A Randomized Controlled Trial of an Educational Intervention to Promote Oral and Dental Health of Patients with Type 2 Diabetes Mellitus
Diabetes is the most prevalent disease resulted from metabolic disorders. This study aimed to investigate the effect of training based on health belief model (HBM) on oral hygiene-related behaviors in patients with type 2 diabetes mellitus. Methods: This study was conducted as an educational randomized controlled trial (single blind) on 120 patients with type 2 diabetes referring to a diabetes clinic selected through systematic sampling, who were assigned to two groups of control (N=60) and
... trol (N=60) and intervention (N=60). The data collection tool was a valid and reliable questionnaire based on HBM which was completed by both groups before the intervention. Then, the intervention group received 4 sessions of educational program based on HBM in one month, and the same questionnaire was completed again after 3 months and the data were analyzed through SPSS version 20 software with inferential statistics, t-test, paired t-tests, Chi square, Mann-Whitney test, and Wilcoxon test analysis. Results: Three months after the intervention, awareness of the patients and perceived susceptibility, benefits, self-efficacy, internal cue to action, and performance in oral and dental hygiene-related behaviors had a significant increase in the intervention group (p<0.05). So that the performance of oral and dental hygiene in the intervention group increased from 2.16 ± 0.71 to 3.25 ± 0.49 (p=0.001) after the education. Conclusion: Our results suggest that training patients with diabetes based on HBM as well as through active follow-up can enhance their skills in oral and dental hygiene-related behaviors. Controlling, monitoring and follow-up during the program are also recommended. Background Diabetes is one of the metabolic diseases and is a multifactorial disorder that is characterized by a chronic rise in blood sugar or hyperglycemia and is caused by either insulin secretion disorder or insulin dysfunction or both. Diabetes is also called a silent epidemic and a major public health problem and it accounts for 9% of all deaths worldwide . Patients with uncontrolled diabetes have oral complications such as increased dry mouth and burning mouth. Alterations in collagen metabolism and consequently periodontal fiber changes, cause periodontal disease, which is due to the presence of microbial plaques and poor hygiene in most diabetics   . Salivary lactate levels in 3 diabetics are higher than in healthy individuals and in advanced cases can reach up to 5 times the normal level, which is a contributing factor to caries . Moreover diabetes mellitus affects virtually all tissues and organs of the body including the hard and soft tissues of the oral cavity, manifesting with several complications  . There are numerous studies showing that the prevalence, progression, severity, and extent of chronic oral diseases are significantly increased in diabetic patients. The main oral complications associated with diabetes, including infection of the gums, periodontal disease, tooth decay, dry mouth, bacterial infections and fungus, halitosis, and prolonged healing of wounds from dental treatments  . Belazi et al. in his research showed that the growth rate of Candida species was significantly higher in people with diabetes than in the healthy group  . Knowledge of diabetics about periodontal disease, dry mouth and prevention of oral and dental problems is of great importance in these patients [5, 9] . Patients with diabetes and their families need to learn and practice new lifestyle skills, including monitoring blood sugar, following medication instructions, having a proper diet, physical activity, and more. These skills are important both in controlling diabetes and in preventing or delaying its complications. Diabetic patients should be active participants in the educational process and in setting educational and behavioral goals [7, 10] . The only effective and efficient strategy for solving oral health problems is prevention and compliance with oral health  . According to the World Health Organization (WHO), health education is the best and most effective way of providing health care to people, both in terms of human resources and heavy cost of medical care . According to WHO, education is the cornerstone of diabetes treatment. In fact, education has been recommended as an essential component of promoting good control of diabetes, and studies have shown that education is effective in controlling and treating the disease, and according to studies, proper training can reduce 80% of diabetes complications   . The Health Belief Model is one of the oldest models of behavior analysis that has been used in numerous studies of health behaviors such as type 2 diabetes mellitus (T2DM)  . Social psychologists developed this model during the 1950s to predict the reasons for people's unwillingness to engage in preventive health behaviors  . MM is a student at 5. Al Habashneh R. Knowledge and awareness about diabetes and periodontal health among Jordanians. J Diabetes Complications. 2010;24:409-414.