Clinical Oral Investigations

, Volume 17, Issue 3, pp 967–974 | Cite as

Relationship between oral health, diabetes management and sleep apnea

  • Ayse Basak CinarEmail author
  • Inci Oktay
  • Lone Schou
Original Article



The aim of this study was to assess the relationship between tooth loss, toothbrushing behaviour, diabetes type 2 (DM2), obesity and sleep apnea among diabetics.

Material and methods

DM2 patients (n = 165) in Istanbul, Turkey, were randomly selected from the outpatient clinics of two hospitals. Baseline clinical measurements (HbA1c, fasting blood glucose, high-density lipoprotein (HDL), low-density lipoprotein (LDL), body mass index (BMI), body-fat proportion, tooth loss) and self-administered questionnaires (toothbrushing, gingival bleeding, sleep apnea) provided data for factor and principal component analysis with Varimax rotation. Univariate statistics and chi-square tests were derived.


Mean maxillary tooth loss (4.49 ± 3.69 teeth) was higher than in the mandible (3.43 ± 3.12 teeth, p< 0.001). Favourable HDL was measured among most patients (77 %); other favourable clinical measures occurred only in a minority of participants (HbA1c, 28 %; fasting blood glucose, 17 %; LDL, 30 %). Twice daily toothbrushing was reported by 33 % (17 %) for healthy BMI; 37 % when healthy body-fat proportions. There was risk of sleep apnea in 37 %. The higher number of lost teeth in the maxilla was linked with obesity and sleep apnea. Non-daily toothbrushers were more likely to have high LDL and low HDL cholesterol and a higher risk of sleep apnea. When “at least occasionally” bleeding on toothbrushing occurred, higher HbA1c levels and sleep apnea were more likely.


Oral care with early diagnosis and monitoring of glycaemic level can help prevent complications of DM2.

Clinical relevance

Dentists may play a key role in better managing and diagnosing sleep apnea early by referring the patients with severe tooth loss and periodontal disease for general medical examination.


Tooth loss Diabetes Sleep apnea BMI Toothbrushing 



We express our deepest thanks to Prof. Nazif Bagriacik (Head, Turkish Diabetes Association), Associate Prof. Mehmet Sargin and Head Diabetes Nurse Sengul Isik (Diabetes Unit, S.B. Kartal Research and Education Hospital) for all their support and help during the research. We thank Prof. Aytekin Oguz for his help on the preparation of the documents for ethical permission. We also thank to periodontologist Duygu İlhan for clinical periodontal examinations during the first phase of the study. We also would like to thank ZENDIUM for oral healthcare kits, SPLENDA (TR) for the promotional tools, ChiBall World Pty Ltd. for exercising chi-balls and IVOCLAR Vivadent, Plandent, Denmark, for help in the provision of CRT kits. Many thanks are due to our patients for their participation and cooperation. The research project is supported by FDI and the International Research Fund of the University of Copenhagen.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Oral Public Health Department, Institute of OdontologyUniversity of CopenhagenCopenhagenDenmark
  2. 2.Oral Public Health DepartmentYeditepe Dental FacultyIstanbulTurkey
  3. 3.Head, Institute of OdontologyUniversity of CopenhagenCopenhagenDenmark

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