Interdental cleaning among persons with diabetes: relationships with individual characteristics

A Comparative Review of Water Flossers in Periodontal Therapy

This study investigated the efficacy of water flossers (WFs), devices used to irrigate the interdental and subgingival areas, compared to other interdental care methods, in the management of periodontal disease. A computerized PubMed search was conducted by the author, encompassing the years 1962 to 2023. The year 1962 was selected due to it being the introduction of the first WF. Keywords included "oral irrigator", "efficacy," and "water flossers." The review provided a broad comparative assessment of WFs, rather than an exhaustive detailed article review. We discussed the history and evolution of commercially available WFs and introduced a novel classification system. The research also evaluated the performance of WFs in comparison to traditional and novel interdental care methods, focusing on crucial clinical parameters such as plaque removal efficiency and reduction in gingival inflammation. The results of the study reveal that WFs appear to be superior in the management of periodontal disease and have demonstrated effectiveness in a variety of indices. However, it's worth noting that the author did not statistically analyze any of the data. We identified gaps in the literature and found opportunities for further clinical studies. These findings hold implications for optimal periodontal disease prevention and management, addressing the evolving landscape of oral care practices.

Disparities in Preventive Oral Health Care and Periodontal Health Among Adults With Diabetes

INTRODUCTION

People with diabetes are more vulnerable to periodontal disease than those without; thus, practicing preventive oral health care is an important part of diabetes self-care. Our objective was to examine disparities in preventive oral health care among US adults with diabetes.

METHODS

We performed a secondary analysis of data from the National Health and Nutrition Examination Survey (NHANES) 2011-2016. Periodontal examinations were conducted in adults aged 30 and older. We compared the weighted prevalence of periodontal disease and the practice of preventive oral health care, including practicing dental interproximal cleaning (flossing or using other interproximal cleaning devices) and use of preventive dental services, among people with and without diabetes. Multivariable logistic regressions were performed to examine the relationship between the presence of diabetes, periodontal disease, and preventive oral health care practices.

RESULTS

Weighted prevalence of periodontal disease in the US population was higher among adults with diabetes than those without (58.0% vs 37.6%). This difference persisted after controlling for sociodemographic characteristics and smoking status. People with diabetes were more likely to have periodontal disease (adjusted odds ratio [aOR] 1.39; 95% CI, 1.17-1.65), less likely to practice daily interproximal cleaning (aOR 0.85; 95% CI, 0.75-0.95), and less likely to visit a dentist for preventive care in the past year (aOR 0.86; 95% CI, 0.76-0.96) than people without diabetes.

CONCLUSION

Adults with diabetes reported suboptimal preventive oral health care behaviors in use of preventive dental services and interproximal dental cleaning than people without diabetes, despite their health disparity related to periodontal disease. Educating people to improve their preventive oral health care is essential for good oral health and diabetes self-management.

Periodontal Treatment Experience Associated with Oral Health-Related Quality of Life in Patients with Poor Glycemic Control in Type 2 Diabetes: A Case-Control Study

Severe periodontitis is a risk factor for poor glycemic control. The appropriate medical treatment and plaque control of periodontitis positively affects blood-sugar control in diabetes patients. We aimed to identify the factors associated with glycemic control and examine the periodontal treatment (PT) experience and oral health-related quality of life (OHQoL) for patients with poor glycemic control in type 2 diabetes mellitus (T2DM). This multicenter case–control study recruited 242 patients with poor glycemic control and 198 patients with good glycemic control. We collected patients’ information through face-to-face interviews using a structured questionnaire. The Oral Health Impact Profile-14 (OHIP-14) was used to measure OHQoL. Based on PT status, the patients were classified into three groups: a non-periodontal disease group, a PT group, and a non-PT (NPT) group. Regression models were used to analyze the data. No interdental cleaning (adjusted odds ratio (aOR) = 1.78) and positive attitudes toward periodontal health (aOR = 1.11) were significantly more likely to be associated with poor glycemic control in patients with T2DM. The PT group had a significantly lower OHIP-14 score than the NPT group (6.05 vs. 9.02, p < 0.001), indicating a better OHQoL among patients with poorly controlled T2DM. However, the OHQoL did not differ significantly in patients with well-controlled T2DM between the PT and NPT groups. This suggested that diabetic patients with poor glycemic control must improve periodontal care practices and receive proper PT, if necessary, to improve their OHQoL.

Clinical implications of age and sex in the prevalence of periodontitis in Korean adults with diabetes

The present study was performed to assess the risk factors for periodontitis in Korean adults with diabetes. Data from the Korean National Health and Nutrition Examination Survey of the Korean population, conducted between January 2012 and December 2014 were used in the investigation. The presence of periodontitis in participants with diabetes in association with demographic variables and the anthropometric characteristics of the participants was investigated. Multiple logistic regression analyses were used to assess the associations between periodontitis and age, sex, diabetic control and duration of diabetes, following adjustment for confounding factors. The odds ratio of periodontitis was higher in individuals ≥65 years old compared with individuals <65 years old (1.152). The odds ratio of periodontitis was significantly higher in males compared with females (1.774). The number of patients with moderate and severe periodontitis differed significantly between different age groups. The present study revealed that age, sex and oral health behavior are risk indicators for periodontitis in patients with diabetes. The present study suggests that that an increased age, being male and engaging in poor oral health behavior increases the risk of periodontitis in participants with diabetes.

Gender Differences in Periodontal Status and Oral Hygiene of Non-Diabetic and Type 2 Diabetic Patients

BACKGROUND

This study investigated gender dependent differences by the comparison of periodontal status and oral hygiene between diabetic patients and non-diabetic subjects.

METHODS

517 mostly obese subjects (171 non-diabetic, 205 type 2 diabetic with oral and 141 with insulin therapy; mean: 59 years) completed an oral hygiene questionnaire and had a clinical examination, including periodontal screening and recording (PSR), percentage of bleeding teeth (PBT), probing pocket depth (PD), gingivitis index (GI), and number of teeth (Tn). Main parameters were "periodontitis" and "oral hygiene behaviour", each defined by 5 sub-parameters. For a comparison of all results, each sub-parameter was set 0.2. The "low performance index" (LoP) was the sum of significantly worse sub-parameters in the compared groups (maximum of low performing = 1.0).

RESULTS

Gender comparison: In non-diabetic and diabetic patients with oral medication, males performed worse (LoP: periodontitis 0.6 - 0.8; oral hygiene 0.4 - 0.6). The male insulin group performed worse oral hygiene (LoP: 0.4) than females with insulin therapy, whereas the periodontal status showed no difference. Diabetic and non-diabetic groups: Females: Diabetic groups performed worse than non-diabetics (LoP: periodontitis 0.2 - 1.0; oral hygiene 0.4). Insulin patients had worse periodontal status and showed no difference in oral hygiene when compared to diabetic patients with oral medication (LoP: 0.2). Males: Diabetic group with oral medication had worse periodontal status than non-diabetics (LoP: 0.6).

CONCLUSIONS

The periodontal status was mainly due to oral hygiene behaviour, which was worse in men. Apparently behaviour and not diabetes is the major determinant of periodontitis. Men apparently need much more advise than women.