People with diabetes visit the dentist less frequently despite link between diabetes, oral health

Adults with diabetes are less likely to visit the dentist than people with prediabetes or without diabetes, finds a new study led by researchers at NYU Rory Meyers College of Nursing and East Carolina University's Brody School of Medicine.

The study, published in The Journal of the American Dental Association, showed an overall decline in dental visits among adults with and without diabetes, but people with diabetes were consistently the least likely to obtain oral healthcare.

Research has shown a two-way relationship between diabetes and oral health. People with diabetes are at an increased risk for periodontal disease, a chronic inflammation of the gums and surrounding tissue and bone, while periodontal disease has an adverse effect on blood glucose control – which can contribute to the progression of diabetes. In fact, periodontal disease has been called the "sixth complication" of diabetes after issues like kidney disease, damage to the retina, and heart disease.

"For people living with diabetes, regular dental check-ups – paired with proactive dental and diabetes self-care – are important for maintaining good oral health. Regular dental visits provide opportunities for prevention, early detection, and treatment of periodontal disease, which can potentially help with blood glucose control and preventing complications from diabetes," said Bei Wu, PhD, Dean's Professor in Global Health and director of Global Health & Aging Research at NYU Meyers and the study's senior author.

Older studies have shown that individuals with diabetes had fewer dental visits than those without diabetes. In order to have an updated understanding of dental visits among people with diabetes, this study assessed the trends of annual dental visits from 2004 to 2014 in adults with diabetes, prediabetes, and without diabetes, and assessed racial and ethnic disparities in dental visits.

The researchers used data from the Behavioral Risk Factor Surveillance System, an annual telephone survey of U.S. adults during which respondents are asked whether or not they had a dental visit in the past 12 months and whether they were ever diagnosed with diabetes or prediabetes. The study sample included 2.5 million adults age 21 years and older, including 248,203 people with diabetes, 30,520 with prediabetes, and 2,221,534 without diabetes.

The researchers found that people with diabetes were the least likely to visit the dentist, followed by people with prediabetes. From 2004 to 2014, the proportion of annual dental visits declined from 66.1 percent to 61.4 percent among people with diabetes, 66 percent to 64.9 percent among people with prediabetes, and 71.9 percent to 66.5 percent among people without diabetes.

"This pattern is concerning, given that timely dental care is essential for good oral health, especially in individuals with diabetes. Those who need dental care the most seem to be the least likely to have it," said study author Huabin Luo, PhD, of East Carolina University.

Several factors may account for the underutilization of dental services by people with diabetes, according to the researchers. People may not be aware of the impact of diabetes on their oral health and vice versa. In addition, in a previous study, individuals with diabetes more frequently reported the cost of dental care as a reason for avoiding routine visits.

The researchers also observed racial and ethnic disparities in dental care. Black and Hispanic individuals were less likely to visit the dentist than were white people, and these disparities persisted over the decade studied. Males and single people were also less likely to regularly visit the dentist than females and married people.

While the study did not measure whether individuals had dental insurance, the researchers found substantial financial barriers to dental services for people with diabetes based comparing dental visits and income levels. The researchers assert that reducing these barriers and improving access to dental providers is needed, especially among people with diabetes and prediabetes.

"Healthcare providers and public health professionals should promote oral health in diabetes management and encourage people with diabetes to visit a dentist at least annually. Increasing access to dental services is vital to achieving this goal," said Wu, who is also co-director of the NYU Aging Incubator.

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In addition to Wu and Luo, study authors include Ronny A. Bell, Wanda Wright, and Qiang Wu of East Carolina University.

About the NYU Rory Meyers College of Nursing

NYU Rory Meyers College of Nursing is a global leader in nursing education, research, and practice. It offers a bachelor of science with a major in nursing, a master of science, post-master's certificate programs, a doctor of nursing practice degree, and a doctor of philosophy in research theory and development.

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Rachel Harrison
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https://www.nyu.edu/about/news-publications/news.h

http://dx.doi.org/10.1016/j.adaj.2018.01.008

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