People With Diabetes Get Fewer Dental Checkups

Laird Harrison

April 04, 2018

People with diabetes and prediabetes visit their dentists less often than people without these conditions, despite their greater need for dental care, researchers say.

"Those who need dental care the most seem to be the least likely to have it," said Huabin Luo, PhD, a researcher at East Carolina University, Greenville, North Carolina, in a news release.

Published online March 31 in the Journal of the American Dental Association, the study shows an overall decline in dental visits among adults with and without diabetes.

Previous studies have shown a two-way relationship between diabetes and oral health. People with diabetes are at an increased risk for periodontal disease, and periodontal disease interferes with blood glucose control, contributing to the progression of diabetes.

"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 senior author Bei Wu, PhD, director of Global Health & Aging Research at New York University, New York City, in the news release.

Older studies have also shown that people with diabetes had fewer dental visits than those without diabetes. To update this research, the authors assessed the trends of annual dental visits from 2004 to 2014 in adults with diabetes, with prediabetes, and without diabetes, as well as racial and ethnic disparities in dental visits.

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

From 2004 to 2014, the proportion of annual dental visits declined from 66.1% to 61.4% among people with diabetes, 66.0% to 64.9% among people with prediabetes, and 71.9% to 66.5% among people without diabetes.

"This pattern is concerning, given that timely dental care is essential for good oral health, especially in individuals with diabetes," said Luo.

The study could not identify the reasons for a decline in dental visits or determine why people with diabetes and prediabetes might be less likely to visit their dentists than others.

However, the researchers note that a previous study found people with diabetes were more likely to cite cost as a barrier to dental care ( JADA. 2000;131:1333-1341).

Likewise, an analysis of the Medical Expenditure Panel Survey data found the proportion of dentist visits in the past year fell from 40.5% in 2001 to 37.0% in 2010 for adults in the United States. A decrease in private dental insurance coverage and family income level contributed to this trend ( Health Serv Res. 2014;49:460-480).

In the current study, people earning $50,000 or more per year were more likely to have a dental visit than those earning less than $25,000, and that was especially true in the more recent years of the study period, perhaps as a result of income stagnation, the researchers write. Greater age and income and having health insurance all reduced the difference in dental visits between people with diabetes and people without diabetes, they report.

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

The researchers note that their study could underestimate the number of people with diabetes and prediabetes, as it relied on people reporting their status and many people do not know they have diabetes.

They conclude by calling for measures to expand insurance and otherwise reduce financial barriers to dental care, especially for people in disadvantaged groups with diabetes.

The authors have disclosed no relevant financial relationships.

JADA. Published online March 31, 2018. Abstract

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