Poor Oral Hygiene Linked To Development of Diabetes

Tae-Jin Song, MD

More information on the relationship between oral hygiene and overall health was revealed through the results of a recent analysis examining periodontal disease and oral hygiene indicators with new-onset diabetes by a team of investigators from South Korea.

Results of the analysis revealed brushing 3 times daily lowered risk of diabetes by 8% while missing teeth increased risk of new-onset diabetes by 21% and presence of periodontal disease was associated with a 9% increase in risk.

In an effort to determine the role of inflammation and transient bacteremia, investigators sought to conduct a study with the goal of assessing how periodontal disease and oral hygiene indicators would be associated with occurrence of new-onset diabetes. With this in mind, a team of investigators from Seoul Hospital and Ewha Womans University College of Medicine carried out an analysis of >180,0000 patients from the National Health Insurance System-Health Screening Cohort (NHIS-HEALS) in Korea.

From NHIS-HEALS, investigators were able to obtain data on patient demographics, past medical history, oral hygiene indicators, and laboratory findings. Oral hygiene behaviors—including the number of tooth brushings, a dental visit for any reason, or professional dental cleanings—were collected as self-reported data from dental health check-ups and the number of missing teeth was ascertained by dentists during an examination.

A total of 183,013 patients was identified for inclusion. From this group, 17.5% were determined to have periodontal disease. Over a median follow-up of 10 years, 31,545 subjects developed diabetes—correlating to an event rate of 16.1% (95% CI, 15.9-16.3).

Additionally, 44% of participants visited a dental clinic for any reason and 1.1% were missing 145 or more teeth. Investigators also noted 42.6% of subjects brushed 3 or more times per day and 25.9% visited a dental clinic for a cleaning at least once a year.

Multivariable models adjusted for factors including exercise, demographics, smoking status, alcohol consumption, and more indicated the presence of periodontal disease (HR 1.09, 95% CI 1.07-1.12, P <.001) and having more than 15 missing teeth were associated with an increased risk of new-onset diabetes (HR 1.21, 95% CI 1.09-1.33, P <.001) (P for trend <.001).

Additionally, tooth brushing 3 or more times a day was associated with a decrease in the occurrence of new-onset diabetes (HR 0.92, 95% CI 0.89, 0.95, P <.001). Professional dental cleaning was not significantly associated with the occurrence of new-onset diabetes, but investigators noted the oral hygiene indicator was associated with a decrease in the occurrence of new-onset diabetes in the invariable analysis.

Based on the results of their study, investigators suggest improvements in oral hygiene could be associated with decreasing risk for the occurrence of new-onset diabetes.

"Frequent tooth brushing may decrease the risk of new-onset diabetes, and the presence of periodontal disease and increased number of missing teeth may increase that risk,” authors wrote. “Overall, improving oral hygiene may be associated with a decreased risk of occurrence of new-onset diabetes."

This study, “Improved oral hygiene is associated with decreased risk of new-onset diabetes: a nationwide population-based cohort study,” was published in Diabetologia.