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Year : 2020  |  Volume : 31  |  Issue : 4  |  Page : 546-549
Dental problems among diabetics: A case control study from an Indian state

1 Department of Community and Family Medicine, AIIMS, Bathinda, Punjab, India
2 Department of Epidemiology, IIHMR, Jaipur, Rajasthan, India
3 Department of Community and Family Medicine, AIIMS, Rishikesh, Uttarakhand, India

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Date of Submission20-Apr-2019
Date of Decision03-Nov-2019
Date of Acceptance09-Jan-2020
Date of Web Publication16-Oct-2020


Background: Diabetes is a metabolic disorder, which affects almost all parts of body. Dental problems remain neglected among diabetics which could have negative impact on health and if untreated could lead to financial loss in treatment of diseases. Aims: To compare the risk, quality of life (QOL), and direct cost of dental problems between cases and controls. Methods: A hospital-based case control study in a tertiary care hospital of Uttarakhand, India. Results: The risk of comorbidities of dental problem was 1.8 times higher as compared with controls. Twenty-six percent of cases were found to be suffering from one or the other type of dental problems as compared with 16.4% among controls. The direct cost expenditure among cases was significantly higher as compared with controls. Limitations: The QOL scores and the cost of treatment obtained could be an overestimate as some of the participants with dental problems also had comorbidities related to other systems of the body. Conclusion: The risk of dental problems and the direct cost was reported to be significantly higher among cases as compared with controls.

Keywords: Dental problems, diabetes mellitus, direct cost, quality of life

How to cite this article:
Nath B, Gupta SD, Kumari R. Dental problems among diabetics: A case control study from an Indian state. Indian J Dent Res 2020;31:546-9

How to cite this URL:
Nath B, Gupta SD, Kumari R. Dental problems among diabetics: A case control study from an Indian state. Indian J Dent Res [serial online] 2020 [cited 2022 Jun 29];31:546-9. Available from:

   Introduction Top

Diabetes is a chronic metabolic disorder characterized by hyperglycemia and it affects all age groups of people. The number of diabetic cases is constantly on the rise. As per the International Diabetes Federation (IDF), if nothing is done, the number of people with diabetes may rise to 629 million by 2045 globally. Diabetes stood at sixth and seventh rank among top 10 leading causes of death in world and in SEAR, respectively, in 2015. As per IDF report, India had 72 million cases of diabetes with a prevalence of 8.8% in 20–79 years of age group, and the figure is expected to rise to 134 million by 2025.[1]

Diabetes in due course of time impacts almost all organs of our body including the oral cavity. The disease affects soft as well as hard tissue of oral cavity giving rise to various dental problems. Prevalence of dental problems among diabetics reported to range from 30% to 92% in different studies.[2],[3],[4],[5],[6] Oral manifestations among patients of diabetes mellitus have been recognized and reported as an important comorbidity of diabetes mellitus. Dental manifestations may cause frequent suffering to the patients due to their frequent occurrence, and therefore are expected to deteriorate quality of life (QOL) of patients, while simultaneously increasing the cost of treatment. It is a common observation that dental problems remains neglected among people, which could give rise to serious oral health problem.

Case control studies related to these aspects of dental problems in diabetics and non-diabetics are scarce in Indian context and none have been published from the state of Uttarakhand, a hilly state with its unique health profile. Therefore, this study attempts to compare dental problems, QOL, and direct cost of treatment among diabetics as cases and matched group of controls.


  • To compare the risk of comorbidities of dental problems between cases and controls.
  • To compare the QOL scores and direct cost between cases and controls.

   Methodology Top

Study design and study population

The present study was a hospital-based case control study carried out in OPD of medicine department in a tertiary care hospital in Srinagar tehsil of Pauri district, Uttarakhand, India.

Selection of cases and controls

Cases were selected from patients ≥30 years of age who have been diagnosed with type 2 diabetes mellitus (T2DM) for at least ≥6 months or more. Equal number of age- and gender-matched controls were selected from among the attendants of patients attending the hospital, without a self-reported history of diabetes and confirmed by a random blood sugar test by glucometer. The period of study was from April 2015 to August 2018. Both cases and controls were selected consecutively.

Sample size

Sample size was calculated to be 390 with 195 cases and controls each.

Sampling procedure

Diabetic cases were recruited consecutively from medicine OPD. Controls were pair-matched individuals with reference to age (within 2 years range) and gender (male or female) and recruited from the same hospital.

Tools of data collection and instruments used

A quantitative structured interview schedule along with detailed clinical examination of oral cavity was done to record basic information on dental problems, QOL, and direct cost. The dental problems were assessed based on history, clinical examination, and medical record of the patient. Laboratory reports of the tests already performed were evaluated if available. Only the principal investigator did data collection, after obtaining training, to reduce interobserver variation in examination findings. QOL was measured using World Health Organization-Quality of life BREF (WHO-QOL BREF) questionnaire (Hindi version), which is a 26-item validated instrument for measuring QOL and covers four domains of health which are physical, psychological, social relationships, and environmental domain.[7]

Data analysis

Data were analyzed using Microsoft Excel and EpiInfo. For comparison of proportions and means, Chi-square and independent 't' test were used, respectively. A 'P value' of <0.05 was considered significant. Estimation of risks was reported in terms of odds ratio (OR) with 95% confidence intervals (CIs).

Ethical considerations

Ethical permission from respective institute was obtained to conduct the study (IEC/VCSGGMS and RI/003). Permission to use WHO-QOL-BREF questionnaire was also obtained from WHO office. Informed written consent from all the participants was obtained prior to the commencement of interview/clinical examination.

   Results Top

In total, 51 (26.2%) cases as compared with 32 (16.4%) controls were found to be suffering from one or the other type of dental problem. The overall risk of dental comorbidity was 1.8 times higher among cases as compared with controls (P = 0.01). Xerostomia and dental caries were reported to be 5.6 and 4.5 times higher among diabetics as compared to controls [Table 1].
Table 1: Risk of dental problems among cases and controls

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Domain wise QOL scores along with overall QOL scores were lower among cases as compared to controls; however, none of them were found to be significantly different [Table 2].
Table 2: Comparison of domain wise quality of life scores between cases and controls with dental problem

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It was observed that the overall six monthly direct cost among cases with dental problems was Rs. 4662.3 as compared with Rs. 965.5 among controls, and the difference was found to be significant. More than two-third (67.2%) of the overall expenditure among cases was on medications in comparison to 48.6% among controls. The expenditure on medication and other expenses was also found to be significantly higher among cases as compared to controls [Table 3].
Table 3: Comparison of 6 monthly direct cost of treatment between cases and controls with dental problems

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   Discussion Top

This study intended to compare dental problems, QOL, and direct cost of treatment among diabetic patients with their controls. The overall proportion of dental problems was 26.2% among cases, which was slightly less in comparison to most of the other studies where prevalence was reported to be higher.[4],[5],[8],[9],[10]

The proportion of periodontal disease among diabetics in various studies ranged from 32% to 92.6% with the lowest proportion being reported from this study.[3],[4],[5],[8],[9],[10],[11],[12] The differences in proportion of periodontal disease could be due to different study setting and the status of control of diabetes achieved, which could not be studied in this study. Nevertheless, the differences of proportion between cases and controls were significant indicating a higher risk among cases.

Our results corroborate with another case control study by Bharateesh et al. where diabetics were reported to have significantly higher percentage of periodontal disease; however, the results were contrary with respect to the proportion of dental caries among cases, which was reported significantly higher in our study which could have been due to different study settings.[9]

The overall QOL scores as well as the domain wise scores in this study were reported to be lower among cases implying that dental problems impact the QOL of individuals; however, the differences were not found to be significant. While similar results were showed by Sandberg et al. in a study from Sweden using SF36 questionnaire, Srivastava reported significant lower scores of QOL among diabetics as compared with non-diabetics which could be attributed to different study design and questionnaire used.[13],[14],[15]

This study provides a comparison of direct cost of all the types of dental problems as a whole in between cases and controls. This study showed a significantly higher direct cost for management of dental problems among cases as compared with controls. The proportional cost of medication was reported to be higher as compared with other components in this study. Some of the studies have shown that regular dental health check-up could be helpful in saving medicine as well as total direct cost among diabetic patients with dental problems; however, authors were unable to compare the results of direct cost among diabetics with dental problems to other studies due to lack of similar studies.[16],[17] Estimation of indirect cost would have provided more details about the impact of dental problems on the cost of treatment, but we could not estimate it due to lack of time and the possibility of recall bias.

   Conclusion and Recommendation Top

Prevalence of dental problem was high among cases as compared with the controls and was reported to impact the cost and QOL. It would be imperative to implying the need for screen these dental problems among diabetics at regular interval, which is quite easy and can be done on an OPD basis. This would definitely reduce the cost of treatment and also improve the QOL of patients.


The QOL scores and the cost of treatment obtained could be an overestimate as some of the participants with dental problems also had comorbidities related to other systems of the body. Cases and controls were not selected randomly from the healthcare facility because of the unavailability of complete list of patients, and therefore, study may have reduced external validity. The findings are nevertheless quite revealing and important in terms of information provided with respect to the comparisons made with a control group, which is unique in this study.


We thank faculties from department of medicine and dentistry, the patients and controls who helped and supported us in completion of the study.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Ogurtsova K, da Rocha Fernandes JD, Huang Y, Linnenkamp U, Guariguata L, Cho NH, et al. IDF diabetes atlas: Global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Res Clin Pract 2017;128:40-50.  Back to cited text no. 1
Available from: [Last accessed on 2017 Apr 20].  Back to cited text no. 2
Mealey BL, Ocampo GL. Diabetes mellitus and periodontal disease. Periodontology 2000 2007;44:127-53.  Back to cited text no. 3
Tsai C, Hayes C, Taylor GW. Glycemic control of type 2 diabetes and severe periodontal disease in the US adult population. Community Dent Oral Epidemiol 2002;30:182-92.  Back to cited text no. 4
Chandna S, Bathla M, Madaan V, Kalra S. Diabetes mellitus–a risk factor for periodontal disease. Internet J Fam Prac 2010;9:181-4.  Back to cited text no. 5
Fouad AF, Burleson J. The effect of diabetes mellitus on endodontic treatment outcome: Data from an electronic patient record. J Am Dent Assoc 2003;134:43-51.  Back to cited text no. 6
Saxena S, Chandiramani K, Bhargava R. WHOQOL-Hindi: A questionnaire for assessing quality of life in health care settings in India. Natl Med J India 1998;11:160-5.  Back to cited text no. 7
Gandara BK, Morton TH. Non-periodontal oral manifestations of diabetes: A framework for medical care providers. Diabetes Spectr 2011;24:199-205.  Back to cited text no. 8
Bharateesh JV, Ahmed M, Kokila G. Diabetes and oral health: A case-control study. Int J Prev Med 2012;3:806-9.  Back to cited text no. 9
Bajaj S, Gupta A, Prasad S, Singh V. Oral manifestations in type-2 diabetes and related complications. Indian J Endocrinol Metab 2012;16:777-9.  Back to cited text no. 10
Campus G, Salem A, Uzzau S, Baldoni E, Tonolo G. Diabetes and periodontal disease: A case-control study. J Periodontol 2005;76:418-25.  Back to cited text no. 11
Löe H. Periodontal disease: The sixth complication of diabetes mellitus. Diabetes Care 1993;16:329-34.  Back to cited text no. 12
Sandberg GE, Wikblad KF. Oral health and health-related quality of life in type 2 diabetic patients and non-diabetic controls. Acta Odontol Scand 2003;61:141-8.  Back to cited text no. 13
Shrivastava S, Naidu GS, Makkad RS, Nagi R, Jain S. Oral health related quality of life of controlled and uncontrolled type II diabetes mellitus patients-a questionnaire based comparative study. J Dent Orofac Res 2018;14:20-4.  Back to cited text no. 14
Sadeghi R, Taleghani F, Farhadi S. Oral health related quality of life in diabetic patients. J Dent Res Dent Clin Dent Prospects 2014;8:230-4.  Back to cited text no. 15
Takeuchi N, Yamamoto T, Hirai A, Morita M, Kodera R. Relationship between community-based dental health programs and health care costs for the metabolic syndrome. [Nihon Koshu Eisei Zasshi] Jpn J Public Health 2010;57:959-67.  Back to cited text no. 16

Correspondence Address:
Dr. Ranjeeta Kumari
Department of Community and Family Medicine, AIIMS, Rishikesh, Uttarakhand
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijdr.IJDR_346_19

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  [Table 1], [Table 2], [Table 3]


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