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Diabetic Neuropathy Can Indicate Poor Oral Health

Sep 22, 2018
 

A new study shows an association between nerve and gum diseases in patients with diabetes.

With the multitude of serious complications that can arise from uncontrolled diabetes, some of the lesser known complications may be overlooked by the over 400 million people living with diabetes around the world. Severe gum disease affects more than one-third of people with diabetes each year, ranging from mild gingivitis to a more serious form — periodontitis. When this more dangerous form of gum disease occurs, this can lead to progression of diabetes, an even greater loss of glycemic control, and eventually could result in permanent destruction of teeth.

Diabetic neuropathy, a form of nerve damage, is another serious, and much more well-known, complication that affects over half of all patients living with diabetes. While there are different forms of diabetic neuropathy, each one can lead to detrimental consequences that can severely impair a patient’s quality of life.

While both periodontal disease and diabetic neuropathy are worrisome ailments associated with diabetes, can we say that the two are related? Investigators out of Romania addressed this question in a new study published in Diabetes Care in July, 2018. A cross-sectional study was performed on a large cohort of Romanian patients with diabetes to examine the association between oral health and diabetic neuropathy.

Patients were evaluated for oral health status using a self-reported questionnaire and were subsequently placed into four different categories based on frequency of gingival pain and bleeding: good (no symptoms), average (rarely experience symptoms), poor (often experience symptoms), and very poor (complete dentures). Patients were also assessed for diabetic neuropathy through a questionnaire and clinical exam, and grouped as either having clinical diabetic neuropathy or symptomatic diabetic neuropathy based on their workup. Clinical diabetic neuropathy was defined as having a Michigan Neuropathy Screening Instrument exam (MNSIe) score of ≥2.5 and symptomatic diabetic neuropathy was defined as having a Michigan Neuropathy Screening Instrument questionnaire (MNSIq) score of ≥4.

A total of 1,379 patients enrolled were included in the analysis. The average age of each patient was 64 years with a little more than half of those patients being women (56.8%). 90% of the enrolled patients had type 2 diabetes while the remainder had type 1 diabetes.

Results of the study showed that patients categorized as having both clinical and symptomatic diabetic neuropathies were more likely to present with poor oral health status. In the same regard, patients with poor oral health status had higher MNSIe and MNSIq scores compared to those with good oral health (p<0.001). When investigators controlled for age, sex, and diabetes duration, they still found a significant association between both clinical and symptomatic diabetic neuropathy and poorer oral health (For MNSIe ≥2.5: 1.23 [1.10–1.36], p<0.001; for MNSIq ≥4: 1.20 [1.08–1.34], p<0.001; for MNSIq4 ≥2: 1.14 [1.02–1.27], p=0.021).

While the results of this study do not necessarily indicate causation, they do further emphasize the importance of maintaining glycemic control in order to prevent a host of complications. Based on what the investigators of this study observed, the poorer the status of a patient’s diabetes, the greater the risk for a variety of complications. As more studies are conducted and continue to show such a relationship, we may see more frequent use of screening methods to evaluate patients with diabetes for oral health status, especially in those with concurrent complications such as diabetic neuropathy.

Practice Pearls:

  • Patients with both clinical and symptomatic diabetic neuropathies were more likely to present with poor oral health status.
  • Patients with poor oral health status had greater prevalence of diabetic neuropathy compared to those with good oral health.
  • Results of the study indicate that the poorer the status of a patient’s diabetes, the greater the risk for diminished oral health.

Resources:

Jivanescu, A., Bondor, C. I., Pop-Busui, R., Veresiu, I. A., Sima, D. I., Cosma, D., Gavan, N. A. (2018). Associations Between Oral Health Status and Diabetic Neuropathy in a Large Romanian Cohort of Patients with Diabetes. Diabetes Care,41(9), Dc180721. doi:10.2337/dc18-0721

Diabetes and Oral Health Problems. (2012, September). Retrieved from http://www.diabetes.org/living-with-diabetes/treatment-and-care/oral-health-and-hygiene/diabetes-and-oral-health.html

Neuropathy (Nerve Damage). Retrieved from http://www.diabetes.org/living-with-diabetes/complications/neuropathy/

Type 2 Diabetes Statistics and Facts. Retrieved from https://www.healthline.com/health/type-2-diabetes/statistics

Clarke Powell, Pharm.D. Candidate 2019, LECOM School of Pharmacy