Association between tooth loss, chronic conditions and common risk factors - results from the 2019 brazilian health survey

Examining the Impact of Natural Teeth Trajectory on Mortality Among CLHLS

BACKGROUND

To investigate the associations between trajectories of the number of natural teeth and all-cause mortality among Chinese middle-aged and older adults.

METHODS

Data for this study were sourced from the 2002, 2005, 2008, 2011, 2014, and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). The number of natural teeth was assessed through self-reports. Population-based trajectory models were utilised to explore potential heterogeneity in longitudinal changes over 16 years and to examine the associations between baseline predictors and different trajectories among cohort members. Additionally, the Cox proportional hazards model was employed to assess the risk factors associated with these trajectories.

RESULTS

Three distinct trajectories in the number of natural teeth were identified: fewer teeth (33.34%), a moderate number of teeth (47.58%), and most teeth retained (19.08%). Several factors were found to influence changes in these trajectories: older age, male gender, poor self-reported health status, impaired vision, a higher number of chronic diseases, diminished cognitive function, and reduced frequency of social activities. Compared to the group with fewer teeth, those with moderate and most teeth demonstrated a better prognosis.

CONCLUSION

The number of natural teeth is associated with mortality, and retaining more natural teeth may play a significant role in promoting healthy aging.

Association between multimorbidity and having less than 20 natural teeth among Chinese older adults: a cross-sectional study

Understanding the impact of multimorbidity on having less than 20 natural teeth is crucial for safeguarding the oral health of older adults with multimorbidity. This study aimed to analyze the association between multimorbidity and having less than 20 natural teeth in older Chinese adults. The data for this analysis were obtained from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), which covers 23 provinces, municipalities, and autonomous regions throughout China. The survey includes information on dental health (such as dentition status), a variety of chronic conditions, and other sociological characteristics of older adults in China. Having less than 20 natural teeth was used as the dependent variable, with multimorbidity as the independent variable. A multivariable logistic regression model was applied to estimate the association between multimorbidity and having less than 20 natural teeth. A total of 3,640 older adults were included in the study, of whom 58.27% (2121) were identified as having less than 20 natural teeth. The results indicated that factors such as age, education level, exercise, ability to perform daily activities, frequency of brushing teeth, and BMI are associated with having less than 20 natural teeth. Additionally, compared with those without chronic disease, the odds ratio (OR) of having less than 20 natural teeth was 1.32 (95% CI: 1.10, 1.57) for older adults with only one chronic disease, and the OR for those with two or more chronic diseases was 1.418 (95% CI: 1.06, 1.89). This study highlights the importance of monitoring the oral health of older adults with multimorbidity and identifies an association between multimorbidity and having less than 20 natural teeth. Oral health care institutions should implement measures to support the development of more comprehensive public health policies.

Association between oral health and physical performance in Brazilian older adults: SABE cohort study

BACKGROUND

Oral health is recognized as integral to general health and impaired dentition status may affect physical performance among older adults. This study evaluated the longitudinal association between clinical and self-reported oral health measures and physical performance (outcome) in Brazilian older adults.

METHODS

This was a longitudinal study that used data from the second (year 2006), third (year 2010) and fourth (year 2015) waves of the Health Well-being and Aging Study conducted in Brazil. Physical performance, evaluated using the Short Physical Performance Battery (SPPB), was the dependent variable. Independent variables of interest were the number of teeth, presence of periodontal pocket, use of dental prostheses, and poor perceived oral health. The association between oral health measures and physical function was analyzed using generalized estimating equations with an ordinal regression model.

RESULTS

In the total sample, every additional tooth was associated with a greater chance of achieving a higher score on the SPPB test. Individuals wearing dental prostheses had higher chances of having higher scores than those not wearing them. In the analyses for the dentate sample, the presence of a periodontal pocket was not associated with SPPB and the increase in the number of teeth increased the chance of achieving a higher score.

CONCLUSION

A greater number of teeth, and using dentures, were associated with higher physical performance. Periodontal disease was not associated with the outcome.

A Cross-Sectional Study Assessing Saudi Population's Awareness Toward the Relationship Between Oral Health and Overall Well-Being

BACKGROUND AND AIM

Oral health constitutes a critical component of overall health. Additionally, there is evidence of a bidirectional interaction between oral health and the progression of chronic diseases. Many chronic illnesses present oral manifestations and thus can impact oral health but conversely, oral health, particularly the presence of oral bacteria, can influence the progression of chronic diseases. Consequently, a comprehensive understanding of this relationship is essential, as it has significant implications for both oral and overall health. This study aimed to evaluate the knowledge of the Saudi population about oral health and its association with systemic diseases, as well as the factors that might affect this knowledge including demographics and educational level.

METHODS

A structured questionnaire using multiple-choice questions was developed in Arabic language and distributed among patients visiting the Dental Teaching Hospital of Umm AlQura University. An electronic version of the questionnaire was developed using Google Forms for distribution through social media outlets. The data were analyzed using SPSS, version 29 (Armonk, NY: IBM Corp.). Descriptive statistics, chi-square test, and Fisher's exact test were used to analyze the data, and the significance level was set at p<0.05. Participants were considered to have good oral health knowledge and awareness if they answered 60% of the questions correctly.

RESULT

Most participants were female (66.5%), predominantly aged 20-29 years. More than half of the participants (166; 52%) reported insufficient knowledge regarding oral health. Additionally, there was a significant association between gender and the level of knowledge (p<0.001), with females exhibiting a higher level of knowledge compared to males. Furthermore, there was a significant association between the source of information and the level of knowledge (p=0.009) with participants who reported social media as their primary source of information being more likely to have sufficient knowledge.

CONCLUSION

Since more than half of the surveyed individuals demonstrated a deficiency in oral health knowledge, there is a necessity for enhanced awareness and educational initiatives regarding the implications of oral health on general health within the Saudi population.

Binge drinking and oral health-related quality of life in older adults: Socioeconomic position matters

OBJECTIVE

The objective of the study was to investigate whether the association between binge drinking and oral health-related quality of life (OHRQoL) differs by socioeconomic position (SEP) in Brazilian older adults.

BACKGROUND

The adverse health effects of alcohol consumption disproportionately affect socioeconomically disadvantaged and older individuals. Moreover, measures of binge drinking may capture different domains of the association between alcohol misuse and health that might be independent of the traditional markers of volume or frequency of consumption. Evidence of the association between alcohol use and oral health outcomes has failed to consider binge drinking and possible effect modification by SEP.

METHODS

We conducted a secondary cross-sectional analysis using the baseline data from The Brazilian Longitudinal Study of Ageing (2015-2016). Effect Measure Modification analyses using multivariable Poisson regression models tested whether the association between past-month binge drinking and higher scores of the Oral Impacts on Daily Performance (OIDP) questionnaire differed in magnitude by level of household wealth and educational attainment, assessed using Relative Excess Risk due to Interaction (RERI) and simple slope test.

RESULTS

The analytical sample comprised 8857 individuals. Participants who were from low-wealth households or with lower education and reported past-month binge drinking had 27% (95% CI: 1.16 to 1.39) and 28% (95% CI: 1.18 to 1.40) higher OIDP scores, respectively, than those not binge drinkers from higher SEP, and super-additive associations were detected (RERI for household wealth: 0.12; RERI for educational attainment: 0.14).

CONCLUSION

Binge drinkers from low SEP have poorer OHRQoL. Public oral health initiatives aiming to combat binge drinking are likely to disproportionately benefit vulnerable groups.

Is tooth loss associated with multiple chronic conditions?

OBJECTIVES

To examine the relationship between tooth loss and co-occurrence of multiple chronic conditions (MCC) among American adults at working age.

MATERIALS AND METHODS

Data was from the Behavioural Risk Factor Surveillance System 2018, a cross-sectional telephone-based, nationally representative survey of American adults. We included participants aged 25-64 years. The survey included sociodemographic data, reported diagnosis of chronic conditions, the number of missing teeth and health behaviours. An aggregate variable of chronic conditions was created which included heart attack, angina, stroke, cancer, chronic pulmonary disease, diabetes, asthma, arthritis, depression, and kidney diseases. The association between the number of missing teeth and the aggregate of chronic conditions was assessed adjusting for confounders.

RESULTS

The analysis included 202,809 participants. The mean number of MCC was 0.86 (95% Confidence Interval 'CI':0.85,0.87). Tooth loss was significantly associated with MCC with rate ratio 1.18 (95% CI:1.15,1.21), 1.53 (95% CI:1.48,1.59) and 1.62 (95% CI:1.55,1.69) for those reporting losing 1-5 teeth, 6 or more but not all, and all teeth, respectively after adjusting for demographic, socioeconomic, and behavioural factors.

CONCLUSION

Tooth loss could be an early marker for the co-occurrence of multiple chronic conditions among adults of working age. The association could be attributed to common risk factors for oral and general health.

Associations between physical activity domains and oral health: an analysis of a Brazilian population-based study

Physical activity comprises four domains (leisure, transportation, domestic, and work activities) that may be differently associated with oral health. The aim of this study was to assess the association between each physical activity domain and oral health conditions in Brazilian adults. A total of 38,539 participants in the 2019 Brazilian Health Survey aged 30 years or older were analyzed. The outcomes were self-perceived oral health (dichotomous) and self-reported number of missing teeth (counts). The presence, frequency, and time of activity in each domain and their combination were analyzed as main exposures. Odds ratios (OR) and mean ratios (MR) were estimated by fitting multivariable models. Higher leisure time physical activity was the only domain associated with better self-perception of oral health (OR = 1.32; 95%CI 1.26-1.38) and lower tooth loss (MR=0.88; 95%CI 0.86-0.90). Higher levels of work, transportation, and household activities were significantly associated with worse self-perception of oral health, while higher levels of work- and transportation-related physical activities were also associated with greater tooth loss. When the total recommended weekly physical activity time was analyzed, no significant associations were found. Sensitivity analysis suggested that this pattern persists in potential periodontitis-related cases, such as when selecting older age or excluding individuals with no tooth loss. In conclusion, leisure physical activity was the only domain with the potential of reflecting the benefits of physical activity on oral health. The inclusion of other domains can confound this association.

Tooth loss, denture use, and all-cause and cause-specific mortality in older adults: a community cohort study

Objectives

The available evidence on the connections between tooth loss, denture use, and mortality from all causes or specific causes among older adults is inconclusive. Therefore, we aimed to investigate the association between tooth loss, denture use, and all-cause and cause-specific mortality in older adults.

Methods

A cohort of 5,403 participants aged 65 and older were recruited in the 2014 Chinese Longitudinal Healthy Longevity Survey wave and followed up in the 2018 wave. Cox proportional hazard models were used to examine the association between the number of natural teeth, denture use, and all-cause and cause-specific mortality.

Results

During a mean (SD) follow-up of 3.1  years (1.3), 2,126 deaths (39.3%) occurred. Individuals with 0 and 1-9 teeth had higher mortality due to all-cause, cardiovascular disease (CVD), cancer, and other causes (all p-trend <0.05) than those with 20+ teeth. At the same time, no association was found with respiratory disease mortality. Participants who used dentures had lower mortality due to all causes [hazard ratios (HR) 0.79, 95% confidence intervals (CI) 0.71-0.88], CVD (HR 0.80, 95% CI 0.64-1.00), respiratory disease (HR 0.66, 95% CI 0.48-0.92), and other causes (HR 0.77, 95% CI 0.68-0.88) than those without dentures. Joint analysis revealed that older adults with fewer natural teeth and no dentures had higher mortality. Additionally, interaction analyses showed that the effects of the number of natural teeth on all-cause mortality were more pronounced in older adults aged <80  years (p-value for interaction = 0.03).

Conclusion

Having fewer natural teeth, particularly less than 10 teeth, is linked to an increased risk of mortality from all causes, including CVD, cancer, and other causes, but not respiratory disease. The use of dentures would mitigate the adverse impact of tooth loss on all-cause and some cause-specific mortality.

Denture wearing status, cardiovascular health profiles, and mortality in edentulous patients: A prospective study with a 27-year follow-up

OBJECTIVES

Life's Simple 7 (LS7) metrics provide insight into improving cardiovascular health (CVH) and help reduce mortality risks. Edentulous older adults have a higher mortality risk than dentulous ones, probably due to worse oral function. It is reported that wearing dentures will decrease the mortality risk factor by improving oral function. This prospective study aimed to investigate if denture wearing could modify the association between CVH profile and mortality risk among edentulous elderly.

METHODS

From the Third National Health and Nutrition Examination Survey (NHANES III), 1,735 edentulous older adults (mean age 69.4 years old) with CVH profiles and data on denture wearing status were selected for this study. CVH profiles according to LS7 metrics were classified into poor, intermediate, or ideal. Denture wearers were defined as those wearing complete dentures in both arches all the time or only when awake. Multivariable Cox proportional-hazards regression was conducted to estimate the association of CVH profiles with all-cause and cardiovascular mortality. Stratified analyses and the testing of interaction terms were used to evaluate the difference between the association in edentulous patients with and without dentures.

RESULTS

A total of 1,420 (81.8%) older adults died during the 27-year follow-up, with 475 (27.6%) cases attributable to heart disease. After controlling for potential confounders, edentulous patients with an ideal CVH (LS7 = 10-14) had a lower mortality risk than those with poor CVH (LS7 = 0-4). Furthermore, we observed an effect modification by denture use (P_interaction = 0.046), with the role of ideal CVH in mitigating mortality among the denture wearers (Hazard Ratio = 0.440 [0.329-0.588]), while no significant association among those without dentures. Similar results were achieved for cardiovascular mortality, but there was no effect modification of denture use (P_interaction = 0.352).

CONCLUSION

In this study, a favorable cardiovascular health profile presents a protective effect on all-cause mortality only among edentulous patients wearing dentures instead of non-wearer.

CLINICAL SIGNIFICANCE

Denture usage could improve oral function (e.g., chewing, smiling, speaking, etc.) and promote general health. Effect modification found in this study indicates having ideal CVH alone cannot substantially reduce mortality risk among edentulous patients. Therefore, health care professionals should keep an eye on the elderly not wearing dentures as they are probably more at risk for adverse health outcomes. It remains unclear if denture wearing has a causal relation with lower mortality risks, and further research is needed.

Association between type 2 diabetes (T2D) and tooth loss: a systematic review and meta-analysis

BACKGROUND

Several studies have assessed the relationship between type 2 diabetes (T2D) and tooth loss; however, results have been inconsistent. Therefore, the present systematic review and meta-analysis of observational studies was designed to examine the association between T2D and tooth loss.

METHODS

This systematic review and meta-analysis was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guideline. We searched all the relevant studies in international databases of Scopus, PubMed, ProQuest, Web of Science, Cochrane Library, and Google scholar search engine until February 2022. The heterogeneity of the studies was calculated using the I2 index. Measure of effect and 95% confidence interval (CI) were extracted from each study. The results of the study were analyzed using the random effects model.

RESULTS

In the present study, 22 eligible studies were included. Meta-analysis of unadjusted and adjusted results showed that T2D significantly increased the risk of tooth loss, and Odds Ratio (OR) unadjusted was 1.87 (95% CI: 1.62-2.13, p < 0.001), and OR adjusted was 1.20 (95% CI: 1.10-1.30, p < 0.001), respectively. Subgroup analysis based on study design for adjusted OR indicated that in the cohort study (OR: 1.29, 95% CI: 1.07-1.51), in the cross-sectional study (OR: 1.15, 95% CI: 1.06-1.23), and in the case-control study (OR: 5.10, 95% CI: 1.01-9.18) there was a significant association between T2D and tooth loss. Other subgroups analyses showed consistent results and no publication bias existed.

CONCLUSIONS

The findings suggest that T2D is associated with increased risk of tooth loss. This conclusion may provide useful evidence for correlated clinical researches.