Longitudinal evaluation of periodontitis and tooth loss among older adults

Smoking impairs cognitive function through the mediating effect of periodontitis in older adults

OBJECTIVES

Evidence has shown that both smoking and periodontitis were linked to cognitive impairment. This study examines whether periodontitis mediates the effects of smoking status on cognitive function in older adults.

METHODS

Using data from the National Health and Nutrition Examination Survey (NHANES) 2011-2014, the study included 1728 older participants who have data on smoking, serum cotinine, periodontal examination, and cognitive function. Mediation analysis was performed to test whether extent of periodontitis mediated associations between smoking status and cognitive function, adjusted for sociodemographic and basic health factors.

RESULTS

Compared to never-smokers, daily smokers exhibited significantly worse global cognitive function, with periodontitis mediating this effect (effect= -0.16; 95% CI= -0.29, -0.05). Similarly, periodontitis mediated the association between serum cotinine levels and cognitive function in the total sample (effect= -0.02; 95% CI= -0.03, -0.00).

CONCLUSIONS

Periodontitis significantly mediates the impact of smoking on cognitive function. The findings highlight the potential roles of maintaining oral health and smoking cessation in mitigating cognitive decline.

Oral Health Status at Age 60 and 72 Years-A Longitudinal Study

OBJECTIVE

This study investigated oral health status in 60-year-old individuals over 12 years.

MATERIALS AND METHODS

Data were obtained from The Swedish National Study on Aging and Care (SNAC). One hundred nineteen 60-year-old individuals (48% females) underwent a clinical and radiographic baseline examination (2001-2003) and follow-up examination in 2013-2015. For statistical analyses, paired t-tests and McNemar's test were performed. Statistical significance was determined at p < 0.05.

RESULTS

At the 12-year follow-up, the mean number of teeth and the proportion of individuals having ≥ 20 teeth decreased (p < 0.001). The mean number of teeth with buccal/lingual and approximal caries lesions increased (p < 0.029 and p < 0.031). Individuals with a distance from the cement-enamel junction to the bone of ≥ 5 mm increased in total (p < 0.002) and in males (p < 0.006). The prevalence of gingivitis increased in total (p < 0.001). The prevalence of periodontitis showed a significant increase in total (p < 0.043) and in females (p < 0.039).

CONCLUSION

The present study indicates that oral health status in 60-year-old individuals deteriorates over 12 years. However, the deteriorations were minor in terms of tooth loss, caries lesions, and changes in periodontal status.

Systemic Factors Affecting Prognosis in Periodontics: Part II

This study gives an insight into certain systemic conditions and factors such as nutrition, age, hematological disorders, hypertension, smoking, obesity, and metabolic syndrome that have a notable effect on the periodontium. The review highlights the importance of taking these factors into consideration in periodontal therapy and their impact on the prognosis of periodontal therapies. The other systemic factors are discussed in detail elsewhere in the special issue.

Trend in the Incidence of Severe Partial Edentulism among Adults Using the Korean National Health Insurance Service Claim Data, 2014-2018

PURPOSE

Missing teeth is one of the most important indicators of oral health behavior and the result of dental caries, periodontal disease, and injuries. This study examined a trend in the incidence of severe partial edentulism (SPE) using the Korean National Health Insurance Service (KNHIS) data.

MATERIALS AND METHODS

Data of adults aged ≥20 years were obtained from the KNHIS for the 2014-2018 period. SPE was defined in dental information within a population with a treatment history of dental scaling as having 1 to 8 natural teeth. Crude incidence rates (CIRs) and age-standardized incidence rates (AIRs) with 95% confidence interval were calculated per 100000 persons. The Cochran Armitage trend (CAT) test and average annual percentage change were used to analyze SPE trends.

RESULTS

The CIRs among Korean adults were from 346.29 to 391.11 in 2014-2016 and from 391.11 to 354.09 in 2016-2018. The AIRs trend statistically increased by 4.31% from 346.29 to 376.80 and decreased by 4.72% from 376.80 to 342.10. The AIRs in men increased by 4.00% and decreased by 3.01%. The AIRs in women decreased by 2.18% and increased by 2.11% (CAT; p<0.01). The AIRs by region and income also showed trends of increase and decrease.

CONCLUSION

The study showed that the incidence trend of SPE increased and decreased from 2014 to 2018. This result would be able to aid in the planning of public oral health, and may also serve as fundamental data for verifying the impact of the public oral health policies implemented.

Systematic review of longitudinal studies on the association between cluster of health-related behaviors and tooth loss among adults

OBJECTIVES

To systematically review longitudinal studies on the association between cluster of/multiple health-related behaviors and tooth loss among adults.  Materials and methods: Inclusion criteria were prospective and retrospective longitudinal studies; adults; multiple or cluster of behaviors; tooth loss, one or more tooth lost and complete tooth loss. Exclusion criteria were intervention studies; cross-sectional studies; case-control studies; children under 18 years-old; single behavior. Two reviewers searched three databases up to April 2023. Open Grey and Google Scholar were searched for grey literature.  Results: Twelve longitudinal studies were included in this review. Nine studies had good quality, two had poor quality, and one had fair quality according to New-Castle-Ottawa Scale. According to ROBINS-E tool, nine studies were judged as moderate risk of bias while two studies were at low risk of bias and one study had serious risk of bias. One study assessed cluster of behavior, while others examined a number of separate health-related behaviors in relation to tooth loss. Meta-analysis was not feasible because of the high heterogeneity in exposure, measure of outcomes, covariates, sample size, and follow-up time. The research found an association between tooth loss and oral hygiene practices (two studies), dental attendance (four studies), smoking (six studies), and alcohol consumption (three studies).  Conclusion: This review provides evidence of a longitudinal association between cluster of/multiple health related-behaviors and tooth loss.

Assessment of nutritional status in chronic periodontitis patients: A cross-sectional study

Background

This cross-sectional study compared the nutritional status of chronic periodontitis (CP) patients who presented with various degrees of severity with systemically healthy individuals using the Mini Nutritional Assessment (MNA®) tool along with laboratory analysis of macro- and micronutrients.

Materials and Methods

This research enrolled a total of 84 participants, of which 63 belonged to the CP group while 21 served as healthy controls. The CP patients were divided into three groups of 21 each, based on severity as mild, moderate, and severe. Clinical periodontal parameters (plaque index, bleeding on probing, probing depth, clinical attachment level/loss, total number of teeth present [NOT-P], furcation involvement, pathological migration, and tooth mobility), biochemical parameters (lipid, protein, iron profiles, and Vitamin D3 and B12), and the MNA® tool were used to assess the nutritional status of all the participants. The results were analyzed statistically.

Results

NOT-P, MNA score, lipid profile (except very-low-density lipoprotein), iron profile (except total iron-binding capacity), and Vitamin D3 showed high significant differences (P < 0.001) among the groups. However, Vitamin B12 and protein profile except for total protein revealed significant differences (P < 0.05).

Conclusion

CP can be a contributing risk factor for the development of malnutrition. MNA® tool can be used for assessing the nutritional status of CP patients.

Oral Hypofunction and Risk of Weight Change among Independent Older Adults

Oral health is essential for nutritional status; however, little is known about its association with weight change. This study aimed to investigate whether the risk of weight change differs according to the presence of each important component of oral hypofunction (fewer remaining teeth, low chewing efficiency, swallowing problems, and xerostomia) among independent older adults. This was a three-year follow-up cohort study based on self-reported questionnaires. The participants were independent older adults aged ≥65 from the Japan Gerontological Evaluation Study (JAGES). We used >5% weight loss/gain during follow-up as the outcome variables, and the number of remaining teeth (≥20/10-19/0-9), the presence of chewing difficulty, swallowing problems, and xerostomia (yes/no) as the exposure variables. We fitted the Poisson regression model, including possible confounders to estimate the risk ratios (RRs) and 95% confidence intervals (CIs). For weight loss, RRs were significantly higher among those with 0-9 remaining teeth (RR = 1.17; 95% CI = 1.11-1.23), chewing difficulty (RR = 1.12; 95% CI = 1.07-1.16), and xerostomia (RR = 1.11; 95% CI = 1.06-1.16), but there was no significant association with swallowing problems (RR = 1.01; 95% CI = 0.97-1.06). For weight gain, we also found similar associations with oral hypofunction. Oral hypofunction among older adults could have non-negligible health impacts on nutritional status.

Oral health status and risk of incident diabetes: a prospective cohort study of 213,389 individuals aged 45 and over

AIMS

To examine whether simple measures of oral health are associated with incident diabetes.

METHODS

This prospective cohort study linked data from the 45 and Up Study, Australia, to administrative health records. The study participants were 213,389 men and women, aged ≥ 45 years, with no diabetes at baseline. The oral health of participants was assessed by questionnaire. Incident diabetes cases were ascertained based on self-report in follow-up questionnaires, linked data on medical and pharmaceutical claims, and hospitalisation data up until 2019. The association between oral health and incident diabetes were calculated using multivariable cox proportional hazards models.

RESULTS

During 2,232,215 person-years of follow-up, 20,487 (9.6%) participants developed diabetes. Compared with those with ≥20 teeth, the adjusted hazard ratio (aHR) for incident diabetes was 1.12 (95% Confidence Interval (CI): 1.08, 1.17) for 10-19 teeth, 1.20 (1.14, 1.26) for 1-9 teeth and 1.15 (1.09, 1.21) for no teeth. Compared with those with excellent/very good teeth and gums, the aHR for incident diabetes was 1.07 (1.03, 1.12) for fair and 1.13 (1.07, 1.20) for poor teeth and gums.

CONCLUSIONS

Simple measures of oral health were associated with risk of developing diabetes, demonstrating the potential importance of oral health screening for diabetes prevention.

Prevalence of Chronic Periodontitis and Chronic Stress in the South Indian Population

Background Chronic stress is commonly thought to have a net negative effect on the efficacy of the immune response, leading to an imbalance between host and parasite and consequently resulting in a periodontal breakdown. Aim To identify the prevalence of chronic periodontitis and chronic stress as well as a comparative evaluation of clinical, demographic, and psychoanalytical parameters among the South Indian population. Materials and methods A total of 500 subjects between the ages of 30 and 60 were chosen from the Trivandrum district, Kerala, using multistage random sampling. Subjects were evaluated based on psychoanalytical parameters as well as periodontal examination. Psychoanalytical parameters were measured by the questionnaire method using the perceived stress scale. Periodontal parameters examined were the probing depth, clinical attachment loss, bleeding on probing, simplified oral hygiene index, and community periodontal index (loss of attachment). Statistical Analysis Categorical and quantitative variables were expressed as frequency (percentage) and mean ± SD respectively. Logistic regression analysis was used to analyze the association between the periodontal variables and psychoanalytical variables. All the statistical analysis was performed using IBM Statistical Package for Social Sciences (SPSS) Statistics for Windows (IBM Corp., USA). Results A total of 500 subjects, of whom 308 (61.6%) were female and 192 (38.1%) were male, participated in this study. The overall prevalence of periodontitis among all the subjects was found to be 42.4%, and the proportion of periodontitis among the stressed participants was found to be 46.2%, which is 10% higher compared to the non-stressed (36.1%) participants. Conclusion Our study showed an increased frequency of periodontitis among the stressed subjects as compared to the non-stressed subjects. These findings suggest that there is a positive association between chronic stress and chronic periodontitis, but further prospective studies are required to establish the extent of the effect chronic stress has on chronic periodontitis and vice versa.

Tooth Loss Trajectories and Their Association with Functional Disability among Older Chinese Adults: Results from the Chinese Longitudinal Healthy Longevity Survey

BACKGROUND

Tooth loss becomes more prevalent with age and increases risk of functional disability. However, the strength of tooth loss varies between individuals rather than a uniform loss with age. We aimed to evaluate tooth loss trajectories and their association with functional disability among older Chinese adults.

METHODS

We included 16,209 participants aged ≥65 years from five waves of the Chinese Longitudinal Healthy Longevity Survey 2002-2014. The number of teeth, Activities of Daily Living (ADL), and Instrumental ADL (IADL) were assessed at baseline and subsequently every three years. ADL disability and IADL disability were defined as needing any help in any item of the Katz scale and a modified Lawton's scale, respectively. A group-based trajectory model was used to determine tooth loss trajectories based on the self-reported number of teeth and generalized estimating equation models were used to explore associations of tooth loss trajectories with ADL disability and IADL disability.

RESULTS

This study identified four tooth loss trajectories, including Progressively Mild Loss (14.4%), Progressively Severe Loss (21.5%), Persistently Severe Loss (45.1%), and Edentulism (19.0%) among older Chinese adults. Compared with the Progressively Mild Loss trajectory, the Progressively Severe Loss (ADL disability: OR=1.45, 95% CI: 1.15-1.84; IADL disability: OR=1.71, 95% CI: 1.47-1.99), Persistently Severe Loss (ADL disability: OR=2.33, 95% CI:1.93-2.82; IADL disability: OR=3.29, 95% CI: 2.82-3.84) and Edentulism (ADL disability: OR=3.25, 95% CI: 2.58-4.09; IADL disability: OR=3.60, 95% CI: 2.93-4.42) trajectories were significantly associated with an increased risk of functional disability with adjustment for potential confounders.

CONCLUSION

Four distinct tooth loss trajectories were identified among older adults and those with severe tooth loss trajectories had an increased risk of functional disability than those with a mild loss trajectory.

Association between oral health markers and decline in muscle strength and physical performance in later life: longitudinal analyses of two prospective cohorts from the UK and the USA

BACKGROUND

Poor oral health could be associated with changes in musculoskeletal health over time. This aim of this study was to investigate the longitudinal relationship between oral health and decline in physical function in later life.

METHODS

We did a prospective analysis of two cohorts of older adults (aged 70 years or older) including men from the British Regional Heart Study (BRHS; n=612), and men and women from the Health, Aging and Body Composition (Health ABC) Study (n=1572), followed up for about 8 years. Data were available for clinical or self-reported oral health measures, muscle (grip) strength, and physical performance (chair stand and gait speed). ANCOVA models were used to assess the association between oral health and follow-up physical function scores. Multivariate logistic regression models were used to examine the associations between oral health and decline in physical function over the follow-up period. In the BRHS, changes in oral health and physical function were also assessed. All models were adjusted for relevant sociodemographic, behavioural, and health-related factors.

FINDINGS

In the BRHS, complete tooth loss and difficulty eating were associated with weaker grip strength at follow-up, and periodontal status was associated with decline in gait speed. In the Health ABC Study, complete tooth loss, poor self-rated oral health, and the presence of one oral health problem were associated with slower gait speed at follow-up. In both studies, dry mouth was associated with declines in physical function. In the BRHS, deterioration of dentition (tooth loss) over the follow-up period was associated with decline in chair stand speed (adjusted odds ratio 2·34 [95% CI 1·20-4·46]), as was deterioration in difficulty eating (2·41 [1·04-5·60]).

INTERPRETATION

Oral health problems are associated with poorer physical function and greater decline in physical function in older adults, and could be an indicator of individuals at risk of reduced physical capacity and subsequent frailty and disability in later life.

FUNDING

The Dunhill Medical Trust and the US National Institutes of Health-National Institute of Dental and Craniofacial Research.

Oral Health Status of Residents in Jiangsu Province, China: An Epidemiologic Survey

Introduction

This study was conducted to characterise the oral health conditions of residents in Jiangsu Province, China.

Methods

In this descriptive study, 5 groups of participants were selected by a multistage stratified equal capacity random sampling, including 3- to 5-year-olds, 12- to 15-year-olds, 35- to 44-year-olds, 55- to 64-year-olds, and 65- to 74-year-olds. The data were collected by using the fifth edition of Oral Health Surveys-Basic Methods recommended by the World Health Organization (WHO).

Results

In these 5 groups, the mean DMFT/dmft of coronal caries were 3.07, 0.69, 4.03, 7.15, and 11.97, respectively, resulting in prevalence rates of 59.69%, 34.98%, 52.05%, 56.86%, and 72.19%, respectively. However, the filling rates were low in all age groups (1.88%, 17.53%, 29.88%, 16.13%, and 19.36%, respectively). Only 3.58% of the 12-year-old participants had good pit and fissure sealants. The adults include three groups, 35- to 44-year-olds, 55- to 64-year-olds, and 65- to 74-year-olds, and the prevalence rates of clinical attachment loss (CAL ≥4 mm) were 32.19%, 76.47%, and 85.43%, respectively. The proportions of adult groups with implant dentures, fixed dentures, removable partial dentures, complete dentures, and substandard dentures were 0%, 26.44%, 11.11%, 0.67%, and 4.89%, respectively. Additionally, 49.64% of adults had missing teeth that were not replaced.

Conclusions

Dental caries and periodontal disease were frequent and common in Jiangsu, China. But only a few of the residents sought treatment. Oral diseases continued to be a major problem for local residents.

Salivary metabolites associated with a 5-year tooth loss identified in a population-based setting

BACKGROUND

Periodontitis is among the most common chronic diseases worldwide, and it is one of the main reasons for tooth loss. Comprehensive profiling of the metabolite content of the saliva can enable the identification of novel pathways associated with periodontitis and highlight non-invasive markers to facilitate time and cost-effective screening efforts for the presence of periodontitis and the prediction of tooth loss.

METHODS

We first investigated cross-sectional associations of 13 oral health variables with saliva levels of 562 metabolites, measured by untargeted mass spectrometry among a sub-sample (n = 938) of the Study of Health in Pomerania (SHIP-2) using linear regression models adjusting for common confounders. We took forward any candidate metabolite associated with at least two oral variables, to test for an association with a 5-year tooth loss over and above baseline oral health status using negative binomial regression models.

RESULTS

We identified 84 saliva metabolites that were associated with at least one oral variable cross-sectionally, for a subset of which we observed robust replication in an independent study. Out of 34 metabolites associated with more than two oral variables, baseline saliva levels of nine metabolites were positively associated with a 5-year tooth loss. Across all analyses, the metabolites 2-pyrrolidineacetic acid and butyrylputrescine were the most consistent candidate metabolites, likely reflecting oral dysbiosis. Other candidate metabolites likely reflected tissue destruction and cell proliferation.

CONCLUSIONS

Untargeted metabolic profiling of saliva replicated metabolic signatures of periodontal status and revealed novel metabolites associated with periodontitis and future tooth loss.

Finite element analysis of bone remodelling with piezoelectric effects using an open-source framework

Bone tissue exhibits piezoelectric properties and thus is capable of transforming mechanical stress into electrical potential. Piezoelectricity has been shown to play a vital role in bone adaptation and remodelling processes. Therefore, to better understand the interplay between mechanical and electrical stimulation during these processes, strain-adaptive bone remodelling models without and with considering the piezoelectric effect were simulated using the Python-based open-source software framework. To discretise numerical attributes, the finite element method (FEM) was used for the spatial variables and an explicit Euler scheme for the temporal derivatives. The predicted bone apparent density distributions were qualitatively and quantitatively evaluated against the radiographic scan of a human proximal femur and the bone apparent density calculated using a bone mineral density (BMD) calibration phantom, respectively. Additionally, the effect of the initial bone density on the resulting predicted density distribution was investigated globally and locally. The simulation results showed that the electrically stimulated bone surface enhanced bone deposition and these are in good agreement with previous findings from the literature. Moreover, mechanical stimuli due to daily physical activities could be supported by therapeutic electrical stimulation to reduce bone loss in case of physical impairment or osteoporosis. The bone remodelling algorithm implemented using an open-source software framework facilitates easy accessibility and reproducibility of finite element analysis made.

Will implants with a fixed dental prosthesis in the molar region enhance the longevity of teeth adjacent to distal free-end edentulous spaces?

OBJECTIVES

Clinical evidence demonstrating the effectiveness of implants in preventing tooth loss is limited because of the many risk factors involved in tooth loss. This retrospective cohort study investigated whether an implant in the molar region of a distal free-end edentulous space affects the loss of the most distal tooth after 6 years, adjusting for other risk factors associated with tooth loss using propensity score matching analysis.

MATERIAL AND METHODS

A total of 571 subjects and 1,085 teeth adjacent to a distal free-end edentulous space were evaluated. At baseline, the 1,085 teeth were divided into two groups according to the presence or absence of a molar implant with a fixed dental prosthesis in the distal free-end edentulous space. Propensity score matching analysis was used to reduce the effects of bias by matching teeth with and without implants according to similar background factors at baseline. The adjusted variables were age group, occlusal support status, Kennedy classification, tooth position, tooth type, restoration status, dental caries, periodontal pocket depth, and condition of the opposing tooth.

RESULTS

A total of 56 teeth (28 associated with a molar implant; 28 with no implant) were enrolled according to propensity score matching. Fisher's exact test showed that a molar implant significantly protected the tooth adjacent to the distal free-end edentulous space (p = .01).

CONCLUSIONS

Within the limitations of this retrospective cohort study, it was found that implants in free-end edentulous spaces may be beneficial in extending the longevity of adjacent teeth. Further research will be necessary to confirm this finding.

Association between periodontitis and Alzheimer's disease and its impact on the self-perceived oral health status: a case-control study

PURPOSE

To test the hypothesis that periodontitis is associated with AD and search whether periodontal and other variables would negatively impact the oral health-related quality of life (OHRQoL) perception.

MATERIALS AND METHODS

Oral examinations and interview on self-perceived oral health status (Geriatric Oral Health Assessment Index (GOHAI) questionnaire (higher score corresponds to better perceived oral status)) were carried out and socio-demographic data were collected from outpatients with mild to moderate AD (cases, n = 50) and from their age- and sex-matched family caregivers (controls, n = 52). Full-mouth periodontal examination was performed. Significance of differences between groups was sought by chi-square, Student's t, or the Mann-Whitney test. The association between the variables periodontitis, probing depth (PD) ≥ 5 mm, and clinical attachment loss (CAL) ≥ 5 mm with the variable group was tested in binary logistic regression models (LRMs). LRMs were used to test the association of oral findings, demographics, and group with GOHAI.

RESULTS

Cases had fewer teeth and greater CAL than controls. Cases had a superior percentage of sites with plaque, calculus, and bleeding on probing than controls. Cases had greater GOHAI scores than controls. Periodontitis was a variable most likely associated with AD (OR = 11.08, p < 0.001). None of the oral findings or demographics, but group, was associated with GOHAI (OR = 14.45, p < 0.001).

CONCLUSION

Periodontitis is associated with AD, but not with patients' OHRQoL.

CLINICAL RELEVANCE

Health care professionals must be aware that AD patients should have a periodic thorough oral examination and preventive intervention aiming at their welfare and maintenance of a pain-free functional dentition.

Association between oral health and incidence of pneumonia: a population-based cohort study from Korea

Pneumonia is related to oral health of the elderly and intensive care unit patients. However, studies on the relationship between overall oral health and pneumonia in the general population have been limited. The purpose of this study was to investigate the association between oral health and pneumonia using a nationwide population-based Korean cohort database. Data from 122,251 participants who underwent health screening and oral examinations in 2004 or 2005 were analyzed. Cox proportional hazard regression analysis was performed to evaluate the association between oral health and pneumonia. The risk of pneumonia increased significantly in groups with a higher number of dental caries and missing teeth, with respective adjusted hazard ratios (HRs) and 95% confidence interval (CI) of 1.265 (1.086–1.473; p = 0.0025) and 1.218 (1.113–1.332; p < 0.0001), and decreased significantly in frequent tooth brushing and regular professional dental cleaning groups, with respective adjusted HRs and 95% CI of 0.853 (0.786–0.926; p = 0.0001) and 0.920 (0.855–0.990; p = 0.0255). In addition, regardless of age and comorbidities, oral health status and oral hygiene behaviors were associated with pneumonia. The results indicate that improved oral health may reduce the risk of pneumonia in the general population.