Oral health checks integral to diabetes management

A population-based study suggests that the incidence of periodontitis co-occurs with various other diabetes-related complications, underpinning the importance of oral health checks in diabetes management.

“To date, data on whether and how periodontitis relates to other diabetes-related complications remain scarce,” said Dr Fernando Valentim Bitencourt from the Department of Dentistry and Oral Health, Section for Periodontology, Aarhus University, Aarhus, Denmark, at EASD 2023.

To evaluate the clustering of periodontitis with other diabetes-related complications and explore pathways linking these complications to common risk factors, Bitencourt and colleagues evaluated 11,917 individuals from NHANES III, 2011, and 2014 who had a complete periodontal examination. [EASD 2023, abstract 949]

They found that periodontitis did cluster with other diabetes complications, forming a latent construct called diabetes-related complications comprising periodontitis (standardized coefficient [SC], 0.40), retinopathy (SC, 0.26), cardiovascular diseases (SC, 0.93), proteinuria (SC, 0.54), and hypertension (SC, 0.59).

Looking at the latent periodontal variables, the SCs for periodontal probing depth ≥5 mm, clinical attachment loss ≥5 mm, and furcation involvement were 0.45, 0.78, and 0.61, respectively.

The diabetes-related complications were found to be directly associated with age (SC, 0.63), sex (SC, -0.20), dyslipidaemia (SC, 0.17), physical activity (SC, -0.11), socioeconomic status (SC, -0.41), waist-hip ratio (SC, 0.08), smoking (SC, 0.39), and HbA_1c (SC, 0.15; p<0.01 for all).

“In addition, physical activity revealed an indirect effect on diabetes-related complications via waist-hip ratio, mediated through the waist-hip ratio pathway, leading to dyslipidaemia,” said Bitencourt.

Among individuals with type 2 diabetes (T2D), a healthy diet demonstrated a significant protective total and indirect effect on diabetes-related complications mediated by dyslipidaemia.

Two-way street

Evidence has shown a bidirectional association between diabetes and periodontitis, suggesting that both conditions could be risk factors for each other. [Ann Periodontol 2001;6:99-112; J Periodontol 1996;67:1085-1093]

Periodontitis has been independently associated with T2D and is three times higher in individuals with T2D compared with those without T2D. [Periodontol 2000 2007;44:127-153] In a previous study, diabetes increased the risk, or progression, of periodontitis by 86 percent. [Acta Diabetologica 2018;55:653-667]

In 2000, the US Surgeon General referred to a ‘silent epidemic’ of oral/dental diseases. [www.nidcr.nih.gov/sites/default/files/2017-10/hck1ocv.%40www.surgeon.fullrpt.pdf, accessed October 23, 2023] In 2007, the WHO recognized the association between oral health, general health, and quality of life. [apps.who.int/gb/ebwha/pdf_files/WHA60/A60_16-en.pdf, accessed October 23, 2023]

However, oral health campaigns ranked low in the agenda of policymakers compared with more life-threatening diseases, as it mostly affects morbidity rather than mortality. [Lancet 2009;373:1]

The current findings add to the growing body of evidence highlighting the importance of managing diabetes and periodontitis accordingly. Diabetes control could reduce the risk and severity of periodontitis, while periodontal therapy can contribute to the improvement of glycaemic control. [Diabetes Care 2010;33:1753-1758; J Clin Periodontol 2007;34:46-52; J Clin Periodontol 2005;32:266-272; Folia Medica (Plovdiv) 2007;49:32-36]

“[T]he presence of oral diseases may serve as a screening tool for other diabetes-related complications … T2D patients, especially those with diabetes-related complications, should be encouraged to undergo oral health screening for inflammation-related diseases, to receive the appropriate care and treatment and subsequently improve their quality of life,” said Bitencourt.