Archives of Gerontology and Geriatrics 84 (2019) 103905 Contents lists available at ScienceDirect Archives of Gerontology and Geriatrics journal homepage: www.elsevier.com/locate/archger Oral health complications in Brazilian and French diabetic older people: A comparative study T ⁎ Danilo L.F. Limaa,b, Maria V.L. Saintraina, Jiovanne R. Neria,b, , Oscar Beckc, Pierre Maletc, Jean A.H. Moizanc, Jean Doucetd a School of Dentistry, University of Fortaleza – UNIFOR, Fortaleza, Brazil b School of Dentistry, Christus University Center – UNICHISTUS, Fortaleza, Brazil c Dental Care Department, Rouen University Hospital, Saint Julien Hospital, Rouen, France d Department of Internal Medicine, Geriatrics and Therapeutics, Saint Julien Hospital, Rouen University Hospital, Rouen, France ARTICLE INFO ABSTRACT Keywords: Introduction: Diabetes mellitus (DM) is a risk factor for periodontitis for over 40 years and novel evidence Epidemiology suggests that periodontitis has an impact on glycemic control in patients with diabetes. This study aimed to Diabetes mellitus compare oral health complications in diabetic older patients from Brazil and France. Oral health Methods: This cross-sectional study included 120 patients aged 65 and over diagnosed with type 2 diabetes. Sixty Older adults patients were admitted to a center for diabetes and hypertension care in Brazil and 60 patients were admitted to Comparative study the Rouen University hospital. Dental conditions were assessed through the decayed, missing and filled teeth index and periodontal condition was assessed using the Community Periodontal Index. The significance threshold was p < 0.05. Results: Decayed teeth differed statistically between the groups (p = 0.001). The French group presented more tooth mobility, gingival recession and furcation involvement (p < 0.001). Tooth brushing frequency differed significantly between the groups (p < 0.030). The main cause of missing teeth was periodontitis in the French group and caries and periodontitis in the Brazilian group (p < 0.001). Statistical significance was found for use of fixed upper (p = 0.013) and lower (p = 0.013) dentures in the French group. The French group needed upper denture rehabilitation (p = 0.010) while the Brazilian group needed lower denture rehabilitation (p = 0.003). Conclusion: Edentulism was prevalent in diabetic older people in both countries. However, the French partici- pants presented with better oral health. 1. Introduction The majority of the studies (21/28) analyzed in a systematic review reported that more than half of people with diabetes were unaware of The world’s older population continues to grow, and the proportions the link between diabetes and oral health and their increased risk for of older people increase in many countries every year. This includes a oral health complications (Poudel et al., 2018). large number of countries, regardless of their level of development Thus, the established link between diabetes and oral health calls for (United Nations, 2015). This phenomenon has been linked to reasons increased effort to study ways to control both diseases, particularly such as economic evaluation and better educational situations and their among populations with health disparities and limited access to oral impact on health care (Dang, Likhar, & Alok, 2016; Kinge et al., 2015). and health care (Leite, Marlow, Fernandes, & Hermayer, 2013). The ultimate concern of the present time is not with living longer, Diabetes mellitus (DM) is one of the most common aging-associated but with the quality of such longevity. Aging with quality of life re- chronic diseases affecting the adult population worldwide. According to quires the adoption of a healthy lifestyle to prevent the early onset of the World Health Organization Global Report on Diabetes, the esti- certain chronic diseases (Marques, Schneider, & D’orsi, 2016). How- mated prevalence of adults with DM was 8.3% in the Americas and ever, it is known that the longer the life of an individual, the greater the 7.3% in Europe in 2014. In addition, the report revealed that circa 422 chances of developing chronic diseases that affect their functional ca- million people had diabetes in 2014 (World Health Organization, pacity and generate associated comorbidities (Palma et al., 2014). 2016). ⁎ Corresponding author at: University of Fortaleza, School of Dentistry, Washington Soares Avenue 1321, 60.811-905, Fortaleza, CE, Brazil. E-mail address: [email protected] (J.R. Neri). https://doi.org/10.1016/j.archger.2019.103905 Received 26 March 2019; Received in revised form 10 June 2019; Accepted 26 June 2019 Available online 27 June 2019 0167-4943/ © 2019 Elsevier B.V. All rights reserved. D.L.F. Lima, et al. Archives of Gerontology and Geriatrics 84 (2019) 103905 DM is traditionally recognized as a risk factor for macrovascular Table 1 complications (coronary heart disease, cerebrovascular disease and Distribution of socioeconomic parameters of diabetic elderly according to place peripheral vascular disease), microvascular complications (retinopathy, of origin. nephropathy and neuropathy), and, in the older population, geriatric Variables Fortaleza Rouen PR (95%CI) p- value syndromes including impairment of multiple physiologic systems that n=60 n=60 can lead to functional disability, frailty, falls, depression, dementia, and Gender incontinence (Corriere, Rooparinesingh, & Kalyani, 2013). – a ff ff Female 30 (50) 30 (50) 1 (0.7 1.43) 1.000 Oral cavity is also a ected by DM through di erent mechanisms. Male 30 (50) 30 (50) 1 The main oral disease associated with diabetes is periodontitis Age groups (Bascones-Martínez, Arias-Herrera, Criado-Cámara, Bascones-Ilundáin, 65–74 years 34 (56.7) 15 (25.0) 6.01 < 0.001 & Bascones-Ilundáin, 2012). Periodontitis is the inflammation of the (2.04–17.72) gingiva and the adjacent attachment apparatus caused by specific types 75–84 years 23 (38.3) 22 (36.7) 4.43 of bacteria and is characterized by loss of clinical attachment due to (1.47–13.33) 85 or older 3 (5.0) 23 (38.3) 1 destruction of the periodontal ligament and its adjacent alveolar bone (American Academy of Periodontology, 2000). This complication is one Level of Education – b of the main causes of tooth loss. Over the last 30 years, extensive studies Illiterate 10 (16.7) 2 (3.3) 1.25 (0.74 2.12) 0.054 Primary 38 (63.3) 48 (80.0) 0.66 (0.39–1.11) have associated periodontitis with coronary artery disease (Orlandi Secondary 6 (10.0) 7 (11.7) 0.69 (0.33–1.46) et al., 2014), premature and low birth weight babies (Basha, Shivalinga Higher education 6 (10.0) 3 (5.0) 1 Swamy, & Noor Mohamed, 2015), and nosocomial pneumonias (Souto, a Silva-Boghossian, & Colombo, 2014). Chi-square test. b ’ DM has been recognized as a risk factor for periodontitis for over 40 Fisher s exact test. years and novel evidence suggests that periodontitis has an impact on glycemic control in patients with diabetes (Costa et al., 2017). In ad- sextant with bleeding; 2- calculus; 3- pocket from 4 to 5 mm (gingival dition to periodontitis, diabetic patients may present a decrease in margin in the black area of the probe); 4- pocket of 6 mm or more salivary flow, xerostomia, and mucosal lesions (Takeuchi et al., 2015; (black area of the probe is not visible); X- excluded sextant (less than 18 World Health Organization, 2013). two teeth). Asterisk is used when there is mobility, gingival recession, The present study aimed to compare oral health complications in and furcation involvement. diabetic older patients from Brazil (Fortaleza Hospital, Ceará, Brazil) All the data were collected by four examiners (two from France and and France (Rouen University Hospital, Normandy, France). two from Brazil) who received extensive training in Brazil and were accompanied by other trained personnel at all times to ensure accuracy 2. Methods and materials and consistency in data collection. The data were tabulated and statistical calculations were performed The study was approved by the Ethics Committee of the University using the Statistical Package for the Social Sciences (SPSS), version 22.0 of Fortaleza under Approval No. 788.534. All the procedures performed (SPSS Inc., Chicago, USA). The older patients with diabetes from in the present study involving human participants were in accordance Fortaleza and Rouen were compared using the Chi-squared test and the ’ with the ethical standards of the national research committee and with Fisher s exact test for categorical variables and the Mann-Whitney test fi the 1964 Helsinki declaration and its later amendments or comparable for numerical variables. The signi cance threshold was set at p < .05. ethical standards. Informed consent was obtained from all individual participants included in the study. 3. Results This quantitative cross-sectional study included 120 patients aged 65 and over, of both genders (women – 50%), who had been diagnosed Participants’ mean age was 77.1 ± 7.9 years (73.8 ± 6.4 in the with type 2 diabetes for at least one year. Sixty patients were enrolled Brazilian group and 80.4 ± 7.9 in the French group). The French for treatment at the Integrated Center for Diabetes and Hypertension of group was significantly older (Table 1). The percentages of patients Ceará (CIHD), a center of excellence and reference in the care of pa- who received insulin did not differ between the 2 groups (around 73%). tients with hypertension and diabetes in the city of Fortaleza, Ceará, The mean number of teeth was 9.0 ± 8.5: 7.5 ± 8.4 in the Northeastern Brazil. The other 60 patients were consecutively recruited Brazilian group and 10.6 ± 8.7 in the French group (p = 0.047). Only from the Department if Internal and Geriatric Medicine of the Rouen the parameter decayed teeth differed statistically between the French University hospital. group and the Brazilian group (p = 0.001). With regard to the number Sociodemographic data (gender, profession, marital status, educa- of existing teeth, the French participants had more teeth (p = 0.047) tion, employment status, household income, tobacco use, and social and more teeth in the maxillary jaw than the Brazilian participants security) were collected in addition to specific information.