Date of Award


Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Suzanne G. Leveille

Second Advisor

Ling Shi

Third Advisor

Sarah Camhi


Poor oral care can contribute to periodontal disease (PD) which affects about half of U.S. adults. People with diabetes are more vulnerable to PD, thus practicing optimal oral self-management such as making preventive dental visits regularly and practicing regular interproximal cleaning (flossing or using other interproximal cleaning devices) adequately are important for people with diabetes. However, it is not clear how oral self-management among people with diabetes have influenced their periodontal health and glycemic control, whether there is an association between good diabetes self-care and good oral self-care, and how health disparities hinder the practice of optimal oral self-care among U.S. adults having diabetes mellitus. In this secondary data analysis using 2011-2016 datasets from the National Health and Nutrition Examination Survey (NHANES), 12,642 US adults (age≥30) were included in the analysis; among them 15% (n=1924) self-reported having diabetes mellitus. The results of this study indicated 1) although people having diabetes were at increased risk for PD, they were less likely to practice optimal oral self-management than their non-diabetes counterparts. 2) People who were socioeconomically disadvantaged were less likely to practice oral self-management. 3) Practicing good oral self-care was not associated with practicing good diabetes self-care, indicating oral care was missing in the diabetes self-management, and 4) practicing optimal oral self-management was associated with a mild-to-moderate additive preventive benefit on glycemic control with presence/absence of periodontal disease among people with diabetes. This study highlighted the gap in practicing optimal oral self-management among U.S. adults living with diabetes, especially among those who are socioeconomically disadvantaged. Among the behaviors in pursuit of optimal oral self-care, preventive dental visits are more likely to be improved through health policy, while the practice of interproximal cleaning everyday is more likely to be enhanced through patients education and health promotion, for example, by nurses providing care for people with diabetes. Future longitudinal studies and randomized controlled clinical trials are warranted to confirm the directionality of the associations that were found in this study and to test the effectiveness of oral self-care interventions in periodontal health and glycemic control among adults living with diabetes.


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