Diabetes and Oral Health: Why It's Important to Fit Dental Care into Your Budget

Written by Sari Harrar

Avoiding the dentist? You aren’t alone. A recent New York University study of 2.5 million Americans has found that more than three out of 10 people with high blood sugar haven’t seen the dentist in the past year. That’s a big concern, says study coauthor Bei Wu, PhD, Dean's Professor in Global Health and director of Global Health & Aging Research at NYU Rory Meyers College of Nursing. Untreated oral-health problems like gum disease can make controlling your blood sugar more difficult—and at the same time, high blood sugar can make gum disease worse, too.

“Periodontal disease [gum disease] is a risk factor for poor metabolic control in individuals with diabetes,” Dr. Wu told On Track Diabetes. “Oral health problems directly increase the risk of poor glycemic control because they aggravate inflammation and may complicate overall management of diabetes.” Some research even suggests that getting treatment for gum disease may improve diabetes control, Dr. Wu notes.  

Results of the Study Show a Decline in Visits to the Tooth Doctor

For the study, researchers from NYU and East Carolina University looked at results from the Center for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System (BRFSS)—the world's largest, on-going telephone health survey—from 2004 to 2014. The study included 2.5 million adults aged 21 years and older. Among them, 248,203 had diabetes, 30,520 had prediabetes, and 2,221,534 were without diabetes.

They found that overall rates for annual dentist appointments dropped nationally during that ten-year period. But rates for those with diabetes and prediabetes stayed the lowest. In 2014, 61.4% of survey takers with diabetes and 64.9% with prediabetes saw a dentist compared to 66% in 2004.  Among people without diabetes, the percent who visited their tooth doctor in the previous year fell from 71.9% to 66.5%. The study was published online March 31 in the Journal of the American Dental Association.

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This study didn’t directly ask survey-takers why they weren’t getting check-ups and oral care. But it finds out that younger adults, people with lower incomes and those without health insurance were the least likely to get the oral check-ups they needed. Cost and lack of dental insurance are likely big obstacles, the researchers note, especially as many Americans are finding their annual salaries aren’t growing. “I think cost certainly is a major barrier for dental care among those without dental insurance,” Dr. Wu says. She notes that some people with diabetes may not be aware that their oral health has an impact on their diabetes, too.

“Periodontal disease has been called the “sixth complication” of diabetes,” the study notes. “The American Diabetes Association has encouraged those with diabetes to visit the dentist at least twice per year… Although there are no specific recommendations for preventive dental care for people with prediabetes, these patients are at higher risk of experiencing dental problems.”

Lead study author Huabin Luo, PhD, assistant professor of public health at East Carolina University’s Brody School of Medicine, notes that keeping up with dental health could have long-term benefits for overall health. “Periodontal infection is associated with poorer glycemic control, which contributes to increased risk for diabetes complications. Although there is no definitive evidence, significant effects of periodontal treatment on glycemic control have been reported, albeit the effect size is small. Thus, timely treatment of periodontal infection in people with diabetes is essential for maintaining oral health, it may also have an important role in establishing and maintaining glycemic control and possibly in delaying the onset or progression of diabetes complications.

While 90%  of people with diabetes (and nearly 100% age 65 and older) have health insurance, less than half have dental coverage. Dental savings cards can keep costs down (compare cards to find the best savings from dentists in your area). “Low cost dental clinics at dental schools are an option,” Dr. Wu adds.
It’s also worth talking to your dentist about costs if you can’t afford check-ups and mouth care, notes Amy Hess-Fischl , MS, RD, LDN, BC-ADM, CDE, of the Kovler Diabetes Center in Chicago.

“Believe me, they would rather prevent a dental emergency,” she notes. “ALL diabetes patients should follow the American Diabetes Association’s Standards of Care and have a dental check up every 6 months. I think not going to the dentist has a lot to do with changes in insurance coverage, people losing their jobs and knowing you should, but thinking “if it isn’t broke, don’t fix it.” The discussion I have with my clients is that by PREVENTING something from happening, they’re reducing the extra appointments that WILL come if they do nothing. It is worth the extra 45 minutes to go to the dentist.”

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