Association between diabetes and oral health in non-smokers

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% ...