ASSOCIATION BETWEEN POOR ORAL HYGIENE AND SYSTEMIC INFLAMMATION IN DIABETIC PATIENTS

Authors

  • Sidra Ashraf University of Lahore, Lahore, Pakistan. Author
  • Usman Rehman King Edward Medical University, Lahore, Pakistan. Author
  • Hira Amin Karachi Institute of Kidney Diseases (KIKD), Karachi, Pakistan. Author https://orcid.org/0009-0002-5327-4876
  • Ramsha Irfan The Indus Hospital, Karachi, Pakistan. Author
  • Khadija Asif , University of Sargodha, Sargodha, Pakistan. Author
  • Mahum Tanweer Al-Shifa School of Public Health, Rawalpindi, Pakistan. Author https://orcid.org/0009-0000-8845-0417
  • Ayesha Ikram Malik School of Dentistry, Islamabad, Pakistan. Author
  • Arush-ul-Jamar FMH College of Medicine and Dentistry, Lahore, Pakistan. Author

DOI:

https://doi.org/10.71000/37c61734

Keywords:

C-reactive protein, Diabetes Mellitus, Inflammation, , Interleukin-6, Oral microbiome, Periodontal diseases, Tumor necrosis factor-alpha

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.

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.

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Published

2025-05-05