Individuals with dental disease and many missing teeth significantly increased their risks of developing the life-threatening disease, further emphasizing the importance of good oral hygiene, according to the researchers.
"The frequency of toothbrushing was associated with a decreased risk of new-onset diabetes, and the presence of periodontal disease and missing teeth may augment the risk of new-onset diabetes," wrote the authors, led by Yoonkyung Chang, MD, of the neurology department at Ewha Womans University College of Medicine Mokdong Hospital in Seoul, South Korea.
Inflammatory reactions are an important cause of diabetes because it increases insulin resistance and endothelial cell dysfunction. Like diabetes, periodontal disease affects many in the general population. Since periodontal disease and poor oral hygiene can provoke transient infection and systemic inflammation, the authors hypothesized that periodontal disease and oral hygiene indicators would be associated with the occurrence of new cases of type 1 and type 2 diabetes.
Researchers collected data on about 188,000 patients from the National Health Insurance System-Health Screening Cohort (NHIS-HEALS) in Korea, dating back between 2003 and 2006. They looked at oral hygiene behaviors, such as the number of times they brushed their teeth and when and why they visited dentists, as well as dental records.
An analysis of the data showed that about 1 in 6 of the included subjects had periodontal disease. About 31,500 people had diabetes when follow-ups were conducted 10 years later, according to the study authors.
Using computer modeling and after adjusting for patient demographics, including age, sex, and blood pressure, physical activity, alcohol consumption, smoking status, vascular risk factors, and history of cancer, the researchers determined that individuals who brushed their teeth at least three or more times per day reduced their risks of developing diabetes by 8%.
On the flip side, dental disease was associated with a 9% increased risk of developing diabetes, while those who had at least 15 missing teeth had a 21% increased risk, the findings showed.
The authors noted multiple study limitations, including that the results couldn't be generalized to other ethnicities because the participants in this study were Korean. Also, there may be recall bias because participants self-reported their oral hygiene indicators.
While the results did not reveal the exact mechanism connecting oral hygiene to the development of diabetes, it showed that toothbrushing likely plays a role in it.
"Improving oral hygiene may be associated with a decreased risk of occurrence of new-onset diabetes," the authors wrote.
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