first group (6.86) and the highest in the third group (7.39).

The dynamics of dental morbidity in examined patients with diabetes mellitus according to the evaluation of DMFT indices is shown on the diagram (Figure 4). The increase of the index with age is observed. When comparing caries incidence DMFT Indices in patients of Group I and IV, Student’s test makes 4.6 which is higher than the critical value of this index (3.38) for a predetermined number of observations at a significance level of 0.001.

Consequently, the difference between the DMFT caries indices in patients aged 40-44 and 55-59 is statistically significant (Figure 5).

Within the DMFT Index structure, in all age groups, conspicuous is a large percentage of extracted teeth. The bar chart indicates that in older age groups the DMFT Index increases due to the increase of extracted teeth (Figure 6).

The survey revealed that the majority of the examined (78%) complained of a deterioration in quality of life, induced by pain, discomfort or other oral problems.

Discussion. Epidemiologic dental examinations are regularly organized by the WHO in different countries. These studies indicate the abrupt increase of dental morbidity in countries with middle and low level of incomes, where the food regulations change and unhealthy way of life is accepted [6]. The prevalence of caries in Ukraine is high: from 92.7 to 100 among adults, it has regional differences . According to the literature data the caries prevalence among the working-age population of Zaporizzhya city is 100%, the caries incidence (DMFT index) is 16.7. The structure of DMFT index among the working-age population is as follows: component “D” (decayed) is 5.99, component “M” (extracted) – 4.32, component “F” (filled) – 6.57 [7]. The caries prevalence among the working-age population of city of Uzhgorod is 100%, the caries incidence (DMFT index) is 16.59, and besides the component “D” (decayed) is 4.55, component “M” (extracted) – 4.88, component “F” (filled) – 6.55 [8]. The results of our study also confirm the high level of dental morbidity in the country: the caries prevalence – 100%, the caries incidence (DMFT index) – 15.85, yet particular qualities in DMFT index structure among the patients with diabetes mellitus aged 40-60 y.o. are found, namely the high number of component “M” (extracted) – 6.96. Therefore, the examined patients with diabetes mellitus more often had the complications of caries which led to loss of teeth, comparing to the people of same age without concomitant diseases.

Conclusions

Despite the fact that the possibilities of caries treatment and prevention grow every year, the indices of dental caries incidence and prevalence in Ukraine remain high. This was confirmed by the results of the oral health status study of type 2 diabetes mellitus patients aged 40 to 60, whose caries prevalence was 100%, and incidence by the DMFT Index was high.

Moreover, a considerable proportion within the DMTF Index is formed by the M component, which characterizes the number of extracted teeth. This value shows a steady growth associated with the age growth of the surveyed. Thus, an increase of the DMFT Index in older age groups occurs precisely due to the extracted teeth. It should be noted that a tooth extraction in diabetes patients, as well as any other surgical treatment, calls for a particular approach and monitoring of the extraction wound healing.

Quality of life of patients as well as their community relief depend on their oral health. Due to their poor dental health a considerable proportion of the surveyed felt a sense of shame, lacked confidence, and refused to smile.

Therefore, the level of medical and preventive dental care for diabetes mellitus patients must be raised and medical efforts should provide the control of prevalence of dental diseases and renewal of life quality.

Prospects for further studies: The study of pathogenetic features of dental tissue damage in patients of different age and sex groups, associated with type 1 and type 2 diabetes, urges to a basic detailed research, results classification, substantiation and design of individualized therapeutic and diagnostic regimens and algorithms.

References

1. Lyakhova N, Kasinets S. The preexposure prophylaxis of stomatological diseases among the population of ukraine in the practice of the family doctor and the pediatrician .Wiadomosci Lekarskie. 2017;3(70): 470–473.

2. Kuzniak N.B, Hodovanets О.І. Stomatologichnyy status ditey iz suputnjoiu somatychnoiu patolohijeiu [Stomatological status of children with concomitant, somatic pathology]. Buk. Med. Herald. 2010; 1 (53) : 45-47

3. Lyakhova N, Golovanova I, Lysak V et al. Shliachy formuvania zdorovoho sposobu zyttia naselennia v praktyci simeynoho likaria. [ Ways of forming the healthy lifestyle in the family doctor practice ]. Modern Medical Technology. 2016; 2: 131-135.

4. Zeliba M.D, Bohachuk M.H, Zarezenko T.P et al. Mikrocirculiatorni zminy v hnijno-zapalnomu vohnyschi u chvorych na cukrovij diabet 2 typu .[Microcirculatory changes in necrotic-inflammatory focus in patients with 2 type diabetes mellitus ]. Clinical Anatomy and Operative Surgery. 2017; 2: 10-12.

5. Biloshicka A. V. Porivnialna ocinka orhanoprotektornoji diji roslynnych preparative na tkanynu pidiazychnoi slynnoi zalozy pry cukrovomu diabeti 2 typu. [ The comparative study of herbal remedies protection on subligual gland tissue during diabetes type 2]. Bulletin of problems biology and medicine. 2016; 2 (128): 336-341.

6. Oral Health Surveys Basic Methods 5th Edition. Geneva: World Health Organization; 2013, p. 60-68.

7. Klymenko V.I, Smirnova I.V. Obgruntuvannia funkcionalnoji modeli profilactyci poshyrenosti ta intensyvnosti poshyrenych stomatolohischnych zachvoriuvan. [ Reasoning of prevalence and intensity of widespread dental diseases’ prevention functional model Ukraine] . Nation’s Health. 2015; 2 (34) : 69-75.

8. Melnyk V.S, Izaj M.E, Duhanchyk J.I. Analiz poshyrenosti zachvoriuvan zuboschelepnoji systemy jaki formuiut popyt na stomatolohychni posluhy. [Analysis of the prevalence of diseases of the dentition, which form the demand for dental services]. Young Scientist. 2016; 12.1 (40): 166-168.

The work was performed as part of the base project : “Development of complex treatment methods of patients with pathologic processes of maxillofacial area of different etiology considering the individual characteristics”

 

Authors’ contributions:

According to the order of the Authorship.

Conflicts of interest:

The Authors declare no conflict of interest.

CORRESPONDING AUTHOR

Тetiana Kanishyna

Pirogova, 103, apt.108, 21018, Vinnytsya, Ukraine

tel: +380674931259

e-mail: Kanyshyna@gmail.com

Received: 19.04.2018

Accepted: 20.06.2018

Figure 1. The 2008-2015 growth rates of the number of diabetes mellitus patients in the Vinnytsia Region.

Figure 2. Number of patients by sex.

Figure 3. Number of patients by age group.

 

Figure 4. The generalized structure of the DMFT Index by age groups.

Figure 5. Growth rates of dental caries incidence by age groups.

Figure 6. Average number of extracted teeth by age groups.

Table I. Incidence and prevalence of dental caries in the key age groups.

Age group

(years)

Prevalence of caries, %

Incidence of caries

D

F

M

DMFT

І (40-44)

100

1,86 ± 1,15

6,83 ± 1,57

5,00 ± 2,09

13,69 ±2,88

ІІ (45-49)

100

1,16 ± 1,14

8,05 ± 4,37

7,09 ± 5,65

16,30 ± 4,79

ІІІ (50-54)

100

1,15 ± 1,13

8,17 ± 3,95

7,39 ± 4,41

16,7 ± 4,55

ІV (55-59)

100

1,00 ± 1,27

7,29 ± 3,18

8,61± 4,46

16,9 ± 4,27

Average of all age groups (40-59)

100

1,3 ± 1,22

7,58 ± 3,48

6,96 ± 4,54

15,85 ± 4,39