The physical tolls of type 2 diabetes — known for its risks of amputation and vision problems — also include tooth loss and gum disease, a recent study in the journal Preventing Chronic Disease reported. The study is titled “Forty-Year Trends in Tooth Loss Among American Adults With and Without Diabetes Mellitus: An Age-Period-Cohort Analysis.”
Researchers in the U.S. found that diabetic patients lose, on average, twice as many teeth as individuals without the disease. The team also reported that, in comparison to white or Mexican Americans, black diabetics are at increased risk of losing teeth as they age.
“We have more evidence that [poor] oral health is related to diabetes,” the study’s lead researcher, Dr. Bei Wu, professor of nursing and global health at Duke University in Durham, North Carolina, said in a news release.
Periodontal disease, also known as gum disease, is a common complication in people with diabetes and a major risk factor for tooth loss. “The ultimate consequence of gum disease is tooth loss,” Dr. Wu said. About half of the adults in the United States have gum disease, and its prevalence is even higher among adults with diabetes.
Diabetes has been increasing rapidly in the United States since the mid-1990s. In 2012, an estimated 28.9 million people ages 20 or older had diabetes, and disease prevalence was higher in racial/ethnic minority groups: 13.2 percent in non-Hispanic blacks and 12.8 percent in Hispanics, compared with 7.6 percent in non-Hispanic whites.
To assess tooth loss among adults with and without diabetes mellitus in the United States, the racial/ethnic disparities in tooth loss patterns, and the trends in tooth loss by age, birth cohorts, and survey periods, Dr. Wu and colleagues gathered clinical information on over 37,000 people who participated in the U.S. National Health and Nutrition Examination Survey between 1971 and 2012.
Results revealed that the estimated number of teeth lost among non-Hispanic blacks with diabetes increased more with age than that among diabetic non-Hispanic whites or Mexican Americans. During those years, results also showed a significant decreasing trend in the number of teeth lost among diabetic non-Hispanic whites and non-Hispanic blacks. However, adults with diabetes still had about twice the tooth loss as those without diabetes.
Previous research has shown that adults with diabetes were less prone to visit a dentist annually compared to adults without the disease. “Research has demonstrated that … they do not brush and floss as often as people without diabetes,” the authors wrote. “Our study findings highlight the need to improve dental self-care and knowledge of diabetes risks among people with diabetes, especially among non-Hispanic blacks, who had more tooth loss and lost teeth at a higher rate.” Dr. Wu also noted that the racial difference in tooth loss found might be due to black American difficulties in accessing good dental care.
It remains unclear why diabetes is associated with tooth loss, but this relationship is bidirectional, the researchers said. Diabetes increases the risk for poor dental health, while deteriorating gums and teeth are linked to worse overall health in diabetics. Gum disease is considered the sixth complication of diabetes, and has been identified as a risk factor for poor metabolic control in diabetic patients.
The American Diabetes Association recommends that doctors refer their diabetic patients to a dentist. However, “In reality, very few doctors are doing that,” Dr. Wu said. Since diabetes is a major cause of vision loss and amputation (resulting from poor circulation and nerve damage), diabetic patients are often referred to specialists in these areas. “Foot care and eye care are on the top of their agenda, but dental care is not,” Dr. Wu added. “Diabetics need to have regular dental care.”
Dr. Edmond Hewlett, a spokesman for the American Dental Association, welcomed the findings. “This study sheds light on two important and timely health issues: the connection between dental health and overall health; and health disparities — the degree to which diseases can affect some racial/ethnic groups more severely than others.”
According to Dr. Hewlett, also a professor at the School of Dentistry, University of California, routine visits to the dentist and good dental home care are vital for diabetes management.