Gingival crevicular glucose estimation and patient’s perception of pain during routine dental examination – a concept based on a novel patented periodontal device
Abstract
Background/Aim. Diabetes mellitus (DM) is a common metabolic disease that causes high mortality and morbidity worldwide. Therefore, in order to implement prevention strategies, physicians need to identify this condition as early as possible. The aim of the study was to test the concept of a novel periodontal device that can be attached to a glucose monitoring device as an innovative tool to screen for periodontitis and DM simultaneously during a routine dental examination. Hence, the correlation of blood glucose between the conventional finger-prick blood glucose (FPBG) and gingival crevicular blood glucose (GCBG) method, along with an estimation of the patient’s pain perception by visual analog scale (VAS) was examined. Methods. A cross-sectional comparative study was conducted among 250 participants whose GCBG and FPBG were estimated. The VAS score scale was recorded for each patient immediately after the procedure. Results. The mean GCBG value was 151.19 ± 42.64 mg/dL, while the mean FPBG was 150.48 ± 42.95 mg/dL, showing a high Pearson’s correlation (r = 0.9932; p < 0.00001). The Mann-Whitney U test for VAS score between both groups showed a statistically significant difference (p < 0.00001). Conclusion. The GCBG method was well tolerated by patients, and highly correlated with peripheral blood glucose levels. The proposed concept of the novel periodontal device appeared to be a feasible option for examining periodontium and screening DM simultaneously in dental clinics.
References
1. Khan T, Yang J, Wozniak G. Trends in Medical Expenditures Prior to Diabetes Diagnosis: The Early Burden of Diabetes. Popul Health Manag 2021; 24(1): 46‒51.
2. Nguyen ATM, Akhter R, Garde S, Scott C, Twigg SM, Colagiuri S, et al. The association of periodontal disease with the complications of diabetes mellitus. A systematic review. Diabetes Res Clin Pract 2020; 165: 108244.
3. Monje A, Catena A, Borgnakke WS. Association between diabetes mellitus/hyperglycaemia and peri-implant diseases: Systematic review and meta-analysis. J Clin Periodontol 2017; 44(6): 636‒48.
4. Abariga SA, Whitcomb BW. Periodontitis and gestational diabetes mellitus: a systematic review and meta-analysis of observational studies. BMC Pregnancy Childbirth 2016; 16(1): 344.
5. Joshipura KJ, Munoz-Torres FJ, Dye BA, Leroux BG, Ramirez-Vick M, Perez CM. Longitudinal association between periodontitis and development of diabetes. Diabetes Res Clin Pract 2018; 141: 284‒93.
6. Kebede TG, Pink C, Rathmann W, Kowall B, Volzke H, Petersmann A, et al. Does periodontitis affect diabetes incidence and haemoglobin A1c change? An 11-year follow-up study. Diabetes Metab 2018; 44(3): 243‒9.
7. Nascimento GG, Leite FRM, Vestergaard P, Scheutz F, Lopez R. Does diabetes increase the risk of periodontitis? A systematic review and meta-regression analysis of longitudinal prospective studies. Acta Diabetol 2018; 55(7): 653‒67.
8. Stohr J, Barbaresko J, Neuenschwander M, Schlesinger S. Bidirectional association between periodontal disease and diabetes mellitus: a systematic review and meta-analysis of cohort studies. Sci Rep 2021; 11(1): 13686.
9. Mealey BL, Oates TW. American Academy of Periodontology. Diabetes mellitus and periodontal diseases. J Periodontol 2006; 77(8): 1289‒303.
10. Genco RJ, Borgnakke WS. Diabetes as a potential risk for periodontitis: association studies. Periodontol 2000 2020; 83(1): 40‒5.
11. Wong SL, Demers M, Martinod K, Gallant M, Wang Y, Goldfine AB, et al. Diabetes primes neutrophils to undergo NETosis, which impairs wound healing. Nat Med 2015; 21(7): 815‒9.
12. Bruen D, Delaney C, Florea L, Diamond D. Glucose Sensing for Diabetes Monitoring: Recent Developments. Sensors (Basel) 2017; 17(8): 1866.
13. Parihar S, Tripathi R, Parihar AV, Samadi FM, Chandra A, Bhavsar N. Estimation of gingival crevicular blood glucose level for the screening of diabetes mellitus: A simple yet reliable method. J Oral biol Craniofac Res 2016; 6(3): 198‒203.
14. Wu J, Lin L, Zhang R, Liu S, Sun W. Can gingival crevicular blood effectively screen for diabetes in Chinese patients with moderate to severe periodontitis? A pilot study. J Dent Sci 2021; 16(1): 1‒6.
15. Bhavsar MV, Brahmbhatt NA, Sahayata V, Bhavsar NV. Gingival crevicular blood for screening of blood glucose level in patients with & without diabetes: a chair-side test. Int J Dent Hyg 2016; 14(2): 92‒7.
16. Rapone B, Ferrara E, Santacroce L, Topi S, Converti I, Gnoni A, et al. Gingival Crevicular Blood as a Potential Screening Tool: A Cross Sectional Comparative Study. Int J Environ Res Public Health 2020; 17(20): 7356.
17. Sibyl S, Bennadi D, Kshetrimayum N, Manjunath M. Correlations between gingival crevicular blood glucose and capillary blood glucose: A preliminary report. J Lab Physicians 2017; 9(4): 260‒3.
18. Strauss SM, Rosedale MT, Pesce MA, Rindskopf DM, Kaur N, Juterbock CM, et al. The potential for glycemic control monitoring and screening for diabetes at dental visits using oral blood. Am J Public Health 2015; 105(4): 796‒801.
19. Wadia R. Screening for diabetes using gingival crevicular blood? Br Dent J 2020; 229(2): 125.
20. Beikler T, Kuczek A, Petersilka G, Flemmig TF. In-dental-office screening for diabetes mellitus using gingival crevicular blood. J Clin Periodontol 2002; 29(3): 216‒8.
21. Gupta A, Gupta N, Garg R, Jain N, Atreja G, Walia SS. Developing a chair side, safe and non-invasive procedure for assessment of blood glucose level using gingival crevicular bleeding in dental clinics. J Nat Sci Biol Med 2014; 5(2): 329‒32.
22. Shetty N, Shankarapillai R, Mathur LK, Manohar B, Mathur A, Jain M. Gingival crevicular blood: As a non-invasive screening tool for diabetes mellitus in dental clinics. J Ind Soc Periodontol 2013; 17(4): 472‒7.
23. Shylaja MD, Punde PA, Sam G, Khan SN, Latheef AA, Thorat AJ. Noninvasive Technique for Estimating Blood glucose Levels among Diabetic Patients. J Contemp Dent Pract 2016; 17(3): 248‒52.
24. Price DD, McGrath PA, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain 1983; 17(1): 45‒56.
25. Muller HP, Behbehani E. Screening of elevated glucose levels in gingival crevice blood using a novel, sensitive self-monitoring device. Med Princ Pract 2004; 13(6): 361‒5.
26. Partheeban IK, Chaly P, Priyadarshni I, Junaid M, Nijesh JE, Vaishnavi S. Evaluation of gingival blood as a minimally invasive screening tool for diabetes mellitus among 40-59-year-old adults in dental clinics: A cross-sectional study. Indian J Dent Res 2017; 28(2): 144‒50.
27. Sande AR, Guru S, Guru R, Gaduputi S, Thati DK, Siddeshappa ST. Gingival Crevicular Blood glucose Levels: Is it a Reliable Tool for Screening Diabetes in a Dental Office? J Contemp Dent Pract 2020; 21(4): 421‒5.
28. Sussman M, Benner J, Haller MJ, Rewers M, Griffiths R. Estimated Lifetime Economic Burden of Type 1 Diabetes. Diabetes Technol Ther 2020; 22(2): 121‒30.
29. Strauss SM, Wheeler AJ, Russell SL, Brodsky A, Davidson RM, Gluzman R, et al. The potential use of gingival crevicular blood for measuring glucose to screen for diabetes: an examination based on characteristics of the blood collection site. J Periodontol 2009; 80(6): 907‒14.
30. Parker RC, Rapley JW, Isley W, Spencer P, Killoy WJ. Gingival crevicular blood for assessment of blood glucose in diabetic patients. J Periodontol 1993; 64(7): 666‒72.
31. Drain M. Quality improvement in primary care and the importance of patient perceptions. J Ambul Care Manage 2001; 24(2): 30‒46.
32. Rosedale MT, Strauss SM. Diabetes screening at the periodontal visit: patient and provider experiences with two screening approaches. Int J Dent Hyg 2012; 10(4): 250‒8.
33. Ciantar M, Spratt DA, Newman HN, Wilson M. Development of an in vitro microassay for glucose quantification in submicrolitre volumes of biological fluid. J Periodontal Res 2002; 37(2): 79‒85.