Persons with diabetes have an increased risk of periodontitis (gum disease) and tooth loss. The risk of inflammation and bone loss at dental implants was also higher. These are the findings of a thesis at the University of Gothenburg.
Diabetes is associated with complications in multiple organs, including the oral cavity. As a group, persons with type 1 or type 2 diabetes are at higher risk for oral diseases.
This thesis is based on a comprehensive dataset from seven Swedish registers covering a long time period, with a high degree of completeness. The thesis was presented by dentist Anna Trullenque Eriksson, who specializes in periodontology.
The thesis addresses the link between the systemic condition diabetes and the oral conditions periodontitis, tooth loss and peri-implantitis (an inflammatory disease in the tissues surrounding dental implants). Compared with previous studies, the study sample is strikingly large, particularly for type 1 diabetes.
Glycemic control matters
Persons with type 1 diabetes and poor control of blood sugar levels were found to have an increased risk of periodontitis and tooth loss, compared to matched controls without diabetes. However, no such differences were evident for those with continuously good glycemic control.
In the case of type 2 diabetes, the risk of periodontitis and tooth loss was elevated, regardless of blood sugar control. The correlation was strongest when glycemic control was poor. In turn, periodontitis was linked to an increased risk of diabetes-related eye and kidney complications in both diabetes types.
Among individuals with dental implants, those with type 1 or type 2 diabetes were at higher risk of peri-implantitis and implant loss. Poor blood sugar control was a key factor for poor implant outcomes.
The risk of complete tooth loss was particularly high among persons with diabetes who were also socio-economically disadvantaged (lower income, shorter education), highlighting the importance of socioeconomic factors. Data from both Sweden and Denmark were considered.
Important to be aware of the risks
The thesis reinforces previous evidence of a link between diabetes and oral diseases and stresses the importance of close collaboration between health care and dental care providers. The findings on dental implants are novel, suggesting that diabetes may affect long-term outcomes of implant therapy.
“Within the dental community, most are aware of the link between diabetes and impaired oral health. Our data support the notion that dental care should be part of diabetes prevention strategies,” states Anna Trullenque Eriksson.

Fact box: Tooth loss and diabetes
Type 1 diabetes (analyses based on 86,273 individuals; mean age 43 years)

• 33.9% had lost one or more teeth over a 10-year period (25.3% among those with good glycemic control; 43.5% among those with poor control). Among matched controls without diabetes 29.0% experienced tooth loss.
• 3.1% had lost five or more teeth over ten years (good control: 1.0%; poor control: 5.6%). The corresponding figure for controls was 1.9%.

Type 2 diabetes (analyses based on 786,305 individuals; mean age 60 years)

• 46.1% had lost one or more teeth over a 10-year period (44.0% among those with good glycemic control; 54.9% among those with poor control). Among matched controls without diabetes 37.8% experienced tooth loss.
• 7.0% had lost five or more teeth over ten years (good control: 5.7%; poor control: 12.6%). The corresponding figure for controls was 3.7%.