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New Way to Screen for Diabetes and Prediabetes

Mar 31, 2018
 

Missing teeth and diabetes: dental exams may be earlier predictor of disease than even blood tests.

By Steve Freed, R.Ph.,
Diabetes Educator/Publisher

Experts predict that by 2050, one in every 3 Americans will have diabetes. Poor dental health, most commonly identified by the presence of periodontal disease and dental caries, has been suggested to be associated with the presence of diabetes since the 1930s. Diabetes is estimated to increase the risk of periodontitis by 2 to 3 fold and severe periodontitis was shown to be associated with an increased risk of poor glycemic control in a Native American cohort. The literature on diabetes and the risk of caries has shown mixed results and there is a paucity of reports aimed at assessing the presence of caries and the risk of developing diabetes. For this study, they examined the impact of glucose tolerance on dental health in a representative US population.

Dental health has been shown to be linked to increased risk for diabetes and prediabetes. The results were presented recently at the ENDO 2018 conference. Lead author Raynald Samoa, M.D., an assistant professor in the Department of Diabetes, Endocrinology & Metabolism at City of Hope National Medical Center in Duarte, California, stated that the results from the study show that poor dental health may be linked with increased risk for diabetes and could be another way to screen for diabetes.

The findings suggest that dental exams may provide a way to identify someone at risk for developing diabetes, earlier then even a blood test. We found a progressive positive relationship between worsening glucose tolerance and the number of missing teeth. “Although a causal relationship cannot be inferred from this cross-sectional study, it demonstrates that poor dental outcome can be observed before the onset of overt diabetes,” Samoa said.

The researchers reviewed the records of 9,670 adults 20 years of age and above who were examined by dentists during the 2009-2014 National Health and Nutrition Examination Survey. They analyzed their reported body mass index (BMI) and glucose tolerance states by fasting plasma glucose, two-hour post challenge plasma glucose, hemoglobin A1c (HbA1c), established diabetes, and whether the condition was treated with oral agents or insulin.

They recorded the numbers of missing teeth due to caries, or cavities, and periodontal disease for individual patients, and they determined the relationship between glucose tolerance and dental condition by considering age, gender, racial and ethnic group, family history of diabetes, smoking status, alcohol consumption, education, and poverty index.

The authors found a progressive increase in the number of patients with missing teeth as glucose tolerance declined, from 45.57 percent in the group with normal glucose tolerance (NGT), to 67.61 percent in the group with abnormal glucose tolerance (AGT), to 82.87 percent in the group with diabetes mellitus (DM). Except for gender, all other covariates had significant impact on the number of missing teeth.

The differences in the average number of missing teeth among the three glucose tolerance groups were significant: 2.26 in the NGT group, 4.41 in the AGT group, and 6.80 in those with DM.

The authors wrote in their abstract that as far back as the 1930s, periodontal disease and dental caries have been suggested to be linked with diabetes, and that that by 2050, one-third of Americans are expected to be affected by diabetes.

The results showed a progressive positive relationship between worsening glucose tolerance and number of teeth missing. Since this is a cross-sectional study, the causal relationship cannot be inferred. However, this study demonstrates that the poor dental outcome can be observed before the onset of overt diabetes.

I, myself, have a passion to educate all dentists and dental hygienists, that they could have an impact in catching diabetes in its early stages and improving the quality of life for their patients.  Studies have been shown that patients not only have lost some teeth, but many of the patients with periodontal disease have elevated blood sugars. So, why not train all dentists, especially periodontists, to provide A1c tests to their patients undergoing tooth removal or any type of surgery, not only to screen for diabetes but also to let them know that those patients with elevated blood sugars need more attention in preventing infections especially after surgery. We need to make dentists part of the DIABETES TEAM!

Practice Pearls:

  • The authors found a progressive increase in the number of patients with missing teeth as glucose tolerance declined.
  • The differences in the average number of missing teeth among the three glucose tolerance groups were significant: 2.26 in the NGT group, 4.41 in the AGT group, and 6.80 in those with DM.
  • Patients with at least 3 or more missing teeth should be tested for diabetes.