ENDOCRINOLOGY AND DIABETES OPEN ACCESS (ISSN:2631-374X)

Aim: The aim of this study was to (1) evaluate the oral health knowledge and awareness among patients with diabetes and (2) to assess the overall attitude and habits towards dental health care among patients with diabetes.

Methods: This cross-sectional survey was conducted at the King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia, from August 2019 to September 2019. A total of 572 patients with diabetes was included in this study. Demographic variable such as age, gender, education, body mass index, smoking and duration of diabetes were collected and a standardized, validated questionnaire consisting of 35 different statements used to collect the oral health awareness and knowledge.

Results: The overall finding of the study showed that the knowledge about oral health care awareness among diabetes was poor. Majority of the responders (59.4%) visited dental clinic, only if they had a problem. Majority (48.6%) of the responders brushed their teeth 1-2 minute and dental aids used by 69.6% of the responders. A total of 264 (47.14%) persons noticed bleeding in their gums, 48.12% reported bleeding means inflamed gingive. A total of 264 (46.2%) responders noticed bleeding in their gums, 44.8% reported bleeding means inflamed gingive. A total of 304 (53.1%) noticed a bad smell from their mouth and heard about the term dental plaque as staining of teeth (24.5%). More than 28% of the responders stated that gum inflammation and dental disease may increased blood sugar in patient with diabetes and 30.1% stated that cleaning gum and treating dental disease may help in improving their blood sugar level. A total of 254 persons agreed that certain systemic diseases can manifest in the oral cavity and 84.6% stated that oral health has an influence on the overall quality of life.

Conclusion: The study concluded that there is a significant lack of awareness and knowledge about oral manifestations among diabetes patients and hence steps have to be taken to upsurge their awareness through various outreach programs. Further, welldesigned randomized controlled trials with higher sample sizes are essential to validate our findings.

Oral health, Oral diseases, dental cavities, gum disease, Saudi Arabia

In a latest article, the World Health Organization (WHO) has emphasized on the dramatic increase of the diabetes mellitus (DM), in the past three decades, in countries across all income groups [1]. During the last few years, the rate of prevalence of diabetes has shown a steep increase in Saudi Arabia, where a substantial number of adult population is suffering from this disease at the moment, thereby showing one of the highest rates in the world in terms of diabetes prevalence and incidence [2-5]. The worrying forecast released by the International Diabetes Federation (IDF) indicated that if protective measures are not taken, half of the Saudi population will be diabetic by 2030. Innumerous studies, this ubiquitousness of diabetes in Saudi Arabia has been coined, as “epidemic” [2,4-8].

Oral health is a basic human right and an significant public health problem but is a ignored area of international health [9]. The oral health is influenced by systemic health, and one of the most common chronic diseases encountered in dental practice is diabetes mellitus anddiabetes can worsen oral infections and vice versa [10]. In both type 1 and type 2 diabetes, long-term poor glycaemic control can generateto major complications comprisingoral diseases [11]. Studies reported that treatment of dental (periodontal) disease by scaling/root planning and oral hygiene in people with diabetes caused in a mean decrease in HbA1c levels [12,13]. Despite growing evidence about the associations between oral health problems in patients with diabetes, there is limited research investigating oral health awareness in patients with diabetes in Saudi Arabia. Hence the present study aimed to evaluate the oral health knowledge and awareness and assess the overall attitude and habits towards dental health care among patients with diabetes in Saudi Arabia.

This cross-sectional survey wasconducted at the King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia, from August 2019 to September 2019. A total of 572 (type 1, type 2 and gestational diabetes) diabetes patientswas included in this study. To be eligible for participation in the study, the candidates needed to satisfy the following criteria: 20 to 79 years of age, having type 1 or type 2 diabetesor gestational diabetes . Patients with severe mental and/or physical disorder wereexcluded from this study, i.e. cerebral palsy, schizophrenia, substance abuse, alzheimer’s, severe stroke, or terminal stages of a disease. The study was conducted in accordance with the declaration of Helsink and the study protocol was approved by the Research Ethics Committee of King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.

Demographic variable such as age, gender, education, weight, smoking and duration of DM were collected. A standard validated questionnaire was used to collect the oral health awareness which developed from the previous literature designed in Arabic and English, The questionnaire contains five subcategories (1) demographic data, (2) clinical variables, (3) frequency of dental visit, (4) oral hygiene and (5) oral complication.

Statistical analysis

Data analysis was carried out using Microsoft Excel 2010 (Microsoft Corporation, Seattle, WA, United States) and Statistical Package for Social Sciences version 22 (SPSS Inc., Chicago, IL, United States). Descriptive analysis was used analysis the data.

Table 1 shows the demographic data of the responders. A higher number of responders were in the age group 50-59 (32.9%), weight 70-79 kg (28.7%), student category responders (51%), male (62.9%), earning a college degree (61.5) and Saudi nationals (92.3%).

Table 2 shows the clinical variables of the responders. The majority of the responders were having type 2 DM (89.2%), treated with oral hypoglycemic (49%), non-smokers (82.9%). A total of 98 (17.1%) responders were smokers, among them 80 (46.5%) responders used cigarettes. The majority of the participants had diabetes ≤ 10 years (276, 48.3%).

Table 3 shows the frequency of dental visit among the responders. The majority of the responders (59.4%) visited dental clinic, only if they had a problem and visited a dental clinic (32.2%) in the last 3 months. A higher number of the responders reported that they visited a dental clinic for pain (20%) and due to lack of time (24.8%) many persons not visited the dental clinic.

Table 4 shows the oral hygiene of the study population. The majority of the responders were brushing their teeth (91.6%) everyday and majority of the responders (79%) brushed by the manual tooth brush and tooth paste and higher number of responders burshed one time in a day (39.9%). Medium type of brush used by (42.7%) many responders, and combined (horizontal, vertical and circular) technique used for brushing (51.7%). A total of 468 (81.8%) persons changed their toothbrush periodically and 32.2% responders changed their toothbrush once in 6 months. The majority (48.6%) of the responders brushing their teeth 1 to 2 minute and dental aids used by 69.6% of the persons, mainly toothpick (44.1%) and clean their tongue by 36.4% responders and mouth wash used by 23.8% of responders.

Table 5 shows the oral complication of the study population. A total of 264 (46.2%) persons noticed bleeding in their gums, 44.8% reported bleeding means inflamed gingive. A total of 304 (53.1%) noticed a bad smell from their mouth and heard about the term dental plaque as staining of teeth (24.5%). More than 28% of the responders stated that gum inflammation and dental disease may increase blood sugar in diabetic patient and 30.1% stated that cleaning my gum and treating dental disease may help in improving their blood sugar level. A total of 254 persons agreed that certain systemic diseases can manifest in the oral cavity and 84.6% stated that oral health has an influence on the overall quality of life.

Oral health status must be considered in the care of patients with DM. The health of these patients’ mouths may have important effects on their overall health and evolution of their disease[14]. Regular dental checkups are necessary for all patients mainly among diabetes. A study reported that more frequent the dental visits, the lower the rate of tooth loss and the lesser the number of teeth with active decay, the higher, however, the average number of fillings. The study also suggests that frequent dental visits help to delay tooth loss and to continue dental function, they do not apparently help to prevent the onset of further disease [15]. In the present study we found that majority of the responders (59.4%) visited dental clinic, only if they had a problem and low number of patients visited a dental clinic (32.29%) in the last 3 months. We also found a higher number of the responders reported that they visited a dental clinic for pain (20%) and due to lack of time many responders (24.8%) not visited the dental clinic. The results of the finding showed the awareness of oral health was less among the Saudi diabetes. Earlier studies have demonstrated that delaying visit to oral health services upsurges the risk of poor oral health outcomes [9]. Socioeconomic conditions, cost, and a number of individual factors have been recognized as potential obstacles to accessing dental care [16,17]. In a study from from Saudi Arabia also reported the reasons for the irregaular visti mainly fear of anesthetic injection (88.2%), while dental surgical procedures (35.7%) and extractions (23%) were the most terrifying dental procedures. Lack of time (79.5%), cost (71.5%), far-situated dental services (62.2%), and fear (57.1%) were causes listed for irregular dental visits [18]. Several studies have indicated deficiencies in general oral health awareness among patients with diabetes. Additionally, most of these studies showed that a very low number of patients diagnosed with diabetes visit the dentist regularly for periodontal checkups, and many patients were unaware of the effect of diabetes on oral health [19-21].

A Saudi study indicated that inadequate health-related practices among the Saudi diabetes, the study reported that 22.2% brushed their teeth twice daily, 73.6% never flossed their teeth. Of the respondents, 94.8% reported that they had never received advice on oral hygiene tasks in relation to diabetes from a health professional [22]. In the present study we found that majority of the surveyed group were brushing their teeth (91.6%) and majority of the responders (79%) brushed by the manual tooth brush and tooth paste, a higher number of responders burshed one time in a day (39.9%). Medium type of brush used by (42.7%) many responders, and combined (horizontal, vertical and circular) technique used for brushing (51.7%). A previous study reported that powered toothbrushes reduce plaque and gingivitis more than manual toothbrushing in the short and long term [23,24]. In the present study we found that a total of 468 (81.8%) persons changed their toothbrush periodically and 32.2% responders changed their toothbrush once in 6 months. The majority (48.6%) of the responders brushing their teeth 1 to 2 minute and dental aids used by 69.6% of the persons, mainly toothpick (44.1%) and clean their tongue by 36.4% responders and mouth wash used by 23.8% of responders. A study stated that insufficient tooth brushing may result in greater harmful oral effects. Maintaining oral health will prevent oral chronic diseases and ameliorate the consequences of chronic inflammatory processes [14].

Studies reported that diabetes can lead to modifications in the oral cavity such as gum-related problems like gingival hyperplasia and periodontitis. Other diabetes-related oral conditions comprise dental decay, candidiasis, and glossodynia [25,26]. In the present study we found a total of 264 (46.2%) persons noticed bleeding in their gums, 44.8% reported bleeding means inflamed gingive. A total of 304 (53.1%) noticed a bad smell from their mouth and heard about the term dental plaque as staining of teeth (24.5%). More than 28% of the responders stated that gum inflammation and dental disease may increase blood sugar in diabetic patient and 30.1% stated that cleaning gum and treating dental disease may help in improving their blood sugar level. A previous study stated that only 28% of responders specified that they followed up gum diseases with the dentist; 48% were aware that diabetic patients are more prone to gum diseases and oral health complications. About a third (38%) recognized that their periodontal health might affect their glycaemic level [20].

The major limitations of this study include: a relatively small sample size, cross-sectional in nature and limited number of risk factors examined. More studies on a larger scale are needed to address the limitations indicated in the study. Despite the limitations, the study delivers valuable data for the oral health awareness and knowledge in patients with diabetes in Saudi Arabia. Conclusively, the findings of this study evidently illustrated that the oral health awareness and knowledge among Saudi diabetes was poor. Further, well-designed randomized controlled trials with higher sample sizes are essential to validate our findings.

The author gratefully acknowledges and thank the following interns: Haya Abdulrahman Alajlan, Samar Abdulrahman Almogbel, and Nourah Mohammed AlQahtani (Princes Nourah Bint Abdulrahman University), for their kind assistance and valuable contributions in distributing and tracking the survey to the participants.

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