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Diabetes Linked to Increased Risk of Tooth Loss

Jan 2, 2016

Study of 40-year trend focused on three ethnic groups prone to dental complications.

Diabetes has been increasing in the United States over the years. According to the CDC, diabetes rate have tripled from 1980 to 2014. Diabetics are at risk for multiple complications such as cardiovascular disease, neuropathy, eye damage, hearing impairment, skin disease, and periodontal disease. Researchers have identified a relationship between diabetes and periodontal disease. About half of the U.S. population suffers from periodontal disease and the prevalence for periodontal disease is greater in adults with diabetes.


“One of the many complications of diabetes is a greater risk for periodontal disease,” said Maria E. Ryan, DDS, PhD, Professor of Oral Biology and Pathology, and Director of Clinical Research, School of Dental Medicine, Stony Brook University, New York, in a recent interview.  “If you have this oral infection and inflammation, as with any infection, it’s much more difficult to control blood glucose levels.”  Intensive periodontitis treatment significantly reduces levels of A1C.

These links between oral and systemic health may start even before clinical diabetes begins.  “We have found evidence that the severity of periodontal disease is associated with higher levels of insulin resistance, often a precursor of type 2 diabetes, as well as with higher levels of A1C, a measure of poor glycemic control of diabetes,” she said.

The importance of these findings were emphasized by her colleague, George W. Taylor, DrPH, DMD, Associate Professor of Dentistry, Schools of Dentistry and Public Health, University of Michigan.  “Several recent studies have shown that having periodontal disease makes those with type 2 diabetes more likely to develop worsened glycemic control and puts them at much greater risk of end-stage kidney disease and death,” he reported.

“Given the numerous medical studies showing that good glycemic control results in reduced development and progression of diabetes complications, we believe there is the potential that periodontal treatment can provide an increment in diabetes control and subsequently a reduction in the risk for diabetes complications,” said Dr. Taylor.

Periodontal (gum) disease is an infection and chronic inflammatory disease of the tissues surrounding and supporting the teeth.  It is a major cause of tooth loss in adults.  In periodontitis, unremoved plaque hardens into calculus (tartar), gums gradually begin to pull away from the teeth, and pockets form between the teeth and gums.  However, people often do not know they have periodontal disease because it is usually painless.

A recent study came out looking at a 40-year trend of diabetes and periodontal disease.  They collected data from nine waves of National Health and Nutrition Examination Survey conducted from 1971 through 2012. The study collected 37,609 dentate individuals aged 25 or older who received an oral examination. The results of the study shows that diabetes was consistently higher among non-Hispanic blacks and Mexican Americans than among non-Hispanic whites (P < 0.001). The study found that tooth loss is associated with diabetes. A trend was identified that the number of teeth lost greatly increased after the age of 60 among the three racial ethnic groups. The rate of tooth loss increased more with age among non-Hispanic blacks than among non-Hispanic whites and Mexican Americans. Non-hispanic blacks with diabetes suffered the greatest rate of tooth loss among the ethnic groups.

Given the study’s results, there is a need to improve dental hygiene and increase awareness of the risk among patients with diabetes. The study identified specific groups and age targets that are more prone to tooth loss, which can be used as target initiatives to improving self-care. By having targeted initiatives toward patients who are older and non-Hispanic blacks to increase their knowledge on diabetes and proper dental hygiene, the risk of tooth loss can be reduced.

Overall, the study indicates that greater tooth loss has been associated with diabetes. Non-hispanic blacks with diabetes are the highest risk of tooth loss and have the highest increase in tooth loss as they age. Healthcare providers should be informed of the associated risk and education on necessary dental care and tooth retention should be promoted to patients.

Practice Pearls:

  • A large cohort study from 1971 through 2012 found that adults with diabetes are at greater risk of tooth loss.
  • Tooth loss increases as a patient ages. In non-Hispanic blacks, risk of tooth loss is greatest and rate of tooth loss increases greatly as they age.
  • It is recommended that you brush your teeth twice daily and floss daily. You should avoid smoking, tobacco, and sugary foods. Patients should have dental check ups every 6 months.

Luo H, Pan W, Sloan F, Feinglos M, Wu B. Forty-Year Trends in Tooth Lss Among American Adults With and Without Diabetes Mellitus: An Age-Period-Cohort Analysis. Prev Chronic Dis 2015;12:150309. DOI: http://dx.doi.org/10.5888/pcd12.150309

Maria E. Ryan, DDS, PhD, Professor of Oral Biology and Pathology, and Director of Clinical Research, School of Dental Medicine, Stony Brook University, New York