Oral health awareness in adult patients with diabetes: a questionnaire study. Br Dent J. 2011;211:E12. [PMID: 21941301 DOI: 10.1038/sj.bdj.2011.769]

Oral hygiene self-care: Concept analysis for the development of a new nursing diagnosis

OBJECTIVE

This study aims to analyze the concept of oral hygiene self-care and develop a new problem-focused nursing diagnosis (ND) based on the NANDA-I terminology.

METHOD

A concept analysis was performed based on the Walker and Avant framework, including a scoping review phase according to the Joanna Briggs Institute guidelines. Searches were performed in PubMed, Cumulative Index to Nursing and Allied Health Literature, Scopus, Web of Science, Virtual Health Library, and specific gray literature databases. The development of the diagnostic structure followed the NANDA-I guidelines with a focus on Orem's self-care theory.

RESULTS

Including 51 studies, the analysis facilitated the formulation of attributes, antecedents, and consequences of oral hygiene self-care. The ND "Oral hygiene self-care deficit" was created and included 17 defining characteristics, 9 related factors, 5 associated conditions, and 5 high-risk populations. Two cases were constructed to illustrate the use of key terms.

CONCLUSIONS

The conceptual analysis provided insight into the concept of oral hygiene self-care and supported the structure of a new ND.

IMPLICATIONS FOR NURSING PRACTICE

This study contributes to the implementation of the nursing process by focusing on the identification of individuals with oral hygiene self-care deficit. It will facilitate the promotion of oral health, thereby impacting the individual's quality of life. In addition, it will aid in the development of public policy for the prevention of oral diseases.

Relationship between Behavior and Periodontal Health Self-Perception in Diabetic and Non-Diabetic Patients from Transylvania, Romania-A Self-Report Study, including The Desire to Use a Mobile App for Oral Care Improvements

The study aimed to assess self-reported symptoms of periodontal disease (gingival bleeding, tooth mobility and halitosis) among diabetic and non-diabetic patients from Transylvania, Romania. Using statistical analysis methods, correlation between the aforementioned symptoms and diet, oral hygiene habits, stress, physical activity, and BMI (body mass index) were researched. Another secondary objective was to assess the impact of self-reported oral health, aesthetics, and halitosis on their life. Patients' willingness to use a mobile app for generating awareness of oro-dental complications, improving their knowledge of oro-dental health, and reminding them to visit the dentist based on an awareness-raising function, was also assessed. Methods: The study was based on an original self-administered questionnaire, applied to 182 subjects, in an unselected, randomized manner. A total of 110 questionnaires were applied in two dental offices and 72 questionnaires were applied in a public clinic for diabetic patients from Cluj-Napoca, Romania. Results: Warning signs and symptoms relevant to periodontal disease were identified by respondents, having statistically significant associations with the declared oral health-care habits, including interdental aids, vicious habits (nail biting, bruxism), etc. Some of these periodontal signs could be correlated with a certain lifestyle, such as the perceived stress, smoking status, practicing maintenance sports, and alcohol consumption. A total of 66% of the non-diabetics and 68% of the diabetics of the surveyed subjects consider a software application for generating awareness of oro-dental complications useful, and are willing to pay around EUR 6 for it. Conclusions: Having a medical condition such as diabetes makes patients pay more attention to dental health compared with non-diabetic patients. Patients expressed their desire to use a software application to help them to be aware of their condition and for improving their self-report capabilities, including their oral-health-related status.

Knowledge of bidirectional relationship between diabetes and periodontal disease among diabetes patients: A systematic review

INTRODUCTION

The bidirectional relationship between diabetes mellitus and periodontal disease has been reported in the literature, suggesting that poor glycemic control is strongly associated with increased risk of developing periodontal disease. Therefore, this systematic review evaluated the level of knowledge of this bidirectional relationship among patients with diabetes.

METHODS

This systematic review (protocol CRD42018117902) was conducted according to PRISMA guidelines. The following databases were considered: Medline/PubMed, Scopus, and Web of Science. Search strategy (April 05^th , 2021) considered proper combination of keywords and eligibility criteria. The quality of studies was evaluated using the Appraisal tool for Cross-Sectional Studies (AXIS).

RESULTS

Among the 328 records identified in the initial search, 24 studies were selected, considering a total of 8,693 patients. All studies used a cross-sectional design. Among the included studies, only five showed prevalence of knowledge higher than 50%, ranging from 5.8% to 75.9%. Interestingly, 58.0% of patients reported that they brush their teeth at least 1x/day, but only four studies reported that the dentist was the main source of information. In terms of methodology and result quality, just one study clearly showed all information evaluated by the AXIS tool. Most of studies did not report sample size calculations and did not used validated questionnaires to assess patient knowledge.

CONCLUSION

The results show that less than half of people with diabetes have knowledge about their increased risk for periodontal disease, and often the dentist is not the main source of information to motivate them.

Body Mass Index as a Proxy Indicator for Poor Oral Hygiene Habits in Adult Diabetic Patients

AIM

To analyse if body mass index (BMI) could be used as a fast proxy indicator of poor oral hygiene habits (POHH) among the adult population with diabetes mellitus.

METHODS

Adults, aged 25-74, from the Slovenian 2016 nationwide cross-sectional survey based on the Countrywide Integrated Non-Communicable Disease Intervention (CINDI) Health Monitor methodology, who reported being diabetic, were included in the study (n=560). We assessed the relationship between POHH and BMI, adjusted to confounders, using multiple binary logistic regression.

RESULTS

In the total sample, the POHH prevalence was 50.9%. Taking into account BMI, POHH prevalence in participants with normal BMI values was only 37.8%, in the overweight group it was 1.22-times higher (46.0%), while in the obese group it was 1.63-times higher (61.6%) (p<0.001). Also, the odds for POHH were 2.64-times higher in the obese group in comparison to the normal BMI group (95% CI: 1.55-4.51; p<0.001). After adjustment for confounders, this OR decreased only moderately (OR=2.45; 95% CI: 1.35-4.44; p=0.003).

CONCLUSIONS

BMI could be used as a readily assessable, fast, simple, and cheap tool indicating higher odds for having POHH among the diabetic population. By defining the high-risk group it could be easier for physicians and dentists to take further referrals and actions for promoting oral health in this group. The suggested tool can save time and could have an important positive impact on the quality of life of diabetics, as well as on health expenditures.

Effectiveness of a Diabetes Oral Nursing Program Including a Modified Diabetes Oral Health Assessment Tool for Nurses (M-DiOHAT©) : A 12-Month Follow-Up Intervention Study

PURPOSE

This study aimed to evaluate the effectiveness of a diabetes oral nursing intervention program for individuals with diabetes.

METHODS

Fifty-six participants with diabetes underwent a diabetes oral nursing intervention program. The program's effect was evaluated through questionnaires and small interviews. The modified diabetes oral health assessment tool (M-DiOHAT©) was used to assess and educate four factors;oral conditions, behaviors, perceptions and knowledge about diabetes and periodontal disease, and health information-sharing, among participants at baseline, 3, 6, and 12 months later. Primary outcomes included changes in the M-DiOHAT© total scores. Secondary outcomes included scores on the motivation stage of changes in oral health behaviors' scales, dental visits, number of present teeth, hemoglobin A1c (HbA1c), and participants' comments.

RESULTS

The M-DiOHAT© total score and the motivation stage score significantly improved with the narrative comment of "being motivated to practice oral health behaviors" between the baseline and 12 months later. Eight participants visited the dentist, whereas no differences were observed in the number of present teeth or HbA1c.

CONCLUSIONS

This program improved participants' M-DiOHAT© total score, motivation stage score, and dental visits. These results suggest the program improved oral health perceptions and behaviors among individuals with diabetes. J. Med. Invest. 69 : 86-96, February, 2022.

Oral Cavity Status of Type 1 Diabetic Patients Who Underwent an Oral Hygiene Tuition

Diabetes mellitus is a civilization disease which affects increasing number of people. Diabetes essentially influences gingival disease, periodontal disease, saliva secretion disorders and its parameters. The aim of the study is both assessing the oral cavity status of that group of patients to clearly identify their treatment needs and the effectiveness of implementation of oral hygiene training. 57 patients with type 1 diabetes and 31 healthy declared their contribution to the research. The research was conducted within two visits. The evaluation was done during clinical examination: teeth condition, oral hygiene. During the end of the first visit patients received professional oral hygiene instructions. Analysis of the clinical research in both groups showed no differences for Decayed- Missing- Filled teeth index and Dental Treatment Index. The results demonstrated disparity between the groups for the decayed teeth component and filled teeth component (symptomatically higher values in the researched group). There was statistically significant difference in the modified Sulcus Bleeding Index values analysis between both groups. Conducting hygiene instructions influenced the decline of Approximal Plaque Index and Oral Hygiene Index in the treatment group. It is essential for dentists in cooperation with diabetologists to educate patients on the necessity to maintain oral hygiene procedures.

Oral health status and self- assessment of oral health risk factors among South Indian diabetic patients

Background

The disease profile of the world is changing at an astonishingly fast rate. It is essential that the impending nature of chronic disease is recognized and acted on urgently. India leads the world with the largest number of diabetics earning the dubious distinction of being termed the "diabetic capital" of the world.

Aim

To assess and compare the oral health status and related oral health risk factors among diabetic patients in Hyderabad and Secunderabad.

Settings

A cross sectional study was carried out in various diagnostic centers among 801 patients aged 30 years and above.

Methods and Materials

Oral health status and self-assessed data on related oral risk factors were measured using modified World Health Organization (WHO) assessment form and oral health questionnaire for adults 2013.

Statistical Analysis

Comparison of mean scores of the variables based on gender was assessed using ANOVA. Statistical significance was set at p < 0.05.

Results

Females had higher proportion of untreated caries (362; 85%) and DMFT (Decayed, Missing and Filled Teeth; 375; 88%) compared to males. On the basis of loss of attachment, the mean number of sextants with no loss of attachment was mostly noted among female subjects.

Conclusion

In the present study, though gingivitis was seen in higher percentage (82%), the presence of periodontal disease was relatively low (68.3%). It can be concluded that diabetic subjects may have poor oral health.

A systematic review investigating patient knowledge and awareness on the association between oral health and their systemic condition

BACKGROUND

The prevalence of the oral-systemic relationship has accounted for potentially preventable chronic conditions and morbidity worldwide. Health literacy is a large contributing factor. This systematic review investigates the knowledge and awareness of patients with major systemic conditions, regarding the oral associations to their condition.

METHODS

Electronic databases including Medline (Ovid), CINAHL, The Cochrane Library, Web of Science, Informit Health Databases and Scopus were searched. All articles from 2011 to 2020, investigating knowledge of the oral-systemic link, of adult patients with the following major system conditions were searched: diabetes mellitus (DM), respiratory disease, cardiovascular disease (CVD), pregnancy and bone disease. Two independent reviewers completed screening, data extraction and quality assessment. A synthesis without meta-analysis was conducted. Twenty-four studies, from 14 different countries, were included in the systematic review.

RESULTS

Analysis showed that globally, patients with major systemic conditions have poor knowledge and awareness (< 50%) of the oral health associations to their condition. Improvements in health education are particularly necessary for patients with heart disease, bone disease and diabetes. Dentists and the media were the most common source of information. There were no relevant studies investigating the knowledge of patients with respiratory disease.

CONCLUSION

To improve the global burden of preventable chronic conditions, it is essential to address inequalities in the dissemination of health education to at-risk populations. Improvements in patient education rely on an increase in patient-practitioner communication on the oral-systemic link, implementation of oral health educational programs and greater interdisciplinary collaboration.

Oral Health Knowledge and Habits of People With Type 1 and Type 2 Diabetes

Objectives

This study aimed to collect information about oral health knowledge and the habits of people living with diabetes (PwD), primarily type 1 diabetes, using the newly developed World Health Organisation Oral Health Questionnaire for Adults (Annex 7).

Materials and methods

Comparable and reliable questionnaires, comprising 23 questions for PwD, were sent to diabetes social media groups, mailing lists, and associations. The survey explored the relationships amongst demographic factors, age, dental education, eating habits, and other factors.

Results

The 23-question survey was answered by 307 individuals from 60 different countries. Alcohol and tobacco use, dental anxiety, and bad habits were often reported. Of the participants, 61.2% (n = 188) had at least 1 drink during the past 30 days. Of the participants, 22.8% (n = 70) were smokers. In total, 80.8% (n = 248) of the participants consumed biscuits, 76.2% (n = 234) consumed sweets, and 63.2% (n = 194) consumed soft drinks regularly. A total of 26.4% (n = 81) of the participants reported being afraid of dental treatment. Of the participants, 48.5% (n = 149) reported dry mouth and other oral complications. The frequency of visits to the dentist was satisfactory. A total of 71.3% (n = 219) of the participants reported visiting a dentist during the past 12 months.

Conclusions

There is a need for proper oral health education for PwD. Trained diabetes advocates could be core messengers. However, interdisciplinary cooperation is mandatory for both education and the clinical aspect of diabetes care. For example, diabetes nurses need to be educated with the help of dentists or oral hygienists.

Disparities in Preventive Oral Health Care and Periodontal Health Among Adults With Diabetes

INTRODUCTION

People with diabetes are more vulnerable to periodontal disease than those without; thus, practicing preventive oral health care is an important part of diabetes self-care. Our objective was to examine disparities in preventive oral health care among US adults with diabetes.

METHODS

We performed a secondary analysis of data from the National Health and Nutrition Examination Survey (NHANES) 2011-2016. Periodontal examinations were conducted in adults aged 30 and older. We compared the weighted prevalence of periodontal disease and the practice of preventive oral health care, including practicing dental interproximal cleaning (flossing or using other interproximal cleaning devices) and use of preventive dental services, among people with and without diabetes. Multivariable logistic regressions were performed to examine the relationship between the presence of diabetes, periodontal disease, and preventive oral health care practices.

RESULTS

Weighted prevalence of periodontal disease in the US population was higher among adults with diabetes than those without (58.0% vs 37.6%). This difference persisted after controlling for sociodemographic characteristics and smoking status. People with diabetes were more likely to have periodontal disease (adjusted odds ratio [aOR] 1.39; 95% CI, 1.17-1.65), less likely to practice daily interproximal cleaning (aOR 0.85; 95% CI, 0.75-0.95), and less likely to visit a dentist for preventive care in the past year (aOR 0.86; 95% CI, 0.76-0.96) than people without diabetes.

CONCLUSION

Adults with diabetes reported suboptimal preventive oral health care behaviors in use of preventive dental services and interproximal dental cleaning than people without diabetes, despite their health disparity related to periodontal disease. Educating people to improve their preventive oral health care is essential for good oral health and diabetes self-management.

Relationship between diabetes self-care practices and control of periodontal disease among type2 diabetes patients in Bangladesh

INTRODUCTION

The prevalence of periodontal disease is high in diabetes patients worldwide, including Bangladesh. Although associations of periodontal disease outcomes and clinical determinants of diabetes have been investigated, few studies have reported on the relationship between periodontal diseases outcomes with modifiable factors, such as self-care and oral hygiene practices, in patients with diabetes. Moreover, in order to develop targeted strategies, it is also important to estimate their aggregated contribution separately from that of the established sociodemographic and diabetics related clinical determinates. Therefore, this study was performed to elucidate 1) the relationship of diabetes patients' self-care and oral hygiene practices to periodontal disease and 2) the relative contributions of selected factors to periodontal disease outcome in type 2 diabetes patients.

METHODS

The data were obtained from the baseline survey of a multicentre, prospective cohort study. A total of 379 adult patients with type 2 diabetes from three diabetic centres in Dhaka, Rajshahi and Barishal, received periodontal examinations using the community periodontal index (CPI) probe, glycated haemoglobin examination, other clinical examinations, and structured questionnaires. Multiple logistics regression analyses were performed to assess the associations between selected factors and prevalence of any periodontal disease and its severity.

RESULTS

More than half of the participants were female (53.8%) and 66.8% of the total participants was 21-50 years old. The prevalence of any (CPI code 2+3+4; 75.7%) and severe form (CPI code 4; 35.1%) of periodontal disease were high in type 2 diabetes patients. In multivariate analysis, the odds of periodontal disease increased with unfavourable glycaemic control indicated by HbA1c ≥ 7%, and decreased by 64%, 85% and 92% with adherence to recommended diet, physical activity, and oral hygiene practices, respectively. Diabetes self-care practice explained the highest proportion of the variance (13.9%) followed by oral hygiene practices (10.9%) by modelling any periodontal disease versus no disease. Variables of diabetes conditions and oral hygiene practices explained 10.9% and 7.3% of the variance by modelling severe (CPI code 4) or moderate (CPI code 3) forms of periodontal disease versus mild form of periodontal disease. Findings also conferred that while poor diabetes control had an individually adverse association with any form of periodontal diseases and its severity, the risk of diseases was moderated by oral hygiene practices.

CONCLUSIONS

This study suggested that, in addition to diabetes-related clinical determinants, self-care practices, and oral hygiene practices must be taken into consideration for prevention and control of periodontal disease in patients with diabetes.

Oral Health Status, Knowledge, and Behaviours of People with Diabetes in Sydney, Australia

This study assessed self-reported oral health status, knowledge, and behaviours of people living with diabetes along with barriers and facilitators in accessing dental care. A cross sectional survey of 260 patients from four public diabetes clinics in Sydney, Australia was undertaken using a 35-item questionnaire. Data were analysed using SPSS software with descriptive and logistic regression analyses. More than half (53.1%) of respondents reported having dental problems which negatively impacted their related quality of life. Less than half (45%) had adequate oral health knowledge. Only 10.8% reported receiving any oral health information in diabetes care settings, which had higher odds of demonstrating adequate oral health knowledge (AOR, 2.60; 95% CI, 1.06-6.34). Similarly, 62.7% reported seeing a dentist in the last 12 months. Having private health insurance (AOR, 3.70; 95% CI, 1.85-7.40) had higher odds of seeing a dentist in the past 12 months. Dental costs were a major contributor to avoiding or delaying dental visit. Patients living with diabetes have unmet oral health needs particularly around the awareness of its importance and access to affordable dental services. Diabetes care providers can play a crucial role in this area by promoting oral health to their patients.

Awareness About the Oral and Systemic Complications of Diabetes Among a Cohort of Diabetic Patients of the Republic of Mauritius

Background

Persistent hyperglycaemia in patients with uncontrolled or poorly controlled diabetes may cause serious oral and systemic complications. Persons with diabetes are mostly unaware of their increased risk of oral complications.

Objective

This study investigated awareness about the association of diabetes with other diseases and knowledge about the systemic and oral complications of diabetes among patients with diabetes in the Republic of Mauritius.

Methods

Data were collected from 720 patients with diabetes using an anonymous closed-end questionnaire. Descriptive statistics and multivariate logistic regression analyses were used to report the results and to identify factors associated with awareness about the link between diabetes and other diseases and knowledge about oral and systemic complications.

Results

The majority of the study participants were aware of the association between diabetes and other diseases. However, knowledge about oral complications of diabetes was limited (caries [29%], periodontal disease [37%], and xerostomia [52%]). Education and the number of years since diagnosis of diabetes were the most significant predictors of awareness about complications. The experience of xerostomia and periodontal disease were associated with knowledge about their respective increased risk. Receiving advice from diabetes care providers increased awareness about caries and periodontal disease. Age and type of diabetes were associated with knowledge about systemic complications.

Conclusion

Awareness about the oral complications of diabetes was limited and was mainly linked with the experience of disease. This indicates a need for increased health promotion with customised educational programs to inform patients with diabetes of their increased risk of developing complications.

Oral Health Messiers: Diabetes Mellitus Relevance

This article aims to narrate the various oral complications in individuals suffering from diabetes mellitus. Google search for "diabetes mellitus and oral complications" was done. The search was also carried out for "diabetes mellitus" and its oral complications individually. Diabetes mellitus is a chronic metabolic disorder that is a global epidemic and a common cause of morbidity and mortality in the world today. Currently, there are about 422 million cases of diabetes mellitus worldwide. Diabetic patients can develop different complications in the body such as retinopathy, neuropathy, nephropathy, cardiovascular disease. Complications in the oral cavity have been observed in individuals suffering from diabetes mellitus. A study noted that more than 90% of diabetic patients suffered from oral complications. Another research has shown a greater prevalence of oral mucosal disorders in patients with diabetes mellitus than non-diabetic population: 45-88% in patients with type 2 diabetes compared to 38.3-45% in non-diabetic subjects and 44.7% in type 1 diabetic individuals compared to 25% in the non-diabetic population. Oral complications in people with diabetes are periodontal disease, dental caries, oral infections, salivary dysfunction, taste dysfunction, delayed wound healing, tongue abnormalities, halitosis, and lichen planus. The high glucose level in saliva, poor neutrophil function, neuropathy, and small vessel damage contribute to oral complications in individuals with uncontrolled diabetes. Good oral health is imperative for healthy living. Oral complications cause deterioration to the quality of life in diabetic patients. Complications like periodontal disease having a bidirectional relationship with diabetes mellitus even contribute to increased blood glucose levels in people with diabetes. This article intends to promote awareness regarding the oral health of diabetics and to stress the importance of maintaining proper oral hygiene, taking preventive measures, early detection, and appropriate management of oral complications of these patients through a multidisciplinary approach.

Diabetes mellitus and periodontal disease: The call for interprofessional education and interprofessional collaborative care - A systematic review of the literature

Diabetes mellitus and periodontal disease are among the most frequently occurring conditions that have a substantial effect on the global health economy. The literature regarding medical professionals' knowledge of the bidirectional link between diabetes mellitus and periodontal disease has not been analyzed systematically. The review aimed to investigate the knowledge and understanding of physicians and specialists regarding the two-way relationship between diabetes mellitus and periodontal disease and their approach to referring their patients for a dental consultation. An electronic search of PubMed and Google Scholar databases was conducted to review the studies that assessed knowledge and understanding of medical professionals regarding the relationship between diabetes mellitus and periodontal disease. Data from 13 included studies involved 4,027 participants: 3,256 primary care physicians and 771 medical specialists. Just over 50% of the medical professionals had an understanding of oral health and/or periodontal disease. Over one-third of medical professionals were ignorant of the relationship between oral health and diabetes mellitus. Only 30% reported ever referring their patients for an oral health assessment. Another key finding of the investigation was the absence of interprofessional collaborative care between medical and dental professionals while managing patients with diabetes mellitus. Medical professionals with an integrated knowledge of elementary oral health education and training could play a central role in the timely diagnosis and management of periodontal disease in patients living with diabetes mellitus.

Are diabetes and dental care providers in the Republic of Mauritius advising patients about the importance of oral health in diabetes management?

Diabetes and dental care providers may greatly contribute in the early detection of oral diseases and diabetes, respectively, and in the prevention of complications of diabetes. However, there is limited collaboration and referrals between these two groups of health professionals.

OBJECTIVE

To investigate whether diabetic providers are addressing the importance of oral care in the management of diabetes and whether dental care providers are advising their patients with diabetes about the importance of glycaemic control.

METHOD

Descriptive statistics was used to report data collected from 720 patients with diabetes using a closed-end questionnaire. Logistic regression analysis revealed the factors significantly impacting whether participants received advice from healthcare providers.

RESULTS

The majority of participants did not receive advice from either diabetes (84%) or dental (75%) care providers regarding the reciprocal nature of diabetes and periodontitis. The factors significantly affecting receiving advice from diabetes care providers were place of residence (p = 0.003), self-reported type of diabetes (p = 0.000) receiving advice from dental care providers (p = 0.000); from dental care providers - education (p = 0.020), place of residence (p = 0.004), the number of years since diagnosis of diabetes (p = 0.002), frequency of dental visits (p = 0.000) and receiving advice from diabetes care providers (p = 0.000).

CONCLUSION

Diabetes and dental care providers in Mauritius are not addressing oral health care as an essential component of diabetes care. Patients with diabetes are neither being advised about the importance of regular dental visits by their treating doctor, nor about the importance of glycaemic control in the prevention of oral complications by their dentist.

Oral Health Screening Status of Diabetes Patients in Selected Hospitals of Addis Ababa, Ethiopia, 2018

Objective

The study assessed the oral health screening status of diabetes patients and its associated factors in selected public hospitals of Addis Ababa, 2018.

Patients and Methods

An institutional-based cross-sectional study was conducted on 388 diabetes patients selected on the bases of a systematic random sampling method from March to May 2018 at two selected public hospitals in Addis Ababa. Data were collected with a pre-tested, structured, and translated questionnaire. Bi-variable and multivariable logistics regression were undertaken to identify predictors of oral health screening among diabetes with their respective 95% CI and a p-value of less than 5% level of significance.

Results

The oral health screening status among diabetes patients in this study was 21.1%. The odds of having had an oral health screening was 82.4% higher in those with an educational status of college and above than those who cannot read and write and it was ten and five folds higher in participants with a monthly income of less than 750 birr than those with above 2,000 birr and those who brushed their tooth twice or more times a day than occasionally, respectively. The odds of having had an oral health screening was 17, four, and five folds higher among participants with perceived susceptibility, perceived severity, and benefit, respectively, whilst it was 8.8% lower in participants with a perceived barrier and it was as high as 19.782 times among participants with malocclusion.

Conclusion

A lower level of oral health screening was observed. A higher educational level, a lower monthly income, a higher frequency of tooth brushing per day, positive perceptions of susceptibility, severity, and benefits, and presence of malocclusions were statistically associated with a higher frequency of oral health screening. Concerned bodies were recommended to work on the identified predictors and improve the oral health screening of diabetes patients.

Prevalence of diabetes among patients and the assessment of the awareness of the bidirectional relation between diabetes and periodontal disease

AIM

To assess the extent of self-awareness and knowledge of diabetes and its association with periodontal disease among patients seeking dental care.

MATERIALS AND METHODS

Data were collected in the form of a questionnaire from 150 consecutive adult patients from the outpatient department of Saveetha Dental College in Chennai, India. Complying patients were tested for diabetes mellitus by checking their random blood sugar and the results were correlated with the questionnaire and their periodontal findings. The findings were interpreted to examine the relationship between self-awareness and clinically diagnosed periodontitis.

RESULTS

One hundred fifty patients participated in the questionnaire and 70% were unaware of diabetes causing periodontal disease. A total of 47.3% of patients were also unwilling to get themselves tested for diabetes by their dentists as nearly 73.3% believed that they did not have diabetes. As a result, out of 150 patients, 41 consented to random blood sugar but only 23 patients followed up. Among these 23, 14 believed they were diabetic but only 12 of those 14 were proven to be so. Additionally, 20 patients were diagnosed with either localized or generalized chronic periodontitis while the remaining 3 patients had gingivitis. All 12 patients diagnosed with diabetes were affected by periodontitis as well.

CONCLUSIONS

Patients are generally apprehensive and misinformed regarding the influence of periodontitis and diabetes between both diseases and must be educated by both the medical and dental practitioners regarding the implications of these chronic inflammatory diseases.

Diabetic patients' knowledge of the bidirectional link: are dental health care professionals effectively conveying the message?

Diabetes mellitus (DM) has emerged as a global public health concern with significant upshots due to its high prevalence, severity and associated complications. The present review aims to evaluate the literature that has investigated the awareness and attitude of diabetic patients about their oral/periodontal health to identify gaps in the dissemination of this critical information. Literature addressing diabetic patient's awareness/knowledge, response to their periodontal health needs, and the source of oral health education was investigated using a computer search of electronic databases. Twenty-six papers were included in the systematic review for analysis. The studies reported data from 13 different countries involving 10 550 participants, 9843 patients with DM and 974 healthy controls. The overall analysis of the studies showed that approximately 73% of the diabetic patients were unaware of the link between their systemic condition (DM) and periodontal health. The results of the study show that a large number of diabetic patients are unaware of the link between oral/periodontal health and DM. There is a strong need to implement the recent guidelines established by the IDF/EFP concerning mutual care of diabetic patients by the medical and dental health care professionals. This will result in improved general and oral health of our diabetic patients.

Awareness of population regarding the effects of diabetes on dental implant treatment in Jeddah, Saudi Arabia

OBJECTIVE

Diabetes mellitus (DM) has several complications. Delayed wound healing, microvascular disease and an impaired response to infections are complications that can have a direct bearing on dental implant therapy. This paper studies the awareness of the population with regard to the effect of DM on dental implant treatment.

MATERIALS AND METHODS

A validated, close-ended questionnaire was distributed to 506 randomly selected mall-goers in the city of Jeddah. Responses were coded and entered into spreadsheet software (SPSS, IBM). The frequency distribution of the responses was calculated, and inferences were drawn.

RESULTS

The study revealed that the majority of the sample were females (62.8%), did not have diabetes (80.4%) and reported a positive family history of diabetes (87.4%). Most of the respondents (56%) believed that uncontrolled diabetes can lead to implant loss and that diabetes affects the healing process (91.6%). Many patients (42%) responded that diabetes could be treated with dental implants if the blood sugar level was controlled.

CONCLUSION

The studied sample revealed a satisfactory level of awareness regarding the association of diabetes and oral hygiene in dental implant therapy. However, there is less than adequate knowledge about the effects of diabetes on dental implants, as the majority of the respondents believe that only controlled diabetics can avail dental implant treatment.

Perioperative changes in knowledge and attitude toward oral health by oral health education

OBJECTIVES

Perioperative oral health care can prevent postoperative complications, but it is also important to maintain oral health afterward to avoid later adverse events. This study examined (a) the relationship between knowledge and attitude toward oral health (KAOH) and oral/periodontal status (OPS) in patients receiving surgery, and (b) the changes in KAOH by perioperative oral health care and education.

METHODS

Patients receiving surgery who visited our hospital's dental clinic beforehand were prospectively recruited. All participants received oral health care and education. In questionnaires assessing KAOH before and after surgery, respondent answers were generally classified as positive or negative. OPS was assessed before surgery. Associations between KAOH and OPS and perioperative changes in KAOH were statistically tested.

RESULTS

A total of 507 patients answered the questionnaire before surgery, among whom 324 patients also completed it afterward. Preoperative OPS was significantly worse in the negative than in the positive KAOH group. Positive answers for KAOH increased significantly from 68.6% to 92.2% during the perioperative period.

CONCLUSIONS

We found that patients with poor KAOH also had poor OPS, but KAOH could be improved by perioperative oral health care and education, suggesting that perioperative oral health management could improve oral health knowledge and attitudes.

Association between Diabetes Mellitus and Periodontal Diseases: A Survey of the Opinions of Dental Professionals

OBJECTIVE

This cross-sectional survey aimed to assess the knowledge of dentists and dental assistants practicing in Saudi Arabia regarding diabetes mellitus (DM) and periodontal diseases.

SUBJECTS AND METHODS

We used a pretested, closed-ended, multiple-choice questionnaire covering 2 principal sections: the assessment of previous educational training and practice, and the knowledge and scientific background regarding DM and periodontal diseases. The responses were grouped using the Likert-type scale.

RESULTS

The questionnaire showed a high reliability value of 0.805 as determined by a Cronbach's α. Out of 365 subjects who were initially interviewed, 239 subjects participated (response rate 65.5%): general dentists (45.6%) and dental hygienists and assistants (54.4%). Of the participating dentists, 70.4% were males; in contrast, 87.7% of dental assistants were female. Eighty-five percent of the participants strongly agreed that evidence supports the association between periodontal diseases and DM. Remarkably, dental assistants (78%) agreed more than dentists (68.5%) that diabetic patients with periodontal conditions would have worse glycemic control compared to diabetic patients with no periodontal diseases. Seventy-five percent of the respondents were confident about performing oral health screening for diabetic patients. Significantly more dental assistants showed their desire to expand their practice to include oral health screening (85%) and education compared to dentists (74%).

CONCLUSIONS

Both dentists and dental assistants in Saudi Arabia revealed a satisfactory knowledge level regarding the periodontal disease-diabetes interactions with no significant difference between the two groups. Further studies are recommended to assess the attitude of dental care providers while dealing with diabetic patients.

Patients' attendance patterns to different healthcare settings and perceptions of stakeholders regarding screening for chronic, non-communicable diseases in high street dental practices and community pharmacy: a cross-sectional study

OBJECTIVE

Non-communicable diseases (NCDs) impose a significant health and economic burden. This study aimed to assess the differential attendance patterns of public to different healthcare professionals and gauge the opinions of key stakeholders towards screening of NCDs by allied healthcare professionals.

DESIGN

Questionnaires were designed piloted and subsequently completed by key stakeholders. The results were analysed descriptively.

SETTING

Public questionnaires were undertaken in a West Midlands transport station and Public Markets. High street dental and community pharmacy settings were selected via local clinical and research networks. Healthcare professionals were identified using professional networks and were emailed a web link to an online survey.

PARTICIPANTS

1371 members of the public, 1548 patients and 222 healthcare professionals (doctors general practitioner (GP), dentists general dental practitioner (GDP) and pharmacists) completed the questionnaires.

OUTCOME MEASURES

The outcome was to compare attendance patterns at GDP and GP practices to determine whether different populations were more likely to access different healthcare professionals, this included determining when patients were last screened for NCDs by their GP. Additionally, the willingness of patients to undergo the required intervention and the opinions of stakeholders regarding the concept of screening for the specified NCDs in general dental and community pharmacy settings were also explored.

RESULTS

12% of patients who reported seeing a GDP biannually reported that they had not had contact with a GP in the last year. Over 61% of the public reported attending a GDP biannually, of this group 48% reported having never had a check-up at the GP. All stakeholders surveyed were in broad support of the concept of allied health professionals undertaking screening for specific general health conditions.

CONCLUSIONS

This study has established that allied healthcare professionals may have access to different cohorts of the population to GPs. If GDPs and pharmacists have access to patients who are not using healthcare services elsewhere, they may be ideally placed to risk assess, and where appropriate offer preventative advice and test for NCDs.

Factors associated with additional time dental hygienists spent on educating patients with diabetes

AIMS

To investigate what dental hygienists' practice characteristics and oral health topics are associated with additional time dental hygienists spent on educating patients with diabetes.

METHODS

A one-page survey was mailed to 2237 registered dental hygienists in South Carolina. Survey questions focused on perceptions of dental hygienists regarding their oral health preventive education for patients with diabetes. After two follow-up mails, we received 995 usable questionnaires.

RESULTS

Multivariable logistic regression modeling showed dental hygienist respondents who spent additional time educating patients with diabetes about oral health felt they had adequately covered the topics on effects of periodontal disease related to diabetes, effects of uncontrolled diabetes on periodontal disease, and nutrition and dietary counseling. In addition, a higher number of patients with diabetes treated per week, and a shorter recall interval for patients were also associated with more likelihood of respondents spending additional time educating patients with diabetes.

CONCLUSION

Results suggest that the additional time that dental hygienist respondents spent on educating patients with diabetes was related to oral health issues associated with diabetes, not just repetition of routine oral hygiene and plaque control instructions.

Impact of General and Oral Complications of Diabetes Mellitus Type I on Lebanese Children's Quality of Life

Introduction

Diabetes mellitus type I (DM1) has been increasing at an alarming rate worldwide. Children suffering from this chronic disease are subject to a high risk of systemic and oral complications, due to their young age and the lack of awareness of the relation between diabetes and oral health.

Objective

The aim of this study is to evaluate the impact of oral and general complications of DM1 on the Lebanese children's quality of life. The goal was to assess the child's behavioral issues on the one hand and the oral issues on the other.

Materials and methods

About 37 diabetic Lebanese children aged between 6 and 12 years, recruited from the Chronic Care Center (CCC), answered two questionnaires, one related to the disease and the second related to the oral complications.

Results

A majority of the participants (81.1%) are aware of their disease, 73% know the importance of their treatment and 54.1% are able to control their glycemia; 45.9% are not annoyed with constantly carrying a monitor and 67.5% are bothered by their restricted diet. Only 5.4% of children isolate themselves.

Concerning the oral complications

About 83.8% of the children do not suffer from oral ulcers, 56.8% are caries-free, and 64.9% have completed their dental treatment; 89.2% do not complain while eating and 94.6% are not able to brush their teeth properly.

Conclusion

Diabetic patients are found to have good knowledge of the disease and its systemic complications but a little on their increased risk for oral diseases. In order to ensure a good quality of life for the diabetic children and their families, optimal control of diabetes, appropriate oral hygiene, and regular visits to the dentist must be respected.How to cite this article: Noueiri B, Nassif N, Ollek A. Impact of General and Oral Complications of Diabetes Mellitus Type I on Lebanese Children's Quality of Life. Int J Clin Pediatr Dent 2018;11(1):40-45.

Oral health knowledge, attitudes and care practices of people with diabetes: a systematic review

Background

People with uncontrolled diabetes are at greater risk for several oral health problems, particularly periodontal (gum) disease. Periodontal disease also impacts diabetes control. Good oral hygiene and regular dental visits are recommended to prevent and manage oral health problems. Several studies have been conducted to assess the oral health knowledge, attitudes, and practices of people with diabetes yet a review of these findings has not yet been undertaken. The aim of this systematic review was to synthesize current evidence on the knowledge, attitudes and practices of people with diabetes in relation to their oral health care.

Methods

A systematic search of all literature was carried out in five databases using key search terms. The inclusion criteria were: 1) published in the English language; 2) from 2000 to November, 2017; 3) conducted on persons with any type of diabetes and of all ages; 4) explored at least one study outcome (knowledge or attitude or practices toward oral health care); and 5) used quantitative methods of data collection. No restrictions were placed on the quality and setting of the study.

Results

A total of 28 studies met the inclusion criteria. The studies included a total of 27,894 people with diabetes and were conducted in 14 countries. The review found that people with diabetes have inadequate oral health knowledge, poor oral health attitudes, and fewer dental visits. They rarely receive oral health education and dental referrals from their care providers. Provision of oral health education by diabetes care providers and referral to dentists when required, was associated with improved oral health behaviours among patients.

Conclusions

Overall, people with diabetes have limited oral health knowledge and poor oral health behaviours. It is therefore essential to educate patients about their increased risk for oral health problems, motivate them for good oral health behaviours and facilitate access to dental care.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5485-7) contains supplementary material, which is available to authorized users.

Extent of Awareness Regarding Oral Health and Dental Treatment Needs among Individuals with Hearing and Speech Impairments in Saudi Arabia

Objective:

This study aims to evaluate the awareness level of the individuals with hearing and speech impairments (deaf and dumb individuals), in relation to their oral health and dental treatment needs.

Materials and Methods:

The approach of stratified randomization method of sampling was used for the selection of participants. About 240 people with hearing and speech impairments (deaf and dumb) were selected from four cities of Saudi Arabia, which includes AlKharj, Riyadh, Dammam and Abha. A questionnaire of two sections was distributed among the participants for collecting data. A simple descriptive analysis was done, and the data were expressed in terms of frequencies and percentages. Microsoft Excel has been used for compilation of data and execution of graphs. Moreover, the questionnaire data were subject to SPSS data analysis (IBM SPSS Statistics for Windows, Version 22.0, Armonk, IBM Corp. NY).

Results:

Most of the participants were not aware of the importance of oral health. Majority of the participants described that they did not visit qualified dentists in the past and many of them did not know the right way of doing tooth brushing. Hence, deaf and dumb individuals lack basic knowledge about oral health and dental treatment needs.

Conclusion:

The study concluded that the awareness level of oral health and dental treatment needs is low among individuals with hearing and speech impairments (deaf and dumb) in Saudi Arabia.

Awareness of oral complications and oral hygiene habits of subjects with diagnosed Diabetes Mellitus

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.

Knowledge, Attitude, and Awareness among Diabetic Patients in Davangere about the Association between Diabetes and Periodontal Disease

Objective:

Diabetes mellitus (DM) is one of the major public health problems. Association of diabetes and periodontitis is widely proven and can influence each other in the development and progression of the disease and its complications, which are largely preventable. Hence, if data could be collected on the knowledge and awareness about the association between DM and periodontal disease, the results could be applied in creating public health campaigns and can bring about lifestyle modification among people. The aim of the present study is to assess the awareness, attitude, and practices of diabetic patients regarding their periodontal health in Davangere city with the objective of enhancing dental health education for this population, which would upgrade their knowledge and awareness.

Materials and Methods:

The present cross-sectional survey was carried out on 600 diabetic patients from various clinics. A time limit of 3 months was set for the data collection which was then subjected to statistical software SAS 9.2, SPSS 15.0, Stata 10.1, MedCalc 9.0.1, Systat 12.0, and R environment version 2.11.1 for statistical analysis.

Results:

On correlation of gender and education with overall knowledge of association between periodontal disease and DM, females and participants below secondary school education and lower duration of DM were significantly associated with lack of knowledge. Other questions revealed limited awareness, sources, and need for more information about this association and depicted poor knowledge and attitude toward the oral health.

Conclusion:

Dental professionals need to create awareness about the importance of maintaining good oral health influencing overall general health in diabetic patients. Oral screening and referral by health professionals to dentists may benefit diabetic patients by improving access to dental care.

Oral health and cardiovascular care: Perceptions of people with cardiovascular disease

MAIN OBJECTIVE

The aim of this study was to explore the perception of patients with cardiovascular disease towards oral health and the potential for cardiac care clinicians to promote oral health.

METHOD

A needs assessment was undertaken with twelve patients with cardiovascular disease attending cardiac rehabilitation between 2015 and 2016, in three metropolitan hospitals in Sydney, Australia. These patients participated in face-to-face semi-structured interviews. Data was analysed using thematic analysis.

RESULTS

Results suggested that while oral health was considered relevant there was high prevalence of poor oral health among participants, especially those from socioeconomic disadvantaged background. Awareness regarding the importance of oral health care its impact on cardiovascular outcomes was poor among participants. Oral health issues were rarely discussed in the cardiac setting. Main barriers deterring participants from seeking oral health care included lack of awareness, high cost of dental care and difficulties in accessing the public dental service. Findings also revealed that participants were interested in receiving further information about oral health and suggested various mediums for information delivery. The concept of cardiac care clinicians, especially nurses providing education, assessment and referrals to ongoing dental care was well received by participants who felt the post-acute period was the most appropriate time to receive oral health care advice. The issues of oral health training for non-dental clinicians and how to address existing barriers were highlighted by participants.

RELEVANCE TO CLINICAL PRACTICE

The lack of oral health education being provided to patients with cardiovascular disease offers an opportunity to improve care and potentially, outcomes. In view of the evidence linking poor oral health with cardiovascular disease, cardiac care clinicians, especially nurses, should be appropriately trained to promote oral health in their practice. Affordable and accessible dental care services for people with cardiovascular disease should be considered and offered by health services in Australia.

Self-awareness of "Gum Disease" Among US Adults

BACKGROUND

To assess the extent of self-awareness of gum disease among adults in the United States.

METHODS

Data were from the 2009-2012 National Health and Nutrition Examination Survey. The outcome variable is self-awareness of gum disease. Multivariate logistic regression models were used to examine the relationship between self-awareness and clinically diagnosed periodontitis. The analytical sample included 6876 participants.

RESULTS

Among those participants (30 years or older) who were classified as having periodontitis, 27% (95% confidence interval [CI], 24.4-29.8) were self-aware of the disease (positive predicted value = 25%). Of those who self-reported having gum disease, 14.1% had a diagnosis of periodontitis (sensitivity = 75%). Older adults were less likely to be aware of gum disease (P < .05). Non-Hispanic blacks (adjusted odds ratio [AOR] = 0.67; 95% CI, 0.53-0.85) were less likely to be aware of the disease than non-Hispanic whites. Adults with diabetes (AOR = 1.61; 95% CI, 1.25-2.06), or with lung disease (AOR = 1.61; 95% CI, 1.25-2.08), or current smokers (AOR = 1.72; 95% CI, 1.29-2.31) were more likely to be aware of the disease.

CONCLUSION

The study showed that self-awareness of gum disease among adults was low. Our study findings suggest that there is a great need to improve oral health knowledge and awareness among the adult population in the United States.

Type 2 diabetes risk screening in dental practice settings: a pilot study

BACKGROUND

Dental surgeries are highlighted in the 2012 NICE guidance Preventing type 2 diabetes: risk identification and interventions for individuals at high risk as a suitable setting in which to encourage people to have a type 2 diabetes risk assessment.

AIM

To assess the feasibility of implementing a type 2 diabetes risk screening pathway in dental settings using the NICE guidance tool.

METHOD

The study was carried out over two weeks in June 2013. The validated tool in the NICE guidance was used to determine risk. This included a questionnaire and BMI measurement used to determine a risk score. Patients were rated low, increased, moderate or high risk. All patients were given written advice on healthy lifestyle. Patients who were moderate or high risk were referred to their general medical practitioners for further investigation. Participating dental teams were asked to nominate a member who would be responsible for overseeing the screening and training the other team members.

RESULTS

A total of 166 patients took part in the pilot (58% male, 75% aged 49 years or younger and 77% were from BME groups). Twenty-six low risk patients (15.7%), 61 increased risk patients (36.7%), 49 moderate-risk patients (29.5%) and 30 high-risk patients (18.1%) were identified during the pilot. Fifteen of the 49 patients (30.6%) identified as moderate-risk and 6 of the 30 high-risk patients (20%) had visited their GP to discuss their type 2 diabetes risk in response to the screening.

CONCLUSION

The pilot suggests that people at risk of developing type 2 diabetes could be identified in primary, community and secondary dental care settings. The main challenges facing dental staff were time constraints, limited manpower and the low number of patients who visited their GP for further advice.

Management of diabolical diabetes mellitus and periodontitis nexus: Are we doing enough?

Periodontitis is the commonest oral disease affecting population worldwide. This disease is notorious for the devastation of tooth supporting structures, ensuing in the loss of dentition. The etiology for this disease is bacterial biofilm, which accumulates on the teeth as dental plaque. In addition to the biofilm microorganisms, other factors such as environmental, systemic and genetic are also responsible in progression of periodontitis. Diabetes mellitus (DM) is metabolic disorder which has an impact on the global health. DM plays a crucial role in the pathogenesis of periodontitis. Periodontitis is declared as the “sixth” major complication of DM. Evidence based literature has depicted an enhanced incidence and severity of periodontitis in subjects with DM. A “two way” relationship has been purported between periodontitis and DM. Mutual management of both conditions is necessary. Periodontal therapy (PT) may assist to diminish the progression of DM and improve glycemic control. Various advanced technological facilities may be utilized for the purpose of patient education and disease management. The present paper clarifies the etio-pathogenesis of periodontitis, establishing it as a complication of DM and elaborating the various mechanisms involved in the pathogenesis. The role of PT in amelioration of DM and application of digital communication will be discussed. Overall, it is judicious to create an increased patient cognizance of the periodontitis-DM relationship. Conjunctive efforts must be undertaken by the medical and oral health care professionals for the management of periodontitis affected DM patients.

Patients' attitudes towards screening for diabetes and other medical conditions in the dental setting

AIM

To determine the attitudes of patients attending routine appointments at primary care dental clinics and general dental practices towards the possibility of chair-side screening for medical conditions, including diabetes, in the dental setting.

METHODS

A brief, anonymous, self-administered questionnaire distributed to adult patients (≥18 years) attending 2 primary care dental clinics and 16 general dental practices in South-West England.

RESULTS

One hundred and ninety-seven completed questionnaires were received from patients at primary care dental clinics and 429 from general dental practice patients. Overall, 87% of respondents thought that it was important or very important that dentists screened patients for medical conditions such as diabetes; 79% were very willing to let a dental team member carry out screening. The majority indicated willingness to be screened for various medical conditions during a visit to the dentist, with significantly higher proportions of respondents in the primary care clinics indicating willingness (hypertension: 83% vs 74%; heart disease: 77% vs 66%; diabetes 82% vs 72% [all p <0.02]). Nearly two thirds of primary care clinic respondents and over half of general practice patients indicated that they would be willing to discuss test results with the dental team. Overall, 61% had never knowingly been screened or tested for diabetes; 20% reported that they had been tested within the previous 12 months.

CONCLUSION

The majority of respondents supported the concept of medical screening in a dental setting and were willing both to have screening tests and discuss their results with the dental team. Patient acceptance is paramount for successful implementation of such screening programmes.

SWEETWISE: developing a multi-professional approach to diabetes mellitus

The formation of a local joint professional network (LJPN) in Northamptonshire has led to a joint Continuing professional development initiative and an audit project to determine the take up of annual health checks by patients with diabetes mellitus with dentists, optometrists, pharmacists as well as the usual check with the General Medical Practice team. The findings showed that a significant number of patients (29-50%) do not access available dental, optometry and pharmacy advice. Better collaboration between the professions has the potential to improve health outcomes in diabetes mellitus and other areas where lifestyle modification reduces adverse health risks. A patient advice card (SWEETWISE) was developed by the group and could be used to help educate patients and health professionals.

Interdental cleaning among persons with diabetes: relationships with individual characteristics

OBJECTIVES

Given the existence of many potential oral health complications for adults with diabetes (especially for those who do not practise regular oral self-care), and the specific importance of regular interdental cleaning, the research determined the proportion of U.S. adults with diabetes who practise daily interdental cleaning and their socio-demographic, economic and oral health characteristics related to this practice.

METHODS

Analyses were conducted using data collected from 573 dentulous adults with diabetes ≥ 30 years who participated in the U.S. 2009-2010 National Health and Nutrition Examination survey. Using complex sample survey software, findings were extrapolated to >15 million U.S. adults. Descriptive statistics were used to determine the frequency of interdental cleaning, and chi-square tests were used to identify salient individual characteristics related to this practice.

RESULTS

41.2% reported that they never used any interdental device, while 24.8% indicated that they practised interdental cleaning daily. Statistically significant relationships (P < 0.05) with daily interdental cleaning included female sex, ever having had treatment for gum disease and using mouthwash daily for a dental problem.

CONCLUSIONS

Because so many adults with diabetes do not practise regular interdental cleaning, and in view of the important role that dental hygienists fulfil as oral healthcare educators, there is a great need for dental hygienists to teach and motivate adults with diabetes to practise regular interdental cleaning. This need is especially great for subgroups of these adults who are men, have not been treated for periodontitis and do not regularly use a mouthwash for dental problems.

Level of information about the relationship between diabetes mellitus and periodontitis--results from a nationwide diabetes information program

Background

A comprehensive knowledge about the mutual influence between diabetes and periodontitis is decisive for the successful treatment of both diseases. The present investigation aimed at assessing the diabetic and periodontal conditions and, in particular, the degree of knowledge about the relationship between diabetes and periodontitis.

Methods

During a diabetes information program, 111 nondiabetics (ND), 101 type 1 diabetics (T1D), and 236 type 2 diabetics (T2D) were subject to a medical and dental examination and completed a self-administered questionnaire. Medical examination included measurements of glycated hemoglobin (HbA1c), blood glucose (BG), and body mass index (BMI). Full-mouth examination consisted of the assessment of the decayed, missing, filled teeth index (DMFT) and the periodontal screening index (PSI). Chi-square test, ANOVA, t test of independent samples, univariate and multivariate logistic regression models with variable selection strategies were used for statistical analyses. Due to the exploratory character of the investigation a value of P ≤0.05 was considered to be statistically substantial.

Results

T2D had a significantly higher PSI when compared to T1D and ND (t test: P <0.001; P = 0.005). Approximately 90% of T2D suffered from periodontitis. In addition, diabetics with periodontitis showed a significantly higher BMI when compared to diabetics without periodontitis (multivariate logistic regression: P = 0.002). Almost 60% of all investigated subjects were not informed about the mutual influence between diabetes and periodontitis. T2D had almost as little information about the increased risk for periodontitis as ND.

Conclusions

The data of the present investigation suggest that there is a strong association between type 2 diabetes and chronic periodontitis. The lack of awareness of the mutual influence between diabetes and periodontitis, especially in T2D, demonstrates that this topic is still neglected in dental and diabetic treatment.

Oral health awareness and care preferences in patients with diabetes: a qualitative study

BACKGROUND

People with type 2 diabetes have an increased risk of oral health problems; however, oral health is currently not included in structured diabetes reviews and education in the UK.

AIM AND OBJECTIVES

This study explores the patient's experience related to oral health and diabetes, especially in relation to: • Awareness of the link between oral health and diabetes and oral self-care needs. • Interaction with health professionals in dental and general practice. • Preferences for receiving oral health information and education. Methods This nested qualitative study involved semi-structured telephone interviews with a purposive sample of 20 participants from a questionnaire study on oral health awareness in patients with diabetes. Interview transcripts were analysed using a thematic framework approach.

RESULTS

Participants were mostly unaware of the link between oral health and diabetes. Those that had been made aware by a health professional were not given concrete self-care advice. Interactions with dental professionals were often limited to informing the dental practice of their diagnosis and current medication. Most participants were in favour of dentists screening for diabetes, but as their general practice was the hub for diabetes care, they felt GPs or nurses should provide oral health information and discuss oral health with patients.

CONCLUSIONS

Written information regarding diabetes and its possible effects on oral health needs to be more readily available to people with diabetes, especially at diagnosis. There may be a place for introducing a structured oral health question in routine diabetes reviews.

Psychometric Properties of a Standardized Questionnaire of Knowledge, Attitude, and Practice of Iranian Medical Specialists about Viral Hepatitis

BACKGROUND

Good knowledge, attitude and practice (KAP) of the physicians allow them to handle their patients in such a way that they prevent themselves from contracting, and their patients from spreading, the infection. However, the Iranian standardized KAP questionnaire of physicians about viral hepatitis is not available. So, we developed a standard questionnaire.

OBJECTIVES

The purpose of this study was to provide a standard questionnaire as a basic tool for assessment of the present situation of the KAP of clinicians. It can also be used for evaluating educational programs and interventions on physicians in addition to any trends in their KAP about viral hepatitis.

PATIENTS AND METHODS

In order to design and standardize a 29-item self-administered questionnaire, we developed a cross sectional pilot study on 60 Iranian physicians. Ten experts in the field of liver diseases and/or designing the questionnaire answered questions about its validity. Cronbach's Alpha (on 60 physicians that participated in a congress) and factor analysis (on 370 persons; participants of two viral hepatitis congresses in Tehran and Zanjan and physicians of two university hospitals in Ahvaz) were used in the analysis.

RESULTS

Reliability was 0.7 according to Cronbach's Alpha score. Face validity was higher than 80%. Content validity of the whole parts of the questionnaire was 96.25% for clarity, 91.56% for relevancy, 96.25% for simplicity and 98.44% for consistency of each question with the questions' set. Factor analysis showed that 13 components account for 67.4% of the total variance.

CONCLUSIONS

This study provided evidence that our questionnaire is a feasible, valid and reliable measure of physicians' KAP status in Iran. The factor analysis did not reveal a strong cluster structure. This questionnaire should be interpreted as a one-dimensional element by the sum of all items, rather than a multi-dimensional instrument.