Oral Microbial and Salivary Alterations Associated with Type 1 Diabetes Mellitus in Children: A Case-Control Study from Erbil City
DOI:
https://doi.org/10.15218/edj.2026.8Keywords:
Dental caries, Diabetic children, real-time PCR, Salivary status, Streptococcus mutansAbstract
Background and objective: Type 1 diabetes mellitus (T1DM) affects the pH, flow rate, and content of saliva, which increases the risk of dental caries. In comparison to their matched healthy controls, this study aimed to assess the association between dental caries, salivary traits, and Streptococcus mutans levels in children with T1DM.
Materials and Methods: A case-control study was conducted with 20 children with T1DM and 20 age- and sex-matched healthy controls. Clinical dental examinations assessed the Ageless DMFT (A‑DMFT) index, and saliva samples were analyzed for secretion rate, pH, and S. mutans using quantitative real-time PCR.
Results: There were no significant differences in A‑DMFT scores or salivary secretion rates between the groups. However, the T1DM group had significantly lower salivary pH (7.00 vs. 7.20, p = 0.002) and higher S. mutans levels (2.73×10⁵ vs. 3.25×10⁴ CFU/mL, p = 0.012). A strong positive correlation between A‑DMFT and S. mutans was found (ρ = 0.724, p < 0.001). No significant correlation was observed between A‑DMFT and saliva secretion rate (ρ = 0.183, p = 0.257). In logistic regression analysis, lower salivary pH (p = 0.005) and higher S. mutans levels (p = 0.023) were independently associated with T1DM status.
Conclusion: Children with T1DM had higher levels of S. mutans and lower salivary pH than controls, indicating an increased risk for dental caries. The results imply that the elevated cariogenic potential shown in this group may be caused by variables other than salivary secretion rate.
References
Koren D, Levitsky LL. Type 2 diabetes mellitus in childhood and adolescence. Pediatr Rev. 2021;42(4):167-79. https://doi.org/10.1542/pir.2019-0236
Chen H, Hill R, Baysan A. Systematic review on dental caries preventive and managing strategies among type 2 diabetic patients. Front Oral Health. 2022;3:998171. https://doi.org/10.3389/froh.2022.998171
de Azevedo JCV, de Medeiros Fernandes TAA, Cavalcante GA, de Medeiros IACM, Lanza DC, de Araújo JMG, et al. Biology and natural history of type 1 diabetes mellitus. Curr Pediatr Rev. 2023;19(3):253-75. https://doi.org/10.2174/1573396318666220409001955
Goodson JM, Hartman M-L, Shi P, Hasturk H, Yaskell T, Vargas J, et al. The salivary microbiome is altered in the presence of a high salivary glucose concentration. PloS one. 2017;12(3):e0170437. https://doi.org/10.1371/journal.pone.0170437
Ferizi L, Bimbashi V, Kelmendi J. Association between metabolic control and oral health in children with type 1 diabetes mellitus. BMC Oral Health. 2022;22(1):502. https://doi.org/10.1186/s12903-022-02555-x
Lamster IB, Lalla E, Borgnakke WS, Taylor GW. The relationship between oral health and diabetes mellitus. J Am Dent Assoc. 2008;139:19S-24S. https://doi.org/10.14219/jada.archive.2008.0363
Alamoudi A, Alamoudi R, Gazzaz Y, Alqahtani AM. Role of salivary biomarkers in diagnosis and detection of dental caries: a systematic review. Diagnostics. 2022;12(12):3080. https://doi.org/10.3390/diagnostics12123080
Birkhed D, Heintze U. Salivary secretion rate, buffer capacity, and pH. Human Saliva, Volume I: CRC press; 2021. p. 25-74. https://doi.org/10.1201/9781003210399-2
Dinis M, Agnello M, Cen L, Shokeen B, He X, Shi W, et al. Oral microbiome: Streptococcus mutans/caries concordant-discordant children. Front Microbiol. 2022;13:782825. https://doi.org/10.3389/fmicb.2022.782825
Luiz RR, dos Santos AP, Gonçalves LS, Nadanovsky P. The Ageless DMFT Index (ADMFT): a proposal for a unified DMFT index for all ages and dentitions. 2022. . doi:10.21203/rs.3.rs-2019060/v1.
Singh A, Singh R, Pawar A. Cariogram-A multifactorial risk assessment model for dental caries. Saarbrücken: Lap Lambert Academic Publishing; 2018.
Chifor I, Badea I, Chifor R, Tarmure D, Popa D, Badea M-E, et al. Healthier choices after saliva ph and buffering tests. New Front Chem. 2013;22(2):19.
Jung W-S, Kim H, Park S-Y, Cho E-J, Ahn S-J. Quantitative analysis of changes in salivary mutans streptococci after orthodontic treatment. Am J Orthod Dentofacial Orthop. 2014;145(5):603-9. https://doi.org/10.1016/j.ajodo.2013.12.025
GAO XL, Seneviratne CJ, Lo EC, Chu CH, Samaranayake LP. Novel and conventional assays in determining abundance of Streptococcus mutans in saliva. Int J Paediatr Dent. 2012;22(5):363-8. https://doi.org/10.1111/j.1365-263x.2011.01207.x
Liu T, Wei Y, Zhu Y, Yang W. Caries status and salivary alterations of type-1 diabetes mellitus in children and adolescents: A systematic review and meta-analysis. J Evid Based Dent Pract. 2021;21(1):101496. https://doi.org/10.1016/j.jebdp.2020.101496
Miko S, Ambrus S, Sahafian S, Dinya E, Tamas G, Albrecht M. Dental caries and adolescents with type 1 diabetes. Br Dent J. 2010;208(6):E12-E. https://doi.org/10.1038/sj.bdj.2010.290
Ismail AF, McGrath CP, Yiu CK. Oral health status of children with type 1 diabetes: a comparative study. J Pediatr Endocrinol Metab. 2017;30(11):1155-9. https://doi.org/10.1515/jpem-2017-0053
Mashima I, Nakazawa F. Interaction between Streptococcus spp. and Veillonella tobetsuensis in the early stages of oral biofilm formation. American Society for Microbiology 1752 N St., NW, Washington, DC; 2015. https://doi.org/10.1128/jb.02512-14
Assiri SA, El Meligy OAES, Alzain IO, Bamashmous NO. Assessment of dental caries and salivary characteristics among type 1 diabetic Saudi children. J Dent Sci. 2022;17(4):1634-9. https://doi.org/10.1016/j.jds.2022.03.010
Rai K, Hegde A, Kamath A, Shetty S. Dental caries and salivary alterations in Type I Diabetes. J Clin Pediatr Dent. 2011;36(2):181-4. https://doi.org/10.17796/jcpd.36.2.x436ln878221g364
Basir L, Aminzade M, Javid AZ, Khanehmasiedi M, Rezaeifar K. Oral health and characteristics of saliva in diabetic and healthy children. Aust Med J. 2017;10(10):884-9. https://doi.org/10.21767/amj.2017.3119
Ambildhok K, Jayakumar H, Patil R. Salivary Flow Rate, Sweet Score And Plaque Status In Type 1 Diabetes Mellitus And Non-Diabetic Subjects Aged 6 To 17 Years And Their Relationship With Dental Caries. 2018.
Đuričković MN, Ivanović M. Dental health status in children with type 1 diabetes mellitus in Montenegro. Vojnosanit Pregl. 2021;78(2). https://doi.org/10.2298/vsp181202050d
Agustina D, Chrismawaty BE, Hanindriyo L. Hyposalivation is the main risk factor for poor oral health status in Indonesian elderly. J Int Oral Health. 2021;13(1):60-4. https://doi.org/10.4103/jioh.jioh_255_18
Sivakumar A, Narayanan R. Comparison of salivary flow rate, pH, buffering capacity, and secretory immunoglobulin A levels between children with early childhood caries and caries-free children. Int J Clin Pediatr Dent. 2024;17(3):334. https://doi.org/10.5005/jp-journals-10005-2751
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Frishta Saber Mohammed, Fighan Jalal Hussein (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The copyright on any article published in Erbil Dental Journal is retained by the author(s) in agreement with the Creative Commons Attribution Non-Commercial ShareAlike License (CC BY-NC-SA 4.0).
