OBJECTIVES: Diabetes mellitus (DM) is associated with a higher risk of periodontal disease. A robust analysis of dental outcomes among diabetics is lacking. This study compares dental utilization and costs of type I and type II diabetics to matched controls using linked dental and medical claims.

METHODS: Adults (aged ≥18 years) with an eligible diagnosis of DM in 2019 were extracted from the MarketScan^® Dental, Commercial, and Medicare Databases. Diabetics were matched directly to non-diabetic controls (ratio 1:2) on age and sex. All patients were required to have continuous medical, pharmacy, and dental benefits and ≥1 dental service during 2019. The number of patients with specific dental procedures (e.g., fillings, crowns, etc.) and costs (overall and by category of dental service) were reported during 2019 and compared between diabetics and matched controls. Additionally, results were reported separately for type I and type II diabetics.

RESULTS: The analysis included 151,825 diabetic patients (mean age 58 years; 6.7% type I, 92.1% type II, 1.2% unknown type) and 303,650 matched controls. Diabetics were less likely to have a preventative visit (75.1% vs. 81.9%; p<0.001) and more likely to have many dental procedures including fillings (28.4% vs. 26.2%; p<0.001), crowns (18.6% vs. 17.9%; p<0.001), root canals (5.9% vs. 4.7%; p<0.001), dentures (3.7% vs. 2.0%; p<0.001), and tooth extraction (11.7% vs. 7.7%; p<0.001). Diabetics experienced significantly higher average costs in most categories of dental services (restorative: $265 vs. $255; periodontics: $67 vs. $58; endodontics: $54 vs. $46, prosthodontics: $58 vs. $38; oral surgery: $41 vs. $28; all p<0.001). While type II diabetics had significantly higher costs in each of these categories, type I diabetics did not show significant differences for periodontics or oral surgery.

CONCLUSIONS: Diabetics have less preventative dental visits and more non-routine dental services than matched controls.