Diabetes, periodontal diseases, dental caries, and tooth loss: a review of the literature

Diabetes mellitus, is a common chronic disease, and its prevalence in the United States, particularly type 2 diabetes, is increasing. Complications associated with diabetes impose a heavy burden on many people, especially among certain minority populations. Periodontal diseases, dental caries, and tooth loss also are common conditions in the United States, but their prevalence is generally decreasing. Nevertheless, among important subgroups of the population, particularly certain minority and economically disadvantaged groups, there is a disproportionately higher burden of periodontal diseases, dental caries, and tooth loss. This article reviews the post-1960 English-language literature on the relationship between diabetes and oral health, specifically focusing on periodontal disease, dental caries, and tooth loss. Substantial evidence exists to support the role of diabetes and poorer glycemic control as important risk factors for periodontal disease. Additionally, the evidence provides support for viewing the relationship between diabetes and periodontal diseases as bidirectional. However, additional research is necessary to firmly establish that treating periodontal infections can contribute to glycemic control management and possibly to the reduction of type 2 diabetes complications. The literature does not describe a consistent relationship between type 2 diabetes and dental caries. It reports increased, decreased, and similar caries experiences between those with and without diabetes. This review suggests that currently there is insufficient evidence to determine whether a relationship between diabetes and risk for coronal or root caries exists. Most of the reviewed studies reported greater tooth loss in people with diabetes. However, the differences were slight and not significant in several of the reports. Furthermore, this review of the association between diabetes and tooth loss reveals that valid population-based evidence generalizable to the US population is sparse. Further investigations of the association of diabetes with dental caries and tooth loss are warranted. If adverse effects of diabetes on dental caries and/or tooth loss are substantiated, the results of such studies would help design intervention studies to prevent or reduce the occurrence of dental caries and tooth loss in people with diabetes. These results also may affect existing clinical practice protocols and promote new public policy related to diabetes.     

Survey of medical doctors' attitudes and knowledge of the association between oral health and pregnancy outcomes

Abstract: Objectives: The study was designed to assess the views and knowledge of healthcare providers in general medicine and other specialties on the association between oral health and pregnancy outcomes. Material and Methods: Two hundred and fifty physicians practicing in northern Jordan hospitals and healthcare centers were asked to complete a questionnaire. Completed questionnaires with the answers were returned completed by 197 participants (response rate was 79%). Results: The majority of the physicians (81%) agreed that pregnancy increases the tendency to have gingival inflammation. However, 88% of doctors advised delay dental treatment until after pregnancy. Only half (54%) thought that tooth and gums problem can affect the outcomes of pregnancy. Moreover, approximately 50% agreed with the possible association between oral health and pregnancy outcomes. Altogether, 52% agreed with the statement ‘a tooth for a baby’ and 57% believed that calcium will be drawn by the developing baby. If asked to advise patient to visit dentist during pregnancy, 50% said they would do so. Moreover, the majority (68%) did not advise women planning to become pregnant to include a periodontal evaluation as part of their prenatal care. About 32% felt that periodontal disease can be treated safely during pregnancy with a procedure called scaling and root planning. Reading the information in a book, magazine or pamphlet was useful and reliable information about preterm births and periodontal disease. Physicians do not routinely advise their patient to seek dental care during pregnancy. General practitioners were less informed about oral health practices on pregnant women. Issues on training need to be addressed. A public health campaign is required to educate healthcare providers to encourage pregnant women on the need for a regular dental check‐up during and prior to attempting pregnancy. Conclusion: There is a need to educate healthcare personnel further about oral health and pregnancy outcomes.     

Poor patient awareness of the relationship between smoking and periodontal diseases

OBJECTIVE: To investigate patients' knowledge of the effects of smoking on periodontal health. DESIGN: Patient answered questionnaires, which were anonymous. SETTING: Patients who attended GKT Dental Institute, King's College, London for dental treatment. SUBJECTS: One thousand patients attending Restorative Consultant Clinics and Primary Dental Care. RESULTS: Seventy-eight per cent of patients were aware that smoking had a negative impact on health. However, 52% of these patients who were aware could not state what the negative effects were on oral health. Seven per cent of patients stated that smoking affected the gums but did not state how it affected the gums. Only 6% of respondents knew specifically of the link between smoking and periodontal disease. The only statistically significant factors associated with increased awareness were smoking status, ie being a non-smoker and being registered with a general dental practitioner. Non-smokers and those registered with GDPs were more likely to be aware of the association between smoking and periodontal diseases. CONCLUSIONS: This study highlights patients' lack of awareness of the relationship between smoking and periodontal diseases, with only 6% of respondents knowing of the link between tobacco and periodontal diseases.     

龈沟液中IL-1β与2型糖尿病和牙周病相关性的研究

目的：比较2型糖尿病患者（DM）、2型糖尿病伴牙周病患者（DM＆AP）及牙周病患者（AP）龈沟液（GCF）中的白细胞介素-1β（IL-1β）水平,探讨DM和DM＆AP糖化血红蛋白（HbAlc）浓度与IL-1β的相关性。方法：使用滤纸条法采集GCF,DM、DM＆AP、AP患者及正常对照组各30例;ELISA法测定GCF中IL-1β含量;运用高效液相层析法测定DM和DM＆AP的糖化血红蛋白水平。结果：DM、DM＆AP、AP的GCF量和IL-1β量均高于正常对照组（P〈0．05）;DM＆AP、AP组GCF量显著高于DM组（P〈0．05）;DM＆AP组IL-1B含量高于DM组和AP组（P〈0．05）。结论：糖尿病患者和糖尿病伴牙周病患者IL-1β均高于正常人,长期的高血糖会使糖尿病患者易患牙周病,提示糖尿病患者在关注血糖控制的同时还高度关注牙周健康。     

Periodontal awareness and knowledge,and pattern of dental attendance among adults in Jordan

AIMS: To provide baseline data on periodontal awareness and health knowledge, and to assess patterns of dental attendance behaviours among 20 to 60 year-old Jordanian adults. METHODS: A questionnaire incorporating items related to personal and socio-demographic data, periodontal awareness and health knowledge, and self-reported dental attendance behaviours. One-thousand questionnaires were distributed among adults attending dental clinics. RESULTS: 743 questionnaires were completed and statistically analysed. About one-quarter of adults reported 'gum bleeding' on brushing, but more subjects (40.4%) believed that they had periodontal disease. Also, 47% of the participants thought that they had a 'rough tooth surface', 16% had 'gum irritation' and 25% had 'bad breath'. There were no statistically significant differences between genders with regard to responses on periodontal awareness (P >0.05). The majority of adults incorrectly defined the meaning of dental plaque and did not know its role in the aetiology of gingival disease. Conversely, the majority of participants (60.8%) were aware that gingival bleeding upon brushing indicated the presence of periodontal disease that can be prevented by brushing and flossing (63.4%), mainly before going to bed (73.9%). The overwhelming majority of subjects (81.4%) were irregular attenders. 'Treatment not necessary' and 'cost' were found to be the common barriers for regular dental attendance. The most common treatment received by the subjects at their last visit was restorative therapy. CONCLUSION: Knowledge and awareness concerning periodontal disease is still poor in Jordan, therefore, more dental health education is needed to improve oral health.     

Obstetricians' knowledge of periodontal disease as a potential risk factor for preterm delivery and low birth weight

There is little information about the knowledge and attitudes of physicians regarding oral care. This study aimed to assess the knowledge and attitudes of obstetricians about the relationship between periodontal disease and preterm/low birth weight. A questionnaire was emailed to members of the Brazilian Federation of Gynecology and Obstetrics (FEBRASGO). The questionnaire elicited both personal information and knowledge and attitudes regarding the relationship between periodontal diseases and preterm labor. A total of 875 obstetricians responded to the questionnaire. The majority of respondents were female (54.1%), resided in the Southeast (45.6%), worked in both the public and private sectors (61.4%), and had over 15 years of experience in obstetrics (48.9%). A large proportion of obstetricians (93.4%) stated that bacteria were associated with periodontal disease, and 94% reported that periodontitis was a condition more severe than gingivitis. In total, over 80% of participating obstetricians reported smoking, preeclampsia, bacterial vaginosis and periodontal disease as risk factors or possible risk factors for preterm birth or low birth weight. A correlation between the experience of the obstetricians and referral of their patients for dental examinations (p < 0.001) was observed. Also, obstetricians who had had their own dental visits more recently were more likely to recommend the same for their patients (p < 0.001). It is concluded that, although obstetricians were aware of the association between gingival inflammation and adverse obstetric outcomes, the attitudes of these professionals were not in agreement with their apparent knowledge regarding periodontal diseases and their possible repercussions.     

Oral Health Literacy and Measures of Periodontal Disease

Background: Existing evidence demonstrating a relationship between health literacy (HL) and periodontal health is insufficient to identify how providers can help patients manage periodontal disease. This study assesses associations between HL measures (word recognition, numeracy, and conceptual knowledge) and signs of periodontal disease. Methods: This study included 325 new patients at a dental school clinic and employed an oral HL (OHL) survey, full‐mouth radiographs, and clinical examination. Evaluations included the relationship between each HL measure versus number of teeth, bleeding score, plaque score, and periodontal severity with linear and ordinal logistic regression models before and after adjusting for covariates. Results: Among HL measures, the Newest Vital Sign demonstrated a significant relationship with number of teeth and the Short Test of Functional Health Literacy in Adults showed a significant association with plaque score. The short Rapid Estimate of Adult Literacy in Medicine and Dentistry (REALMD‐20) showed participants who performed in the highest quartile had nearly two additional teeth, over 5.5% fewer bleeding sites, and nearly 9% fewer teeth with plaque after adjustment for demographic variables, smoking, and diabetes mellitus (DM). Participants who scored in the highest quartile of the Comprehensive Measure of Oral Health Knowledge (CMOHK) had nearly 9% less plaque. Conclusions: Two OHL instruments (REAMLD‐20 and CMOHK) provided statistical associations with clinical measures of periodontal health at a level that could be considered of moderate clinical relevancy. Findings suggest dentists may wish to assess familiarity of their patients with dental terminology and knowledge of periodontal disease to provide education on oral hygiene, smoking, and DM.     

上海市嘉定区家庭医师对妊娠期口腔疾病治疗的调查分析

目的: 调查分析上海市嘉定区家庭医师对妊娠期口腔疾病治疗问题的认识。方法: 采用问卷方式调查嘉定区家庭医师对妊娠期口腔保健知识的掌握度和口腔疾病治疗相关问题的认识,采用SPSS20.0软件包对数据进行统计学分析。结果: 203名家庭医师参与问卷调查,共回收有效问卷192份。受调查者对于妊娠期口腔治疗安全期的知晓率为70.3%,知道口腔疾病可能导致不良妊娠结局的比例为90.1%,告知服务对象孕前进行口腔检查和治疗的比例为90.6%,认为孕期出现口腔疾病需要及时就诊的比例为93.8%。认为孕妇可以接受龋齿充填、冠修复、龈上洁治、根管治疗、龈下刮治和拔牙的比例分别为91.9%、60.4%、51.0%、40.1%和31.8%,认为孕妇可以接受口腔局麻以及牙科X线检查的比例为55.2%和31.8%,家庭医师的年龄、学历和技术职称是影响观点的主要因素（P值均<0.05）。结论: 嘉定区家庭医师对妊娠期口腔保健知识知晓度较高,但对妊娠期口腔疾病治疗相关问题的看法存在差异,认为孕妇可以接受局麻和牙科X线片检查的医师多具备较高学历和高技术职称。     

Dental Care Visits among Dentate Adults with Diabetes and Periodontitis

Objectives: Two national surveys have shown that dentate adults with diabetes are less likely to visit a dentist than are those without diabetes; one survey showed this association only among women. We hypothesize that periodontal health among those with diabetes could explain this disparity. This report investigates the influence of periodontitis on the association between diabetes and dental care visits. It also tests whether disparities are limited to women. Methods: Data from the 1999‐2004 National Health and Nutrition Examination Survey were used. Covariates included age, sex, race/ethnicity, poverty status, education level, dental insurance, and periodontitis status. Weighted analyses were limited to dentate adults aged ≥25 years. Results: Overall, 56.8 percent of dentate adults with diabetes reported having a dental care visit in the preceding year compared with 64.7 percent for those without diabetes. In a multivariable model, diabetes status was significantly associated with having a dental care visit, independent of periodontitis status and covariates. Neither periodontitis status nor sex served as effect modifiers for the association between diabetes status and dental care visits. Conclusions: These data revealed that dental care visits for dentate adults with diabetes were unrelated to their periodontal health, suggesting that fear of periodontal therapy did not influence visit patterns. These data also showed that dental care visit disparities existed for all adults with diabetes, not just women. Future research should investigate whether factors that are indirectly related to diabetes status, such as competing costs, attitudes, and knowledge, are influencing dental care visit patterns among dentate adults with diabetes.     

Periodontal health, oral health behaviours, and chronic obstructive pulmonary disease

Aim: To evaluate the associations of periodontal health status and oral health behaviours with chronic obstructive pulmonary disease (COPD).
Materials and Methods: We conducted a case–control study of 306 COPD patients and 328 controls with normal pulmonary function. Their periodontal status and respiratory function were clinically examined and information on oral health behaviours was obtained using a validated questionnaire.
Results: Patients with COPD had fewer teeth and a higher plaque index than the controls. Univariate analysis showed that tooth brushing times and method, experience of dental floss use, dental visit and regular supra-gingival scaling, and oral health knowledge were significantly related to the risk of COPD. After adjusting for age, sex, and body mass index and stratifying by smoking status, inappropriate tooth brushing method ( p =0.025 among non-smokers), lower regular supra-gingival scaling ( p =0.027 among non-smokers and p <0.0001 among former smokers), and poorer oral health knowledge ( p <0.0001 among non-smokers and p =0.019 among former smokers and p =0.044 among current smokers) remained significantly associated with COPD.
Conclusions: Poor periodontal health, dental care, and oral health knowledge were significantly associated with an increased risk of COPD. Our findings indicate the importance of promoting dental care and oral health knowledge that can be integrated into the prevention and treatment of COPD.     

Obstetric Knowledge,Attitude, and Behavior Concerning Periodontal Diseases and Treatment Needs in Pregnancy: Influencing Factors in France

Background: Many studies have shown that periodontal diseases are risk factors for adverse pregnancy outcomes. The aim of this study is to assess the knowledge and clinical attitude of French obstetricians and/or gynecologists regarding periodontal diseases. Methods: A cross‐sectional study was performed on randomly selected French obstetricians and/or gynecologists using a self‐administered, structured questionnaire during an annual French professional congress. Results: The questionnaire was completed by 190 French obstetricians and/or gynecologists. Among respondents, 88% were aware of the inflammatory and infectious nature of periodontal diseases. Furthermore, 74.7% of respondents were conscious of its negative impact on pregnancy outcomes. Few obstetricians and/or gynecologists (26.3%) interviewed patients about oral health. Information on oral health was systematically provided to patients by 10.5% of the practitioners. However, 55.6% addressed this issue if they considered the patient at risk for pregnancy. Only 33.2% of practitioners systematically referred the patient to a dentist. Periodontal disease knowledge and consideration levels increased in more experienced practitioners with a private practice and a personal history of periodontal disease. Conclusions: Periodontal knowledge of the French obstetricians and/or gynecologists surveyed seemed satisfyingly apparent and influenced by levels of professional experience and personal history. However, clinical behavior did not adequately correlate with this knowledge.     

冠心病与缺牙及义齿修复关系分析

目的：探讨牙齿缺失与冠心病的相关关系。方法：选取90例研究对象，其中冠心病人45例作为实验组，非冠心病人45例作为对照组，比较2组间牙齿缺失数、牙周病牙数及龋病牙数等相关指标的差异，并调查分析2组的义齿修复情况。结果：冠心病组牙齿缺失数、牙周病牙数较对照组明显增多，二者差异具统计学意义（P〈0．05）；且复杂牙列缺损病例也较对照组明显增多，二者差异也具有统计学意义（P〈0．05）；2组义齿修复情况比较，差异无统计学意义（P〉0．05）。结论：冠心病组牙齿缺失数较对照组明显增多，牙周健康状况较对照组差，复杂牙列缺损病例也较对照组明显增多，提示口腔修复科医师在日常对中老年人复杂牙列缺损和牙列缺失的修复过程中，应充分认识到患者可能存在的全身健康问题，尤其要注意其与冠心病的关系，充分考虑冠心病人义齿修复的特点及对修复效果的影响，并将口腔健康与全身健康关系的宣教工作纳入椅旁议事日程，作为应尽的责任与义务。     

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.     

Bidirectional interrelationships between diabetes and periodontal diseases: an epidemiologic perspective

This review evaluates evidence for a bidirectional relationship between diabetes and periodontal diseases. A comprehensive Medline search of the post-1960 English language literature was employed to identify primary research reports of relationships between diabetes and periodontal diseases. Reports included in the review on the adverse effects of diabetes on periodontal health (DM-->PD) were restricted to those comparing periodontal health in subjects with and without diabetes. Review of adverse affects of periodontal infection on glycemic control included reports of periodontal treatment studies and follow-up observational studies in which changes in glycemic control could be assessed. Observational studies reporting DM-->PD provided consistent evidence of greater prevalence, severity, extent, or progression of at least one manifestation of periodontal diseases in the large majority of reports (supportive evidence in 44/48 total reviewed; 37/41 cross-sectional and 7/7 cohort). Additionally, there were no studies reviewed with superior design features to refute this association. Treatment studies provided direct evidence to support periodontal infection having an adverse, yet modifiable, effect on glycemic control. However, not all investigations reported an improvement in glycemic control after periodontal treatment. Additional evidence to support the effect of severe periodontitis on increased risk for poorer glycemic control comes from 2 follow-up observational studies. The evidence reviewed supports viewing the relationship between diabetes and periodontal diseases as bidirectional. Further rigorous, systematic study is warranted to establish that treating periodontal infections can be influential in contributing to glycemic control management and possibly to the reduction of the burden of complications of diabetes mellitus.     

Low Social Position,Periodontal Disease,and Poor Oral Health‐Related Quality of Life in Adults With Systemic Arterial Hypertension

Background: There is little evidence on the association between periodontal disease and oral health‐related quality of life (OHRQoL) in individuals with chronic diseases, including hypertension. The aim of this study is to identify relationships among sociodemographic characteristics, smoking, tooth loss, dental caries, periodontal status, and OHRQoL in adults with systemic arterial hypertension. Methods: A cross‐sectional study involving 195 adults (mean age: 55.7 years) with systemic arterial hypertension used interviews and oral examinations to collect data on sociodemographic characteristics (age, sex, income); use of antihypertensive medication; smoking; tooth loss; dental caries; periodontal status (bleeding on probing, calculus, and attachment loss); and OHRQoL/oral health impact profile. The Wilson and Cleary (Wilson IB, Cleary PD. JAMA 1995;273:59‐65) conceptual model was used to test direct and indirect relationships among variables using structural equation modeling. Results: Lower age, male sex, smoking, and lower income directly predicted worse periodontal status. Tooth loss, dental caries, worse periodontal status, and smoking were directly linked to poor OHRQoL. Age was indirectly linked to worse periodontal status via income. Income and smoking indirectly predicted poor OHRQoL via periodontal status. Conclusions: Findings support an effect of periodontal disease on OHRQoL in people with systemic arterial hypertension. Periodontal status mediated associations of sociodemographic characteristics and smoking with OHRQoL through different pathways.     

Halitosis among racially diverse populations: an update

The aim of this paper is to highlight the cultural perceptions of halitosis to dental professionals. Halitosis (oral malodour or bad breath) is caused mainly by tongue coating and periodontal disease. Bacterial metabolism of amino acids leads to metabolites including many compounds, such as indole, skatole and volatile sulphur compounds (VSC), hydrogen sulphide, methyl mercaptan and dimethyl sulphide. They are claimed to be the main aetiological agents for halitosis. Gastrointestinal diseases are also generally believed to cause halitosis. In general, physicians and dentists are poorly informed about the causes and treatments for halitosis. The paper reviews the prevalence and distribution of halitosis, oral malodour, its aetiology, concepts of general and oral health and diseases and their perception among racially diverse population. Eating, smoking and drinking habits and understanding of halitosis as a social norm among different people has been highlighted. The treatment options have also been presented very briefly. A brief discussion about general importance within existing healthcare services has been highlighted. Oral malodour may rank only behind dental caries and periodontal disease as the cause of patient's visits to the dentist. It is a public social health problem. The perception of halitosis is different in culturally diverse populations. So the dental professionals should be aware of the cultural perceptions of halitosis among racially and culturally diverse populations. There is a need to integrate the cultural awareness and knowledge about halitosis among the dental professional for better understanding of halitosis to treat patients with the social dilemma of halitosis to improve the quality of life and well-being of individuals with the problem. It is concluded that dental professionals (especially dental hygienists) should be prepared to practice in a culturally diverse environment in a sensitive and appropriate manner, to deliver optimal oral health and hygiene care.     

Relationship between the oral cavity and cardiovascular diseases and metabolic syndrome

The components of the human body are closely interdependent; as a result, disease conditions in some organs or components can influence the development of disease in other body locations. The effect of oral health upon health in general has been investigated for decades by many epidemiological studies. In this context, there appears to be a clear relationship between deficient oral hygiene and different systemic disorders such as cardiovascular disease and metabolic syndrome. The precise relationship between them is the subject of ongoing research, and a variety of theories have been proposed, though most of them postulate the mediation of an inflammatory response. This association between the oral cavity and disease in general requires further study, and health professionals should be made aware of the importance of adopting measures destined to promote correct oral health. The present study conducts a Medline search with the purpose of offering an update on the relationship between oral diseases and cardiovascular diseases, together with an evaluation of the bidirectional relationship between metabolic syndrome and periodontal disease. Most authors effectively describe a moderate association between the oral cavity and cardiovascular diseases, though they also report a lack of scientific evidence that oral alterations constitute an independent cause of cardiovascular diseases, or that their adequate treatment can contribute to prevent such diseases. In the case of metabolic syndrome, obesity and particularly diabetes mellitus may be associated to an increased susceptibility to periodontitis. However, it is not clear whether periodontal treatment is able to improve the systemic conditions of these patients. Key words:Cardiovascular diseases, periodontitis, metabolic syndrome, obesity, diabetes mellitus.     

Diabetes mellitus, periapical inflammation and endodontic treatment outcome

The possible connection between chronic oral inflammatory processes, such as apical periodontitis and periodontal disease (PD), and systemic health is one of the most interesting aspects faced by the medical and dental scientific community. Chronic apical periodontitis shares important characteristics with PD: 1) both are chronic infections of the oral cavity, 2) the Gram-negative anaerobic microbiota found in both diseases is comparable, and 3) in both infectious processes increased local levels of inflammatory mediators may have an impact on systemic levels. One of the systemic disorders linked to PD is diabetes mellitus (DM); is therefore plausible to assume that chronic apical periodontitis and endodontic treatment are also associated with DM. The status of knowledge regarding the relationship between DM and endodontics is reviewed. Upon review, we conclude that there are data in the literature that associate DM with a higher prevalence of periapical lesions, greater size of the osteolityc lesions, greater likelihood of asymptomatic infections and worse prognosis for root filled teeth. The results of some studies suggest that periapical disease may contribute to diabetic metabolic dyscontrol.