ASSOCIATION BETWEEN POOR ORAL HYGIENE AND SYSTEMIC INFLAMMATION IN DIABETIC PATIENTS

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Sidra Ashraf
Usman Rehman
Hira Amin
Ramsha Irfan
Khadija Asif
Mahum Tanweer
Ayesha Ikram Malik
Arush-ul-Jamar

Abstract

Background: Type 2 diabetes mellitus (T2DM) is associated with chronic low-grade systemic inflammation, which significantly contributes to disease progression and complications. Emerging evidence suggests a link between poor oral hygiene and elevated systemic inflammatory markers in diabetic individuals, mediated by increased oral bacterial load.


Objective: To investigate the association between oral bacterial load and systemic inflammation in patients with T2DM, and to determine whether oral microbial burden independently contributes to heightened inflammatory responses.


Methods: This cross-sectional study was conducted at a tertiary care hospital in Lahore from July 2024 to March 2025. A total of 100 adults with T2DM were enrolled based on defined inclusion and exclusion criteria. Oral bacterial load was quantified using quantitative real-time PCR (qRT-PCR) targeting 16S rRNA gene sequences from subgingival plaque samples. Systemic inflammation was assessed by measuring serum levels of high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) using ELISA. Data were analyzed using Pearson correlation and multivariate linear regression, with statistical significance set at p<0.05.


Results: Participants had a mean age of 52.3 ± 7.1 years and mean HbA1c of 8.1 ± 1.2%. High oral bacterial load (>8 log10 copies/mL) was observed in 38% of participants. Significant positive correlations were found between bacterial load and hs-CRP (r=0.58), IL-6 (r=0.61), and TNF-α (r=0.56), all p<0.001. Regression analysis confirmed bacterial load as an independent predictor of systemic inflammation.


Conclusion: Oral bacterial load is significantly associated with systemic inflammation in T2DM patients. These findings highlight the importance of oral health in managing systemic complications of diabetes.

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Author Biographies

Sidra Ashraf, University of Lahore, Lahore, Pakistan.

MPhil Student, University of Lahore, Lahore, Pakistan.

Usman Rehman, King Edward Medical University, Lahore, Pakistan.

Physician Internal Medicine, Dawadmi General Hospital, Al-Riyadh, KSA; Graduate, King Edward Medical University, Lahore, Pakistan.

Hira Amin, Karachi Institute of Kidney Diseases (KIKD), Karachi, Pakistan.

PGY2 Internal Medicine, Medical Officer, Karachi Institute of Kidney Diseases (KIKD), Karachi, Pakistan.

Ramsha Irfan, The Indus Hospital, Karachi, Pakistan.

Year 2 Resident Family Medicine, The Indus Hospital, Karachi, Pakistan.

Khadija Asif, , University of Sargodha, Sargodha, Pakistan.

MPhil Scholar, College of Pharmacy, University of Sargodha, Sargodha, Pakistan.

Mahum Tanweer, Al-Shifa School of Public Health, Rawalpindi, Pakistan.

General Dentist (BDS, MPH), Al-Shifa School of Public Health, Rawalpindi, Pakistan.

Ayesha Ikram Malik, School of Dentistry, Islamabad, Pakistan.

School of Dentistry, Islamabad, Pakistan.

Arush-ul-Jamar, FMH College of Medicine and Dentistry, Lahore, Pakistan.

4th Year MBBS, FMH College of Medicine and Dentistry, Lahore, Pakistan.