Association of Diabetes With Tooth Loss in Diverse Hispanic Adults

Objectives: Diabetes is related to various oral and systemic health conditions, including periodontal disease, poor wound healing, and missing teeth. Hispanics have a high prevalence of both diagnosed and undiagnosed diabetes, and a greater risk of having diagnosed diabetes than non-Hispanic whites. We investigated the linkage between diabetes and missing teeth using data from the Hispanic Community Health Study / Study of Latinos (HCHS/SOL).
Methods: HCHS/SOL is a multi-center, interview- and physical including oral examination-based, cross-sectional study (N=15,945) comprised of participants aged 18-74 years old. Diabetes was assessed on physical exam and according to the American Diabetes Association definition, which includes fasting glucose, glycosylated hemoglobin percentages, and anti-diabetes medication use. Mean numbers of missing teeth were calculated based upon age categories (18-44, 45-64, 65-74), and then examined by gender. The relationship between diabetes and missing teeth was assessed using poisson regression.
Results: Persons with diabetes had consistently higher mean numbers of missing teeth than those without diabetes across all age groups in men and women combined. After adjustment for age, income, education, Hispanic background, nativity, ability to afford care, smoking, drinking, physical activity, hypertension, obesity, and self-reported kidney disease, the difference was attenuated (1.5 versus 1.4, 7.5 versus 6.7, and 13.7 versus 12 mean missing teeth comparing diabetics with non-diabetics across increasing age categories, respectively). This association did, however, persist in women aged 65-74 years (11.3 average missing teeth [95% confidence interval (CI) 9.7-13.3] versus 14.6 average missing teeth [95% CI 13.4-15.9] comparing non-diabetics with diabetic women, respectively).
Conclusions: Dental providers should encourage patients at risk for diabetes to be screened by primary care providers. Further investigation is needed to understand the novel finding that the relationship between diabetes and missing teeth is especially strong in Hispanic women aged 65-74. Cultural and language barriers and limited healthcare access are targets of additional study.