Risk of complications among diabetics self-reporting oral health status in Canada: A population-based cohort study

Abstract

BackgroundPeriodontitis has persistently been associated with diabetes and poor health outcomes. While clear associations have been identified for the diabetes-oral health link, less is known about the implications of poor oral health on incident complications of diabetes. This study sought to investigate the risk of diabetes complications associated with self-reported "poor to fair" and "good to excellent" oral health status among diabetics living in Ontario, Canada. MethodsThis cohort study was undertaken of diabetics from the Canadian Community Health Survey (2003 and 2007-8). Self-reported oral health was linked to electronic health records at the Institute for Clinical Evaluative Sciences. Participants under the age of 40, missing self-reported oral health and those who could not be identified in linked databases were excluded (N=5,183).A series of Cox Proportional hazard models were constructed to determine the risk of diabetes complications. Participants who did not experience any diabetes complication were censored at time of death or at the study termination date (March 31, 2016). Models were adjusted for age and sex, followed by social characteristics and behavioural factors. ResultsDiabetes complications differed by self-reported oral health. For those reporting "poor to fair" oral health, the hazard of a diabetes complication was 30% greater (HR 1.29 95%CI 1.03, 1.61) than those reporting "good to excellent" oral health. ConclusionsOur findings indicate that oral health status is associated with increased risk for complications among diabetics, after adjusting for a wide range of confounders. Examining oral health and the risk for diabetes complications from a broader perspective including socio-behavioural and biological pathways is principal for informing policies and interventions that aim to mitigate the burdens of poor systemic health.

Oral Health Access and Inequities in Rural Regions

“…Diabetics patients with poor periodontal health found difficulties controlling their blood sugar levels as periodontal inflammation promotes insulin resistance (53). For example, a long-term follow-up report of diabetic Ontarians demonstrated that for those reporting poor to fair oral health status, the adjusted risk of diabetes was 29% greater than those informing good to excellent oral health status (54).…”

“…Diabetes is a chronic illness that has been strongly associated with poor oral health (99) and is one of the leading causes of death worldwide, according to the World Health Organization (100). The evidence suggests that oral health care providers can significantly and positively impact the oral and genital health of diabetes patients (54,101). The responses were dichotomized into yes (presence of disease) or no (no presence of disease).…”