Addressing California’s diabetes-related health burden

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OPINION – Diabetes isn’t just a growing national concern – it’s a crisis in California. More than 10% of California’s adults have diagnosed diabetes, significantly higher than the national average 8.5%. Each year, nearly a quarter-million Californians are diagnosed with diabetes, which was the seventh leading cause of death in the U.S. in 2023. Too often, discussions about this alarming trend focus solely on medical treatments, lifestyle changes, or the rising use of GLP-1 medications.

But there’s a critical part of the diabetes story we’re overlooking: oral health.

That’s why I want to shift the conversation on this expensive health burden – we need to tackle this with a new lens. As a pediatric dentist and now Chief Dental Officer for Sun Life, the largest U.S. dental benefits company by membership, I’ve seen firsthand how poor oral health both amplifies the risks of diabetes and worsens health outcomes. And yet, the connection between these two issues is not widely understood.

While periodontal disease doesn’t cause diabetes or vice versa, the two can influence each other. Diabetes weakens the body’s ability to fight infection, making people more susceptible to gum disease, which itself can fuel inflammation and make blood sugar harder to control. High blood sugar also increases the amount of sugar and acid in the mouth, accelerating tooth decay and leading to dry mouth, which in turn traps bacteria and food debris. The result? More serious infections, impaired chewing and nutrition, and a dramatic increase in tooth loss.

And the data is striking: having diabetes increases the risk of gum disease by 86%, while adults over age 50 with diabetes are 46% more likely to have fewer than 20 teeth and 56% more likely to suffer from severe tooth loss. But the impact goes far beyond dental function. Missing teeth can affect mental health, job prospects, and overall well-being. Worse still, this decline can be entirely preventable with routine dental care.

The financial implications are equally staggering. Diagnosed diabetes costs California an estimated $47.5 billion annually. Americans with diabetes have medical expenses more than 2.5 times higher than those without. But when patients receive preventive oral care – especially treatment for gum disease – overall health care costs drop. One study showed that periodontal treatment reduced overall health care spending by 12% to 14%, depending on insurance type. Another indicated providing nonsurgical oral health care for gum disease could reduce the chance of tooth loss by 34% and save individuals roughly $6,000 annually on health care costs. And even a 1% drop in high blood sugar levels can reduce total diabetes-related health care costs by 13%, according to another study.

All of this underscores the need to broaden how we diagnose, treat and educate. If California hopes to reverse its troubling diabetes trend, we must embrace a more comprehensive approach – one that breaks down the silos between dental and medical care.

Dentists are uniquely positioned to detect signs of diabetes – even before a physician does. A 2011 study at the Columbia University College of Dental Medicine dental clinic showed dentists correctly identified 73% of patients who had diabetes or prediabetes. That’s an immense opportunity to intervene early, especially when over a third of people with diabetes are unaware they have it.

Some organizations are already taking steps to bridge this gap. Sun Life, which provides dental benefits to more than 35 million Americans, has a philanthropic focus on addressing diabetes. It’s DentaQuest business also focuses member services and programs on increasing access to medical, dental and community-based services including a chronic conditions management program that helps position oral health as an integral part of a patient’s care.

The rise in diabetes among both children and adults over the past two decades is a wake-up call. Tackling this epidemic requires not just medication or lifestyle changes, but a shift in how we view the whole person – including their mouth.

Let’s start in the dental chair. And consider this the next time you visit the dentist: it may do more than save your smile. It may save your life.

Todd A. Gray, DDS is chief dental officer for Sun Life U.S., including DentaQuest, the nation’s largest dental benefits administrator by membership.