Document Type : Original Article


1 Student of Dentistry, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran

2 Associate Professor, Research Center for Caries Prevention, Dentistry Research Institute AND Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran

3 Associate Professor, Department of Periodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran

4 Researcher, Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran


BACKGROUND AND AIM: Studies have confirmed a strong association between periodontal disease (PD) and diabetes mellitus (DM). Treatment of DM is in the field of internists. This study aimed to assess the knowledge, attitude, and performance of Iranian internists regarding the relationship of DM and PD.
METHODS: In this cross-sectional study, a questionnaire comprising of five domains and 34 questions was utilized (12 questions regarding demographics, 2 questions regarding the need for continuing education courses on oral health for physicians, 5 questions about knowledge, 12 questions about attitude, and 3 questions about the performance of physicians regarding the association of PD and DM). This questionnaire has been previously used in a study conducted in North Carolina, United States of America. The questionnaire was translated to Persian and its validity and reliability were confirmed. Next, 134 internists participating in a national congress filled out the questionnaire. The response rate was 97%. Data were analysed using the linear regression model in SPSS software.
RESULTS: The mean and standard deviation (SD) of score of knowledge, attitude, and performance of internists was 57 ± 26, 61 ± 12, and 37 ± 28, respectively, out of one hundred. Among the participants, 96% emphasized on the significance of cooperation with dentists in management of patients with DM and 81% of them confirmed the need for periodontal examination training for physicians. The total score of performance was significantly higher in internists with academic positions (β = 0.177, P = 0.047), older age (β = 0.234, P = 0.011), higher mean weekly working hours (β = 0.185, P = 0.043), and those who had passed a course regarding clinical, dental, and periodontal examination as part of their educational curricula (β = 0.190, P = 0.035).
CONCLUSION: This study showed that internists had low level of knowledge and performance regarding the relationship of PD and DM. This casts light on importance of enrichment of the educational curriculum and continuing medical educations in this regard.


  1. International Diabetes Federation. IDF Diabetes Atlas. Brussels, Belgium: International Diabetes Federation; 2013.
  2. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: Estimates for the year 2000 and projections for 2030. Diabetes Care 2004; 27(5): 1047-53.
  3. Zimmet P, Alberti KG, Shaw J. Global and societal implications of the diabetes epidemic. Nature 2001; 414(6865): 782-7.
  4. Ebrahimi H, Emamian MH, Hashemi H, Fotouhi A. High incidence of diabetes mellitus among a middle-aged population in Iran: A longitudinal study. Can J Diabetes 2016; 40(6): 570-5.
  5. Phipps KR, Stevens VJ. Relative contribution of caries and periodontal disease in adult tooth loss for an HMO dental population. J Public Health Dent 1995; 55(4): 250-2.
  6. Mealey BL. Periodontal disease and diabetes. A two-way street. J Am Dent Assoc 2006; 137(Suppl): 26S-31S.
  7. Kim J, Amar S. Periodontal disease and systemic conditions: A bidirectional relationship. Odontology 2006; 94(1): 10-21.
  8. Taylor GW, Borgnakke WS. Periodontal disease: Associations with diabetes, glycemic control and complications. Oral Dis 2008; 14(3): 191-203.
  9. Loe H. Periodontal disease. The sixth complication of diabetes mellitus. Diabetes Care 1993; 16(1): 329-34.
  10. American Diabetes Association. Standards of medical care for patients with diabetes mellitus. Diabetes Care 2003; 26(Suppl 1): S33-S50.
  11. Herring ME, Shah SK. Periodontal disease and control of diabetes mellitus. J Am Osteopath Assoc 2006; 106(7): 416-21.
  12. Parks ET, Lancaster H. Oral manifestations of systemic disease. Dermatol Clin 2003; 21(1): 171-82.
  13. Al Habashneh R, Khader Y, Hammad MM, Almuradi M. Knowledge and awareness about diabetes and periodontal health among Jordanians. J Diabetes Complications 2010; 24(6): 409-14.
  14. Finney LS, Finney MO, Gonzalez-Campoy JM. What the mouth has to say about diabetes. Careful examinations can avert serious complications. Postgrad Med 1997; 102(6): 117-26.
  15. Laudenbach JM, Simon Z. Common dental and periodontal diseases: Evaluation and management. Med Clin North Am 2014; 98(6): 1239-60.
  16. Owens JB, Wilder RS, Southerland JH, Buse JB, Malone RM. North Carolina internists' and endocrinologists' knowledge, opinions, and behaviors regarding periodontal disease and diabetes: need and opportunity for interprofessional education. J Dent Educ 2011; 75(3): 329-38.
  17. Tasdemir Z, Alkan BA. Knowledge of medical doctors in Turkey about the relationship between periodontal disease and systemic health. Braz Oral Res 2015; 29: 55.
  18. Obulareddy VT, Nagarakanti S, Chava VK. Knowledge, attitudes, and practice behaviors of medical specialists for the relationship between diabetes and periodontal disease: A questionnaire survey. J Family Med Prim Care 2018; 7(1): 175-8.
  19. Asa'ad F, Al-Maflehi N, Alelyan B, Asaad L, Alrumaih W, Alassad F, et al. Knowledge and orientations of medical interns toward periodontal disease in Saudi Arabia. Saudi J Oral Sci 2014; 1(2): 98-104.
  20. Al-Khabbaz AK, Al-Shammari KF, Al-Saleh NA. Knowledge about the association between periodontal diseases and diabetes mellitus: Contrasting dentists and physicians. J Periodontol 2011; 82(3): 360-6.
  21. Quijano A, Shah AJ, Schwarcz AI, Lalla E, Ostfeld RJ. Knowledge and orientations of internal medicine trainees toward periodontal disease. J Periodontol 2010; 81(3): 359-63.
  22. Bassir Shabestari S, Shirinbak I, Shervin Badv R. Evaluation of the knowledge and diagnostic skills of the Zanjan University of Medical Sciences interns in the the field of oral medicine. J Med Educ Dev 2014; 7(13): 9-15. [In Persian].
  23. Al-Habashneh R, Barghout N, Humbert L, Khader Y, Alwaeli H. Diabetes and oral health: Doctors' knowledge, perception and practices. J Eval Clin Pract 2010; 16(5): 976-80.
  24. Allen EM, Ziada HM, O'Halloran D, Clerehugh V, Allen PF. Attitudes, awareness and oral health-related quality of life in patients with diabetes. J Oral Rehabil 2008; 35(3): 218-23.