Periodontitis is a complication of diabetes mellitus, according to researchers. In addition, patients with diabetes appear to have a higher prevalence of other oral conditions such as dry mouth, Candida infections, taste disorders and oral malignancies.
“Clinical, fundamental and epidemiological research into the connection between diabetes and oral health has been accumulating over several decades,” Martijn J. L. Verhulst, a PhD candidate in the department of periodontology at the University of Amsterdam and Vrije Universiteit in the Netherlands, told Healio Primary Care. “We believed now was the time to investigate how clinicians in primary care could use that knowledge on a daily basis, in a way that actually benefits patients.”
Verhulst recruited 24 family medicine practices and randomly assigned them in a 1:1 ratio to be part of an experimental cohort or a control cohort. The practices chose which patients with type 2 diabetes would participate in the study. Those in the experimental cohort received:
- repeated messages about the importance of good oral health and the need to brush twice daily with a soft toothbrush and a fluoride toothpaste;
- frequent encouragement to visit a dentist and, since oral care is not covered under the Netherlands’ mandatory basic health care insurance, the paperwork that would be required to see a dentist twice annually; and
- kits that contained oral hygiene products and a brochure with information on the link between diabetes and oral health.
The family practitioners in the control cohort did not provide any “extra attention to oral health” for their patients with diabetes, Verhulst and colleagues wrote in Annals of Family Medicine.
The researchers reported that among the 764 patients in the study, 543 completed most of the 14-item Oral Health Impact Profile — a survey that measures frequency of functional limitations, physical pain, psychologic difficulties, handicaps and physical, psychologic and social disabilities — at baseline and 1 year later.
More patients in the experimental cohort said their oral health improved compared with the control cohort (35.2% vs. 25.9%; P = .046). A secondary post hoc analysis that included the 18 family medicine practices where 60% or more of the patients completed the Oral Health Impact Profile also favoured the experimental cohort (38.3% vs. 24.9%, P = .011). There was no significant improvement in the number of self-reported oral health complaints among the cohorts, and the researchers said that the experiment had a minimal effect on the general health of its participants.
Verhulst encouraged physicians to find time to discuss oral health with their patients.
“In a number of cases, this will result in the identification of previously undiagnosed periodontitis, which can then be treated appropriately,” he said in the interview. “Beyond this potential benefit, the impact poor oral health has on quality of life, social life, speech, self-confidence, chewing, pain, loss of productivity, etc., should be reason enough to strive for an interdisciplinary approach.”
Lisa Simon, MD, DMD
In many ways, this study proves what we already know about lots of other health outcomes and behaviours: motivational interviewing and longitudinal support from a primary care team helps empower patients. It is high time these principles were also applied to oral health.
This study leverages the team‐based care and trusting primary care relationships patients already had to help them achieve better oral health, something all of us who work in primary care should aspire to. I also think it is wonderful that this study focused on oral health‐related quality of life — a patient‐centred outcome.
While there is a developing evidence base that suggests oral health may affect diabetes outcomes, what is far more important is that oral health causes unnecessary suffering for far too many people. Independent of quantitative clinical outcomes, allowing people to live happier lives is an outcome worth celebrating.
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