Toothbrushing twice daily may be linked to better glucose levels in type 2 diabetes
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Key takeaways:
- There is a bidirectional relationship between oral health, cardiovascular disease and type 2 diabetes.
- Adults with type 2 diabetes may have a lower HbA1c if they brush their teeth more often.
HOUSTON — Toothbrushing two times per day may improve glycemic control for people with type 2 diabetes, but more studies on the link between oral health and type 2 diabetes are needed, according to presenters.
In findings from a scoping review presented at the Association of Diabetes Care & Education Specialists annual meeting, researchers analyzed studies that investigated associations between regular toothbrushing, periodontal disease and glycemic metrics among adults with type 2 diabetes. Some studies found a link between more frequent toothbrushing and better oral health and glycemic control, but the researchers found only 11 studies that met the inclusion criteria and said more research must be performed.
“There were several papers that had enough evidence to show there was a small improvement in HbA1c if you started brushing your teeth [twice a day], but it wasn’t rigorous research,” Michelle F. Magee, MD, director of the MedStar Diabetes Institute and professor of medicine at Georgetown University School of Medicine, told Healio. “Just one study was in the United States, the rest were predominantly from Turkey and India, other parts of the world where they have many challenges with oral health.”
Researchers conducted a systematic scoping review of the MEDLINE and CINAHL Complete databases of studies that assessed home toothbrushing activities, a glycemic measure and oral health among adults with type 2 diabetes. Observational and interventional studies published within the past 20 years were included.
Of 148 studies screened, seven observational studies and four interventional studies met the inclusion criteria for the review. Findings were mixed as to whether brushing frequency impacted the prevalence of type 2 diabetes. In nearly all observational studies among people with type 2 diabetes, adults who self-reported brushing their teeth more often also had better glycemic control, as measured by HbA1c, 2-hour post-prandial plasma glucose or fasting glucose. More frequent tooth brushing was associated with better oral outcomes in nearly all studies examined, which is a well-established relationship, according to Magee.
In most of the interventional studies, health coaching when compared to oral health education alone was associated with enhanced improvements in glycemic control measures, oral health and self-reported toothbrushing. Magee said one study reported an association between oral hygiene coaching and increased engagement in other self-care behaviors.
“It is also of interest from the perspective of self-care management education, the people that were provided with health coaching did better than the people who had oral health education alone,” Joan Bardsley, MBA, RN, of the MedStar Diabetes Institute, told Healio. “But [the study] didn’t really describe the health coaching intervention. There needs to be more work done to clarify what the components of successful health coaching are.”
Conversely, adults who brushed less frequently had worse periodontal disease outcomes in most studies.
Bardsley and Magee said there were several limitations to the review, including an inconsistency in glycemic outcome measures, the reliance on self-reported toothbrushing, small sample sizes and lack of recent reports. The studies, as previously mentioned, were conducted in several different countries, and only one of the 11 studies was published since 2016.
Bardsley and Magee said further research, ideally a randomized controlled trial is needed to better evaluate the impact of oral health on type 2 diabetes outcomes. Magee said such a trial could use electronic toothbrushes that measure how often and how long participants are brushing their teeth to provide a more rigorous measure than self-reported data.
“Research is clearly needed,” Magee said. “Hopefully that research will generate enough evidence that toothbrushing as a self-care behavior will be considered for inclusion in the Standards of Care for the American Diabetes Association and in the ADCES diabetes self-management education and support curriculum.”
Bardsley and Magee said providers should remind people with type 2 diabetes about the importance of seeing a dentist regularly and following the American Dental Association’s guidelines on toothbrushing.
“We really have to emphasize the importance of brushing your teeth at least twice per day,” Bardsley said.
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Lipman RD, et al. P318. Presented at: ADCES23; Aug. 4-7, 2023; Houston.
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