Title: Determinants of Oral Health Outcomes and Quality of Life in Diabetic Patients

Abstract: Oral health and diabetes are closely linked through shared inflammatory, behavioral, and socioeconomic factors. This study examined the determinants of oral health outcomes and oral-health-related quality of life (OHRQoL) in Romanian diabetic patients using Andersen’s Behavioral Model. Methods: A cross-sectional study was conducted in early 2025 among 79 diabetic patients at a public clinic in Western Romania. Data were collected through questionnaires, clinical oral exams, and the OHIP-14 instrument. Variables were analyzed using Andersen’s Behavioral Model and standard statistical tests, including regression and correlation analyses. Results: Participants had a mean age of 61.2 years; 86.1% had type 2 diabetes and 13.9% type 1. Over 49% reported gingival bleeding, and 38% experienced dental sensitivity. Regression analysis identified limited awareness (OR = 2.21, p = 0.033) and low income (OR = 1.89, p = 0.041) as significant predictors of periodontal symptoms. OHIP-14 scores were weakly correlated with glycemic control (r = 0.17) and dental sensitivity (r = 0.16) but not with objective periodontal parameters. Rural residence, lower education levels, and poor awareness were associated with reduced service utilization and poorer perceived oral health. Conclusions: This study highlights the impact of behavioral, clinical, and socioeconomic factors on oral condition and OHRQoL. Oral health should be integrated into chronic disease care, with prevention-focused strategies aimed at improving access and reducing disparities, especially in older and rural populations.