Salivary IgA and Dental Caries in Type II Diabetics in Indian Adult Population

Mithra N Hegde^*, Fayaz Gafoor, Darshana Devadiga, Divya Tahiliani and Chittaranjan Shetty

Department of Conservative Dentistry and Endodontics, AB Shetty Memorial Institute of Dental Sciences, Nitte University, Deralakatte, Mangalore, Karnataka, India

Corresponding Author:

Mithra N. Hegde
Senior Professor and Head of the Department
Department of Conservative Dentistry and Endodontics
AB Shetty Memorial Institute of Dental Sciences
Nitte University, Deralakatte, Mangalore, Karnataka, India
Tel: 9845284411
E-mail: drhegdedentist@gmail.com

Received date: April 11, 2014; Accepted date: June 30, 2014; Published date: July 7, 2014

Citation: Hegde MN, Gafoor F, Devadiga D, Tahiliani D, Shetty C (2014) Salivary IgA and Dental Caries in Type II Diabetics in Indian Adult Population. J Interdiscipl Med Dent Sci 2:133. doi:10.4172/2376-032X.1000133

Copyright: © 2014 Hegde, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

Aim: To evaluate relationship between Salivary IgA and Dental caries in Type II Diabetics in Indian Adult Population.

Method: Study was conducted on 30 patients of age group ranging from 25-60years including type II diabetic and non diabetic patients. Patients were divided into 3 groups of 10 subjects each according to diabetic and DMFT scores as G-1 (control, non diabetic) DMFT- 0, G-2 (non diabetic) DMFT 4 - 8 and G-3 (diabetic) DMFT 4 - 8. Unstimulated saliva samples were collected from each subject for estimation of IgA using the Turbidometric method. Data obtained were statistically analysed.

Results: Correlation of Salivary IgA and DMFT showed steady decrease in values of Salivary-IgA from Group I – III. The variation in Salivary- IgA level was Very Highly Significant [VHS] when diabetic DMFT 4-8 was compared with control and non diabetic DMFT 4-8; Highly significant [HS] between control and non diabetic DMFT 4-8.

Conclusion: Salivary-IgA values showed an inverse relationship to the DMFT values with levels of Salivary-IgA decreasing with an increase in DMFT Values. Salivary-IgA level in type II Diabetic patients with DMFT-4-8 had significantly lower values than non diabetic patients of similar DMFT scores.

Keywords

Dental caries; DMFT; Salivary-IgA; Diabetes

Introduction

There are many factors responsible for dental caries such as poor oral hygiene, concentration of bacteria in oral cavity with acidophilic activity, hereditary, cariogenic diet and reduced level of fluoride in drinking water [1].

Since the infectious process of caries has been well established in humans one may justify that some kind of host immunity regulates caries activity. Salivary IgA (S-IgA) is the first line of defence of the host against pathogens which invade oral mucosal surfaces. The Salivary-IgA antibodies improve the oral immunity by preventing adherence of microbes, neutralizing enzymes, toxins and viruses; or by acting in synergy with other factors such as lysozyme and lactoferrin [4-6].

An increase in the rate of dental caries has been reported in patients with diabetes and may relate to salivary dysfunction [12].Salivary-IgA this study was done to evaluate the relationship between Salivary-IgA and dental caries in type II Diabetics in Indian adult population.

Materials and Methods

Patients aged between 25-60 years of age with type II diabetes and non-diabetes visiting the Department of Conservative Dentistry and Endodontics, A.B. Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka were screened for DMFT. Subjects including caries-free, caries-active and Type II diabetic subject^’s showing positive results for Fasting Blood Sugar (FBS) and Haemoglobin Assay (Hb A_1C) were included in the study. Patients with systemic conditions other than diabetes, such as those with medication induced Xerostomia, patients on radiotherapy and completely edentulous patients were excluded from the study. Informed consent from all the patient^’s and institutional ethical clearance was obtained for this study.

The DMFT index (WHO 2013) of the consenting patients was recorded [13-15] and based on their DMFT scores and diabetic status, a total of 30 patients were selected and divided into three groups of 10 subjects each as follows: Group I [Control group] - with DMFT Score - 0, Group II [non-diabetic] - with DMFT Score 4 -8, Group III [diabetic] - with DMFT Score 4-8.

Unstimulated saliva samples were collected according to Dawe’s method [16,17]. Prior to the collection of saliva samples, the subjects were asked to abstain from smoking, brushing of teeth, use of mouth wash and eat or drink for 1 hour. During sample collection, the subject was seated in a normal chair instead of the dental chair to maintain a stress-free environment. The un-stimulated (resting) saliva samples were collected by asking the subjects to pool the saliva on the floor of the mouth and then made to expectorate it into a collection cup. The Salivary-IgA levels in the salivary samples were estimated using a semi-auto analyzer by the immune-turbidometric method [AGAPPE Diagnostics Switzerland IgA kit 11815001]. [Figure 1]

Figure 1: Salivary IgA Kit

The data collected were statistically analyzed with ANOVA and Tukey’s HSD test.

Results

The Salivary IgA levels were found to be the highest in Group I [control - DMFT score–0] 309.346mg/dl followed by Group II [non-diabetic- DMFT score 4-8] 254.26 mg/dl and Group III [Diabetic -DMFT score 4-8] 160.476 mg/dl as shown in Table 1.

Table 1: Comparison of Salivary IgA & DMFT

Inter group comparison with Post -hoc analysis showed the variation in Salivary-IgA level. [Table 2]

Table 2: Inter-Group Comparison of Salivary IgA Levels

Statistically significant results P < 0.001 (P < 0.005) were seen between:

a) GI (control, nondiabetic- DMFT 0) and GIII (diabetic - DMFT 4-8)

b) GII (non diabetic- DMFT 4-8) and GIII (diabetic DMFT 4-8) P<0.001(P<0,005).

c) GI (control, non diabetic DMFT-0) and GII (nondiabetic DMFT 4-8) P<0.001(P<0.005).

Discussion

Saliva contains many components present in serum that can be used in diagnosing various systemic diseases [18,19]. The Salivary-IgA is a protective agent against infections occurring in the oral cavity and shows variations in different conditions and diseases. In the present study a positive correlation was seen in diabetic patients between salivary-IgA concentration and caries index which is in agreement with Tenuvuo j et al [20-22]. The Salivary-IgA levels in Type II Diabetic patients with DMFT – 4 - 8 was less (160.476 mg/dl) compared to non-diabetic patients with same DMFT (254.26 mg/dl); whereas it was lesser in comparison to control group DMFT- 0 (309.346mg/dl) [Table I]. As the DMFT value increases the Salivary-IgA levels show a steady decrease as seen in group I and II, while it is further decreased in group III. In a study by Bhuyan et al the Salivary-IgA levels progressively decreased from normal individuals to controlled diabetics and further in uncontrolled diabetics [23]. This is due to decrease in local immune response of diabetic patients in the form of low Salivary-IgA levels which makes them more susceptible to oral infections [23]. In a study done by Mithra et al it has been shown that the infectious nature of dental caries can be due to some form of host immunity which can regulate caries activity. If immunity could regulate the caries then Salivary-IgA might give a clear correlation. It has been suggested that S-IgA antibodies generated by the mucosal immune system play an important role in the immune response against dental caries [1] which is in agreement with the present study. Semiautoanalyser has been used for estimating salivary IgA Samples as we have used AGAPPE kit for the estimation of salivary IgA.

However, in contradiction Charles et al and Farid et al found Salivary-IgA levels of Type II diabetic patients to be significantly higher than those in the control group, which indicates that elevation of IgA could be due to infections as it was seen in patients with infections included in their study [24,25].

Conclusion

From the results of the study we conclude that:

•Salivary-IgA values showed an inverse relationship to the DMFT values with levels of Salivary-IgA decreasing with an increase in the DMFT values.

•Salivary-IgA level in type II Diabetic patients with DMFT-4-8 has significantly lower value than non diabetic patients of same DMFT.

References

1. Hegde M, Devadiga D, Shetty C, She tty A (2013)Correlation between dental caries and salivary immunoglobulin in adult Indian population: An in vivo study. J Res Dent 1: 22-25.
2. Gambhir RS, Singh G, Singh R, Nanda T (2012) Vaccine against Dental Caries- An Urgent Need. J Vaccines Vaccin 3:136.
3. Doifode D, Damle SG (2011) Comparison of salivary IgA levels in caries free and caries active children. Int Journal of Clinical Dental Science.
4. Jafarzadeh A, Sadeghi M, Karam GA, Vazirinejad R (2010) Salivary IgA and IgE levels in healthy subjects: relation to age and gender. Braz Oral Res 24: 21-27.
5. Marcotte H, Lavoie MC (1998) Oral microbial ecology and the role of salivary immunoglobulin A. Microbiol Mol Biol Rev 62: 71-109.
6. Ranadheer E, Nayak UA, Reddy NV, Rao VA (2011) The relationship between salivary IgA levels and dental caries in children. J Indian SocPedodPrev Dent 29: 106-112.
7. Cole MF, Arnold RR, Rhodes MJ, McGhee JR (1977) Immune dysfunction and dental caries: a preliminary report. J Dent Res 56: 198-204.
8. Robertson PB, Mackler BF, Wright TE, Levy BM (1980) Periodontal status of patients with abnormalities of the immune system. II. Observations over a 2-year period. J Periodontol 51: 70-73.
9. Robertson PB, Wright TE 3rd, Mackler BF, Lenertz DM, Levy BM (1978) Periodontal status of patients with abnormalities of the immune system. J Periodontal Res 13: 37-45.
10. American diabetes association (2013) Diagnosis and Classification of Diabetes Mellitus.
11. Azra Mohiti- Ardekani, Mohammad Hasan Karbassi, JavadMohiti- Ardekani, FoadAkhondinasab, Mohammad Haji Mirza Mohammad (2012) Evaluation of Salivary IgA in Diabetic and Non-Diabetic Patients: A Case-Control Study. Iranian journal of diabetes and obesity 4: 167.
12. Vernillo AT (2003) Dental considerations for the treatment of patients with diabetes mellitus. J Am Dent Assoc 134 Spec No: 24S-33S.
13. World Health Organisation (2013) Oral Health Survey: Basic Methods.
14. Roshan NM, Shigli AL, Deshpande SD (2010) Microbiological Evaluation of salivary streptococcus mutans from children of age 5-7 years Pre- and post atraumatic restorative treatment. ContempClin Dent 1: 94-97.
15. Zingler S, Pritsch M, Wrede DJ, Ludwig B, Bister D, et al. (2014) A randomized clinical trial comparing the impact of different oral hygiene protocols and sealant applications on plaque, gingiva and caries index scores. Eur J Orthod 36: 150-163.
16. Dawes C (1993) Consideration in the development of diagnostic tests on saliva. Ann NY Acadsci 694: 265-269.
17. Dawes C, MacPherson LM (1993) The distribution of saliva and sucrose around the mouth during the use of chewing gum and the implications for the site-specificity of caries and calculus deposition. J Dent Res 72: 852-857.
18. BakianianVaziri P, Vahedi M, Mortazavi H, AbdollahzadehSh, Hajilooi M (2010) Evaluation of salivary glucose, IgA and flow rate in diabetic patients: a case-control study. J Dent (Tehran) 7: 13-18.
19. Kaufman E, Lamster IB (2002) The diagnostic applications of saliva--a review. Crit Rev Oral Biol Med 13: 197-212.
20. Nadia Al-Rawi, Sulafa El-Samarrai (2010) Salivary and serum immune system in relation to caries-experience among type 1 insulin-dependent diabetic children. J Bagh College Dentistry.
21. Tenovuo J, Lehtonen OP, Viikari J, Larjava H, Vilja P, et al. (1986) Immunoglobulins and innate antimicrobial factors in whole saliva of patients with insulin-dependent diabetes mellitus. J Dent Res 65: 62-66.
22. Tenovuo J, Lumikari M (1991) Organic factors in human saliva in relation to dental caries. Dental caries. Cambridge University Press.
23. Sanat Kumar Bhuyan, RN Mody, RuchiBhuyan (2011) Estimation and comparison of Serum and Salivary IgA levels in controlled, uncontrolled diabetics and normal individuals. Journal of Indian academy of oral medicine and radiology 23: 548-553.
24. Gill CW, Bush WS, Burleigh WM, Cooke-Gomes D (1981) Elevation of IgA levels in the non-insulin-dependent (type II) diabetic patient. Diabetes Care 4: 636-639.
25. Farid NR, Anderson J (1973) Immunoglobulins and complement in diabetes mellitus. Lancet 2: 92.