DiabetesTooth loss associated with morbidity and mortality

Editor: David L. Joffe, BSPharm, CDE, FACA

The impact of impaired wound healing in people with diabetes mellitus (DM) contributes to their increased risk of developing periodontitis, leading to tooth loss (TL).

It is estimated that 463 million people are affected by diabetes, and this number continues to grow globally. Because a complication of diabetes is impaired healing, people with diabetes may see the destruction of the soft tissues that help support their teeth. Additionally, there is evidence that periodontitis, with its inflammatory mediators, can impair glycemic control and lead to insulin resistance. With the increasing number of people with diabetes, information is needed to identify the exact mechanism of severe tooth loss (having fewer than nine permanent teeth) and the association with diabetic status. According to the Centers for Disease Control and Prevention (CDC), there was a greater than 50% chance of developing TL in people with uncontrolled diabetes compared to those without diabetes. In addition to tooth loss, different health problems arise in uncontrolled diabetes, such as heart problems, retinopathy, and metabolic syndrome.

This review was conducted with an extensive literature search between January 2000 and April 2021 and included key terms such as diabetes, morbidity, mortality, tooth loss and ageing. Inclusion criteria included controlled trials, cohorts, case-control studies and cross-sectional studies that showed an association between tooth loss and diabetes morbidity and mortality in a population group aged 50 years and over. more, even if the definition of age for the elderly exceeds 60 years. Of 1089 abstracts that the authors themselves screened after applying exclusions and removing duplicates, the systematic review had a total of thirteen studies.

Studies looking at the incidence and prevalence of diabetes (as outcomes) have reached statistical significance. They found in three articles that a loss of twenty teeth, more than nine teeth and more than eight teeth was associated with an odds ratio (OR 1.7), a risk ratio (HR 1.37) and a odds (OR 1.74), respectively. , showing the prevalence of diabetes in people with TL. In terms of analyzing HbA1c in people who had lost their teeth, they found that HbA1c was inversely correlated with the number of remaining teeth. If the individual had fewer teeth, the HbA1c would be higher and vice versa. Other complications due to diabetes were also examined to determine if they also had significant tooth loss. TL has also been observed in people with diabetic retinopathy and metabolic syndrome. Heart disease was not as prevalent among those with healthier teeth. Although there were data on the incidence and prevalence of HbA1c and diabetes, there were no statistically significant results to predict mortality in people with tooth loss and diabetes.

To conclude, this systematic review showed an association in older people with TL and the incidence and prevalence of diabetes and other diabetes-related health problems. The loss of more than eight teeth showed in several papers that diabetes was present and could be attributed to the inflammatory system. This study was adjusted for some confounders, but diet was not controlled and significantly affected diabetes and TL. Lost to follow-up were high in one study and not included in another. Other limitations included that each study differed in the number of teeth lost as a benchmark, some did not have reliable tests, and the patient could self-report their missing teeth. The longer the individual has had diabetes, the worse it can get without the proper medications, diet, and lifestyle modifications, and therefore can potentially lead to worse outcomes for TL. However, the temporality of diabetes outcome and exposure to tooth loss was not found due to the lack of a large number of studies in this review. Future studies should include diagnosing the onset of diabetes in terms of years to determine whether progression of diabetes leads to tooth loss or whether diabetes severity is primarily responsible for extensive tooth loss. There is a need for high quality studies with different evaluations to show the association between diabetes and tooth loss and possible steps to add dental care to diabetes education. Dental professionals and health care providers need to educate their patients on the importance of tooth cleaning and tooth retention. Studies have shown decline in quality of life even if some teeth are lost. Dental hygiene should be emphasized as an essential preventative step in their daily lives, like checking their feet or checking their blood sugar.

Practice Beads:

  • There is a 50% chance of developing tooth loss in people with uncontrolled diabetes compared to those without diabetes.
  • As the number of lost teeth increases, the outcomes for diabetes deteriorate.
  • Insulin resistance may be linked to periodontitis due to inflammatory mediators.

Raju, Karen, et al. “Association of tooth loss with morbidity and mortality by diabetes status in the elderly: a systematic review.” BMC Endocrine Disorders, vol. 21, no. 1, 2021, https://doi.org/10.1186/s12902-021-00830-6.

Helal, Omar et al. “Predictors of tooth loss in patients with periodontitis: systematic review and meta-analysis.” Journal of Clinical Periodontology vol. 46.7 (2019): 699-712. doi:10.1111/jcpe.13118

Megan Jane, 2022 PharmD Candidate, USF Taneja College of Pharmacy

Learn more about dental problems and diabetes.

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