Improved oral hygiene is associated with decreased risk of new-onset diabetes: a nationwide population-based cohort study

Abstract

Aims/hypothesis Inflammation plays an important role in the development of diabetes, a major global health problem. Periodontal disease is also common in the general population. Because periodontal disease and poor oral hygiene can provoke transient bacteraemia and systemic inflammation, we hypothesised that periodontal disease and oral hygiene indicators would be associated with the occurrence of new-onset diabetes. Methods In this study we analysed data collected between 2003 and 2006 on 188,013 subjects from the National Health Insurance System-Health Screening Cohort (NHIS-HEALS) in Korea who had no missing data for demographics, past medical history, oral hygiene indicators or laboratory findings. The presence of periodontal disease was defined on the basis of a modified version of ICD-10 codes (Korean Classification of Disease, sixth edition), if claims for treatment for acute periodontitis (K052), chronic periodontitis (K053) and periodontosis (K054) were made more than two times by a dentist, or if, according to medical records, subjects received treatment by a dentist for periodontal disease with ICD-10 codes K052, K053 or K054. Oral hygiene behaviours (number of tooth brushings, a dental visit for any reason and professional dental cleaning) were collected as selfreported data of dental health checkups. Number of missing teeth was ascertained by dentists during oral health examination. The incidence of new-onset diabetes was defined according to ICD-10 codes E10-E14. The criterial included at least one claim per year for both visiting an outpatient clinic and admission accompanying prescription records for any glucose-lowering agent, or was based on a fasting plasma glucose ≥7 mmol/l from NHIS-HEALS. Results Of the included subjects, 17.5% had periodontal disease. After a median follow-up of 10.0 years, diabetes developed in 31,545 (event rate: 16.1%, 95% CI 15.9%, 16.3%) subjects. In multivariable models, after adjusting for demographics, regular exercise, alcohol consumption, smoking status, vascular risk factors, history of malignancy and laboratory findings, the presence of periodontal disease (HR 1.09, 95% CI 1.07, 1.12, p < 0.001) and number of missing teeth (≥15 teeth) remained positively associated with occurrence of new-onset diabetes (HR 1.21, 95% CI 1.09, 1.33, p < 0.001, p for trend <0.001). Frequent tooth brushing (≥3 times/ day) was negatively associated with occurrence of new-onset diabetes (HR 0.92, 95% CI 0.89, 0.95, p < 0.001, p for trend <0.001). Conclusions/interpretation Frequent tooth brushing may be an attenuating factor and the presence of periodontal disease and an increased number of missing teeth may be augmenting factors for the occurrence of new-onset diabetes. Improving oral hygiene may be associated with a decreased risk of occurrence of new-onset diabetes.

Number of teeth and masticatory function are associated with sarcopenia and diabetes mellitus status among community-dwelling older adults: A Shimane CoHRE study

“…Our findings support the negative association between MF and diabetes, as reported by Yamazaki et al [ 17 ]. A previous longitudinal study reported that the number of missing teeth (≥15 teeth) was positively associated with the occurrence of new-onset diabetes (hazard ratio = 1.21; 95% CI, 1.09–1.33) among 188,013 Korean adults [ 26 ]. This was consistent with our findings that individuals with an increasing number of remaining teeth tended to have lower odds of developing diabetes.…”

“…Third, our study could not control for the effects of the unmeasured factors. These include the effects of oral factors (e.g., periodontal disease, denture use, and brushing teeth) on the relationship between oral health and sarcopenia or diabetes [ 14 , 26 , 36 ]. Thus, future longitudinal studies are essential for investigating these associations.…”

Trend Analysis of Average Frequency Using Toothbrushing per Day in South Korea: An Observational Study of the 2010 to 2018 KNHANES Data

“…The frequency of toothbrushing per day is a major variable representing the oral health behavior of an individual, which is not only a powerful factor influencing oral diseases, but is also closely associated with health risk behaviors [10,11]. According to a recent study conducted by Lee and Song [12], the risk of diabetes was increased in the group with periodontal disease and the group with high tooth loss, whereas the risk of diabetes was decreased in the group that received regular teeth scaling. Periodontal disease is also known to increase cerebrovascular disease, atherosclerosis, and premature birth [13,14].…”

Bidirectional Association between Tooth Loss and Hypertension: A Systematic Review and Meta-analysis

“…Compared with individuals lost no more than three teeth, participants lost more than 15 teeth showed no signi cant difference in incidence of hypertension, which was partly consistent with our pooled analysis. Therefore, though several studies showed that tooth loss might act as a predictor for diabetes [28,29] and metabolic syndrome [30] , there is still no comprehensive evidence for the effectiveness of tooth loss as a predicator of incident hypertension. However, our result didn't repudiate the possibility that after the number of tooth loss exceed a certain number, the incidence of hypertension might increase.…”