Introduction

Among the most common chronic disorders of modern time, Diabetes Mellitus (DM) remains unique because of its multisystem ramifications.¹  DM is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both.²  Type 2 DM is a complex disease with both metabolic and vascular components that affects more than 100 million people worldwide of which 13-15 million are Americans.³  Prevalence of DM is about 3-7% in the western countries.⁴  In Saudi Arabia, where modernization and industrialization are rapidly increasing, the incidence of DM appears to be on the rise. A high prevalence of DM has been noted in Saudi populations (2.55-5.32% among males and females respectively).⁵

Periodontitis is a bacterial infection caused by gram-negative anaerobes, which populate the subgingival plaque⁶ causing a chronic inflammatory condition characterized by loss of connective tissue attachment and alveolar bone.⁷  The prevalence of periodontal disease among individuals with type 2 DM is generally higher than those free of the systemic disorder.^8,9

A study of the relationship between periodontal disease and blood glucose level among type 2 diabetic patients revealed that periodontal disease severity was high among diabetic subjects with a high blood glucose level and an increased community periodontal index of treatment needs (CPITN) score.¹⁰  In one study, the effect of periodontal treatment on glycemic control in patients with type 2 DM revealed periodontal therapy was associated with improved glycemic control in the subjects.¹¹

Oral self-care plays a role in maintaining and promoting periodontal health and the prevalence of periodontal disease varies according to individual health behavior.  Despite the high risk of periodontal diseases, oral self-care in patients with DM has not been adequately studied.¹²  There is evidence the control of periodontal inflammation has the potential to influence glucose metabolism¹³, but knowledge about the ability of periodontal therapy to improve metabolic control of diabetes is still incomplete.¹⁴  On the other hand, most well-controlled diabetics who practiced good oral hygiene and apparently maintained themselves generally seem not to be at an increased risk of developing periodontal disease compared with healthy subjects.¹⁵  An extensive literature search has revealed there are no studies on the role of oral hygiene instruction as part of periodontal therapy among type 2 DM Saudi patients.

As a result, the aims of this study are (1) to assess the effect of oral hygiene instructions on periodontal disease and (2) to assess the glycemic changes in healthy, type 2 male diabetic Saudi patients.

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Citation Number: Vol. 4, No. 3, Page 025