Effectiveness of Personalized Oral Hygiene Advice Delivered by Artificial Intelligence or Dental Professionals Versus Standard Oral Hygiene Advice on Oral and Systemic Health in Community-based Type II Diabetes Patients: A Randomized Controlled Trial

Diabetes is a systemic condition characterized by elevated blood glucose levels and is associated with multiple long-term complications. This systemic disease is mutually linked to inflammatory gum diseases through circulating inflammatory mediators. Controlling inflammatory gum diseases improves blood glucose levels and reduces long-term complications. While maintaining good oral hygiene through home care is essential for managing inflammatory gum diseases, close supervision of patients' home care is labor-intensive and expensive. Artificial intelligence (AI) has been used to provide personalized advice on the adequacy of patients' home care (oral hygiene). We hypothesize that the use of AI can improve home care, thereby enhancing both gum health and systemic health, compared to the absence of AI in chronic disease healthcare.

Diabetes is a serious public health problem and accounts for 9% of all deaths worldwide. According to the World Health Organization (WHO), by 2030, the number of diabetics will increase to at least 366 million worldwide. In Europe, the diabetic population is estimated at 66 million, a number that will rise to 89 million by 2045. However, these figures are not as dramatic as in America and many other low- and middle-income countries. Diabetes has become a major public health problem in China, increasing rapidly in last decades. About 90% of diabetes patients have type 2 diabetes mellitus (T2DM ), which causes a range of health complications, such as eye, mouth, and skin infections, cardiovascular diseases, blindness, and kidney failure, and can lead to lower limb amputation, reducing patients' quality of life and imposing a burden on them, their families, and the wider society. The main predisposing factors for T2DM are the existence of prediabetes, obesity, age ≥ 45 years, a family history of T2DM in first-degree relatives, a lack of physical exercise, the onset of gestational diabetes or the birth of a new-born weighing > 4 kg, the presence of non-alcoholic fatty liver disease, and smoking.

Prevention of T2DM is a major challenge worldwide, as both its prevalence and incidence are increasing rapidly. The main symptoms of T2DM are typical and common to all types; they include polyuria, polydipsia, polyphagia, dry mouth and/or dry skin, excessive fatigue, blurred vision, and trauma, such as cuts and bruises that are slow to heal.

Chronic oral diseases are significantly more common and more severe in diabetic patients. In addition to gingival infection and periodontal inflammation, there may be complications of implants, caries, dry mouth, bacterial and fungal infections, oral malodour, and slow healing of wounds from dental treatments. In addition, the Candida species are seen more often in people with diabetes than in healthy people. Periodontitis is the main and most important complication of T2DM, with a prevalence of 7 in 10 adults having some type of periodontal disease, and almost half of this population having moderate or severe periodontitis. Age, sex, education level, family income, smoking, oral hygiene-related behaviours, T2DM, and other comorbidities, such as some autoimmune diseases, have been identified as important potential risk factors for periodontitis in many studies.

The findings of the studies also show that T2DM is associated with an increased risk of tooth loss because of periodontal disease, possibly through the mechanism of inflammation: directly due to an inflammatory response of the gums and indirectly due to the creation of a substrate resulting from reduced saliva production secondary to medication. In particular, periodontal disease is caused by changes in collagen metabolism-and consequently, in periodontal fibers-and by the presence of microbial plaque and poor hygiene in most diabetics, resulting in resorption of the gums, the underlying connective tissue, and the jawbones, leading to loss of teeth.