Relationship between oral health, diabetes management and sleep apnea.

OBJECTIVES: The aim of this study was to assess the relationship between tooth loss, toothbrushing behaviour, diabetes type 2 (DM2), obesity and sleep apnea among diabetics.

MATERIAL AND METHODS: DM2 patients (n = 165) in Istanbul, Turkey, were randomly selected from the outpatient clinics of two hospitals. Baseline clinical measurements (HbA1c, fasting blood glucose, high-density lipoprotein (HDL), low-density lipoprotein (LDL), body mass index (BMI), body-fat proportion, tooth loss) and self-administered questionnaires (toothbrushing, gingival bleeding, sleep apnea) provided data for factor and principal component analysis with Varimax rotation. Univariate statistics and chi-square tests were derived.

RESULTS: Mean maxillary tooth loss (4.49 ± 3.69 teeth) was higher than in the mandible (3.43 ± 3.12 teeth, p< 0.001). Favourable HDL was measured among most patients (77%); other favourable clinical measures occurred only in a minority of participants (HbA1c, 28%; fasting blood glucose, 17%; LDL, 30%). Twice daily toothbrushing was reported by 33% (17%) for healthy BMI; 37% when healthy body-fat proportions. There was risk of sleep apnea in 37 %. The higher number of lost teeth in the maxilla was linked with obesity and sleep apnea. Non-daily toothbrushers were more likely to have high LDL and low HDL cholesterol and a higher risk of sleep apnea. When "at least occasionally" bleeding on toothbrushing occurred, higher HbA1c levels and sleep apnea were more likely.

CONCLUSION: Oral care with early diagnosis and monitoring of glycaemic level can help prevent complications of DM2.

CLINICAL RELEVANCE: Dentists may play a key role in better managing and diagnosing sleep apnea early by referring the patients with severe tooth loss and periodontal disease for general medical examination.