Denture stomatitis and salivary vascular endothelial growth factor in immediate complete denture wearers with type 2 diabetes Katarina Radovic, DMD, MDS,a Jugoslav Ilic, DMD, PhD,b Jelena Roganovic, DMD, PhD,c Dragica Stojic, DMD, PhD,d Bozidar Brkovic, DMD, PhD,e and Georgina Pudar, DMD, PhDf School of Dental Medicine, University of Belgrade, Belgrade, Serbia; University Medical Center Zvezdara, Belgrade, Serbia Statement of problem. Diabetes mellitus type 2 is associated with a variety of oral mucosal changes, including an altered level of salivary vascular endothelial growth factor. However, the authors identified no studies concerning denture stomatitis and salivary vascular endothelial growth factor in immediate denture wearers with diabetes mellitus type 2. Purpose. The purpose of this study was to investigate the incidence of and risk factors for denture stomatitis in immediate complete denture wearers with and without diabetes mellitus type 2 and to investigate the relationship between levels of salivary vascular endothelial growth factor and clinical forms of denture stomatitis in both groups. Material and methods. Individuals without diabetes (n¼42) or with diabetes mellitus type 2 (n¼36) who were candidates for complete immediate dentures were included in the study. After 1 year of wearing relined immediate dentures, participants were evaluated for denture stomatitis and potential contributing factors. Salivary vascular endothelial growth factor levels were measured with enzyme-linked immunosorbent assays. Data were analyzed with the c2 test or the Student t test where appropriate, as well as with binary logistic regression analysis. Results. The incidence of denture stomatitis was 61% in participants with diabetes mellitus type 2 and 38% in those without diabetes. Low denture stability and diabetes mellitus type 2 were risk factors for denture stomatitis. Salivary vascular endothelial growth factor concentrations at the beginning of the study were 557.6 94.7 pg/mL in participants with diabetes mellitus type 2 and 103.5 21.6 pg/mL in those without diabetes. In Newton Type I and Newton Type II denture stomatitis, vascular endothelial growth factor levels were 460.9 55.4 pg/mL and 1445.2 422.1 pg/mL in individuals with diabetes and 73.2 10.0 pg/mL and 306.5 22.6 pg/mL in those without diabetes. Conclusions. Perceived denture stability and diabetes mellitus type 2 are independent risk factors for the occurrence of denture stomatitis. Altered salivary vascular endothelial growth factor levels and denture stomatitis are more prevalent in denture wearers with diabetes mellitus type 2. (J Prosthet Dent 2014;111:373-379)
Clinical Implications Wearers of immediate complete dentures, especially those with diabetes mellitus type 2, require special attention regarding denture stability. Results indicate alterations in the salivary vascular endothelial growth factor levels of denture wearers with type 2 diabetes and suggest that the modulation of vascular endothelial growth factor activity could be a useful therapeutic approach to regulating oral complications such as denture stomatitis in those with diabetes mellitus type 2.
This study was supported by the Serbian Ministry of Education and Science, Grant No. 175021. a
Lecturer, Department of Prosthodontics, School of Dental Medicine, University of Belgrade. Lecturer, Department of Restorative Odontology and Endodontics, School of Dental Medicine, University of Belgrade. c Lecturer, Department of Pharmacology in Dentistry, School of Dental Medicine, University of Belgrade. d Professor, Department of Pharmacology in Dentistry, School of Dental Medicine, University of Belgrade. e Assistant Professor, Department of Oral Surgery, School of Dental Medicine, University of Belgrade. f Professor, Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Center Zvezdara, Belgrade. b
Radovic et al
374
Volume 111 Issue 5 Diabetes mellitus is commonly found in dental patients.1 The common oral disturbances associated with diabetes mellitus include periodontal disease, salivary gland dysfunction, burning mouth, delayed healing of oral wounds, and various types of stomatitis, including denture stomatitis.2-6 Diabetes mellitus is a disease with serious systemic complications, and extensive clinical efforts have been made to improve the quality of life of patients with diabetes. Given that a wellbalanced diet is a component of diabetes therapy, the rational therapeutic option for future complete denture wearers, who are also candidates for preprosthetic extraction procedures, could be to receive immediate dentures on the day of extractions.7 In denture wearing, the oral mucosa must be able to mechanically and physiologically resist the persistent pressure required for denture support and movement during function.8 Incorrect vertical dimension and denture instability may contribute to the occurrence of denture stomatitis.9,10 Although studies have found a prevalence of denture stomatitis among complete denture wearers,10-12 information is lacking as to immediate denture wearers with diabetes mellitus type 2. Vascular endothelial growth factor (VEGF) is a potent cytokine produced by many types of cells and functions as a major regulator of physiologic and pathologic angiogenesis.13,14 This factor may be one of the underlying markers of chronic inflammatory or autoimmune conditions in the oral cavity.15-18 The level of VEGF in human saliva derived from the secretions of the major and minor salivary glands19,20 is elevated in patients with diabetes.21 The objective of this study was to determine the frequency of and risk factors for denture stomatitis in immediate complete denture wearers with and without diabetes mellitus type 2. Because salivary VEGF may be involved in the maintenance of oral mucosa homeostasis, and because its connection with denture stomatitis has not yet been reported, the salivary levels of VEGF
were also determined in different types of denture stomatitis in individuals with and without diabetes. The null hypotheses were that diabetes mellitus type 2 is not associated with denture stomatitis and that the level of salivary VEGF is not changed in denture stomatitis.
MATERIAL AND METHODS Study population The study population comprised 78 participants aged 45 to 64 years. Fortytwo participants with diagnosed diabetes mellitus type 2 were recruited from the Zvezdara University Medical Center, Belgrade, and 42 participants without diabetes were recruited from the Department of Prosthodontics, School of Dental Medicine, University of Belgrade. The inclusion criteria were wearing maxillary partial removable dental prostheses and mandibular complete dentures for approximately 10 years; the presence of 3 teeth with signs of terminal periodontitis in the anterior and premolar maxillary regions; the absence of any lesions in the oral cavity; and, for participants with diabetes, a disease history of at least 2 years with a glycosylated hemoglobin measurement less than 9 (HbA1c
Clinical Implications Wearers of immediate complete dentures, especially those with diabetes mellitus type 2, require special attention regarding denture stability. Results indicate alterations in the salivary vascular endothelial growth factor levels of denture wearers with type 2 diabetes and suggest that the modulation of vascular endothelial growth factor activity could be a useful therapeutic approach to regulating oral complications such as denture stomatitis in those with diabetes mellitus type 2.
This study was supported by the Serbian Ministry of Education and Science, Grant No. 175021. a
Lecturer, Department of Prosthodontics, School of Dental Medicine, University of Belgrade. Lecturer, Department of Restorative Odontology and Endodontics, School of Dental Medicine, University of Belgrade. c Lecturer, Department of Pharmacology in Dentistry, School of Dental Medicine, University of Belgrade. d Professor, Department of Pharmacology in Dentistry, School of Dental Medicine, University of Belgrade. e Assistant Professor, Department of Oral Surgery, School of Dental Medicine, University of Belgrade. f Professor, Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Center Zvezdara, Belgrade. b
Radovic et al
374
Volume 111 Issue 5 Diabetes mellitus is commonly found in dental patients.1 The common oral disturbances associated with diabetes mellitus include periodontal disease, salivary gland dysfunction, burning mouth, delayed healing of oral wounds, and various types of stomatitis, including denture stomatitis.2-6 Diabetes mellitus is a disease with serious systemic complications, and extensive clinical efforts have been made to improve the quality of life of patients with diabetes. Given that a wellbalanced diet is a component of diabetes therapy, the rational therapeutic option for future complete denture wearers, who are also candidates for preprosthetic extraction procedures, could be to receive immediate dentures on the day of extractions.7 In denture wearing, the oral mucosa must be able to mechanically and physiologically resist the persistent pressure required for denture support and movement during function.8 Incorrect vertical dimension and denture instability may contribute to the occurrence of denture stomatitis.9,10 Although studies have found a prevalence of denture stomatitis among complete denture wearers,10-12 information is lacking as to immediate denture wearers with diabetes mellitus type 2. Vascular endothelial growth factor (VEGF) is a potent cytokine produced by many types of cells and functions as a major regulator of physiologic and pathologic angiogenesis.13,14 This factor may be one of the underlying markers of chronic inflammatory or autoimmune conditions in the oral cavity.15-18 The level of VEGF in human saliva derived from the secretions of the major and minor salivary glands19,20 is elevated in patients with diabetes.21 The objective of this study was to determine the frequency of and risk factors for denture stomatitis in immediate complete denture wearers with and without diabetes mellitus type 2. Because salivary VEGF may be involved in the maintenance of oral mucosa homeostasis, and because its connection with denture stomatitis has not yet been reported, the salivary levels of VEGF
were also determined in different types of denture stomatitis in individuals with and without diabetes. The null hypotheses were that diabetes mellitus type 2 is not associated with denture stomatitis and that the level of salivary VEGF is not changed in denture stomatitis.
MATERIAL AND METHODS Study population The study population comprised 78 participants aged 45 to 64 years. Fortytwo participants with diagnosed diabetes mellitus type 2 were recruited from the Zvezdara University Medical Center, Belgrade, and 42 participants without diabetes were recruited from the Department of Prosthodontics, School of Dental Medicine, University of Belgrade. The inclusion criteria were wearing maxillary partial removable dental prostheses and mandibular complete dentures for approximately 10 years; the presence of 3 teeth with signs of terminal periodontitis in the anterior and premolar maxillary regions; the absence of any lesions in the oral cavity; and, for participants with diabetes, a disease history of at least 2 years with a glycosylated hemoglobin measurement less than 9 (HbA1c
