Relationship between oral health, diabetes management and sleep apnea

Association of edentulism and obstructive sleep apnea: A systematic review

PURPOSE

Sleep apnea is a common and underdiagnosed sleep-related breathing disorder. This systematic review aimed to evaluate the scientific evidence regarding the association between obstructive sleep apnea (OSA) and edentulism.

METHODS

An electronic search was conducted through PubMed (MEDLINE), Scopus, and Cochrane Library, up to January 2024. A systematic approach was followed according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) statement guidelines. The literature search intended to retrieve all relevant clinical studies about any possible association between OSA and edentulism. Only publications in the English language were selected, and animal studies, in vitro studies, case reports, case series, technique presentation articles, and expert opinions were excluded.

RESULTS

A total of 23 studies met the inclusion criteria and were included in this systematic review. They were published between 1999 and 2023 and were all clinical studies. These studies examined a possible association between OSA and edentulism and all of them agreed on their positive relation. Tooth loss favors anatomic alterations that deteriorate breathing. The severity of OSA was related to the extent and duration of edentulism. Mean Apnea-Hypopnea Index (AHI) scores in edentulous patients were found to be two to three times higher in comparison to dentate individuals, although the statistical data about it are scarce. No agreement was reached, however, about the use of dentures during sleep time, since the data are controversial.

CONCLUSION

The findings suggest that there is a plausible association between edentulism and OSA. Tooth loss impairs significant anatomic alterations and increases the risk for OSA. However, clinical data are limited and heterogeneous so more clinical studies should be encouraged for more robust conclusions.

Patient preferences and willingness to pay for dental services: a systematic review

BACKGROUND

Oral health is a fundamental aspect of overall well-being. However, dental diseases have a significant impact on access to care due to economic and social barriers. This systematic review of the literature on willingness to pay (WTP) for dental services aims to inform policy and planning by identifying the key factors influencing preferences.

METHODS

A systematic literature review was conducted using the following databases: PubMed, Embase, Web of Science core collection, Scopus, and Google Scholar. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations were followed. Original studies on the preference and WTP for dental services published up to October 2023 were considered. Inclusion criteria included an active population aged ≥ 18 years and various methodological approaches to eliciting WTP, such as discrete choice experiment (DCE) and contingent valuation (CV) techniques. The quality of selected studies was assessed by using the ISPOR checklist.

RESULTS

A total of 45 articles were eligible for inclusion, indicating that WTP research was primarily based on convenience and non-probabilistic sampling. Mean WTP showed significant variation and was influenced by demographic factors (age, gender), socioeconomic conditions, insurance cover, and perceived need for dental care. The main attributes identified from the studies related to cost (out of pocket payment, price), service delivery, time, and treatment outcome.

CONCLUSIONS

The review underlined that demographic and socio-economic variable greatly influence WTP, implying the need for district policies to improve access to dental services. Future research should address the methodological limitations of the included studies and evaluate the potential for prospective studies to enhance understanding of patient preferences in dental care.

Impact of Oral Hygiene Practices in Reducing Cardiometabolic Risk, Incidence, and Mortality: A Systematic Review

Cardiometabolic diseases share many modifiable risk factors. However, periodontitis, a chronic inflammatory condition of the gums, is a risk factor that is rarely publicized. This systematic review aims to evaluate the impact of oral hygiene practices on the risk, incidence, and/or mortality rate of cardiovascular disease (CVD), type 2 diabetes mellitus (T2DM), and chronic kidney disease (CKD). Searches were conducted using MEDLINE, Embase, Scopus, and CINHAL. Randomized controlled trials (RCTs), quasi-RCTs, and observational studies were included. Eligible studies reported on associations of toothbrushing, interdental cleaning, mouthwash, or toothpaste use, either alone or in combination with CVD, CKD, and/or T2DM outcomes in adults ≥ 18 years. Fifty-five studies were included. Cochrane's risk of bias tool and the Newcastle-Ottawa Scale were used for quality assessment. Data synthesis is narratively presented. Toothbrushing and interdental cleaning were associated with lower risk of developing T2DM or hypertension HR 0.54 [p < 0.001] and a lower mortality risk in those with CVD HR = 0.25 [p = 0.03]. Mouthwash use reportedly increased the risk of developing hypertension and diabetes by 85% and 55%, respectively. This review highlights how simple oral hygiene practices can reduce cardiometabolic risk. Non-dental clinicians could integrate the findings into chronic disease health promotion.

Association between metabolic syndrome and tooth loss: A systematic review and meta-analysis

BACKGROUND

The authors conducted a systematic review and meta-analysis to verify the existence and level of scientific evidence concerning the association between metabolic syndrome (MetS), as the main exposure, and tooth loss (TL), as the outcome.

TYPES OF STUDIES REVIEWED

Through electronic databases and partially through gray literature, the authors identified observational studies in adults. The authors used no date or language restrictions. The authors evaluated the studies' methodological quality by using the Newcastle-Ottawa Scale. The authors conducted a random-effects model meta-analysis. The authors assessed the quality of evidence by using the Grading of Recommendations Assessment, Development and Evaluation criteria.

RESULTS

Twelve studies met the eligibility criteria, and 9 were retained for the meta-analysis. Most were cross-sectional studies with good methodological quality. Participants with MetS had fewer teeth (standardized mean difference, -2.77; 95% confidence interval, -4.56 to -0.98) and an increased likelihood of lacking functional dentition (odds ratio, 2.37; 95% confidence interval, 1.89 to 2.96) than did those without MetS. The overall quality of evidence was very low.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Better-conducted longitudinal studies are necessary to establish a causal relationship between MetS and TL to inform the best strategies to prevent TL in populations with MetS.

Interrelation between patient satisfaction and patient-provider communication in diabetes management

The present study aims to assess how patient satisfaction with medical provider-patient communication can affect oral health, diabetes, and psychobehavioural measures among type 2 diabetes (T2DM) patients. It is part of a prospective intervention study among randomly selected T2DM patients, in Turkey. The data analyzed were Community Periodontal Need Index (CPI), HbA1c, patient satisfaction with communication, and psychobehavioural variables. Data was collected initially and at the end of the intervention. The participants were allocated to either health coaching (HC) or health education (HE). At baseline, there were no statistical differences between the HC and the HE groups on any of the measures (P > 0.05). Patients in both the HC and the HE groups had low satisfaction with communication. At postintervention, the increase in patient satisfaction with communication in the HC group was significantly higher than that in the HE group (P = 0.001). Principal component analysis revealed that patient satisfaction with communication shared the same cluster with clinical measures (CPI and HbA1c) and quality of life in the HC group. In conclusion, the present study showed, to our knowledge for the first time, that overall patient satisfaction with medical care provider-patient communication, empowered by HC approach, was interrelated with well-being of T2DM patients, in terms of psychobehavioural and clinical measures.

The impacts of adenotonsillar hypertrophy on periodontal health in children: a prospective controlled pilot study

OBJECTIVES

To evaluate the impacts of obstructive adenotonsillar disease on periodontal health and to assess the efficacy of adenotonsillectomy in the prevention of chronic periodontitis in children.

METHODS

This prospective and controlled clinical study was conducted between August 2012 and February 2013 with 35 pediatric patients who had permanent anterior dentition. The study group included twenty patients (n = 20) who had complaints of chronic mouth breathing and snoring and were diagnosed with obstructive adenotonsillar disease. These patients underwent adenoidectomy with or without tonsillectomy. We performed periodontal examinations to assess the periodontal health status in these children before and two months after surgery. The periodontal measures included plaque index (PI), pocket depth (PD) and gingival index scores (GI). Subsequently, these periodontal measures were compared with healthy control group who had no adenotonsillar disease (n = 15).

RESULTS

Among the study group six patients underwent adenoidectomy and 14 patients underwent adenoidectomy combined with either tonsillectomy or tonsillotomy. The preoperative PI, PD and GI scores of the study group were 1.27 ± 0.39, 1.34 ± 0.31 and 0.97 ± 0.37 respectively. These scores were significantly higher compared to the control group (p < 0.001). These periodontal index scores were significantly improved after surgery (p = 0.008 for PI and p < 0.001 for both PD and GI). In addition, we found no difference in postoperative values of PD and GI between the study group and control group.

CONCLUSION

We concluded that obstructive adenotonsillar disease adversely affects periodontal health in children and surgical management of obstruction improves the clinical findings. However, more comprehensive research is required to elucidate the association between adenotonsillar hypertrophy and periodontal disease.