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Table 1 Summary of the included studies with main results

From: Oral health knowledge, attitudes and care practices of people with diabetes: a systematic review

Author, Year, Country Sample/ Questionnaire characteristics Results Quality Rating
Yuen et al. 2009, USA [18] 253 (T1DM and T2DM); ≥18y/
20-Q; V
K ▪ OH~DM: 47%
▪ Adequate OH knowledge significantly associated with brushing (twice/day), flossing (once/day), and dental visit (twice/year) (P < 0.01)
▪ Receiving OH information significantly associated with adequate OH knowledge (P = 0.008)
b
P ▪ Brushing: 61.2%
▪ Flossing: 34.9%; never: 35.3%
▪ Dental visit: 58.6%
Tomar et al. 2000, USA [25] N = 4570 (DM), 101,148 (NDM); ≥25 y/
4-Q; V
A ▪ Reasons behind not visiting dentists: perceived need to visit a dentist (37.2%), cost (28.6%), fear/anxiety (10.5%), and other reasons (23.7%) a
P ▪ Dental visit: PWD 65.8% vs NDM 73.1% (P = 0.0000); result was consistent even after controlling confounders and other correlates: sex, age, race or ethnicity, educational attainment, income, and dental insurance coverage (OR 0.82, 95% CI 0.73–0.93)
Macek et al.,2008, USA [26] N = 725 (DM), 7816 (NDM); ≥25 y P ▪ Dental visit: 56.8% PWD vs 64.7% NDM; result remain consistent even after adjusting periodontitis status, age, sex, race/ethnicity, education, poverty status and dental insurance status a
Moffet. 2010, USA [27] N = 12,405 (DM)
Q: V
P ▪ Dental visit: 77% of patients (82% with dental insurance vs 61% without dental insurance (age sex adjusted OR 2.66, 95%CI 2.33–3.0). a
Oh et al. 2012, USA [28] N = 1209 (DM) 9140 (NDM); ≥45 y P ▪ Dental visit: 72.7% PWD vs 83.5% NDM (95% CI: 82.6%–84.4%, p < .0001)
▪ Diabetes status adversely affected the rate of preventive dental care
▪ Adults from racial/ethnic minority background (OR = 0.51, 95% CI: 0.33–0.79) or lower educational attainment (OR = 0.64, 95% CI: 0.47–0.88) had lower odds of having received preventive dental care
a
Orlando, et al., 2010, USA [29] N = 89 (T1DM);
12–19 y/
40-Q
K ▪ Perio~DM; 44%
▪ Health care providers advised PWD for dental check up (77%)
b
A ▪ Care of their OH was as important as taking care of medical health: 49%
▪ Plaque or tartar build up was a problem: 33%
P ▪ Dental visit: 95.4%; majority (86.5%) paid through insurance
Moore et al. 2000, USA [30] N = 390 (T1DM), 203 age matched (NDM) K ▪ OH would be better if not have diabetes: 18.2%
▪ Health care providers advised for oral hygiene and dental visit: 27.1%
b
A ▪ PWD rated their overall oral health lower than control subjects
▪ The cost of dental care was main reason for avoiding routine visit
P ▪ Brushing: 72.2% PWD vs 80.2% NDM
▪ Flossing: 33% vs 30%
▪ Dental visit: 68.9% vs 75.7%
Alves et al., 2009, Brazil [31] N = 55 (T1DM), 55 age matched (NDM) K ▪ None enrolled in an oral health educational program
▪ Informed to visit dentist by health professional: 65.5%
b
A ▪ Reasons for avoiding dental visit: difficulty in scheduling an appointment (36.1%) and high treatment costs (27.8%)
P ▪ Brushing: 92.7% PWD vs 76.4% NDM
▪ Flossing: 30.9% vs 18.2%
▪ Dental visit: 63.8% vs. 48.7%
Arunkumar et al. 2015. India [32] N = 185 (T2DM) K ▪ Perio~DM: 33%
▪ Informed about OH from physicians; none
b
Kejriwal et al.2014, India [33] N = 300 (T2DM);18-65y/
20-Q; V
K ▪ Increased risk for oral diseases: 50%
▪ Informed about OH from physicians: 10%
b
A ▪ Preferred to see physicians for oral problem: 41%
P ▪ Brushing: 65%
▪ Dental visit (in 6 months): 27%
Sandberg, et al.2001, Sweden [34] N = 102 (T2DM), 102 age, gender matched (NDM); 34-77y K ▪ OH~DM: 27%  
A ▪ Perceived satisfaction with teeth and mouth: satisfied (83.3%), dissatisfied (16.7%)
▪ Main reason for avoiding dental visits: belief that it was not necessary
b
P ▪ Brushing: ≥ 1times: 91.3%
▪ Dental visit: 85.1% PWD vs 95.1% NDM (P < 0.05)
Lee et al. 2009, South Korea [35] N = 75 (T2DM) A ▪ 62.7% perceived their OH status as poor with 37.3% perceived as good b
P ▪ Brushing: 90.6%
▪ Dental visit (within 6 months): 45.3%
Sahril et al. 2014, Malaysia [36] N = 4017 (T2DM);
≥18 y
K ▪ OH~DM: 35.5% b
A ▪ Wanted dental referral: 59.9%
▪ Reasons not wanting a referral: perceived lack of necessity, absence of dental problems and perception that dental problems were not serious
P ▪ Dental visit: 16.7%; highest among: 18–19 y, lowest: 70 yrs
Aggarwal et al. 2012, India [37] N = 500 (T2DM); ≥35 y/ K ▪ OH~DM: 38.4%
▪ Never received a referral for dental care: 79.4%
b
A ▪ Avoiding dental visits due to unpleasant experience: 18.4%
P ▪ Brushing: 33.4%
▪ Dental visit: 75.6%; visited for regular dental checkups: 10.8%
Al Habashneh et al. 2010, Jordon [38] N = 405 (DM); RR 81%
33-Q
K ▪ Perio~DM: 47.7%; source of information: diabetes nurse (43%), physicians (38%), dentist (30%), b
A ▪ Did not pay attention to bleeding gums: 13.7%
▪ Rated their overall oral health as poor: 60%
P ▪ Brushing: 28.1%
▪ Dental visit (regular): 10%
Allen et al., 2008, Ireland [39] N = 101 (DM)
31-79y/
20-Q; V
K ▪ Perio~DM: 33%; source of information: dentist (51%), diabetes care providers (32%) b
A ▪ Would choose to save a painful posterior tooth: 32%
P ▪ Dental visit: 42.5%; not attended for > 5 yrs.: 34%
Badiah et al. 2012. Malaysia [40] N = 102 (DM)
RR 93%/
10-Q; V
K ▪ Perio~DM: 26.5%
▪ Needs to be extra careful on oral health practices: 19.6%
▪ Those who were aware of the risk and the need for extra oral health practice were more among those who brushed at least twice a day and regular attendees
b
P ▪ Brushing: 80.4%
▪ Dental visit (1-2y): 33.3%
Bahammam .2015, Saudi Arabia [41] N = 454 (T1DM & T2DM); RR-87%. K ▪ Perio~DM: 46.7%
▪ Gum disease makes it harder to control diabetes: 21.8%
▪ Participants who had regular dental visits had significantly greater awareness of the Perio~DM link (P < 0.05)
b
P ▪ Brushing: 26.8%,
▪ Flossing: occasional: 23.2%; never:73.6%
▪ Dental visit: 12.6%
Bowyer et al. 2011, UK [42] N = 229 (T1DM & T2DM); ≥ 25 y;
RR 37.2%
K ▪ Aware of mouth dryness: 43%
▪ Never received any OH advice: 69.1%
b
A ▪ Reasons for avoiding dental visit: cost (43.9%), lack of need (37.6%) and unpleasant visit (19.1%)
P ▪ Brushing: 67.2%
▪ Flossing: 15.3%
▪ Dental visit: 85.2%
Kamath,net al.2015, India [43] N = 137 DM
RR 90.6%
K ▪ Perio~DM: 22.5% c
P ▪ Brushing: 33.3%
▪ Dental visit: 27.5%
Mirza et al. 2007, Pakistan [44] N = 240 (T1DM & T2DM)/
Q;V
K ▪ Aware about OH complications: 35.4%
▪ OH Knowledge was significantly related to brushing frequency (p = 0.005) as counselled patients brushed more frequently than uncounselled (53.4% vs 22.3%)
b
A ▪ Denied of DM~OH: 7.6%
▪ If advised about their predisposition to oral disease, willing to increase brushing frequency (45%) and consult a dentist (23%). Nevertheless, some (31.5%) were not reluctant to change
P ▪ Brushing: 24%
Sadeghi et al. 2014, Iran [45] N = 200 (DM)
Q; V
K ▪ OH~DM: 36.5%; source of information: dentist (65%), physicians (35%) b
P ▪ Brushing: 7%; no brushing: 49.5%
▪ Dental visits: 83%
Al Amassi et al.2017, Saudi Arabia [46] N = 278 (DM); 18 -64y/
20-Q
K ▪ Perio~DM: 75.9%; source of information: media (31%), dentist (23%), physicians (21%)
▪ Controlling diabetes is important to minimize OH complications: 74.4%
▪ Patients with higher levels of education had greater awareness of the increased risk of OH problems and had better oral hygiene practices than those with lower levels of education (p < 0.05)
c
P ▪ Brushing: 19.1%
▪ Regular dental visit: 15.1%
Bangash et al. 2011, Pakistan [47] 300 (T1DM & T2DM)/
Q;V
K ▪ DM~OH: 64%; source of information: physicians (35%) and dentists (65%) b
A ▪ Denied existence of a link OH~DM: 23%
▪ Would increase brushing frequency if told of their predisposition to oral disease: 30%
P ▪ Brushing: 86%
Ummadisetty et al. 2016, India [48] N = 60 (DM),143 (NDM); 40-55y/
Q;V
K ▪ Perio~DM: 61.7%; source of information: physicians (36.6%) and dentist (30.69%)
▪ Physicians advised to visit a dentist: 46%
 
Eldarrat. 2011, UAE [49] N = 100 (DM)
RR 50%
K ▪ Perio~DM: 60% b
A ▪ Main reason of dental visit: due to pain/discomfort
P ▪ Brushing: 31%; did not brush daily: 19%
▪ Flossing: once a day: 11%; never: 66%
▪ Dental visit: 40%
Karikosk et al. 2002, Finland [50] N = 336 (T2DM); 1 ≥ 18 y/
29-Q
A ▪ Main reason for not seeing a dentist: not having any problems (95%)
▪ Important for the diabetes nurse to also offer advice about dental care: 92%
b
P ▪ Brushing: 38%
▪ Dental visit: 63%
Kanjirath,P.P, 2011, USA [52] N = 77 (DM) and 366 (NDM) P ▪ Brushing: 31.5% PWD vs 49% NDM
▪ Flossing: 19.4% vs 26.7.%
▪ Dental visit: 86.7% vs 82.2%
b
  1. K Knowledge, A Attitudes, P Practices; Brushing ≥2times/day; Flossing≥1time/week; Dental visits: ≥1 time in the last 12 months; T1: Type 1; T2: Type 2; DM diabetes mellitus, NDM Non diabetes mellitus, y year, RR response rate, Q questionnaire/items, V validated questionnaire/items, Perio Periodontal disease, OH Oral health, PWD People with diabetes
  2. aall or most of the criteria have been fulfilled (a score of 80–100%); bsome of the criteria have been fulfilled (50–79%); and cfew or none of the criteria have been fulfilled (< 50%) [24]