Incidence of Endodontic Treatment in Diabetics: VA Dental Longitudinal Study

Objectives: Understanding oral disease processes in the growing diabetic population is vital to providing quality, evidence-based dental care. Data on the potential link between diabetes and endodontic health is limited. The goal of this retrospective analysis was to compare the incidence of endodontic treatment in diabetic versus non-diabetic individuals.
Methods: Participants from the VA Dental Longitudinal Study (DLS) were followed for an average of 28.9±6.8years. Of the initial 661 DLS participants used for our analysis, all of them were male, 14 had a positive diabetes status at baseline, and 159 developed diabetes over the course of follow-up. All medical and dental care was provided in the private sector and not by the VA. Primary analysis examined the association between diabetes status and incidence of root canal treatment (RCT). Tooth-level Cox proportional hazards models accounted for the clustering of teeth within an individual. Hazards ratios (HR) were adjusted for age, education, smoking status, body mass index, cardiovascular disease status, number of tooth surfaces with restorations and/or decay and the degree of alveolar bone loss around each tooth.
Results: Diabetics were found to be 1.57 times more likely to have one or more teeth treated with RCT compared to non-diabetics (95%CI 1.03-2.39). Additional significant predictors of RCT in the cohort were number of tooth surfaces with restoration and/or decay (HR 5.45, 95%CI 3.21-9.24) and degree of alveolar bone loss around each tooth (HR 1.86, 95%CI 1.65-2.09).
Conclusions: Increased incidence of RCT in diabetics may indicate that diabetes status is a risk factor for pulpal infection. The effect of accounting for teeth that were extracted rather than treated with RCT needs to be further investigated. Future studies may also consider exploring the association between degree of hyperglycemia and incidence of endodontic treatment.