Association Between Preventive Dental Visits and Flossing with Periodontitis and Diabetes Control – National Health and Nutrition Examination Survey, 2011-2014

Abstract

Background Diabetes and periodontitis are two intertwined chronic diseases linked by the inflammatory mechanism. Experimental studies indicate that treating periodontitis may benefit glycemic control among people with diabetes. It is not clear whether good oral self-care behaviors such as flossing may reduce risk for periodontitis and improve glycemic control among diabetes populations. The purpose of this study was to examine the associations between flossing and preventive dental care with periodontitis and glycemic control among US dentate adults with diabetes. Methods We analyzed data from the National Health and Nutrition Examination Survey 2011–2014 for 892 participants aged 30 years and older with diabetes who completed the periodontal examination and lab test for hemoglobin A1c (HbA1c). Sampling weights were applied. Multivariable logistic regression and multivariable linear modeling were performed to examine the effects of flossing and preventive dental services on periodontal health and HbA1c levels, respectively, controlling for sociodemographic characteristics, body mass index(BMI), smoking, and other risk factors. Results Among U.S. dentate adults with diabetes, 52.1% of flossers and 72.1% of non-flossers had periodontitis (p < 0.001). Flossers were 39% less likely to have periodontitis (Adj. OR 0.61, 95% CI 0.43–0.88) compared to non-flossers. Flossers had an average HbA1c reading 0.30% (95% CI 0.02% − 0.58%) lower than non-flossers, adjusted for covariates (p = 0.037). Conclusion Flossing was associated with better periodontal health and glycemic control among US dentate adults with diabetes. Although longitudinal and experimental studies are needed, the findings support that emphasis on oral self-care may be particularly beneficial for adults with diabetes.