Assessment of some salivary enzymes levels in type 2 diabetic patients with chronic periodontitis (Clinical and biochemical study)

Abstract

Background: Diabetic patients have been reported to be more susceptible to gingivitis and periodontitis than healthy subjects. Many intracellular enzymes like (alkaline phosphatase- (ALP), aspartate aminotransferase- (AST) and alanine aminotransferase- (ALT) that are released outside cells into the gingival crevicular fluid (GCF) and saliva after destruction of periodontal tissue during periodontitis. This study was conducted to determine the periodontal health status and the levels of salivary enzymes (ALP, AST and ALT) of the study and control groups and to correlate the levels of these enzymes with clinical periodontal parameters in each study group. Subjects, Materials and Methods: One hundred subjects were enrolled in the study, with an age range of (35-50) years, only males were included. The subjects were divided intostudy groups (group-I consists of 30 patients with controlled type 2 diabetes mellitus(T2DM), group-II consists of 30 patients with uncontrolled T2DM, group-III consists of 25 patients non-diabetics, all of them have chronic periodontitis(CP) and group-IV consists of 15 apparently- systemically healthy subjects and have healthy periodontium, as control group. Unstimulated saliva samples were collected for biochemical analysis of salivary enzymes (ALP, AST and ALT).The clinical periodontal parameters including: plaque index (PLI), gingival index (GI), bleeding on probing (BOP), probing pocket depth (PPD) and clinical attachment level (CAL) were recorded for all subjects at four sites per tooth except third molars. Results: All clinical periodontal and biochemical parameters were highest in uncontrolled T2DM with CP patients and all enzymes levels revealed highly significant differencesbetween all pairs of the study and control groups except AST enzyme level which demonstrated a non-significant difference between controlled T2 diabetics with CP and non-diabetics with CP. There were weak correlations between all clinical periodontal parameters and biochemical parameters except between PPDand ALT enzyme in non-diabetics with CP group and between CAL and AST enzyme in uncontrolled T2 diabetics with CP which demonstrated highly significant strong positive correlations. Conclusion: It was concluded that T2DM and poor glycemic control have negative impact on periodontal health status. Salivary enzymes were considered as good biochemical markers of periodontal tissue destruction and useful in diagnosis, monitoring and efficient management of periodontal diseases and T2DM. Key words: Enzymes, saliva, type 2 diabetes mellitus, periodontal diseases.