Dental caries and diabetes in the elderly population in San Juan, Puerto Rico

Abstract

People 65 years or older constitute 11.2% of the population in Puerto Rico, where the prevalence of diabetes is 31.9%. It has been hypothesized that diabetes could be a risk factor for caries due to increased glucose in saliva, decreased salivary flow and frequent intervals of food ingestion. This cross-sectional study compared the caries distribution among non-institutionalized adults aged 70 years and older, with and without diabetes. Participants were selected from a large representative sample of the Puerto Rican Elderly Health Conditions Study. Our study group included 184 individuals who underwent a comprehensive oral exam where decayed, missing, and filled surfaces, root caries and root restorations were assessed. Linear regression was used to analyze the caries outcome of DMFS, while DS and FS were assessed by a Poisson regression model. The outcome of MS was dichotomized by the median (≤50 and >50 surfaces) and analyzed by a logistic regression model. When comparing mean DMFS index, participants with diabetes had significantly less filled surfaces (10.5 vs. 17.0; p<0.05) than those without diabetes. Due to interaction effects in the Poisson multivariate models to explain the decayed and filled surfaces, the analysis was stratified in subgroups. Among male participants, diabetes was significantly associated with decayed surfaces among smokers (RD = 2.23, 95% CI: 1.09, 4.56) and among non- smokers (RD = 4.43, 95% CI: 2.08, 9.40); however, these differences were not significant among women. Participants with diabetes had less filled surfaces in both age groups (<78 years: RD = 0.84; 95% CI: 0.53, 1.33; ≥78 years: RD = 0.55; 95% CI: 0.29, 1.04) when compared to those without diabetes. A non- significantly higher odds of having more missing surfaces was found among participants with diabetes (OR = 1.51; 95% CI: 0.76, 2.99). No differences were found in root caries and root restorations across diabetes status (p>0.05). Further prospective studies are warranted to confirm the higher number of decayed and missing surfaces among elderly people with diabetes.