Relationship between type 2 diabetes and oral health status

Abstract

Aims: This prospective cross-sectional study aimed to compare the decayed, missing, filled teeth (DMFT) index values and dental caries prevalence of patients with type 2 diabetes mellitus (T2DM) to those of healthy individuals, and to examine the effect of inadequate glycemic control on DMFT and caries prevalence. Methods: T2DM patients were divided into two groups based on metabolic control: well-controlled (WC; HbA1c ≤7%) and poorly controlled (PC; HbA1c >7%). The clinical parameters assessed were the number of natural teeth, the coronal DMFT index, the simplified oral hygiene index (OHI-S), and body-mass index (BMI). Results: The DMFT index and number of filled teeth were similar between the WC and healthy control groups. In contrast, the PC group showed significantly higher values than both the WC and control groups. The highest DMFT index (14.38) was observed in the PC group, and the lowest (9.90) in the control group (p<0.001). Conclusion: Patients with poor glycemic control exhibited higher DMFT and filled-teeth (FT) index values than those with good glycemic control. No difference was determined in the decay index between diabetic patients with good or poor glycemic control, and the healthy subjects.

Keywords

• DMFT
• decay
• filling
• HbA1c
• diabetes

References

1. Chatterjee S, Khunti K, Davies M. Type 2 diabetes. Lancet. 2017; 389(10085):2239-2251. doi:10.1016/S0140-6736(17)30058-2
2. Aranaz P, Navarro-Herrera D, Zabala M, et al. American Diabetes Association 2010: diagnosis and classification of diabetes mellitus. Diabetes Care. 2023;33(1):S62-S69. doi:10.25403/UPresearchdata. 23256521
3. Leite RS, Marlow NM, Fernandes JK, Hermayer K. Oral health and type 2 diabetes. Am J Med Sci. 2013;345(4):271-273. doi:10.1097/MAJ. 0b013e31828bdedf
4. Löe H. Periodontal disease. The sixth complication of diabetes mellitus. Diabetes Care. 1993;16(1):329-334. doi:10.2337/diacare.16.1.329
5. Urzua I, Mendoza C, Arteaga O, et al. Dental caries prevalence and tooth loss in Chilean adult population: first national dental examination survey. Int J Dent. 2012;2012:810170. doi:10.1155/2012/810170
6. Malvania EA, Sheth SA, Sharma AS, Mansuri S, Shaikh F, Sahani S. Dental caries prevalence among type II diabetic and nondiabetic adults attending a hospital. J Int Soc Prev Community Dent. 2016;6(Suppl 3): S232-S236. doi:10.4103/2231-0762.197202
7. Collin HL, Uusitupa M, Niskanen L, Koivisto AM, Markkanen H, Meurman JH. Caries in patients with non–insulin-dependent diabetes mellitus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;85(6): 680-685. doi:10.1016/s1079-2104(98)90035-x
8. Taylor GW, Manz MC, Borgnakke WS. Diabetes, periodontal diseases, dental caries, and tooth loss: a review of the literature. Compend Contin Educ Dent. 2004;25(3):179-184.

9. Lin BP, Taylor GW, Allen DJ, Ship JA. Dental caries in older adults with diabetes mellitus. Spec Care Dent. 1999;19(1):8-14. doi:10.1111/j.1754- 4505.1999.tb01361.x
10. Bakhshandeh S, Murtomaa H, Vehkalahti MM, Mofid R, Suomalainen K. Dental findings in diabetic adults. Caries Res. 2008;42(1):14-18. doi: 10.1159/000111745
11. Yonekura S, Usui M, Murano S. Association between numbers of decayed teeth and HbA1c in Japanese patients with type 2 diabetes mellitus. Ups J Med Sci. 2017;122(2):108-113. doi:10.1080/03009734.2017. 1285838
12. Akpata ES, Alomari Q, Mojiminiyi OA, Al-Sanae H. Caries experience among children with type 1 diabetes in Kuwait. Pediatr Dent. 2012;34(7): 468-472.
13. Saes Busato IM, Bittencourt MS, Machado MA, et al. Association between metabolic control and oral health in adolescents with type 1 diabetes mellitus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109(3):e51-e56. doi:10.1016/j.tripleo.2009.10.037
14. Sampaio N, Mello S, Alves C, et al. Dental caries–associated risk factors and type 1 diabetes mellitus. Pediatr Endocrinol Diabetes Metab. 2011; 17(3):152-157.
15. American Diabetes Association. Glycemic targets: Standards of Medical Care in Diabetes 2020. Diabetes Care. 2020;43(Suppl 1):S66-S76. doi:10. 2337/dc20-S006
16. American Diabetes Association. Classification and diagnosis of diabetes: Standards of Medical Care in Diabetes 2021. Diabetes Care. 2021;44(Suppl 1):S15-S33. doi:10.2337/dc21-S002
17. American Diabetes Association. Glycemic targets: Standards of Medical Care in Diabetes 2021. Diabetes Care. 2021;44(Suppl 1):S73-S84. doi:10. 2337/dc21-S006
18. Petersen PE, Baez RJ. Oral health surveys: basic methods. 3rd ed. Geneva: World Health Organization; 2013.
19. Greene JC, Vermillion JR. The oral hygiene index: a method for classifying oral hygiene status. J Am Dent Assoc. 1960;61(2):172-179. doi: 10.14219/jada.archive.1960.0177
20. Miko S, Ambrus SJ, Sahafian S, Dinya E, Tamas G, Albrecht MG. Dental caries and adolescents with type 1 diabetes. Br Dent J. 2010;208(6):E12. doi:10.1038/sj.bdj.2010.290
21. Rahiotis C, Petraki V, Mitrou P. Changes in saliva characteristics and carious status related to metabolic control in patients with type 2 diabetes mellitus. J Dent. 2021;108:103629. doi:10.1016/j.jdent.2021.103629
22. Reddy C, Maurya M. A comparative study to assess the oral health status and treatment needs of diabetics and nondiabetic population attending some of the hospitals in Mysore City. J Indian Assoc Public Health Dent. 2008;6(12):1-14.
23. Singh I, Singh P, Singh A, Singh T, Kour R. Diabetes as an inducing factor for dental caries: a case–control analysis in Jammu. J Int Soc Prev Community Dent. 2016;6(2):125-129. doi:10.4103/2231-0762.178748
24. Kanjirath PP, Kim SE, Rohr Inglehart M. Diabetes and oral health: the importance of oral health–related behavior. J Dent Hyg. 2011;85(4):264-272.
25. Lalla RV, D’Ambrosio JA. Dental management considerations for the patient with diabetes mellitus. J Am Dent Assoc. 2001;132(10):1425-1432. doi:10.14219/jada.archive.2001.0059
26. Aziz HK. The relationship between dental caries and blood glucose level among type II non–insulin-dependent diabetic patients. J Bagh Coll Dent. 2012;24(Suppl 1):108-114.
27. Gupta VK, Malhotra S, Sharma V, Hiremath SS. The influence of insulin-dependent diabetes mellitus on dental caries and salivary flow. Int J Chronic Dis. 2014;2014:790898. doi:10.1155/2014/790898
28. Zhou G, Shu X, Long Y, et al. Dental caries and salivary alterations in patients with type 2 diabetes: a systematic review and meta‐analysis. J Dent. 2024;150:105321. doi:10.1016/j.jdent.2024.105321
29. Latti BR, Kalburge JV, Birajdar SB, Latti RG. Evaluation of relationship between dental caries, diabetes mellitus, and oral microbiota in diabetics. J Oral Maxillofac Pathol. 2018;22(2):282. doi:10.4103/jomfp.JOMFP_163_16
30. Majbauddin A, Tanimura C, Aoto H, et al. Association between dental caries indicators and serum glycated hemoglobin levels among patients with type 2 diabetes mellitus. J Oral Sci. 2019;61(2):335-342. doi:10.2334/josnusd.18-0156
31. Selwitz RH, Ismail AI, Pitts NB. Dental caries. Lancet. 2007;369(9555):51-59. doi:10.1016/S0140-6736(07)60031-2
32. Moore PA, Weyant RJ, Mongelluzzo MB, et al. Type 1 diabetes mellitus and oral health: assessment of periodontal disease. J Periodontol. 1999; 70(4):409-417. doi:10.1902/jop.1999.70.4.409
33. Kogawa EM, Grisi DC, Falcão DP, et al. Impact of glycemic control on oral health status in type 2 diabetes individuals and its association with salivary and plasma levels of chromogranin A. Arch Oral Biol. 2016;62: 10-19. doi:10.1016/j.archoralbio.2015.11.005
34. Zero D, Fontana M, Lennon AM. Clinical applications and outcomes of using indicators of risk in caries management. J Dent Educ. 2001;65(10): 1126-1132. doi:10.1002/j.0022-0337.2001.65.10.tb03461.x
35. Negrato CA, Tarzia O. Buccal alterations in diabetes mellitus. Diabetol Metab Syndr. 2010;2:3. doi:10.1186/1758-5996-2-3
36. Das D, Gupta R, Menon I, Sharma A, Arora V, Ahsan I. Oral health status among type 2 diabetic versus nondiabetic adult population of Muradnagar: a cross-sectional comparative study. Asian J Pharm Res. 2022;14(1):34-42. doi:10.4103/ajprhc.ajprhc_1_21
37. Hintao J, Teanpaisan R, Chongsuvivatwong V, Dahlen G, Rattarasarn C. Root surface and coronal caries in adults with type 2 diabetes mellitus. Community Dent Oral Epidemiol. 2007;35(4):302-309. doi:10.1111/j. 1600-0528.2007.00325.x