Diabetes and Tooth Loss Among Working Age African American Adults: A National Perspective

Background and Purpose:Oral health is critical for increasing quality of life.  Cumulative exposure to various risk factors that contribute to losing some or many teeth are particularly pronounced among those unable to maintain an optimum level of oral health.  Despite improvements in dental care, insurance coverage, and strategies to retain teeth, adults experiencing chronic illness, such as Type II diabetes, can still lose natural teeth across the lifespan. Tooth loss remains a significant grand challenge because of the loss in the ability to chew food, effects on self-esteem, and stay physically healthy. Questions remain about what represents relevant unmet oral health risk factors among populations at highest risk for tooth loss. Therefore, the present study aims were to examine the context of African American adults experiencing Type II diabetes to learn whether tooth loss represents a significant problem. The study also examined whether gender and dental insurance mitigate tooth loss in a national sample of African American and White adults.

Methodology: Online survey data from the Service Utilization among African Americans with Co-morbid Depression and Type II Diabetes study (N = 275; African Americans: n = 175 and Whites: n = 100) were analyzed using bivariate and logistic regression analyses in SAS software version 9.3 (SAS Institute, 2012). Two dichotomous outcome measures were constructed based on two questions about missing teeth. The first question asked: “Do you have any missing teeth?” The second asked: “How many missing teeth do you have?” Responses ranged between no missing teeth and 32 missing teeth.  The missing teeth variable was recoded as less than seven teeth (0) and more than 8 teeth (1). Covariates included: gender, age, race, education, annual income, a self-esteem score, and self-reported physical health.  The level of significance was set at 5%.  Prevalence ratios (PR) and 95% confidence intervals (CI) were calculated to evaluate the associations.

Results: Diabetes was most prevalent among men (73.5%). No statistically significant racial differences were found.  In the total sample, and among the women, those without diabetes have approximately 50% fewer missing teeth than those with diabetes (PR = 0.50; 95% CI: 0.30, 0.83).  The results with respect to diabetes status (n=177) show that having diabetes was associated with an increase in the odds of missing teeth among males (PR = 2.71; 95% CI: 1.12, 6.55) when compared to females.  The association persisted even after adjusting for confounders.

Implications: Tooth loss is a traumatic experience and a serious life event that may require significant social and psychological re-adjustment. Attention to self-esteem represented an unmet oral health risk factor for men with missing teeth, a surrogate for presence of periodontal disease.  Preventing more severe complications from Type II diabetes via poor oral health remains a priority given the evidence that supports access to and use of routine preventive dental care. The study results imply that oral health intervention efforts need to target men diagnosed with Type II diabetes.  Public health social workers can reinvest in advocacy efforts to secure targeted funding policies and treatment services.