Exploring the association between number of teeth, food intake, and cognitive function: A 9-year longitudinal study

OBJECTIVES

This study aimed to investigate the association between the number of teeth, food intake, and cognitive function in Japanese community-dwelling older adults.

METHODS

This 9-year longitudinal study included a total of 293 analyzable participants who participated in baseline and follow-up surveys. Dental status (number of teeth and periodontal pocket depth), dietary assessment using the brief-type self-administered diet history questionnaire, cognitive function, and the following confounding factors were evaluated: educational level, financial satisfaction, living situation, smoking and drinking habits, history of chronic diseases, apolipoprotein E-ε4 carrier, body mass index, handgrip strength, instrumental activities of daily living, and depressive symptomatology. The Japanese version of the Montreal Cognitive Assessment was used to evaluate cognitive function. A multinomial logistic regression analysis for the intake level of each food categorized into three groups (low, moderate, high), and a generalized estimating equation (GEE) for cognitive function over nine years were performed.

RESULTS

After controlling for confounding factors, the number of teeth was shown to be associated with the intake of green-yellow vegetables and meat. Furthermore, the GEE indicated that the lowest quartile of intake of green-yellow vegetables significantly associated with lower cognitive function (unstandardized regression coefficient [B] = -0.96, 95 % confidence interval [CI]: -1.72 to -0.20), and the lowest quartile of intake of meat significantly associated with lower cognitive function (B = -1.42, 95 % CI: -2.27 to -0.58).

CONCLUSIONS

The intake of green and yellow vegetables and meat, which is influenced by the number of teeth, was associated with cognitive function in Japanese community-dwelling older adults.

CLINICAL SIGNIFICANCE

There are few studies that have examined the association between oral health, food intake, and cognitive function. This 9-year longitudinal study suggests that it is important to maintain natural teeth to enable the functional means to consume green-yellow vegetables and meat, and thereby help maintain cognitive function.

Association between tea types and number of teeth: a cross-sectional study of the Chinese Longitudinal Healthy Longevity Survey

BACKGROUND

Previous studies have suggested that tea consumption may have a positive impact on oral health. However, the effects of different tea types on oral health remain unclear. Therefore, this study aimed to determine the association between residual teeth and consumption habits of different types of tea (green tea, black tea, oolong tea, and scented tea) in older adults.

METHODS

We conducted a secondary analysis using data from the Chinese Longitudinal Healthy Longevity Survey in 2018. In a sample of 6,387 older adults, we performed logistic regression analysis to examine the relationship between persistent tea consumption and oral health according to sex and brushing frequency. The indices for particularly healthy oral health and relative health were set at more than 20 teeth and more than 10 teeth, respectively.

RESULTS

The study included 2,725 males and 3,662 females, both aged 65 and older. Among individuals with more than 20 teeth, drinking green tea significantly improved oral health in men (adjusted odds ratio [ORs]: 1.377; 95% confidence interval [CI]: 1.082-1.752) and drinking black tea significantly improved the oral health of women (ORs: 2.349, 95%CI: 1.028-5.366). In the daily brushing group, green tea had a significant beneficial effect on increasing the number of teeth in men and black tea had a significant beneficial effect in women. Among individuals with more than 10 teeth, drinking green tea significantly improved oral health in men (ORs: 1.539; 95% CI: 1.209-1.959) and drinking green tea and scented tea significantly improved the oral health of women (ORs: 1.447, 95%CI: 1.052-1.991; ORs: 1.948, 95%CI: 1.137-3.340). In the daily brushing group, consumption of green tea and black tea had significant beneficial effects on increasing the number of teeth in men, whereas that of green tea, black tea, and scented tea had significant beneficial effects in women.

CONCLUSION

Long-term green tea consumption in males and black tea consumption in females were significantly associated with maintaining functional dentition (≥20 teeth). Similarly, long-term green tea consumption in males and green tea and scented tea consumption in females were associated with avoiding severe tooth loss (≥10 teeth). Furthermore, in the daily tooth brushing group, long-term consumption of black tea was associated with avoiding severe tooth loss in both sexes. However, tea consumption alone had no effect on oral health without good brushing habits.

Validity of self-reported number of teeth among Saudi older adults: A public health perspective

Objectives

This study aimed to evaluate the agreement between self-reported and clinically measured numbers of teeth in older adults from Almadinah Almunawwarah, KSA, and to identify factors associated with self-reporting accuracy.

Methods

This study included 337 older adults (≥60 years). Participants completed a survey assessing sociodemographic characteristics, self-rated oral and general health, and the self-reported number of teeth. Clinical examination was conducted using the 2013 criteria published by the World Health Organization. Bland-Altman plots and correlation coefficients were used to assess the agreement between self-reported and clinically measured teeth.

Results

The mean age of the study participants was 67.1 (SD = 6.5) years, and the majority were males (71.2%). The self-reported teeth count was higher than the clinically measured number, and only 47.7% (n = 161) of the sample showed complete agreement between the two measures. The mean difference between the self-reported and clinically recorded number of teeth was 0.41 teeth, and almost two-thirds of the study participants reported their number of teeth within an error margin of two teeth (p < 0.001). Both Spearman's and Pearson's correlation methods revealed a significant positive correlation between the two measures. Specifically, the Spearman's rho was 0.91, while Pearson's r coefficient was 0.96.

Conclusion

Among Saudi older adults, the self-reported number of teeth correlated with the clinically measured numbers of teeth. This suggests that self-reports can be a reliable and cost-effective method for assessing oral health in large-scale surveys, potentially guiding health policies and interventions for older adults.

Empirically derived dietary patterns in relation to periodontitis and number of teeth among Norwegian adults

OBJECTIVES

To explore dietary patterns in relation to periodontitis and number of teeth.

DESIGN

A cross-sectional study.

SETTING

We used data from the seventh survey of the Tromsø Study in Norway, 2015-2016. Three periodontitis groups were compared: (i) no periodontitis/slow bone loss; (ii) moderate bone loss; and (iii) rapid bone loss. Number of teeth was categorised as 25-28, 20-24 and ≤ 19. Dietary patterns were identified by principal component analysis. Multiple logistic regression was applied to examine associations between tertiles of dietary pattern scores and periodontitis, and between these same tertiles and number of teeth.

PARTICIPANTS

1487 participants (55·5 % women) aged 40-79 years who were free of major chronic diseases, attended an oral health examination and completed a FFQ.

RESULTS

Four dietary patterns were identified, which explained 24 % of the total variability in food intake: fruit and vegetables, Westernised, meat/fish and potatoes, and refined grain and dessert. The fruit and vegetables pattern was inversely associated with periodontitis characterised by rapid bone loss when compared with no periodontitis/slow bone loss (OR tertile 3 v. 1 0·49, 95 % CI: 0·25, 0·98). Participants who were in the highest tertile of the refined grain and dessert pattern (tertile 3 v. 1) had 2·38- and 3·52-fold increased odds of having ≤ 19 than 20-24 and 25-28 teeth, respectively.

CONCLUSION

Out of four identified dietary patterns, only the fruit and vegetables pattern was negatively associated with advanced periodontitis. A more apparent positive association was observed between the refined grain and dessert pattern and having fewer teeth (≤ nineteen teeth).

Association of a lesser number of teeth with more risk of developing depressive symptoms among middle-aged and older adults in Japan: A 20-year population-based cohort study

OBJECTIVES

This 20-year prospective cohort study aimed to longitudinally explore the relationship between the number of teeth and the incidence of depressive symptoms among community-dwelling middle-aged and older adults.

METHODS

Data were collected from the National Institute for Longevity Sciences-Longitudinal Study of Aging (NILS-LSA) database from 2002 to 2022 (3rd-9th waves). Data of adults aged ≥40 years were analyzed and those who had depressive symptoms at baseline (3rd wave), had missing data, or did not participate in follow-up, were excluded. We collected data on the number of teeth at baseline. Depressive symptoms were defined as a score of ≥16 on the Center for Epidemiologic Studies Depression Scale. The generalized estimating equation (GEE) model was used to examine the longitudinal relationships between the number of teeth at baseline and the subsequent incidence of depressive symptoms.

RESULTS

The final analysis included 1668 participants, with a mean (standard deviation) age of 58.8 (11.1) years and a mean follow-up time of 12.9 years. After GEE analysis with adjustment for multiple covariates, compared to participants with ≥20 teeth, participants with 10-19 teeth and < 10 teeth at baseline were associated with a higher risk of depressive symptoms. The subgroup analysis showed that the effect was stronger in men than in women.

CONCLUSIONS

Among middle-aged and older community dwellers, particularly men, a small number of teeth after the age of 40 was associated with the future incidence of depressive symptoms.

Association between number of remaining teeth and incident depression in a rural Chilean cohort

OBJECTIVES

Previous studies have established an association between tooth loss and depression. However, longitudinal evidence is scarce and needs to be verified in other populations. The aim of this study was to examine the longitudinal association between the number of remaining teeth and incident depression at 2- and 4-years follow-up in individuals enrolled in the Maule cohort (MAUCO) in Chile.

METHODS

This prospective study used the information of individuals, aged 38 to 74 years, excluding those with depression at baseline. The number of remaining teeth at baseline was determined in four groups: "20 or more teeth", "10 to 19 teeth", "1 to 9 teeth" and "no natural teeth". Depression was measured through the PHQ-9. Logistic regression was performed to calculate the odds ratios (OR) for incidence depression at both periods of follow-ups, adjusting for age, sex, educational attainment, diabetes mellitus II, and stressful events at follow-up. Also, we performed adjusted multinomial logistic models to analysis the association between the number of remaining teeth and depression severity.

RESULTS

In total individuals (n = 3335 at follow 1, n = 2461 at follow 2), all groups have ORs for incident depression above 1 considering 20 or more teeth as reference. In men, those with 10-19 teeth have 2.44 times higher odds of incident depression than those with 20 or more teeth (OR 2.44, CI 95% 1.33-4.50). Edentulous subjects at 4 years follow-up had 2.24 times higher odds of depression than those with more than 20 teeth (OR 2.24 CI 95%1.35-3.72). In women, the ORs (CI 95%) of incident depression were 2.56 (1.50-4.39), 1.56 (1.02-2.40) and 1.27 (0.90-1.81) for "none", "1-9", "10-19" respectively in comparison to the reference group. In edentulous individuals at baseline, the odds for each of the comparisons "mild vs no", "moderate vs no", "moderately severe vs no" and "severe vs no" were above 1, at both follow-ups.

CONCLUSION

Individuals with less than 20 teeth in the mouth could had higher odds of incident depression at 2- and 4-years follow-up, with differences between men and women. Also, in our study, edentulism was associated with increased odds of incident depression at 4-years follow-up in women, and with higher levels of severity of depressive symptoms.

[Multivariable analysis of tooth loss in subjects with severe periodontitis over 4-year natural progression]

OBJECTIVE

To evaluate the characteristics of severe periodontitis with various number of tooth loss during 4-year natural progression, and to analyze the factors related to higher rate of tooth loss.

METHODS

A total of 217 patients aged 15 to 44 years with severe periodontitis were included, who participated in a 4-year natural progression research. Data obtained from questionnaire survey, clinical examination and radiographic measurement. Tooth loss during 4-year natural progression was evaluated. The baseline periodontal disease related and caries related factors were calculated, including number of teeth with bone loss > 50%, number of missing molars, number of teeth with widened periodontal ligament space (WPDL), number of teeth with periapical lesions and etc. Characteristics of populations with various number of tooth loss and the related factors that affected higher rate of tooth loss were analyzed.

RESULTS

In 4 years of natural progression, 103 teeth were lost, and annual tooth loss per person was 0.12±0.38. Nine patients lost 3 or more teeth. Thirty-four patients lost 1 or 2 teeth, and 174 patients were absent of tooth loss. Molars were mostly frequent to lose, and canines presented a minimum loss. The number of teeth with WPDL, with periapical lesions, with intrabony defects, with probing depth (PD)≥7 mm, with PD≥5 mm, with clinical attachment loss≥5 mm, with bone loss > 50% and with bone loss > 65% were positively correlated to number of tooth loss. Results from orderly multivariate Logistic regression showd that the number of teeth with bone loss > 50% OR=1.550), baseline number of molars lost (OR=1.774), number of teeth with WPDL (1 to 2: OR=1.415; ≥3: OR=13.105), number of teeth with periapical lesions (1 to 2: OR=4.393; ≥3: OR=9.526) and number of teeth with caries/residual roots (OR=3.028) were significant risk factors related to higher likelihood of tooth loss and multiple tooth loss.

CONCLUSION

In 4 years of natural progression, the number of teeth with bone loss > 50%, baseline number of missing molars, number of teeth with WPDL, baseline number of teeth with periapical lesions and number of teeth with caries/residual roots were significantly related to higher risk of tooth loss and multiple tooth loss among Chinese young and middle-aged patients with severe periodontitis in rural areas.

Cross-sectional study of the factors associated with the number of teeth in middle-aged and older persons with intellectual disabilities

BACKGROUND

We investigated the number of teeth in middle-aged and older individuals with intellectual disability and evaluated the related factors.

METHODS

A questionnaire survey on oral health was administered to 604 persons over 40 years old with intellectual disabilities in Aichi Prefecture, Japan. The questionnaire designed for this study included items on diagnosis of disability, severity of intellectual disability and type of residence. As oral-health-related factors, the proxy-reported number of teeth, family dentist, regular dental check-ups, problems during dental treatment and tooth-brushing frequency were evaluated. A multinomial logistic regression analysis was performed using the proxy-reported number of teeth (≥20, 10-19 or 0-9) as the dependent variable, and the odds ratios (ORs) and 95% confidence intervals (CIs) of independent variables were calculated. In addition, linear regression analysis was performed using the proxy-reported number of teeth as the dependent variable.

RESULTS

In the multivariate multinomial logistic regression analysis, age, diagnosis of disability and type of residence were significantly associated with having 10-19 versus ≥20 teeth. Participants with autism spectrum disorder had a significantly lower OR for 10-19 teeth compared with those with intellectual disability [OR (95% CI): 0.49 (0.22-1.08)]. Age, diagnosis of disability, regular dental check-ups and tooth-brushing frequency were significantly associated with having 0-9 versus ≥20teeth. Participants with Down syndrome had a significantly higher OR for 0-9 teeth compared with those with intellectual disability [OR (95% CI): 3.17 (1.09-9.23)]. The ORs for 0-9 teeth of participants who did not attend regular dental check-ups and who brushed their teeth 1 time/day compared with ≥3 times/day were significantly high, and the OR (95% CI) was 2.37 (1.06-5.30) and 4.76 (1.09-20.77), respectively. [Corrections made on 22 August 2022, after first online publication: in the previous sentence, "who attend" has been changed to "who did not attend".] In the multivariate linear regression analysis, age, diagnosis of disability and regular dental check-ups were significantly associated with the proxy-reported number of teeth. The proxy-reported number of teeth was -0.42 less with each 1-year increase in age. With autism spectrum disorder, the proxy-reported number of teeth was 0.74 more compared with intellectual disability. In Down syndrome, the proxy-reported number of teeth was -0.93 less compared with intellectual disability. The proxy-reported number of teeth was -2.12 less for those who did not have regular dental check-ups.

CONCLUSIONS

The number of teeth in middle-aged and older individuals with intellectual disability was related to age and the type of disability. Regular dental visits may be effective at preventing tooth loss in middle-aged and older persons with intellectual disability.

Nutrition mediates the relationship between number of teeth and sarcopenia: a pathway analysis

Objectives

The relationship between the number of teeth and sarcopenia remains poorly investigated. Although nutrition plays an important role in maintaining bone and muscle health, the complex relationship between number of teeth and nutrition in the pathogenesis of sarcopenia remains to be elucidated.

Methods

A large multi-ethnic sample of 4149 participants aged over 50 years old from West China Health and Aging Trend (WCHAT) study was analyzed. We examined the associations between number of teeth with nutritional status and sarcopenia, and the mediating role of nutrition in the association between number of teeth and sarcopenia. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019. We assessed nutrition using Mini Nutrition Assessment-Short Form (MNA-SF) scale. Direct relationships between number of teeth, nutrition and sarcopenia were assessed using multiple linear regression. Mediation models and structural equation model (SEM) pathway analysis were used to test the mediating role of nutrition in the relationship between number of teeth and sarcopenia.

Results

Of 4149 participants aged 50 years old or older, the prevalence of sarcopenia was 22.5, 9.0% for moderate sarcopenia, and 13.5% for severe sarcopenia, respectively. Regression analysis indicated a total association between number of teeth (β = − 0.327, 95% CI − 0.471 to − 0.237, p < 0.001) and sarcopenia. After adjusted MNA-SF scores, the association between number of teeth and sarcopenia was still significant (β = − 0.269, 95% CI − 0.364 to − 0.175, p < 0.001), indicating a partial mediation effect of nutrition. Mediation analysis verified nutrition partially mediate the associations between number of teeth and sarcopenia (indirect effect estimate = − 0.0272, bootstrap 95% CI − 0.0324 to − 0.0222; direct effect estimate = − 0.0899, bootstrap 95% CI − 0.1049 to − 0.0738). And this mediation effect was through impacting SMI (indirect effect estimate = − 0.0283, bootstrap 95% CI − 0.0336 to − 0.0232) and grip strength (indirect effect estimate = − 0.0067, bootstrap 95% CI − 0.0094 to − 0.0043). Structural equation model (SEM) framework pathway analysis confirmed the association between number of teeth, nutrition, and sarcopenia.

Conclusions

Our findings indicated that sarcopenia was associated with number of teeth and poorer nutritional status, with nutrition partially mediating the association between number of teeth and sarcopenia. Our findings supported early nutritional assessment and intervention in oral health to mitigate the risk of sarcopenia.

The validity of self-reported number of teeth and edentulousness among Norwegian older adults, the HUNT Study

Background

Number of teeth is an established indicator of oral health and is commonly self-reported in epidemiological studies due to the costly and labor-intensive nature of clinical examinations. Although previous studies have found self-reported number of teeth to be a reasonably accurate measure, its accuracy among older adults ≥ 70 years is less explored. The aim of this study was to assess the validity of self-reported number of teeth and edentulousness in older adults and to investigate factors that may affect the accuracy of self-reports.

Methods

This study included two different samples of older adults ≥ 70 years drawn from the fourth wave of the Trøndelag Health Study (the HUNT Study), Norway. Sample 1 (n = 586) was used to evaluate the validity of self-reported number of teeth and sample 2 (n = 518) was used to evaluate self-reported edentulousness. Information on number of teeth and background variables (education, smoking, cognitive function, and self-perceived general and oral health) were self-reported in questionnaires, while clinical oral health examinations assessed number of teeth, number of teeth restored or replaced by fixed prosthodontics and edentulousness. Spearman and Pearson correlation coefficients, Bland–Altman plot, chi-square test and kappa statistics were used to assess the agreement between self-reported and clinically recorded number of teeth.

Results

The mean difference between self-reported and clinically recorded number of teeth was low (− 0.22 teeth), and more than 70% of the participants reported their number of teeth within an error of two teeth. Correlations between self-reports and clinical examinations were high for the total sample (0.86 (Spearman) and 0.91 (Pearson)). However, a lower correlation was found among participants with dementia (0.74 (Spearman) and 0.85 (Pearson)), participants having ≥ 20 teeth (0.76 (Spearman) and 0.67 (Pearson)), and participants with ≥ 5 teeth restored or replaced by fixed prosthodontics (0.75 (Spearman) and 0.77 (Pearson)). Self-reports of having teeth or being edentulous were correct in 96.3% of the cases (kappa value 0.93, p value < 0.001).

Conclusions

Among older Norwegian adults, self-reported number of teeth agreed closely with clinical tooth counts and nearly all the edentulous participants correctly reported having no teeth.

Association of tooth loss with morbidity and mortality by diabetes status in older adults: a systematic review

OBJECTIVE

This systematic review assesses the association of tooth loss (TL), as the exposure, with morbidity and mortality by diabetes mellitus (DM) status, as the outcome, in older adults.

BACKGROUND

Individuals with DM have higher prevalence of severe TL and increased risk of developing morbidities and mortality. No systematic review has evaluated the association between TL with morbidity and mortality by DM status.

MATERIAL AND METHODS

Comprehensive searches used multiple publication databases containing reports published between 01/01/2000 and 04/21/2021. Two authors independently evaluated included studies for quality and risk of bias using the Critical Appraisal Skills Programme (CASP) checklist for cohort and Center for Evidence-Based Medicine (CEBM) critical appraisal sheet for cross-sectional studies, while a third author arbitrated decisions to resolve disagreements.

RESULTS

Thirteen studies met the inclusion criteria: eight cross-sectional and five cohort. Qualitative review of the included studies indicated TL is associated with increased incidence and prevalence of DM. TL is also associated with DM-related morbidities including greater prevalence of heart disease, diabetic retinopathy, metabolic syndrome; poorer health-related quality of life; poorer survival of participants with chronic kidney disease; and increased medical expenditure. Overall, the quality of the evidence reviewed was medium, as per the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence.

CONCLUSIONS/PRACTICAL IMPLICATIONS

This review found significant associations of TL with prevalence and incidence of DM and adverse DM-related outcomes. An interprofessional team-care approach that includes an oral health component could benefit the prevention and management of DM.

Higher number of teeth is associated with decreased prevalence of hearing impairment in Japan

BACKGROUND/OBJECTIVES

There is limited evidence on the association between tooth loss and hearing impairment (HI). The present cross-sectional study investigated the association between tooth loss and the prevalence of HI in 1004 Japanese adults aged 36 to 84 years.

METHODS

HI was defined as present when pure-tone average was > 25 dB at a frequency of 0.5, 1, 2, and 4 kHz in the better hearing ear. Visual oral examinations were performed. Adjustments were made for age, sex, smoking status, leisure-time physical activity, hypertension, dyslipidemia, diabetes mellitus, history of depression, body mass index, waist circumference, employment, education, and household income.

RESULTS

Of 1004 study subjects, the prevalence of HI was 24.8% (n = 249). Compared with having 28 teeth, having < 22 teeth, but not having 26 to < 28 or 22 to < 26 teeth, was associated with an increased prevalence of HI; the multivariate adjusted ORs (95% CI) of having 26 to < 28, 22 to < 26, and < 22 teeth were 1.41 (0.85-2.38), 1.51 (0.90-2.57), and 1.96 (1.18-3.30), respectively (p for trend = 0.01).

CONCLUSIONS

The results suggest that tooth loss may be associated with an increased prevalence of HI.

[Trends in dental and oral health status in Germany between 1997 and 2014]

Hintergrund

Zur Veränderung der oralen Krankheitslast in der deutschen Allgemeinbevölkerung über die letzten 20 Jahre gibt es bisher keine umfassende Darstellung.

Fragestellung

Wie haben sich die Prävalenzen der Karies, der Parodontitis und des Zahnverlustes und deren Determinanten von 1997 bis 2014 in Deutschland verändert?

Material und Methoden

Ausgewertet wurden Daten von 35- bis 44- und 65- bis 74-Jährigen der Deutschen Mundgesundheitsstudien (DMS) III, IV und V sowie von 25- bis 74-Jährigen der Studies of Health in Pomerania (SHIP‑0 und SHIP-Trend-0). Der Decayed, Missing, Filled Teeth Index (DMFT), die Anzahl füllungsfreier Zähne, der Community Periodontal Index (CPI) als auch Daten zur Zahnzahl und Zahnlosigkeit wurden herangezogen.

Ergebnisse

In beiden Studien waren bzgl. der Determinanten eine Zunahme der Probanden mit hoher Schulbildung, eine geringfügige Abnahme der Raucher sowie eine Verbesserung der Mundhygiene zu beobachten. Bei den 35- bis 44-Jährigen stieg die Anzahl gesunder Zähne von 11,9 in DMS III auf 16,8 in DMS V, während bei den Senioren die Anzahl gesunder Zähne um 5,9 anstieg. In SHIP wurde ein ähnlicher Trend beobachtet. Die Prävalenz des höchsten CPI-Grades 4 fiel in den DMS bei den 35- bis 44-Jährigen von 9,3 % auf 3,5 %; bei den Senioren lag der Wert 2014 wieder auf dem Niveau von 1997 (10,5 % und 9,8 %). Parallel dazu hat sich der Anteil der zahnlosen Senioren in beiden Studien halbiert. Die Zahnzahl nahm über alle Altersklassen hinweg zu.

Diskussion

DMS und SHIP zeigten über die Jahre konsistent eine Zunahme gesunder, füllungsfreier Zähne, eine geringfügige Reduktion der Probanden mit CPI-Grad 4 sowie mehr Zahnerhalt und weniger Zahnlosigkeit. Bedingt durch den höheren Zahnerhalt und die Alterung der Gesellschaft ist in Zukunft mit einer erhöhten parodontalen Behandlungslast zu rechnen.

Zusatzmaterial online

Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00103-021-03345-6) enthalten.

Oral health and use of dental services in different stages of adulthood in Norway: a cross sectional study

Background

Socioeconomic status and oral health care habits may change throughout adult life. This calls for age-stratified analyses of oral health in the adult population to uncover differences that could be of importance for organizing adequate oral health care services. The aim of the present study was to describe self-reported oral health in different age groups in a general adult population in Norway, and to explore associations between self-reported oral health and age groups, sociodemographic factors, use of dental services, number of teeth and dental caries.

Methods

We used data from a cross-sectional study of almost 2000 Norwegian adults, 20–79 years old. The study included both a structured questionnaire and a clinical examination to assess sociodemographic variables, use of dental services, self-reported oral and general health as well as dental caries and number of teeth. For analysis, the participants were divided into three age groups: young adults (20–29 years), middle-aged adults (30–59 years), and senior adults (60 years and older). Differences among groups were analyzed by cross-tabulation, and logistic regression analyses were used to assess associations between variables.

Results

Forty-eight percent of the participants rated their oral health as good. Almost half of the participants had at least one carious tooth, with the highest caries prevalence among the young adults. To be caries free was strongly associated with reporting good oral health among the young and middle-aged adults. One third of the senior adults had fewer than 20 teeth, which was associated with reporting moderate or poor oral health. Less than half of the young adults reported regular use of dental services, and 40% of them had postponed dental visits for financial reasons during the past 2 years. Regardless of age group, having to postpone dental visits for financial reasons or having poor-to-moderate general health were associated with high odds for reporting moderate or poor oral health.

Conclusions

That there were important age-group differences in self-reported and clinical measures of oral health and in the use of dental health services demonstrates the importance of age-stratified analyses in oral health research. Many adults, especially among the young, faced financial barriers for receiving dental health services, which was associated with poorer self-reported oral health. This argues for a need to revisit the financing of oral health care for adults in Norway.

The Relationship between Dental Findings and Tongue Pressure: A Survey of 745 Community-Dwelling Adults and Elderly Persons in Japan

INTRODUCTION

Reduced tongue pressure is one of the causes of dysphagia. The purpose of this study was to investigate the relationship between dental findings and tongue pressure, and whether prosthetic treatment prevents reduced tongue pressure.

METHODS

This was a cross-sectional study. Participants were 745 community-dwelling adults and elderly persons in the Goto Islands in Nagasaki, who underwent a health checkup for residents in 2015 and 2016. Data were collected on gender; age; grip strength; hemoglobin; Creatinine (Cr); glycated hemoglobin (HbA1c); history of stroke; smoking, drinking, exercise, and walking habits; number of teeth; wearing of removable dentures; functional units of natural teeth (n-FTUs), fixed prostheses (nif-FTUs), and removable dentures (t-FTUs); and tongue pressure. The associations between each variable and tongue pressure were examined using multiple regression analysis. Next, those with 3 or fewer n-FTUs were selected, and differences in tongue pressure were compared between those with 3 or fewer nif-FTUs and those with 4 or more nif-FTUs, using a propensity score matching method.

RESULTS

Male gender, weak grip strength, low HbA1c, no drinking, and a low number of teeth were independent factors significantly associated with lower tongue pressure. Among participants with 3 or fewer n-FTUs, the 43 with 4 or more nif-FTUs showed significantly higher tongue pressure than the 43 with 3 or fewer nif-FTUs after propensity score matching, although the number of t-FTUs was not associated with tongue pressure.

DISCUSSION/CONCLUSION

Tooth loss was significantly associated with lower tongue pressure. It was suggested that fixed prosthesis treatment might prevent the reduction of tongue pressure, but removable dentures did not have such an effect.

Relationships between cognitive function and frailty in older Korean adults: The moderating effect of the number of teeth

BACKGROUND

Cognitive function and physical frailty are known to be closely related. Among older adults with dementia, those who wear dentures have a higher mortality rate than those who do not wear them. This suggests the possibility that oral health may affect the cognitive-frailty relationship. This study aims to investigate whether the number of teeth present, acts as a moderating variable in the cognitive function-frailty relationship.

METHODS

Data were obtained from the cross-sectional baseline study of the Korean Frailty Aging Cohort Study (2016-2017). Cognitive function was assessed using the Mini-Mental State Examination. Frailty score was based on the Cardiovascular Health Study Index. Oral condition was evaluated by the number of teeth present and analyzed using categories of 0-9 teeth, 10-19 teeth, and ≥20. The moderation effect was analyzed using the ordinary least squares (OLS) regression.

RESULTS

Data on 2,310 older adults (1,110 men; mean age 75.9 ± 3.9 years) was analyzed. Adjusting for age, sex, income, education, alcohol drinking, body mass index, and number of comorbidities, cognitive function and frailty showed a negative association (B=-.030, p = .011). In the 10-19 teeth category, compared to the 0-9 teeth category, a negative association with frailty was found (B=-.152, p = .026). A significant interaction effect between the number of teeth and cognitive function was detected (p = .007).

CONCLUSION

The number of teeth may modify the degree of the association between cognitive function and frailty. For effective frailty management of older persons, cognitive function management and oral management should be considered and performed together.

Association between oral health status and handgrip strength in older Korean adults

PURPOSE

Poor oral conditions in older adults are not limited to oral problems, which lead to physical problems. Prior research insufficiently has probed the relationship between oral health and physical function. This study investigated the relationship between oral health status and grip strength in older adults living in the community.

METHODS

This study used data from the 2014-2018 Korean National Health and Nutrition Survey. Oral health status was assessed by the type of dental prosthesis, the number of teeth. Grip strength was determined as the highest value among the three consecutive measurements of the dominant hand. The covariates included age, income, education, alcohol drinking, smoking, body mass index, sedentary time, comorbidity and number of caries teeth. Multiple logistic regression analysis was performed to examine the association between oral health status and grip strength.

RESULTS

Data on 6,437 older adults (men 2766; women 3671) were analyzed. The mean age was 72.9 ± 0.1 years. In the crude model of logistic regression analysis, both men and women had an association between full denture use and low grip strength compared to high grip strength. After controlling for covariates, the remaining 0-9 teeth was associated with low grip strength compared to high grip strength in men [odds ratio (OR) = 1.39, 95% confidence interval (CI) = 1.03-1.88]. The use of full dentures was also associated with low grip strength compared to high grip strength in men (OR = 1.47, 95% CI = 1.09-1.98). No significant associations were found in women.

CONCLUSION

Low handgrip strength was associated with using full dentures and remaining 0-9 teeth in older men. Low grip strength, one of the key characteristics of sarcopenia and frailty, may serve as an important indicator of poor oral health, especially among men in late life.

Validity of the self-reported number of teeth in Chilean adults

Background

Clinical dental evaluations are considered complex and costly measurements that epidemiological surveillance studies of multiple simultaneous chronic diseases currently require, for example National Health Surveys (ENS). Accordingly, simpler and more affordable methods need to be validated. The aim of this study was to assess the validity of the self-report on the total number of teeth in the general Chilean adult population.

Methods

A substudy was conducted on ENS 2016–2017 participants. A stratified random sample of 101 of them was subjected to a telephone questionnaire. This information was then compared with the results obtained from the oral examination performed by a trained nurse during a home visit. Spearman correlations, intraclass correlation coefficients and the Bland-Altman method were used to analyse the data.

Results

In men, the average number of teeth recorded during the oral examination coincided with the number of teeth in the self-report (22 teeth). In women, the total teeth average was 18 and 19 teeth according to the examination and self-report, respectively. For the total number of participants, a strong and significant Spearman correlation was obtained (ρ = 0.93); in men and women, the Spearman correlation observed was also strong and significant (ρ = 0.90 and ρ = 0.96 respectively). The value of the intraclass correlation coefficient indicated a significant concordance (CCI = 0.96) in both men and women (CCI = 0.93 and 0.98 respectively). A tendency to greater correlation was observed as the number of teeth decreased.

Conclusions

The number of teeth self-reported by the subjects in this study correlated with the number of teeth recorded in the clinical examination. Self-report is a valid method to determine the number of teeth in national health surveys.

Number of existing permanent teeth is associated with chronic kidney disease in the elderly Korean population

BACKGROUND/AIMS

The aim of this study was to assess the association between the number of existing permanent teeth and chronic kidney disease (CKD) in a representative sample of the elderly Korean population.

METHODS

A total of 2,519 subjects who participated in the Korean National Health and Nutrition Examination Survey were cross-sectionally examined. The number of existing permanent teeth was evaluated by clinical oral examination. CKD was defined based on definition and classification by Kidney Disease: Improving Global Outcomes (KDIGO) 2012 guidelines. Multivariable logistic regression analyses were performed controlling for age, gender, income, education, tooth-brushing frequency, periodontitis, state of dentition, smoking, alcohol consumption, hypertension, obesity, diabetes mellitus, and hypercholesterolemia. Subgroup analyses by age and gender were also performed.

RESULTS

The number of teeth was significantly associated with CKD after controlling for all potential confounders (adjusted odds ratio [AOR], 1.67; 95% confidence interval [CI], 1.04 to 2.70 for lower number of teeth; AOR, 1.59; 95% CI, 1.14 to 2.23 for moderate number of teeth). In the subgroup analyses, the association was highlighted in females aged 75 years over (AOR, 2.55; 95% CI, 1.05 to 6.20 for lower number of teeth; AOR, 1.95; 95% CI, 1.01 to 3.80 for moderate number of teeth).

CONCLUSION

Our findings suggest that the number of existing permanent teeth may be associated with CKD among Korean elderly.

Temporary employment and tooth loss: a cross-sectional study from the J-SHINE study

Background

Temporary employment leads to psychological distress and higher mortality, but data on its associations with oral health is limited. We examined whether having the experience of temporary employment was associated with tooth loss among working adults in Japan.

Methods

We conducted a cross-sectional study from the 2010–2011 Japanese Study on Stratification, Health, Income, and Neighborhood study that analyzed 2652 participants aged 25–50 years (men = 1394; women = 1258). Independent variable was changes in employment status (continuous regular employment and the experience of temporary employment). Dependent variable was self-reported tooth loss (none, 1 tooth, 2 teeth, 3 teeth, 4 teeth, and more than 4 teeth). Covariates were sex, age, years of education, self-rated household economic status in early life at 5 years old, marital status, number of family members in the household, history of diabetes, and body mass index. We conducted a negative binomial regression analysis to estimate prevalence rate ratios (PRRs) and 95% confidence intervals (95%CIs) for tooth loss. We also confirmed the interaction term between changes in employment status and sex.

Results

The median age of the participants was 37 years. The percentages of men and women who experienced temporary employment were 14.5% and 61.3%, respectively. Compared with continuous regular employment, the experience of temporary employment was significantly associated with tooth loss in both sexes after adjusting for the covariates (men: PRR = 1.50 [95%CI = 1.13, 2.00]; women: PRR = 1.42 [95%CI = 1.14, 1.76]). The interaction term between employment status and sex was not significant (p = 0.71).

Conclusions

Temporary employment is adversely associated with oral health.

Measures of Dynamic Chewing Function, Rather than the Number of Teeth, are a Better Predictors of the Elderly's Ability to Intake Food and Nutrients

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Dietary intake is associated with occlusal force rather than number of teeth in 80-y-old Japanese. Inomata C, Ikebe K, Okubo H et al. J Dent Res 2016;2(2):187-97.

SOURCE OF FUNDING

The study was supported by a Grant-in-Aid for Scientific Research (Nos. 23390440 and 25293394) from the Japan Society for the Promotion of Science TYPE OF STUDY/DESIGN: Cross-sectional study.

Midlife Cognitive Ability, Education, and Tooth Loss in Older Danes

OBJECTIVE

To examine the possible influence of cognitive ability and education at age 50 or 60 on number of teeth at age 70.

SETTING

Community-dwelling population in Copenhagen, Denmark.

PARTICIPANTS

Men and women born in 1914 (N = 302).

MEASUREMENTS

Cognitive ability was assessed using the Wechsler Adult Intelligence Scale at age 50 or 60. A global cognitive ability measure was used as a continuous measure and according to tertile. Information on education was gathered using a questionnaire at age 50 or 60. A clinical oral examination took place at age 70, and oral health was measured according to number of teeth (<6 vs ≥6). Baseline covariates were smoking, alcohol, sex, and income.

RESULTS

Logistic regression analyses revealed that greater cognitive ability and educational attainment had a protective effect against risk of tooth loss. The associations were significant and persisted after adjusting for confounders and a two-way interaction between cognitive ability and education.

CONCLUSION

Higher education level and cognitive ability measured at age 50 or 60 were associated with having more teeth at age 70. Whether these findings are due to the interaction of these factors with oral health, related socioeconomic factors, or other factors remains to be studied.

Validity of self-reported number of teeth and oral health variables

BACKGROUND

Oral condition and number of teeth were investigated by questionnaire in the Japan Multi-Institutional Collaborative Cohort (J-MICC Study). The aim of the present study was to assess the validity of the tooth number measure by comparing the self-reported number of teeth with the number of teeth determined at clinical dental examination.

METHODS

A self-administered questionnaire and dental examination were performed by 1275 participants of a company medical examination who requested dental check-up and 377 subjects of the J-MICC study. The validity of the tooth number measure was assessed by comparing the self-reported number of teeth with that determined at clinical examination. Spearman's rank correlation coefficient was calculated to quantitatively evaluate the validity.

RESULTS

In males, the mean clinically-examined and self-reported numbers of teeth were 26.5 and 24.8 teeth, respectively. In females, the mean clinically-examined and self-reported numbers of teeth were 26.4 and 25.5 teeth, respectively. There was a tendency toward underestimation of the number of natural teeth by self-reporting. A significant correlation was observed between the clinically-examined and self-reported numbers of teeth in total (ρ = 0.69) and both males (ρ = 0.70) and females (ρ = 0.67).

CONCLUSIONS

The self-reported oral health variables were valid and reflected clinical status. Further revision of the question on the remaining tooth in the questionnaire improves the validity of self-reported number of teeth.

Removable dental prostheses and cardiovascular survival: a 15-year follow-up study

OBJECTIVES

In previous studies, increasing number of teeth predicted better survival and the acute needs for dental treatment predicted mortality. We sought to investigate whether restored dentitions by various removable dental prostheses impact cardiovascular (CVD) longevity.

METHODS

Kuopio Oral Health and Heart study was initiated as a cross-sectional investigation with 256 subjects with diagnosed coronary artery disease [CAD] and 250 age- and sex-matched controls without CAD in 1995-1996. The mean age of both groups was 61, 30% were females. We appended mortality follow-up records to the baseline data and formulated this 15-year follow-up study. We examined the relationship between various types of dental prostheses and cardiovascular mortality by proportional hazard regression analyses. We also explored their correlation to oral and systemic inflammatory markers such as asymptotic dental score and C-reactive protein.

RESULTS

In a model adjusted for age, sex and smoking, groups having only natural teeth (NT), removable partial denture(s) [PD] and NT, a PD and a full denture [FD], and FD/FD or FD/NT demonstrated the following hazard ratios for mortality (95% confidence interval). NT both arches: 1.00 [reference]; PD and NT: 0.75 [0.22-2.56]; PD and FD: 1.99 [1.05-3.81]; and FD opposed by FD or NT: 1.71 [0.93-3.13], respectively [p for trend=0.05]. Although statistically not significant, those with PD and NT with mean a number of teeth [Nteeth] of 15.4 had better survival compared with those who had all NT [Nteeth=22.5]; while those who had FD and PD [Nteeth=6.5] had shorter longevity than those with FD/FD or FD/NT [Nteeth=3.5].

CONCLUSIONS

Although not all subgroups of dental prostheses reached significant relationship with CVD mortality, our study suggests that not only the number [quantity] of remaining teeth but their maintenance [quality] removing potential inflammatory foci, such as pericoronitis or retained root tips, may positively impact on cardiovascular survival.