Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 10  |  Issue : 2  |  Page : 117-120

Two Different Methods for Collection of Gingival Crevicular Blood to Estimate Random Blood Glucose Levels—A Comparative Study


1 Sree Balaji Dental College and Hospital, BIHER; Department of Oral Medicine and Radiology, Tamilnadu Govt Dental College & Hospital, Chennai, Tamil Nadu, India
2 Department of Biochemistry, Sree Balaji Dental College and Hospital, BIHER, Chennai, Tamil Nadu, India
3 Department of Periodontics, Sree Balaji Dental College and Hospital, BIHER, Chennai, Tamil Nadu, India
4 Department of Oral Medicine and Radiology, Tamilnadu Govt Dental College & Hospital, Chennai, Tamil Nadu, India
5 Department of Oral and Maxillofacial Surgery, Tagore Dental College and Hospital, Chennai, Tamil Nadu, India

Date of Web Publication2-Jan-2019

Correspondence Address:
Dr. Aarthi Nisha Venkatesan
Department of Oral Medicine and Radiology, Tamilnadu Govt Dental College & Hospital, Chennai, Tamil Nadu
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jofs.jofs_141_18

Rights and Permissions
  Abstract 


Aim and Objective: The present study was done to validate a reliable method for collection of gingival crevicular blood (GCB) and to use it as an alternative to routinely collected venous blood (VB) to estimate random blood glucose (RBS) levels. Materials and Methods: The study group comprised of 50 type 2 diabetic patients (n = 50), aged between 21 and 80 years attending the outpatient department of Sree Balaji Dental College and Hospital, Chennai. The study was a cross-sectional observational study that comprised of thorough clinical evaluation and estimation of RBS levels from GCB by two different methods, namely, direct glucometric method and collection through capillary tube method. Results: Out of the 50 patients, 27 (54%) were females and 23 (46%) were males. All the patients were among 20 to 70 years of age. On comparing the RBS levels from gingival crevicular obtained by direct intraoral method and capillary tube method, a statistically significant correlation of P < 0.05 was obtained proving statistically significant results. Further on comparing the results with VB glucose levels, there was no statistically significant difference found among the methods. Conclusion: The above study concludes that GCB collected by both capillary tube and direct intraoral method yielded almost similar blood glucose results which conclude either of the methods can be used to collect the sample.

Keywords: Capillary tube method, direct intraoral glucometric method, gingival crevicular blood glucose, type 2 diabetes mellitus, venous blood glucose


How to cite this article:
Venkatesan AN, Amaldas J, Valiathan M, Jayaram V, Jayaraman P. Two Different Methods for Collection of Gingival Crevicular Blood to Estimate Random Blood Glucose Levels—A Comparative Study. J Orofac Sci 2018;10:117-20

How to cite this URL:
Venkatesan AN, Amaldas J, Valiathan M, Jayaram V, Jayaraman P. Two Different Methods for Collection of Gingival Crevicular Blood to Estimate Random Blood Glucose Levels—A Comparative Study. J Orofac Sci [serial online] 2018 [cited 2019 Jan 17];10:117-20. Available from: http://www.jofs.in/text.asp?2018/10/2/117/249089




  Introduction Top


Diabetes mellitus (DM) represents one of the major chronic health problems faced by the society today. The incidence of DM worldwide, and especially in India, is on a steep rise.[1] As per World Health Organization estimates, it could rise to 333 million in 2025. Predictions also show that 70% of those affected will belong to the developing world.[2] DM is one of the most frequent metabolic disorders with an estimated prevalence of 7% in industrialized countries, of which nearly half the cases are undiagnosed.[3]

Emerging trends have placed oral physicians at the forefront in diagnosing DM, control the illness, and help those with prediabetes avoid full onset. It is undiagnosed in approximately half of the patients actually suffering from the disease.[4] Gingival inflammation with or without the complicating factor of DM is known to produce ample extravasated blood during routine probing and is less traumatic than a finger puncture with a sharp lancet.[5] Diabetes and periodontitis seem to interact in a bidirectional manner.[6] A lot of diabetic patients undergoing dental treatment need to be first ascertained of their existing blood sugar level, so that appropriate treatment strategies can be provided to the individual patients. For this, they need to provide blood sample after a small prick. However, in such patients, this small amount of blood can also be obtained by simply probing the periodontium without any discomfort to the patient.[7] Periodontal examination as a rule comprises careful probing of periodontal pockets which result in some amount of bleeding from the gingival sulcus. Instead of swabbing and disposing the gingival crevicular blood (GCB), this can be employed to assess blood glucose by glucometer.[8] Glucometers are reliable, rapid, affordable, and commonly used for blood glucose determinations in diabetes screening and domestic monitoring. When utilized in a dental office, such a system may offer a more objective parameter in the diagnosis of DM.[9] Various studies have been conducted to assess the use of this GCB with self-monitoring devices in the dental office to measure blood glucose.[10] Many studies showed the efficacy of GCB as a alternative to venous or finger prick blood for blood glucose estimation where GCB was collected either directly through glucometeric test strips or by capillary tube from the gingival crevice and levels were measured. This study is unique and was done to prove GCB collected through both the techniques produced equally effective results. In many previous studies, only capillary tube method was used to collect GCB to avoid possible contamination of saliva. Hence, in our study, we have done collection of GCB by both capillary tube and direct glucometric test strip methods and compared the results with laboratory venous blood (VB) glucose levels to prove that direct glucometric method can be used for GCB collection which will be convenient, time saving, and easier than the former.


  Materials and Methods Top


Patients reporting as outpatient to Department of Oral Medicine and Radiology, Sree Balaji Dental College and Hospital, aged between 20 and 70 years for a period of 3 months were included in this study after obtaining informed consent. The study was commenced after approval from the Institutional Ethical Committee.

Ethical clearance

Ethical approval for this study was provided by the Institutional Ethical Committee, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education & Research, Chennai, Ref No. SBDCECM105/13/43, November 11, 2013.

Methodology

A total of 50 patients who were known diabetic were included in the study.

Inclusion criteria

  • Patients 20 to 70 years of age.
  • Patients who had moderate-to-severe grade of periodontitis who were already known diabetics under medication (oral hypoglycemics/insulin).


Exclusion criteria

  • Patients with underlying bleeding/clotting disorders like hemophilia, thrombocytopenic purpura, etc.


Collection of data

A thorough case history was recorded followed by clinical examination. The periodontal status of the patient was recorded. Area to be examined was isolated using saliva ejector and cotton rolls. Probing was done using Williams periodontal probe to obtain sufficient amount of bleeding and site which had profuse bleeding was selected. GCB was collected for the same patient at the same site by two different methods.
  1. The glucometer was turned on with the reagent strip and directly placed against the bleeding site where blood was drawn by capillary action. The blood glucose levels were recorded for each patient.
  2. A plastic capillary tube of 2-mm bore marked up to 3 µl was kept in the gingival sulcus to collect the blood and was then transferred to the test strip of the glucometer to obtain the values.


VB was drawn then to measure the VB glucose levels as a gold standard.

The above-mentioned procedure was done for all the 50 patients, and the results were tabulated. Statistical analysis was done using the SPSS 22.0 (IBM,USA) statistical package.


  Results Top


A total of 50 patients who were included in the study included 27 females and 23 males with a mean age of 49.14 [[Figure 1]]. Descriptive statistics was done for the variables. One-way analysis of variables (ANOVA) test was performed to compare the mean values of random blood glucose (RBS) (GCB) by direct intraoral, RBS (GCB) by capillary tube method and RBS (VB). The mean and standard deviation were 198.82, 199.02, 198.16 and 47.24, 47.5, 47.56, respectively [[Table 1]]. A statistically significant correlation of P < 0.05 was obtained proving statistically significant results [[Table 2]] and [Figure 2]]. Tukey post hoc analysis for multiple comparison was done, and none of the comparisons were statistically significant with P > 0.05 [[Table 3]]. There was no statistically significant difference found among the methods.
Figure 1 Distribution of male and female

Click here to view
Table 1 Descriptive statistics showing the maximum, minimum, mean, standard error of mean, and standard deviation values of the variables

Click here to view
Table 2 Intraoral method, RBS (GCB) by capillary tube method and RBS (VB)

Click here to view
Figure 2 Mean values of RBS assessed by three methods (mg/dl)

Click here to view
Table 3 Tukey post hoc analysis for multiple comparison

Click here to view



  Discussion Top


The American Diabetes Association recommends screening for diabetes should start at the age of 45 years and should be repeated every 3 years in individuals without risk factors, earlier and more often in those with risk factors for diabetes.[11] The primary methods used to diagnose DM and monitor blood glucose levels have traditionally been fasting blood glucose, a combination of fasting blood glucose with a 2-h test after glucose loading (2-h postprandial) and oral glucose tolerance test.[12]

Glucose testing with the Accu-Chek active (Roche Diabetes Care, Inc., USA) self-monitoring device is sensitive, as it can provide results with just 2 to 3 µl of blood within 5 s. Gingival blood glucose level (GBGL) collected during periodontal examination may be an excellent source of blood, safe, easy to perform, and comfortable to the patient.[13] It is a reliable technique to use GCB sample to screen diabetes as there is not much of patient discomfort while probing and the time taken for probing and blood to ooze out through the gingival crevice is also less. A lot of research has been performed to estimate the blood glucose levels from the GCB through painless noninvasive techniques. Most of the studies were done using a fine capillary tube (2 mm) diameter to minimize the contamination of gingival blood with calculus, debris, or inflammatory exudates. A few recent researchers used the technique of placing the glucometric test strip directly in the gingival crevice to record the GCB values.[7],[10],[14],[15] When there was proper isolation by cotton rolls and air drying of the surface where GCB, even in direct intraoral technique, there was less chance of contamination from calculus, inflammatory exudates, etc.Earlier only capillary tube method was used to collect the oozing blood through the gingival crevices.[16],[17],[18] But it is a time-consuming procedure and chances of contamination are possible while transferring to the glucometric test strip. Though both the techniques were used widely to collect the GCB, no study has been performed to the compare these two methods to collect the GCB to evaluate the results obtained from both the techniques. Hence, this study was taken up to compare the GCB glucose values collected by both capillary tube and direct intraoral method. On comparing the mean values of RBS (GCB) by direct intraoral, RBS (GCB) by capillary tube method the results were statistically significant with (P > 0.05). Moreover, there was no statistically significant difference found among the methods when they were compared with the gold standard VB glucose levels. This clearly concludes that either of the above two techniques can be used for collection of GCB which will not affect the results.


  Conclusion Top


GCB collected by both capillary tube and direct intraoral method gave almost similar blood glucose results, which concludes that either of the methods can be used to collect the GCB sample. Moreover, direct intraoral method is time saving, easy to perform, and immediate transfer of the sample to glucometer minimizing chance of contamination.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: Estimates for the year 2000 and projections for 2030. Diabetes Care 2004;27:1047-53.  Back to cited text no. 1
    
2.
Narayan P. Diabetes may soon become a pandemic. Bangalore: The Times of India; March 7, 2006. Retrieved from http://epaper.timesofindia.com.2012.  Back to cited text no. 2
    
3.
Beikler T, Kuczek A, Petersilka G, Flemming TF. In-dental-office screening for diabetes mellitus using gingival crevicular blood. J Clin Periodontol 2002;29:216-8.  Back to cited text no. 3
    
4.
Kumar P, Clark M. Clinical medicine. 5th ed. Philadelphia:McGraw Hill, Saunders Elsevier; 2002. pp 1077.  Back to cited text no. 4
    
5.
Parker RC, Rapley JW, Isley W, Spencer P, Killoy WJ. Gingival crevicular blood for assessment of blood glucose in diabetic patients. J Periodontol 1993;64:666-72.  Back to cited text no. 5
    
6.
Stanko P, Izakovicova Holla L. Bidirectional association between diabetes mellitus and inflammatory periodontal disease. A review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2014;158:35-8.  Back to cited text no. 6
    
7.
Gupta A, Gupta N, Garg R, Jain N. Developing a chair side, safe and non-invasive procedure for assessment of blood glucose level using gingival crevicular bleeding in dental clinics. J Nat Sci Biol Med 2014;5:329-32.  Back to cited text no. 7
    
8.
Kandwal A, Batra M. Gingival crevicular blood as a screening tool for diabetic patient: A randomized clinical trial. Ann Dent Speciality 2014;2:6-8.  Back to cited text no. 8
    
9.
Ervasti T, Knuuttila M, Pohjamo L, Haukipuro K. Relation between control of diabetes and gingival bleeding. J Periodontol 1985;56:154-7.  Back to cited text no. 9
    
10.
Rajesh KS, Irshana R, Arun Kumar MS, Hegde S. Effectiveness of glucometer in screening diabetes mellitus using gingival crevicular blood. Contemp Clin Dent 2016;7:182-5.  Back to cited text no. 10
[PUBMED]  [Full text]  
11.
Parker RC, Rapley JW, Isley W, Spencer P, Killoy WJ. Gingival crevicular blood for assessment of blood glucose in diabetic patients. J Periodontol 1993;64:666-72.  Back to cited text no. 11
    
12.
Verma S, Bhat KM. Diabetes mellitus—A modifier of periodontal disease expression. J Int Acad Periodontol 2004;6:13-20.  Back to cited text no. 12
    
13.
Parker RC, Rapley JW, Isley W, Spencer P, Killoy WJ. Gingival crevicular blood for assessment of blood glucose in diabetic patients. J Periodontol 1993;64:666-72.  Back to cited text no. 13
    
14.
Singh A, Bhat N, Kahlon H, Gambhir RS, Sandhu AR, Jagpal JS. Screening for diabetic patients using gingival crevicular blood with a self monitoring device in a dental outreach program: A cross-sectional study. J Indian Assoc Public Health Dent 2017;5:210-3.  Back to cited text no. 14
    
15.
Kaur H, Singh B, Sharma A. Assessment of blood glucose using gingival crevicular blood in diabetic and non-diabetic patients: A chair side method. J Clin Diagn Res 2013;7:3066-9.  Back to cited text no. 15
    
16.
Debnath P, Govila V, Sharma M, Saini A, Pandey S. Glucometric assessment of gingival crevicular blood in diabetic and non-diabetic patients: A randomized clinical trial. J Oral Biol Craniofac Res 2015;5:2-6.  Back to cited text no. 16
    
17.
Subodh A, Panchmal GS, Shenoy RP, Jodalli PS, Sonde L, Pasha I. Comparison of blood glucose level in gingival crevicular blood and tissue capillary blood in diabetic and non-diabetic patients. J Appl Dent Med Sci 2017;3:28-33.  Back to cited text no. 17
    
18.
Meti Mangala, Praveenkumar SR, Kalburgi Veena. Screening for diabetes mellitus using gingival crevicular blood. J Oral Health Res 2010;1:160-4.  Back to cited text no. 18
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed66    
    Printed0    
    Emailed0    
    PDF Downloaded13    
    Comments [Add]    

Recommend this journal