EFFECT OF STRUCTURED ORAL HYGIENE INTERVENTION ON GLYCEMIC CONTROL IN DIABETIC PATIENTS
DOI:
https://doi.org/10.71000/qkhscs94Keywords:
Clinical Attachment Level, Diabetes Mellitus, Type 2, Gingival Index, Glycated Hemoglobin A, Oral Hygiene, Periodontal Index, Periodontitis.Abstract
Background: Periodontal disease is common among individuals with type 2 diabetes mellitus (T2DM) and is linked to poor glycemic control through systemic inflammation. Structured oral hygiene interventions may improve both oral and metabolic outcomes, yet evidence from standardized, behavior-based protocols remains limited.
Objective: To evaluate the impact of a structured oral hygiene regimen on glycemic control and periodontal status in patients with T2DM through a multicentre randomized controlled trial.
Methods: A total of 104 adults with T2DM and moderate to severe periodontitis were recruited from private hospitals in Lahore, Multan, and Islamabad. Participants were randomized equally into intervention and control groups. The intervention comprised personalized oral hygiene education, supervised training in the modified Bass brushing technique, provision of oral hygiene aids, and monthly reinforcement for six months. The control group received routine advice without structured reinforcement. Primary outcome was change in HbA1c measured by high-performance liquid chromatography. Secondary outcomes included Plaque Index, Gingival Index, Probing Pocket Depth, and Clinical Attachment Level, assessed by calibrated examiners at baseline, three months, and six months. Data were analyzed using independent t-tests and repeated measures ANOVA for normally distributed variables.
Results: At six months, the intervention group showed a mean HbA1c reduction from 8.42 ± 0.56% to 7.58 ± 0.49% (p < 0.001), whereas the control group showed a non-significant change from 8.39 ± 0.59% to 8.28 ± 0.53%. Significant improvements were also observed in periodontal parameters in the intervention group (all p < 0.001), with negligible changes in the control group.
Conclusion: Structured oral hygiene interventions significantly improved glycemic control and periodontal health in T2DM patients and should be considered a practical adjunct in comprehensive diabetes management.
References
Chen H, Hill R, Baysan A. Systematic review on dental caries preventive and managing strategies among type 2 diabetic patients. Frontiers in Oral Health. 2022;3:998171.
La Rosa GRM, Pedullà E, Chapple I, Kowalski J, Walicka M, Piro S, et al. A systematic review of oral health outcomes following smoking cessation in type 2 diabetes: Clinical and research implications. J Dent. 2025;156:105665.
Hasan SMM, Rahman M, Nakamura K, Tashiro Y, Miyashita A, Seino K. Relationship between diabetes self-care practices and control of periodontal disease among type2 diabetes patients in Bangladesh. PLoS One. 2021;16(4):e0249011.
Malekmahmoodi M, Shamsi M, Roozbahani N, Moradzadeh R. A randomized controlled trial of an educational intervention to promote oral and dental health of patients with type 2 diabetes mellitus. BMC Public Health. 2020;20(1):287.
Sødal ATT, Skudutyte-Rysstad R, Diep MT, Koldsland OC, Hove LH. Periodontitis in a 65-year-old population: risk indicators and impact on oral health-related quality of life. BMC Oral Health. 2022;22(1):640.
Hsu Y-J, Lin K-D, Chen J-H, Lee M-Y, Lin Y-C, Yen F-C, et al. Periodontal treatment experience associated with oral health-related quality of life in patients with poor glycemic control in type 2 diabetes: A case-control study. International journal of environmental research and public health. 2019;16(20):4011.
Xiao C, Zhang L, Li Z, Xu Q, Lin S, Zheng S, et al. Periodontal health intervention for oral health-related outcomes in older type 2 diabetes patients: a randomized controlled trial in a Chinese tertiary hospital. Sci Rep. 2025;15(1):28014.
Lipták K, Lipták L, Haba KS, Bányai D, Veres DS, Rózsa NK, et al. Oral health practices and literacy in Hungarian diabetes patients: insights from a pilot-study using a WHO-adapted questionnaire. BMC Oral Health. 2025;25(1):431.
Valentim FB, Carneiro VC, Costa Gomes PD, Rosetti EP. The Importance of Integrated Healthcare in the Association Between Oral Health and Awareness of Periodontitis and Diabetes in Type 2 Diabetics. Oral Health Prev Dent. 2021;19:1-6.
Falcón-Flores JA, Jiménez-Corona ME, Flores-Hernández S, Vázquez-Duran M, Jiménez-Corona A. [Impact of self-reported periodontal status on oral health-related quality of life in adult population with Type 2 Diabetes from Mexico City]. Rev Esp Salud Publica. 2024;98.
Kitamura T, Shimazaki Y, Hashimoto H, Ito M, Fukumori T, Inamoto Y, et al. The impact of a workplace dental-health program on glycemic control in Japanese working adults: a cohort study. BMC Oral Health. 2025;25(1):670.
Bolchis V, Jumanca D, Dumitrescu R, Balean O, Toderas NA, Popescu S, et al. Glycemic Control, Inflammatory Mediators, and Periodontal Health: A Cross-Sectional Study in Patients with Diabetes. Journal of Clinical Medicine. 2025;14(8):2847.
Qureshi A. Glycemic Control in Type-2 Diabetes Mellitus Patients through Non-Surgical Periodontal Therapy–A Randomized Controlled Trial: Dow University of Health Sciences; 2021.
Corbella S, Alberti A, Donos N, Morandi B, Ercal P, Francetti L, et al. Efficacy of different protocols of non-surgical periodontal therapy in patients with type 2 diabetes: A systematic review and meta-analysis. J Periodontal Res. 2025;60(5):417-37.
Phetnin N, Tippanart V, Chuchai A. Effectiveness of the oral care program in type 2 diabetic elderly patients with periodontitis: a clustered randomised controlled study with 6-month follow-up. 2020.
Kumar S. Effectiveness of Structured Teaching Program on Oral Hygiene Among Diabetic Patients Attending A Tertiary Care Centre: A Quasi-Experimental Study. J Dental Oral Health. 2021;3(2):1-12.
Dauod AS. the effect of oral health education program on awareness and improving glycemic control of patients with type2 diabetes in erbil city: the effect of oral health education program on awareness and improving glycemic control of patients with type2 diabetes in erbil city. AL-QADISIYAH MEDICAL JOURNAL. 2025;21(1):42-6.
Zhang Y, Chen Y, Wang C, Xu H, Zhou N, Hong X. Community interventions improve diabetes management and oral health in type 2 diabetes patients with chronic periodontitis. Scientific Reports. 2025;15(1):24395.
Meto A, Shpati A, Alushi A, Filippini T, Kamberi A, Meto A, et al. Associations Between Glycemic Control, Self-Reported Gingival Bleeding and Lifestyle Factors in Hospitalized Diabetic Patients. Journal of Clinical Medicine. 2025;14(12):4201.
Mainas G, Santamaria P, Zoheir N, Alamri MM, Hughes F, Lu EM, et al. Association between calcium-channel blockers and gingival enlargement: A case-control study. J Dent. 2024;149:105315.
Rahim A, Hassan S, Ullah N, Noor N, Ahmed, Rafique R, et al. Association and comparison of periodontal and oral hygiene status with serum HbA1c levels: a cross-sectional study. BMC Oral Health. 2023;23(1):442.
Deng L, Guan G, Cannon RD, Mei L. Age-related oral microbiota dysbiosis and systemic diseases. Microb Pathog. 2025;205:107717.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Malika Attiq, Ayesha Ikram Malik, Maheen Zulfiqar , Haleema Sadia Baloch, Irtta Nasreen khan , Sahil Ghouri (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
