Dental News - Patients, their teeth and type 2 diabetes

University of Buffalo

Tue. 1 August 2023

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BUFFALO, NY, US: In a study published in PLOS ONE and further demonstrating the link between dental care and full-body care, University at Buffalo researcher Dr. Mehmet A. Eskan has demonstrated that patients with type 2 diabetes (T2D) who have full chewing function have a blood glucose level that is significantly lower than patients whose ability to chew effectively is impaired.

Eskan is a clinical assistant professor in the Department of Periodontics and Endodontics at the School of Dental Medicine at UB.

The retrospective study looked at data gathered from 94 patients with T2D who had been seen at an outpatient clinic in a hospital in Istanbul, Turkey. The patients were divided into two groups: the first group included patients who had good “occlusal function” — enough teeth placed properly and making contact in such a way that a person can chew their food well. That group’s blood glucose level was 7.48.

The second group couldn’t chew well, if at all, because they were lacking some or all of those teeth; their blood glucose level was almost 2 percent higher, at 9.42.

Digestion, the process by which your body extracts nutrients from food, begins as chewing stimulates the production of saliva. Nutrients that are important to reduce blood glucose levels include fiber, which is obtained in large part through chewing appropriate foods.

Chewing also has been reported to stimulate reactions in the intestine that lead to increased insulin secretion and the hypothalamus that promote a feeling of satiety, resulting in less food intake. Eating less decreases the likelihood of becoming overweight, which is a major risk factor for developing T2D.

Dr. Eskan received his DDS at Hacettepe University, a leading medical research center in Turkey, and earned his PhD at the University of Louisville, where he also completed a residency in periodontology.

“My special clinical interest is to treat dental patients who are systemically compromised,” he said.

His research goal is to contribute to the big picture of improving public health. This research notes that, as of 2019, almost half a billion people worldwide had diabetes, and at least 90 percent of those patients with diabetes have T2D.

Addressing oral health has recently become part of the approach to managing diabetes along with encouraging patients to maintain a healthy weight, eat a healthy diet and quit smoking.

“Our findings show there is a strong association between mastication and controlling blood glucose levels among T2D patients,” Dr. Eskan said.

This study did not find any independent variables that could affect blood glucose levels among the subjects because there were no statistical differences among subjects regarding body mass index, sex, smoking status, medications or infection as indicated by white blood cell count at the baseline.

The dramatic improvement in one patient’s case described in a 2020 study co-led by Eskin illustrates the potential benefit of improving occlusal function through dental implants and appropriate fixed restoration. A T2D patient whose chewing function was severely impaired by missing teeth presented initially with a blood glucose level of 9.1. The patient obtained nutrition by using a bottle and eating baby food. Four months after treatment with a full mouth implant-supported fixed restoration, the patient’s glucose level dropped to 7.8. After 18 months, it decreased to 6.2.

Research has shown that an increase of just 1% in blood glucose level is associated with a 40% increase in cardiovascular or ischemic heart disease mortality among people with diabetes, according to Dr. Eskan. Other complications can include kidney disease, eye damage, neuropathy and slow healing of simple wounds like cuts and blisters.

“I’m interested in research that can improve people’s health now,” Dr. Eskan said.

He and co-author Dr Yeter E. Bayram, Department of Internal Medicine, Hamidiye Sisli Etfal Education and Research Hospital in Istanbul, want to work on further studies that explore possible causal relationships between occlusal support and blood glucose levels.