|Year : 2015 | Volume
| Issue : 4 | Page : 193-199
Oral diseases and diabetes: Nigerian medical and dental caregivers' perspective
Matthew A Sede1, Adebola O Ehizele2
1 Department of Restorative Dentistry, University of Benin, Benin City, Nigeria
2 Department of Periodontics, University of Benin, Benin City, Nigeria
|Date of Web Publication||16-Oct-2015|
Adebola O Ehizele
University of Benin, Benin City
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Objectives: The objective was to determine the knowledge of medical and dental caregivers regarding the link between oral diseases and diabetes mellitus (DM); and their role in the management of the oral complications of DM.
Materials and Methods: This comparative study was carried out among a group (n = 100) of resident doctors undergoing postgraduate training in medicine and dentistry at a Nigerian Teaching Hospital. A 28-item self-administered questionnaire was used for data collection and it elicited information on respondents' demographics, practice behaviors, knowledge about link between oral diseases, and DM, as well as their knowledge about oral complications of DM.
Results: Majority of the dental senior residents (83.3%) had adequate knowledge of the oral manifestation of DM and the link between oral disease and DM while only 43.8% of the medical junior residents had adequate knowledge (P = 0.060). Majority (63.0%) who strongly agreed that physicians need to collaborate with dental professionals to reduce DM patients' risk of developing oral diseases belonged to the dental group (P = 0.040) and only 35.3% of medical group strongly agreed that physicians should be taught how to screen for oral disease in DM patients (P = 0.009). A vast majority (89.6%) of the medical group however felt that they needed additional information about the link between oral disease and DM (P = 0.036).
Conclusion: The findings indicate that there is still a major gap in knowledge of the link between oral diseases and DM; as well as a poor appreciation of the need for a collaborative management of DM patients by medical and dental practitioners.
| Abstract in French|| |
Objectifs: L'objectif était de déterminer les connaissances des soignants médicaux et dentaires concernant le lien entre les maladies buccodentaires et le diabète sucré (DM); et leur rôle dans la gestion des complications orales de DM.
Matériel et méthodes: Cette étude comparative a été menée auprès d'un groupe (n = 100) des médecins résidents en formation postdoctorale en médecine et en dentisterie dans un hôpital nigérian enseignement. Un 28-article questionnaire auto-administré a été utilisé pour la collecte des données et il a suscité des informations sur les caractéristiques démographiques des répondants, les comportements de pratique, la connaissance de lien entre les maladies buccales, et DM, ainsi que leurs connaissances sur les complications orales de DM.
Résultats: La majorité des résidents seniors dentaires (83,3%) avaient une connaissance suffisante de la manifestation orale de DM et le lien entre les maladies buccodentaires et DM alors que seulement 43,8% des résidents juniors médicales avait une connaissance suffisante (P = 0,060). La majorité (63,0%) qui ont fortement d'accord que les médecins doivent collaborer avec les professionnels des soins dentaires pour réduire le risque de DM patients de développer des maladies orales appartenu au groupe dentaire (P = 0,040) et seulement 35,3% du groupe médical fortement d'accord que les médecins devraient être enseignées comment dépister les maladies bucco-dentaires chez les patients DM (P = 0,009). Une grande majorité (89,6%) du groupe médical a toutefois estimé qu'ils avaient besoin de plus d'informations sur le lien entre les maladies buccodentaires et DM (P = 0,036).
Conclusion: Les résultats indiquent qu'il ya encore une lacune importante dans la connaissance du lien entre les maladies buccodentaires et DM; ainsi que d'une mauvaise appréciation de la nécessité d'une gestion collaborative des patients atteints de diabète par les praticiens médicaux et dentaires.
Mots-clιs: Diabθte, les praticiens mιdicaux et dentaires, maladies bucco-dentaires
Keywords: Diabetes, medical and dental practitioners, oral diseases
|How to cite this article:|
Sede MA, Ehizele AO. Oral diseases and diabetes: Nigerian medical and dental caregivers' perspective. Ann Afr Med 2015;14:193-9
| Introduction|| |
Diabetes mellitus (DM) is a chronic global disease, which is costly and debilitating with many complications and estimated to affect up to 366 million adults of the world's population. It is expected that the number of people affected with this disease may increase to an alarming 552 million by the year 2030. DM has been reported as a risk factor for periodontal disease; an inflammatory infection caused by bacteria and characterized by progressive destruction of the supporting tissues of the teeth.
There is a large body of evidence suggesting that DM worsens periodontal disease and vice versa.,,,,,, It has been suggested that periodontal diseases may result in increased insulin resistance thereby making the management of DM more difficult., On the other hand, poor oral hygiene, deep periodontal pockets, rapid bone loss, frequent periodontal abscesses, and tooth loss have been said to be common in diabetic patients.,, The relationship between these two disease entities was considered stronger with the finding of advanced glycation end-products, altered lipid mechanisms, oxidative stress, and systemically elevated cytokine levels in patients with DM and periodontitis.
Although periodontal disease has been widely referred to as the sixth complication of DM, other oral complications of diabetes such as xerostomia  and dental caries , have been reported. Oral mucosa lesions in the form of stomatitis, candidiasis, geographic tongue, benign migratory glossitis, fissured tongue, traumatic ulcer, lichen planus, lichenoid reaction, and angular cheilitis have also been reported.,, Delayed mucosal wound healing, mucosal neurosensory disorders are also possible complications of DM.
A good knowledge of oral health among medical practitioners is considered very important. Hence, it is expected that dental and medical care providers should have standard referral patterns and coordinated therapies for the management of diabetic patients., Previous studies to determine the knowledge of physicians about oral health and its relationship to systemic disease, in general  and DM specifically  have been done. These studies are in support of promotion of interprofessional education and collaboration to enhance patient management.
However, not much has been done on this subject matter in our environment. There is also a general assumption that medical and dental practitioners are knowledgeable about the link between oral diseases and DM, but this may not necessarily be so. The aim of this study was to determine the difference in the opinions of medical and dental caregivers regarding the link between oral diseases DM and their present role in the management of the oral complications of DM.
| Materials and Methods|| |
This comparative study was carried out among a group (n = 100) of resident doctors undergoing postgraduate training in medicine and dentistry at a Nigerian Teaching Hospital. This study group was categorized based on their level of specialization into dental junior residents (dental residents), medical junior residents (medical residents), dental senior residents, and medical senior residents.
A 28-item self-administered questionnaire was used for data (Appendix 1). Items 1–5 elicited information on demography, items 6 determined previous management of a diabetic patient, items 7 determined routine discussion of oral health with diabetic patients, item 8 determined level of confidence to provide adequate oral health screening to diabetic patients while item 9 asked their opinion on the need for additional information about the link between oral diseases and diabetes. Items 10–28 were true statements reflecting knowledge of the link between oral diseases and DM. A Likert scale was used for the responses to these true statements, that is, strongly agree (score 5), agree (score 4), undecided (score 3), disagree (score 2), and strongly disagree (score 1). The highest and lowest obtainable scores were 95 and 19, respectively. The scores were converted to percentages. Scores <80% were considered inappropriate knowledge while scores 80–100% were considered appropriate knowledge.
The data were analyzed using the statistical package for social sciences version 15.0 for Windows (SPSS Inc., Chicago, IL, USA). Bivariate analyzes using Chi-square was done to assess whether participants specialty or level of training affected their behaviors or opinions. Level of significance was set at P < 0.05. The study was approved by the Ethics and Research Committee of the institution where the study was carried out.
| Results|| |
The study participants were dental residents (33%), medical residents (32%), dental senior registrars (18%), and medical senior registrars (17%) [Figure 1]. Majority (83.3%) of dental senior residents, 60.6% of dental residents, 58.8% medical senior residents, and 43.8% of the medical residents had adequate knowledge of the oral manifestation of DM and the link between oral disease and DM (P = 0.060) [Table 1].
|Table 1: Knowledge of practitioners on the link between oral diseases and diabetes mellitus|
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Majority of the study participants claimed to have managed diabetic patients before (75.8% dental residents, 81.3% medical resident, 88.9% of senior dental residents, and 100% of medical senior residents) (P = 0.047). More dental practitioners (72.7% dental residents and 77.8% dental senior residents) routinely discuss oral health with diabetic patients, while only a few of the medical practitioners (25.0% of medical residents and 29.4% of medical residents) did so (P = 0.001). Majority of the dental residents (84.8%) and dental senior residents (94.4%) were confident of providing adequate oral health screening to diabetic patients while on 37.5% of medical residents and 52.9% of medical senior resident are confident of providing adequate oral health screening to diabetic patients (P = 0.001) [Table 2].
While 61.5% of practitioners in the dental group felt that patients with diabetes were at an increased risk for severe periodontal disease, only 25.0% in the medical group strongly agree (P = 0.001). More persons in the dental group (48.1%) and only 27.1% in the medical group strongly agreed that a diabetic patient with periodontal disease is more likely to have poor glycemic control (P = 0.190). Majority (63.0%) who strongly agreed that physicians needed to collaborate with dental professionals to reduce DM patients' risk of developing oral diseases belonged to the dental group (P = 0.028). Only 35.3% of medical group strongly agreed that physicians should be taught the screening for oral diseases in DM patients (P = 0.002). The participants who strongly agreed that oral health component should be added to the medical continuing education modules were 63.5% of the dental group and 31.3% of the medical group (P = 0.001) [Table 3]. A vast majority however (73.1% in the dental group and 89.6% in the medical group) felt they needed additional information about the link between oral disease and DM (P = 0.036) [Figure 2].
|Table 3: Respondent's opinion on the link between oral disease and diabetes mellitus|
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|Figure 2: Respondents' opinion on the need for additional information on the link between oral diseases and diabetes mellitus|
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| Discussion|| |
The management of diabetic patients includes clinical medical management, diet education, dental screening as well as oral health education. This interdisciplinary approach is recommended because of the established link between oral diseases and DM. It is therefore of utmost importance that dental and medical practitioners who provide health care for diabetic patients should be knowledgeable about such a relationship; and recognize the possible areas of interaction between both disciplines in the course of managing these patients.
The result of this study suggests that dental practitioners seem to know more about the link between oral diseases and DM than their medical counterparts. This may be because medical practitioners do not receive extensive training on oral health. Studies carried out among physicians reported that they received only a few educational hours on oral health., A previous study suggest that dentists are more aware of the effects of diabetes on periodontal health than physicians. Another study  carried out among physicians (internists and endocrinologists) however suggested good awareness among medical practitioners. The study revealed that 72% of the physicians were aware of research works supporting the relationship between DM and oral diseases. This good awareness may be due to specialization. It has been reported that general medical practitioners were less informed than specialized doctors about the relationship between oral health and diabetes. The result of this study is also suggesting that the level of knowledge of the studied dental and medical practitioners increases as their level of specialization increases. It is generally expected that the longer an individual stays in training, the more his or her depth of knowledge and level of skill.
Some of the findings of this study necessitate an urgent call for the education of medical practitioners on the bidirectional relationship between oral health and DM. First, only a few of the medical practitioners strongly believed that oral health will influence the outcome of the management of the diabetic patient or vice versa. This is similar to a previous report where majority of the studied physician agreed that patients with poor glycemic control were more likely to have periodontal disease; but only a few of them agreed that the treatment of periodontal diseases in these patients may improve their glycemic control. However, in an African study, only 46% of the studied doctors considered periodontal disease a risk factor for DM.
Second, despite the fact that slightly over a third of the medical practitioners in this study felt confident about performing oral screening, a smaller number saw the need to undergo training on the procedure. This is different from a previous report, where 78% of the physicians were of the opinion that they should be trained to screen for oral diseases in their patients. In this present study, only a few medical practitioners routinely discuss oral health with diabetic patients. This is similar to a North Carolina study, where only 24% of the studied physicians performed oral examination on their patients with diabetes at every visit.
Another surprise finding is that despite the fact that majority of the participants in both groups appreciated the need for additional information on the link between oral disease and DM, many in the medical group did not agree with the subject matter becoming a part of their medical continuing education updates. A need to develop a collaborative teaching about oral conditions and their relationship to systemic health was expressed by a previous study carried out among internists and endocrinologists, where 89% agreed that physicians needed to collaborate with dental professionals to reduce the risk of their patients' developing oral complications of DM.
The result from the North Carolina study however differs from that of this study in the sense that although majority had no knowledge about studies linking oral diseases and DM, they had a generally positive attitude toward receiving more training and learning how to screen for oral disease in their diabetic patients. Many previous studies have reported either no training or inadequate training in oral examinations during medical school or residency [24,26-28,33] training. A study conducted by Lewis et al. reported that 50% of the physicians had no training on oral health and only a few (12%) had clinical requirements regarding assessments of the gums and teeth, and clinical experiences during their medical education. It has also been reported that where an oral examination was done, many physicians often fail to examine vitally important teeth and supporting structures., Lack of training may be the reason for the sub-optimal oral health knowledge previously reported among a group of Nigerian family physicians.
| Conclusion|| |
The findings indicate that there is still a major gap in knowledge of the link between oral diseases and DM; as well as a poor appreciation of the need for a collaborative management of DM patients by medical and dental practitioners.
Source of Support:
Conflict of Interest:
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]