Although tooth loss has decreased over the last four decades, US adults with diabetes lose twice as many teeth as adults without diabetes, according to a new study by researchers at Duke University. Moreover, the researchers found that black Americans with diabetes are at greater risk of experiencing tooth loss as they age than white or Mexican Americans with diabetes.

The study, published in the journal Preventing Chronic Disease, assessed National Health and Nutrition Examination Survey (NHANES) trends in tooth loss from 1971 to 2012. While overall tooth loss declined over the 40-year study period, tooth loss remained more common in people with diabetes. Black Americans with diabetes lost more teeth than white and Mexican Americans with diabetes. The researchers suggest this difference could be a result of historical challenges non-Hispanic blacks faced in obtaining proper dental care because of a lack of dental services and dental knowledge.

“People with diabetes have poorer oral health-related behaviors and do not brush and floss as often as people without diabetes,” the researchers suggest. “Our study findings highlight the need to improve dental self-care and knowledge of diabetes risks among people with diabetes, especially among African Americans who experience more tooth loss.”