Type of Article:  Original Research

Volume 7; Issue 4.3 (December 2019)

Page No.: 7132-7139

DOI: https://dx.doi.org/10.16965/ijar.2019.326


Neeraj T. Master *1, Nisha Parmar 2.

*1, 2 Tutor, Department of Anatomy, Surat Municipal Institute of Medical Education and Research (SMIMER), Surat-395010, Gujarat, India.

Corresponding  Author:  Dr. Neeraj Master, Tutor, Department of Anatomy, Surat Municipal Institute of Medical Education and Research (SMIMER), Surat-395010, Gujarat, India. E-Mail: dr.neerajmaster@yahoo.com


Background: Diabetes mellitus is a metabolic disease and affects many organs of the body including oral mucosa. Exfoliative cytology can be used to detect the effects of diabetes on buccal mucosa cells.

Aim: The present study will evaluate the qualitative changes (cytomorphology) of buccal mucosal cells in type 2 diabetic patients and compare that with the non-diabetic individuals of South Gujarat region.

Materials and Method: Present study was done on 50 type 2 diabetic patients (case) and 50 healthy individuals (control) selected as per exclusion and inclusion criteria. Procedure was explained to the participants and informed written consent was taken. Buccal mucosa smears were taken and stained with Pap’s stain.  100 cells of each Pap stained smear was examined under a research microscope for various cytomorphological changes. Smears were examined for cell morphology like binucleation, pyknosis, perinuclear halo, cytoplasmic granules, karyolysis, karyorrhexis, cytoplsmic vacuoles and micronuclei. All data were noted and subjected to statistical analysis.

Results: Mean values of binucleated cells, pyknotic cells, perinuclear halo, cytoplasmic granules, karyolytic cells, karyorrhectic cells, cytoplasmic vacuoles and micronuclei were noted in controls and cases. Significant differences in between non-diabetic control and diabetic cases for mean values of binucleation (p<0.001), pyknosis (p<0.001), perinuclear halo (p<0.001), cytoplasmic granules (p<0.001), karyolysis (p=0.026) and karyorrhexis (p<0.001) was observed. But no significant differences in the mean cells for cytoplasmic vacuoles (p=0.109) and micronuclei (p=0.176) were found between diabetics cases and non-diabetics control.

Conclusion: The results of present study showed that buccal mucosa of diabetic case group is associated with significant differences in the mean values of qualitative changes like binucleation, pyknosis, perinuclear halo, cytoplasmic granules, karyolysis and karyorrhexis when compare to non-diabetic control group. Diabetes produces significant qualitative (cytomorphologic) changes in the buccal mucosa cells that can be documented by exfoliative cytology.

Key words: type 2 diabetes, buccal mucosa, exfoliative cytology, qualitative (cytomorphologic) changes.


  1. Haslett C, Chilvers ER, Hunter JA, Boon NA. Davidson’s Principles and practice of medicine. 18th Ed. Great Britain: ELBS with Churchill Livingstone; 2000; p.472.
  2. 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.
  3. Beck Nielsen H, Groop LC: Metabolic and genetic characterization of prediabetic states. Sequence of events leading to noninsulin- dependent diabetes mellitus. J Clin Invest., 1994;1714–1721.
  4. Saini R, Al-Maweri SA, Saini D, Ismail NM, Ismail AR. Oral mucosal lesions in non oral habit diabetic patients and association of diabetes mellitus with oral precancerous lesions. Diabetes Res Clin Pract. 2010; 89(3):320-6.
  5. Alberti S., Spudella CT, Francischone TRCG, Assis GF, Crstari TM, Taverira LAA. Exfoliative cytology in type 2 diabetes patients- morphology and cytomorphometry. J Oral Pathol Med 2003; 32: 538-43.
  6. Jajaram HH, Mohtasham N, Rangiani A. Evaluation of Oral Mucosa Epithelium in Type 2 Diabetic Patients by an Exfoliative Cytology Method. J Oral Science, 2008; 50(3):335-40.
  7. Shareef BT, Ang KT, Naik VR. Qualitative and Quantitative Exfoliative Cytology of Normal Oral Mucosa in Type 2 Diabetic Patients. Oral Med Oral Pathol Oral Cir Bucal, 2008:1; 13(11):E693-6.
  8. Prasad H, Ramesh V, Balamurali PD. Morphologic and Cytomorphometric Analysis of Exfoliated Buccal Mucosal Cells in Diabetes Patients. J Cytol 2010; 27(4):113-7.
  9. Mohammad TA, Balkees TG ,Cytological Features of Oral Cytobrush Smears in Type II Diabetes Mellitus Patients, Tikrit Journal for Dental Sciences, 2012;6-12.
  10. Donald PM, George R, Sriram G, Kavitha B, and  Sivapathasundharam B , Hormonal changes in exfoliated normal buccal mucosal cells, J Cytol. 2013 Oct-Dec; 30(4): 252–56.
  11. Teitz NW, Glucose Oxidase-paroxidase method, Fundamentals of Clinical Chemistry, 2nd Edition, WB. Saundas Company,1986, p1388-90.
  12. Henry JB, Cynmathemoglobin estimation, Clinical Diagnosis And Management By Laboratory Methods, WB Saundas Company,19th edition,1996; p550-551. (SYSMAX KX-21/ABACUS DIATRON, Three part automated hemoglobin analyser)
  13. Bancroft JD, Rapid Pap Stain method, Theory and Practicle of Histological Techniques, 6th Edition, p. 127-8.
  14. Vernillo AT. Dental considerations for the treatment of patients with Diabetes mellitus. Journal of American Dental Association, 2003; 134:24S-33S. Cited: Vernillo AT. Diabetes mellitus: relevance to dental treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;91:263-70
  15. Nersesyan A, Muradyan R, Kundi M And Knasmueller S, Impact Of Smoking On The Frequencies Of Micronuclei And Other Nuclear Abnormalities In Exfoliated Oral Cells: A Comparative Study With Different Cigarette Types, Mutagenesis 2011; Vol. 26(2), p. 295–301.
  16. Seifi S, Feizi F, Moazzezi Z et al.: Evaluation of oral mucosal epithelium in diabetic male patients by exfoliative cytology method. Journal of Diabetes & Metabolic Disorders 2014; 13:77.
  17. Jois HS, Kale AD, Mohan KKP. Micronucleus as potential biomarker of oral carcinogenesis. Ind J Dent Advancements2010; 2(2):197–202.
  18. Sanchez-Siles M, Ros-Llor I, Camacho-Alonso F, Lopez-Jornet P. A novel application of the buccal micronucleus cytome assay in oral lichen planus: A pilot study. Arch Oral Biol 2011; 56(10):1148-53.
  19. Koss LG; Koss diagnostic cytology and its histopathologic basis; Recognizing and classifying cells; chapter 5; 5th edition; Lippincott and Wilkins, Philadelphia,USA; 2006; volume 1(2); 136.
  20. Kini SR., colour atlas of differential diagnosis in exfoliative and aspiration cytopathology, Williums & Wilkins, 1999; p.50.
  21. Kumar V, Cortan RS, Robbins SL, Robbins Basic pathology. 7th edition, Saunders, Philadelphia, 2003; p.3-31.

Cite this article: Neeraj T. Master, Nisha Parmar. AN EXFOLIATIVE CYTOLOGICAL STUDY OF QUALITATIVE CHANGES IN BUCCAL MUCOSA CELLS OF TYPE 2 DIABETES PATIENTS IN SOUTH GUJARAT REGION. Int J Anat Res 2019;7(4.3):7132-7139. DOI: 10.16965/ijar.2019.326