Tooth loss as a potential risk factor for deficient sleep: an analysis of a nationally representative sample of adults in the USA

Association of periodontitis, tooth loss, and self-rated oral health with circadian syndrome in US adults: a cross-sectional population study

BACKGROUND

This study was to investigate associations of periodontitis, tooth loss and self-rated oral health with circadian syndrome.

METHODS

Data regarding periodontitis, dentition, oral health questionnaire and circadian syndrome of 30-85 years old participants from US National Health and Nutrition Examination Survey 2005-2020 were analyzed. Periodontitis questions for periodontitis and dentition status were validated. Weighted multivariable logistic regression analyses were used.

RESULTS

Weighted prevalence of circadian syndrome and stage II-IV periodontitis was 33.29% and 88.87%, respectively. When compared with stage I periodontitis, stage II periodontitis was significantly associated with greater circadian syndrome prevalence after adjustment (odds ratio (OR) and 95% confidence interval (CI): Stage II: 1.35 (1.03, 1.76), P = 0.032; Stage III: 1.30 (0.97, 1.73), P = 0.069; Stage IV: 1.17 (0.82, 1.65), P = 0300). Stage II periodontitis was significantly associated with greater prevalence of lower high-density lipoprotein cholesterol (HDL) and elevated triglycerides and stage III and stage IV periodontitis were significantly associated with greater hypertension prevalence. A 1 tooth increase in the number of missing teeth was associated with a 1% increase in circadian syndrome and its components of obesity, elevated fasting plasma glucose (FPG) and short sleep. Poor or fair self-rated oral health showed a specificity of > 70% for periodontitis and lack of functional dentition. Meanwhile, poor or fair self-rated oral health had relatively higher levels of sensitivity for stage II-IV periodontitis (35%), stage III-IV periodontitis (46%), stage IV periodontitis (60%) and lacking functional dentition (56%). When compared to excellent self-rated oral health, good, fair and poor self-rated oral health were significantly associated with higher circadian syndrome prevalence (OR and 95% CI: Very good: 1.13 (0.97, 1.32), P = 0.120; Good: 1.34 (1.14, 1.57), P < 0.001; Fair: 1.41 (1.16, 1.71), P = 0.001; Poor: 1.63 (1.32, 2.03), P < 0.001). Additionally, participants with worse self-rated oral health had significantly higher prevalence of elevated FPG, hypertension, low HDL, elevated triglycerides, short sleep and depression.

CONCLUSIONS

Periodontitis, tooth loss and worse self-rated oral health were associated with circadian syndrome in US adults. Self-rated oral health may be a simple question to indicate oral and systemic health.

Association of edentulism and obstructive sleep apnea: A systematic review

PURPOSE

Sleep apnea is a common and underdiagnosed sleep-related breathing disorder. This systematic review aimed to evaluate the scientific evidence regarding the association between obstructive sleep apnea (OSA) and edentulism.

METHODS

An electronic search was conducted through PubMed (MEDLINE), Scopus, and Cochrane Library, up to January 2024. A systematic approach was followed according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) statement guidelines. The literature search intended to retrieve all relevant clinical studies about any possible association between OSA and edentulism. Only publications in the English language were selected, and animal studies, in vitro studies, case reports, case series, technique presentation articles, and expert opinions were excluded.

RESULTS

A total of 23 studies met the inclusion criteria and were included in this systematic review. They were published between 1999 and 2023 and were all clinical studies. These studies examined a possible association between OSA and edentulism and all of them agreed on their positive relation. Tooth loss favors anatomic alterations that deteriorate breathing. The severity of OSA was related to the extent and duration of edentulism. Mean Apnea-Hypopnea Index (AHI) scores in edentulous patients were found to be two to three times higher in comparison to dentate individuals, although the statistical data about it are scarce. No agreement was reached, however, about the use of dentures during sleep time, since the data are controversial.

CONCLUSION

The findings suggest that there is a plausible association between edentulism and OSA. Tooth loss impairs significant anatomic alterations and increases the risk for OSA. However, clinical data are limited and heterogeneous so more clinical studies should be encouraged for more robust conclusions.

Association of changes in the number of teeth on psychological distress among community-dwelling older adults in Taiwan

BACKGROUND

Aging populations worldwide face a substantial burden of psychological distress that affects their quality of life and overall health. Oral health is associated with psychological distress; however, the effect of changes in the number of teeth on psychological distress remains unknown. This study aimed to evaluate the association of changes in the number of teeth with the development of psychological distress among community-dwelling older adults in Taipei City.

METHODS

From 2005 to 2013, 62,119 community-dwelling individuals aged 65 years and older participated in the physical examination program in Taipei. We collected data on the number of teeth during each examination. Psychological distress was defined as a score of ≥6 on the Brief Symptoms Rating Scale. A generalized estimating equation (GEE) model was used to examine the longitudinal relationship between changes in the number of teeth and the development of psychological distress.

RESULTS

The participants lost an average of 6.6 teeth during the follow-up, with 9.9% of oral examination records showing the loss of ≥5 teeth compared with the previous examination. After GEE analysis with adjustment for multiple covariates, participants were at higher risk of developing psychological distress if they lost 1-4 teeth, 5-9 teeth, or ≥10 teeth compared to that at their previous oral examination. Subgroup analysis revealed that participants with ≥20 teeth at baseline and those who used dentures to compensate for the tooth loss had a lower risk of developing psychological distress than those who experienced tooth loss and did not use dentures.

CONCLUSION

A rapid decrease in the number of teeth is associated with an increased risk of psychological distress in older adults. Regular dental checkups, nutritional counseling, and the use of dentures are critical in mitigating the adverse psychological effects of the tooth loss.

Associations between tooth loss, denture use, and dementia in older Taiwanese adults

BACKGROUND

The literature has mainly focused on the association between tooth loss and dementia, and evidence regarding the separate and joint effects of tooth loss and denture use on the risk of dementia is limited. This study investigated the links among tooth loss, denture use, and dementia risk in Taiwanese adults aged 65 years or older.

METHODS

This retrospective cohort study utilized data from the 2009 National Health Interview Survey and 2008-2017 National Health Insurance claim records, including the records of 2247 individuals free from dementia treatment in 2008-2009. Dementia diagnoses were tracked until 2017. The Cox proportional hazards model was used to calculate hazard ratios (HRs) for exploring the correlations among tooth loss, denture use, and dementia risk.

RESULTS

Older adults with 20 or more natural teeth and dentures had the lowest dementia incidence (1.43 per 100 person-years). Those with <20 natural teeth, with or without dentures, experienced high dementia incidence rates of 2.31 and 3.33 per 100 person-years, respectively. After adjusting for various factors (i.e., sociodemographic characteristics, health conditions/comorbidities, and lifestyles), having <20 natural teeth or not using dentures was associated with non-significantly increased HRs of 1.30 (95% CI, 0.99-1.71) and 1.20 (95% CI, 0.95-1.52). Subgroup analysis revealed that compared to older adults with 20 or more natural teeth and dentures, those with <20 natural teeth and not wearing dentures had a significantly increased risk of dementia (adjusted HR, 1.57; 95% CI, 1.04-2.37).

CONCLUSION

This study found that having <20 natural teeth and not using dentures was significantly associated with an increased risk of dementia in Taiwanese individuals aged 65 years or above.

Sleep and periodontal health

Sleep is fundamental for health and well-being. An adequate amount and quality of sleep is a cardinal component of a healthy lifestyle at the basis of the prevention of many non-communicable chronic diseases. Recent evidence suggests that sleep disorders, particularly obstructive sleep apnea, represent an emerging risk factor for periodontal health. This review article provides a critical appraisal of the existing literature concerning the association between sleep duration, sleep quality, sleep disorders in general, and obstructive sleep apnea with periodontal diseases, including gingivitis and periodontitis. The putative mechanisms underlying these associations are described as well as the potential clinical implications for diagnosis and treatment.

No genetic association between sleep traits and periodontitis: A bidirectional two-sample Mendelian randomization study

OBJECTIVE

This study aimed to investigate the potential genetic link between sleep traits and periodontitis.

METHODS

A two-sample bidirectional Mendelian randomization (MR) analysis was conducted using publicly available genome-wide association studies data on chronotype, daytime sleepiness, daytime napping frequency, insomnia, sleep duration, snoring, and the apnea-hypopnea index (AHI), along with a separate dataset on periodontitis.

RESULTS

Chronotype (OR = 0.929, 95% CI = 0.788-1.095), daytime sleepiness (OR = 0.492, 95% CI = 0.186-1.306), daytime napping frequency (OR = 1.178, 95% CI = 0.745-1.863), sleep duration (OR = 0.868, 95% CI = 0.644-1.169), AHI (OR = 1.124, 95% CI = 0.980-1.289), insomnia (OR = 0.832, 95% CI = 0.440-1.573), and snoring (OR = 0.641, 95% CI = 0.198-2.075) had no effect on periodontitis. Similarly, periodontitis demonstrated no significant effect on sleep traits.

CONCLUSIONS

There is no evidence of a bidirectional genetic relationship between sleep traits and the risk of periodontitis.

Association of Sleep Duration with Tooth Loss and Periodontitis: Insights from the National Health and Nutrition Examination Surveys (2005-2020)

OBJECTIVE

Sleep disorders such as insomnia, apnea, and restless leg syndrome can negatively affect a person's overall health and may cause hypertension, heart failure, and coronary heart disease. Likewise, periodontitis, a gum disease, can lead to both physical and psychological health issues, exerting a considerable effect on one's overall well-being-periodontitis stands as a primary cause of tooth loss. Nevertheless, there has been insufficient research on the correlation between the amount of sleep individuals get and the occurrence of periodontitis/tooth loss among Americans. Therefore, this study aimed to assess the influence of sleep length on periodontitis in the American population.

METHODS

Periodontitis severity was classified (none, mild, moderate, and severe) using American Periodontal Association criteria. Sleep duration was assessed by self-reported data and categorized into three groups (deficient, adequate, and excessive). Tooth loss was assessed by the oral examination. To establish a connection between the duration of sleep and periodontitis/tooth loss, a weighted multivariable logistic regression analysis was employed. A GAM analysis and smooth curve fitting assessment were conducted to identify non-linear relationships. Subgroup, interaction, and mediation analyses were also performed.

RESULTS

The prevalence of tooth loss was significantly high, affecting 96.4% of the individuals, whereas 46.6% of the study sample experienced moderate to severe periodontitis. The average age of participants was 52.7 years. After adjusting for potential confounding factors, the analysis of weighted multivariable logistic regression revealed a significant association between sleep insufficiency and moderate/severe periodontitis (OR 1.15, 95% CI 1.01-1.30, P = 0.0298), as well as tooth loss (OR 1.16, 95% CI 1.01-1.33, P = 0.0371). Additionally, the research showed a correlation between the length of sleep and periodontitis that followed a U-shaped pattern. In addition, the analysis of mediation revealed that high blood pressure explained 7.0% (95% CI 4.0% to 12.9%; P < 0.0001) of the link between the amount of sleep and the likelihood of losing teeth.

CONCLUSION

Sleep duration was independently correlated with moderate/severe periodontitis/tooth loss and had a non-linear relationship.

Poor Self-Rated Sleep Quality and Quantity Associated with Poor Oral Health-Related Quality of Life among Indigenous Australian Adults

BACKGROUND

Indigenous Australians score worse on both sleep and oral health. This study aimed to evaluate sleep quality and quantity associated with oral health-related quality of life (OHRQoL) among Indigenous Australian adults.

METHODS

A cross-sectional study involving 728 Indigenous Australian adults aged 18+ years was conducted. Exposure variables were sleep quality and quantity. The primary outcome variable was Oral Health Impact Profile-14 (OHIP14), which has been used to assess OHRQoL. Multivariable log-Poisson regression models were applied to estimate the mean ratios (MRs) for mean OHIP14 scores.

RESULTS

The average OHIP14 score was 14.9, and the average amount of sleep was 6.8 h/night. After adjusting for all covariates, self-rated very bad sleep quality was associated with 2.2 times (MR = 2.17, 95% CI: 1.97-2.37) higher OHIP14 scores than those who rated their sleep quality as very good. Participants who self-reported sleeping 7-8 h/night had 0.9 times (MR = 0.89, 95%CI: 0.83-0.95) lower OHIP14 scores than those sleeping more than 8 h.

CONCLUSIONS

The average number of sleep hours for Indigenous participants were lower than recommended (7-8 h/night). Our findings indicate that poor sleep quality and quantity, and oral health-related behaviours associated with sleep deprivation were positively associated with poor oral health related quality of life among Indigenous Australian adults.

The influence of periodontitis case definition on the association between periodontal disease and glycaemic status

OBJECTIVE

The association between periodontitis and glycaemic control is complex, and often described as 'bidirectional'. Although epidemiological studies have examined this relationship extensively, a disagreement on periodontitis case definition still exists. This study aimed to assess the influence of case definition on the association between periodontal disease and glycaemic status.

METHODS

The study is a secondary analysis of data from the United States National Health and Nutrition Examination Survey (NHANES), 2009-2014 cycles. The association between periodontitis and glycated haemoglobin (HbA1c) was assessed using different periodontitis case definitions: the definition by the Centers for Disease Control and Prevention and the American Academy of Periodontology (CDC/AAP), Community Periodontal Index (CPI), ≥1 site with ≥3 mm clinical attachment loss (CAL) and ≥4 mm probing depth (PD), ≥1 site with ≥4 mm CAL and ≥4 mm PD, the 5th European Workshop definitions, Machtei et al. 'established periodontitis', the 2017 World Workshop classification, and self-reported periodontitis. The associations between periodontitis and HbA1c were compared across the case definitions.

RESULTS

There was substantial variability in prevalence estimates of periodontitis, and in the strength of association between periodontitis and HbA1c when different case definitions were applied. The CDC/AAP and stage III/IV periodontitis were consistently significantly associated with elevated HbA1c. For stage III/IV, the adjusted odds ratios of prediabetes and diabetes HbA1c were 1.19 and 1.76, respectively.

CONCLUSION

Comprehensive periodontitis case definitions that account for CAL and PD, such as the CDC/AAP and the 2017 classification, seem to better detect the association between periodontal disease and HbA1c.

The relationship between oral health status, loneliness, and sleep quality among the migrant elderly following children in Weifang, Shandong Province, China: A comparative analysis on different migration types

BACKGROUND

The migrant elderly following children (MEFC) are a vulnerable group that emerged during fast urbanization in China. The MEFC faced physical and psychological discomfort upon their arrival in the inflow city, particularly those who came from rural areas.

OBJECTIVE

This study aimed to explore the relationship between oral health status, loneliness, and sleep quality among the MEFC in China and to clarify the disparities in the above mentioned relationship by migration type.

METHODS

In 2021, a cross-sectional survey was conducted in Weifang, Shandong Province, using multistage cluster random sampling to collect data from the MEFC aged 60 years and over. In total, 613 respondents [525 rural-to-urban (RTU) and 88 urban-to-urban (UTU)] were included in the final database. The chi-square test, t-test, and structural equation modeling (SEM) were used to investigate the relationship between oral health status, loneliness, and sleep quality among the RTU and UTU MEFC.

RESULTS

Total scores [mean ± standard deviation (SD)] for oral health status, loneliness, and sleep quality were 54.95 ± 6.47, 8.58 ± 3.03, and 4.47 ± 3.60, respectively. SEM revealed that, among the RTU and UTU MEFC, oral health status was positively and significantly related to sleep quality; however, the correlation was slightly stronger in the UTU MEFC. In both groups, there was a significant negative correlation between oral health status and loneliness, which was stronger in the UTU MEFC. In the RTU MEFC, a significant negative correlation between loneliness and sleep quality was observed, and in the UTU MEFC, no significant association between loneliness and sleep quality was observed.

CONCLUSION

The sleep quality among the MEFC in this study was higher compared to previous studies. Oral health status was negatively correlated with loneliness and positively associated with sleep quality, whereas loneliness was negatively correlated with sleep quality. These three associations differed significantly between the UTU and RTU MEFC. The government, society, and families should take measures to improve oral health and reduce loneliness among the MEFC to improve their sleep quality.

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of the 2021 dental literature in restorative dentistry to inform busy dentists regarding noteworthy scientific and clinical progress over the past year. Each member of the committee brings discipline-specific expertise to coverage of this broad topical area. Specific subject areas addressed, in order of the appearance in this report, include COVID-19 and the dental profession (new); prosthodontics; periodontics, alveolar bone, and peri-implant tissues; implant dentistry; dental materials and therapeutics; occlusion and temporomandibular disorders; sleep-related breathing disorders; oral medicine and oral and maxillofacial surgery; and dental caries and cariology. The authors focused their efforts on reporting information likely to influence daily dental treatment decisions with an emphasis on future trends in dentistry. With the tremendous volume of dentistry and related literature being published daily, this review cannot possibly be comprehensive. Rather, its purpose is to update interested readers and provide important resource material for those interested in pursuing greater details on their own. It remains our intent to assist colleagues in negotiating the extensive volume of important information being published annually. It is our hope that readers find this work useful in successfully managing the patients and dental problems they encounter.

Edentulism and select chronic diseases among adults aged ≥45 years in China, 2011-2018: A longitudinal study

OBJECTIVES

Information on the association between edentulism and chronic medical conditions in developing countries is lacking. We investigated such information among adults aged ≥45 years in China.

METHODS

A national longitudinal data set from the China Health and Retirement Longitudinal Study (CHARLS) 2011-2018 was analysed. A multilevel logistic regression model was applied to analyse the association between edentulism and select chronic diseases.

RESULTS

There were 74 240 Chinese adults aged ≥45 years in this study. The prevalence of self-reported edentulism was 8.8% in 2011 and had increased to 16.4% by 2018.

CONCLUSION

Edentulism was a factor associated with a higher risk of various self-reported chronic diseases among adults aged ≥45 years in China. Edentulism is one of the comorbidities among ageing people with chronic conditions. Preventive public health policy should consider controlling shared risk factors at an earlier age.

Poor sleep quality and oral health among older Brazilian adults

OBJECTIVES

This study evaluates the association between normative and subjective oral health measures and poor self-reported sleep quality among community-dwelling older adults in Brazil.

METHODS

This was a cross-sectional study with data from the Brazilian Longitudinal Study of Aging. The dependent variable was the poor sleep quality. Independent variables of interest included number of teeth and self-reported impact of oral health on eating/chewing and on maintaining emotional stability.

RESULTS

Poor sleep quality was reported by 17.8 (95% CI 16.6; 19.2) of the participants, 29% of the participants were edentulous, and 30% had 20 or more teeth. Impacts of oral health on eating and maintaining emotional stability was found among 33.3% and 20% of the older adults, respectively. After adjusting for all oral health measures and covariates, the magnitude of the associations between the number of teeth and sleep quality was attenuated. Sleep quality was related to oral health impacts on eating (OR 1.19 [95% CI 1.00; 1.41]) and on emotional stability (OR 1.51 [95% CI 1.21; 1.87]).

CONCLUSIONS

This study found an association between oral health and sleep quality emphasizing the importance of oral health to general health.