Implementation of oral care in primary diabetes care

Understanding of the bi-directional relationship between diabetes mellitus (DM) and periodontitis has increased after decades of research and clinical experience. From both an epidemiologic and pathogenic perspective, periodontitis can be considered as a complication of DM. Other oral diseases and conditions are also more prevalent in patients with DM. National and international medical guidelines now recommend implementing oral care into primary diabetes care. However, diabetes care providers struggle to adhere to these guidelines, since they rely on oral examinations they cannot perform themselves. To aid them, a simple and rapid screening tool for periodontitis was developed in this thesis, based on self-reported oral health and demographics. This allowed to accurately predict the presence of periodontitis. Exploring self-reported oral health diseases and complaints in a population with T2DM revealed a high prevalence of periodontitis (69%) and dry mouth (37%). Furthermore, three-quarters of the population reported to regularly visit a dentist, although certain subpopulations demand extra attention, such as smokers and edentulous patients. Interestingly, impaired oral health-related quality of life coincided with reduced general health-related quality of life. Modern primary diabetes care programs mainly focus on prevention and management of complications, in order to optimize quality of life. In this thesis, primary diabetes care providers implemented an oral care protocol into their daily routine, educating and motivating the patient to pay attention to oral health. This improved their oral health-related quality of life. This further justifies implementation of oral care into the interdisciplinary approach of patients with T2DM in primary care.