(PR043) Impact of Second-line Oral Anti-diabetic Medications on the Risk of Pulp Diseases in Patients With Type 2 Diabetes

Objective: Patients with poorly controlled type 2 diabetes mellitus (T2DM) are at risk for pulp diseases. However, whether treatments for T2DM may alleviate pulp diseases is unknown. This study aims to investigate the effects of sodium-glucose cotransporter-2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1RA) and dipeptidyl peptidase-4 inhibitors DPP4i) on the risk of pulp diseases in patients with T2DM.

Methods: This population-based cohort study included patients with T2DM who were newly treated with SGLT2i, GLP-1RA, or DPP4i from 2015 to 2023 in the U.S. Propensity score matching was applied to control for baseline differences. Risk ratios (RRs) and 95% confidence intervals (CIs) for the risk of new-onset pulp diseases were calculated.

Results: A total of 704,668 propensity score-matched pairs of patients on SGLT2i and DPP4i, and 649,119 matched pairs of patients on GLP-1RA and DPP4i were included. During follow-up, SGLT2i treatment was associated with significantly lower risks of pulp and periapical diseases (RR=0.65, 95%CI=0.63-0.68, p< 0.001), including pulpitis (RR=0.61, 95%CI=0.48-0.79, p<0.001), acute apical periodontitis (RR=0.33, 95%CI=0.26-0.42, p<0.001), and chronic apical periodontitis (RR=0.53, 95%CI=0.34-0.82, p=0.005). Treatment with GLP-1RA also showed protective effects against pulp and periapical diseases (RR=0.71, 95%CI=0.69-0.74, p<0.001), with a reduced incidence of pulpitis (RR=0.59, 95%CI=0.46-0.76, p<0.001) and acute apical periodontitis (RR=0.50, 95%CI=0.41-0.62, p<0.001).

Conclusion: SGLT2i and GLP-1RA treatment significantly reduced the risk of pulp diseases in patients with T2DM. These second-line anti-diabetic medications could play an important role in preventing oral complications in patients with T2DM, potentially reducing the need for invasive procedures.