This is a 3-page summary of the introduction of one of the researches I conducted in my final year in Dental school.
ORAL HEALTH KNOWLEDGE AND PRACTICES OF PATIENTS ATTENDING THE DIABETIC CLINIC IN LAGOS STATE UNIVERSITY TEACHING HOSPITAL (LASUTH), LAGOS, NIGERIA.
Aforka C. Adaora
Diabetes mellitus is a metabolic disorder which is characterized by chronic hyperglycemia associated with symptoms of polyuria, polydipsia and weight loss, sometimes with polyphagia and blurred vision, which may be accompanied by growth impairment and increased susceptibility to certain infections.1It is a chronic disease that occurs either when the pancreas does not produce enough insulin (a hormone that regulates blood sugar) or when the body cannot effectively use the insulin it produces.2
The prevalence of diabetes has increased worldwide to epidemic proportions, The World Health Organization, estimates that cases of diabetes has increased from 30 million in 1985 to 135million in 1995, and is projected to increase from 171 million in 2000 to 366 million by the year 2030.3 In 2014 the global prevalence of diabetes was estimated to be 9% among adults aged 18+ years.2 In 2015, 415 million people had diabetes in the world and more than 14 million people in Africa; however, there were more than 1.56 million cases of diabetes in Nigeria.4 The greatest increase in prevalence is expected to occur in Asia and Africa, this increase in the incidence of diabetes in developing countries follows the trend of urbanization and lifestyle changes.5
Diabetes mellitus (DM) is a significant cause of death; in 2012, an estimated 1.5 million deaths were directly caused by diabetes.2 More than 80% of diabetes deaths occur in low- and middle-income countries.2 Going by these rising figures, WHO projects that diabetes will be the 7th leading cause of death in 2030.3
The most common oral health problems associated with diabetes are: Periodontal disease, gum disease, salivary gland dysfunction, fungal infections, oral burning and taste impairment, oral mucosal diseases including lichen planus and recurrent aphthous stomatitis, dental caries, traumatic ulcers and irritation fibroma.5-7
Despite DM being prevalent in populations worldwide; it is only recently that much attention has been paid to the link between this disease and oral health.
A two-way relationship between periodontitis and diabetes has been described, with each condition having adverse impacts on the other. For example, periodontitis has been associated with a worse long-term glycemic control in people with type 2 diabetes, as well as increased risk of diabetic nephropathy (macroalbuminuria and end-stage renal disease) and cardiorenal mortality (ischaemic heart disease and diabetic nephropathy) combined.8 Periodontitis has also been associated with longitudinal HbA1c increases in people who do not have diabetes, suggesting that periodontal inflammation may influence the risk of developing diabetes.9 Although the emerging evidence linking periodontal disease to cardiovascular diseases and diabetes mellitus has been mainly published in dental journals, the association is still however not widely appreciated amongst healthcare professionals working in cardiology and diabetes.10
In broad terms, the risk of periodontitis is increased approximately three-fold in people with diabetes and the risk is greater with poor glycemic control (i.e. those with HbA1c >75 mmol/mol>9%.8,11 In well-controlled diabetes (HbA1c ?53 mmol/mol ?7%), there appears to be little evidence for an increased risk of periodontitis.12 Therefore, it is important to be aware of the increased risk of periodontitis and other possible oral complications in all people with diabetes and, in particular, those with poor glycemic control, regardless of age.13
However, the current knowledge of diabetics about their increased risk to oral diseases is alarming; the results of a study done in Pakistan showed that only 35.4% of the patients had knowledge about the oral complications of diabetes, 57 % did not know that diabetes predisposed them to oral disease and 7.6 % denied any existence of a link between diabetes and oral health.13 Similarly, another study found that the awareness of diabetics about their increased risk for oral diseases was low compared to their awareness of systemic diseases.14 In a study conducted in India among 300 diabetic subjects, 67% were aware of the kidney complications, 57% of the eye complications, 53% of the heart complications and the lowest percentage (42%) was found with awareness of oral complications.15
Diabetic patients’ attitude towards oral health is not any different if not worse; the same study done in India shows, the attitude of the participants towards maintaining good oral health is poor, as only 26% out of 300 said they brush twice a day and only 41% out of 300 said they use floss daily and about 6% said they don’t even brush daily. The data from the study also showed that only 146 from 300 visited their dentists within the last year and the reason was due to pain or discomfort only.15 However, a study carried out on the awareness of periodontitis among Nigerian diabetics involving 155 diabetic subjects and 106 healthy controls showed that 73.6% of the controls had never been to the dentist before and also 62.1% of the diabetic subjects. In conclusion, the level of awareness of periodontal disease is quite low amongst both groups; hence there is a need to promote periodontal health awareness in the general populace as well as clinics.16
Previous studies indicate that oral health may not be a priority for diabetic patients and that these patients are less likely than non-diabetic patients to have visited a dentist.17 Furthermore, it was reported that twice-daily tooth brushing is less common in diabetic patients than in non-diabetic patients.17