Evidence for improved systemic outcomes in type 2 diabetics receiving oral care

Diabetes is a major global health problem and the number of individuals with Type 2 diabetes is rapidly increasing. Glycemic control is key to managing diabetes related systemic outcomes/complications. A bidirectional relationship between oral health and metabolic control has been suggested. If evidence for oral care driven improved systemic outcomes is demonstrated, the dental workforce could be utilized to combat the diabetes epidemic. The purpose of this study is to evaluate this evidence and identify any knowledge gaps. Methods: A systematic search was conducted of electronic databases including: PubMed, EMBASE, Web of Science, NIH eReporter and Google Scholar. Additional searches of grey literature were conducted in collaboration with medical librarians. Domain experts were consulted after the final search to ensure completeness. Results: The initial literature search yielded a combined total of 926 published articles. Preliminary screening of these articles identified 79 potentially relevant articles. Final review included 15 articles that met the inclusion criteria. Additional information was obtained from abstracts, grants in progress, and personal communications. Conclusions: There is moderate evidence currently available suggesting that oral care can lead to systemic health improvements in diabetics, most commonly measured by glycosylated hemoglobin (HbA1c). However, there is a paucity of research that focuses on older patients who comprise a large proportion of Type 2 diabetics. While oral care may be an effective intervention for the clinical management of diabetics, evidence may need to be stronger and include a broader population spectrum before becoming a treatment recommendation.