Background. Pregnancy and diabetes increase the risk of developing pathological conditions in the periodontium. Salivary biomarkers, such as matrix metalloproteinase-9 (MMP-9), as well as antioxidants can be used as diagnostic indicators in monitoring periodontitis.Objectives. The aim of the study was to assess the periodontal status of pregnant women with regard to the presence of diabetes. In addition, we aimed to assess antioxidant activity and the level of MMP-9 in saliva in order to establish the optimal noninvasive determinants of periodontitis. Material and methods.The study included 104 pregnant women: 35 patients had gestational diabetes mellitus (GDM); 30 patients had type 1 diabetes (T1D); and 39 patients did not have diabetes (the control group). The physical examination included the assessment of the approximal plaque index (API), the gingival index (GI), bleeding on probing (BOP), the probing pocket depth (PPD), and clinical attachment loss (CAL). In the saliva study, MMP-9 concentration as well as the ferric reducing ability of plasma (FRAP), and the activity of superoxide dismutase (SOD), glutathione reductase (GR) and glutathione peroxidase (GPX) were measured.Results. The pregnant patients with GDM and T1D had higher GI, BOP, PPD, and CAL scores than the control women (p < 0.0001, p = 0.0040, p = 0.0100, p = 0.0030, and p < 0.0001, p < 0.0009, p < 0.0001, p < 0.0001, respectively). The T1D patients had higher API scores as compared to the control women (p = 0.0010). The patients with periodontitis had higher salivary MMP-9 levels than the patients without periodontitis (p = 0.0001). The salivary antioxidant levels and activity were comparable among the study groups. The determinants of periodontitis (p < 0.0001) were MMP-9 concentration (p = 0.0008) and oral hygiene (p = 0.0001). The concentration of MMP-9 was also a useful determiner of the presence of periodontitis (p < 0.0001). Conclusions.In the pregnant women with diabetes, we observed worse gingival conditions, deeper periodontal pockets and greater attachment loss in comparison with the women from the control group. The concentration of MMP-9 in saliva is a good predictor of periodontitis and might be a useful tool for diagnosing periodontitis.
Periodontitis is a multifactorial bacterial infection that causes destruction of tissues surrounding the tooth. Its relationship with numerous systemic diseases was confirmed in vast studies. Concerns of maternal and fetus wellness are raised by gestational diabetes mellitus and prepregnancy diabetes causing need for regular periodontal control. The paper is a review of available literature published in medical databases (PubMed, EMBASE, MEDLINE) and in Polish dental journals in the years 1999-2018. Diabetes is one of the risk factors for periodontitis occurrence and its exacerbation. In pregnant women there may be an exacerbation of the already existing periodontal disease. Periodontitis in pregnant patients with diabetes is associated with the risk of many complications for both the mother and the fetus. Pregnant women with diabetes should be under constant control of a gynecologist, diabetologist and dentist. Periodontal care in such patients should focus on rapid diagnostics of periodontal diseases and the implementation of appropriate treatment. Future mothers should be educated that oral health can affect pregnancy, childbirth and the health condition of mother and the child.
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