Document Type

Thesis

Date of Degree Completion

Winter 2022

Degree Name

Master of Public Health (MPH)

Department

Health Sciences

Committee Chair

Katarina Mucha

Second Committee Member

Amie Wojtyna

Third Committee Member

Tishra Beeson

Abstract

Diabetes mellitus and periodontal disease are major global public health concerns. Within the United States (U.S.) over 34 million adults have diagnosed diabetes (Centers for Disease Control and Prevention [CDC], 2020a), and 64 million U.S. adults have periodontitis (American Academy of Periodontology [AAP], 2021a). Research has shown that persons with diabetes have a coinfection with periodontal disease at a rate between 2.6 and 2.9 times higher than persons without diabetes (Wang et al., 2014). Diabetes and periodontal disease collectively and disproportionately affect persons of low socioeconomic status (SES), age, and particular racial/ethnic identities (AAP, n.d.b; CDC, 2021; Connolly et al., 2000; Nazir et al., 2020). Given the disparities in periodontal disease and diabetes, this systematic review of the literature has two aims: (1) to identify how the prevailing research currently accounts for socio-demographic inclusiveness within the investigation of periodontal disease treatment effects on hemoglobin A1c (HbA1c) and (2) to contextualize those strategies through qualitative analyses of recruitment strategies and study limitations within clinical dental research. Methods. Primary Aim utilized a methodologically focused PICO and PRISMA checklist for systematic reviews and included experimental and observational studies through evidence synthesis conducted via Academic Search Complete. Key words included “periodontitis”, “periodontal disease”, “type 2 diabetes”, “periodontal therapy”, “glycemic control”, and “HbA1c”. A thematic and contextual qualitative analysis was implemented to meet the secondary aim through reporting and deductively coding author accounts that assessed how the limitations, if any, related to the impact of recruitment barriers among the sample population, and the presence or absence of participant socio-demographics. Results. Results demonstrated that participants included in the systematic review of existing studies were predominantly middle-aged, White women with access to primary care providers. Meanwhile, qualitative results revealed two major themes, including the ability to perceive and engage in health care access and utilization as barriers to care. Implications. Study findings highlight the need for improving recruitment strategies that address socio-demographic disparities, in addition to intersecting dental and medical professions; ultimately contributing toward advancing equitable access to dental care within the U.S. that is more inclusive to persons most vulnerable to diabetes and periodontal disease.

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