Effects of oral health instructions on glycemic control and oral health status of periodontitis patients with type 2 diabetes mellitus: A preliminary observation

Diabetes mellitus (DM) is a group of metabolic diseases,1 and several studies have demonstrated a relationship between DM and periodontitis.2, 3, 4, 5 Diabetic complications include an increase in oxidative stress, inflammation, and advanced glycation end product formation. Poorly controlled DM is strongly associated with clinical attachment loss and edentulism in people with DM,6 and periodontal therapy influences glycemic control in type 2 DM (T2DM).7 A meta-analysis showed that scaling and root planning (SRP) improved the levels of glycated hemoglobin (HbA1c) and fasting plasma glucose (FPG), although statistically nonsignificant.3 Other systematic reviews and meta-analysis have reported that nonsurgical periodontal therapy (NSPT) significantly reduces mean HbA1c levels and also FPG levels.4,5 As periodontitis is caused due to dental plaque accumulation, maintaining oral hygiene is essential for preventing inflammation from periodontitis. Poor oral hygiene increases the risk of periodontitis by 2- to 5-fold,8 and plaque removal and control has been shown to be fundamentally important in preventing periodontal disease occurrence and progression.9 However, only a few studies have reported that oral hygiene instructions (OHIs) improve glycemic control in patients with T2DM.10, 11, 12 Furthermore, patients with DM recognize the characteristic oral malodor as “a disagreeable odor that emanates from the mouth.”13,14 Oral malodor is socially awkward for others to point out. As diabetes causes abnormal liver metabolism, abnormal ketone metabolism in the body results in acetone metabolism.15 We hypothesized that HbA1c level and oral malodor may decrease by regulating a patient's oral hygiene instructed by a dental hygienist. The aim of our study was to investigate the effects of OHIs on glycemic control and oral malodor in patients with T2DM.