BACKGROUND: There is a dearth of studies on the association between diabetes mellitus (DM) and the risk of developing oral health complications in nonsmokers. Recent studies have presented a strong link between smoking and increased risk of periodontal disease in patients with T2DM. This study attempts to look at the risk of developing caries and poor oral health in nonsmokers who also have DM. Male and female subjects from the cross-sectional National Health and Nutrition Examination Survey (NHANES) 2017-2018 study who were 21+ years at the time of entering the study were included. The exposures are DM and smoking, and the outcome is oral health.
HYPOTHESIS: DM-IFG will increase the risk of developing dental caries and tooth loss, thus lowering the quality of oral health in smokers compared to nonsmokers.
METHODS: DM was defined as either the self-report of a doctor’s diagnosis of DM or a fasting glucose level of 126mg/dL or higher, or both. IFG was defined as a level of fasting glucose between 100mg/dL and 126mg/dL, as well as being informed by a medical doctor about having borderline DM. Subjects with IFG or DM were further combined into a DM-IFG group. Each subject’s status was classified on the basis of both DM-IFG status and smoking status, yielding four exposure groups: (1) no DM-IFG/non-smokers, (2) no DM-IFG/smokers, (3) DM-IFG/non-smokers, and (4) DM-IFG/smokers. Oral health outcomes were defined as a percent of missing teeth (due to dental health issues), percent of teeth with dental caries, and percent of teeth either missing or with caries. The primary statistical analysis for association between DM-IFG and smoking exposures and oral health outcomes was multivariable logistic regression. Adjusted models controlled for covariates such age, gender, Body Mass Index (BMI), education level, minutes of sedentary activity, race, HR, and percent of calories from fat intake.
RESULTS: Overall, the prevalence of having 25% or more of teeth with dental caries was similar in those with and without DM-IFG (50.9% vs. 49.9%, respectively) and, surprisingly, was with higher among non-smokers than smokers (51.9% vs. 42.1%, respectively. Those with DM-IFG had a prevalence of missing teeth due to dental causes (≥ 15% missing) of 43.2% compared with a prevalence of 28.6% among those without DM-IFG. Since the majority of missing teeth were likely to be due to caries as well, the final outcome for these analyses consists of participants with either missing teeth or carious remaining teeth. Here, we found that 55.8% of those with DM-IFG had 40% of more of teeth missing vs. 44.8% of those without DM-IFG (p<0.0001). Similarly, 52.1% of smokers vs. 48.8% of non-smokers had more missing or carious teeth (p=0.1587). In the multivariable models, adjusting for age, race, HR, and percent of calories from fat, these analyses showed that DM-IFG alone (among non-smokers) was associated with a 1.42-fold increased risk of missing teeth while smoking along was associated with a 2.86-fold increased risk. The combined effects of the two factors were even stronger. Those who smoked cigarettes and who had DM-IFG (compared with those who did not smoke and had no DM-IFG) had a 3.88-fold increased risk of have 15% or more of their teeth missing due to dental health issues. Lastly, I examined these same effects on the risk of having either missing teeth or dental caries. In these analyses, smokers without DM-IFG had a 67% higher risk (95% CI: 1.27-2.19) of have 40% or more of their teeth missing or with caries while non-smokers with DM-IFG had no excess risk. Finally, those with DM-IFG who also smoked cigarettes had a 52% increased risk (95% CI: 1.08-2.14) of have 40% or more of their teeth missing or with caries compared with non-smokers who did not have DM-IFG.
CONCLUSION: These results suggest that smoking was a more important risk factor for having missing teeth or dental caries than was DM or IFG.
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/43827 |
| Date | 07 February 2022 |
| Creators | Cojocaru, Eugenia |
| Contributors | Moore, Lynn L. |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
| Rights | Attribution 4.0 International, http://creativecommons.org/licenses/by/4.0/ |
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