At DONTE GROUP, we have promoted the report “Oral health and diabetes: a bidirectional relationship with social, healthcare and economic impact”, which reveals that more than 50% of people living with diabetes in Spain have lost at least one tooth and more than 66% have or have been diagnosed with periodontitis, an oral disease that mainly affects the gums. This work is endorsed by the Spanish Diabetes Society (SED) and the Spanish Diabetes Federation (FEDE).
In this document, we analyze the relationship between oral health and diabetes based on scientific evidence, two population-based studies, and an economic analysis of healthcare expenditure. As we highlight, there is a bidirectional relationship between both conditions: diabetes increases the risk of developing oral diseases such as periodontitis, while these, in turn, can make metabolic control more difficult and worsen the progression of diabetes.
With this report, “we aim to provide data on a clinical reality that is widely observed but still underestimated: the relationship between oral health and general health. Today, we know that poor oral health is not limited to the oral cavity but can be associated with the development of various systemic diseases. In the case of diabetes, this link becomes even more relevant, as oral care can directly influence metabolic control and disease progression,” explains Dr. Filipa Nunes, Quality Director at DONTE GROUP.
In terms of perception and disease burden, we observe significant differences: while 70% of the general population considers their oral health to be good or very good, this percentage drops to 56% among people with diabetes. In the latter group, we also detect a high burden of periodontal disease: more than two-thirds have been diagnosed with or are suspected of having periodontitis, more than 60% have experienced gum bleeding in the past year, and more than half have lost at least one tooth.
Regarding these figures, Dr. Xiana Pousa, periodontist at DONTE GROUP and member of the report’s scientific committee, emphasizes that recurrent gingival bleeding and periodontal disease should not be considered minor issues in patients with diabetes. “In these cases, periodontal monitoring can never be a secondary aspect, but rather an essential part of the comprehensive management of the disease to preserve oral health, prevent tooth loss, and contribute to better metabolic control,” she notes.
Awareness of the relationship between diabetes and oral health
Beyond the clinical impact, we also analyze the level of awareness of the relationship between these two conditions, where we identify a clear gap. Among the general population, 64% recognize that diabetes affects oral health, but only 41% know that periodontal disease can negatively influence its control. Among people with diabetes, nearly 80% identify the higher risk of oral problems, yet almost half report not having received sufficient information about the impact of periodontitis on glycemic control or having adequate knowledge to care for their oral health.
“The data show that the challenge is not only clinical, but also one of care coordination. More than one-third of people with diabetes have implants, and more than 70% are unaware of how glycemic control influences the risk of implant infection or failure. This highlights significant room for improvement, where the key lies in coordination: shared protocols, clear information, and consistent messaging between medicine and dentistry,” says Dr. Luis Aguirre, implantologist at DONTE GROUP and member of the study’s scientific committee.
In the same vein, Dr. Virginia Bellido, coordinator of the Periodontal Disease Group at the Spanish Diabetes Society (SED), highlights that information is central to prevention. “People with diabetes are up to three times more likely to develop periodontitis, which can hinder disease control and increase the risk of complications. Lack of awareness of this relationship is not neutral: it has real clinical impact. Better understanding this connection can translate into improved diabetes control, fewer complications, and an improved quality of life.”
For her part, María José Salmerón, Secretary of the Board of the Spanish Diabetes Federation (FEDE), emphasizes the value of this type of research in improving health education. “The fact that more than 80% of respondents — both people with diabetes and the general population — stated that they would like to receive more information about this relationship highlights that there is no lack of interest in health, but rather a clear need for greater care coordination, better communication among professionals, and a truly multidisciplinary approach.”
Economic impact of diabetes and periodontal disease
Our report also incorporates an economic analysis conducted by Alberto Montero, Professor of Economics at the University of Málaga, which broadens the perspective on diabetes not only from a healthcare standpoint but also from an economic and social perspective, as well as its close relationship with periodontal diseases. This analysis focuses on how addressing both conditions jointly could generate both clinical and economic benefits.
Currently, diabetes has become one of the major global challenges in health and economics. In 2021, associated healthcare expenditure reached 966 billion dollars, representing 11.5% of global health spending, after a 316% increase in just 15 years. Some forecasts suggest that this figure could exceed 1.05 trillion dollars by 2045.
However, as highlighted in the analysis, the real impact of diabetes goes far beyond direct healthcare expenditure. When productivity losses and unpaid care time are included, total costs multiply, reaching significantly higher figures in the coming decades. “Diabetes not only involves high healthcare resource consumption, but also steadily reduces economic productivity and shifts a significant part of the burden onto families through informal care,” explains Professor Montero.
This situation is compounded by periodontal diseases, which also represent a very high economic burden, with costs amounting to hundreds of billions of dollars annually in healthcare spending and productivity losses. Therefore, the analysis suggests that a joint approach to both diseases could generate significant benefits.
In conclusion, we show that periodontal treatment in people with diabetes could improve blood glucose control, reducing complications and, consequently, the use of resources and healthcare costs. For this reason, integrating oral health into diabetes care not only improves patients’ health, but also helps make the healthcare system more efficient and alleviates the economic burden on society.
