Awareness of Oral Complications and Oral Hygiene Habits of Subjects with Diagnosed Diabetes Mellitus

Open access


Background/Aim: The aim was to evaluate Diabetes Mellitus (DM) patients’ awareness of their risk for oral and dental complications, to evaluate their oral health behaviors, assess their sources of related information, and to detect the influence of their awareness on oral health and dental management.

Material and Methods: Total of 240 DM patients presenting to a university outpatient dental facility for routine care completed a self-administered questionnaire about demographic-socioeconomic characteristics, oral health care and awareness on oral complications of DM. Dental status of each patient was recorded. Data were analyzed with Chi- square test; p was set as 0.05.

Results: The patients’ mean age was 52.85 years; the majority had Type 2 DM (72.1%) and 61.7% were females. Two thirds of the patients had tooth loss; 65% brushed daily and used toothpick for interproximal cleaning (35%). Only 12.9% had regular dental visits and 37.5% reported their oral health as “poor”. DM patients rarely received guidance from their health care professionals regarding their oral health (28.3%). Even though 62.5% were aware of oral complications of DM, only 46.3% knew that oral health may affect DM. The patients with Type 1 and Type 2 DM had similar perceptions about their oral health status (p=0.15>0.05). However, insulin users were more aware of the interaction between oral health and DM (p>0.05), and were more likely to consider their oral health as “poor” (p>0.05).

Conclusions: DM patients’ awareness of the effect of DM on oral health was higher than that of the effect of oral health on DM management. Medical health care providers were failing to provide the necessary information regarding these issues when compared to dentists.

1. Moore PA, Orchard T, Guggenheimer J, Weyant RJ. Diabetes and oral health promotion: A survey of disease prevention behaviors. J Am Dent Assoc, 2000;131:1333-1341.

2. Amos AF, McCarty DJ, Zimmet P. The Rising Global Burden of Diabetes and its Complications: Estimates and Projections to the Year 2010. Diabet Med, 1997;14:S7-S85.

3. Eldarrat A. Diabetics’ Awareness of Oral Disorders Associated with Diabetes Mellitus. Review. 2011.

4. International Diabetes Federation.

5. Ship JA, Chavez EM. Special Senses: Disorders of Taste and Smell. In: Silverman S Jr, Eversole LR, Truelove EL, Eds. Essentials of Oral Medicine. Hamilton, London: BC Decker Inc, 2001;279-280.

6. Ship JA. Diabetes and oral health: An overview. J Am Dent Assoc, 2003;134:4-10.

7. Manfredi M, McCullough MJ, Vescovi P, Al-Kaarawi ZM, Porter SR. Update on diabetes mellitus and related oral diseases. Oral Dis, 2004;10:187-200.

8. Grossi SG, Skrepcinski FB, DeCaro T, Robertson DC, Ho AW, Dunford RG, et al. Treatment of periodontal disease in diabetics reduces glycated hemoglobin. J Periodontol, 1997;68:713-719.

9. Faria-Almeida R, Navarro A, & Bascones A. Clinical and metabolic changes after conventional treatment of Type 2 diabetic patients with chronic periodontitis. J Periodontol, 2006;77:591-598.

10. Daly B, Arroll B, Kenealy T, Sheridan N, Scragg R. Management of diabetes by primary health care nurses in Auckland, New Zealand. J Prim Health Care, 2015;7:42-49.

11. Boyle E, Saunders R, Drury V. A qualitative study of patient experiences of Type 2 Diabetes care delivered comparatively by General Practice Nurses and Medical Practitioners. J Clin Nurs, 2016;25:1977-1986.

12. Yuen HK, Mountford WK, Magruder KM, Bandyopadhyay D, Hudson PL, Summerlin LM, et al. Adequacy of oral health information for patients with diabetes. J Public Health Dent, 2009;69:135-141.

13. Al-Khabbaz AK, Al-Shammari KF. Diabetes mellitus and periodontal health: dentists’ knowledge. Med Princ Pract, 2011;20:538-544.

14. Al-Khabbaz AK, Al-Shammari KF, Al-Saleh NA. Knowledge about the association between periodontal diseases and diabetes mellitus: contrasting dentists and physicians. J Periodontol, 2011;82:360-366.

15. Friesen LR, Walker MP, Kisling RE, Liu Y, Williams KB. Knowledge of risk factors and the periodontal disease-systemic link in dental students’ clinical decisions. J Dent Educ, 2014;78:1244-1251.

16. Paquette DW, Bell KP, Phillips C, Offenbacher S, Wilder RS. Dentists’ knowledge and opinions of oral-systemic disease relationships: relevance to patient care and education. J Dent Educ, 2015;79:626-635.

17. Habashneh R, Barghout N, Humbert L, Khader Y, Alwaeli H. Diabetes and oral health:doctors’ knowledge, perception and practices. J Eval Clin Pract, 2010;16:976-980.

18. Owens JB, Wilder RS, Southerland JH, Buse JB, Malone RM. North Carolina internists’ and endocrinologists’ knowledge, opinions, and behaviors regarding periodontal disease and diabetes: need and opportunity for interprofessional education. J Dent Educ, 2011;75:329-338.

19. Lopes MH, Southerland JH, Buse JB, Malone RM, Wilder RS. Diabetes educators’ knowledge, opinions and behaviors regarding periodontal disease and diabetes. J Dent Hyg, 2012;86:82-90.

20. Allen EM, Ziada HM, O’Halloran D, Clerehugh V, Allen PF. Attitudes, awareness and oral health-related quality of life in patients with diabetes. J Oral Rehabil, 2008;35:218-223.

21. Taiwo JO. Oral health education needs of diabetic patients in Ibadan. Afr J Med Med Sci, 2000;29:269-274.

22. Habashneh R, Khader Y, Hammad MM, Almuradi M. Knowledge and awareness about diabetes and periodontal health among Jordanians. J Diabetes Complications, 2010;24:409-414.

23. Eldarrat AH. Diabetic patients: their knowledge and perception of oral health. Libyan J Med, 2011;9:6.

24. Eldarrat AH. Awareness and attitude of diabetic patients about their increased risk for oral diseases. Oral Health Prev Dent, 2011;9:235-241.

25. Yuen HK, Wolf BJ, Bandyopadhyay D, Magruder KM, Salinas CF, London SD. Oral health knowledge and behavior among adults with diabetes. Diabetes Res Clin Pract, 2009;86:239-246.

26. Bowyer V, Sutcliffe P, Ireland R, Lindenmeyer A, Gadsby R, Graveney M, et al. Oral health awareness in adult patients with diabetes: a questionnaire study. Br Dent J, 2011;23:211:E12.

27. Akyüz S, Yarat A, Bayer H, Ipbuker A. Diabetic patient’s knowledge level on oral health and habits (questionnaire). OHDMBSC, 2004;III:11-14.

28. Faten MRI, Neima A. Diabetic Patients Knowledge, Attitude and Practice toward Oral Health. J Educ Pract, 2013;4:19-25.

29. Kamat DG, Nayak SU, Pai KK, Shenoy R. Knowledge and awareness of oral health among diabetic patients-a cross-sectional study from Mangalore City. Int J Diabetes Dev Ctries, 2015;35:71-75.

30. Albert DA, Ward A, Allweiss P, Graves DT, Knowler WC, Kunzel C, et al. Diabetes and oral disease: implications for health professionals. Ann N Y Acad Sci, 2012;1255:1-5.

31. Simpson TC, Weldon JC, Worthington HV, Needleman I, Wild SH, Moles DR, et al. Treatment of periodontal disease for glycaemic control in people with diabetes mellitus. Cochrane Database Sys Rev, 2015;11:CD004714.

32. Cheng L, Leung DY, Wu YN, Sit JW, Yang MY, Li XM. Psychometric Properties of the Modified Personal Diabetes Questionnaire Among Chinese Patients With Type 2 Diabetes. Eval Health Prof, 2018;41:3-24.

33. Martin D, Elie C, Dossier C, Godot C, Gagnayre R, Choleau C, et al. AJD Study Group. Diabetes knowledge in adolescents with type 1 diabetes and their parents and glycemic control. Pediatr Diabetes, 2017;18:559-565.

34. Kawamura M, Fukuda S, Kawabata K, IwamotoY. Comparison of health behaviour and oral/medical conditions in non-insulin-dependent (type II) diabetics and non-diabetic. Aust Dent J, 1998;43:315-320.

35. Mirza KM, Khan AA, Ali MM, Ghaudhry S. Oral health Knowledge, Attitude, and Practices and Sources of Information for Diabetic Patients in Lahore, Pakistan. Diabetes Care, 2007;30:3046-3047.

36. Delong L, Burkhart N. Endocrine disorders. In general and oral pathology for the dental hygienist. Philadelphia: Lippincott Williams & Wilkins 2008;147-178.

37. Forouhi NG, Wareham NJ. Epidemiology of diabetes. Medicine (Abingdon), 2014;42:698-702.

38. Bin Abdulrahman KA. Diabetes mellitus and its oral complications: A brief review. Pakistan Oral & Dent Jr, 2006;26:97-100.

39. American Diabetes Association. Classification and diagnosis of diabetes. Diabetes Care, 2015;38:8-16.

40. Bahammam MA. Periodontal health and diabetes awareness among Saudi diabetes patients. Patient Prefer Adherence, 2015;9:225-233.

41. Sandberg GE, Sundberg HE, Wikblad KF. A controlled study of oral self-care and self-perceived oral health in type 2 diabetic patients. Acta Odontol Scand, 2001;59:28-33.

42. Karikoski A, Ilanne-Parikka P, Murtomaa H. Oral self-care among adults with diabetes in Finland. Community Dent Oral Epidemiol, 2002;30:216-223.

43. Commisso L, Monami M, Mannucci E. Periodontal disease and oral hygiene habits in a type 2 diabetic population. Int J Dent Hyg, 2011;9:68-73.

44. Apoorva SM, Sridhar N, Suchetha A. Prevalence and severity of periodontal disease in type 2 diabetes mellitus (non-insulin-dependent diabetes mellitus) patients in Bangalore city: An epidemiological study. J Indian Soc Periodontol, 2013;17:25-29.

45. Bakhshandeh S, Murtomaa H, Vehkalahti MM, Mofid R, Suomalainen K. Oral self-care and use of dental services among adults with diabetes mellitus. Oral Health Prev Dent, 2008;6:279-286.

46. Tomar SL, Lester A. Dental and other health care visits among U.S. adults with diabetes. Diabetes Care, 2000;23:1505-1510.

47. Kanli A, Kanbur NO, Dural S, Derman O. Effects of oral health behaviors and socioeconomic factors on a group of Turkish adolescents. Quintessence Int, 2008;39:e26-32.

48. Peker I, Alkurt MT. Oral impacts on daily performance in Turkish adults attending a dental school. J Contemp Dent Pract, 2014;15:92-98.

49. Kamel NM, Badawy YA, El-Zeiny NA, Merdan IA. Sociodemographic determinants of management behaviour of diabetic patients. II. Diabetics’ knowledge of the disease and their management behaviour. East Mediterr Health J, 1999;5:974-983.

50. Jansson H, Lindholm E, Lindh C, Groop L, Bratthall G. Type 2 diabetes and risk for periodontal disease: a role for dental health awareness. J Clin Periodontol, 2006;33:408-414.

51. Valerio MA, Kanjirath PP, Klausner CP, Peters MC. A qualitative examination of patient awareness and understanding of type 2 diabetes and oral health care needs. Diabetes Res Clin Pract, 2011;93:159-165.

52. Emrich LJ, Shlossman M, Genco RJ. Periodontal disease in non-insulin-dependent diabetes mellitus. J Periodontol, 1991;62:123-131.

53. Grossi SG, Genco RJ. Periodontal disease and diabetes mellitus: a two-way relationship. Ann Periodontol, 1998;3:51-61.

54. Iwamoto Y, Nishimura F, Nakagawa M, Sugimoto H, Shikata K, Makino H, et al. The effect of antimicrobial periodontal treatment on circulating tumor necrosis factor-alpha and glycated hemoglobin level in patients with type 2 diabetes. J Periodontol, 2001;72:774-778.

55. Stewart JE, Wager KA, Friedlander AH, Zadeh HH. The effect of periodontal treatment on glycemic control in patients with type 2 diabetes mellitus. J Clin Periodontol, 2001;28:306-310.

56. Taylor GW. Bidirectional interrelationships between diabetes and periodontal diseases: an epidemiological perspective. Ann Periodontol, 2001;6:99-112.

57. Rodrigues DC, Taba MJ, Novaes AB, Souza SL, Grisi MF. Effect of non-surgical periodontal therapy on glycemic control in patients with type 2 diabetes mellitus. J Periodontol, 2003;74:1361-1367.

58. Stanko P, Izakovicova Holla L. Bidirectional association between diabetes mellitus and inflammatory periodontal disease. A review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub, 2014;158:35-38.

59. Siminerio LM, Funnell MM, Peyrot M, Rubin RR. US nurses’ perceptions of their role in diabetes care: results of the cross-national Diabetes Attitudes Wishes and Needs (DAWN) study. Diabetes Educ, 2007;33:152-162.

60. van Dijk CE, Verheij RA, Hansen J, van der Velden L, Nijpels G, Groenewegen PP, et al. Primary care nurses: effects on secondary care referrals for diabetes. BMC Health Serv Res, 2010;10:230.

61. Walsh JL, Harris BH, Roberts AW. Evaluation of a community diabetes initiative: Integrating diabetes care. Prim Care Diabetes, 2015;9:203-210.

62. Ishani A, Greer N, Taylor BC, Kubes L, Cole P, Atwood M, et al. Effect of nurse case management compared with usual care on controlling cardiovascular risk factors in patients with diabetes: a randomized controlled trial. Diabetes Care, 2011;34:1689-1694.

Balkan Journal of Dental Medicine

Successor of the Balkan Journal of Stomatology

Journal Information


All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 120 120 46
PDF Downloads 71 71 27