Acetone Level and Salivary Oral Status Patient with Type 2 Diabetes

Mellitus (In Vivo)

Ameta Primasari

, Yumi Lindawati

, Yendriwati

, Almida Purnama Nasution

, and Tulus Ikhsan

Nasution

Department of Oral Biology Faculty of Dentistry, Universitas Sumatera Utara Medan, Indonesia

Departement of Physics, Faculty of Mathematics And Natural Sciences, Universitas Sumatera Utara Medan, Indonesia

Keyword: Salivary flow rate, pH salivary, and acetone level

Abstract: Diabetes mellitus is a chronic metabolic disease characterized by hyperglycemia due to lack in the production

of insulin produced by isled cell of pancreas, and systemic disease associated in oral manifestations.

Reduction of salivary flow is one of the oral complication in patients with diabetes mellitus that can cause dry

mouth, acidic pH and others. Acetone is the most abundant compound in the breath, acetone concentrations

increased in patients with diabetes mellitus. The objective of this research is to analyze acetone level in mouth

and salivary status (salivary flow rate and salivary pH) in type 2 diabetes mellitus patients, and to analyze the

relationship between blood sugar levels and acetone levels, salivary flow rate, and salivary pH. This research

is an analytical observational research with cross sectional and total sampling in this research were 31 patients

by purpossive sampling, measurement of acetone levels and salivary samples was carried out at Aviati Clinic

Medan. Stimulated saliva respondents has diagnose as DM was collected by spitting for 5 minutes in the

saliva pot. The salivary pH measurement using GC saliva test for pH and acetone level measurement using

Diasen. Data were analysis using fisher’s exact test. The results of this research showed the average salivary

flow rate is normal with value 1,5 ml/menit, pH salivary normal with value 7,2, and acetone levels normal

with value 377,38mV. Fisher Exact Test showed a significant relationship between blood sugar levels with

salivary flow rate (p< 0,05) but did not show a significant association between blood sugar levels with pH

salivary and acetone levels (p>0,05). Test graph to find out relationship between acetone levels with salivary

pH, relationship between acetone levels with salivary flow rate, and relationship between salivary flow rate

with salivary pH it was found there was correlation was significant. The conclusion of this research if salivary

status normal in patient type 2 DM, it would appeared normal the acetone levels.

1 INTRODUCTION

Diabetes mellitus is a metabolic disease characterized

by hyperglycemia due to absolute or relative decrease

in insulin secretion or due to insulin resistance which

results in a decrease in glucose into the cell and an

increase in blood sugar levels, and changes in fat,

protein and carbohydrate metabolism (Humairo,

2014).

Diabetes mellitus is divided into two types,

namely type 1 diabetes mellitus (insulin dependent

diabetes mellitus) and type 2 diabetes mellitus

(noninsulin dependent diabetes mellitus). World

Health Organization (WHO) estimates that in 2025

the number of people with diabetes mellitus will

increase to 300 million people and will increase to

438 million by 2030 world wide, including type 2 DM

patients. According to WHO estimates, 70% of the

prevalence of DM is found in developing countries.

The results of Regional Health Research

(RISKESDAS) in 2013, the prevalence of diabetes

mellitus in North Sumatra was 1.8% (Rikesdas and

Riskesdas, 2013).

In people with DM, there are often several

manifestations of the oral mucosa, some

manifestations that often occur in the form of

candidiasis, burning mouth syndrome, oral lichen

planus, recurrent aphthous stomatitis, xerostomia and

salivary gland dysfunction, in patients with type 2

DM there is a change in salivary flow rate and

salivary components , decrease in salivary flow rate

occurs due to parenchymal damage, changes in

500

Primasari, A., Lindawati, Y., Yendriwati, ., Nasution, A. and Nasution, T.

Acetone Level and Salivary Oral Status Patient with Type 2 Diabetes Mellitus (In Vivo).

DOI: 10.5220/0010076305000504

In Proceedings of the International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches (ICOSTEERR 2018) - Research in Industry 4.0, pages

500-504

ISBN: 978-989-758-449-7

salivary gland microcirculation, dehydration, and

disturbances in glycemic contraction. Complications

that are often found in patients with type 2 diabetes

mellitus include, xerostomia, tooth loss, gingivitis,

periodontitis, odontogenic abscess, and soft tissue

lesions on the tongue and oral mucosa. In type 2

diabetes mellitus patients also have a significant

decrease in salivary pH compared with non diabetes

mellitus subjects and is associated with microbial

activity or decreased bicarbonate which occurs

simultaneously with salivary flow rates (Almeida,

2018), (Lopez, 2016).

Acetone (C3H6O) is one of the most abundant

compounds in human breathing. Acetone is produced

by heptocyse through decarboxylation from excess

acetyl-Coa. Acetone formed by decarboxylation

originating from lipolysis or lipid peroxidation.

Ketone bodies, such as acetone are oxidized through

the krebs cycle in peripheral tissues. Acetone

concentration in breathing increases in uncontrolled

patients with diabetes mellitus. The concentration of

acetone in breath of people who do not suffer from

diabetes mellitus is 800-900ppb, while patients with

diabetes mellitus range from 1800ppb. Acetone

causes bad breath, which is the smell of pears caused

by ketoacidosis. this is a complication of oral cavity

(Mitrayana, 2014), (Ozougwu, 2013).

2 MATERIALS AND METHODS

This study is an analytical observational research with

cross sectional, and the total samples in this study

were 30 patients and met the inclusion criteria are

ages 40-55, patient with diabetes mellitus controlled,

willing to participate in the study, in good health, has

no other complicated diseases, and exclusion are

alcoholic drinkers, copulate, smokers, not undergoing

radiotherapy, patient with other complicated diseases,

taking drug that affect secretion, mental disorders,

unwilling to participate in the study, and using

insulin.

Sampling of stimulated saliva and acetone levels

is done after obtaining approval from the Medical

Research Ethics committee of the Faculty of

Medicine, Universitas Sumatera Utara and the patient

has signed an informed concern sheet to be patient.

The subjects were asked to fasting 2 hours before

sampling, the sampling technique using draining

method, the subjects were asked to chew wax

paraffin, saliva accommodated on saliva pot for 5

minutes and labeled. Salivary flow rate (ml/minute),

salivary pH was measured using GC salivary test for

pH (Kasuma, 2015).

In the GC Saliva Check Buffer, normal values of

mean salivary flow rate stimulated in healthy

individuals range from 1.0 to 3.0 ml/min. It the value

is below 0,7 ml/min then the condition is

hyposalivated and if beetwen 0,1-0,25 ml/min then

the value is very low. Salivary pH normal ranges from

6,8-7,8 and acid range from 6,0-6,6, very acidic

ranges from 5,0-5,8. Furthermore, SPSS and

STATCAL were used to perform classical

assumption test and linear regression (Sutiksno,

2018), (Gio, 2013).

3 RESULT AND DISCUSSION

3.1 Result

Table 1 shows the average of normal salivary flow

rate, salivary pH, and acetone levels in type 2 diabetes

mellitus patients.

Table 1. Analysis of salivary flow rate, salivary pH, and

acetone levels in patient with type 2 diabetes mellitus

Diabetes Mellitus Type 2

Variable n

± SD

Salivary flow rate

(ml/minute)

31 1,5 ± 0,7

pH Salivary 31 7,2 ± 0,5

Acetone Levels

(mV)

31 377,38 ±171,20

Table 2 shows the analysis results of of the

relationship between blood sugar levels and salivary

flow rate and salivary pH as evidenced by the

significant Pearson Correlasion Test p <0.05 which

showed that there was no correlation between fasting

blood sugar levels and salivary flow rate, salivary pH,

and salivary buffer capacity with a positive

correlation type of closeness is very weak, which

means the tendency of blood sugar levels will

increase that cause salivary flow rates and salivary pH

will increase.

Acetone Level and Salivary Oral Status Patient with Type 2 Diabetes Mellitus (In Vivo)

501

Table 2. Analysis between blood sugar levels and salivary

flow rate, Ph and salivary buffer capacity in type 2 diabetes

mellitus patients.

Variable Fasting Blood Sugar Levels

r p

Salivary flow

rate

0,181 0,527

pH salivary 0,043 0,820

Uji correlasi pearson

Table 3 shows the analysis results of the

relationship of blood sugar levels with acetone levels

using Pearson Correlation Test of significance p

<0.05. The results obtained there is no significant

relationship between blood sugar levels and acetone

levels with a very weak type of positive correlation

which means the tendency of sugar levels increased

blood will cause acetone levels to increase.

Table 3. Analysis of blood sugar levels in patient with type

2 diabetes mellitus.

Variabel Fasting Blood Sugar Levels

r p

Acetone Leve

0,078 0,678

Uji correlasi pearson

Figure 1 shows the analysis results of salivary

flow rate relationship with salivary pH using graph

test. The result of this research showed a significant

correlation

Figure 1. Relationship of salivary flow rate with salivary

Figure 2 shows the analysis results of salivary

flow rate relationship with acetone levels using graph

test. The result of this research showed a significant

correlation between acetone levels and salivary flow

rate.

Figure 2. Relationship of acetone levels and salivary flow

rate.

Figure 3 shows the analysis results of salivary pH

relationship with acetone levels using graph test. The

result of this research showed a significant correlation

between salivary pH and acetone levels.

Figure 3. Relationship of acetone levels and salivary pH.

3.2 Discussion

In this research, the average patient had a normal

salivary flow rate with a value of 1.5 ± 0.64, a pH of

7.2 ± 0.41 (table 1), and this research had the same

results as the research of Bernadi et al ( 2007). The

results of his research stated that the mean value of

salivary flow rate (1.95 ± 0.73) and salivary pH (6.7

± 1.8) in patients with controlled diabetes mellitus

was normal. Research of (Prathibha, 2013) explains

the average prevalence of salivary flow rate and

salivary pH in uncontrolled type 2 diabetes mellitus

patients, which is different from this research, that

salivary flow rate 0.46 ± 0.02 categorized as

hyposalivation (< 0.7ml / min)

and value pH 6.69 ±

0.35 is categorized as low. The difference between

the results of this research due to differences in

research subjects and methods. Prathibha conducted

an uncontrolled test of subjects with diabetes mellitus

and methods of taking saliva with unstimulated

spitting, while in this research conducted a test with

controlled diabetes mellitus patients and used saliva

spitting stimulation sampling methods (Prathibha,

2013).

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:0,005

:0,164

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

502

Research by Lasisi and Fasanmade shows that

salivary flow rate in uncontrolled diabetes mellitus

patients is lower than controlled diabetes mellitus

patients, with uncontrolled type 2 diabetes mellitus

patients having a low salivary flow rate (Lasisi and

Fasanmade, 2012).

(Karuniawani, 2015) stated that salivary gland

secretion can be stimulated in several ways, such as

with mechanical stimulation. By chewing food,

chewing can increase salivary secretion because

chewing activity will stimulate the parasympathetic

nerves, and dilate blood vessels in the salivary glands.

Salivary secretion is highly dependent on the

nutrients supplied by the blood vessels to the salivary

gland. (Roletta, 2002) states that stimulation with

paraffin mastication increases salivary pH and, in this

research, obtained an average salivary pH of 7.22, as

known salivary pH is affected by salivary flow rate.

The speed of stimulated salivary flow rate with

paraffin mastication has increased, so that the salivary

pH with stimulated flow rate will also increase

(Karuniawati, 2015), (Roletta, 2002).

Glucose is a small molecule that capable to move

easily inside the blood vessels membrane, which can

be removed from blood plasma to gingival fluid

through the gingival sulcus, and reach the saliva.

Enhancement of blood glucose level in diabetes

mellitus patients can lead to the increase of salivary

glucose level (Sumintarti and Rahma, 2015).

The relationship between fasting blood sugar

levels and salivary flow rate and salivary pH (table 2)

has been tested using the Pearson Correlation of

significance p <0.05. Pearson Correlation between

fasting blood sugar levels and salivary flow rate

shows that a non-significant value (p> 0.05) with a

very weak type of positive correlation (r = +0.181).

(Bernardi, 2007) stated that in the uncontrolled of

controlled diabetes mellitus group, there was a

change in salivary flow rate but not significant. In this

research showed that there was a relationship between

salivary flow rate and blood sugar levels. Blood

glucose concentration indicates hyperglycemia is

factor that influences salivary flow rates. In this

research has found the results of normal salivary flow

rate with high blood sugar levels. It can be influenced

by other things that can stimulate salivary secretion.

In this research using masticatory stimulation with

paraffin candy which can increase salivary secretion

(Bernardi, 2007).

Table 2 showed that there was not relationship

between blood glucose and salivary pH in type 2

diabetes mellitus patient. Salivary pH value in the

majorities of the research subjects had. Normal

salivary pH value in fasting blood glucose with high,

moderate, and normal categories, and there were only

3 patients had acid value. (Hedge, 2010) stated that,

there was a significant differences between diabetes

mellitus group and control group. Patients with

diabetes mellitus had acid value in salivary pH, and it

influenced by poor oral hygiene. Other research

stated a different results. According to (Priyanto,

2017), there were not significant relationship between

blood glucose level and salivary pH. There are several

assumption that can explained why there wasn’t any

relationship between blood glucose level with the

acidity of salivary pH. Blood glucose level had

variation value that sometimes up and down which

was due to the endogen factor of each respondents

and was also affected by several non-physics and

environmental factors. The decrease of medicine

effect will leads to the increase of blood glucose level.

while salivary pH affected by overall health factors

such as diabetes mellitus disorders. Xerostomia is

affected by local disturbances in salivary gland,

medicine effects, and stress (Hedge, 2010), (Priyanto,

2017).

Table 3 showed that there was not relationship in

blood glucose level with acetone level in type 2

diabetes mellitus patient. According to (Mitrayana,

2014), acetone is the most abundant compound in

human airway system, and acetone concentration in

airway system was increased in uncontrolled diabetes

patient. According to (Muttaqin, 2012), blood glucose

level and acetone concentration in saliva had a

relationship, that patient with higher blood glucose

will had higher acetone level in their saliva, however

this research was done using

spectroscopy. This

research used diasen to assess the relationship

between blood glucose and acetone level and this

research showed that there wasn’t any significant

relationship using diasen. Diasen is a tool to detect the

acetone level in breath that was applied to type 2

diabetes mellitus patient (Muttaqin, 2012).

Figure 1 showed that there was a relationship

between salivary flow rate and salivary pH. Normal

salivary pH value range 6-7 and depends on the flow

rate. An acidic pH will affect the flow rate become

viscous (Pandey, 2014).

Figure 2 showed that there was a relationship

between acetone level and salivary flow rate. In graph

3 showed that there was a relationship between

acetone level and salivary pH. There is a inverse

relationship between salivary pH and acetone level,

acid value in pH causes an increase in ketoacidosis,

therefore acetone level also increases.

Acetone Level and Salivary Oral Status Patient with Type 2 Diabetes Mellitus (In Vivo)

503

4 CONCLUSION

The subjects of this research, generally, had salivary

flow rate, normal salivary pH and normal acetone

levels with high fasting blood sugar level. The

relationship between fasting blood sugar level, flow

rate, and salivary pH is no significant relationship,

acetone levels also do not have a significant

relationship with fasting blood sugar levels. In this

research, the relationship between acetone levels with

salivary pH and flow rate has contained a significant

relationship, also there was significant relationship

between flow rate and salivary pH.

ACKNOWLEDGEMENTS

This study is funded by university of north sumatera

according to the TALENTA research executing

contract number : 2590/UN5.1. R/PPM/2018.16

march 2018.

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