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ABSTRACT Objective Methods Results Conclusion To investigate the association between dental attendance with periodontal care and the risk of dialysis initiation in patients with type 2 diabetes mellitus (T2D).This retrospective cohort study used data from the Japan Medical Data Center (JMDC) claims database (January 2015 to August 2022). Patients with T2D, aged 40–74, were included. Dental attendance with periodontal care and initiation of dialysis were used as the exposure and outcome variables, respectively. We fitted the Cox proportional hazards model, including potential confounders, to estimate hazard ratios (HRs) and 95% confidence intervals (95%CIs).Among 99,273 participants (mean age = 54.4 years [SD = 7.8], male = 71.9%), the incidence rate of dialysis initiation was 0.92 per 1000 person‐years. After adjusting for all covariates, those with periodontal care (HR = 0.68 [95%CI = 0.51–0.91] for ≥ 1 time/year and HR = 0.56 [95%CI = 0.41–0.77] for ≥ 1 time/6 months) had a significantly lower risk of dialysis initiation compared to those without dental attendance.Periodontal disease care in patients with T2D is associated with a reduced risk of dialysis initiation by 32%–44%. This suggests that integrating periodontal care into diabetes management may help prevent the progression of diabetic nephropathy and improve patient outcomes. [ABSTRACT FROM AUTHOR]