1. Controlling Oral Health in Diabetic Clients with Chronic Periodontitis
Megan Gauley
Algonquin College Dental Clinic
ENL5507
Angela Slonosky
December 5th, 2014
CONTROLLING ORAL HEALTH IN DIABETIC PATIENTS WITH CHRONIC PERIODONTITIS! 1

2. Abstract
For many years, diabetes and the condition’s effect on oral health has been studied among dental
health care professionals. Clients with diabetes are at a greater risk for periodontal disease. In
order to control periodontal disease in diabetic patients dental health care professionals must
modify the treatment plan to improve overall health. Three studies have been reviewed to outline
the most important concepts a dental health professional can convey to their client to obtain oral
health. The validity of these studies are based on their unbiased research and publishing date. All
publishing dates are within 5 years of 2014. All participants at the time of publication have
chronic periodontitis and diabetes. Plaque indices, gingival condition, HbAC1, total cholesterol
and triglyceride levels are compared among the participants to determine effective methods for
client’s to control their diabetes orally. Data is gathered by using cross-sectional analysis. Initial
scaling and root planing, maintenance appointments and regular oral hygiene have the potential
to improve cholesterol and triglyceride levels and the overall oral condition. Further research is
needed in diet and lifestyle choices of chronic periodontitis diabetic patients and how those
choices effects their oral health.
Keywords: diabetes, chronic periodontitis, oral hygiene
CONTROLLING ORAL HEALTH IN DIABETIC PATIENTS WITH CHRONIC PERIODONTITIS! 2

3. Controlling Oral Health in Diabetic Clients with Chronic Periodontitis
Clients with diabetes have a higher percent of gingival recession, mobility, restorations
and missing teeth (Nassar, P., Schmitt Walker, C., Salvador, C., Felipetti, F., Orrico, S., & Nassar,
C., 2011). These dental features indicate the result of periodontitis. Periodontal disease is often
considered a complication with diabetes. If a client does not control their periodontitis, their
blood sugar can be manipulated and vice versa. Dental hygienists see clients who are faced with
this struggle every day. How can dental hygienists assist diabetics in controlling their chronic
periodontitis?
Methods
Three studies were used in this cross-sectional analysis to determine how diabetic clients
can improve their oral condition. All participants of the following studies have been diagnosed
with diabetes and chronic periodontitis. Dental self-efficacy as a determinant to oral health
behaviour, oral hygiene and HbA1c level among diabetic patients is a study published by the
Journal of Clinical Periodontology. This study will further be known as article #1. The main
focus of this study includes patient records, glycated hemoglobin (HbA1c) levels, plaque indices
and quantitative questionnaires. These aspects were used to gather data among 149 subjects
(Syrjälä, A., Kneckt, M., & Knuuttila, M, 1999). Article #2, Diabetes and Oral Health: The
Importance of Oral Health-Related Behaviour, was done over 720 days with 20 adult patients.
This study was used to evaluate improvement of lipids and periodontal disease in patients with
Type II Diabetes. Subjects were divided into two groups. The first group received periodontal
scaling and root planing and oral hygiene education for proper brushing technique. The second
study group was given periodontal scaling and root planing, oral hygiene education for proper
CONTROLLING ORAL HEALTH IN DIABETIC PATIENTS WITH CHRONIC PERIODONTITIS! 3

4. brushing technique and maintenance appointments. They compared blood levels of cholesterol,
triglycerides and clinical periodontal parameters. These comparisons were done at 0, 180 and
720 days (Nassar, P., Schmitt Walker, C., Salvador, C., Felipetti, F., Orrico, S., & Nassar, C.,
2011). Article #3, published in 2014, is titled Effect of nonsurgical periodontal therapy verses
oral hygiene instructions on Type 2 diabetes subjects with chronic periodontitis: a randomised
clinical trial. A group of 15 people obtained Non-Surgical Periodontal Therapy (NSPT) while
the second group of 12 people were treated with oral hygiene education. Plaque index and
glycaemic control were tested at the two month recall visit (Cheta Raman, R., Taiyeb-Ali, T.,
Siew Pheng, C., Chinna, K., & Vaithilingam, R., 2014). All studies demonstrated validity and no
bias.
Results
Demographically, education and age played a factor in the oral health of the diabetic
participants. Younger age groups and those with a higher level of education had superior oral
conditions. Subjects from article #1, displayed lower HbA1c levels on those who had higher
scores on toothbrushing self-efficacy (p=0.020) and toothbrushing frequencies (p=0.032)
(Syrjälä, A., Kneckt, M., & Knuuttila, M, 1999). Plaque indices correlated inversely with
toothbrushing self-efficacy (p=0.012) and dental visiting self-efficacy (p=0.004) (Syrjälä, A.,
Kneckt, M., & Knuuttila, M, 1999).
Results in Article #2 showed there was a statistically significant improvement of total
cholesterol, triglycerides, high-density lipoprotein (HDL) and low-density lipoprotein (LDL).
Advancements were evident at the 720 day recall appointment. The second control group who
received maintenance appointments exhibited further improvements. This group showed a
CONTROLLING ORAL HEALTH IN DIABETIC PATIENTS WITH CHRONIC PERIODONTITIS! 4

5. reduction in probing depths opposed to the first group who saw no change (Nassar, P., Schmitt
Walker, C., Salvador, C., Felipetti, F., Orrico, S., & Nassar, C., 2011).
Table 1
HDLHDL LDLLDL
Group 1Group 1 Group 2Group 2
1st exam (0) 43.6 33.4 137.0 127.9
2nd exam (180 days) 44.6 45.7 135.8 115.8
3rd exam (720 days) 50.4 46.1 104.3 110.3
Table 1 displays the average figures of HDL and LDL of the 3 periods studied (0, 180 and 720
days). The values are displayed are expressed as mean. (Nassar, P., Schmitt Walker, C., Salvador,
C., Felipetti, F., Orrico, S., & Nassar, C., 2011)
Article #3 outlined the role of dental health care professionals. Baseline data for the
subjects who participated in the study differentiating the effects of NSPT and oral hygiene
education showed no significant findings. However, at the two month recall appointment there
was a notable difference in plaque indices (p=0.013) among the two groups. In the oral hygiene
education group, the average Probing Pocket Depth (PPD) reduced by less than 50% at the two
month recall appointment (p < 0.001). Additionally, the average PPD within the NSPT group
decreased from 6 mm at baseline to 2 mm at the two month recall (p = 0.004) (Cheta Raman, R.,
Taiyeb-Ali, T., Siew Pheng, C., Chinna, K., & Vaithilingam, R., 2014). Although the oral
hygiene education group had significant data, the NSPT group showed a greater difference in the
improvement of oral health.
CONTROLLING ORAL HEALTH IN DIABETIC PATIENTS WITH CHRONIC PERIODONTITIS! 5

6. Discussion
Client compliance is the most fundamental part of controlling chronic periodontitis in
diabetic patients. The mechanical removal of plaque by toothbrushing has the ability to lower the
amount of glycated hemoglobin in the bloodstream. Non-Surgical Periodontal Therapy, even
more so, lowered the content of total cholestrol, HDL, LDL and triglycerides. Reduced plaque
indices and pocket depths within the studies are related to repetitive professional debridement by
dental hygienists. Maintenance appointments not only eliminate plaque retentive factors but also
make it easier for the client to control. Therefore, diabetics who have received proper brushing
and plaque control procedures can clinically improve metabolic control. These findings support
the urgency that diabetic patients can not rely on medication to control their condition when
faced with chronic periodontitis. Dental visits, routine home care and maintenance appointments
can reduce both the visible signs of periodontal disease and the fatty compounds within the body.
Conclusion
Dental hygienists must strive to provide clients with knowledge and resources to obtain
their full oral health potential. Diabetics, who are already disadvantaged when it comes to oral
health, must be given proper oral hygiene education. Dental hygienists are in the position to
discuss with their clients the importance of meticulous oral hygiene care and outline the risks
associated with diabetes. If the patient complies with frequent dental visits, as well as with daily
oral hygiene routines, their oral condition will improve. Therefore, diabetics overall health will
ameliorate related to the improving levels of glycated hemoglobin. Exceptional oral health is the
gateway to overall health.
CONTROLLING ORAL HEALTH IN DIABETIC PATIENTS WITH CHRONIC PERIODONTITIS! 6

7. Recommendations
1. Client education must to be a crucial component to the treatment plan. Consulting with the
client’s physician through interprofessional collaboration may be the key to a clients ability to
control their condition. With this being said, dental health care professionals must participate
in continued learning regarding diabetes to better advocate for oral health.
2. Further research is needed to determine how oral hygiene, dental visits and maintenance
appointments effect those with different dietary habits. Although, in the reviewed studies
participants showed statistically significant changes in their metabolic control. However, there
was no data regarding the lifestyle choices they made while in the duration of the study and if
those choices had any effect on blood levels.
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8. References
Cheta Raman, R., Taiyeb-Ali, T., Siew Pheng, C., Chinna, K., & Vaithilingam, R. (2014). Effect
of nonsurgical periodontal therapy verses oral hygiene instructions on Type 2 diabetes
subjects with chronic periodontitis: a randomised clinical trial. BMC Oral Health, 14(1),
2-19. doi: 10.1186/1472-6831-14-79.
Nassar, P., Schmitt Walker, C., Salvador, C., Felipetti, F., Orrico, S., & Nassar, C. (2011). Lipid
profile of people with Diabetes mellitus type 2 and periodontal disease. Diabetes
Research and Clinical Practice, 96, 35-39.
Syrjälä, A., Kneckt, M., & Knuuttila, M. (1999). Dental self-efficacy as a determinant to oral
health behaviour, oral hygiene and HbA1c level among diabetic patients. Journal Of
Clinical Periodontology, 26(9), 616-621.
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