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


Background: Diabetic patients have been reported to be more susceptible to gingivitis and periodontitis thanhealthy 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 salivaafter destruction of periodontal tissue during periodontitis. This study was conducted to determine the periodontalhealth status and the levels of salivary enzymes (ALP, AST and ALT) of the study and control groups and to correlatethe 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 withcontrolled type 2 diabetes mellitus(T2DM), group-II consists of 30 patients with uncontrolled T2DM, group-III consists of25 patients non-diabetics, all of them have chronic periodontitis(CP) and group-IV consists of 15 apparentlysystemicallyhealthy subjects and have healthy periodontium, as control group. Unstimulated saliva samples werecollected for biochemical analysis of salivary enzymes (ALP, AST and ALT).The clinical periodontal parametersincluding: plaque index (PLI), gingival index (GI), bleeding on probing (BOP), probing pocket depth (PPD) andclinical 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 andall enzymes levels revealed highly significant differencesbetween all pairs of the study and control groups except ASTenzyme level which demonstrated a non-significant difference between controlled T2 diabetics with CP and nondiabeticswith CP. There were weak correlations between all clinical periodontal parameters and biochemicalparameters except between PPDand ALT enzyme in non-diabetics with CP group and between CAL and ASTenzyme 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 healthstatus. Salivary enzymes were considered as good biochemical markers of periodontal tissue destruction and usefulin diagnosis, monitoring and efficient management of periodontal diseases and T2DM