Tooth loss in diabetic patients


Periodontal disease is an important cause of tooth loss and a number of studies have indicated an association between diabetes and periodontal disease. Tooth loss has an impact on oral health related quality of life and a number of predictors of tooth loss in periodontal patients were assessed in a 2019 review by Helai et al (Dental Elf – 1st Jul 2019).

The aim of this review was to assess the risk of losing teeth among patients with diabetes mellitus (DM) compared to those without DM,


Searches were conducted in Cochrane Central, Medline/PubMed, national ( ) and international trial registries ( , . OpenGrey , British Library Inside , the European Federation of Periodontology , the International Association for Dental Research , Web of Science, BIOSIS Previews and OVID with no limitation was on language or date of publication. This was supplemented by hand searches of the previous 12 months of the journals; Journal of Operative Dentistry, Journal of Clinical Dentistry, Journal of Dental Research, Journal of Caries Research, International Journal of Dental Hygiene, The Journal of Dental Hygiene, Journal of Clinical Periodontology, The Journal of Periodontology, Periodontology 2000, Oral Health and Preventive Dentistry. Papers that primarily evaluate the number of teeth in DM patients compared to non-DM individuals published in English were considered. Two reviewers independently searched, screened and selected studies and assessed methodological quality using the risk of bias in observational studies of exposures (ROBINS-E) instrument.  Descriptive analyses of the included studies was presented and meta-analyses where possible.


  • 10 studies reported in 11 papers involving a total of 29,278 patients were included.
  • Of the 29278 patients, 5,699 were diabetics and 23,579 ‘controls’.
  • The prevalence of diabetes in the included cross-sectional studies was 16.8%.
  • 8 studies were cross-sectional, 1 a prospective cohort and 1 a case-controlled study.
  • 2 studies were considered to be at low risk of bias, 5 at moderate risk and 3 at serious risk of bias.
  • Meta-analyses [ 10 studies] showed a higher risk of tooth loss in diabetic than non-diabetics; Risk ratio = 1.63 (95%CI; 1.33 to 2.00).
  • A number of subgroup analyses were also conducted (see table).
Subgroup analyses Risk ratio (95%CI)
Low risk studies 1.22 (1.20 to 1.24)
Moderate risk studies 1.85 (1.27 to 2.71)
Serious risk of bias studies 1.48 (1.27 to 2.71)
European studies 1.39 (1.35 to 1.42)
Asia studies 2.30 (2.25 to 2.36)
North America Studies 1.22 (1.20 to 1.24)
South American Studies 2.27 (2.00 to 2.58)
Type 2 diabetes only 1.56 (1.02 to 2.39)
Poorly controlled v well controlled diabetics 1.25 (1.22 to 1.29)


The authors concluded: –

There is moderate certainty for a small but significantly higher risk of tooth loss in DM patients as compared to those without DM.


The authors followed the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines and have undertaken an extensive literature search. However restricting inclusion to English language papers means that relevant information could have been excluded. The authors noted that 3 potential non-English publications were identified with abstract suggesting similar findings to those of the review.  Only one of the included studies was prospective and the authors indicate that none of the studies provided information on the reasons for tooth extraction so extraction due to caries may have been included.  In addition, there is little indication of the studies adjusting for potential confounders such as age, smoking, socio-economic status, dental behaviours including toothbrushing.  So while the findings of the review indicates a higher risk of tooth loss in patients with diabetes the findings should be viewed cautiously and additional well conducted and reported studies should be conducted to clarify the impact of diabetes on tooth loss.


Primary Paper

Weijdijk LPM, Ziukaite L, Van der Weijden GAF, Bakker EWP, Slot DE. The risk of tooth loss in patients with diabetes: A systematic review and meta-analysis. Int J Dent Hyg. 2021 May 11. doi: 10.1111/idh.12512. Epub ahead of print. PMID: 33973353.

Other references

Dental Elf – 1st Jul 2019

Tooth loss predictors in periodontal patients

Dental Elf – 2nd  Oct 2015

Smoking and tooth loss associated finds study

Dental Elf – 10th Aug 2015

Low income and tooth loss: a positive association

Dental Elf  – 14th Jul 2021

Tooth loss during long-term periodontal maintenance



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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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