Number of teeth and selected cardiovascular risk factors among elderly people

Patients With Metabolic Syndrome May Experience More Tooth Loss and Poorer Functional Dentition Than Those Without Metabolic Syndrome

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Association between metabolic syndrome and tooth loss: A systematic review and meta-analysis. Souza ML, Massignan C, Glazer Peres K, Aurélio Peres M. J Am Dent Assoc 2019;150(12):1027-1039.e7.

SOURCE OF FUNDING

Government. Foundation for Research and Innovation Support of Santa Catarina State (Brazil), Coordination of Improvement of Higher Level Personnel (Brazil).

TYPE OF STUDY/DESIGN

Systematic review with meta-analysis of data.

Association between metabolic syndrome and tooth loss: A systematic review and meta-analysis

BACKGROUND

The authors conducted a systematic review and meta-analysis to verify the existence and level of scientific evidence concerning the association between metabolic syndrome (MetS), as the main exposure, and tooth loss (TL), as the outcome.

TYPES OF STUDIES REVIEWED

Through electronic databases and partially through gray literature, the authors identified observational studies in adults. The authors used no date or language restrictions. The authors evaluated the studies' methodological quality by using the Newcastle-Ottawa Scale. The authors conducted a random-effects model meta-analysis. The authors assessed the quality of evidence by using the Grading of Recommendations Assessment, Development and Evaluation criteria.

RESULTS

Twelve studies met the eligibility criteria, and 9 were retained for the meta-analysis. Most were cross-sectional studies with good methodological quality. Participants with MetS had fewer teeth (standardized mean difference, -2.77; 95% confidence interval, -4.56 to -0.98) and an increased likelihood of lacking functional dentition (odds ratio, 2.37; 95% confidence interval, 1.89 to 2.96) than did those without MetS. The overall quality of evidence was very low.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Better-conducted longitudinal studies are necessary to establish a causal relationship between MetS and TL to inform the best strategies to prevent TL in populations with MetS.

Poor Oral Health as a Determinant of Malnutrition and Sarcopenia

Aging is accompanied by profound changes in many physiological functions, leading to a decreased ability to cope with stressors. Many changes are subtle, but can negatively affect nutrient intake, leading to overt malnutrition. Poor oral health may affect food selection and nutrient intake, leading to malnutrition and, consequently, to frailty and sarcopenia. On the other hand, it has been highlighted that sarcopenia is a whole-body process also affecting muscles dedicated to chewing and swallowing. Hence, muscle decline of these muscle groups may also have a negative impact on nutrient intake, increasing the risk for malnutrition. The interplay between oral diseases and malnutrition with frailty and sarcopenia may be explained through biological and environmental factors that are linked to the common burden of inflammation and oxidative stress. The presence of oral problems, alone or in combination with sarcopenia, may thus represent the biological substratum of the disabling cascade experienced by many frail individuals. A multimodal and multidisciplinary approach, including personalized dietary counselling and oral health care, may thus be helpful to better manage the complexity of older people. Furthermore, preventive strategies applied throughout the lifetime could help to preserve both oral and muscle function later in life. Here, we provide an overview on the relevance of poor oral health as a determinant of malnutrition and sarcopenia.

Dental status in the Polish senior population and its correlates-Results of the national survey PolSenior

OBJECTIVE

The aim of the study was to assess dental status of Polish seniors having and wearing dentures in relation to demographic, socioeconomic and lifestyle factors.

BACKGROUND

Tooth loss is associated with deterioration of general health status. The epidemiological data on dental status in Poland, including Polish seniors, are fragmented.

MATERIALS AND METHODS

The study cohort consisted of 4524 randomly selected participants, aged 65 years and over, representative for Polish seniors. Demographic, socioeconomic, lifestyle factors and dental status were collected using standardised questionnaires.

RESULTS

The prevalence of partial and complete edentulism in the Polish senior population was estimated at 45.7% and 47.1%, respectively. Fourteen point four per cent (14.4%) of complete edentulous participants and 31.1% with partial edentulism (1-19 natural teeth) did not have dentures, and one-twelfth of respondents having dentures were not wearing them. The independent correlates of complete edentulism were: female sex, advanced age, rural dwelling, lower education level, physical work in the past, smoking and diabetes. Male sex, age 90+, rural dwelling, type of work, dependence in activities of daily living and partial edentulism were independent correlates of not having dentures and denture disuse. Lower than average personal income was only significant for not having dentures.

CONCLUSIONS

Complete edentulism is frequent among older Poles and affects almost 50% of them. It is associated with female sex, age, rural dwelling, poor economic status, smoking and diabetes. Rural dwelling and dependence of daily living are significant correlates of not having dentures and denture disuse.

Does Oral Health Predict Functional Status in Late Life? Findings From a National Sample

OBJECTIVE

This study aims to examine the association between oral health and the decline in functional status among middle-aged and older adults in the United States.

METHOD

Generalized estimation equation (GEE) Poisson regression models with robust standard errors were used to analyze the longitudinal panel data (2008-2014) from the Health and Retirement Study ( N = 1,243). Oral health was evaluated using self-rated oral health, poor mouth condition, and tooth loss. Decline in functional status was assessed by disabilities in activities of daily living (ADLs) and instrumental activities of daily living (IADLs).

RESULTS

Respondents with poor oral health were more likely to experience decline in ADLs/IADLs. Adjusting for sociodemographics and comorbidities attenuated the effects of oral health.

DISCUSSION

Findings suggest that oral health might be one of the important predictors of functioning decline in late life, after adjusting sociodemographics and comorbidities.

Association between oral health status and central obesity among Brazilian independent-living elderly

The aim of this study was to investigate the association between oral health status and central obesity (CO) in Brazilian independent-living elderly. A cross-sectional study was carried out in a sample of 489 elderly, who were participants of the Study on Aging and Longevity, in Londrina, state of Parana. The number of natural teeth and use of prostheses were evaluated according to the World Health Organization criteria. The presence of CO was assessed using measures of waist circumference (WC) and waist-hip ratio (WHR). Information concerning sociodemographic profile and some systemic conditions was also collected. Data were analyzed using stepwise logistic regression, α=5%. According to WC and WHR measures, the prevalence of central obesity was 79.3% and 76.1%, respectively. CO according to WC was not associated with oral status. Considering the WHR measure, the following oral conditions were associated to CO: having fewer natural teeth (OR = 2.61; 95%CI = 1.17-5.80), being edentulous and wearing both upper and lower complete dentures (OR = 2.34; 95%CI = 1.11-4.93), and being edentulous wearing only the upper complete denture (OR = 2.64; 95%CI = 1.01-6.95). Traditional risk factors for CO such as gender, dyslipidemia, hypertension and diabetes were associated with both measures. A poor oral health due to extensive tooth loss, whether partial or complete, even if rehabilitated by removable prostheses, may be considered a good predictor of CO in Brazilian independent-living elderly.

Associations between the number of natural teeth and metabolic syndrome in adults

AIM

To explore associations between the number of natural teeth and metabolic syndrome in adults.

MATERIAL AND METHODS

Cross-sectional data from the National Health and Nutrition Examination Survey 2005-2008 were used. Eligible adults (n = 5511) were classified into four groups by their number of natural teeth (excluding third molars): full dentition, 21-27 teeth, 1-20 teeth, or edentulous. Metabolic syndrome was defined by diagnostic guidelines from the American Heart Association and National Heart, Lung, and Blood Institute. Associations were analysed by survey logistic regression. Biometric and metabolic parameters in different dentition groups were compared.

RESULTS

Adjusting for age, gender, race/ethnicity, ratio of family income to poverty, physical activity, smoking, and energy intake, tooth loss was significantly associated with metabolic syndrome (p = 0.002). Compared to participants with full dentition, the odds were 32% higher in those with 21-27 teeth, 55% higher in those with 1-20 teeth and 79% higher in edentulous participants. The number of natural teeth was inversely associated with body mass index, waist circumference, blood pressure, fasting plasma glucose and insulin concentrations (p < 0.01 for all); it was positively associated with serum HDL cholesterol concentration (p = 0.003).

CONCLUSIONS

The number of natural teeth is inversely associated with the presence of metabolic syndrome in adults.

Investigating tooth loss and associated factors among older Taiwanese adults

The aim of this study was to evaluate factors associated with tooth loss in older Taiwanese adults with different numbers of remaining teeth. This study evaluated oral health status and tooth loss among 2286 adults aged over 65. Subjects were classified according to number of teeth (Group 1 <20 teeth vs. Group 2 ≥20 teeth). Tooth loss and oral health data were collected from the National Health Interview Survey (NHIS), compared between groups and analyzed by multivariate modeling. Group 1 subjects were older and had more partial dentures. Tooth loss was associated with self-limited food choices due to oral health status, and malnutrition. Tooth loss in Group 2 subjects was significantly associated with lower mental status. Tooth loss may predict cognitive status (odds ratio (OR) 1.30) and physical-disability (OR 1.79). Our results suggested that tooth loss was associated with age, more partial dentures, self-limited food choices, malnutrition, and lower mental and cognitive status and physical disability.

Oral health conditions and frailty in Mexican community-dwelling elderly: a cross sectional analysis

Background

Oral health is an important component of general well-being for the elderly. Oral health-related problems include loss of teeth, nonfunctional removable dental prostheses, lesions of the oral mucosa, periodontitis, and root caries. They affect food selection, speaking ability, mastication, social relations, and quality of life. Frailty is a geriatric syndrome that confers vulnerability to negative health-related outcomes. The association between oral health and frailty has not been explored thoroughly. This study sought to identify associations between the presence of some oral health conditions, and frailty status among Mexican community-dwelling elderly.

Methods

Analysis of baseline data of the Mexican Study of Nutritional and Psychosocial Markers of Frailty, a cohort study carried out in a representative sample of people aged 70 and older residing in one district of Mexico City. Frailty was defined as the presence of three or more of the following five components: weight loss, exhaustion, slowness, weakness, and low physical activity. Oral health variables included self-perception of oral health compared with others of the same age; utilization of dental services during the last year, number of teeth, dental condition (edentate, partially edentate, or completely dentate), utilization and functionality of removable partial or complete dentures, severe periodontitis, self-reported chewing problems and xerostomia. Covariates included were gender, age, years of education, cognitive performance, smoking status, recent falls, hospitalization, number of drugs, and comorbidity. The association between frailty and dental variables was determined performing a multivariate logistic regression analysis. Final models were adjusted by socio-demographic and health factors

Results

Of the 838 participants examined, 699 had the information needed to establish the criteria for diagnosis of frailty. Those who had a higher probability of being frail included women (OR = 1.9), those who reported myocardial infarction (OR = 3.8), urinary incontinence (OR = 2.7), those who rated their oral health worse than others (OR = 3.2), and those who did not use dental services (OR = 2.1). For each additional year of age and each additional drug consumed, the probability of being frail increased 10% and 30%, respectively.

Conclusions

Utilization of dental services and self-perception of oral health were associated with a higher probability of being frail.

Total tooth loss and systemic correlates of inflammation: role of obesity

Obesity and edentulism are both associated with multiple systemic disorders with an inflammatory background including periodontal diseases. This study aimed to evaluate the different impact of obesity on inflammation in dentate and toothless subjects. The data came from the population-based, cross-sectional study SHIP (Study of Health in Pomerania). We determined anthropometric measures including BMI, waist-to-hip ratio (WHR), diagnostic periodontal parameters, and systemic metabolites. It was shown that measures of systemic markers of inflammation and lipid or glucose metabolism (P < 0.001) were increased with higher WHR. When adjusted for age, sex, smoking, diabetes, education, physical activity, and last dentist's appointment, C-reactive protein (CRP), fibrinogen, and leukocyte count were significantly related to WHR increasing from the first to the fourth WHR quartile (P < 0.001) as well as to the BMI. In both dentate and edentulous subjects higher WHR contributes significantly to increasing systemic CRP and fibrinogen with sex differences. In toothless subjects, while still dependent on increasing WHR, the inflammatory markers CRP and fibrinogen were higher than in dentate subjects, thereby revealing effect modification between sex and edentulism (P < 0.010). In conclusion, subjects with total tooth loss, although devoid of periodontal inflammation, may exhibit increased levels of systemic inflammatory mediators. Possible implications are discussed with respect to obesity and its relationship to inflammation.