Dental Visits Found to Reduce Diabetes Hospitalization

Laird Harrison

January 11, 2012

January 11, 2012 —Patients with diabetes were one third less likely to visit an emergency department or be hospitalized for the disease when they got regular dental care, researchers report in the January 2012 issue of the Journal of the American Dental Association.

"What was encouraging was the magnitude of the association," lead author David Mosen, PhD, MPH, an affiliate investigator at Kaiser Permanente Northwest in Portland, Oregon, told Medscape Medical News.

He cautioned that the retrospective study could not prove that dental care directly reduced the patients' risk for a diabetic emergency. "We don't know if it's because of the dental care, or if it's just because people with good dental care also have good general healthcare," he said.

However, Dr. Mosen said the researchers did use statistical methods to adjust for such factors as visits to primary care physicians, and still found a strong association with dental visits.

The study is the latest among several that have associated dental care with better systemic health. Similar findings have emerged for cardiovascular disease, preterm birth, and other disorders.

Dr. Mosen noted that the databases available at Kaiser Permanente Northwest offered an unusual advantage because they include both medical and dental records. Most US patients have separate dental and medical insurance, even at other Kaiser Permanente affiliates.

The researchers identified 537 patients with diabetes who received 2 or more prophylactic treatments, periodontal treatments, or both each year for the calendar years 2005, 2006, and 2007. They compared these patients with 747 patients with diabetes who had no dental care visits during these 3 years.

The 2 populations were similar in age, sex, hospital admission, and emergency department use during 2005; Charlson comorbidity scores (a measurement of the risk for death) in 2005; primary care use from 2005 through 2007; and periodontal risk factors (diabetes and smoking) in 2005.

However, the patients who did not get dental care were less likely to have good control of hemoglobin A1c (HbA1c) values in 2005, and they had a higher body mass index in 2005.

The 2 groups had no statistically significant differences, and although the patients in the dental group were slightly more likely to have had low-density lipoprotein cholesterol tests, the researchers did not think the difference was clinically significant.

The researchers also found no association between glycemic control and dental care.

In 2007, in the dental group, 54.8% had good HbA1c control vs 43.2% in the nondental group (P < .001), but that association dropped just below statistical significance when it was adjusted for other variables.

However, diabetes-specific emergency department visits in 2007 were independently associated with dental care, as were diabetes-specific hospital admissions in 2007. In the dental group, 10.1% had emergency department visits vs 16.2% of the nondental group (P = .005). Likewise, 8.3% of the dental group was admitted to the hospital for diabetes care vs 14.8% of the nondental group (P = .001).

The odds ratio of a diabetes-specific emergency room visit for the dental group compared with the nondental group was 0.61 (95% confidence interval [CI], 0.40 - 0.92; P = .02) compared with the nondental group. For diabetes-related hospital admission, the odds ratio for the dental group compared with that for the nondental group was 0.61 (95% CI, 0.39 - 0.95; P = .03).

Although the association does not prove causality, the relationship of diabetes to dental care is worth further investigation, said Dr. Mosen. In separate research, some evidence is emerging that inflammation from periodontal disease affects glycemic control, he added.

Asked to comment on the study, Marjorie Jeffcoat, DMD, a professor of periodontics at the University of Pennsylvania, told Medscape Medical News that the data reinforced previous findings. "When you treat dental disease, you end up with fewer medical problems," said Dr. Jeffcoat, who has been involved in similar studies, but not this one.

Although the study was similar to others, it is important because it included a large number of patients, she said. "This is now the third database in which we're seeing this, and it does speak to there being an effect," she said.

It adds to the message that dental professionals can provide overall health benefit for their patients, she added. "Based on this information, clinicians can say, 'Your whole body is connected. If you keep any part of it healthy, that will keep the whole body healthier.' "

The authors and Dr. Jeffcoat have disclosed no relevant financial relationships.

J Am Dent Assoc. 2012;143:20-30. Abstract

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