Aims <p>Individuals with diabetes are at increased risk for periodontitis and tooth loss, yet the primary causes of tooth extractions and associated postoperative complications in this population remain underexplored. This retrospective cross-sectional study investigated the reasons for tooth extractions and the prevalence of postoperative complications among individuals with and without diabetes.</p> Methods <p>Patient- and tooth-related data between 2022 and 2024 were collected from participants undergoing permanent tooth extractions, excluding third molar and orthodontic extractions. Descriptive statistics and structural equation modeling (SEM) assessed the effects of age, diabetes, and smoking on the number of remaining teeth, mediated by periodontitis.</p> Results <p>Of 490 participants, 100 reported type 2 diabetes (mean HbA1c: 7.5%). The diabetic group exhibited more periodontitis and retained significantly fewer teeth after extractions (<i>p</i> &lt; 0.01). 90% of extractions in both groups were due to nonperiodontal conditions (caries or subsequent endodontic infections). Post-extraction complications were rare (2%) and did not differ between the two groups, but antibiotics were prescribed significantly more often for the diabetic group. The SEM revealed that age and smoking were significant negative predictors for the remaining teeth number (<i>p</i> &lt; 0.001), while diabetes and periodontitis were not (<i>p</i> &gt; 0.05).</p> Conclusions <p>Tooth extractions in individuals with diabetes were largely due to nonperiodontal infections rather than periodontitis. The higher prescription of antibiotics in this group reflects clinical concern about postoperative infection risk. These findings underscore the importance of caries prevention and cautious use of antibiotics to reduce postoperative complications among individuals with diabetes.</p>