Edentulism in diabetics compared to non-diabetics

Diabetes mellitus is a common endocrine disease thought to affect more than 500 million people worldwide. Links between diabetes and tooth loss from periodontitis have been reported (Dental Elf – 10^th Sep 2021) as well as links with caries (Dental Elf – 11^th Sep 2023).

The main aim of this review was to assess the evidence related to the prevalence of edentulism among diabetic patients compared to non-diabetic people.

Methods

Searches were conducted in PubMed and Cochrane Central Register of Controlled Trials (CENTRAL) with no language restrictions. Two reviewers independently selected studies with observational studies (cross-sectional, cohort or case-control) with the primary aim of investigating the prevalence of edentulism in diabetic (type 1, type II or undefined) patients being considered. Two reviewers extracted data with risk of bias being assessed using the Newcastle-Ottawa Scale (NOS). Weighted mean prevalence was calculated, the odds ratio (OR) and 95% confidence intervals (CIs) were calculated for edentulousness among diabetic patients compared to those without diabetes and meta-analysis conducted.

Results

7 cross-sectional studies involving a total of 2216 edentulous cases were included.
Study sample sizes ranged from 293 to 15,943.
4 studies were from Europe, 2 from North America and one from South America.
5 studies were considered to have a low risk of bias and 2 a moderate risk.
Edentulism was assessed clinically in 6 studies and from dental records in the other study.
3 studies focused on type II diabetes, 4 studies did not differentiate or specify type.
The prevalence of edentulism among the whole study population was 8.3% with a range across the studies of 3.3% to 45%.
The overall weighted mean prevalence of edentulism was 14.0% for diabetic patients and 7.1% among non-diabetic people.
Prevalence of edentulism for patients self-reporting diabetes was 8% compared with 7.7% for clinically assessed diabetes.
Edentulism prevalence was 11.3% for Europe, 6.8% for North America and 8.4% for South America.
The odds for being edentulous were higher for diabetes that non-diabetics (see table) below).

	No. of Studies	Odds ratio (95%CI)
Overall	7	2.39 (1.73 to 3.28)
Self-reported diabetes	3	2.61 (2.15 to 3.17)
Professionally diagnosed diabetes	3	2.39 (2.09 to 2.73)

Conclusions

The authors concluded: –

There appears to be moderate certainty that the risk of being edentulous for diabetic patients compared to non-diabetic people is significant, but the odds ratio is estimated to be small.

Comments

No protocol was registered for the review but the authors followed the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Searches were conducted in two major databases with no language restrictions. Seven studies were included with five being considered to be at low risk of bias. All the included studies were cross-sectional in nature which as the authors indicate prohibits the inference of any causal relationship. The overall estimate for the prevalence of edentulism derived from the 7 included studies was (8.3% (range 3.3% to 45%) which much lower than the WHO estimate for the global prevenance of edentulism of 26%. While the findings of the review suggest higher levels of edentulousness in diabetics the general prevalence should be taken into account as the oral care system may influence the decisions of patients and dentists. Future prospective studies where are range of potential confounders such as age, gender, smoking, obesity, socio- economic status etc are taken into account are needed to provide more clarity on the relationship between diabetes, tooth loss and edentulism.

Links

Primary Paper

Žiūkaitė L, Weijdijk LPM, Tang J, Slot DE, van der Weijden GAF. Edentulism among diabetic patients compared to non-diabetic controls: A systematic review and meta-analysis. Int J Dent Hyg. 2023 Oct 27. doi: 10.1111/idh.12762. Epub ahead of print. PMID: 37890036.

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