Etiopathogenetic features of xerostomia syndrome in adolescents with type 1 diabetes mellitus with different levels of metabolic control

BACKGROUND: Adolescent patients with type 1 diabetes mellitus (T1DM) report dry mouth in 95% of cases. Xerostomia syndrome may be associated with impaired metabolic control with the result of decreased salivary gland function. AIM: To determine the relationship of clinical manifestations of xerostomia syndrome and the degree of periodontal damage in adolescents with T1DM with different level of metabolic control. METHODS: The study included 122 adolescents aged 14 (13; 16) years. The participants were divided into groups: the study group (n = 61) with the diagnosis ‘Insulin-dependent diabetes mellitus', and the comparison group (n = 61) without metabolic diseases, but with the diagnosis ‘Chronic catarrhal gingivitis'. All subjects underwent evaluation of the Papillary-Marginal-Alveolar Index (PMA), Sulcus Bleeding Index (SBI). Xerostomia syndrome was evaluated by a survey on XI scale (Xerostomia Inventory), oral dryness was evaluated using Clinical Oral Dryness Score (CODS), sialometry, salivation flow rate measurement; pH-metry. RESULTS: The SBI index was 0.33 (0.16; 0.66) in the study group with glycated hemoglobin (HbA1c) 7% (study group 1) and 0.50 (0.33; 0.92) in the group with HbA1c ≥ 7% (study group 2), and 0.10 (0.00; 0.40) in the comparison group (p = 0.001). PMA was 19.50% (11.75%; 31.50%) in study group 1, 35.00% (22.50%; 44.50%) in study group 2, and 10.00% (0.00%; 15.00%) in the comparison group. Differences in PMA were statistically significant both between all the groups (p 0.001) and in pairwise comparisons (p 0.05). The mean pH of saliva was 6 (5; 6) in study group 1, 5 (5; 6) in study group 2, and 7 (6; 7) in the comparison group (p 0.001). The salivation flow rate was lower in patients with type 1 diabetes: 0.22 (0.14; 0.26) ml/min in study group 1, 0.13 (0.06; 0.24) ml/min in study group 2, and 0.56 (0.30; 0.60) ml/min in the comparison group (p 0.001). CODS achieved 4 (3; 4) points in study group 1, 5 (5; 6) points in study group 2, and 1 (0; 2) point in the comparison group (p 0.001). The saliva volume measured by sialometry was 1.10 (0.73; 1.30) ml in study group 1, 0.60 (0.28; 1.20) ml in study group 2, and 2.80 (1.50; 3.00) ml in the comparison group (p 0.001). CONCLUSION: Xerostomia syndrome should be considered an important clinical sign indicating the development of periodontal diseases in T1DM. Metabolic control influences the condition of the oral cavity in adolescents with T1DM, which confirms the importance of maintaining normal blood glucose level for dental and gingival health in this category of patients.