{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T05:00:59Z","timestamp":1790139659209,"version":"4.0.1"},"reference-count":59,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T00:00:00Z","timestamp":1763942400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000329","name":"Novo Nordisk UK Research Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100000329","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dentistry Journal"],"abstract":"<jats:p>Background\/Objective: Diabetes mellitus type 2 (T2DM) is a significant global public health concern. This analytical cross-sectional study aimed to evaluate the impact of T2DM on the severity of dental caries and salivary properties. Methods: A total of 182 participants (n = 91 per group) were recruited into the T2DM and non-diabetes (ND) groups. Unstimulated whole saliva (UWS) and blood samples for HbA1c were collected. Clinical assessments included plaque index, SoproLIFE, ICDAS, and severity index for root caries. Results: A total of 92 male and 89 female participants were recruited in this study. The results showed that the mean of UWS pH was slightly lower in the T2DM (6.65 \u00b1 1.12) than the ND group (6.88 \u00b1 0.49), however the difference was statistically insignificant (p = 0.065). The mean saliva buffer capacity was almost identical between the two groups, with values of 7.38 \u00b1 3.2 in T2DM and 7.37 \u00b1 2.83 in the ND groups (p = 0.973), indicating an insignificant difference. The mean saliva spinnbarkeit was slightly high and insignificant in the T2DM (4.57 \u00b1 4.34) compared to the ND group (3.69 \u00b1 3.6) (p = 0.141). The T2DM group had a significantly high proportion of participants with very low saliva flow rate (&lt;0.1 mL\/min) in comparison to ND (20.9% vs. 5.5%) (p = 0.004). ICDAS scores were significantly higher in T2DM (0.67 \u00b1 0.32) when compared to the ND group (0.57 \u00b1 0.24) (p = 0.014). ICDAS scores 3 and 6 were significantly higher in T2DM (2.76 \u00b1 2.66; 0.86 \u00b1 2.61) in comparison to ND (2.10 \u00b1 2.00, 0.26 \u00b1 0.96). Conclusions: Within the limitations of this analytical cross-sectional study, participants with T2DM demonstrated a higher risk of developing severe carious lesions and exhibited low salivary pH and flow rate when compared with non-diabetic individuals, supporting a possible association between glycemic status, salivary alterations, and caries severity.<\/jats:p>","DOI":"10.3390\/dj13120553","type":"journal-article","created":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T13:09:25Z","timestamp":1763989765000},"page":"553","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Severity of Dental Caries and Saliva Properties in Diabetes Mellitus"],"prefix":"10.3390","volume":"13","author":[{"given":"Ashwaq","family":"Alkahtani","sequence":"first","affiliation":[{"name":"Department of Dental Health, The College of Applied Medical Sciences (CAMS), King Saud University, Riyadh 11433, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8775-3950","authenticated-orcid":false,"given":"Aylin","family":"Baysan","sequence":"additional","affiliation":[{"name":"Institute of Dentistry, Bart\u2019s and the London Faculty of Medicine and Dentistry, Queen Mary University of London, London E1 2AD, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1097\/MAJ.0b013e31828bdedf","article-title":"Oral health and type 2 diabetes","volume":"345","author":"Leite","year":"2013","journal-title":"Am. J. Med. Sci."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"282","DOI":"10.4103\/jomfp.JOMFP_163_16","article-title":"Evaluation of relationship between dental caries, diabetes mellitus and oral microbiota in diabetics","volume":"22","author":"Latti","year":"2018","journal-title":"J. Oral Maxillofac. Pathol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e053","DOI":"10.1590\/1807-3107bor-2021.vol35.0053","article-title":"Risk factors for dental caries in Latin American and Caribbean countries","volume":"35","author":"Martignon","year":"2021","journal-title":"Braz. Oral Res."},{"key":"ref_4","first-page":"123","article-title":"Association of diabetes and dental caries among US adolescents in the NHANES dataset","volume":"43","author":"Beheshti","year":"2021","journal-title":"Pediatr. Dent."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Schmolinsky, J., Kocher, T., Rathmann, W., V\u00f6lzke, H., Pink, C., and Holtfreter, B. (2019). Diabetes status affects long-term changes in coronal caries: The SHIP Study. Sci. Rep., 9.","DOI":"10.1038\/s41598-019-51086-z"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1038\/s41579-018-0089-x","article-title":"The oral microbiota: Dynamic communities and host interactions","volume":"16","author":"Lamont","year":"2018","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1111\/j.1754-4505.1999.tb01361.x","article-title":"Dental caries in older adults with diabetes mellitus","volume":"19","author":"Lin","year":"1999","journal-title":"Spec. Care Dent."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"5780916","DOI":"10.1155\/2018\/5780916","article-title":"The influence of type 1 diabetes mellitus on dental caries and salivary composition","volume":"2018","author":"Ferizi","year":"2018","journal-title":"Int. J. Dent."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1177\/0022034518805739","article-title":"The oral microbiota is modified by systemic diseases","volume":"98","author":"Graves","year":"2019","journal-title":"J. Dent. Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"9367404","DOI":"10.1155\/2019\/9367404","article-title":"The interplay between immune system and microbiota in diabetes","volume":"2019","author":"Moffa","year":"2019","journal-title":"Mediat. Inflamm."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"125","DOI":"10.4103\/2231-0762.178748","article-title":"Diabetes an inducing factor for dental caries: A case-control analysis in Jammu","volume":"6","author":"Singh","year":"2016","journal-title":"J. Int. Soc. Prev. Community Dent."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"S179","DOI":"10.1016\/j.mjafi.2020.09.012","article-title":"Prevalence and severity of coronal and radicular caries among patients with type 2 diabetes mellitus: A cross-sectional study","volume":"78","author":"Varughese","year":"2022","journal-title":"Med. J. Armed Forces India"},{"key":"ref_13","first-page":"ZC12","article-title":"Correlation of salivary pH, incidence of dental caries and periodontal status in diabetes mellitus patients: A cross-sectional study","volume":"10","author":"Seethalakshmi","year":"2016","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"S232","DOI":"10.4103\/2231-0762.197202","article-title":"Dental caries prevalence among type II diabetic and nondiabetic adults attending a hospital","volume":"6","author":"Malvania","year":"2016","journal-title":"J. Int. Soc. Prev. Community Dent."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1111\/idj.12282","article-title":"Dental and periodontal health, and microbiological and salivary conditions in patients with or without diabetes undergoing haemodialysis","volume":"67","author":"Schmalz","year":"2017","journal-title":"Int. Dent. J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.archoralbio.2015.11.005","article-title":"Impact of glycemic control on oral health status in type 2 diabetes individuals and its association with salivary and plasma levels of chromogranin A","volume":"62","author":"Kogawa","year":"2016","journal-title":"Arch. Oral Biol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1111\/j.1754-4505.2002.tb01169.x","article-title":"Oral health in the elderly with non-insulin-dependent diabetes mellitus","volume":"22","author":"Zielinski","year":"2002","journal-title":"Spec. Care Dent."},{"key":"ref_18","first-page":"279","article-title":"Oral self-care and use of dental services among adults with diabetes mellitus","volume":"6","author":"Bakhshandeh","year":"2008","journal-title":"Oral Health Prev. Dent."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e8562","DOI":"10.1097\/MD.0000000000008694","article-title":"Association between the number of natural teeth and diabetic retinopathy among type 2 diabetes mellitus: The Korea National Health and Nutrition Examination Survey","volume":"96","author":"Song","year":"2017","journal-title":"Medicine"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1113\/jphysiol.1972.sp009721","article-title":"Circadian rhythms in human salivary flow rate and composition","volume":"220","author":"Dawes","year":"1972","journal-title":"J. Physiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1177\/00220345820610100901","article-title":"A comparison of whole mouth resting and stimulated salivary measurement procedures","volume":"61","author":"Navazesh","year":"1982","journal-title":"J. Dent. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/j.jdent.2004.01.006","article-title":"A new automatic device for measuring the spinnbarkeit of saliva: The Neva Meter","volume":"32","author":"Gohara","year":"2004","journal-title":"J. Dent."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1111\/j.1600-0528.2007.00347.x","article-title":"The International Caries Detection and Assessment System (ICDAS): An integrated system for measuring dental caries. Community Dent","volume":"35","author":"Ismail","year":"2007","journal-title":"Oral Epidemiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1177\/00220345930720031201","article-title":"A microbiological study of primary root-caries lesions with different treatment needs","volume":"72","author":"Beighton","year":"1993","journal-title":"J. Dent. Res."},{"key":"ref_25","first-page":"41","article-title":"Reversal of primary root caries using dentifrices containing 5000 and 1100 ppm fluoride","volume":"35","author":"Baysan","year":"2001","journal-title":"Caries Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1308\/135576106775193897","article-title":"The use of ozone in dentistry and medicine. Part 2. Ozone and root caries","volume":"13","author":"Baysan","year":"2006","journal-title":"Prim. Dent. Care"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Rechmann, P., Charland, D., Rechmann, B.M., and Featherstone, J.D.B. (2012). Performance of laser fluorescence devices and visual examination for the detection of occlusal caries in permanent molars. J. Biomed. Opt., 17.","DOI":"10.1117\/1.JBO.17.3.036006"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"10242","DOI":"10.1016\/j.pdpdt.2021.102422","article-title":"The performance of SoproLIFE for early detection of coronal caries using the International Caries Classification and Management System\u2014A preliminary laboratory-based study","volume":"35","author":"Alkahtani","year":"2021","journal-title":"Photodiagn. Photodyn. Ther."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e846","DOI":"10.1002\/cre2.846","article-title":"The impact of sociodemographic determinants and diabetes type 2 on oral health outcomes: An analytical cross-sectional study","volume":"10","author":"Alkahtani","year":"2024","journal-title":"Clin. Exp. Dent. Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1513","DOI":"10.1016\/S0140-6736(16)00618-8","article-title":"Worldwide trends in diabetes since 1980: A pooled analysis of 751 population-based studies with 4.4 million participants","volume":"387","author":"Zhou","year":"2016","journal-title":"Lancet"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1161\/CIRCULATIONAHA.118.035550","article-title":"Sex differences in the prevalence of, and trends in, cardiovascular risk factors, treatment, and control in the United States, 2001 to 2016","volume":"139","author":"Peters","year":"2019","journal-title":"Circulation"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"109119","DOI":"10.1016\/j.diabres.2021.109119","article-title":"IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045","volume":"183","author":"Sun","year":"2022","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_33","first-page":"100","article-title":"The genetic basis of type 2 diabetes","volume":"2","author":"Das","year":"2006","journal-title":"Cellscience"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"174","DOI":"10.4103\/ajm.ajm_53_20","article-title":"Pathophysiology of diabetes: An overview","volume":"10","author":"Banday","year":"2020","journal-title":"Avicenna J. Med."},{"key":"ref_35","first-page":"1592","article-title":"Evaluation of salivary profile among adult type 2 diabetes mellitus patients in South India","volume":"7","author":"Kumar","year":"2013","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_36","first-page":"722","article-title":"What is the critical pH and why does a tooth dissolve in acid?","volume":"69","author":"Dawes","year":"2003","journal-title":"J. Can. Dent. Assoc."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"900","DOI":"10.2337\/diacare.15.7.900","article-title":"Xerostomia in diabetes mellitus","volume":"15","author":"Sreebny","year":"1992","journal-title":"Diabetes Care"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1034\/j.1600-0528.2001.290304.x","article-title":"Type 1 diabetes mellitus and oral health: Assessment of coronal and root caries. Community Dent","volume":"29","author":"Moore","year":"2001","journal-title":"Oral Epidemiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1111\/j.1600-0722.2006.00277.x","article-title":"Dental caries and salivary status in children with type 1 diabetes mellitus, related to the metabolic control of the disease","volume":"114","author":"Siudikiene","year":"2006","journal-title":"Eur. J. Oral Sci."},{"key":"ref_40","first-page":"85","article-title":"Diurnal behaviour of some salivary parameters in patients with diabetes mellitus (flow rate, pH, thiocianat, LDH activity)\u2014Note II","volume":"35","author":"Ionescu","year":"1998","journal-title":"Rom. J. Physiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"35S","DOI":"10.14219\/jada.archive.2008.0353","article-title":"Measuring salivary flow: Challenges and opportunities","volume":"139","author":"Navazesh","year":"2008","journal-title":"J. Am. Dent. Assoc."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/S1079-2104(98)90152-4","article-title":"Saliva in non-insulin-dependent diabetic patients and control subjects: The role of the autonomic nervous system","volume":"86","author":"Meurman","year":"1998","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod."},{"key":"ref_43","first-page":"338","article-title":"Oral health of patients with insulin-dependent diabetes mellitus","volume":"94","author":"Tenovuo","year":"1986","journal-title":"Scand. J. Dent. Res."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1016\/j.ejpb.2009.10.003","article-title":"Thermally sensitive gels based on chitosan derivatives for the treatment of oral mucositis","volume":"74","author":"Rossi","year":"2010","journal-title":"Eur. J. Pharm. Biopharm."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1660","DOI":"10.1177\/0022034515609070","article-title":"Changes in saliva rheological properties and mucin glycosylation in dry mouth","volume":"94","author":"Chaudhury","year":"2015","journal-title":"J. Dent. Res."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"105321","DOI":"10.1016\/j.jdent.2024.105321","article-title":"Dental caries and salivary alterations in patients with type 2 diabetes: A systematic review and meta-analysis","volume":"150","author":"Zhou","year":"2024","journal-title":"J. Dent."},{"key":"ref_47","unstructured":"Abayon, M. (2009). Diabetes and Dental Caries Prevalence: Is There an Association?. [Master\u2019s Thesis, University of Rochester]."},{"key":"ref_48","first-page":"10509","article-title":"ICDAS score comparison in diabetic vs","volume":"1","author":"Sadhvi","year":"2022","journal-title":"non-diabetic patients among South Indian population. Spec. Ugdym."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"295","DOI":"10.2337\/diacare.29.02.06.dc05-1355","article-title":"Periodontal changes in children and adolescents with diabetes: A case-control study","volume":"29","author":"Lalla","year":"2006","journal-title":"Diabetes Care"},{"key":"ref_50","unstructured":"Tungare, S., and Paranjpe, A.G. (2025, August 15). Diet and nutrition to prevent dental problems, StatPearls [Internet], Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK534248\/."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"103629","DOI":"10.1016\/j.jdent.2021.103629","article-title":"Changes in saliva characteristics and carious status related to metabolic control in patients with type 2 diabetes mellitus","volume":"108","author":"Rahiotis","year":"2021","journal-title":"J. Dent."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1038\/s41415-021-3240-4","article-title":"Root caries","volume":"231","author":"Hellyer","year":"2021","journal-title":"Br. Dent. J."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1038\/sj.bdj.4800853a","article-title":"The condition of teeth in the UK in 1998 and implications for the future","volume":"189","author":"Nunn","year":"2000","journal-title":"Br. Dent. J."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"9963917","DOI":"10.1155\/2024\/9963917","article-title":"A Cross-Sectional Study to Assess Diabetes as a Risk Factor for Root Caries Amongst the Elderly Population in Udupi District, Karnataka State, India","volume":"2024","author":"Kalra","year":"2024","journal-title":"Sci. World J."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1038\/sj.ebd.6400633","article-title":"Periodontal treatment could improve glycaemic control in diabetic patients","volume":"10","author":"Garcia","year":"2009","journal-title":"Evid. Based Dent."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Du, Y., Xiao, H., Luo, R., Li, G., and Ren, Y. (2025). The role of HbA1c in the bidirectional relationship between periodontitis and diabetes and related interventions: A narrative review. Front. Nutr., 12.","DOI":"10.3389\/fnut.2025.1606223"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1111\/j.1399-302X.2007.00341.x","article-title":"The microbiological profiles of saliva, supragingival and subgingival plaque and dental caries in adults with and without type 2 diabetes mellitus","volume":"22","author":"Hintao","year":"2007","journal-title":"Oral Microbiol. Immunol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1111\/scd.12065","article-title":"Root caries among type 2 diabetes mellitus patients visiting a hospital","volume":"34","author":"Soni","year":"2014","journal-title":"Spec. Care Dent."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"3801","DOI":"10.1007\/s00784-020-03531-x","article-title":"Diabetes mellitus and poor glycemic control increase the occurrence of coronal and root caries: A systematic review and meta-analysis","volume":"24","author":"Stefani","year":"2020","journal-title":"Clin. Oral Investig."}],"container-title":["Dentistry Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2304-6767\/13\/12\/553\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T05:29:54Z","timestamp":1764134994000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2304-6767\/13\/12\/553"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,24]]},"references-count":59,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["dj13120553"],"URL":"https:\/\/doi.org\/10.3390\/dj13120553","relation":{},"ISSN":["2304-6767"],"issn-type":[{"value":"2304-6767","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,24]]}}}