We all know that what we eat can have an effect on our risk of getting diabetes or controlling it once we have it. But cleaning the teeth that chew the food?
That’s the subject of a new study from South Korea published in Diabetologia, the journal of the European Association for the Study of Diabetes.
The researchers began by noting that “inflammation plays an important role in the development of diabetes.” In addition, they pointed out that “periodontal disease is also common in the general population.” As a result, they proposed a hypothesis: because periodontal disease and poor oral health can trigger inflammation, periodontal disease and oral hygiene are associated with the onset of diabetes (both type 1 and type 2).
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To test their hypothesis, the researchers collected data between 2003 and 2008 from nearly 200,000 subjects in a South Korean database known as the National Health Insurance System-Health Screening Cohort. The database contained information on medical history, demographics, and indicators of oral hygiene, such as how often the subjects brushed their teeth, their visits to the dentist for any reason, how often they had their teeth professionally cleaned, and whether they had any missing teeth (and, if so, how many) because missing teeth can be an indication of poor oral health.
The data showed that about one in six of the subjects (17.5%) had periodontal disease. After a follow-up of about ten years, 16% of the subjects developed diabetes. The researchers then adjusted the data to account for other factors, such as age, weight and height, gender, blood pressure, socioeconomic status, physical activity, smoking, alcohol consumption, and a history of cancer or vascular conditions. After making the adjustments, the researchers determined that there is in fact a connection between oral hygiene and the risk of diabetes. In general, the presence of periodontal disease was linked to a 9% greater risk of developing diabetes. If subjects had 15 or more missing teeth, their diabetes risk was 21% greater. On the other hand, frequent tooth brushing (three or more times a day) was associated with an 8% decreased risk of developing diabetes.
The researchers also reported some noteworthy differences regarding the age and sex of the subjects. In the younger group (under age 52) those who brushed their teeth twice a day showed a 10% lower risk of developing diabetes and those who brushed three times a day had a 14% lower risk. But among those older than 51, the researchers found no difference between those who brushed twice a day and those who brushed just once a day or not at all. However, the older subjects who brushed three times a day had a decreased risk of 7%. Younger subjects who had one to seven missing teeth had a 16% higher risk of diabetes, while the most powerful effect of tooth loss was found in older subjects who had 15 or more missing teeth. Their risk was 34% higher. Younger people also seemed to be more affected by periodontal disease. In the younger group, periodontal disease was associated with a 14% increased risk of diabetes, while in the older group it was 6%. Interestingly, women who brushed three or more times a day showed a reduced risk of 15% and women who brushed twice a day showed an 8% reduced risk, but among men who brushed three times a day or more the risk reduction was only 5%. Finally, the researchers found no significant difference between men who brushed twice a day and those who brushed once a day or not at all.
The authors of the study said their research did not determine the specific process that links oral health to the onset of diabetes, but they pointed out that tooth decay can contribute to inflammation, especially the production of inflammatory biomarkers that are known to be related to insulin resistance and the development of diabetes. They concluded, “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.
Want to learn more about oral health for diabetes? Read “Diabetes and Oral Health: What’s Their Relationship?” “Disease, Treatment, and Oral Health,” and “Choosing Dental Care.”