C-reactive protein in type 2 diabetes and denture stomatitis

Objectives: Candida-associated denture stomatitis (CaDS), is a common disease in complete denture wearers with type 2 diabetes mellitus (T2DM). C-reactive protein (CRP), an acute phase reactant is a sensitive marker of inflammation associated with diabetes. The aim of this study was to determine the concentrations of CRP in patients with T2DM and CaDS, and investigate the relationship between CRP concentrations and glycated hemoglobin A1c (HbA1c) levels, which was used as an indicator of glycemic control. Materials and Methods: The study involved 110 T2DM patients (63 women and 47 men, mean age 63.2±10.5 years) with CaDS, and 20 patients (12 women and 8 men, mean age 65.8±12.9 years), with T2DM and healthy oral mucosa. A group of 20 non-diabetics (11 women and 9 men, mean age 59.2±9.9 years) with healthy oral mucosa served as a control. The yeasts were isolated by the culture method, and identified by microscopic examination and with the test kit, ID 32 C (bioMerieux SA, Marcy-l\u27Etoile, France). Serum concentrations of CRP were determined by rocket immunoelectrophoresis according to Laurell. Glycemic control was evaluated by measuring HbA1c levels using HPLC together with the Variant Hemoglobin A1c Program (Bio-Rad Laboratories, Hercules CA, USA). Results: The mean duration of diabetes was 10.6±5.1 years, and the mean HbA1c levels in T2DM subjects were 8.6 ±1.9%. Patients with T2DM had significantly elevated mean levels of CRP in comparison to patients with normal glucose metabolism (6.12±2.86 vs 2.57±0.96 mg/l, p\u3c0.05). The highest CRP levels were observed in diabetics with type II (Newton classification) CaDS (8.39±2.70 mg/l). A positive correlation was found between the concentrations of CRP and fasting plasma glucose levels (rS=0.517, p\u3c0.001) and HbA1c levels (rS=0.572, p\u3c0.001). Conclusions: The findings suggest that CRP concentrations can be used as a non-specific indicator of ongoing inflammation in patients with T2DM

Avaliação da estomatite protética em portadores de próteses totais Evaluation of denture stomatitis in users of complete dentures

As próteses muco-suportadas são consideradas facilitadoras em potencial da estomatite protética (EP), lesão comumente observada sob a base das próteses, caracterizada por aspectos eritematosos difusos ou pontilhados na mucosa de suporte. Sua etiologia é controversa, podendo estar relacionada principalmente a fatores locais. Diversos aspectos funcionais associam-se a estes fatores representados pela oclusão, dimensão vertical, retenção, estabilidade dinâmica e estática além de aspectos qualitativos relacionados às condições encontradas no desdentado. Foram levados em consideração o período de edentulismo, número e tempo de uso das próteses, uso contínuo, conservação, presença de placa e higiene bucal. Os fatores foram avaliados, visando esclarecer a possível relação dos aspectos funcionais e protéticos com a EP. Exame clínico foi realizado em 116 pacientes de ambos os sexos, desdentados bimaxilares, que utilizavam as duas próteses muco-suportadas, portadores ou não de estomatite protética (EP). Os resultados indicaram que a maioria dos pacientes examinados tinha EP frente ao menor número de pacientes sem EP, havendo nos dois grupos equivalência nos resultados da avaliação clínica e protética. Os fatores funcionais e qualitativos das próteses, avaliados isoladamente, não puderam ser considerados responsáveis pela ocorrência dessa patologia, constatando-se que um único fator protético não demonstrou, de per si, ser responsável pela presença da EP, embora possa ser um facilitador para o seu desenvolvimento.<br>Functional and qualitative factors in complete dentures can contribute to the development of lesions in the oral mucosa. Such lesions are classified as denture stomatitis (DS). There are considerable differences of opinion as to its etiology, mainly related to systemic and local factors. The influence of functional and qualitative features of complete dentures on denture stomatitis was evaluated. The functional factors considered were: occlusion, vertical dimension of occlusion (VDO), dynamic and static retention, as well as stability. The qualitative factors were: oral and prosthetic hygiene, continuous use, complete denture status, time of use and time of edentulism. The study group comprised 116 totally edentulous patients, with and without DS, of both genders using tissue-supported prostheses. The data were analyzed through the Chi-square test, at the 0.05 significance level, and through the Fisher test, when the frequency was low. The results indicated that the majority of our patients presented DS. None of these factors was by itself responsible for the presence of DS, indicating that DS was probably due to many factors