The Use of the Slipping Slipper Sign to Explore the Connection between the Feet and the Mouth in Patients with Diabetes Mellitus

Ramaa Lalita Balkaran, Siara Shivana Teelucksingh, Rahul Siram Naidu, Khama Emily Lutchmansingh, Lerissa Aimee Morris, Vrijesh Tripathi, Surujpal Teelucksingh


Objective: Both periodontal disease and peripheral neuropathy are complications associated with poorly controlled diabetes. This study aimed to determine whether periodontal disease was more prevalent and more severe among patients with severe diabetic peripheral neuropathy. Methods: A case-control study was performed; 46 patients with and 48 without the slipping slipper sign (SSS)—a surrogate clinical marker for severe peripheral neuropathy—were recruited from a diabetic outpatient clinic. Demography and data from the Basic Periodontal Examination (BPE) were assessed, in addition to the patients’ periodontal health by 2 examiners blinded to patients’ SSS status. Multivariate logistic regression was used to evaluate the associations between the risk factors for and the presence of the SSS, adjusting for age, gender, and ethnicity. Results: The mean age of the sample was 55.8 years (±10.69 years). Most of the participants (77.7%) had either never been to a dentist or had last attended a dental clinic more than a year before this examination, and 83% did not have a dentist. Periodontal disease was advanced in 61.7%, and there was no association between the SSS and periodontal disease. Dental-service utilization variables were significantly associated with the SSS. Patients who did not have a regular dentist were more than 7 times more likely to have the SSS than were those who did (OR = 7.70; 95% CI: 1.12 53.21). Conclusion: In diabetic patients, oral health–related risk factors, such as not having a dentist, wearing a denture or dentures, and visiting a dentist once a year or more, may be associated with systemic complications, including peripheral neuropathy. Early collaboration between dentists and doctors on the care of patients with diabetes is recommended.


Technical efficiency; Public hospitals; Health services; DEA Model; Turkey.

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