Correlation Between Poor Oral Hygiene And The Number Of Missing Teeth With Degree Of Carotid Atherosclerosis In Patients With Type 2 Diabetes Mellitus

Objective:1.To investigate the oral status and hygiene habits of type 2 diabetes inpatients;2.To explore the correlation between the poor oral hygiene,tooth loss and the degree of carotid atherosclerosis in hospitalized patients with type 2 diabetes mellitus,and to provide a basis for maintaining oral health and preventing the occurrence and development of carotid atherosclerosis in type 2 diabetes inpatients.Methods:1.The cross-sectional study was used in this study.According to the inclusion criteria,patients with type 2 diabetes mellitus who were hospitalized in the Department of Endocrinology of the Second Hospital of Shanxi Medical University from March to August2021 were selected as the research subjects.A face-to-face questionnaire survey was conducted by the trained researchers.General demographic characteristics(gender,age,etc.),general health(hypertension,hyperlipidemia,family history of diabetes,etc.),oral behavior habits(smoking,alcohol consumption,dietary habits(such as high calorie food intake),oral health habits(brushing method,time,frequency,age to start brushing,use of floss or interdental brush,etc.),oral health problems(gums bleeding,tooth loss),and health care seeking conditions(periodontal scaling history,frequency of dental visits,etc.).2.Based on the cross-sectional study,The T2DM inpatients who met the inclusion and exclusion criteria were examined by oral specialty examination(oral hygiene status(plaque index,calculus index,debris index),number of missing teeth),laboratory examination(serum glucose and lipid metabolism indexes,plasma fibrinogen),and ultrasound examination of carotid artery(occurrence,location,number,size,Crouse score).The patients were divided into two groups based on the presence or absence of carotid atherosclerotic plaque:T2DM group and T2DM with carotid atherosclerotic plaque group.3.SPASS 26.0 was used for data analysis.Count data were expressed as frequency constituent ratio or incidence,andχ~2 test was used for comparison between groups.The measurement data were expressed as mean±standard deviation((?)±s)if followed normal distribution.The independent sample t test was used for comparison between two groups,and the one-way ANOVA test was used for comparison between multiple groups.If it did not obey the normal distribution,it was expressed as the median(25%quantiles,75%quantiles)M(Q1,Q3).Mann-Whitney U test was used for comparison between two groups,and Kruskal-Wallis H test was used for comparison between multiple groups.Spearman rank correlation test was used for correlation analysis.Binary qualitative data were analyzed using unconditional Logistic regression,and continuous data were analyzed using multiple linear regression.P<0.05 was considered statistically significant.Results:1.Analysis of oral status and hygiene habits in patients with type 2 diabetes1.1 Oral conditions and hygiene habits of type 2 diabetesThe proportion of gingival bleeding and tooth loss in type 2 diabetes patients was 87.31%and 64.62%,respectively.66.54%began to brush their teeth after 12 years old,and the proportions of brushing frequency≥2 times/day and time≥3 minutes/time were 52.31%and 30.77%,respectively.The proportions of using BASS method and floss or interdental brush were 12.69%and 14.23%,respectively.43.46%and 3.46%had oral cleaning history and regular oral examination,and 83.85%saw a doctor only when they had oral problems.It is suggested that T2DM patients have poor oral hygiene habits and oral health awareness.1.2 Comparison of oral status and hygiene habits of patients with different characteristics of T2DM1.The proportion of brushing frequency≥2 times/day in males(43.41%)was significantly lower than that in females(61.07%),and the difference was statistically significant(P=0.004).There were no statistically significant differences in brushing bleeding,tooth loss,age to start brushing,time of brushing,method of brushing,use of floss or interdental brush,history of periodontal cleaning and frequency of visits among different genders of T2DM patients(P>0.05).2.The proportion of tooth loss in patients with diabetes duration≥10 years(55.56%)was higher than that in patients with diabetes duration<10 years(73.13%),the difference was statistically significant(χ~2=8.777,P=0.003).There were no statistically significant differences in brushing bleeding,age to start brushing,brushing frequency,brushing time,brushing method,use of floss or interdental brush,periodontal cleaning history,and visit frequency among T2DM patients with different duration of diabetes(P>0.05).3.There were no statistically significant differences in brushing bleeding,tooth loss,age to start brushing,brushing frequency,brushing time,brushing method,use of dental floss or interdental brush,periodontal cleaning history,and frequency of visits among T2DM patients with different blood glucose control(P>0.05).2.Correlation between the poor oral hygiene,tooth loss and carotid atherosclerosis and its degree in patients with type 2 diabetesOn the basis of the first part of the study,according to the exclusion criteria,26 patients who did not have carotid ultrasound examination were excluded,and 64 patients were combined with other diseases that might affect the results of this study(such as acute complications of diabetes,infection,heart,liver and renal insufficiency,etc.)were excluded.Finally,170 patients with T2DM were included.There were 43 patients(25.29%)in T2DM group and 127 patients(74.71%)in T2DM+CAS group.2.1 General Information and oral conditionIn the study subjects,the overall plaque detection rate was 74.71%,and the proportion of single,double and multiple plaques was 29.13%,14.96%and 55.91%,respectively.Age(t=-5.580,P<0.001),male(χ~2=5.292,P=0.021),history of coronary heart disease(χ~2=4.484,P=0.034),tooth loss(χ~2=5.671,P=0.017),and plaque index of 3(χ~2=8.334,P=0.040)in the T2DM+CAS group were higher than those in the T2DM group,and the difference was statistically significant.There were no significant differences in BMI,hypertension,hyperlipidemia,family history of diabetes,and smoking between the two groups(P>0.05).2.2 The relationship between the poor oral hygiene,tooth loss and carotid atherosclerotic plaque1.Unconditional logistic regression analysis showed that after adjusting for age,gender,hypertension,hyperlipidemia,history of coronary heart disease,family history of diabetes,smoking,scale index,calculus index and tooth loss,Plaque index was an independent risk factor for carotid atherosclerotic plaque[OR(95%CI)was 2.96(1.08-8.10)].No correlation has been found between debris index and calculus index and the occurrence of carotid atherosclerotic plaque(P>0.05).2.Tooth loss(OR=2.33,95%CI:1.15～4.71,P=0.019)and the number of missing teeth(OR=1.28,95%CI:1.08～1.51,P=0.004)were associated with carotid atherosclerotic plaque,but no association was found between tooth loss and carotid atherosclerotic plaque after controlling for confounding factors.2.3 The relationship between the poor oral hygiene,tooth loss and degree of carotid atherosclerosis1.Multiple linear regression analysis showed that after adjusting for age,gender,hypertension,hyperlipidemia,family history of diabetes,and smoking,the number of missing teeth(P=0.012),age(P<0.001),male(P=0.003),hypertension(P=0.033)and hyperlipidemia(P=0.009)were the independent risk factor for the degree of carotid atherosclerosis in T2DM patients.2.Fibrinogen was positively correlated with the number of missing teeth(rs=0.191,P=0.013),Crouse score(rs=0.178,P=0.020).It is suggested that fibrinogen may be a marker of systemic inflammation for the potential association between the number of teeth missing and the degree of carotid atherosclerosis in patients with T2DM.No correlation was found between total cholesterol,triglyceride,HDL cholesterol,LDL cholesterol,and glycosylated hemoglobin levels and the number of missing teeth and Crouse score(P>0.05).Conclusions:1.Patients with type 2 diabetes have poor oral hygiene and a high proportion of missing teeth,poor oral hygiene habits and oral health awareness.The proportion of men with type2 diabetes who brush their teeth more than twice a day is lower than that of women.Patients with diabetes time more than 10 years had a higher rate of tooth loss.2.The plaque index of patients with T2DM is an independent risk factor for the occurrence of carotid atherosclerotic plaque.3.The number of missing teeth,age,male,hypertension and hyperlipidemia are independent risk factors for the degree of carotid atherosclerosis in T2DM patients..4.The level of fibrinogen is positively correlated with the number of missing teeth and Crouse score,suggesting that fibrinogen may be a systemic inflammatory marker for the potential relationship between the number of teeth lost and the degree of carotid atherosclerosis in T2DM patients.