Association of total tooth loss with smoking, drinking alcohol and nutrition in elderly Japanese: analysis of national database

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

OBJECTIVES

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

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.

Using machine learning to study the association of sociodemographic indicators, biomarkers, and oral condition in older adults in Colombia

BACKGROUND

Chronic health conditions and socioeconomic problems that affect the well-being and life expectancy of older adults are common. The objective of this cross-sectional study was to analyze the association between sociodemographic variables, oral conditions, and general health and the biomarkers of older adults using machine learning (ML).

METHODS

A total of 15,068 surveys from the national study of Health, Well-Being and Aging (Salud, Bienestar y Envejecimiento) data set were used for this secondary analysis. Of these, 3,128 people provided blood samples for the analysis of blood biomarkers. Sociodemographic, oral health, and general health variables were analyzed using ML and logistic regression.

RESULTS

The results of clustering analysis showed that dyslipidemia was associated with poor oral condition, lower socioeconomic status, being female, and low education. The self-perception of oral health in older adults was not associated with the presence of teeth, blood biomarkers, or socioeconomic variables. However, the necessity of replacing a dental prosthesis was associated with the lowest self-perception of oral health. Edentulism was associated with being female, increased age, and smoking.

CONCLUSIONS

Socioeconomic and educational disparities, sex, and smoking are important factors for tooth loss and suboptimal blood biomarkers in older adults. ML is a powerful tool for identifying potential variables that may aid in the prevention of systemic and oral diseases in older adults, which would improve geriatric dentistry.

PRACTICAL IMPLICATIONS

These findings can help the academic community identify critical sociodemographic and clinical factors that influence the process of healthy aging and serve as a useful guide to enhance health care policies and geriatric oral health care services.

Circulating vitamin C and D concentrations and risk of dental caries and periodontitis: A Mendelian randomization study

AIM

This Mendelian randomization (MR) study was performed to explore the causal relationship among circulating vitamin C and D levels, dental caries, and periodontitis.

MATERIALS AND METHODS

MR analyses were conducted with the inverse variance weighted (IVW) method, weighted median, MR-Egger approaches, and MR-robust adjusted profile score method to assess the causal relationships between circulating vitamin C and D concentrations and dental caries, the number of remaining natural permanent teeth in the mouth (N teeth), and periodontitis.

RESULTS

We found potential causal association of circulating vitamin D concentrations with N teeth (β = 0.085; 95% confidence interval: 0.019 to 0.150; p = .012) based on the IVW method. No significant causal relationship between circulating vitamin D levels and dental caries and periodontitis was observed. Similarly, no evidence supported a causal relationship between circulating vitamin C concentrations and the risk of dental caries, N teeth, and periodontitis.

CONCLUSIONS

There is no obvious evidence suggesting a causal relationship among circulating vitamin D, dental caries, and periodontitis, drawing into question the mechanism for any association with N teeth. Additionally, there is insufficient power to detect small effects in vitamin C levels and caries and periodontitis.

Socioeconomics, health-related factors, and tooth loss among the population aged over 80 years in China

Background

The prevalence of tooth loss varies across the globe among oldest-old individuals. The presence of fewer than 20 teeth in old age was associated with a decrease in people’s health and quality of life. This paper explored the association between socioeconomics, health-related factors, and tooth loss among the population over the age of 80 in China.

Methods

The tooth loss status of older Chinese adults was collected with a structured questionnaire from the 8^th wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). A total of 6716 individuals aged 80 years and above were included. Logistic regression was used to assess the association between socioeconomic statuses, dietary intake at approximately 60 years old, health-related factors, and tooth loss.

Results

Of the 6716 individuals aged 80 years and above, the composition of the group with fewer teeth for both men and women was statistically significant in many ways. Multivariate logistic regression analyses show that for men, being older than 90 years and being ADL disabled (adjusted OR: 1.71, 95% CI: 1.01–2.89) are factors that are significantly and consistently associated with a higher risk of having fewer than 20 teeth, while having a higher household income per capita (adjusted OR: 0.56, 95% CI: 0.32–0.99) decreases the risk. For women, an age of above 95 years, brushing teeth less than once per day (adjusted OR: 1.96, 95% CI: 1.26–3.03), consuming sugar some of the time as opposed to less than once per month at approximately 60 years old (adjusted OR = 1.74, 95% CI: 1.15–2.62), and being ADL disabled (adjusted OR: 1.70, 95% CI: 1.04–2.77) are factors that are significantly associated with the risk of having fewer than 20 teeth.

Conclusion

The analysis suggests that socioeconomic status, dietary intake in early old age, and ADL capacity are associated with the risk of having fewer teeth for the population aged 80 years and above, and the risk factors vary between sexes.

Beverages Consumption and Oral Health in the Aging Population: A Systematic Review

Little study has yet been made of the effect of different beverages on oral health outcomes in the aging population. The purpose of this systematic review is to evaluate the association between different beverages, including alcohol intake, coffee, milk, tea, and sugary drinks, and a cluster of oral health outcomes, including periodontal disease, oral dysbiosis, and tooth loss in older adults. The literature was screened from the inception up to May 2021 using six different electronic databases. Two independent researchers assessed the eligibility of 1308 retrieved articles regarding inclusion criteria; only 12 fitted the eligibility requirements, representing 16 beverage entries. A minimum age of 60 was the inclusion criterion. No exclusion criteria were applied to outcomes assessment tools, recruiting facilities (hospital or community), general health status, country, and study type (longitudinal or cross-sectional). The consumption of alcoholic beverages was expressed as alcohol intake in all eligible studies, thereby replacing alcoholic beverages in the analysis. The quality of evidence was judged as moderate for alcohol and low or very low for beverages. In regard to oral health in the elderly, the review identified information on alcohol (56.25%), followed by coffee (18.75%), milk (12.50%), tea (6.25%), and sugary drinks (6.25%). Alcohol, sugary drinks, and coffee were found to be related to tooth loss. Periodontal disease was inversely related to coffee and milk, but fostered by alcohol consumption. In one article, tea but not coffee seemed to improve oral microbiota. In summary, alcohol seems to be a driver for tooth loss and periodontal disease in the aging population. However, more research is needed to gain a more solid knowledge in this research area. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, PROSPERO, Identifier: CRD42021256386.

Salutogenic factors for oral health among older people: an integrative review connecting the theoretical frameworks of Antonovsky and Lalonde

OBJECTIVE

The aim of this integrative review was to describe salutogenic factors associated with oral health outcomes in older people, from the theoretical perspectives of Antonovsky and Lalonde.

MATERIAL AND METHODS

This study was based on a primary selection of 10,016 articles. To organize reported salutogenic factors, the Lalonde health field concept and Antonovsky's salutogenic theory were cross tabulated.

RESULTS

The final analysis was based on 58 studies. The following oral health outcome variables were reported: remaining teeth, caries, periodontal disease, oral function and oral health related quality of life (OHRQoL). We could identify 77 salutogenic factors for oral health and OHRQoL. Salutogenic factors were identified primarily within the fields of Human Biology (such as 'higher saliva flow', 'BMI < 30 kg/m²' and 'higher cognitive ability at age 11'), Lifestyle (such as 'higher education level', 'social network diversity' and 'optimal oral health behaviour') and Environment (such as 'lower income inequality', 'public water fluoridation' and 'higher neighbourhood education level'). In the age group 60 years and over, there was a lack of studies with specific reference to salutogenic factors.

CONCLUSIONS

The results provide an overview of salutogenic factors for oral health from two theoretical perspectives. The method allowed concomitant disclosure of both theoretical perspectives and examination of their congruence. Further hypothesis-driven research is needed to understand how elderly people can best maintain good oral health.

Tooth Loss Predicts Long-Term Prognosis of Esophageal Cancer After Esophagectomy

BACKGROUND

Oral health is associated with various diseases, including cancer. Tooth loss is a simple and objective index of oral health.

OBJECTIVE

The purpose of this study was to investigate the association between preoperative tooth loss and esophageal cancer prognosis after esophagectomy.

METHODS

This study included 191 patients who underwent esophagectomy for esophageal cancer after perioperative dental evaluation and oral care at Kobe University Hospital from April 2011 to March 2016. Patients were divided into two groups: Group A (tooth loss < 7) and Group B (tooth loss ≥ 7). Three-year overall survival (OS) and multivariate analysis were performed, along with subgroup analysis for elderly patients (age ≥ 65 years).

RESULTS

The 3-year OS rate was 68.1% in Group A (104 patients) and 49.2% in Group B (87 patients). Group A had significantly higher OS than Group B (p = 0.002), and there were no significant differences in sex and clinical T or N stage between the two groups. However, the mean age of Group A was younger than that of Group B (64.2 vs. 68.5 years; p = 0.0002). Among elderly patients, the 3-year OS rate was 68.2% in Group A (55 patients) and 45.1% in Group B (65 patients) [p = 0.003]. Multivariate analysis that included age demonstrated that tooth loss is an independent prognostic factor (hazard ratio 1.87, 95% confidence interval 1.22-2.87), in addition to clinical T stage and preoperative serum albumin.

CONCLUSION

Tooth loss is an independent prognostic factor for esophageal cancer after esophagectomy.

Association between age at asthma diagnosis and tooth loss

OBJECTIVES

This study aimed to investigate the association between age at asthma diagnosis and tooth loss due to caries using data obtained from the Korean National Health and Nutrition Examination Survey.

MATERIALS AND METHODS

A complex sample multivariable linear regression was used, and the results were analysed. Age at diagnosis and the number of teeth lost were set as independent and dependent variables, respectively. Among the total 65,973 subjects, 10,056 aged <12 years and 11,714 with missing values in dependent and independent variables were excluded. Asthmatic subjects were divided into the following age groups based on the age at diagnosis: 0-6 years, 7-12 years, 13-18 years, 19-28 years, and 29-64 years. In each analysis, the calibration was performed by adding covariates to each model.

RESULTS

Compared with the no asthma group (β = 0), the values of β in asthmatic subjects belonging to the age groups 0-6 years (β = 0.794, 0.521, 0.560) and 7-12 years (β = 0.527, 0.407, 0.437) were high in all models.

CONCLUSIONS

Our findings revealed significant increase in tooth loss due to caries after early asthma diagnosis at 0-6 years (β = 0.560, p < .001) and 7-12 years (β = 0.437, p < .001). Clinicians need to shift their perception of dental risks in young asthmatic patients and provide active oral health care to them.

Association between alcohol dependence and both periodontal disease and tooth loss: a cross-sectional study

The impact of alcohol consumption on periodontal disease and tooth loss is still under debate. The aim of this cross-sectional study was to evaluate the association between alcohol dependence and both periodontal diseases and tooth loss in Brazilian native Indians. Full mouth periodontal examination was performed and tooth loss was clinically evaluated in a representative sample of 225 Indians (≥ 19 years). Sociodemographic, oral health-related data, and alcohol dependence were evaluated using structured questionnaires. The subjects were categorized as either alcohol-dependent or non-dependent according to the Alcohol Use Disorders Identification Test results. Severe periodontal disease was defined in individuals with ≥ 2 proximal sites with a clinical attachment level ≥ 6 mm, not on the same tooth, and ≥ 1 proximal site with a probing depth ≥ 5 mm. Tooth loss was categorized as one or more missing teeth, or no missing teeth. Bivariate models followed by logistic regression were used to assess the association between alcohol dependence and both periodontal disease and tooth loss. Prevalence ratio (PR) was calculated using Mantel-Haenszel analysis. Alcohol dependence increased 2.5 times the risk for tooth loss (prevalence ratio [PR] =2.49, 95% confidence interval [CI] = 1.01-9.04, p = 0.05). Severe periodontal disease was not associated with alcohol dependence (OR = 0.54, 95% CI = 0.22-1.31, p = 0.23). In conclusion, alcohol dependence was associated with tooth loss in the present population, but severe periodontal disease was not. Questions on alcohol dependence should be included in dental anamnesis questionnaires, and patients diagnosed with alcohol dependence should be referred for dental evaluation.

Association Between Sarcopenia and Tooth Loss

Background

The aim of this study was to determine whether the prevalence and extent of periodontal disease and tooth loss are increased in participants with sarcopenia.

Methods

This cross-sectional study included 8,053 males (sarcopenia, 2,772; nonsarcopenia, 5,281) and 10,729 females (sarcopenia, 3,085; nonsarcopenia, 7,644) ≥18 years of age who participated in the Korean National Health and Nutrition Examination Survey (KNHANES) from 2008 to 2011 and underwent assessments of oral health and appendicular skeletal muscle mass. Muscle mass index was calculated as appendicular muscle mass divided by height squared. The cutoff values for sarcopenia were 7.0 kg/m² for males and 5.4 kg/m² for females.

Results

The group with sarcopenia brushed their teeth less frequently. The presence of periodontitis was significantly higher in participants with sarcopenia (males, 30.3%; females, 45.9%) than in participants without sarcopenia (males, 18.3%; females, 17.4%) (p<0.001). The number of natural teeth was significantly lower in participants with sarcopenia. The adjusted odds ratio for sarcopenia in participants with <20 natural teeth compared to those with full dentition was 1.96 (95% confidence interval [CI], 1.58–2.48) in males and 2.86 (95% CI, 2.31–3.56) in females. Subgroup analysis of the adjusted odds ratio for sarcopenia in older (≥65 years) individuals with <20 natural teeth was 1.92 (95% CI, 1.49–2.66) in males and 2.63 (95% CI, 2.25–3.64) in females.

Conclusion

Loss of the natural teeth wass significantly associated with sarcopenia.

Association between number of teeth present and mandibular cortical erosion in Japanese men and women aged 40 years and older: A cross-sectional study

Mandibular cortical erosion detected on dental panoramic radiographs is associated with increased risk of osteoporosis in older adults. Additionally, many reports have demonstrated an association between decreased number of teeth present and osteoporosis. However, whether mandibular cortical erosion is associated with a decreased number of teeth remains unclear. The purpose of this study, therefore, was to clarify the association between mandibular cortical erosion and number of teeth present in Japanese men and women aged 40 years and older. Among patients who visited our university hospital and underwent dental panoramic radiography for the diagnosis of dental diseases, 839 patients (293 men and 546 women) aged 40–89 years (mean [SD], 63.7 [10.6] years) participated in this study. Multiple regression analysis revealed that mildly to moderately eroded cortex (p = 0.007) and severe eroded cortex (p < 0.001) were significantly associated with a decreased number of teeth present. Analysis of covariance adjusted for covariates revealed a significant association between mandibular cortical erosion category and number of teeth present (p < 0.001). Subjects with a severely eroded cortex had significantly fewer teeth present than those with a normal cortex (mean [SE], 20.7 [0.5] vs. 23.4 [0.3], p < 0.001) or mildly to moderately eroded cortex (22.2 [0.4], p = 0.04). Subjects with a mildly to moderately eroded cortex had significantly fewer teeth present than those with a normal cortex (p = 0.033). Our results suggest the significant association between mandibular cortical erosion and number of teeth present in Japanese men and women aged 40 years and older.

Common risk factors and edentulism in adults, aged 50 years and over, in China, Ghana, India and South Africa: results from the WHO Study on global AGEing and adult health (SAGE)

BACKGROUND

Edentulism (loss of all teeth) is a final marker of disease burden for oral health common among older adults and poorer populations. Yet most evidence is from high-income countries. Oral health has many of the same social and behavioural risk factors as other non-communicable diseases (NCDs) which are increasing rapidly in low- and middle-income countries with ageing populations. The "common risk factor approach" (CRFA) for oral health addresses risk factors shared with NCDs within the broader social and economic environment.

METHODS

The aim is to improve understanding of edentulism prevalence, and association between common risk factors and edentulism in adults aged 50 years and above using nationally representative samples from China (N = 11,692), Ghana (N = 4093), India (N = 6409) and South Africa (N = 2985). The data source is the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) Wave 1 (2007-2010). Multivariable logistic regression describes association between edentulism and common risk factors reported in the literature.

RESULTS

Prevalence of edentulism: in China 8.9 %, Ghana 2.9 %, India 15.3 %, and South Africa 8.7 %. Multivariable analysis: in China, rural residents were more likely to be edentulous (OR 1.36; 95 % CI 1.09-1.69) but less likely to be edentulous in Ghana (OR 0.53; 95 % CI 0.31-0.91) and South Africa (OR 0.52; 95 % CI 0.30-0.90). Respondents with university education (OR 0.31; 95 % CI 0.18-0.53) and in the highest wealth quintile (OR 0.68; 95 % CI 0.52-0.90) in China were less likely to be edentulous. In South Africa respondents with secondary education were more likely to be edentulous (OR 2.82; 95 % CI 1.52-5.21) as were those in the highest wealth quintile (OR 2.78; 95 % CI 1.16-6.70). Edentulism was associated with former smokers in China (OR 1.57; 95 % CI 1.10-2.25) non-drinkers in India (OR 1.65; 95 % CI 1.11-2.46), angina in Ghana (OR 2.86; 95 % CI 1.19-6.84) and hypertension in South Africa (OR 2.75; 95 % CI 1.72-4.38). Edentulism was less likely in respondents with adequate nutrition in China (OR 0.68; 95 % CI 0.53-0.87). Adjusting for all other factors, compared with China, respondents in India were 50 % more likely to be edentulous.

CONCLUSIONS

Strengthening the CRFA should include addressing common determinants of health to reduce health inequalities and improve both oral and overall health.

Effects of Salivary Oxidative Markers on Edentulous Patients' Satisfaction with Prosthetic Denture Treatments: A Pilot Study

Objectives

The purpose of this study was to assess relationships among periodontal conditions, salivary antioxidant levels, and patients’ satisfaction with their prostheses.

Methods

This study was conducted at the Division of Prosthodontics, Department of Dentistry, Taipei Medical University Hospital. The periodontal condition of patients was based on an assessment of the plaque index (PI) and gingival index (GI). The pH value, flow rate, and buffer capacity of the saliva were estimated. The salivary total antioxidant status (TAS) and superoxide dismutase (SOD) level were also determined. Patients’ satisfaction with prosthetic treatments was evaluated using the Chinese version of the short-form Oral Health Impact Profile (OHIP-14C). A multivariate regression model was used to determine whether patients’ satisfaction with prosthetic treatment was affected by their oral health status.

Results

In total, 35 edentulous patients were recruited. In the Spearman correlation analysis, salivary pH (r = -0.36, p = 0.03) and the buffer ability (r = -0.48, p<0.01) were associated with OHIP-14C scores. In the multivariate analysis, patients who had a higher GI also had a higher score of physical disabilities (β = 1.38, p = 0.04). Levels of SOD increased with the scores of psychological discomfort (β = 0.33 U/g protein, p = 0.04).

Conclusions

This study suggested that both the GI and SOD levels were associated with patients’ satisfaction with prosthetic treatments. To the best of our knowledge, this is the first study to elucidate the relationship between OHIP scores and salivary oxidative markers in edentulous patients.

Secondary Data Analysis of National Surveys in Japan Toward Improving Population Health

Secondary data analysis of national health surveys of the general population is a standard methodology for health metrics and evaluation; it is used to monitor trends in population health over time and benchmark the performance of health systems. In Japan, the government has established electronic databases of individual records from national surveys of the population’s health. However, the number of publications based on these datasets is small considering the scale and coverage of the surveys. There appear to be two major obstacles to the secondary use of Japanese national health survey data: strict data access control under the Statistics Act and an inadequate interdisciplinary research environment for resolving methodological difficulties encountered when dealing with secondary data. The usefulness of secondary analysis of survey data is evident with examples from the author’s previous studies based on vital records and the National Health and Nutrition Surveys, which showed that (i) tobacco smoking and high blood pressure are the major risk factors for adult mortality from non-communicable diseases in Japan; (ii) the decrease in mean blood pressure in Japan from the late 1980s to the early 2000s was partly attributable to the increased use of antihypertensive medication and reduced dietary salt intake; and (iii) progress in treatment coverage and control of high blood pressure is slower in Japan than in the United States and Britain. National health surveys in Japan are an invaluable asset, and findings from secondary analyses of these surveys would provide important suggestions for improving health in people around the world.

Tooth loss and associated factors in elders: results from a national survey in Uruguay

OBJECTIVES

This study evaluated the prevalence and severity of tooth loss in Uruguayan elders, assessing its association with demographic, socioeconomic, and behavioral factors; the use of health services; and self-reported dental treatment need.

METHODS

A population-based cross-sectional study was done among Uruguayan individuals of ages 65-74 years. Data were collected through questionnaires and clinical examinations. The dependent variable, tooth loss, was classified into three distinct outcomes: functional dentition (≥20 teeth), severe tooth loss (<9 teeth), and edentulism. The independent variables were: sex, socioeconomic status, use of health services, hypertension, diabetes mellitus, tobacco use, frequent consumption of alcohol, hygiene habits, and need for dental care.

RESULTS

The sample comprised 341 individuals, and the mean number of teeth present was 9.73 (95% confidence interval, 8.77-10.69) for each individual. After multivariate analysis, lack of a functional dentition, severe tooth loss, and edentulism were found to be associated with lower socioeconomic level, frequent consumption of alcohol, and receiving treatment from the public health system (P < 0.05). Individuals with self-reported dental treatment need had more severe tooth loss and presented a higher degree of edentulism (P < 0.05).

CONCLUSIONS

There is a high and severe prevalence of tooth loss in elderly Uruguayans, especially among those from lower socioeconomic levels. Our findings highlight the importance of public health policies to prevent and treat tooth loss.

Dental status of an institutionalized elderly population of 60 years and over in Qingdao, China

Objectives

The aim of this study was to investigate dental status of institutionalized elders and to relate outcomes with background variables and oral functionality.

Materials and methods

Dental status of 512 elders (≥60 years) from eight nursing homes in Qingdao were analyzed in terms of prevalence of decayed (D), missing (M), filled (F), and replaced teeth (R). Multivariate logistic regression was applied to determine relationships with the background variables age, gender, and SES. Prevalence of D, M, and F was analyzed also for separate dental regions. For determining oral functionality, prevalence of dentitions with ≥20 teeth without and with tooth replacements was plotted against age.

Results

Mean number of D varied from 3.8 at 60 years to 4.6 at 90 years, M from 3.6 at 60 years to 6.7 at 90 years for the lower jaw, and from 3.0 at 60 years to 8.0 at 90 years for the upper. Mean number of F in each jaw was low: 0.2 at 60 years to 0.4 at 90 years. Gender and SES effects were limited. Molars had significantly higher prevalence of D and M than premolar and anterior teeth. Seventy percent of participants of 60 years had ≥20 natural teeth and 12 % at 90 years. Including tooth replacements, 96 % at 60 years, and 84 % at 90 years had ≥20 teeth.

Conclusions

In this sample of institutionalized elders, dental status of the majority of participants did not represent a functional dentition without tooth replacements.

Clinical relevance

Institutionalized Chinese elders showed relatively low numbers of decayed teeth but high numbers of missing teeth.

Prevalence of loss of all teeth (edentulism) and associated factors in older adults in China, Ghana, India, Mexico, Russia and South Africa

Little information exists about the loss of all one’s teeth (edentulism) among older adults in low- and middle-income countries. This study examines the prevalence of edentulism and associated factors among older adults in a cross-sectional study across six such countries. Data from the World Health Organization (WHO’s) Study on global AGEing and adult health (SAGE) Wave 1 was used for this study with adults aged 50-plus from China (N = 13,367), Ghana (N = 4724), India (N = 7150), Mexico (N = 2315), Russian Federation (N = 3938) and South Africa (N = 3840). Multivariate regression was used to assess predictors of edentulism. The overall prevalence of edentulism was 11.7% in the six countries, with India, Mexico, and Russia has higher prevalence rates (16.3%–21.7%) than China, Ghana, and South Africa (3.0%–9.0%). In multivariate logistic analysis sociodemographic factors (older age, lower education), chronic conditions (arthritis, asthma), health risk behaviour (former daily tobacco use, inadequate fruits and vegetable consumption) and other health related variables (functional disability and low social cohesion) were associated with edentulism. The national estimates and identified factors associated with edentulism among older adults across the six countries helps to identify areas for further exploration and targets for intervention.

Smoking and Drinking as Risk Indicators for Tooth Loss in Middle-Aged Danes

Objectives: To investigate tobacco and alcohol consumption as risk indicators for missing teeth in late middle-aged Danes. Method: In all, 1,517 Copenhagen Aging and Midlife Biobank (CAMB) participants received a clinical oral examination that included number of teeth. Information on smoking, drinking, and various covariates was obtained using self-administered, structured questionnaires. Descriptive statistics and logistic regression (dependent variable: 6+ vs. <6 missing teeth) were used to investigate smoking and drinking in relation to missing teeth. Results: Current smokers, persons who currently or previously smoked >15 tobacco units/day, and persons who had smoked for 27+ years had elevated mean scores of missing teeth and associated odds ratios (OR) compared with never smokers. Relative to nondrinkers, alcohol consumption was associated with reduced odds of missing 6+ teeth. Discussion: Our findings suggest that smoking is positively associated, while alcoholic beverage consumption is inversely related to tooth loss in middle-aged Danes.

Sociodemographic and health-related risk factors associated with tooth loss among adults in Rhode Island

Introduction

Oral health is an integral component of overall health and well-being. Very little Rhode Island state-level information exists on the determinants of tooth loss. The objective of this study was to systematically identify sociodemographic characteristics, health behaviors, health conditions and disabilities, and dental insurance coverage associated with tooth loss among noninstitutionalized adults in Rhode Island.

Methods

We analyzed Rhode Island’s 2008 and 2010 Behavioral Risk Factor Surveillance System survey data in 2011. The survey had 4 response categories for tooth loss: none, 1 to 5, 6 or more but not all, and all. We used multinomial logistic regression models to assess the relationship between 4 risk factor domains and tooth loss.

Results

An estimated 57.6% of Rhode Island adults had all their teeth, 28.9% had 1 to 5 missing teeth, 8.9% had 6 to 31 missing teeth, and 4.6% were edentulous. Respondents who had low income, low education, unhealthy behaviors (ie, were former or current smokers and did not engage in physical activity), chronic conditions (ie, diabetes and obesity) or disabilities, and no dental insurance coverage were more likely to have fewer teeth compared with their referent groups. However, the association of these variables with tooth loss was not uniform by age group.

Conclusion

Adults who report risky health behaviors or impaired health may be considered target subpopulations for prevention of tooth loss and promotion of good oral health.

Factors related to tooth loss among community-dwelling middle-aged and elderly Japanese men

Background

Using data from a large-scale community-based Japanese population, we attempted to identify factors associated with tooth loss in middle-aged and elderly men.

Methods

A total of 8352 men aged 40 to 79 years who lived in the north of the main island of Japan and underwent health checkups were enrolled between 2002 and 2005. Number of teeth was assessed by the question, “How many teeth do you have (0, 1–9, 10–19, or ≥20)?”. On the basis of the answer to this question, participants were classified into 2 groups (≤19 teeth or ≥20 teeth). Using multivariate logistic regression, factors related to having 19 or fewer teeth were estimated.

Results

The numbers (percentages) of participants who had 0, 1 to 9, 10 to 19, and 20 or more teeth were 1764 (21.1%), 1779 (21.3%), 1836 (22.0%), and 2973 (35.6%), respectively. Among the participants overall and those aged 65 to 79 years, having 19 or fewer teeth was significantly associated with older age, smoking status (current smoking and ex-smoking), and low education level. In addition, men with 19 or fewer teeth were more likely to have a low body mass index and low serum albumin level and less likely to be current alcohol drinkers. Among men aged 40 to 64 years, but not men aged 65 to 79 years, those with 19 or fewer teeth were more likely to have a low serum high-density lipoprotein cholesterol level and high glycosylated hemoglobin (HbA1c) level.

Conclusions

Smoking, low education level, and poor nutritional status were associated with tooth loss among middle-aged and elderly Japanese men.

Substance-use screening and interventions in dental practices: survey of practice-based research network dentists regarding current practices, policies and barriers

BACKGROUND

Dental visits represent an opportunity to identify and assist patients with unhealthy substance use, but little is known about how dentists are addressing patients' use of tobacco, alcohol and illicit drugs. The authors surveyed dentists to learn about the role their practices might play in providing substance-use screening and interventions.

METHODS

The authors distributed a 41-item Web-based survey to all 210 dentists active in the Practitioners Engaged in Applied Research and Learning Network, a practice-based research network. The questionnaire assessed dental practices' policies and current practices, attitudes and perceived barriers to providing services for tobacco, alcohol and illicit drug use.

RESULTS

One hundred forty-three dentists completed the survey (68 percent response rate). Although screening was common, fewer dentists reported that they were providing follow-up counseling or referrals for substance use. Insufficient knowledge or training was the most frequently cited barrier to intervention. Many dentists reported they would offer assistance for use of tobacco (67 percent) or alcohol or illicit drugs (52 percent) if reimbursed; respondents who treated publicly insured patients were more likely to reply that they would offer this assistance.

CONCLUSIONS

Dentists recognize the importance of screening for substance use, but they lack the clinical training and practice-based systems focused on substance use that could facilitate intervention. Practical Implications. The results of this study indicate that dentists may be willing to address substance use among patients, including use of alcohol and illicit drugs in addition to tobacco, if barriers are reduced through changes in reimbursement, education and systems-level support.

Relationship between Subjective Oral Health Status and Lifestyle in Elderly People: A Cross-Sectional Study in Japan

Objective. The aim of this study was to assess the relationship between subjective oral health status and lifestyle in elderly people living in Japan. Methods. Subjects were 5383 inhabitants of the Kagawa Prefecture, Japan, at the age of 75-100. Records of the number of remaining teeth and the data from self-reported questionnaire were analyzed statistically. Results. Remaining teeth were significantly correlated to "no current smoking," while not related to other lifestyle. On the other hand, "subjective masticatory ability" defined as a condition allowing chewing all foods well was related to favorable lifestyles. "Subjective masticatory ability" was also related to "not feeling stress," "no deviated food habit" as well as to other good oral health conditions. A logistic regression analysis for "remaining teeth more than 20" revealed a significant relationship between "no current smoking" (OR = 1.582) and "no alcohol drinking" (OR = 0.851). Regarding "subjective masticatory ability," all favorable lifestyles analyzed in this study were found to be significant positive factors. Conclusions. "Subjective masticatory ability" seems to be strongly associated with favorable lifestyles. Therefore, it can be suggested that "subjective masticatory ability" might be a good landmark for quality of life of elderly people in addition to the number of remaining teeth.

Epidemiological survey on edentulousness

India has a large geriatric population of 77 millions, comprising 7.7% of its total population. One of the major handicaps in the elderly is loss of teeth, affecting their mastication, dietary intake and nutritional status.

AIMS AND OBJECTIVES

The present study was planned to assess the level of edentulousness, cause of edentulousness, denture wearing and denture needs of the middle and elderly in the society and study was correlated between habits and socioeconomic variables, diet and body mass index (BMI).

MATERIALS AND METHODS

A total of 500 subjects (random sampling) from dental outpatient were studied. A prepared questionnaire was developed, explained, interviewed and questions were filled personally.

RESULTS

The level of edentulousness was found to be high in the subjects with low socioeconomic status and in advancing age with no significant difference between male and females. Another finding was very low level of denture wearing of 62% needing complete denture and partial denture only 10.4% of subjects wearing dentures. Mixed diet population had higher level of edentulousness compared with vegetarians. The BMI was correlated with level of edentulousness.

CONCLUSION

The study clearly showed that there is lack of dental awareness, so dental education and motivation in very important. The study concludes that the need for prosthodontics care will increase due to the increase in life span. This study is clinically significant with regard to knowing the root cause of edentulism, either partial or complete. Out of 62% tooth loss, dental caries (37.4%) topped the cause for tooth loss followed by combination of dental caries and periodontal disease (12.2%).

Factors associated with edentulousness in an elderly population in Valencia (Spain)

OBJECTIVE

To determine the prevalence of edentulism and its association with various socioeconomic factors and oral health habits in the population aged 65-74 years old in the region of Valencia.

METHODS

A cross sectional study was designed. Thirty-four primary health centers and five nursing homes were chosen at random in the region of Valencia (10-15 voluntary participants per sampling point). Clinical examinations were carried out by three calibrated dentists (kappa>0.85) in the same centers. The total sample consisted of 531 individuals (235 men and 296 women).

RESULTS

The percentage of toothlessness was 20.7% and the mean number of natural teeth present was 14.92. The prevalence of edentulism was significantly higher (p <0.05) in men, institutionalized persons, those with no schooling, those with poor oral hygiene, those who visited the dentist regularly and those living in peri-urban/rural areas. In a multivariate logistic regression model with edentulism as the dependent variable, the following factors were identified as significant independent variables: institutionalization (odds ratio [OR]=2.88), poor oral hygiene (OR=2.35), regular visits to the dentist (OR=2.34) and age (OR=1.19).

CONCLUSION

Edentulousness is a complex phenomenon that involves distinct social and economic factors.

Amount and type of alcohol consumption and missing teeth among community-dwelling older adults: findings from the Copenhagen Oral Health Senior study

OBJECTIVES

To study if an association between total weekly intake of alcohol, type-specific weekly alcohol intake, alcoholic beverage preference, and the number of teeth among older people exists.

METHODS

A cross-sectional study including a total of 783 community-dwelling men and women aged 65-95 years who were interviewed about alcohol drinking habits and underwent a clinical oral and dental examination. Multiple regression analyses were applied for studying the association between total weekly alcohol consumption, beverage-specific alcohol consumption, beverage preference (defined as the highest intake of one beverage type compared with two other types), and the number of remaining teeth (≤ 20 versus >20 remaining teeth).

RESULTS

The odds ratio (OR) of having a low number of teeth decreased with the total intake of alcohol in women, with ORs for a low number of teeth of 0.40 [95 percent confidence interval (CI) 0.22-0.76] in women drinking 1-14 drinks per week and 0.34 (95 percent CI 0.16-0.74) in women with an intake of more than 14 drinks per week compared with abstainers. Similar relations could also be obtained for type-specific alcohol intake of wine and for wine and spirits preference among women. Men who preferred beer showed a decreased risk for a low number of teeth compared with men with other alcohol preferences.

CONCLUSION

In this study, alcohol consumption, wine drinking, and wine and spirits preference among women were associated with a higher number of teeth compared with abstainers. Among men, those who preferred beer also had a higher number of teeth.

Causal assessment of smoking and tooth loss: a systematic review of observational studies

BACKGROUND

Tooth loss impairs oral function. The aim of the present review was to evaluate the causal association between smoking and tooth loss on the basis of high-quality studies.

METHODS

Relevant literature was searched and screened, and the methodological quality was assessed. Information on the strength of the association between smoking and tooth loss, the dose-response relationship and natural experimental data was collected and evaluated with respect to consistency and study design.

RESULTS

Our literature search yielded 496 citations, and 6 cross-sectional and 2 cohort high-quality studies examining 58,755 subjects in four countries. All studies reported significant associations, although the strength of the association was usually moderate. Four studies reported dose-response relationships between exposure to smoking and the risk of developing tooth loss. A decrease in the risk of tooth loss for former smokers was evident in six studies. Interpretation of evidence for each element was consistent, despite some shortcomings regarding study type and population.

CONCLUSIONS

Based on the consistent evidence found with the existing biological plausibility, a causal association between smoking and tooth loss is highly likely. Further studies using a cohort design and different populations are necessary to confirm this association.

Cigarette smoking and tooth loss in a cohort of older Australians: the 45 and up study

BACKGROUND

Data regarding the long-term effects of smoking, smoking cessation and environmental tobacco smoke (ETS) on tooth loss are limited.

METHODS

The authors collected information about tooth loss and other health-related characteristics from a questionnaire administered to 103,042 participants in the 45 and Up Study conducted in New South Wales, Australia. The authors used logistic regression analyses to determine associations of cigarette smoking history and ETS with edentulism, and they adjusted for age, sex, income and education.

RESULTS

Current and former smokers had significantly higher odds of experiencing edentulism compared with never smokers (prevalence odds ratio [OR], 2.51; 95 percent confidence interval [CI], 2.31-2.73 and OR, 1.50; 95 percent CI, 1.43-1.58, respectively). Among former smokers, the risk declined significantly with increasing time since smoking cessation; however, the risk remained elevated even in those who ceased smoking 30 or more years previously compared with that in never smokers (OR, 1.10; 95 percent CI, 1.02-1.19). Furthermore, among never smokers, the OR for edentulism was 1.37 (95 percent CI, 1.17-1.60) in those who reported having exposure to ETS for six or more hours per week versus those who were not exposed to any ETS.

CONCLUSIONS

and

CLINICAL IMPLICATIONS

Although the risk of experiencing tooth loss declines with time since smoking cessation, the effects of smoking may persist for at least 30 years. The effect of ETS requires further investigation.

Alcohol and the older adult: a comprehensive review

Alcohol consumption in the older adult is of major concern with the advent of baby boomers coming into the over 65-age bracket. Alcohol consumption has been touted as beneficial for health, and while that may be accurate for moderate consumption in younger persons, there is considerable risk associated with increased alcohol intake in older adults. This increase is partially due to age-related physiological changes, existing diagnoses, number of comorbid conditions, and increased use of prescribed and/or over-the-counter medications, coupled with other concerns. This review addresses the current research regarding ethanol consumption in older adults and all-cause mortality as well as several conditions more frequently seen in the geriatric population. These conditions include vascular diseases, hypertension, type 2 diabetes, gastrointestinal disorders, hepatic disorders, dental and oro-facial problems, bone density decline, and falls and fractures. In addition, drug interactions and recent research into select vitamin and mineral considerations with increased alcohol intake in older persons are addressed. While recommendations for alcohol intake have not been specifically established for age ranges within the 65-year-and-older bracket, and practitioners do not routinely assess alcohol intake or ethanol related adverse events in this population, common sense approaches to monitoring will become increasingly important as the generation of "boomers" who believe that alcohol intake improves health comes of age.

Edentulism risk indicators among Mexican elders 60-year-old and older

The objective of this study was to determine the prevalence of edentulism in Mexican elders aged 60 years and older, and the associated risk indicators. A cross-sectional study was undertaken in 139 elders living in either of two long-term care (LTC) facilities, or attending an adult day center (ADC) in Pachuca, Mexico. A subject was edentulous when natural teeth were completely absent, determined through a clinical examination. Risk indicators were collected using questionnaires. Analyses were performed using binary logistic regression in STATA 9.0. Mean age was 79.0±9.8 years. Many subjects were women (69.1%). The prevalence of edentulism was 36.7%. In multivariate analysis, after adjusting for age and sex, the variables that were inversely associated (p<0.05) with edentulism were living with a spouse (odds ratio=OR=0.31), and lacking health insurance (OR=0.70). Variables associated with higher risk of being edentate were lower educational attainment (OR=1.61), having received radiation therapy (OR=4.49), being a smoker (OR=4.82), and having diabetes (OR=2.94) or other chronic illnesses (OR=1.82) (with hypertension approaching significance, p=0.067). In this sample of Mexican elders, diverse variables were associated with edentulism, in particular smoking and past radiotherapy. Oral health programs within and outside LTC/ADC should take into account risk factors specific to the older population.

Association of total tooth loss with socio-behavioural health indicators in Korean elderly

This study examined the association between total tooth loss, and socio-behavioural factors and general health indicators in elderly Koreans using national databases. Cross-sectional data for this study were from the third Korean National Health and Nutrition Examination Survey (KNHANES III), which was conducted among non-institutionalised civilians by the Korean Ministry of Health and Welfare in 2005. KNHANES III used a stratified, multistage probability sampling design on a representative of total South Korean population, according to geographical areas, age and sex groups. Among them, 1091 subjects aged 65 years and above were identified as potential participants in this study. The dependent variable in this study was the self-reported total tooth loss. The independent variables consisted of the following four categories: demographic information, socio-behavioural factors, psychological factors and general health indicators. The data were weighted to adjust for the sampling complexity, and SPSS version 14 for Windows software was used for data analysis. There were significant differences in total tooth loss odds according to the socio-behavioural backgrounds (education and smoking), psychological conditions (perceived oral health) and general health status (diabetes and body mass index as underweight). This suggests that the total tooth loss is associated with the socio-economic status, health-related behaviour and general health. However, more extensive longitudinal data and research will be needed to better explain the relationship between the total tooth loss and these variables.

Association of some specific nutrient deficiencies with periodontal disease in elderly people: A systematic literature review

OBJECTIVE

Deficiency of vitamin B complex, vitamin C, vitamin D, calcium, and magnesium has been associated with periodontal disease. This article systematically reviews the currently available literature on the feasible association of vitamin B complex, vitamin C, vitamin D, calcium, and magnesium deficiencies with periodontal disease in elderly people.

METHODS

We performed a systematic review of relevant English- and Dutch-language medical literature published from January 1990 to May 2007, with critical appraisal of those studies evaluating the association of vitamin B complex, vitamin C, vitamin D, calcium, and magnesium deficiencies with periodontal disease in elderly people.

RESULTS

None of the studies meeting the selection criteria included institutionalized elderly people. In the studies on non-institutionalized elderly people, no significant or consistent association was found between vitamin B complex, vitamin C, vitamin D, calcium, and magnesium dietary intakes and serum levels and periodontal disease. Although in those studies decreased dietary vitamin C intake was found to be associated with increased risk of periodontal disease, no conclusive evidence could be demonstrated.

CONCLUSION

There is no evidence of an association of vitamin B complex, vitamin C, vitamin D, calcium, and magnesium deficiencies with periodontal disease in non-institutionalized elderly people. To produce conclusive evidence on the subject of this systematic literature review, longitudinal cohort studies and follow-up randomized controlled trials are needed.

Association between alcohol consumption and dental health

OBJECTIVES

To study the association of alcohol consumption with dental health in a sample from the County of Stockholm.

MATERIAL AND METHODS

In a longitudinal investigation, 513 individuals were examined in 1970 and 1990. Clinical and radiographic examinations were performed as well as an interview including questions on alcohol consumption. The clinical investigation consisted of the registration of the number of remaining teeth, dental restorations, caries and periodontal conditions. The marginal bone level and longitudinal bone loss were determined by assessments on the proximal surfaces of all measurable teeth on the radiographs. Stepwise multiple regression analyses were adopted to calculate the partial correlations between alcohol consumption and the investigated odontological variables.

RESULTS

The group of subjects with the highest alcohol consumption (>5 cl pure alcohol per day) had more tooth surfaces with caries, more calculus and more teeth with apical lesions compared with those who reported an alcohol consumption </=5 cl of pure alcohol per day. Alcohol consumption was not associated with periodontal disease.

CONCLUSION

The observations do not support any association between alcohol consumption and periodontal disease. However, individuals with high alcohol consumption had significantly more teeth with decayed surfaces and apical lesions indicating that lifestyle-related factors may influence dental health.

Association between vitamin D receptor gene haplotypes and chronic periodontitis among Japanese men

BACKGROUND

The vitamin D receptor (VDR) is involved in a variety of biological processes, such as bone metabolism and modulation of the immune response. Recent findings suggest that the pathway involving bone mineral density-mediated effects is important for the development of periodontitis, but their effects of combined VDR gene polymorphisms have not been confirmed on periodontitis. We assessed the relationship between ApaI, BsmI, and FokI VDR polymorphisms and the risk of severe chronic periodontitis among Japanese adult men.

MATERIALS AND METHODS

In a cross-sectional study, we examined 97 unrelated healthy Japanese men (mean age: 45.6 years, range: 22-59). A clinical examination was performed at a worksite health checkup, and information was obtained using a self-reported questionnaire. DNA was extracted from whole blood, and the VDR ApaI, BsmI, and FokI polymorphisms were genotyped using polymerase chain reaction.

RESULTS

F-carriers of FokI VDR polymorphisms were less likely to develop severe chronic periodontitis than non-F-carriers (p = 0.09). The ApaI and BsmI VDR polymorphisms did not show significant differences in the alleles or genotypes between the subjects with or without severe chronic periodontitis. The haplotype analysis of the three combined VDR polymorphisms revealed that the Abf homozygote had a notably higher prevalence of severe chronic periodontitis than the others, and adjustments for age, smoking status, number of teeth present, and prevalence of diabetes did not change this association (OR = 7.5; 95% CI = 1.6-34.4; p = 0.01).

CONCLUSION

The VDR haplotype constructed from the ApaI, BsmI, and FokI polymorphisms is related to the risk of severe chronic periodontitis in Japanese men.