Diabetes mellitus is associated with several clinically significant abnormalities in the oral cavity and salivary glands, the most common being periodontitis, salivary gland enlargement and a sensation of dry mouth. The pre­valence of dental caries in diabetics is mostly reported to be decreased or unaffected. Since there is a shortage of information concerning the influence of metabolic control and duration of diabetes on these abnormalities, the present studies were performed. Three-month-old rats were made alloxan-diabetic and investigated after one and twelve months’ duration of dia­betes for oral lesions and feeding behavior. They had free access to a standard pellet diet and tap water. Strepto­coccus mutans and lactobacilli were naturally occurring. In diabetic rats the proportion of the oral flora which was lactobacilli was positively correlated to the blood glucose level. Untreated long-term alloxan-diabetic rats de­veloped advanced periodontal disease and root surface caries in the molars at sites of interdental impaction of foreign material. The degree of alveolar bone loss was positively correlated to the blood glucose level. Diabetic rats were hyperphagic and had a longer total eating time, including day-time eating, mainly by having longer meals but no significant increase of meal frequency, as compared with non-diabetic animals. The untreated al­loxan-diabetic rats developed reduced salivary gland weight which was of the same degree in short- and long­term diabetic animals. Short- and long-term untreated alloxan-diabetic rats showed a similar degree of morpho- metrically estimated lipid accumulation in the acinar cells of the submandibular glands, and the degree was posi­tively correlated to the blood glucose level. However, lipid inclusion occurred only in rats with a morning non­fasting blood glucose level exceeding 15 mmol/L. The capillaries in the submandibular glands of the untreated long-term alloxan-diabetic rats had a significantly increased thickness of the basement membranes as compared with the observations in short-term diabetic and non-diabetic rats. Untreated alloxan-diabetic rats were also shown to have a decreased salivary flow rate compared with non-diabetic rats, and the decreased flow was negatively correlated to the blood glucose concentration. Salivary flow rate increased with the duration of the disease. The diabetic rats had increased salivary glucose levels, which were positively correlated to blood glucose values when the latter were above 15 mmol/L, suggesting a threshold mechanism for salivary glucose excretion. Insulin therapy reversed salivary flow rate and salivary glucose concentrations toward normal. Salivary investigations were performed in eleven diabetic patients on two occasions with different metabolic con­trol. Salivary flow rate showed marked interindividual differences but was not significantly changed by improv­ed metabolic control although several of the patients initially had severely deranged glucose metabolism. A posi­tive correlation between the glucose concentration in blood and saliva was seen in the parotid saliva during secre­tory stimulation. No significant change in electrolytes, amylase or antimicrobial factors was found. / <p>S. 1-48: sammanfattning, s. 49-90: 5 uppsatser</p> / digitalisering@umu

Made available in DSpace on 2015-05-14T12:56:01Z (GMT). No. of bitstreams: 1 parte 1.pdf: 286274 bytes, checksum: 680b6739458bd32bbb943941a13dc712 (MD5) Previous issue date: 2007-12-05 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Diabetes mellitus is an endocrine disease, which causes alteration in assimilation, metabolism and balance of the blood glucose concentration. It is believed that the high level of blood glucose is linked to the development of buccal alterations; however, there is some controversy in the studies that aim to compare the concentration of blood and salivary glucose in diabetic patients. The objective of this paper is to comparatively evaluate the concentration of blood and salivary glucose as well as the salivary flow and xerostomia in type 2 diabetic and non-diabetic patients. Eighty adult subjects of both sexes have been selected, being 40 adults diabetic of the experimental type and 40 adults non-diabetic belonging to control. The total in-rest and stimulated salivary flow has been determined as well as the concentration of peripheral blood and salivary glucose. Descriptive analysis was carried out and Mann-Whitney and qui-square tests were applied considering significant values of p<0,05. The average value of salivary glucose in diabetic patients was 14,03±16,76 mg/dl and in the control group, 6,35±6,02 mg/dl, with p= 0,036. The capillary blood glucose in diabetic patients presented an average value equivalent to 213,23±87,98 mg/dl and, in non-diabetic patients it was equivalent to 99,15±13,72 mg/dl, with p= 000. The average value for the in-rest salivary flow was 0,21±0,16 ml/min in diabetic patients and 0,33±0,20 ml/min in the control group with p= 0,002. The stimulated salivary flow was lower in the group of diabetic patients, with an average of 0,63±0,43 ml/min, in relation to the control group, which presented an 1,20±0,70 ml/min average, with p= 0,00. Out of the diabetic patients, 45% had hyposalivation contrasting to 2,5% out of the non-diabetic patients, with p=0,00. Xerostomia was reported in 12,5% of diabetic patients and 5% of non-diabetic patients, with p=0,23. We can conclude that the salivary glucose concentration was significantly higher in the experimental group and that there was no correlation between the salivary and blood glucose concentration in diabetic patients. The total salivary flows were significantly reduced in diabetic patients and there was no significant difference as to the presence of xerostomia in both groups. / O diabetes mellitus é uma doença endócrina que causa alteração na assimilação, metabolismo e equilíbrio da concentração da glicose sanguínea. Acredita-se que o elevado nível de glicose sangüínea esteja associado ao desenvolvimento de alterações bucais, porém, existe controvérsia nos estudos que objetivam comparar a concentração de glicose sanguínea e salivar em pacientes diabéticos. O objetivo do presente estudo foi avaliar comparativamente a concentração de glicose salivar e sanguínea, o fluxo salivar e a xerostomia em pacientes diabéticos tipo 2 e não diabéticos. Foram selecionados 80 indivíduos adultos, de ambos os sexos, sendo 40 adultos diabéticos pertencentes ao experimental e 40 adultos não diabéticos pertencentes ao controle. Determinou-se o fluxo salivar total em repouso e estimulado, a concentração de glicose salivar e sanguínea periférica. Realizou-se análise descritiva e aplicaram-se testes de Mann-Whitney e qui-quadrado, considerando significantes valores de p<0,05. O valor médio de glicose salivar nos diabéticos foi 14,03±16,76 mg/dl e, no grupo controle, 6,35±6,02 mg/dl, com p= 0,036. A glicose sanguínea capilar nos diabéticos apresentou valor médio equivalente a 213,23±87,98 mg/dl e, nos não diabéticos, a 99,15±13,72 mg/dl, com p= 000. O valor médio para o fluxo salivar em repouso foi de 0,21±0,16 ml/min nos diabéticos e 0,33±0,20 ml/min no grupo controle, com p= 0,002. O fluxo salivar estimulado foi inferior no grupo dos diabéticos, com média de 0,63±0,43 ml/min, em relação ao grupo controle que apresentou média 1,20±0,70 ml/min, com p= 0,00. Entre os diabéticos, 45% apresentaram hipossalivação, contrastando com os 2,5% entre os não diabéticos, com p=0,00. A xerostomia foi referida em 12,5% dos diabéticos e 5% dos não diabéticos, com p=0,23. Pode-se concluir que concentração de glicose salivar foi significativamente maior no grupo experimental e que não houve correlação entre a concentração da glicose salivar e glicose sanguínea nos indivíduos diabéticos. Os fluxos salivares totais mostraram-se significativamente reduzidos nos pacientes diabéticos e não houve diferença significativa quanto à presença de xerostomia em ambos os grupos.