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Dental intervention in patients with type 2 diabetes improved their oral health-related quality of life, a pilot study in the Netherlands showed.
According to researchers, periodontitis is a complication of diabetes mellitus. In addition, patients with diabetes appear to have a higher prevalence of other oral diseases such as dry mouth, candida infections, taste disorders, and oral malignancies.
Dental intervention in patients with type 2 diabetes improved their oral health-related quality of life, a pilot study in the Netherlands showed.
Photo source: Adobe Stock
“Clinical, fundamental, and epidemiological research on the relationship between diabetes and oral health has accumulated over several decades.” Martijn JL Verhulst, a PhD student in the Department of Periodontology at the University of Amsterdam and Vrije Universiteit in the Netherlands, said Healio Primary Care. “We believed it was time to examine how primary care doctors use this knowledge on a daily basis can ensure that the patients actually benefit from it. “
Martijn Verhulst
Verhulst recruited 24 general practitioner practices and randomly assigned them in a 1: 1 ratio to an experimental cohort or a control cohort. The practices selected which patients with type 2 diabetes would take part in the study. Those in the experimental cohort received:
- repeated communications on the importance of good oral health and the need to brush with a soft toothbrush and fluoride toothpaste twice a day;
- frequent encouragement to visit the dentist and, since oral care is not covered by the compulsory basic insurance in the Netherlands, the paperwork that would be required to visit a dentist twice a year; and
- Oral hygiene product kits and a booklet containing information on the relationship between diabetes and oral health.
The general practitioners in the control cohort paid no “special attention to oral health” to their patients with diabetes, Verhulst and colleagues wrote in the Annals of Family Medicine.
The researchers reported that of the 764 patients in the study, 543 completed the majority of the 14-point oral health impact profile – a survey that measured the incidence of functional limitations, physical pain, mental difficulties, disabilities, and physical, mental and Social disability measures – at the starting point and 1 year later.
More patients in the experimental cohort reported that their oral health improved compared to the control cohort (35.2% vs. 25.9%; p = 0.046). A post-hoc secondary analysis that included the 18 primary care practices where 60% or more of patients completed the oral health impact profile also favored 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 the experiment had minimal impact on the overall health of the participants.
Verhulst encouraged doctors to find time to talk to their patients about oral health.
“In some cases, this identifies a previously undiagnosed periodontal disease, which can then be treated accordingly,” he said in an interview. “Beyond these potential benefits, the effects of poor oral health on quality of life, social life, language, self-confidence, chewing, pain, loss of productivity, etc. should be reason enough to take an interdisciplinary approach.”
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Lisa Simon, MD, DMD
In many ways, this study proves what we already know about many other health outcomes and behaviors: motivational interviews and longitudinal support from a primary care team help empower patients. It is high time these principles were applied to oral health as well.
This study leverages the team-based care and trusting relationships with primary care that patients have already had to help them achieve better oral health, which all of us who work in primary care should strive for. I also think it’s wonderful that this study focuses on oral health-related quality of life – a patient-centered finding.
While there is evolving evidence to suggest that oral health can affect the outcomes of diabetes, more importantly, oral health causes unnecessary suffering in far too many people. Regardless of quantitative clinical results, one result worth celebrating is bringing happier lives to people.
Lisa Simon, MD, DMD
Fellow, Oral Health and Medicine Integration, Harvard School of Dental Medicine
Disclosure: Simon does not report any relevant financial information.
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