Periodontal health status and implication of periodic acid–Schiff diastase - a key in exfoliative cytology among diabetics mellitus patients: A case–control study

ABSTRACT

Objectives: The objectives of the study are: (i) To determine if periodic acid–Schiff (PAS)-Diastase is an effective tool to diagnose DM noninvasively, (ii) to use three different types of staining procedures to identify the staining pattern over the exfoliated cells of normal and diabetic patients, (iii) to study the periodontal health status of DM and normal subjects. Materials and Methods: Basic questions regarding the demographic data were asked, following which community periodontal index (CPI) was recorded. Oral smears were collected from clinically normal buccal mucosa of 150 patients using wooden tongue spatulas. The subjects were asked to gargle their mouth with water and the wooden spatula was scraped at the site from buccal mucosa. The smears were spread evenly on a dry clean glass slide and fixed immediately with absolute ethyl alcohol. Three slides were prepared for each of the patients. PAS, PAS with diastase digestion, and Papanicolaou staining were performed and examined under a microscope. Results: Average CPI for study subjects was 3.2 and control subjects was 2.1. The average loss of attachment was 1.1 in the study group and 0.2 in the control group (P - 0.00) and the result are statistically highly significant. All the 150 cases (100%) were positive for PAS staining, while PAS-diastase (PAS-D) staining showed positivity only for normal subjects and was negative (100%) in the diabetic group (P - 0.00) and the result are statistically highly significant. Conclusions: Results of our study showed that exfoliative cytology of the oral cavity, when stained with PAS and PAS-D, can be used as an effective screening and diagnostic tool for DM patients.

Key words:

Diabetes mellitus - exfoliative cytology - periodic acid–Schiff-diastase - periodontitis

• REFERENCES

• 1 Mohan V, Sandeep S, Deepa R, Shah B, Varghese C. Epidemiology of type 2 diabetes: Indian scenario. Indian J Med Res 2007; 125: 217-30
• 2 Ramachandran A, Snehalatha C, Viswanathan V. Burden of type 2 diabetes and its complications – The Indian scenario. Curr Sci 2002; 83: 1471-5
• 3 Bancroft J, Stevens A. Theory and Practice of Histological Techniques. 2nd ed.. New York: Churchill-Livingstone; 1980: p. 187-8
• 4 Powell RN. Gingival tissue physiology in vitro 2. Glycogen storage and utilization. J Periodontal Res 1969; 4: 36-41
• 5 Porter K, Lefkowitz W. Glycogen in developing and young rat oral epithelium. J Dent Res 1965; 44: 954-8
• 6 Shlossman M, Knowler WC, Pettitt DJ, Genco RJ. Type 2 diabetes mellitus and periodontal disease. J Am Dent Assoc 1990; 121: 532-6
• 7 Bartolucci EG, Parkes RB. Accelerated periodontal breakdown in uncontrolled diabetes. Pathogenesis and treatment. Oral Surg Oral Med Oral Pathol 1981; 52: 387-90
• 8 Preshaw PM, Alba AL, Herrera D, Jepsen S, Konstantinidis A, Makrilakis K. et al. Periodontitis and diabetes: A two-way relationship. Diabetologia 2012; 55: 21-31
• 9 Rickles NH. Oral exfoliative cytology: An adjunct to biopsy. CA Cancer J Clin 1972; 22: 163-71
• 10 Goregen M, Akgul HM, Gundogdu C. The cytomorphological analysis of buccal mucosa cells in smokers. Turk J Med Sci 2011; 41: 205-10
• 11 Cohen DW, Friedman LA, Shapiro J, Kyle GC, Franklin S. Diabetes mellitus and periodontal disease: Two-year longitudinal observations. I. J Periodontol 1970; 41: 709-12
• 12 Carson FreidaL, Christa H. Histotechnology: A Self-Instructional Text. 3rd ed.. Hong Kong: American Society for Clinical Pathology Press; 2009: p. 361-3363
• 13 Qin L, Zhao L, Tan C, Chen XU, Yang Z, Mo W. A novel method of combining periodic acid schiff staining with wright-giemsa staining to identify the pathogens Penicillium marneffei, Histoplasma capsulatum, Mucor and Leishmania donovani in bone marrow smears. Exp Ther Med 2015; 9: 1950-4
• 14 Kim EK, Lee SG, Choi YH, Won KC, Moon JS, Merchant AT. et al. Association between diabetes-related factors and clinical periodontal parameters in type-2 diabetes mellitus. BMC Oral Health 2013; 13: 64
• 15 Radhika T, Ranganathan K. Periodontal health in type 2 diabetics. J NTR Univ Health Sci 2014; 3: S37-42
• 16 Popławska-Kita A, Siewko K, Szpak P, Król B, Telejko B, Klimiuk PA. Relationship between type 2 diabetes and periodontal disease. Prog Health Sci 2013; 3: 137-44
• 17 Das M, Upadhyaya V, Ramachandra SS, Jithendra KD. Periodontal treatment needs in diabetic and non-diabetic individuals: A case-control study. Indian J Dent Res 2011; 22: 291-4
• 18 Prakash S, Dhingra K, Priya S. Similar hematological and biochemical parameters among periodontitis and control group subjects. Eur J Dent 2012; 6: 287-94
• 19 Gupta N, Gupta ND, Gupta A, Goyal L, Garg S. The influence of type 2 diabetes mellitus on salivary matrix metalloproteinase-8 levels and periodontal parameters: A study in an Indian population. Eur J Dent 2015; 9: 319-23
• 20 Alberti S, Spadella CT, Francischone TR, Assis GF, Cestari TM, Taveira LA. Exfoliative cytology of the oral mucosa in type II diabetic patients: Morphology and cytomorphometry. J Oral Pathol Med 2003; 32: 538-43
• 21 Jajarm HH, Mohtasham N, Moshaverinia M, Rangiani A. Evaluation of oral mucosa epithelium in type II diabetic patients by an exfoliative cytology method. J Oral Sci 2008; 50: 335-40
• 22 Shareef BT, Ang KT, Naik VR. Qualitative and quantitative exfoliative cytology of normal oral mucosa in type 2 diabetic patients. Med Oral Patol Oral Cir Bucal 2008; 13: E693-6
• 23 Nandita KP, Boaz K, Srikant N, Lewis AJ, Manaktala N. Oral epithelium in diabetics: A cytomorphometric correlation. Dent Hypotheses 2014; 5: 59-65
• 24 Prasad H, Ramesh V, Balamurali P. Morphologic and cytomorphometric analysis of exfoliated buccal mucosal cells in diabetes patients. J Cytol 2010; 27: 113-7
• 25 Satpathy Y, Kumar PS, Singh N. Promising role of exfoliative cytology in the evaluation of glycaemic status of type II diabetics: A pilot study. J Maxillofac Oral Surg 2015; 14: 206-11
• 26 Latti BR, Birajdar SB, Latti RG. Periodic acid schiff-diastase as a key in exfoliative cytology in diabetics: A pilot study. J Oral Maxillofac Pathol 2015; 19: 188-91
• 27 Kishi K, Nishijima K, Medak H, Burlakow P. Cytochemical study of exfoliated cells of oral mucosa. I. The glycogen deposition and keratinization. Acta Med Okayama 1975; 29: 103-9