Disclosures: The authors report no relevant financial disclosures.
December 17, 2021
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Tooth loss may signal increased risk for diabetes in older adults

Disclosures: The authors report no relevant financial disclosures.
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Older adults may have an increased risk for developing diabetes and experiencing adverse diabetes-related outcomes if they lose teeth, according to a systematic review published in BMC Endocrine Disorders.

“All studies included in this review, except one, consistently demonstrated a significant association between tooth loss and diabetes-related outcomes in older adults,” Susan Hyde, DDS, MPH, PhD, professor in the department preventive and restorative sciences, division of oral epidemiology and dental public health at the University of California, San Francisco, School of Dentistry, and colleagues wrote. “This review’s finding that retained teeth is inversely correlated with HbA1c in older adults with diabetes is consistent with previous studies reporting people with high HbA1c have poorer periodontal health and fewer teeth than those without diabetes. This review also bolstered the findings of studies conducted to explore the relationship between tooth loss and metabolic syndrome.”

Elderly woman
Source: Adobe Stock

Researchers conducted a systematic review of cross-sectional, case-control, cohort and controlled studies examining the association between tooth loss and diabetes morbidity and mortality among adults aged 50 years and older.

The review included 13 observational studies, of which eight were cross-sectional and five were cohort studies. Of studies with diabetes incidence as the outcome, one concluded missing 25 or more teeth (OR = 1.7; P < .05) was associated with an increased risk for diabetes, and another found missing nine or more teeth (HR = 1.37; 95% CI, 1.02-1.86) increased the risk for diabetes. Bite instability (OR = 4.45; 95% CI, 1.43-13.88) and missing eight or more teeth (OR = 1.74; 95% CI, 1.35-2.27) were associated with a greater prevalence of diabetes in two other studies. One study found no significant associations with individual diabetes outcomes and missing teeth, and another found the prevalence of diabetes decreased by 11% for those losing more teeth vs. fewer.

Tooth loss was associated with a higher likelihood for diabetic retinopathy (OR = 4.27; 95% CI, 1.38-13.19) and metabolic syndrome (OR = 1.45; 95% CI, 1.1-1.91) in two studies. Retaining more healthy teeth was associated with a lower likelihood for heart disease, regardless of diabetes status (OR = 0.96; 95% CI, 0.926-0.998) in one study. In another study, missing any teeth was associated with worse health-related outcomes among older adults with diabetes (OR = 1.25; 95% CI, 1.13-1.37). One study found those with chronic kidney disease and more than 25 remaining teeth had a lower mortality risk than those with 25 or fewer remaining teeth. However, another study found no association between the number of teeth and mortality among men with diabetes.

The researchers wrote that caution should be taken when assessing the findings due to a lack of research available on the topic and a medium level of quality of the evidence. However, they added, dentists and health care providers should focus more on associations between tooth loss and poor health outcomes.

“Dental care providers should include broader diabetes-related medical care and self-care messaging in their patient assessments and education, and medical care providers should include oral health and dental care-related messaging during their patient encounters,” the researchers wrote.