Main Article Content
Abstract
Background: It is well-established that diabetes alters the oral environment, particularly the composition and acidity of saliva, which can affect the microbial balance in the oral cavity. This study investigates the impact of oral acidity disturbances on the growth of pathogenic bacteria in diabetic patients. Saliva samples were collected and analyzed to measure pH levels, acid neutralization capacity, and microbial composition. The results indicate that: diabetic patients exhibit a lower saliva pH compared to non-diabetic individuals, creating favorable conditions for the proliferation of pathogenic bacteria such as Streptococcus mutans, Candida albicans, and Porphyromonas gingivalis. Oral acidity disturbances were positively correlated with increased bacterial colonization and a higher risk of oral infections. Conclution :These findings highlight the importance of monitoring oral health in diabetic patients and suggest that maintaining oral acid balance may play a crucial role in preventing the growth of pathogenic bacteria and their associated complications.
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Copyright (c) 2026 Shamam k. Oudah, Abdul-Razzak L. Al-Rubaie, Laila.S.Abu_Hadal

This work is licensed under a Creative Commons Attribution 4.0 International License.
References
- Puttaswamy KA, Puttabudhi JH, Raju S. Correlation between salivary glucose and blood glucose and the implications of salivary factors on the oral health status in type 2 diabetes mellitus patients. Journal of International Society of Preventive & Community Dentistry. 2017;7(1):28. https://DOI:10.4103/2231-0762.200703
- Ferizi L, Dragidella F, Spahiu L, Begzati A, Kotori V. The influence of type 1 diabetes mellitus on dental caries and salivary composition. International journal of dentistry. 2018;2018. 10.1155/2018/5780916
- Ahmad R, Haque M. Oral health messiers: Diabetes mellitus relevance. Diabetes, metabolic syndrome and obesity: targets and therapy. 2021:3001-15. 10.2147/DMSO.S318972
- Graves DT, Ding Z, Yang Y. The impact of diabetes on periodontal diseases. Periodontology 2000. 2020;82(1):214-24. 10.1111/prd.12318
- Rahiotis C, Petraki V, Mitrou P. Changes in saliva characteristics and carious status related to metabolic control in patients with type 2 diabetes mellitus. Journal of Dentistry. 2021;108:103629. 10.1016/j.jdent.2021.103629
- Liccardo D, Cannavo A, Spagnuolo G, Ferrara N, Cittadini A, Rengo C, et al. Periodontal disease: a risk factor for diabetes and cardiovascular disease. International journal of molecular sciences. 2019;20(6):1414. DOI: 10.3390/ijms20061414
- Stoica SA, Valentini G, Dolci M, D’Agostino S. Diabetes and non-surgical periodontal therapy: What can we hope for? Hygiene. 2022;2(2):85-93. https://doi.org/10.3390/hygiene2020007
- Polak D, Sanui T, Nishimura F, Shapira L. Diabetes as a risk factor for periodontal disease—plausible mechanisms. Periodontology 2000. 2020;83(1):46-58. https://doi.org/10.1111/prd.12298Digital Object Identifier (DOI)
- Minty M, Canceil T, Serino M, Burcelin R, Tercé F, Blasco-Baque V. Oral microbiota-induced periodontitis: a new risk factor of metabolic diseases. Reviews in Endocrine and Metabolic Disorders. 2019;20:449-59.
- Rohani B. Oral manifestations in patients with diabetes mellitus. World journal of diabetes. 2019;10(9):485. doi: 10.4239/wjd.v10.i9.485.
- Ibraheem LM, Ahmmad BZ, Dhafer AM, Dhafer JM. Effect of diabetes mellitus on periodontal health status, salivary flow rate and salivary pH in patients with chronic periodontitis. Journal of Baghdad College of Dentistry. 2020;32(2):12-6. DOI: https://doi.org/10.26477/jbcd.v32i2.2888.
- Amato M, Polizzi A, Viglianisi G, Leonforte F, Mascitti M, Isola G. Impact of periodontitis and oral dysbiosis metabolites in the modulation of accelerating ageing and human senescence. Metabolites. 2025;15(1):35. https://doi.org/10.3390/metabo15010035.
- Gupta V, Kaur A. Salivary glucose levels in diabetes mellitus patients: A case–control study. Journal of Oral and Maxillofacial pathology. 2020;24(1):187. DOI: 10.4103/jomfp.JOMFP_15_20.
- Pawlaczyk-Kamieńska T, Borysewicz-Lewicka M, Batura-Gabryel H. Salivary biomarkers and oral microbial load in relation to the dental status of adults with cystic fibrosis. Microorganisms. 2019;7(12):692. https://doi.org/10.3390/microorganisms7120692.
- Latti BR, Kalburge JV, Birajdar SB, Latti RG. Evaluation of relationship between dental caries, diabetes mellitus and oral microbiota in diabetics. Journal of oral and maxillofacial pathology: JOMFP. 2018;22(2):282. doi: 10.4103/jomfp.JOMFP_163_16.
- Al-Khayoun JD, Diab BS. Dental caries, Mutans Streptococci, Lactobacilli and salivary status of type1 diabetic mellitus patients aged 18-22 years in relation to Glycated Haemoglobin. Journal of Baghdad College of Dentistry. 2013;25(1):153-8.
- Shami S, Chittenden S. Microangiopathy in diabetes mellitus: II. Features, complications and investigation. Diabetes Research (Edinburgh, Scotland). 1991;17(4):157-68. PMID: 1823636.
- Nagendra L, Boro H, Mannar V. Bacterial Infections in Diabetes. Endotext [Internet]. 2022.
- Bahrololoomi Z, Zare Bidoki F, Sajedi S, Pourhosseini M, Pourhosseini N. Evaluation of Unstimulated Salivary Flow and pH in Type I Diabetics Aged 6-16 years. International Journal of Pediatrics. 2022;10(12):17085-92. DOI: 10.22038/ijp.2022.68599.5089.
- Schwerdt G, Schulz M-C, Kopf M, Mildenberger S, Reime S, Gekle M. Physiological regulation of oral saliva ion composition and flow rate are not coupled in healthy humans—Partial revision of our current knowledge required. Pflügers Archiv-European Journal of Physiology. 2025;477(1):55-65. https://doi.org/10.1007/s00424-024-03025-9.
- Mohiti A, Ghadiri-Anari A, Entezary F. Comparison of pH and viscosity of unstimulated saliva in Type 2 diabetic patients and control group. Journal Dental School. 2017;35(3):89-92.
- Kumar A, Kumar T, Bhargava M, Raj R, Vaibhav V, Kishore J. Salivary and serum glucose levels in diabetes mellitus patients versus control–A randomised control trial. Journal of Medicine and Life. 2020;13(2):235. 10.25122/jml-2020-0062.
- Salguero MV, Al‑Obaide MA, Singh R, Siepmann T, Vasylyeva TL. Dysbiosis of Gram‑negative gut microbiota and the associated serum lipopolysaccharide exacerbates inflammation in type 2 diabetic patients with chronic kidney disease. Experimental and therapeutic medicine. 2019;18(5):3461-9. https://doi.org/10.3892/etm.2019.7943.
- Pachoński M, Koczor-Rozmus A, Mocny-Pachońska K, Łanowy P, Mertas A, Jarosz-Chobot P. Oral microbiota in children with type 1 diabetes mellitus. Pediatric Endocrinology Diabetes and Metabolism. 2021;27(2):100-8. DOI: 10.22038/ijp.2022.68599.5089.
- Janem WF, Scannapieco FA, Sabharwal A, Tsompana M, Berman HA, Haase EM, et al. Salivary inflammatory markers and microbiome in normoglycemic lean and obese children compared to obese children with type 2 diabetes. PLoS One. 2017;12(3):e0172647. 10.1371/journal.pone.0183600
- Wade WG. Resilience of the oral microbiome. Periodontology 2000. 2021;86(1):113-22. https://doi.org/10.1111/prd.12365.
- Al-Janabi AAHS. A positive or negative connection of diabetes mellitus to the oral microbiota. The Eurasian journal of medicine. 2023;55(1):83. 10.5152/eurasianjmed.2023.21164.
- Yassen FS, Makki MA. Investigation of some Gram-Negative Bacteria from Dental Caries in Diabetic Patients in Al-Muthana. https://doi.org/10.33899/rjs.2024.185379.
References
Puttaswamy KA, Puttabudhi JH, Raju S. Correlation between salivary glucose and blood glucose and the implications of salivary factors on the oral health status in type 2 diabetes mellitus patients. Journal of International Society of Preventive & Community Dentistry. 2017;7(1):28. https://DOI:10.4103/2231-0762.200703
Ferizi L, Dragidella F, Spahiu L, Begzati A, Kotori V. The influence of type 1 diabetes mellitus on dental caries and salivary composition. International journal of dentistry. 2018;2018. 10.1155/2018/5780916
Ahmad R, Haque M. Oral health messiers: Diabetes mellitus relevance. Diabetes, metabolic syndrome and obesity: targets and therapy. 2021:3001-15. 10.2147/DMSO.S318972
Graves DT, Ding Z, Yang Y. The impact of diabetes on periodontal diseases. Periodontology 2000. 2020;82(1):214-24. 10.1111/prd.12318
Rahiotis C, Petraki V, Mitrou P. Changes in saliva characteristics and carious status related to metabolic control in patients with type 2 diabetes mellitus. Journal of Dentistry. 2021;108:103629. 10.1016/j.jdent.2021.103629
Liccardo D, Cannavo A, Spagnuolo G, Ferrara N, Cittadini A, Rengo C, et al. Periodontal disease: a risk factor for diabetes and cardiovascular disease. International journal of molecular sciences. 2019;20(6):1414. DOI: 10.3390/ijms20061414
Stoica SA, Valentini G, Dolci M, D’Agostino S. Diabetes and non-surgical periodontal therapy: What can we hope for? Hygiene. 2022;2(2):85-93. https://doi.org/10.3390/hygiene2020007
Polak D, Sanui T, Nishimura F, Shapira L. Diabetes as a risk factor for periodontal disease—plausible mechanisms. Periodontology 2000. 2020;83(1):46-58. https://doi.org/10.1111/prd.12298Digital Object Identifier (DOI)
Minty M, Canceil T, Serino M, Burcelin R, Tercé F, Blasco-Baque V. Oral microbiota-induced periodontitis: a new risk factor of metabolic diseases. Reviews in Endocrine and Metabolic Disorders. 2019;20:449-59.
Rohani B. Oral manifestations in patients with diabetes mellitus. World journal of diabetes. 2019;10(9):485. doi: 10.4239/wjd.v10.i9.485.
Ibraheem LM, Ahmmad BZ, Dhafer AM, Dhafer JM. Effect of diabetes mellitus on periodontal health status, salivary flow rate and salivary pH in patients with chronic periodontitis. Journal of Baghdad College of Dentistry. 2020;32(2):12-6. DOI: https://doi.org/10.26477/jbcd.v32i2.2888.
Amato M, Polizzi A, Viglianisi G, Leonforte F, Mascitti M, Isola G. Impact of periodontitis and oral dysbiosis metabolites in the modulation of accelerating ageing and human senescence. Metabolites. 2025;15(1):35. https://doi.org/10.3390/metabo15010035.
Gupta V, Kaur A. Salivary glucose levels in diabetes mellitus patients: A case–control study. Journal of Oral and Maxillofacial pathology. 2020;24(1):187. DOI: 10.4103/jomfp.JOMFP_15_20.
Pawlaczyk-Kamieńska T, Borysewicz-Lewicka M, Batura-Gabryel H. Salivary biomarkers and oral microbial load in relation to the dental status of adults with cystic fibrosis. Microorganisms. 2019;7(12):692. https://doi.org/10.3390/microorganisms7120692.
Latti BR, Kalburge JV, Birajdar SB, Latti RG. Evaluation of relationship between dental caries, diabetes mellitus and oral microbiota in diabetics. Journal of oral and maxillofacial pathology: JOMFP. 2018;22(2):282. doi: 10.4103/jomfp.JOMFP_163_16.
Al-Khayoun JD, Diab BS. Dental caries, Mutans Streptococci, Lactobacilli and salivary status of type1 diabetic mellitus patients aged 18-22 years in relation to Glycated Haemoglobin. Journal of Baghdad College of Dentistry. 2013;25(1):153-8.
Shami S, Chittenden S. Microangiopathy in diabetes mellitus: II. Features, complications and investigation. Diabetes Research (Edinburgh, Scotland). 1991;17(4):157-68. PMID: 1823636.
Nagendra L, Boro H, Mannar V. Bacterial Infections in Diabetes. Endotext [Internet]. 2022.
Bahrololoomi Z, Zare Bidoki F, Sajedi S, Pourhosseini M, Pourhosseini N. Evaluation of Unstimulated Salivary Flow and pH in Type I Diabetics Aged 6-16 years. International Journal of Pediatrics. 2022;10(12):17085-92. DOI: 10.22038/ijp.2022.68599.5089.
Schwerdt G, Schulz M-C, Kopf M, Mildenberger S, Reime S, Gekle M. Physiological regulation of oral saliva ion composition and flow rate are not coupled in healthy humans—Partial revision of our current knowledge required. Pflügers Archiv-European Journal of Physiology. 2025;477(1):55-65. https://doi.org/10.1007/s00424-024-03025-9.
Mohiti A, Ghadiri-Anari A, Entezary F. Comparison of pH and viscosity of unstimulated saliva in Type 2 diabetic patients and control group. Journal Dental School. 2017;35(3):89-92.
Kumar A, Kumar T, Bhargava M, Raj R, Vaibhav V, Kishore J. Salivary and serum glucose levels in diabetes mellitus patients versus control–A randomised control trial. Journal of Medicine and Life. 2020;13(2):235. 10.25122/jml-2020-0062.
Salguero MV, Al‑Obaide MA, Singh R, Siepmann T, Vasylyeva TL. Dysbiosis of Gram‑negative gut microbiota and the associated serum lipopolysaccharide exacerbates inflammation in type 2 diabetic patients with chronic kidney disease. Experimental and therapeutic medicine. 2019;18(5):3461-9. https://doi.org/10.3892/etm.2019.7943.
Pachoński M, Koczor-Rozmus A, Mocny-Pachońska K, Łanowy P, Mertas A, Jarosz-Chobot P. Oral microbiota in children with type 1 diabetes mellitus. Pediatric Endocrinology Diabetes and Metabolism. 2021;27(2):100-8. DOI: 10.22038/ijp.2022.68599.5089.
Janem WF, Scannapieco FA, Sabharwal A, Tsompana M, Berman HA, Haase EM, et al. Salivary inflammatory markers and microbiome in normoglycemic lean and obese children compared to obese children with type 2 diabetes. PLoS One. 2017;12(3):e0172647. 10.1371/journal.pone.0183600
Wade WG. Resilience of the oral microbiome. Periodontology 2000. 2021;86(1):113-22. https://doi.org/10.1111/prd.12365.
Al-Janabi AAHS. A positive or negative connection of diabetes mellitus to the oral microbiota. The Eurasian journal of medicine. 2023;55(1):83. 10.5152/eurasianjmed.2023.21164.
Yassen FS, Makki MA. Investigation of some Gram-Negative Bacteria from Dental Caries in Diabetic Patients in Al-Muthana. https://doi.org/10.33899/rjs.2024.185379.
