AIMS/HYPOTHESIS Inflammation plays an important role in the development of diabetes, a major global health problem. Periodontal disease is also common in the general population. Because periodontal disease and poor oral hygiene can provoke transient bacteraemia and systemic inflammation, we hypothesised that periodontal disease and oral hygiene indicators would be associated with the occurrence of new-onset diabetes. METHODS In this study we analysed data collected between 2003 and 2006 on 188,013 subjects from the National Health Insurance System-Health Screening Cohort (NHIS-HEALS) in Korea who had no missing data for demographics, past medical history, oral hygiene indicators or laboratory findings. The presence of periodontal disease was defined on the basis of a modified version of ICD-10 codes (Korean Classification of Disease, sixth edition), if claims for treatment for acute periodontitis (K052), chronic periodontitis (K053) and periodontosis (K054) were made more than two times by a dentist, or if, according to medical records, subjects received treatment by a dentist for periodontal disease with ICD-10 codes K052, K053 or K054. Oral hygiene behaviours (number of tooth brushings, a dental visit for any reason and professional dental cleaning) were collected as self-reported data of dental health check-ups. Number of missing teeth was ascertained by dentists during oral health examination. The incidence of new-onset diabetes was defined according to ICD-10 codes E10-E14. The criterial included at least one claim per year for both visiting an outpatient clinic and admission accompanying prescription records for any glucose-lowering agent, or was based on a fasting plasma glucose ≥7 mmol/l from NHIS-HEALS. RESULTS Of the included subjects, 17.5% had periodontal disease. After a median follow-up of 10.0 years, diabetes developed in 31,545 (event rate: 16.1%, 95% CI 15.9%, 16.3%) subjects. In multivariable models, after adjusting for demographics, regular exercise, alcohol consumption, smoking status, vascular risk factors, history of malignancy and laboratory findings, the presence of periodontal disease (HR 1.09, 95% CI 1.07, 1.12, p < 0.001) and number of missing teeth (≥15 teeth) remained positively associated with occurrence of new-onset diabetes (HR 1.21, 95% CI 1.09, 1.33, p < 0.001, p for trend <0.001). Frequent tooth brushing (≥3 times/day) was negatively associated with occurrence of new-onset diabetes (HR 0.92, 95% CI 0.89, 0.95, p < 0.001, p for trend <0.001). CONCLUSIONS/INTERPRETATION Frequent tooth brushing may be an attenuating factor and the presence of periodontal disease and an increased number of missing teeth may be augmenting factors for the occurrence of new-onset diabetes. Improving oral hygiene may be associated with a decreased risk of occurrence of new-onset diabetes.

中文翻译：

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改善口腔卫生与降低新发糖尿病的风险有关：一项基于全国人群的队列研究。

目的/假设炎症在糖尿病的发展中起着重要作用，糖尿病是一个主要的全球性健康问题。牙周疾病在普通人群中也很常见。由于牙周疾病和口腔卫生不良会引起短暂的菌血症和全身性炎症，因此我们假设牙周疾病和口腔卫生指标与新发糖尿病的发生有关。方法在本研究中，我们分析了2003年至2006年间从韩国国家健康保险系统健康筛查队列（NHIS-HEALS）收集的188,013名受试者的数据，这些受试者均没有人口统计学，既往病史，口腔卫生指标或实验室检查结果的缺失数据。牙周病的存在是根据ICD-10代码的修订版（韩国疾病分类，第六版），如果牙医要求治疗急性牙周炎（K052），慢性牙周炎（K053）和牙周病（K054）两次以上，或者根据医学记录，受试者接受了牙医的治疗， ICD-10代码为K052，K053或K054的牙周疾病。口腔卫生行为（刷牙次数，出于任何原因的牙齿访视和专业的牙齿清洁）均作为自我报告的牙齿健康检查数据而收集。牙医在口腔健康检查期间确定了牙齿缺失的数量。根据ICD-10编码E10-E14定义了新发糖尿病的发生率。该标准包括每年至少有一项就门诊诊所和任何降糖药处方记录的入院索赔，或基于NHIS-HEALS的空腹血糖≥7 mmol / l。结果在纳入的受试者中，有17.5％患有牙周疾病。在中位随访10.0年后，在31,545名受试者中发生了糖尿病（事件发生率：16.1％，95％CI 15.9％，16.3％）。在多变量模型中，在调整了人口统计学，规律的运动，饮酒，吸烟状况，血管危险因素，恶性病史和实验室检查结果后，发现牙周疾病（HR 1.09、95％CI 1.07、1.12，p <0.001）和缺失牙齿的数量（≥15颗牙齿）仍与新发糖尿病的发生呈正相关（HR 1.21，95％CI 1.09，1.33，p <0.001，p趋势<0.001）。频繁刷牙（≥3次/天）与新发糖尿病的发生呈负相关（HR 0.92，95％CI 0.89，0.95，p <0.001，p <0.001。001）。结论/解释频繁刷牙可能是一种减轻因素，牙周疾病的存在和缺失牙齿数量的增加可能是新发糖尿病发生的增加因素。改善口腔卫生可能会降低新发糖尿病的发生风险。