Among 82 outpatients with type 2 diabetes mellitus at Yogyakarta Regional Hospital (RSUD Yogyakarta), more than half—59.76 percent—were found to have poor oral health-related quality of life. This finding is more than just a statistic. Behind the numbers are people who struggle to chew, feel uncomfortable eating in front of others, and even feel self-conscious about the condition of their teeth and gums.
This was one of the key findings of a study published in the April 2021 issue of the Indonesian Dentistry Magazine, led by Prof. Dr. drg. Dewi Agustina, MDSc, from the Department of Oral Medicine, Faculty of Dentistry, Universitas Gadjah Mada. The study specifically examined oral health-related quality of life (OHRQoL) among patients with type 2 diabetes mellitus (DM) in Yogyakarta, the Indonesian province with the highest prevalence of diabetes, at 2.4 percent.
The Mouth Is a Mirror of the Body
Yogyakarta presents an interesting paradox: a city known as an educational hub with relatively comprehensive healthcare facilities, yet it is also recorded as the province with the highest diabetes prevalence nationally. Approximately 90 percent of people with diabetes have type 2 diabetes, while oral complications often receive less attention than cardiovascular or kidney complications.
Prof. Dewi and her team conducted the study from August to October 2017, involving 82 outpatients aged 40–81 years, comprising 50 men and 32 women. The participants underwent intraoral examinations and were interviewed using two instruments: the Geriatric Oral Health Assessment Index (GOHAI) to assess OHRQoL and the Xerostomia Inventory (XI) to identify complaints of dry mouth.
The results were concerning. Nearly all participants (95.12 percent) had periodontal tissue damage. Poor oral hygiene was found in 96.34 percent of participants. Nearly half (47.56 percent) reported xerostomia, or dry mouth. This was not coincidental: poorly controlled diabetes can affect salivary gland function, while antihypertensive medications taken by some patients may also have xerogenic effects, thereby worsening dry mouth.
When the Remaining Teeth Speak
Among all the variables examined, only one showed a statistically significant association with GOHAI scores: the number of remaining teeth. Patients with 20 or more teeth had a significantly greater proportion of better OHRQoL than those with fewer than 20 remaining teeth (p = 0.032).
“Only ‘present teeth’ made a significant contribution to the proportion of GOHAI status among patients with type 2 DM in this study. Patients with type 2 DM who had ≥20 teeth had a significantly higher proportion of high GOHAI status than those with <20 teeth.” — Prof. Dr. drg. Dewi Agustina, MDSc, in the research report
This finding is not surprising when viewed in the context of the “cascade phenomenon” described by the research team. Xerostomia reduces the natural self-cleansing capacity of the oral cavity. This facilitates plaque accumulation, worsens periodontal disease, and ultimately accelerates tooth loss. Missing teeth make it difficult for patients to chew, make eating uncomfortable, and may gradually lead them to withdraw from social interactions.
All three dimensions of the GOHAI—physical function, pain and discomfort, and psychosocial impact—were affected. In the physical dimension, difficulty biting and chewing was the most common complaint. In the pain and discomfort dimension, the inability to eat comfortably was the dominant concern. Meanwhile, in the psychosocial dimension, dissatisfaction with the condition of the teeth, gums, or dentures was the most frequently reported issue.
Numbers That Demand Attention
These findings are relevant not only clinically but also from a health policy perspective. 41.46 percent of the study participants had fewer than 20 remaining teeth, a threshold often used as a functional marker in geriatric dentistry. With a mean participant age of 63.41 years, this condition reflects years of accumulated and untreated oral health problems.
Prof. Dewi and her team emphasized that quality-of-life assessments are highly subjective and influenced by education, social circumstances, culture, and individual value systems. This is why not every patient with fewer than 20 remaining teeth automatically has a low GOHAI score. Some patients may have already “accepted” their condition, while others may simply have different expectations.
Yet this is precisely where one of the greatest challenges for healthcare professionals lies: helping patients recognize that their oral condition directly affects their overall quality of life, rather than being merely a matter of aesthetics or temporary pain.
Diabetes and oral health do not follow two separate paths. They can exacerbate one another, and this study serves as a reminder that dental visits for patients with diabetes are not merely supplementary care but an essential component of chronic disease management.
Source DOI: DOI: http://doi.org/10.22146/majkedgiind.43693
Authors: Anny Anggraini; drg. Achmad Zam Zam Aghasy, M.Kes.
Photo: Freepik