olume No: 8, Issue No: 1

ISSN No: 2582-0559

KNOWLEDGE AND AWARENESS OF THE ASSOCIATION BETWEEN

DIABETES AND PERIODONTAL DISEASE AMONG DIABETIC

PATIENTS IN MADURAI

Dr. Balaji. V. R, Dr. Manikandan. D, Dr. Gunasundari. A

Department of Periodontology, CSI College of Dental Sciences and Research, Madurai, Tamil Nadu, India.

Address for Correspondence:
Dr A.Gunasundari, Postgraduate Student,
Department of Periodontology,
CSI College of Dental Sciences and Research, Madurai,
Tamil Nadu, India.
Email id: gunasundarialappan1995@gmail.com

ABSTRACT

One of the common major health problems that affect all

age group is diabetes mellitus. There are proven evidences

regarding the association between periodontitis and diabetes

mellitus. The aim of the present study was to assess the

knowledge and awareness of the association between diabetes

and periodontal disease among the diabetic patients in Madurai.

A total of 600 diabetic patients aged between 35-65 years who

reported to the Department of Periodontology and Implant

dentistry were included in the study. The overall knowledge,

awareness score regarding the association was significantly low.

The present study revealed that the dental professionals need to

increase the awareness about importance of maintaining the oral

health through awareness programs to educate and encourage the

patients.

KEYWORDS:

Diabetes mellitus, Periodontal disease, Awareness

Received:

10.02.2021

First Published: 18.03.2021

Accepted:

15.03.2021

Published:

27.03.2021

ORIGINAL ARTICLE

DOI:1.37841/jidam_2021_V8_I1_01

Balaji et al: Knowledge And Awareness Of The Association Between Diabetes And Periodontal Disease

Volume No: 8, Issue No: 1

ISSN No: 2582-0559

INTRODUCTION

Diabetes mellitus is a chronic disorder, which is

characterized by hyperglycemia, that further leads to

complications such as nephropathy, retinopathy, neuropathy,

microvascular diseases, delayed wound healing and

periodontitis. Periodontitis is a more commonly encountered

oral health problem that leads to tooth mobility and tooth

loss. According to American Diabetes Association in 1997,

periodontitis has been considered as sixth complication of

diabetes mellitus. Also, it has been proved that there is a

bidirectional relationship between diabetes mellitus and

periodontitis. There are substantial evidences supporting this

two way relationship where diabetes mellitus increases the

risk of periodontitis and the periodontal inflammation

negatively affects the glycemic control.

The recent rise in number of diabetic patients is not

only based on the genetic factor but also due to

environmental factors like change in lifestyle. For successful

treatment of both diabetes and periodontitis, patients

themselves are the most determining factor. Lack of

information is one of the major reasons for no adherence to

lifestyle modification. Patients comply better with

health-care regimens when they are informed and positively

reinforced. Health education attempts to change behavior by

altering an individual’s knowledge, attitude and belief about

one’s own health matters.

2,3

National diabetes fact sheet presented by the Centre

for Disease Control and Prevention (CDC) in 2011 reported

that adults aged 45 years or older with poorly controlled

diabetes were 2.9 times more likely to develop severe

periodontitis than nondiabetics. In the successful treatment

and prevention of both these commonly prevalent diseases,

knowledge about their mutual influence among the dentists,

general practitioners and patients play a very critical role.

The present study was aimed to gather information

on awareness and knowledge of the association between

diabetes and periodontal disease among the diabetic patients

in Madurai in view of enhancing dental health education that

would upgrade their knowledge and awareness.

MATERIALS AND METHODS:-

The present cross-sectional study was conducted in

Madurai, Tamilnadu. Ethical clearance was obtained from

institutional ethical committee of CSI College of Dental

Sciences and Research, Madurai (IEC NO -

CSICDSR/IEC/0101/2019). Time limit of 3 months was set

for data collection.

All the diabetic patients who participated in the study

were given a questionnaire printed in English focusing on the

knowledge and awareness of periodontitis. Pregnant,

lactating mothers, patients on antibiotic therapy and

participants not willing to participate in the study were

excluded.

The structured questionnaire consisted of about 25

questions that focused on the awareness and knowledge

about association between periodontitis and diabetes.

Demographic data such as age, sex, educational status, and

occupation have also been included in the questionnaire.

STATISTICAL ANALYSIS:-

The collected data were imported into the Statistical

Package for Social Sciences (SPSS) version 21 for statistical

analysis. Data were represented in the form of pie charts and

graphs. Chi-square test was used for assessing the awareness

and knowledge about the association between diabetes and

periodontitis among the diabetic patients.

RESULTS: -

Out of 600 diabetic patients who were included in the

study, 37% were males and 63% were females.

Figure 1: Demographic distribution of the participants
included in the study.

Among all the six complications of diabetes mellitus,

the diabetic patients were mostly aware of delayed wound

healing when compared to other complications. Only 17%

were aware of periodontitis being one of the complications

for diabetes mellitus.

Male

37%

Female

63%

GENDER

Balaji et al: Knowledge And Awareness Of The Association Between Diabetes And Periodontal Disease

Volume No: 8, Issue No: 1

ISSN No: 2582-0559

Figure 2: Percentage of study participant’s awareness on
the complications of diabetes.

The patients were asked if they were aware of the

association between diabetes mellitus and periodontitis.

About 42.7% were aware of the association between diabetes

and periodontitis whereas 57.3% were not aware.

Figure 3: Awareness of participants on the association
between diabetes and periodontitis.

It was observed that 38% of the participants got

reliable information regarding the relationship between

diabetes and periodontitis from dentist, 35% from physician

and 27% through other sources like media, internet and

magazines.

Figure 4: Source of knowledge of study participants on
the association between periodontitis and diabetes.

Among 600 participants, only 33% were unaware

about the signs and symptoms of periodontitis and 67% were

aware on the signs and symptoms of periodontitis.

Figure 5: Percentage of participants on awareness about
signs and symptoms of periodontitis.

The present study shows that only 42% of the

physicians suggested their patients to visit a dentist.

0% 20% 40% 60%

eye disease

heart disease

kidney…

stroke

delayed…

periodontitis

Complications you are aware

eye disease

heart disease

kidney disease

stroke

delayed wound
healing

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

yes

Aware of association between

Diabetes mellitus and Periodontitis

yes

38%

35%

27%

From whom did you get reliable

information

dentist
physician
other sources - media,internet,magazine

33%

67%

Awareness of signs and symptoms of

Periodontitis among Diabetic

patients

unaware

Balaji et al: Knowledge And Awareness Of The Association Between Diabetes And Periodontal Disease

Volume No: 8, Issue No: 1

ISSN No: 2582-0559

Figure 6 – Percentage of participants whose physician has
suggested them to visit a dentist.

DISCUSSION:-

Both periodontitis and diabetes mellitus are most

frequently occurring diseases. Several studies and meta-

analysis indicated the relationship between diabetes and

periodontal disease. Grossi and Genco et al in 1988 proposed

the bidirectional relationship between diabetes and

periodontitis.

4,5

There are various factors that deter the diabetic

patients from obtaining dental care. Type II diabetic patients

have increased risk for periodontal disease progression.

According to a study by Aggarwal and Panat,

only 10.8% of

the patients with DM visit a dentist for regular check-ups and

Indians with type 2 diabetes reported suboptimal oral

hygiene behavior.

Weinspach et al

reported that a total of 56% of the

participants of their study had an insufficient knowledge

about the mutual influence between diabetes and

periodontitis, which correlates with the current study

(50.2%). Among the diabetic study population, 38.3% had no

idea about mutual relationship. In the present study, only

42.7% were aware of the association between diabetes and

periodontitis whereas 57.3% were not aware.

Ummadisetty T et al concluded that only 49.8% of

the sample population knew about the mutual relationship

between diabetes and periodontitis and only 46% of the

diabetic study population was suggested to visit a dentist by

the physician.

Paquette et al stated that medical and dental

professionals should be taught to practice more

collaboratively to actively participate in their patient’s

overall health management.

According to Shanmukappa et al (2017), only 46% of

the general physicians suggested their patients to visit a

dentist and 50.2% had insufficient knowledge and

awareness.

Studies have consistently shown that improved

glycemic control would reduce the rate of complications and

evidence also suggests that patients who are knowledgeable

about diabetes mellitus, self-care have better long-term

glycemic control. Thus, it is indispensable to ensure that

patient’s knowledge, attitude, and practices are adequate for

preventive behaviors such as brushing, flossing, and periodic

dental visits.

11-13

STRENGTH OF THE STUDY:-

The strength of the study is large sample size

(n=600). Also, it was found that patients were more aware of

the systemic complications related to the eye and wound

healing. There was less awareness related to the oral health

which can be thus promoted.

LIMITATION OF THE STUDY:-

A future study of a larger diabetic population will be

needed to substantiate the findings from the present study

with the inclusion of economic status that might potentiate

the study.

In our study, the questionnaire has been used as a tool

to assess the knowledge and awareness and it would be more

substantiating if we do the oral examination as well, to

correlate the clinical findings and the presence of

periodontitis.

CONCLUSION:-

Association between diabetes mellitus and

periodontal disease must be made aware to the general public

and as well as to the medical fraternity, who in turn can guide

and motivate the patient for better diabetic control by

maintaining good oral health. Periodontal therapy has

positive effect on diabetic control, hence periodic care and

maintenance of oral health is of utmost importance.

42%

58%

yes

Did your physician suggest you to

visit the dentist

yes

Balaji et al: Knowledge And Awareness Of The Association Between Diabetes And Periodontal Disease

Volume No: 8, Issue No: 1

ISSN No: 2582-0559

FINANCIAL SUPPORT AND SPONSORSHIP

Nil

CONFLICTS OF INTEREST

There are no conflicts of interest.

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