Adult diabetic and nondiabetic subjects as users of dental services. A longitudinal study

Oral health behavior and HbA1c in Indian adults with type 2 diabetes

Prevention and treatment of oral diseases and diabetes require persistent daily self-care, as there is a mutual association between periodontitis severity and level of diabetes control. In this questionnaire study, we investigated oral health behavior, attitudes, and knowledge of diabetes-related factors among 500 Indian adults with type 2 diabetes mellitus. The questionnaire asked about oral self-care, dental visits, self-perceived problems, and knowledge of the relationship between diabetes and oral health. The most recent glycosylated hemoglobin (HbA1c) value was obtained from patient medical records. Overall, 22% of participants reported twice-daily toothbrushing; women were more likely than men to brush twice daily (P< 0.001). With respect to age and diabetes control, participants aged 35-44 years with good diabetes control had the highest rate of twice-daily brushing (P< 0.001). Oral self-care and use of dental services were poor among participants. The present results indicate that Indians with type 2 diabetes need further promotion of oral self-care and regular dental checkups to compensate for their increased risk of oral disease.

Knowledge and awareness about diabetes and periodontal health among Jordanians

The aim of this study is to evaluate the awareness, perception, sources of information, and knowledge of diabetes mellitus and periodontal health among Jordanians, to examine the factors related to their knowledge, and organize effective education programs. A random sample of 500 diabetic patients was recruited from three hospitals and three comprehensive health centers that represent both urban and rural populations in Jordan between September 25, 2006, and February 20, 2007. Completed questionnaires with the answers were returned by 405 participants (response rate was 81%). Only 28% indicated that they followed up gum diseases with the dentist; 48% were aware that diabetic patients are more prone to gum diseases and oral health complications. About a third (38%) recognized that their periodontal health might affect their glycaemic level. Television and Internet were the main source of knowledge for dentists with the rate of 50%. Knowledge about diabetes and periodontal health among diabetic patients is low, and majority of patients were unaware of the oral health complications of their disease and the need for proper preventive care. Issues on education need to be addressed. Therefore, appropriate educational programs should be planned according to community needs, and the target of these programs should be patients with irregular visits to the dentist and physicians. The clinical implication of our findings is that dentists, physicians, and other health providers should inspect diabetic patients for gum diseases each time they come for care and recommend that diabetic patient see a dentist regularly.

Periodontal status of diabetics compared with nondiabetics: a meta-analysis

BACKGROUND

This meta-analysis was conducted to assess the association between diabetes mellitus and periodontal diseases by comparing the extent and severity of periodontal diseases between diabetics and nondiabetics.

METHODS

A literature search was performed using MEDLINE database for published studies from January 1970 through October 2003 with manual search for references in relevant studies. This meta-analysis was based on 18 comparative cross-sectional studies, three prospective cohort studies and baseline data of two clinical trials that compared oral hygiene, gingival and periodontal status between diabetics and nondiabetics. Heterogeneity was obvious among included studies; therefore, the analysis using random-effects model was conducted.

RESULTS

This study demonstrated that diabetics had significantly worse oral hygiene as measured by the average of plaque index (P1I), higher severity of gingival disease as measured by the average of gingival index (GI) and higher severity of periodontal disease as measured by the average of probing pocket depth (PPD) and clinical attachment loss (CAL). However, diabetics had similar extent of oral hygiene, gingival and periodontal disease as measured by percentages of surfaces or sites with specific scores of P1I, GI, bleeding on probing (BOP), PPD and CAL.

CONCLUSIONS

Diabetics had a significantly higher severity but the same extent of periodontal disease than nondiabetics.

Oral health promotion among adults with diabetes in Finland

OBJECTIVES

In the present community trial, changes in oral health among adults with diabetes in Finland were assessed in three differing intervention groups and in a control group. The goal of intervention was to promote periodontal health.

METHODS

The study population comprised of 120 adults with diabetes, who were regular patients at the Salo Regional Hospital Diabetes Clinic in Salo, Finland. All underwent periodontal examination in 1999 and 2001. The percentage of dropouts was 4%. Outcome measures were visible plaque, presence of calculus, and the Community Periodontal Index of Treatment Needs (CPITN) index calculated for each tooth separately. Oral-health-related factors were determined by a questionnaire. Intervention based on the recommended treatment interval was carried out in the following groups: diabetes nurse-letter-reminder group (n = 26), diabetes nurse-reminder group (n = 31), letter-reminder group (n = 30), and a control group (n = 28).

RESULTS

A significant decrease occurred in the visible plaque index between 1999 and 2001 in all groups, and in calculus index in the diabetes-nurse-reminder group and in the letter-reminder group. During the study period, only in the control group, the CPITN index codes 3 and 4, calculated for each tooth separately, increased.

CONCLUSION

These positive results emphasize the potential of existing health-care actions for promoting periodontal health. With minimal recourse demands, it was possible to increase oral health behaviors and periodontal health among patients with diabetes.

Diabetes and oral health promotion: a survey of disease prevention behaviors

BACKGROUND

Diabetes is a chronic metabolic disease known to affect oral disease progression. The authors surveyed health behaviors essential for preventing dental and periodontal diseases and maintaining oral health is a population of adult patients with type 1 (insulin-dependent) diabetes. The goals of this study were to assess these patients' oral health behaviors, access to dental care and need for improved health education.

METHODS

As part of a dental and periodontal examination, 406 subjects with type 1 diabetes completed a questionnaire regarding their oral health attitudes, behaviors and knowledge. The authors also evaluated 203 age-matched nondiabetic control subjects.

RESULTS

The authors found that diabetic subjects' tobacco use and oral hygiene behaviors were similar to those of the nondiabetic control subjects. Diabetic subjects, however, more frequently reported the cost of dental care as a reason for avoiding routine visits. Most of these subjects were unaware of the oral health complications of their disease and the need for proper preventive care.

CONCLUSIONS

Patients with diabetes appear to lack important knowledge about the oral health complications of their disease. The results of this survey did not indicate improved prevention behaviors among the subjects with diabetes compared with nondiabetic control subjects.

CLINICAL IMPLICATIONS

Dentists have an opportunity and the responsibility to promote good oral health behaviors such as regular dental examinations, proper oral hygiene and smoking cessation that may significantly affect the oral health of their diabetic patients.