jsmc-10011

ORAL FINDINGS AND MICROFLORA IN TYPE II DIABETES MELLITUS IN SULAIMANI CITY

Varin T. Abass * and Sherko A. Omer **

*  Infection control centre, Sulaimani Directorate of Health.

** Department of Microbiology, School of Medicine, Faculty of Medical Sciences, University of Sulaimani. 

Submitted: 29/5/2011; Accepted: 21/10/201; Published 1/12/2011

DOI Link: https://doi.org/10.17656/jsmc.10011

ABSTRACT

Background 

The effects of diabetes mellitus on human include long term dysfunction and failure of various organs. A number of oral diseases and disorders have been associated with diabetes mellitus. The susceptibility to periodontal disease often called the "sixth complication of diabetes mellitus" is the most common oral complication of diabetes. The oral cavity is comprised of many surfaces, each coated with a plethora of different bacteria, some of which have been implicated in oral diseases such as caries and periodontitis. 

Objective 

This study was conducted to determine the most common microorganisms inhabiting the oral cavity of diabetic individuals in comparison to non diabetics, to determine the relation of oral microflora to oral conditions in diabetes and determine the susceptibility of oral microflora to common antimicrobial agents. 

Methods 

A case control study on two hundred persons with type II diabetes mellitus and fifty control cases. Oral findings were documented based on physical examination, microbial identification was based on culture methods and various identification tests. Antimicrobial susceptibility was performed according to Kirby- Bauer method. 

Results 

The oral findings in persons with type II diabetes mellitus showed higher occurrence of gingivitis, periodontitis, dental pain, xerostomia, taste disturbance, palatal ulceration and oral candidiasis in comparison with person without diabetes. Microorganisms studied by culture-dependent methods showed more bacterial isolates in diabetic groups of many stains such as of Bacillus species, Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus saprophyticus, Streptococcus pneumoniae, Streptococcus pyogenes, Viridans streptococci, Branhamella catarrhalis, Escherichia coli, Stomatococcus, Veillonella and Candida albicans. The bacterial isolate susceptibility to antimicrobial agents showed wide resistance to several commonly used antimicrobial agents in dental practice and intermediate response was shown to be arising to some antimicrobial agents.

Conclusion 

Various oral and dental problems such as periodontitis and dental loss was observed in diabetics, also more microbial isolates were documented from diabetics with a notable shift to more virulent species. Most of the isolated organism were resistant to several commonly antimicrobial agents in use. Oral problems may reflect on the increasing oral population of certain bacterial species and this will further complicate their oral problems. 

KEYWORDS

Oral flora, Type II diabetes mellitus, Iraq, Sulaimani.

References 

1. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004 May;27(5):1047-53.

2. Amos AF, McCarty DJ, Zimmet P. The rising global burden of diabetes and its complications: estimates and projections to the year 2010. Diabet Med. 1997;14 Suppl 5:S1-85.

3. Khatib OMN. Guidelines for the prevention, management and care of diabetes mellitus Cairo: World Health Organization. Regional Office for the Eastern Mediterranean 2006.

4. Blaum CS. Descriptive epidemiology of diabetes In: Munsshi MN, Lipsitz LA, editors. Geriatric Diabetes. New York Informa  Healthcare; 2007. p. 1-10.

5. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998 Jul;15(7):539-53.

6. Loe H. Periodontal disease. The sixth complication of diabetes mellitus. Diabetes Care. 1993 Jan;16(1):329-34.

7. Albandar JM, Tinoco EM. Global epidemiology of periodontal diseases in children and young persons. Periodontol 2000. 2002;29:153-76.

8. Rylander H, Ramberg P, Blohme G, Lindhe J. Prevalence of periodontal disease in young diabetics. J Clin Periodontol. 1987 Jan;14(1):38-43.

9. Ebersole JL, Holt SC, Hansard R, Novak MJ. Microbiologic and immunologic characteristics of periodontal disease in Hispanic americans with type 2 diabetes. J Periodontol. 2008 Apr;79(4):637-46.

10. Rees TD. Periodontal management of the patient with diabetes mellitus. Periodontol 2000. 2000 Jun;23:63-72.

11. Moore PA, Weyant RJ, Mongelluzzo MB, Myers DE, Rossie K, Guggenheimer J, et al. Type 1 diabetes mellitus and oral health: assessment of periodontal disease. J Periodontol. 1999 Apr;70(4):409-17.

12.Kolenbrander PE, Jakubovics NS, Bachrach G. Oral Microbiology In: Schaechter M, editor. Encyclopedia of microbiology. Third ed: Elsevier/Academic Press; 2009. p. 566-88.

13. Michael JH, Philip DM. Human Microbial Ecology: CRC Press 1990.

14. Tannock GW. Normal Microflora: An introduction to microbes inhabiting the human body. London: Chapman and Hall; 1995.

15. Michael W, Rod M, Brian H. Bacterial disease mechanisms: An introduction to cellular microbiology: Cambridge University Press; 2002.

16.Harley JP, Prescott LM. Laboratory Exercises in Microbiology. Fifth ed. New York: The McGraw-Hill Companies.; 2002.

17. Colaninno PM. Identification of Gram-Positive Organisms. In: Goldman E, H. GL, editors. Practical Handbook of Microbiology. Second ed. Boca Raton CRC Press; 2009.

18. Brown AE. Benson: Microbiological Applications : Laboratory in General Microbiology. Eight ed. USA: McGraw-Hill 2001.

19. Barrow GI, Feltham RKA. Cowan and Steel's Manual for the Identification of Medical Bacteria: Cambridge University Press; 2004.

20. Kohlerschmidt DJ, Musser KA, Nellie BD. Identification of Aerobic Gram-Negative Bacteria. In: Goldman E, H. GL, editors. Practical Handbook of Microbiology. Second ed. Boca Raton CRC Press; 2009.

21. Priest FG. Extracellular enzyme synthesis in the genus Bacillus. Bacteriol Rev. 1977 Sep;41(3):711-53.

22. Bauer AW, Kirby WM, Sherris JC, Turck M. Antibiotic susceptibility testing by a standardized single disk method. Am J Clin Pathol. 1966 Apr;45(4):493-6.

23.Standards NCCLS. Performance Standards for Antimicrobial Disk Susceptibility Tests: Approved Standard M2-A7. USA: NCCLS,Villanova, PA; 2000.

24. Yalda B, Offenbacher S, Collins JG. Diabetes as a modifier of periodontal disease expression. Periodontol 2000. 1994 Oct;6:37-49.

25. Pinson M, Hoffman WH, Garnick JJ, Litaker MS. Periodontal disease and type I diabetes mellitus in children and adolescents. J Clin Periodontol. 1995 Feb;22(2):118-23.

26. Soskolne WA, Klinger A. The relationship between periodontal diseases and diabetes: an overview. Ann Periodontol. 2001 Dec;6(1):91-8.

27. Zambon JJ, Reynolds H, Fisher JG, Shlossman M, Dunford R, Genco RJ. Microbiological and immunological studies of adult periodontitis in patients with noninsulin-dependent diabetes mellitus. J Periodontol. 1988 Jan;59(1):23-31.

28. Armitage GC. Development of a classification system for periodontal diseases and conditions. Ann Periodontol. 1999 Dec;4(1):1-6.

29. Group TDCaCTR. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977-86.

30. Al-Mubarak S, Ciancio S, Aljada A, Mohanty P, Ross C, Dandona P. Comparative evaluation of adjunctive oral irrigation in diabetics. J Clin Periodontol. 2002 Apr;29(4):295-300.

31. Grossi SG, Zambon JJ, Ho AW, Koch G, Dunford RG, Machtei EE, et al. Assessment of risk for periodontal disease. I. Risk indicators for attachment loss. J Periodontol. 1994 Mar;65(3):260-7.

32. Grossi SG, Genco RJ, Machtei EE, Ho AW, Koch G, Dunford R, et al. Assessment of risk for periodontal disease. II. Risk indicators for alveolar bone loss. J Periodontol. 1995 Jan;66(1):23-9.

33. Genco RJ. Current view of risk factors for periodontal diseases. J Periodontol. 1996 Oct;67(10 Suppl):1041-9.

34. Soskolne WA. Epidemiological and clinical aspects of periodontal diseases in diabetics. Ann Periodontol. 1998 Jul;3(1):3-12.

35. Moore PA, Guggenheimer J, Etzel KR, Weyant RJ, Orchard T. Type 1 diabetes mellitus, xerostomia, and salivary flow rates. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001 Sep;92(3):281-91.

36. Reuterving CO, Reuterving G, Hagg E, Ericson T. Salivary flow rate and salivary glucose concentration in patients with diabetes mellitus influence of severity of diabetes. Diabete Metab. 1987 Jul-Aug;13(4):457-62.

37. Binder A, Maddison PJ, Skinner P, Kurtz A, Isenberg DA. Sjogren's syndrome: association with type-1 diabetes mellitus. Br J Rheumatol. 1989 Dec;28(6):518-20.

38. Deems DA, Doty RL, Settle RG, Moore-Gillon V, Shaman P, Mester AF, et al. Smell and taste disorders, a study of 750 patients from the University of Pennsylvania Smell and Taste Center. Arch Otolaryngol Head Neck Surg. 1991 May;117(5):519-28.

39. Iacopino A, Wathen W. Oral candidal infection and denture stomatitis: a comprehensive review J Am Dent Assoc. 1992;123:46-51.

40. Mattson JS, Cerutis DR. Diabetes mellitus: a review of the literature and dental implications. Compend Contin Educ Dent. 2001 Sep;22(9):757-60, 62, 64 passim; quiz 73.

41. Amen  F. Oral manifestation of type 2 diabetes mellitus Sulaimani, Iraq: University of Sulaimani; 2003.

42. Collin HL, Uusitupa M, Niskanen L, Koivisto AM, Markkanen H, Meurman JH. Caries in patients with non-insulin-dependent diabetes mellitus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998 Jun;85(6):680-5.

43. Guggenheimer J, Moore PA, Rossie K, Myers D, Mongelluzzo MB, Block HM, et al. Insulin-dependent diabetes mellitus and oral soft tissue pathologies: II. Prevalence and characteristics of Candida and Candidal lesions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000 May;89(5):570-6.

44. Bartholomew GA, Rodu B, Bell DS. Oral candidiasis in patients with diabetes mellitus: a thorough analysis. Diabetes Care. 1987 Sep-Oct;10(5):607-12.

45.David HB, John GH. Bergey's manual of determinative bacteriology. 9 ed. Baltimore  Rylandnd  21202: Lippincott Williams and Wilkins; 1993. p. 348-9.

46. Harvey RA, Champe PC, Fisher BD. Lippincott's Illustrated Reviews: Microbiology, 2nd Edition. 2nd Edition ed. Philadilphia: Lippincott Williams & Wilkins; 2007.

47. Paster BJ, Boches SK, Galvin JL, Ericson RE, Lau CN, Levanos VA, et al. Bacterial diversity in human subgingival plaque. J Bacteriol. 2001 Jun;183(12):3770-83.

48. Mashimo PA, Yamamoto Y, Slots J, Park BH, Genco RJ. The periodontal microflora of juvenile diabetics. Culture, immunofluorescence, and serum antibody studies. J Periodontol. 1983 Jul;54(7):420-30.

49. Mandell RL, Dirienzo J, Kent R, Joshipura K, Haber J. Microbiology of healthy and diseased periodontal sites in poorly controlled insulin dependent diabetics. J Periodontol. 1992 Apr;63(4):274-9.

50. Chow AW. Infections of the oral cavity, head, and neck. In: Gerald LM, John EB, Raphael D, editors. Principles and Practice of Infectious Diseases. 5th ed: Churchill Livingstone; 2000. p. 689.

51. Yuan K, Chang CJ, Hsu PC, Sun HS, Tseng CC, Wang JR. Detection of putative periodontal pathogens in non-insulin-dependent diabetes mellitus and non-diabetes mellitus by polymerase chain reaction. J Periodontal Res. 2001 Feb;36(1):18-24.

52. Vazquez GJ, Archer GL. Antibiotic therapy of experimental Staphylococcus epidermidis endocarditis. Antimicrob Agents Chemother. 1980 Feb;17(2):280-5.

53. Archer GL, Johnston JL, Vazquez GJ, Haywood HB, 3rd. Efficacy of antibiotic combinations including rifampin against methicillin-resistant Staphylococcus epidermidis: in vitro and in vivo studies. Rev Infect Dis. 1983 Jul-Aug;5 Suppl 3:S538-42.

54. Shennan A, Crawshaw S, Briley A, Hawken J, Seed P, Jones G, et al. A randomised controlled trial of metronidazole for the prevention of preterm birth in women positive for cervicovaginal fetal fibronectin: the PREMET Study. Bjog. 2006 Jan;113(1):65-74.

55. Grossi SG, Skrepcinski FB, DeCaro T, Robertson DC, Ho AW, Dunford RG, et al. Treatment of periodontal disease in diabetics reduces glycated hemoglobin. J Periodontol. 1997 Aug;68(8):713-9.

56. Westfelt E, Rylander H, Blohme G, Jonasson P, Lindhe J. The effect of periodontal therapy in diabetics. Results after 5 years. J Clin Periodontol. 1996 Feb;23(2):92-100.

Full Text

 © The Authors, published by University of Sulaimani, College of Medicine

This work is licensed under a Creative Commons Attribution 4.0 International License.