Oral hygiene may be a key factor in diabetes risk, new data from a Korean national health database suggest.
"Frequent toothbrushing may be an attenuating factor for the risk of new-onset diabetes, and the presence of periodontal disease and increased number of missing teeth may be augmenting factors," write Yoonkyung Chang, MD, of the Department of Neurology, Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, South Korea, and colleagues.
"Improving oral hygiene may be associated with a decreased risk of occurrence of new-onset diabetes," they continue in an article published online March 2 in Diabetologia.
Periodontal disease involves inflammatory reactions affecting the surrounding tissues of the teeth. Inflammation, in turn, is an important cause of diabetes via increasing insulin resistance and endothelial dysfunction, Chang and colleagues explain.
They analyzed data from 188,013 individuals from the Korean National Health Insurance System – Health Screening Cohort who had complete data and did not have diabetes at baseline (2003-2006). Oral hygiene behaviors, including frequency of toothbrushing, and dental visits or cleanings, were collected by self-report.
Over a median follow-up of 10 years, there were 31,545 new cases of diabetes, with an estimated overall 10-year event rate of 16.1%. The rate was 17.2% for those with periodontal disease at baseline versus 15.8% for those without, which was a significant difference even after adjustments for multiple confounders (hazard ratio [HR], 1.09; P < .001).
Compared with no missing teeth, the event rate for new-onset diabetes rose from 15.4% for one missing tooth (HR, 1.08; P < .001) to 21.4% for 15 or more missing teeth (HR, 1.21; P < .001).
Professional dental cleaning did not have a significant effect after multivariate analysis. However, the number of daily tooth-brushings by the individual did. Compared with 0-1 times/day, those who brushed ≥ 3 times/day had a significantly lower risk for new-onset diabetes (HR, 0.92; P < .001).
In subgroup analyses, periodontal disease was more strongly associated with new-onset diabetes among adults aged 51 and younger (HR, 1.14) compared with those aged 52 and older (HR, 1.06).
The study was supported by a grant from the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education. The authors have reported no relevant financial relationships.
Diabetologia. Published online March 2, 2020. Abstract
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