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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 23  |  Issue : 1  |  Page : 76-80

Prevalence of oral problems among patients with Type II Diabetes Mellitus in the Selected Urban Area of Vellore City, Tamil Nadu


1 Assistant Professor, Departments of Community Health Nursing, College of Nursing, CMC, Vellore, Tamil Nadu, India
2 Professor, Departments of Community Health Nursing, College of Nursing, CMC, Vellore, Tamil Nadu, India
3 Professor, Department of Dental Surgery, CMC, Vellore, Tamil Nadu, India
4 Lecturer, Department of Biostatistics, CMC, Vellore, Tamil Nadu, India

Date of Submission10-Mar-2021
Date of Decision09-Jul-2021
Date of Acceptance17-Aug-2021
Date of Web Publication20-May-2022

Correspondence Address:
Mrs. Irene Dorathy
College of Nursing, CMC, Vellore, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijcn.ijcn_22_21

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  Abstract 


There is a rapid increase in diabetes mellitus worldwide causing premature deaths (1.6 million deaths in 2016) due to complications of the disease. India is said to have a greater number of diabetics, and diabetes remains one of the leading causes of death due to complications in India. Poor glycaemic control in patients not only affects their heart, kidneys, eyes and nerves but also affects the oral cavity. Periodontal disease is considered the sixth complication of diabetes mellitus, and it is seldom addressed. This study was conducted to assess the extent of oral problems amongst the clients with Type II diabetes mellitus in the selected urban area of Vellore district. A total of 150 samples were selected using simple random technique method. Informed consent was obtained from every subject, and the study was approved by the institutional review board. Data were collected using a structured pro forma, and a thorough oral examination was done to identify oral problems. The data were analysed using SPSS and were presented with explanatory statements in tables and graphs. The study findings revealed that the prevalence of periodontitis was high (64.7%) amongst the Type II diabetes mellitus and half of the subjects (53%) had one or the other oral problems such as calculus, stains dental caries, bleeding or swollen gum, gum recession and loose tooth or missing tooth. Regular dental check-up is mandatory for all diabetics, and oral health education is much required for better glycaemic control which will help to reduce the mortality rate and country's burden.

Keywords: Diabetes mellitus, periodontal disease, prevalence of oral problems


How to cite this article:
Dorathy I, Siva R, Chacko R, Sebastian T. Prevalence of oral problems among patients with Type II Diabetes Mellitus in the Selected Urban Area of Vellore City, Tamil Nadu. Indian J Cont Nsg Edn 2022;23:76-80

How to cite this URL:
Dorathy I, Siva R, Chacko R, Sebastian T. Prevalence of oral problems among patients with Type II Diabetes Mellitus in the Selected Urban Area of Vellore City, Tamil Nadu. Indian J Cont Nsg Edn [serial online] 2022 [cited 2022 Aug 20];23:76-80. Available from: https://www.ijcne.org/text.asp?2022/23/1/76/345779




  Introduction Top


Chronic diseases are the leading cause of death and disability worldwide. The most rapid increase in the burden of chronic disease is happening in developing countries. The major chronic diseases account for 40% of the global burden of diseases and by 2045, there would be a large social, financial and health system burden across the world.[1]

The four of the major prominent chronic diseases are cardiovascular diseases, cancer, chronic obstructive pulmonary disease and Type II diabetes mellitus. The prevalence of diabetes is rapidly increasing amongst Asian Indians, particularly in the past two decades. Urbanisation, changes from traditional healthier diets to high-refined carbohydrate intake and sedentary lifestyles have contributed to this steep increase in the prevalence of diabetes in India.[2] The prevalence of Type II diabetes mellitus has been reaching epidemic proportions across the globe, affecting low/middle-income and developed countries. Two main contributors to this burden are the reduction in mortality from infectious conditions and concomitant negative changes in lifestyles, including diet.[3] India leads the world with the largest number of diabetic subjects earning the term “diabetes capital of the world.”

Diabetes mellitus causes premature deaths mainly due to poorly controlled blood sugars. A monocentric observational study showed that Type II diabetes mellitus accounts for microangiopathy complications such as retinopathy (23.6%), nephropathy (25%) and neuropathy (40%) and macroangiopathies such as stroke (5%), limb ischaemic disease (17.1%) and coronary heart disease (23.6%).[4] Most of the literature describes these complications. However, periodontal disease is considered the “sixth complication” of diabetes mellitus which is seldom discussed.[5]

Periodontal disease is also considered a component of global diseases, and it is greatly associated with diabetes mellitus.[6] Periodontitis is a common chronic inflammatory disease characterised by the destruction of the supporting structures of the teeth. It is highly prevalent (severe periodontitis affects 10%–15% of adults) and has multiple negative impacts on quality of life. Epidemiological data confirm that diabetes is a major risk factor for periodontitis. Susceptibility to periodontitis is increased by approximately threefold in people with diabetes mellitus.[6] Periodontal disease is an entity of localised infections that involve tooth-supporting tissues, the structures that make up the periodontium (i.e., gingiva, periodontal ligament, root cementum and alveolar bone). The designation of periodontal disease includes both reversible (gingivitis) and irreversible (periodontitis) processes. In periodontitis, there is the destruction of the connective tissue of the tooth attachment apparatus accompanied by apical migration of the apparatus and eventual tooth loss.[7]

Diabetes Association of India reports that India will see the greatest increase in people diagnosed with diabetes by 2045. Hence, with the increase in the number of diabetes mellitus, periodontal diseases are also expected to increase which will lead to increase mortality. Furthermore, research suggests that previously healthy patients with severe periodontitis are at increased risk of developing diabetes mellitus. In addition, periodontitis can have significant adverse effects on diabetes mellitus outcomes. Severe periodontitis in people with diabetes mellitus has been shown to increase the risk of poor glycaemic control, which creates a higher prevalence of renal disease, cardiovascular complications and associated mortality. Periodontal bacteria make their way into the circulation, possibly increasing systemic inflammation and contributing to insulin resistance.[8]

Unfortunately, caring for the oral cavity is often overlooked when trying to control other problems associated with diabetes which may contribute to hidden morbidity and undue suffering from oral health problems. Hence, regular follow-up of dental problems of diabetes and oral health education is much required.[9]

Community health nurses are in an excellent position to help the nation achieve its goal in terms of reduction of oral problems amongst diabetes by implementing effective teaching programmes and by performing oral health assessments as part of the assessment in clients with diabetes mellitus. There is very limited evidence of the contribution of nurses in educating clients with diabetes mellitus on oral care. There is a paucity of published literature in terms of oral care amongst diabetics. This study was intended to identify the prevalence of oral problems amongst subjects with Type II diabetes mellitus and to determine the significant association of oral problems with selected demographic and clinical variables.


  Methods Top


The research approach used for the study was quantitative design. The study was conducted in the selected urban area of South Indian city, Vellore. The urban community health nursing programme, of a tertiary care medical centre caters to population of 19,000 providing health services. The population included for the study covered all the clients with Type II diabetes mellitus. Subjects with Type II diabetes mellitus in the age group of 30–70 years and who understood Tamil language were included in the study, and subjects who had cognitive, visual and hearing impairment, seizure disorder, oral cancer and orofacial fracture were excluded from the study.

A total of 150 clients with Type II diabetes mellitus who fulfilled the inclusion criteria were selected for the study using simple random sampling. The sample size was calculated using the finding of the pilot study using the formula 4pq/d2. Prevalence of the oral problem was 80% amongst the pilot study population. The investigator obtained the details of the population from the public health nurses and the registers of the urban health programme of a tertiary care medical centre.

Instruments

The instruments used were a structured interview questionnaire and an oral examination pro forma for adults (Modified WHO format by the dental department, tertiary medical care centre) to assess the oral problems. The structured interview questionnaire contained the demographic details of clients with diabetes such as age, sex, marital status, education, occupation, income and type of family and the clinical profile contained items pertaining to duration of diabetes mellitus, type of medication and recent blood sugar levels (within last 6 months) and oral health status. The oral examination pro forma was a checklist which included general assessment of the oral cavity including dentition status, periodontal status and loss of attachment, dental erosion, dental trauma, oral mucosal lesion and dentures. The tool was validated by experts in dental science. The content validity was found to be 0.85.

Ethical clearance for the conduction of the study was obtained from Institution Review Board, tertiary medical care centre, South India. Written consent was obtained individually from all the clients after an adequate explanation of the study purpose. Confidentiality of the information was maintained. A follow-up dental camp was organised where many of the subjects had their consultation and appropriate treatment with the dentist.

Analysis

The data were analysed using SPSS Statistics for Windows, Version 17.0. Chicago, Illinois, USA: SPSS Inc. The demographic variables, clinical variables and oral examination findings were presented in terms of frequencies, percentages, mean, median and standard deviation (SD). Chi-square test was used to determine the significant association of oral problems with selected demographic and clinical variables


  Results Top


The descriptive analysis of demographic variables showed that 62 (41.3%) of the clients with Type II diabetes mellitus were between 51 and 60 years of age with the mean age of 54.89 (SD = 9.40 years). Majority of 111 (76%) of the subjects were female. Fifty-three of them (35.3%) had their primary education and 95 (63.3%) of them were unemployed. Most of them, 49 (32.7%), were from low-middle-income families [Table 1].{Table 1}

More than half of them, 86 (57.3%), were diagnosed to have diabetes mellitus for <5 years and 82 (57.4%) with hypertension. Majority of them, 138 (92%), were on oral glycaemic lowering agent and 137 (91.3%) were on regular treatment. Nearly half of them, 73 (48.7%), were taking treatment from an urban health centre and 70 (46.7%) had poorly controlled sugar. A review of the record showed that 29 (19.3%) of them had not checked their blood sugar in the last 3 months and the majority of them, 117 (78.0%), had no record of any complications relating to diabetes [Table 2].{Table 2}

The majority of subjects (72%) expressed that they do not have any oral problems, whereas on oral examination, the majority of them had one or more oral problems. Some of them, 41 (28%), perceived one or more oral complaints. The perceived problems were decayed tooth 10 (6.7%) and loose tooth 8 (5.3%) [Figure 1].{Figure 1}

Among the subjects, 96% of them had one or the other oral problems on examination. More than half of them had dental caries (60.2%), stains (52.6%) and calculus (56.7%). One-fourth of them had root stump (28.6%) and attrition (27.3%). The other problems were swollen gum (11.3%), fractured teeth (6.7%), filled teeth (6.0%), proclinated teeth (18%) and crowded teeth. Some had either complete dentures (0.7%) or partial dentures (12%). The prevalence of periodontitis was high (64.7%) amongst study subjects [Figure 2]. More than half, 87 (58%), of them had poor oral hygiene and only 17 (11.3%) of them had good oral hygiene [Figure 3]. The higher rate of periodontitis was associated with poor oral hygienic practices and amongst the clients with uncontrolled diabetes (P < 0.001).{Figure 2}{Figure 3}


  Discussion Top


Perception of oral problems

The majority of subjects (72%) expressed that they do not have any oral problems, whereas the study revealed the majority of them had one or more oral problems which were elicited during the oral examination by the investigator. Some of them, 41 (28%), perceived one or more oral complaints. The perceived problems were decayed tooth 10 (6.7%) and loose tooth 8 (5.3%). The most common oral problems perceived by the individuals in another study were also painful teeth, mobile teeth, difficult chewing, swelling and bleeding gum.[10]

Prevalence of oral problems

Among the subjects, 96% of them had one or the other oral problems on examination. More than half of them had dental caries (60.2%), stains (52.6) and calculus (56.7%). One-fourth of them had root stump (28.6%) and attrition (27.3%). The other problems were swollen gum (11.3%), fractured teeth (6.7%), filled teeth (6%), proclinate teeth (18%) and crowded teeth. Some had either complete dentures (0.7%) or partial dentures (12%). A study showed that DMFT (decay, missing, and filled Teeth) index in diabetic patients was higher (P < 0.05) compared to non-diabetic patients. The mean value of decay was significantly higher in the diabetic group that was 6.70 (SD = 2.067). The means for DMFT were significantly higher in the diabetic group 13.52 (SD = 3.694).[10]

Periodontitis

The prevalence of periodontitis was high (64.7%) amongst study subjects. Another similar study done also had found that periodontal disease was the most prevalent (81.4%) oral complication seen in their participants.[11] The very high prevalence of periodontal disease in this study is consistent with the findings of three studies.[9],[12],[13] It was noticed that patients with uncontrolled diabetes had a higher prevalence (48.5%) of periodontal disease.

In this study, periodontitis was evaluated using four indices, namely, gingivitis, gingival recession, bleeding of gums, mobile teeth and loss of teeth. Bleeding gum was seen in 2 (1.3%). In this study, 17 (11.3%) of them had swollen gum, of which 8 (5.3) had bleeding on probing. Half of them, 76 (50.7%), had gum recession, of which 13 (8.7) had generalised gum recession and 63 (42%) of them had localised gum recession. Similarly, the rates of gingival inflammation in adults with T2DM were higher than those in adults without diabetes.[14] It also revealed nearly 64% of patients with T2DM have gingivitis; however, only 50% of subjects without diabetes had a gingival recession.

The present study found mobile teeth Grade I was found amongst the 45 (30%) and 33 (22%) of them had mobile teeth Grade 2 and 13 (8.7%) of them had fractured teeth and 38 (25.3%) of them had at least <5 root stumps. Half of them, 64 (42.7%), had their tooth extraction for either loose tooth or decayed teeth. A similar study amongst the older adults with diabetes mellitus reported that (82.3%) of them had a greater proportion of permanent tooth loss because of caries or periodontal disease.[15]

Investigators also found that 28 (18.7%) of them had <5 teeth exfoliated and 13 (8.7%) of them had more than 20 teeth exfoliated. A study done in Finland to predict the incidence of diabetes showed that incidence of diabetes was associated with ≥9 missing teeth (P < 0.040).[16]

Hygiene practices

More than half, 87 (58%) of them, had poor oral hygiene and only 17 (11.3%) of them had good oral hygiene [Figure 3].

Oral hygiene and periodontitis

The higher rate of periodontitis was associated with poor oral hygienic practices (P < 0.001). Another study by Lertpimonchai, Rattanasiri, Arj-Ong Vallibhakara, Attia and Thakkinstian[17] found a similar association between poor oral hygiene and severe periodontal disease amongst diabetics.


  Conclusion Top


It is evident that there is an increase in the prevalence of oral problems amongst clients with diabetes. Hence, the assessment of a client with diabetes mellitus must include an examination of the oral cavity. Community health nurses who play a vital role in the health promotion of people must also educate the clients with diabetes mellitus about the importance of oral care for good glycaemic control.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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