Relationship Between Oral Health and Clinical Osteoporosis Among Hospitalized Patients with and Without Diabetes.

Objective Diabetes mellitus (DM) is associated with poor oral health and osteoporosis (OP). The aim of this study was to assess the relationship between OP, periodontal disease (PD), and other dental and health outcomes in a cohort of hospitalized patients with and without DM. Method Using a cross-sectional study design, we enrolled consecutive hospitalized patients. We administered a questionnaire to gather demographic information, oral health history, smoking history, and history of OP. We inspected their dentition and reviewed their charts. Data were analyzed using t-tests, chi-square tests, and logistic regression models. Result  Out of 301 patients enrolled, 275 had PD, 102 had DM, and 30 had OP. In univariate analyses, factors associated with OP included older age (p<0.001), female gender (p=0.046), presence of DM (p=0.049), and having more discharge medications (p=0.01). There was no significant relationship between PD and OP. In logistic regression analyses, age remained significantly associated with having OP among all hospitalized patients and in the non-DM populations. In the DM population, female gender was the only significant predictor for having OP. Conclusion Although we found no significant relationship between having PD and OP in our population, we found that among patients with DM, female gender predicted OP, whereas in patients without DM, age was a stronger predictor. Earlier screening for OP in female patients with DM may be useful in identifying and treating OP sooner in this population.

Relationship between dental loss and health outcomes among hospitalized patients with and without diabetes.

There is mixed evidence regarding the impact of poor dental health on cardiovascular disease and other health outcomes. Our objective was to determine the outcomes associated with poor dental health among hospitalized patients with and without diabetes mellitus (DM) at our institution. We enrolled a consecutive sample of adult patients admitted to an academic medical center. We gathered demographic, health and dental information, reviewed their medical records and then examined their teeth. We analyzed data using SPSS V.24. There was a high prevalence of dental loss among all hospitalized patients. Older age (p<0.001), smoking (p=0.034), having DM (p=0.001) and lower frequency of teeth brushing (p<0.001) were predictors of having a lower number of healthy teeth. Among DM and non-DM patients, fewer remaining healthy teeth was associated with presence of heart disease (p=0.025 and 0.003, respectively). Patients with diabetes mellitus (DM) had a higher prevalence of stroke (p=0.006) while patients without DM had a higher number of discharge medications (p=0.001) associated with having fewer number of healthy teeth. There was no correlation between number of healthy teeth and the length or frequency of hospitalization. Patients with DM are more likely to have fewer number of healthy teeth compared with non-DM patients. Fewer number of healthy teeth was associated with higher prevalence of heart disease in both DM and non-DM patients and with more discharge medications in non-DM patients.

Changes in Inflammatory and Bone Turnover Markers After Periodontal Disease Treatment in Patients With Diabetes.

BACKGROUND: The underlying mechanisms for increased osteopenia and fracture rates in patients with diabetes are not well understood, but may relate to chronic systemic inflammation. We assessed the effect of treating periodontal disease (POD), a cause of chronic inflammation, on inflammatory and bone turnover markers in patients with diabetes. MATERIALS AND METHODS: Using an investigator-administered questionnaire, we screened a cross-section of patients presenting for routine outpatient diabetes care. We recruited 22 subjects with POD. Inflammatory and bone turnover markers were measured at baseline and 3 months following POD treatment (scaling, root planing and subantimicrobial dose doxycycline). RESULTS: There were nonsignificant reductions in high-sensitivity C-reactive protein (6.34-5.52mg/L, P = 0.626) and tumor necrosis factor-alpha (10.37-10.01pg/mL, P = 0.617). There were nonsignificant increases in urinary C-terminal telopeptide (85.50-90.23pg/mL, P = 0.684) and bone-specific alkaline phosphatase (7.45-8.79pg/mL, P = 0.074). Patients with >90% adherence with doxycycline were 6.4 times more likely to experience reduction in tumor necrosis factor-alpha (P = 0.021) and 2.8 times more likely to experience reductions in high-sensitivity C-reactive protein (P = 0.133). CONCLUSIONS: Treatment of POD in patients with diabetes resulted in nonsignificant lowering of inflammatory markers and nonsignificant increase in bone turnover markers. However, adherence to doxycycline therapy resulted in better treatment effects.

DENTAL LOSS AMONG AMBULATORY PATIENTS WITH DIABETES.

AIMS: There is a high prevalence of dental loss among patients with diabetes. Understanding the factors that impact dental loss in this population will aid with developing new strategies for its prevention. METHODS: Using a cross-sectional study design, diabetes patients presenting for routine clinic visit were evaluated with an investigator-administered questionnaire. Data was collected on demographics, dental history, duration, control and complications of diabetes. RESULTS: Among 202 subjects, 100 were female, mean age: 58.9 ± 13.2 years, duration of diabetes: 15.8 ± 11.0 years, and hemoglobin A1c: 7.7 ± 1.6%. Thirty-one patients (15.3%) had lost all their teeth and only 13 (6.4%) had all 32 of their natural teeth. Using multiple linear regression, older age (ß= - 0.146; 95% CI: - 0.062 to - 0.230), not flossing (ß= - 3.462; 95% CI: - 1.107 to - 5.817), and presence of diabetic retinopathy (ß= - 4.271; 95% CI: - 1.307 to - 7.236) were significant predictors of dental loss. CONCLUSIONS: Dental loss is common in patients with diabetes and is associated with older age, diabetic retinopathy and not flossing. In order to reduce dental loss among patients with diabetes, regular flossing should be emphasized as an important component of dental care.

Impact of periodontal disease on outcomes in diabetes.

INTRODUCTION: The prevalence of periodontal disease (POD) among adults aged 30years and older in the United States is reported to be more than 47%, with higher prevalence seen among patients with diabetes mellitus (DM). POD has been associated with systemic inflammation, a known risk factor for cardiovascular and bone disease, both of which are more common in patients with DM. However, there is mixed evidence that treatment of POD reduces inflammation, improves DM control, and reduces DM complications. Our study objectives are to assess factors associated with POD in patients with DM and determine the impact of POD treatment on inflammation and bone turnover biomarkers associated with complications of DM. METHODS: In this pilot study, we will first recruit 200 patients with DM to complete a 48-item investigator-administered questionnaire designed to assess socio-economic status, oral health status, adequacy of oral care, glycemic control and presence of DM complications. Responses will be verified by individual chart review. Then, using a crossover design, a subgroup of 24 subjects with responses suggestive of POD will be assigned to undergo POD treatment for three months followed by three months of routine dental care (group 1) or be followed for three months during routine dental care then receive POD treatment for three months (group 2). Outcome measures will be collected before and after POD treatment and include glycemic control and inflammatory and bone turnover biomarkers. RESULTS: We hypothesize that the prevalence of POD among DM patients will be associated with inadequate glycemic control and greater DM complications.