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ORIGINAL RESEARCH
Year : 2023 | Volume
: 14
| Issue : 2 | Page : 59-61
Relationship between Salivary Levels of Protein Carbonyl and Total Antioxidant Capacity and Prevalence of Dental Caries among Type 1 Diabetic Children: An Analytical Cross-Sectional Study
Shahad Fahim Obaid1, Shahbaa Munther1, Marwa Hasan Abbas2
1 Department of Pedodontics and Preventive Dentistry, College of Dentistry, University of Baghdad, Iraq
2 Pediatrician, Al-Imam Al-Hasan Center for Endocrinology and Diabetes, Karbala, Iraq
Correspondence Address:
Shahad Fahim Obaid
Department of Pedodontics and Preventive Dentistry, College of Dentistry, University of Baghdad
Iraq
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/denthyp.denthyp_44_23
Introduction: We aimed to assess the possible relationship between dental caries prevalence and oxidative stress markers such as protein carbonyl (PC) and total antioxidant capacity (TAOC) of saliva among type 1 diabetic children. Methods: An analytical cross-sectional study was performed among 45 type 1 diabetic children and compared with 45 healthy control children aged 10 to 12 years old. Dental caries was diagnosed and recorded using the decayed, missing, and filling index (DMFS/dmfs). Unstimulated salivary specimens were collected for evaluation of TAOC and PC using an enzyme-linked immune-sorbent assay (ELISA). A linear regression model and one-way ANOVA test were employed for data analysis using the R 4.3.0. Results: Salivary levels of TAOC and PC, having diabetes, and diabetes status (controlled or uncontrolled) were not statistically significant (P > 0.05) predicators regarding the prevalence of dental caries among type 1diabetic children. Conclusion: The diabetic status had a significant effect on salivary levels of TAOC and PC, but no significant effect on the prevalence of dental caries.
Keywords: Children, dental caries, ELISA assay, oxidative stress, protein carbonyl, salivary biomarkers, total antioxidant capacity, Type 1 diabetes mellitus
In a diabetic patient, insulin hormone deficiency changes saliva’s quantity and composition, resulting in hyposalivation and an increased glucose level in saliva, thus increasing the chance of developing dental caries.[1],[2] Wang et al. conducted a systematic review and meta-analysis that included 10 articles and 538 patients to assess the prevalence of dental caries in children and adolescents with type 1 diabetes. The general pervasiveness of dental caries among kids and adolescents with type 1 diabetes was 67%. Interestingly, the prevalence was lower among diabetic patients with good metabolic control (47%). According to geographical region, the highest prevalence was in South America (84%), and the lowest in Europe (57%).[3]
In type 1 diabetes mellitus, chronic hyperglycemia has been linked to an increase in the formation of oxygen-free radicals through auto-oxidation of glucose and non-enzymatic glycation.[4] The imbalance in the oxidant/antioxidant ratio causes a condition known as oxidative stress, which is harmful to health.[5] The impairment of the equilibrium between free radicals and salivary antioxidants may play an important role in initiating and developing dental caries.[6],[7] A recent global investigation showed that the connection between salivary oxidative stress and dental caries remains understudied, with few examinations looking at the connection between these disorders.[8]
This study was performed to assess the possible relationship between dental caries prevalence and oxidative stress markers such as protein carbonyl (PC) and total antioxidant capacity (TAOC) of saliva among type 1 diabetic children.
Materials and methodsThe study protocol was approved by the Scientific Committee in the College of Dentistry/University of Baghdad (ref. no.578322 on June 2, 2022). This analytical cross-sectional study was performed in Karbala City/Iraq, among type 1 diabetic children aged 10 to 12 years old from March to the end of June 2022. Written informed consent form signed by parents. The study sample includes 45 diagnosed children with type 1 diabetes mellitus (the quality of disease control is determined by the level of HbA1c with more than 7.5 considered non-control diabetes) with normal body mass index (BMI = 5 percentile to less than 85 percentile) and without any other systemic problem from different geographical areas in the city, who were attending Al-Imam Al-Hasan Center for Endocrinology and Diabetes, compared with a control group that includes 45 healthy children without any systemic disease and with the same age range as the study group, attending Al Hur Riahi Specialized Dental Center. Study subjects were instructed to avoid eating, drinking, chewing gum, or brushing for 1 hour before beginning the collection of the saliva sample. Unstimulated saliva was collected from children between 9:00 a.m. and 12:00 p.m. by spitting method using saliva sample collection kits (Runmei, Hunnan, China). Samples were centrifuged for 20 minutes at 2000 to 3000 rpm (Thermo Scientific, Pico 17 centrifuge, Massachusetts, USA), and the clear salivary supernatants were separated and frozen at −20 °C.[9]
The concentrations of TAOC and PC in saliva were determined using a total antioxidant capacity enzyme-linked immune-sorbent assay (ELISA) kit (Shanghai YL Biotech Co. Ltd/ Shanghai/ China) and a protein carbonyl ELISA kit (Shanghai YL Biotech Co. Ltd./ Shanghai/China).
The decayed, missing, and filled index (DMFS/dmfs) was used to diagnose and record dental caries according to the criteria of Manjie et al.[10]
The sample was determined statistically by using G Power (http://www.gpower.hhu.de/). With a power of 80%, alpha error of probability of 0.05 two-sided, assuming the moderate effect size of Cohen d of 0.6. The relationship between DMFS and dmfs as dependent variables and predictor variables, including salivary levels of TAOC and PC and status of diabetes, were assessed via a linear regression model and one-way ANOVA test using the R 4.3.0 (R Foundation for Statistical Computing, Vienna, Austria).
ResultsNinety participants were included in this study (mean age = 11.2 ± 0.81, range 10–12 years, 47.78% male). Patient flow-up diagram is available via: https://doi.org/10.6084/m9.figshare.22722700.v1
There were statistically significant differences regarding salivary levels of TAOC (P = 0.02) and PC (P = 0.01) just between healthy and uncontrolled diabetes subjects. DMFS (P = 0.19) and dmfs (P = 0.41) were not significantly different among study groups.
Salivary levels of TAOC and PC, having diabetes, and diabetes status (controlled or uncontrolled) were not statistically significant (P > 0.05) predicators regarding the prevalence of dental caries among type 1diabetic children [Table 1].
Table 1 Results of linear regression model evaluating predictor parameters related to the prevalence of dental caries Discussion The result of the present study showed that caries experience was slightly higher in the non-diabetic group but statistically not significant; this result came in accordance with Ismail et al.,[11] and Al-Badr et al.,[12] who found that the diabetic and non-diabetic groups showed no significant difference in caries experience. While this finding was in contrast with many studies that reported the caries experience was significantly higher in type 1 diabetes mellitus children.[13],[14],[15] This result might be explained in light of the fact that diabetic children may have a diet with a restricted intake of sugar according to the nutritional recommendation and a good dietary regime that prevents the most harmful changes in saliva, such as high glucose and low pH.[14] Additionally, diabetic children’s oral hygiene practices and education appear to be slightly better than healthy children’s.[16] Hence, the progression of caries occurs less frequently.
In this study, the mean of salivary TAOC was significantly higher in the non-diabetic group than in uncontrolled diabetes subjects. This result was consistent with Basir et al.[17] This finding could be attributed to the role of oxidative stress in the pathogenesis of type I diabetes mellitus and the involvement of salivary glands in the disease.[18] In contrast, Rai et al. showed that the antioxidant power is increased in people with diabetes.[19] While Tabatabaei et al.[20] observed a non-significant difference in TAOC between healthy and diabetics individuals. The variation in the method used to measure salivary antioxidants can explain the different results between these studies.
Our results showed the salivary levels of TAOC were not statistically significant predicators for the prevalence of dental caries among type 1 diabetic children. Yet, a systematic review by de Sousa Né et al. showed that salivary TAOC was increased in the group of healthy children or adolescents with caries in 16 selected articles.[21] A systematic review and meta-analysis by Martins et al. showed the salivary TAOC levels were higher in healthy kids impacted by dental caries in comparison with caries-free ones, despite of age (standardized mean difference: 2.66, CI: 1.33–3.98) or sex (standardized mean difference: 0.98, CI: 0.56–1.39).[22]
Carbonyl group formation is considered an early and stable marker for protein oxidation.[23] To our knowledge, the effect of PC on the prevalence of dental caries has rarely been studied and reported in the literature. Our outcomes showed the salivary levels of PC were not statistically significant predicators for the prevalence of dental caries among type 1diabetic kids. Awn BH reported non-significant week correlation between salivary PC and prevalence of dental caries among pregnant and non-pregnant women.[24]
The limitation of the present study may be due to the small sample size; hence, the data collected may not have been varied enough, in addition to the inherent limitations of a cross-sectional study. Larger sample sizes and well-designed longitudinal studies are recommended to be used in future studies, considering the socioeconomic and educational levels of the parents, which have a profound indirect effect on their children’s oral health.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
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