journal

Controlling Oral Health in Diabetic Clients with Chronic Periodontitis

Megan Gauley

Algonquin College Dental Clinic

ENL5507

Angela Slonosky

December 5th, 2014

CONTROLLING ORAL HEALTH IN DIABETIC PATIENTS WITH CHRONIC PERIODONTITIS! 1

Abstract

For many years, diabetes and the condition’s effect on oral health has been studied among dental

health care professionals. Clients with diabetes are at a greater risk for periodontal disease. In

order to control periodontal disease in diabetic patients dental health care professionals must

modify the treatment plan to improve overall health. Three studies have been reviewed to outline

the most important concepts a dental health professional can convey to their client to obtain oral

health. The validity of these studies are based on their unbiased research and publishing date. All

publishing dates are within 5 years of 2014. All participants at the time of publication have

chronic periodontitis and diabetes. Plaque indices, gingival condition, HbAC1, total cholesterol

and triglyceride levels are compared among the participants to determine effective methods for

client’s to control their diabetes orally. Data is gathered by using cross-sectional analysis. Initial

scaling and root planing, maintenance appointments and regular oral hygiene have the potential

to improve cholesterol and triglyceride levels and the overall oral condition. Further research is

needed in diet and lifestyle choices of chronic periodontitis diabetic patients and how those

choices effects their oral health.

Keywords: diabetes, chronic periodontitis, oral hygiene


Controlling Oral Health in Diabetic Clients with Chronic Periodontitis Clients with diabetes have a higher percent of gingival recession, mobility, restorations

and missing teeth (Nassar, P., Schmitt Walker, C., Salvador, C., Felipetti, F., Orrico, S., & Nassar,

C., 2011). These dental features indicate the result of periodontitis. Periodontal disease is often

considered a complication with diabetes. If a client does not control their periodontitis, their

blood sugar can be manipulated and vice versa. Dental hygienists see clients who are faced with

this struggle every day. How can dental hygienists assist diabetics in controlling their chronic

periodontitis?

Methods

Three studies were used in this cross-sectional analysis to determine how diabetic clients

can improve their oral condition. All participants of the following studies have been diagnosed

with diabetes and chronic periodontitis. Dental self-efficacy as a determinant to oral health

behaviour, oral hygiene and HbA1c level among diabetic patients is a study published by the

Journal of Clinical Periodontology. This study will further be known as article #1. The main

focus of this study includes patient records, glycated hemoglobin (HbA1c) levels, plaque indices

and quantitative questionnaires. These aspects were used to gather data among 149 subjects

(Syrjälä, A., Kneckt, M., & Knuuttila, M, 1999). Article #2, Diabetes and Oral Health: The

Importance of Oral Health-Related Behaviour, was done over 720 days with 20 adult patients.

This study was used to evaluate improvement of lipids and periodontal disease in patients with

Type II Diabetes. Subjects were divided into two groups. The first group received periodontal

scaling and root planing and oral hygiene education for proper brushing technique. The second

study group was given periodontal scaling and root planing, oral hygiene education for proper


brushing technique and maintenance appointments. They compared blood levels of cholesterol,

triglycerides and clinical periodontal parameters. These comparisons were done at 0, 180 and

720 days (Nassar, P., Schmitt Walker, C., Salvador, C., Felipetti, F., Orrico, S., & Nassar, C.,

2011). Article #3, published in 2014, is titled Effect of nonsurgical periodontal therapy verses

oral hygiene instructions on Type 2 diabetes subjects with chronic periodontitis: a randomised

clinical trial. A group of 15 people obtained Non-Surgical Periodontal Therapy (NSPT) while

the second group of 12 people were treated with oral hygiene education. Plaque index and

glycaemic control were tested at the two month recall visit (Cheta Raman, R., Taiyeb-Ali, T.,

Siew Pheng, C., Chinna, K., & Vaithilingam, R., 2014). All studies demonstrated validity and no

bias.

Results

Demographically, education and age played a factor in the oral health of the diabetic

participants. Younger age groups and those with a higher level of education had superior oral

conditions. Subjects from article #1, displayed lower HbA1c levels on those who had higher

scores on toothbrushing self-efficacy (p=0.020) and toothbrushing frequencies (p=0.032)

(Syrjälä, A., Kneckt, M., & Knuuttila, M, 1999). Plaque indices correlated inversely with

toothbrushing self-efficacy (p=0.012) and dental visiting self-efficacy (p=0.004) (Syrjälä, A.,

Kneckt, M., & Knuuttila, M, 1999).

Results in Article #2 showed there was a statistically significant improvement of total

cholesterol, triglycerides, high-density lipoprotein (HDL) and low-density lipoprotein (LDL).

Advancements were evident at the 720 day recall appointment. The second control group who

received maintenance appointments exhibited further improvements. This group showed a


reduction in probing depths opposed to the first group who saw no change (Nassar, P., Schmitt

Walker, C., Salvador, C., Felipetti, F., Orrico, S., & Nassar, C., 2011).

Table 1

HDLHDL LDLLDL

Group 1Group 1 Group 2Group 2

1st exam (0) 43.6 33.4 137.0 127.9

2nd exam (180 days) 44.6 45.7 135.8 115.8

3rd exam (720 days) 50.4 46.1 104.3 110.3

Table 1 displays the average figures of HDL and LDL of the 3 periods studied (0, 180 and 720

days). The values are displayed are expressed as mean. (Nassar, P., Schmitt Walker, C., Salvador,

C., Felipetti, F., Orrico, S., & Nassar, C., 2011)

Article #3 outlined the role of dental health care professionals. Baseline data for the

subjects who participated in the study differentiating the effects of NSPT and oral hygiene

education showed no significant findings. However, at the two month recall appointment there

was a notable difference in plaque indices (p=0.013) among the two groups. In the oral hygiene

education group, the average Probing Pocket Depth (PPD) reduced by less than 50% at the two

month recall appointment (p < 0.001). Additionally, the average PPD within the NSPT group

decreased from 6 mm at baseline to 2 mm at the two month recall (p = 0.004) (Cheta Raman, R.,

Taiyeb-Ali, T., Siew Pheng, C., Chinna, K., & Vaithilingam, R., 2014). Although the oral

hygiene education group had significant data, the NSPT group showed a greater difference in the

improvement of oral health.


Discussion

Client compliance is the most fundamental part of controlling chronic periodontitis in

diabetic patients. The mechanical removal of plaque by toothbrushing has the ability to lower the

amount of glycated hemoglobin in the bloodstream. Non-Surgical Periodontal Therapy, even

more so, lowered the content of total cholestrol, HDL, LDL and triglycerides. Reduced plaque

indices and pocket depths within the studies are related to repetitive professional debridement by

dental hygienists. Maintenance appointments not only eliminate plaque retentive factors but also

make it easier for the client to control. Therefore, diabetics who have received proper brushing

and plaque control procedures can clinically improve metabolic control. These findings support

the urgency that diabetic patients can not rely on medication to control their condition when

faced with chronic periodontitis. Dental visits, routine home care and maintenance appointments

can reduce both the visible signs of periodontal disease and the fatty compounds within the body.

Conclusion

Dental hygienists must strive to provide clients with knowledge and resources to obtain

their full oral health potential. Diabetics, who are already disadvantaged when it comes to oral

health, must be given proper oral hygiene education. Dental hygienists are in the position to

discuss with their clients the importance of meticulous oral hygiene care and outline the risks

associated with diabetes. If the patient complies with frequent dental visits, as well as with daily

oral hygiene routines, their oral condition will improve. Therefore, diabetics overall health will

ameliorate related to the improving levels of glycated hemoglobin. Exceptional oral health is the

gateway to overall health.


Recommendations

1. Client education must to be a crucial component to the treatment plan. Consulting with the

client’s physician through interprofessional collaboration may be the key to a clients ability to

control their condition. With this being said, dental health care professionals must participate

in continued learning regarding diabetes to better advocate for oral health.

2. Further research is needed to determine how oral hygiene, dental visits and maintenance

appointments effect those with different dietary habits. Although, in the reviewed studies

participants showed statistically significant changes in their metabolic control. However, there

was no data regarding the lifestyle choices they made while in the duration of the study and if

those choices had any effect on blood levels.


References

Cheta Raman, R., Taiyeb-Ali, T., Siew Pheng, C., Chinna, K., & Vaithilingam, R. (2014). Effect

of nonsurgical periodontal therapy verses oral hygiene instructions on Type 2 diabetes

subjects with chronic periodontitis: a randomised clinical trial. BMC Oral Health, 14(1),

2-19. doi: 10.1186/1472-6831-14-79.

Nassar, P., Schmitt Walker, C., Salvador, C., Felipetti, F., Orrico, S., & Nassar, C. (2011). Lipid

profile of people with Diabetes mellitus type 2 and periodontal disease. Diabetes

Research and Clinical Practice, 96, 35-39.

Syrjälä, A., Kneckt, M., & Knuuttila, M. (1999). Dental self-efficacy as a determinant to oral

health behaviour, oral hygiene and HbA1c level among diabetic patients. Journal Of

Clinical Periodontology, 26(9), 616-621.


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