Multimorbidity and tooth loss: the Brazilian National Health Survey, 2019

Understanding poor oral health among older adults in Türkiye: socioeconomic and healthcare access challenges

BACKGROUND

Oral health is an integral part of overall well-being, and older individuals are particularly vulnerable due to age-related changes and barriers to healthcare access. Despite Türkiye's comprehensive public health insurance system, significant disparities in oral health persist, highlighting the need for targeted research and interventions. This study assesses the oral health of people aged 65 and older in Türkiye and explores the factors linked to poor oral health, such as individual characteristics, lifestyle, socioeconomic status, social support, overall health, and access to healthcare services.

METHODS

A secondary analysis was performed using the cross-sectional 2022 Türkiye Health Survey, which gathered data from 3,144 individuals aged 65 and above. Oral health was self-reported, with poor oral health defined as participants rating their dental and gum condition as 'bad' or 'very bad.' Factors assessed included age, gender, education, social support, healthcare access, and the presence of chronic diseases.

RESULTS

Among the participants, 25.8% reported poor oral health. Key factors associated with this included being older, female, having lower levels of education, difficulty communicating in one's mother tongue, experiencing limitations in daily activities, and facing cost-related barriers to dental care. Multivariable analysis found that cost related barriers and limitations in daily activities had the strongest impact on oral health. The study also highlighted the importance of social support in maintaining better oral health.

CONCLUSIONS

Poor oral health in older adults in Türkiye is strongly influenced by cost-related barriers, limitations in daily activities, and lack of social support. Expanding public dental services, reducing out-of-pocket costs, and integrating oral health into chronic disease programs are critical steps. Providing culturally sensitive and mobile care options can also address mobility challenges and enhance oral health outcomes for the elderly.

Presumed periodontitis and multimorbidity patterns: a prospective cohort study in the UK Biobank

OBJECTIVES

To examine the pattern of multimorbidity among people with high risk of periodontitis.

MATERIALS AND METHODS

Over 358,000 UK Biobank participants aged 40-69 years at baseline who took part in the baseline assessment and answered mouth/teeth dental problems were included (2006-2010). Cox proportional hazard models and logistic regression models were used to estimate the association of the risk factors of periodontitis with chronic diseases and multimorbidity, stratified by follow-up time.

RESULTS

A total of 154,985 participants developed multimorbidity during follow-up. We observed increased risk of multimorbidity among participants with presumed periodontitis (adjusted HR = 1.06, 95% confidence interval [CI] = 1.05-1.08), especially in those participants with age < 50 years old (adjusted HR = 1.11, 95% CI = 1.08-1.14). Among the different multimorbidity patterns, presumed periodontitis was mainly associated with the mental disorder pattern and metabolic and vascular disease pattern.

CONCLUSIONS

Presumed periodontitis was positively associated with multimorbidity, even more so in younger age. We need to pay more attention to the prevention of periodontitis in the early stage to reduce the burden of multimorbidity in the future.

CLINICAL RELEVANCE

Early life interventions to prevent periodontitis are crucial to reduce the incidence of multimorbidity and enhance the quality of life in older adults. Additionally, greater attention should be given to the mental and cardiovascular metabolic health of patients with periodontitis.

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.

Multimorbidity and tooth loss: data from Chilean National Health Survey 2016-2017

BACKGROUND

Oral diseases are a significant global public health challenge. Current evidence indicates that several chronic conditions are individually associated with tooth loss. People are living with more than one chronic condition, known as multimorbidity (MM). Considering the common risk factors for oral and chronic diseases, this study aimed to evaluate the association between MM and tooth loss in the Chilean population.

METHODS

Cross-sectional study with secondary data from the latest Chilean National Health Survey (ENS 2016-17). The number of remaining teeth was classified into four groups: functional dentition (≥ 20 remaining teeth), moderate tooth loss (10 to 19), severe tooth loss (1 to 9), and edentulism (0). MM was defined based on the number of chronic conditions as a binary variable (MM≥ 2) and as a 4-level categorical variable (MMG0-G3), G0: none, G1: 1, G2: 2-4, and G3: ≥5 conditions. Stratified analysis by age group (< 65, ≥ 65 years) was performed. Mean and SD were calculated for crude and adjusted remaining teeth. Significance level was set to 0.05. Prevalence ratios were estimated with Poisson regression models with robust variance, crude and adjusted for sex, age, geographic area, and educational level. Logistic regressions models were fitted to calculate odds ratios as a sensitivity analysis.

RESULTS

Of 4,151 adults aged 17-98, 54.9% had MM and the prevalence of moderate, severe tooth loss and edentulism was 25.4%, 6.9% and 4.8% respectively. Adults aged ≥ 65 years with MM≥ 2 were 1.66 [1.04-2.66] times more likely to have severe tooth loss than those without MM. Adults aged < 65 years with MMG3 were 1.76 [1.12-2.77] times more likely to have moderate tooth loss and 2.55 [1.02-6.36] times more likely to have severe tooth loss than those without MM.

CONCLUSIONS

In this study, we found statistically significant associations between the number of chronic conditions and moderate/severe tooth loss in both analyzed age groups. These findings highlight the need to provide oral health care for adults with multimorbidity using a person-centred model and to seek strategies to prioritize health care.

Association between toothbrushing behavior and cardiometabolic multimorbidity among middle aged and older adults in North China: a cross-section study

OBJECTIVES

To evaluate the association between toothbrushing behavior and cardiometabolic multimorbidity (CMM) among middle-aged and older adults.

METHODS

Data from the Beijing Health Service Survey were used to estimate the association between toothbrushing behavior and the risk of CMM using multilevel logistic models (N = 18,158).

RESULTS

There were 554 patients with CMM, with a prevalence of 3.05%. We found a higher risk of CMM for those with toothbrushing once or less (OR = 2.16, 95%CI: 1.80, 2.59) compared with those brushed two or more times per day in the crude model. After adjusting for confounding factors, the association between the two remained significant (OR = 1.68, 95%CI: 1.39, 2.04). The effect size was higher in adults with a higher education level (OR = 2.32) compared to those with a lower education level (OR = 1.39, P forinteraction<0.01).

CONCLUSIONS

Poor toothbrushing practices were associated with CMM among middle-aged and older people. Longitudinal study can be considered to explore the causal association between the two and whether good toothbrushing habits can predict CMM and its progression.

Oral Health Literacy and Patient Education Practices Among Non-Dental Professionals in Chongqing, China: A Cross-Sectional Study

BACKGROUND Preventing oral diseases is a critical aim in maintaining general health. Non-dental professionals (NDPs) should understand oral health-related knowledge to help patients maintain oral and general health. We investigated the oral health knowledge, behaviors, and attitudes of NDPs regarding patient education and intersectoral collaborations for oral health. MATERIAL AND METHODS For this cross-sectional study, a web-based questionnaire of 36 questions was designed to collect characteristics, oral health knowledge, behaviors, and attitudes of spreading oral health knowledge. A total of 406 NDPs, including 166 doctors and 240 nurses, at 3 randomly selected hospitals in Chongqing, China, were included. Data were collected electronically and statistically analyzed using the chi-square test. RESULTS Only 35.96% and 39.41% of respondents disagreed with "extraction can cause loosening of adjacent tooth" and "tooth loss is a natural part of aging", respectively. Of the respondents, 92.12% were aware of oral healthcare needs before pregnancy; 67.48% agreed with cleaning the gums before the eruption of children's teeth; only 57.14% and 56.16% knew the start time of dental cleaning for children and the relatively safe period of dental treatment for pregnant women, respectively; 73.40% of respondents were interested in oral health knowledge, and they mainly consulted dental professionals; 95.56% agreed with intersectoral collaborations for oral health; and 68.47% thought to conduct oral health education in the future. CONCLUSIONS NDPs knew about common oral health knowledge; however, the oral healthcare knowledge for special groups was insufficient. NDPs should improve their ability to educate the public on oral health and establish intersectoral collaborations.

Association between oral health conditions and the risk of major noncommunicable diseases: A protocol for systematic review and meta-analysis

Objective

Although epidemiological studies suggest that oral health conditions may be associated with an increased risk of noncommunicable diseases, the findings have yet to be comprehensively synthesized, particularly for a major noncommunicable diseases-related health and economic burden. Therefore, we will perform a systematic review and meta-analysis of all available observational studies investigating the association between oral health conditions and subsequent risk of major noncommunicable diseases.

Methods

With limited English publications, we will search electronic databases, including MEDLINE, Embase, PubMed, Cochrane Library, Scopus, and CINAHL. Based on the temporal properties and natural course of disease progression, we will seek cohort or case-control studies that investigate the association between oral disease conditions and the risk of noncommunicable diseases. Regarding the World Health Organization agenda, oral health conditions will include dental caries, periodontal disease, oral cancer, edentulism, other oral conditions (i.e., oro-dental trauma, cleft lip and palate, and noma), and endodontic lesions. Based on the global disease burden, primary outcomes of interest will include the four major systemic noncommunicable diseases: cardiovascular diseases, cancers, chronic respiratory diseases, and type 2 diabetes mellitus. Random-effects meta-analysis will be used to estimate pooled effects estimate and 95% confidence intervals. Statistical heterogeneity will be investigated using the I 2 index and τ 2 statistics. Preplanned subgroup and sensitivity analyses and random-effects meta-regression analyses will be performed to address possible heterogeneity and establish the robustness of the meta-analytic estimates. The prediction intervals, expected (E)-value, and evidence certainty will be appraised to synthesize the findings and draw evidence-based conclusions.

Conclusion

This systematic review will summarize all available evidence regarding the association between oral health conditions and the risk of major noncommunicable diseases. The findings will encourage collaboration between oral health and primary care professionals for early detection and management of noncommunicable diseases and promote oral health well-being.

Systematic review registration

PROSPERO: CRD42021274184.

Estimating the burden of care for oral potentially malignant disorders and oral cancer in Brazilian dental practice

BACKGROUND

Oral cancer (OC) and oral potentially malignant disorders (OPMD) pose significant challenges to public health in Brazil. This study aimed to estimate the prevalence of oral cancer (OC) and oral potentially malignant disorders (OPMD) among patients who would be treated by Brazilian dentists during their careers.

MATERIAL AND METHODS

Data on the number of dentists in Brazil were extracted from the 2022 census data, while incidence rates for OC cases were sourced from the Brazilian National Cancer Institute (INCA). Population estimates for Brazil and data on dental check-up rates were obtained from relevant national sources.

RESULTS

Our analysis indicates that a general dentist in Brazil can expect to encounter on average two to three OC patients and on average 675 patients with OPMDs over a 35-year career. Regional disparities were observed, with certain regions showing higher than the average number of encounters due to low density of dentists in some rural districts.

CONCLUSIONS

Brazilian dentists are likely to confront a substantial number of OC and OPMD cases during their professional tenure, emphasizing the need for public health policies aimed at enhancing dental surgeons' education in oral cancer prevention and early detection.

Social Disadvantage and Multimorbidity Including Oral Conditions in the United States

Existing studies on multimorbidity have largely excluded oral diseases in multimorbidity prevalence estimates. The reason behind this is somewhat unclear, as chronic oral conditions are highly prevalent, affecting over half the global population. To address this gap, we examined the relationship between social disadvantage and multimorbidity, stratifying by the inclusion and exclusion of oral conditions. For participants aged 30 y and over (n = 3,693), cross-sectional analysis was carried out using the US National Health and Nutrition Survey (2013-2014). Multimorbidity was defined as having 2 or more chronic conditions. Five medical conditions were examined: diabetes, asthma, arthritis, cardiovascular disease, and depression, as well as 4 oral health conditions: caries, periodontal disease, number of teeth, and edentulousness. Education and income poverty ratio were selected as measures of social disadvantage. Multimorbidity prevalence estimates according to social disadvantage were analyzed on an absolute and relative scale using inverse probability treatment weighting (IPTW), adjusting for age, sex, and ethnicity. The inclusion of oral health conditions in the assessment of multimorbidity increased the overall prevalence of multimorbidity from 20.8% to 53.4%. Findings from IPTW analysis demonstrated clear social gradients for multimorbidity estimates stratified by the exclusion of oral conditions. Upon inclusion of oral conditions, the prevalence of multimorbidity was higher across all social groups for both education and income. Stratifying by the inclusion of oral conditions, the mean probability of multimorbidity was 27% (95% confidence interval [CI], 23%-30%) higher in the low-education group compared to the high-education group. Similarly, the mean probability of multimorbidity was 44% (95% CI, 40%-48%) higher in the low-income group. On a relative scale, low education was associated with a 1.52 times (95% CI, 1.44-1.61) higher prevalence of multimorbidity compared to high education. Low income was associated with a 2.18 (95% CI, 1.99-2.39) higher prevalence of multimorbidity. This novel study strongly supports the impact of chronic oral conditions on multimorbidity prevalence estimates.

Prevalence of complete edentulism among US adults 65 years and older: A Behavioral Risk Factor Surveillance System study from 2012 through 2020

BACKGROUND

The rapid growth of the older adult population in the United States and their increased risk of edentulism make it essential to analyze trends and factors associated with edentulism.

METHODS

Data were obtained from the Behavioral Risk Factor Surveillance System from 2012 through 2020. US- and state-level trend lines were reported. Multiple logistic regression analyses were used to evaluate the association between self-reported complete edentulism and demographic characteristics, chronic diseases, smoking status, and health insurance status. Multiple imputations were used to address the missing data.

RESULTS

A total of 771,513 (weighted n = 50,410,576) participants were included in the study. There was a significant (P = .021) downward trend in the prevalence of edentulism from 2012 (16.36%) through 2020 (13.54%). Having less than a high school education, being a smoker, being non-Hispanic Black, having an annual household income less than $75,000, and having chronic conditions, including diabetes, myocardial infarction, arthritis, depression, and stroke, were significantly associated with complete edentulism.

CONCLUSIONS

Despite a decrease in prevalence of edentulism, disparities based on race, income, and education still exist. Edentulism is associated with chronic diseases in older adults.

PRACTICAL IMPLICATIONS

Public health initiatives should be aimed at reducing the impact of edentulism and improving overall quality of life among older adults. Community health programs allocating resources to improve access to affordable care, reducing precursors to edentulism, expanding dental coverage, and promoting oral and general health awareness are vital components of these efforts.

Breastfeeding Duration Is Associated with the Risk of Tooth Loss, Chewing Difficulty, and Undernutrition among Older Korean Women: Results of the Korea National Health and Nutrition Examination Survey (KNHANES) 2013-2015

We investigated whether older Korean women with prolonged breastfeeding duration have an increased risk of tooth loss, chewing difficulty, or undernutrition, as well as whether tooth loss and chewing difficulty mediate the association between breastfeeding duration and undernutrition risk. This study included 1666 women aged ≥65 years from the 2013-2015 Korea National Health and Nutrition Examination Survey who breastfed after delivery. The number of teeth and chewing ability were investigated based on the status of individual teeth and a self-report questionnaire, respectively. Dietary intake was estimated using the 24 h recall method. Compared with women who breastfed for 1-18 months, the odds ratios for tooth loss were 1.16 (95% confidence interval [CI] = 0.69-1.94), 1.79 (95% CI = 1.08-2.94), and 1.86 (95% CI = 1.16-2.97) among women who breastfed for 19-36, 37-72, and ≥73 months, respectively (p for trend = 0.004). Similar results were obtained for chewing difficulty and undernutrition. Furthermore, tooth loss and chewing difficulty partially mediated the association between breastfeeding duration and undernutrition risk. In conclusion, older Korean women who breastfed for longer periods are more likely to experience tooth loss, chewing difficulty, and undernutrition, which are particularly severe among women who breastfed for ≥37 months. The association between breastfeeding duration and undernutrition risk is mediated by tooth loss and chewing difficulty.

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.

Multiple Chronic Diseases Associated With Tooth Loss Among the US Adult Population

Background

Half of US adults aged 20–64 years have lost at least one permanent tooth; one in six adults aged 65 and over in the USA is edentulous. Tooth loss and edentulism interfere with nutritional intake and quality of life. Although selected chronic diseases (e.g., diabetes) have been identified as possible risk factors for tooth loss, data on multiple chronic diseases and on having two or more concurrent chronic diseases (multimorbidity) in relation to tooth loss are lacking. Therefore, this study aimed to assess the association between multiple chronic diseases, multimorbidity, and tooth loss in US adults.

Methods

We performed a secondary data analysis using the US 2012 Behavioral Risk Factor Surveillance System (BRFSS), a national cross-sectional telephone survey studying health conditions and health behaviors among US adults (≥18 years) who are non-institutionalized residents. Variables were derived from the BRFSS Standard Core Questionnaire. Descriptive analysis including means, standard deviations (SDs), and percentages was calculated. Sample weights were applied. The stepwise multinomial logistic regression method was used to examine the relationship between several chronic diseases and tooth loss. Separate multinomial logistic regression models were used to examine the relationship between multimorbidity and tooth loss among all adults aged more than 18 years, adults aged 18–64 years, and adults aged more than 65 years, respectively.

Results

Among the samples (n = 471,107, mean age 55 years, 60% female), 55% reported losing no tooth loss, 30% reported losing one to five teeth, 10% reported losing six or more but not all teeth, and 5% reported losing all teeth. After adjusting for demographic characteristics, socioeconomic status, smoking, BMI, and dental care, chronic diseases that were associated with edentulism were chronic obstructive pulmonary disease (COPD) [adjusted risk ratio (adj. RR) 2.18, 95% confidence interval (CI) 2.08–2.29]; diabetes (adj. RR 1.49, 95% CI 1.44–1.56); arthritis (adj. RR 1.49, 95% CI 1.44–1.54); cardiovascular disease (adj. RR 1.38, 95% CI 1.30–1.45); stroke (adj. RR 1.31, 95% CI 1.24–1.40); kidney disease (adj. RR 1.16, 95% CI 1.08–1.25); cancer (adj. RR 1.05, 95% CI 1.01–1.11); and asthma (adj. RR 1.07, 95% CI 1.02–1.12). For those who reported losing six or more teeth, the association remained significant for all the chronic diseases mentioned, albeit the magnitude of association appeared to be comparative or smaller. In addition, adults with multimorbidity were more likely to have tooth loss (loss of one to five teeth: adj. RR 1.17, 95% CI 1.14–1.19; loss of six or more teeth: adj. RR 1.78, 95% CI 1.73–1.82; edentulous: adj. RR 2.03, 95% CI 1.96–2.10).

Conclusions

Multiple chronic diseases were associated with edentulism and tooth loss. People with multimorbidity are more likely to be edentulous than those with one or no chronic disease. The findings from this study will help to identify populations at increased risk for oral problems and nutritional deficits, thus the assessment of oral health should be evaluated further as an important component of chronic illness care.

Salivary Proteome, Inflammatory, and NETosis Biomarkers in Older Adult Practitioners and Nonpractitioners of Physical Exercise

Since aging has been associated with increased production of inflammatory biomarkers, the ability to monitor older adults repeatedly is highly desirable, and saliva is an interesting biofluid for the search of biomarkers, as it is easily accessible in a noninvasive manner. However, given the incipient knowledge of salivary biomarkers in aging and its relationship to physical exercise, the present study is aimed at evaluating the protein expression and the levels of inflammatory and NETosis biomarkers in the saliva of practitioners (PE) and nonpractitioners (NPE) of physical exercise older adults. Six (6) practitioner and 4 nonpractitioner older adults were enrolled in this study. Unstimulated whole saliva was collected for analysis of the proteome by label-free mass spectrometry, as well as of the inflammatory status by evaluation of C-reactive protein (CRP), vascular endothelial growth factor (VEGF), and cytokines (TNF-α, interleukin- (IL-) 1β, and IL-8), while NETosis was assessed by myeloperoxidase (MPO) and neutrophil elastase. Regarding oral health, the decayed, missing, and filled teeth (DMF-T) index, bleeding on probing, suppuration, and probing depth measurement (mm) were evaluated. In addition, functional capacity was investigated using the General Physical Fitness Index (GPFI). In relation to the proteome analysis, 93 and 143 proteins were found exclusively in the PE and NPE groups, respectively; 224 proteins were common to both groups. Among these proteins, 10 proteins showed statistical difference ( $p<0.05$ ) between the groups: alpha-2-macroglobulin, component 3 of the complement, serotransferrin, and protein soluble in brain acid 1 were less expressed, while lactotransferrin, alpha-amylase 1, S100-A8, S100-A9, lactoperoxidase, and galectin-3 binding protein were more expressed in the PE group. No differences between groups were observed in the analysis of inflammatory and NETosis biomarkers. This study shows the potential utility of saliva for detecting protein biomarkers in a noninvasive biological sample of the elderly population.