Poor Oral Hygiene Linked To Development of Diabetes

March 3, 2020
Patrick Campbell

An analysis of 180,000 patients in South Korea is shedding new light on the potential poor oral hygiene can have on a person's risk 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.