Denture wearing and mortality risk in edentulous American adults: A propensity score analysis

Efficient complete denture metal base design via a dental feature-driven segmentation network

BACKGROUND AND OBJECTIVE

Complete denture is a common restorative treatment in dental patients and the design of the core components (major connector and retentive mesh) of complete denture metal base (CDMB) is the basis of successful restoration. However, the automated design process of CDMB has become a challenging task primarily due to the complexity of manual interaction, low personalization, and low design accuracy.

METHODS

To solve the existing problems, we develop a computer-aided Segmentation Network-driven CDMB design framework, called CDMB-SegNet, to automatically generate personalized digital design boundaries for complete dentures of edentulous patients. Specifically, CDMB-SegNet consists of a novel upright-orientation adjustment module (UO-AM), a dental feature-driven segmentation network, and a specific boundary-optimization design module (BO-DM). UO-AM automatically identifies key points for locating spatial attitude of the three-dimensional dental model with arbitrary posture, while BO-DM can result in smoother and more personalized designs for complete denture. In addition, to achieve efficient and accurate feature extraction and segmentation of 3D edentulous models with irregular gingival tissues, the light-weight backbone network is also incorporated into CDMB-SegNet.

RESULTS

Experimental results on a large clinical dataset showed that CDMB-SegNet can achieve superior performance over the state-of-the-art methods. Quantitative evaluation (major connector/retentive mesh) showed improved Accuracy (98.54 ± 0.58 %/97.73 ± 0.92 %) and IoU (87.42 ± 5.48 %/70.42 ± 7.95 %), and reduced Maximum Symmetric Surface Distance (4.54 ± 2.06 mm/4.62 ± 1.68 mm), Average Symmetric Surface Distance (1.45 ± 0.63mm/1.28 ± 0.54 mm), Roughness Rate (6.17 ± 1.40 %/6.80 ± 1.23 %) and Vertices Number (23.22 ± 1.85/43.15 ± 2.72). Moreover, CDMB-SegNet shortened the overall design time to around 4 min, which is one tenth of the comparison methods.

CONCLUSIONS

CDMB-SegNet is the first intelligent neural network for automatic CDMB design driven by oral big data and dental features. The designed CDMB is able to couple with patient's personalized dental anatomical morphology, providing higher clinical applicability compared with the state-of-the-art methods.

The impact of dentition status and barriers to dental care services on perceived oral health of medicare beneficiaries

OBJECTIVE

To examine the association among barriers to dental care services, dentition groups, and self-reported oral health status for Medicare beneficiaries.

METHODS

We used data from the 2017 to 2018 National Health and Nutrition Examination Survey (NHANES), which included participants aged ≥65 years who were enrolled in Medicare and had completed the oral health exam. We created a dentition group variable using the detailed dental examination data to account for the presence of natural, replaced, removable, or missing teeth. Through bivariate and logistic analyses, we explored the relationship between barriers to receiving dental care services, dentition groups, and reported oral and general health statuses, along with other control variables.

RESULTS

For the total Medicare population as well as in the four subgroup analyses, we showed that those with barriers to dental care services were more likely to report fair or poor oral health status. Those who were edentulous, had complete dentures, or had less than a full mouth of teeth had greater barriers and worse oral and general health than did those with all-natural teeth. Among those who reported fair or poor general health, those with less than a full mouth of teeth showed similar levels of barriers to dental care services and worse perceived oral health than did those without any teeth.

CONCLUSIONS

Helping the 65 years and older population retain their teeth in good condition will improve their overall health. Investment in oral hygiene and health for the current and future Medicare populations could improve their overall health.

Self-reported oral health is associated with systemic health outcomes and all-cause mortality

BACKGROUND

Self-reported oral health questions (OHQs) are used commonly for epidemiologic surveillance of periodontal disease (PD). The authors' objective was to investigate how OHQs are associated with well-established systemic comorbidities of PD and their impact on all-cause mortality. The authors hypothesized that OHQs exhibit associations with systemic comorbidities similar to PD.

METHODS

Two independent data sets were used to achieve these objectives: the Women's Health Study, a prospective cohort of women 45 years or older with self-reported information on PD, OHQs, cardiovascular disease, diabetes, and osteoporosis in various timeframes (continuous from 1992) and the National Health and Nutrition Examination Survey (NHANES), with data on OHQs and linked mortality (1999-2018). The authors applied multivariate logistic regression models and Cox proportional hazard regression survival analyses to test their hypotheses.

RESULTS

The Women's Health Study participants who reported having PD until 2006 were more likely to later report deteriorating oral health, bone loss around their teeth, or periodontal treatment in 2018. Self-rated fair or poor oral health was independently associated with increased risk of cardiovascular disease (odds ratio, 1.39; 95% CI, 1.14 to 1.69; P < .001), diabetes (odds ratio, 1.21; 95% CI, 1.02 to 1.43; P = .028), and osteoporosis (odds ratio, 1.60; 95% CI, 1.38 to 1.84; P < .001). National Health and Nutrition Examination Survey participants who self-rated fair or poor oral health had higher risks of all-cause mortality (hazard ratio, 1.18; 95% CI, 1.02 to 1.37; P = .027).

CONCLUSIONS

Self-reported oral health had a similar magnitude of associations with systemic comorbidities as established with PD previously. Moreover, self-rated fair or poor oral health, suboptimal dental visits, or infrequent flossing were associated with increased all-cause mortality.

PRACTICAL IMPLICATIONS

These results support the use of OHQs in assessing systemic connections, especially when clinical dental access is limited. This clinical trial was registered at ClinicalTrials.gov. The registration number is NCT00000479.

Association between dental visit behavior and mortality: a nationwide longitudinal cohort study from NHANES

OBJECTIVES

The benefits of professional dental treatment for oral diseases have been widely investigated. However, it is unclear whether professional dental treatment provides additional benefits for improving general health.

MATERIALS AND METHODS

Data were obtained from the US National Health and Nutrition Examination Survey (NHANES) 1999 to 2004 and 2011 to 2018 cycles. A total of 36,174 participants were included and followed-up for mortality until December 31, 2019. Dental visit behavior was defined as the time interval of last dental visit (TIDV, < 0.5 year, 0.5-1 year, 1-2 years, 2-5 years, and > 5 years) and the main reasons of the last dental visit (treatment, examination, and other reasons). The Cox proportional risk model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI).

RESULTS

Compared with participants with time interval of less than 0.5 year, the multivariate-adjusted HRs and 95%CI for participants with time interval of more than 5 years were 1.45 (1.31, 1.61) for all-cause mortality (P trend < 0.0001), 1.49 (1.23, 1.80) for cardiovascular diseases mortality (P trend = 0.0009) and 1.53 (1.29, 1.81) for cancer mortality (P trend = 0.013). Compared with dental visit for examination, participants who had their dental visit for treatment had higher risk for mortality. For participants with dental visit for examination, TIDV of less than 1 year showed lower risk for mortality, whereas TIDV of less than 0.5 year is recommend for population with dental visit for treatment.

CONCLUSIONS

Poor dental visit behavior is associated with an increased risk of mortality. Further well-designed studies are needed to confirm the association between professional dental visit and mortality.

CLINICAL RELEVANCE

This study highlights the potential benefits of regular dental visits in maintaining general health.

Functional dentition and edentulism associated with mortality: A cohort study of older adults in Southern Brazil

OBJECTIVE

The aim of this study was to evaluate the association between the lack of a functional dentition and edentulism with mortality in a cohort of older adults in a Southern Brazilian city.

MATERIALS AND METHODS

This is a longitudinal study carried out with community-dwelling older adults (≥60 years old) from Pelotas, Brazil, using data from the baseline (2014) and the first follow-up (2017). Main exposures were functional dentition (20+ teeth present) and edentulism (absence of all teeth), derived from self-reported number of teeth. All-causes mortality was evaluated according to the city's Epidemiological Surveillance Department. Potential confounders were age, sex, socioeconomic position, smoking, diabetes, hypertension, and body mass index (BMI). To test the association between functional dentition and edentulism with mortality, Poisson regression models with robust variance were used, to estimate Relative Risks and 95% confidence intervals.

RESULTS

A total of 1289 older adults had information on all variables of interest and comprise the analytical sample (from 1451 at baseline). When analysing the presence of functional dentition, only 222 individuals (17.2%) had 20 or more teeth in their mouth, while 490 older adults were edentulous (38.0%). Crude analysis showed an association between tooth loss indicators and mortality. Models adjusted for sociodemographic variables and health conditions and behaviours revelled no association between the exposures and mortality.

CONCLUSIONS

With the findings of this study, we did not identify an association between edentulism and functional dentition with mortality, after considering important shared risk factors.

Dose-response effect of Montelukast on post-extraction dental socket repair and skeletal phenotype of mice

Bone metabolism and repair are directly regulated by arachidonic acid metabolites. At present, we analyzed the dose-response effects of a selective cysteinyl leukotriene receptor type-1 antagonist during bone repair after tooth extraction and on non-injured skeleton. Sixty-three 129 Sv/Ev male mice composed the groups: C-Control (saline solution); MTK2-2 mg/Kg of Montelukast (MTK) and MTK4-4 mg/Kg of MTK, daily administered by mouth throughout all experimental periods set at 7, 14, and 21 days post-operative. Dental sockets were analyzed by computed microtomography (microCT), histopathology, and immunohistochemistry. Femurs, L5 vertebra and organs were also removed for observation. Blood was collected for plasma bone and liver markers. Histopathology and microCT analysis revealed early socket repair of MTK2 and MTK4 animals, with significant increased BV/TV at days 14 and 21 compared to C. Higher plasma calcium was detected at days 7 and 21 in MTK4 in comparison to C, while phosphate was significantly increased in MTK2 in the same periods in comparison to C and MTK4. No significant differences were found regarding plasma ALP and TRAP, neither for local TRAP and Runx2 immunolabeling at the healing sockets. Organs did not present histological abnormalities. Increased AST levels have been detected in distinct groups and periods. In general, femur phenotype was improved in MTK treated animals. Collectively, MTK promoted early bone formation after tooth extraction and increased bone quality of femurs and vertebra in a time-dose-dependent manner, and should be considered as an alternative therapy when improved post-extraction socket repair or skeleton preservation is required.

Relation between number of teeth, malnutrition, and 3-year mortality in elderly individuals ≥85 years

OBJECTIVE

The number of teeth has been shown to affect mortality. However, it is unclear why the number of teeth is associated with mortality. We focused on the number of teeth and malnutrition and examined whether these differences affect 3-year all-cause mortality among very elderly individuals.

METHODS

This analysis was conducted using data from the Tokyo Oldest Old Survey on Total Health study. Altogether 513 participants ≥85 years were categorized based on remaining teeth (0, 1-7, 8-18, ≥19). All-cause mortality was determined by calculating the cumulative 3-year survival rate according to the remaining number of teeth and the presence/absence of malnutrition. Further, hazard ratios (HRs) were analyzed using Cox regression analyses.

RESULTS

No difference was observed according to the number of teeth (p = 0.638), but the presence/absence of malnutrition was significantly associated with mortality (p < 0.001). Malnutrition was independently associated with higher HRs, even after adjusting for confounding factors associated with mortality. (HR: 2.315, 95% CI: 1.431-3.746). Additionally, adjusting for the number of teeth, HR remained significant (HR: 2.365, 95% CI: 1.449-3.853).

CONCLUSION

In the very elderly, malnutrition-but not the number of teeth-was independently associated with 3-year all-cause mortality after adjusting for various health issues.

Oral Health and Mortality Among Older Adults: A Doubly Robust Survival Analysis

INTRODUCTION

Evidence on the association between oral health and mortality is inconclusive, and few studies have accounted for the nonrandom selection bias in estimating their relationship. This study aims to investigate the link between oral health and mortality in community-dwelling older adults by adjusting for confounding factors with a doubly robust survival estimation.

METHODS

Data came from the third National Health and Nutrition Examination Survey (1988-1994) and were linked to the National Death Index mortality data through December 2015. The analytic sample consisted of 4,880 adults aged ≥60 years. Oral health measures included objective clinical indicators (edentulism, periodontitis, and untreated dental caries) and self-rated oral health. Cox proportional hazards regression models and inverse probability weighting with regression adjustment for observational survival-time estimation were utilized to assess the relationship between oral health and mortality. Analyses were conducted in 2021.

RESULTS

Edentulism (average treatment effect= -26.13, 95% CI= -48.69, -3.57) was associated with a reduction in survival time. Periodontal conditions and dental caries were related to all-cause mortality in Cox models but became nonsignificant when inverse probability weighting with regression adjustment survival estimation was applied. Good self-rated oral health was significantly related to an increase in survival time (average treatment effect=21.50; 95% CI= 4.92, 38.07).

CONCLUSIONS

Both objective and subjective oral health are risk factors for mortality among older adults. Improving access to dental screening and treatment among community-dwelling older adults has the potential to reduce oral health‒related risks of mortality.

Removable partial dentures and mortality among partially edentulous adults

OBJECTIVES

The aim of this study was to evaluate whether the use of removable partial dentures (RPDs) has an effect on long-term survival outcomes amongst partially edentulous adults.

METHODS

Data were extracted from the Third National Health and Nutrition Examination Survey and linked to public-use mortality files for the period up to 2019. Partially edentulous adults with fewer than 20 teeth were included. RPD use and dentition status were determined by clinical examination. The cohort was propensity score weighted to create a sample which was balanced across 27 covariates (sociodemographics, health behaviors and insurance, laboratory markers, and general health status). Survival analysis was undertaken to compute absolute (mortality rate and median survival time) and relative (event time ratio [ETR]) measures of exposure effect.

RESULTS

The analyzed cohort included 1246 participants, which equated to 22,557 person-years of follow-up. The difference in all-cause mortality rate between RPD wearers and non-wearers was found to be -6.5 (95% CI: -11.6 to -1.4), with the median survival time in RPD wearers being 3.1 years longer (20.3 years versus 17.2 years). A 26% increase in survival time was observed in RPD wearers (ETR: 1.26, 95% CI: 1.17 to 1.37) and it was found that, for every 7.5 individuals treated with RPDs, one death would be prevented after 10 years of treatment.

CONCLUSIONS

The use of RPDs may have long-term benefits in reducing mortality amongst adults with a non-functional dentition, but further research is needed to validate these findings and assess the factors mediating the relationship.

CLINICAL SIGNIFICANCE

The use of RPDs may have long-term benefits in reducing mortality amongst adults with a non-functional dentition.

Denture wearing status, cardiovascular health profiles, and mortality in edentulous patients: A prospective study with a 27-year follow-up

OBJECTIVES

Life's Simple 7 (LS7) metrics provide insight into improving cardiovascular health (CVH) and help reduce mortality risks. Edentulous older adults have a higher mortality risk than dentulous ones, probably due to worse oral function. It is reported that wearing dentures will decrease the mortality risk factor by improving oral function. This prospective study aimed to investigate if denture wearing could modify the association between CVH profile and mortality risk among edentulous elderly.

METHODS

From the Third National Health and Nutrition Examination Survey (NHANES III), 1,735 edentulous older adults (mean age 69.4 years old) with CVH profiles and data on denture wearing status were selected for this study. CVH profiles according to LS7 metrics were classified into poor, intermediate, or ideal. Denture wearers were defined as those wearing complete dentures in both arches all the time or only when awake. Multivariable Cox proportional-hazards regression was conducted to estimate the association of CVH profiles with all-cause and cardiovascular mortality. Stratified analyses and the testing of interaction terms were used to evaluate the difference between the association in edentulous patients with and without dentures.

RESULTS

A total of 1,420 (81.8%) older adults died during the 27-year follow-up, with 475 (27.6%) cases attributable to heart disease. After controlling for potential confounders, edentulous patients with an ideal CVH (LS7 = 10-14) had a lower mortality risk than those with poor CVH (LS7 = 0-4). Furthermore, we observed an effect modification by denture use (P_interaction = 0.046), with the role of ideal CVH in mitigating mortality among the denture wearers (Hazard Ratio = 0.440 [0.329-0.588]), while no significant association among those without dentures. Similar results were achieved for cardiovascular mortality, but there was no effect modification of denture use (P_interaction = 0.352).

CONCLUSION

In this study, a favorable cardiovascular health profile presents a protective effect on all-cause mortality only among edentulous patients wearing dentures instead of non-wearer.

CLINICAL SIGNIFICANCE

Denture usage could improve oral function (e.g., chewing, smiling, speaking, etc.) and promote general health. Effect modification found in this study indicates having ideal CVH alone cannot substantially reduce mortality risk among edentulous patients. Therefore, health care professionals should keep an eye on the elderly not wearing dentures as they are probably more at risk for adverse health outcomes. It remains unclear if denture wearing has a causal relation with lower mortality risks, and further research is needed.

The effect of denture-wearing on physical activity is associated with cognitive impairment in the elderly: A cross-sectional study based on the CHARLS database

BACKGROUND

Currently, only a few studies have examined the link between dental health, cognitive impairment, and physical activity. The current study examined the relationship between denture use and physical activity in elderly patients with different cognitive abilities.

METHODS

The study data was sourced from the 2018 China Health and Retirement Longitudinal Study (CHARLS) database, which included information on denture use and amount of daily physical activity undertaken by older persons. Physical activity was categorized into three levels using the International Physical Activity General Questionnaire and the International Physical Activity Scale (IPAQ) rubric. The relationship between denture use and physical activity in middle-aged and older persons with varying degrees of cognitive functioning was studied using logistic regression models.

RESULTS

A total of 5,892 older people with varying cognitive abilities were included. Denture use was linked to physical activity in the cognitively healthy 60 + age group (p = 0.004). Denture use was positively related with moderate physical activity in the population (odds ratio, OR: 1.336, 95% confidence interval: 1.173-1.520, p < 0.001), according to a multivariate logistic regression analysis, a finding that was supported by the calibration curve. Furthermore, the moderate physical activity group was more likely to wear dentures than the mild physical activity group among age-adjusted cognitively unimpaired middle-aged and older persons (OR: 1.213, 95% CI: 1.053-1.397, p < 0.01). In a fully adjusted logistic regression model, moderate physical activity population had increased ORs of 1.163 (95% CI: 1.008-1.341, p < 0.05) of dentures and vigorous physical activity population had not increased ORs of 1.016 (95% CI: 0.853-1.210, p > 0.05), compared with mild physical activity population.

CONCLUSION

This findings revealed that wearing dentures affects physical activity differently in older persons with different cognitive conditions. In cognitively unimpaired older adults, wearing dentures was associated with an active and appropriate physical activity status.

Number of teeth is associated with all-cause and disease-specific mortality

BACKGROUND

Tooth loss has been shown to correlate with multiple systemic comorbidities. However, the associations between the number of remaining natural teeth (NoT) and all-cause mortality have not been explored extensively. We aimed to investigate whether having fewer NoT imposes a higher risk in mortality. We tested such hypotheses using three groups of NoT (20-28,10-19, and 0-9), edentulism and without functional dentition (NoT < 19).

METHODS

The National Health and Nutrition Examination Survey in the United States (NHANES) (1999-2014) conducted dental examinations and provided linkage of mortality data. NHANES participants aged 20 years and older, without missing information of dental examination, age, gender, race, education, income, body-mass-index, smoking, physical activities, and existing systemic conditions [hypertension, total cardiovascular disease, diabetes, and stroke (N = 33,071; death = 3978), or with femoral neck bone mineral density measurement (N = 13,131; death = 1091)] were analyzed. Cox proportional hazard survival analyses were used to investigate risks of all-cause, heart disease, diabetes and cancer mortality associated with NoT in 3 groups, edentulism, or without functional dentition.

RESULTS

Participants having fewer number of teeth had higher all-cause and disease-specific mortality. In fully-adjusted models, participants with NoT0-9 had the highest hazard ratio (HR) for all-cause mortality [HR(95%CI) = 1.46(1.25-1.71); p < .001], mortality from heart diseases [HR(95%CI) = 1.92(1.33-2.77); p < .001], from diabetes [HR(95%CI) = 1.67(1.05-2.66); p = 0.03], or cancer-related mortality [HR(95%CI) = 1.80(1.34-2.43); p < .001]. Risks for all-cause mortality were also higher among the edentulous [HR(95%CI) = 1.35(1.17-1.57); p < .001] or those without functional dentition [HR(95%CI) = 1.34(1.17-1.55); p < .001].

CONCLUSIONS

Having fewer NoT were associated with higher risks for all-cause mortality. More research is needed to explore possible biological implications and validate our findings.

The role of polymeric nanofibers on the mechanical behavior of polymethyl methacrylate resin

This study aimed to synthesize and characterize non-woven acrylonitrile butadiene styrene (ABS), polyamide-6 (P6), and polystyrene (PS) nanofibers, and evaluate their effects on the flexural strength and fracture resistance of fiber-modified polymethyl methacrylate (PMMA) resin. ABS, P6, and PS polymer solutions were prepared and electrospun into fiber mats, which were characterized by means of morphological, chemical, physical, and mechanical analyses. The fiber mats were then used to modify a thermally-activated PMMA resin, resulting in four testing groups: one unmodified group (control) and three fiber-modified groups incorporated with ABS, P6, or PS fiber mats. Flexural strength, work of fracture, and fractographic analysis were performed for all groups. Data were analyzed using Kruskal-Wallis or ANOVA tests (α = 0.05). The fiber diameter decreased, respectively, as follows: ABS > P6 > PS. Only the P6 fiber mats demonstrated a crystalline structure. Wettability was similar among the distinct fiber mats, although tensile strength was significantly greater for P6, followed by ABS, and then PS mats. Flexural strength of the fiber-modified PMMA resins was similar to the control, except for the weaker P6-based material. The work of fracture seemed to be greater and lower when the P6 and PS fibers were used, respectively. The fiber-modified groups exhibited a rougher pattern in the fractured surfaces when compared to the control, which may suggest that the presence of fibers deviates the direction of crack propagation, making the fracture mechanism of the PMMA resin more dynamic. While the neat PMMA showed a typical brittle response, the fiber-modified PMMA resins demonstrated a ductile response, combined with voids, suggesting large shear deformation during fracture. Altogether, despite the lack of direct reinforcement in the mechanical strength of the PMMA resin, the use of electrospun fibers showed promising application for the improvement of fracture behavior of PMMA resins, turning them into more compliant materials, although this effect may depend on the fiber composition.