Association between smoking intensity and duration and tooth loss among Finnish middle-aged adults: The Northern Finland Birth Cohort 1966 Project

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.

Impact of Smoking on the Healing of Apical Periodontitis after Nonsurgical Endodontic Treatment

OBJECTIVES

 The aim of this prospective study was to compare the healing of periapical bone between smokers and nonsmokers after root canal therapy. The effects of duration and intensity of smoking on the healing rate of apical periodontitis were analyzed.

MATERIALS AND METHODS

 Fifty-five smokers were included in this study. The control group consisted of healthy nonsmokers who matched the smoker group in age and sex. Only teeth with a favorable periodontal prognosis and adequate coronal restoration were included in the study. The periapical status of treated teeth was assessed using the periapical index system at follow-ups after 6 and 12 months.

STATISTICAL ANALYSIS

 The chi-squared test and Mann-Whitney U test were used to assess the changes in periapical index score at baseline and in subsequent time intervals between the two groups examining dichotomized and ordinal data, respectively. Multivariate logistic regression analysis was used to test the association of independent variables age, gender, tooth type, arch type, and smoking index with the outcome variable. The outcome variable was set as the presence versus absence of apical periodontitis.

RESULTS

 The analysis at 12-month follow-up revealed a significantly higher healing rate in control group than in smokers (90.9 vs. 58.2; χ2 = 13.846; p < 0.001). Smokers had significantly higher periapical index scores than the control group (p = 0.024). The multivariate logistic regression analysis demonstrated that an increase in the value of the smoking index significantly increases the risk of apical periodontitis persistence (odds ratio [OR] =7.66; 95% confidence interval [CI]: 2.51-23.28; p < 0.001) for smoking index < 400 and (OR = 9.65; 95% CI: 1.45-64.14; p = 0.019) for smoking index 400 to 799.

CONCLUSION

 The results from this study show a lower rate of apical periodontitis healing in a group of smokers at 1-year follow-up. Delayed periapical healing seems to be associated with the cigarette smoking exposure.

The association between oral hygiene and head and neck cancer: a meta-analysis

OBJECTIVE

Oral hygiene has been suspected to contribute to the aetiology of head and neck cancer (HNC). Based on the meta-analysis, we evaluated the impact of oral hygiene on head and neck cancer (HNC) and its survival.

MATERIALS AND METHODS

Relevant case-control and cohort studies reporting survival data, oral hygiene data were searched via PubMed, Embase, Cochrane Library, and Web of Science databases. The odds ratios (ORs), hazard ratios (HRs), and 95% confidence intervals (CIs) were used. Subgroup analysis was performed.

RESULTS

Oral hygiene was associated with HNC. Tooth brushing ≥2 a day, dental floss use, denture wearing, caries ≥3, and dental visit ≥1 reduced the risk of oral cavity cancer while mouth wash use, missing teeth >5, gum bleeding, and periodontal disease increased the risk of oral cavity cancer. For oropharynx cancer, tooth brushing ≥2 and caries ≥3 were associated with reduced risk of it. Tooth brushing ≥2 and dental visits ≥1 decreased the risk of pharynx cancer risk and larynx cancer risk, however, missing teeth >5 increased both of them.

CONCLUSION

Oral hygiene was associated with HNC and its sub sites. Oral hygiene should be strengthened, a dental floss use and dentist's visits can be recommended.

Explaining income inequities in tooth loss among Brazilian adults

OBJECTIVE

To determine the extent to which individual and contextual variables explain income inequities in tooth loss in Brazilian adults.

METHODS

A nationally representative sample of 65,784 Brazilian adults aged 18-59 who participated in the Brazilian National Health Survey 2019 was analyzed. Self-reported tooth loss was the outcome. Per capita income was the main exposure, and minimum wage was the cutoff point. Individual covariates included sex, race, and schooling, dental visits, smoking status, use of dental floss, and self-reported chronic conditions. Contextual covariates included access to treated water and geographic region of residence. Blinder-Oaxaca decomposition analysis was used to estimate the share of each factor in income-related tooth loss inequities by age groups.

RESULTS

Age-standardized tooth loss showed large income inequities. The average difference in tooth loss related to income inequities in the 18-34-year-old group was 0.50 (95% CI 0.39; 0.60), increasing to 4.51 (95% CI 4.09; 4.93) in the 45-59 years. Individual and contextual covariates explained almost 90% of income inequities in the 45-59 year group. Use of dental floss, schooling, and geographic region of residence (a proxy for human development level) had a higher proportion of contribution to the inequities examined.

CONCLUSIONS

Individual and contextual covariates (proxy for human development level and water fluoridation coverage) explained a large share of income-related tooth loss inequities. Tailored strategies to act at both levels can help reduce tooth loss inequities among Brazilian adults.

Factors Associated with Tooth Loss in General Population of Bialystok, Poland

Background: The aim of this study was to assess risk factors for tooth loss in the population of the city of Bialystok, in north-eastern Poland, taking into account the entire population and different age groups. The study included 1138 subjects divided into three subgroups: 20–44 years, 45–64 years, and 65–79 years. Participants were classified according to the number of teeth lost (0–8 vs. 9–28). Socio-economic variables, smoking history, and dental habits were collected through a questionnaire. Medical examinations provided data on the body mass index and the fasting blood glucose level. Data were statistically analysed using Mann-Whitney U, Student’s t, chi² tests, and binary logistic regression, p < 0.05. Results: For the general population, being female (OR 1.38, 1.07–1.79, p = 0.015), having secondary education (OR 4.18, Cl 2.97–5.87, p < 0.000), higher body mass index (OR 1.13, Cl 1.10–1.17, p < 0.000), higher fasting blood glucose level (OR 1.03 1.03–1.04, p < 0.000), being former smoker (OR 1.72, Cl 1.29–2.31, p < 0.000), ever smoker (OR 1.69, Cl 1.29–2.20, p < 0.000), current smoker (OR 1.62, Cl 1.15–2.29, p < 0.006), longer smoking period (OR 1.11, Cl 1.09–1.14, p < 0.000), last visit to the dentist over a year ago (OR 1.92, Cl 0.44–2.58, p < 0.000) and tooth brushing less than two times a day (OR 1.6, Cl 1.14–2.23, p < 0.006) were associated with losing more than 8 teeth. In the subgroup aged 20–44 years, only smoking duration was a risk factor for tooth loss (p = 0.02). For the middle-aged and oldest groups, education level (respectively p < 0.001, and p = 0.001), body mass index (respectively, p < 0.001, and p = 0.037), smoking status ever/former/current (respectively p < 0.001 and p = 0.002), smoking status never/ever (respectively p < 0.001 and p = 0.009), smoking duration (p < 0.001) were related to tooth loss. Additionally, in the elderly group, fasting blood glucose level (p = 0.044) and frequency of dental visits (p = 0.007) were related to tooth loss. We concluded that in the evaluated population, tooth loss was associated with socio-demographic, medical, and behavioural factors.

Oral Health Disparities in the Royal Netherlands Armed Forces

INTRODUCTION

In the military, good oral health is essential for combat readiness. The Royal Netherlands Armed Forces (RNAF) Dental Service is responsible for delivering a high standard of dental care to soldiers to ensure that commanding officers can deploy dentally fit troops. Oral health inequalities are associated with lower socioeconomic status. Rank is reflective of social status within the military hierarchy. The aim of this study was to analyze differences in the oral health status of RNAF personnel in relation to ranks and other determinants.

MATERIALS AND METHODS

All soldiers of the RNAF who underwent a regular dental inspection between January 15, 2018 and February 2, 2018 were enrolled. The decayed, missing, filled permanent teeth (DMFT) index, Dutch Periodontal Screening Index, and Simplified Oral Hygiene Index (OHI-S) were used to assess their oral health. Dental fitness was categorized. Patients were questioned about their smoking behavior and perception of their oral health. Personnel were divided into the following three groups according to rank: officers, noncommissioned officers (NCOs), and enlisted ranks.

RESULTS

Nine hundred and eighty-four soldiers of the RNAF were included in this study. Enlisted ranks had significantly higher DMFT index and OHI-S scores than officers and NCOs (both P < .001), which was associated with smoking and older age. Enlisted ranks were also significantly more often determined to have unacceptable dental fitness than officers and NCOs after the examination (P = .033). There was also a difference in dental fitness classification between officers and NCOs, but this was not statistically significant (P = .103).

CONCLUSIONS

The lowest ranked military personnel are more frequently classified as dentally unfit for deployment than officers and NCOs due to oral health conditions. This is important when considering the allocation of dental resources to maximize the pool of deployable personnel.

Impact of a novel oral health promotion program on routine oral hygiene among socioeconomically disadvantaged smokers: results from a randomized semi-pragmatic trial

Smokers are at high risk of oral disease and report sub-optimal oral hygiene. Improving smokers’ oral hygiene could reduce their future disease risk. The purpose of this study is to assess the effects of a novel, multi-modal oral health promotion program (Oral Health 4 Life; OH4L) targeted to socioeconomically disadvantaged smokers and delivered through state-funded tobacco quitlines. Smokers (n = 718) were randomized to standard quitline care or standard care plus OH4L. OH4L recipients received a comprehensive behavioral intervention and were advised of the benefits of routine oral hygiene, encouraged to brush and floss daily (for better oral health and to manage cigarette cravings), and provided a toothbrush and floss. Participants were followed for 6 months to assess the intervention effects on routine oral hygiene (brushing and flossing) and changes in motivation and self-efficacy. Data were collected between 2015 and 2017. At 2-month follow-up, OH4L participants were more likely to meet the American Dental Association (ADA) recommendations for brushing twice daily (adjusted RR = 1.15 [1.04, 1.27], p = .006), flossing daily (adjusted RR = 1.20 [1.03, 1.39], p = .02), and for both brushing and flossing (adjusted RR = 1.33 [1.10, 1.61], p = .003). Daily flossing was more likely at 6-month follow-up (adjusted RR = 1.21 [1.04, 1.42], p = .02) among OH4L participants. The change in self-efficacy and motivation for daily flossing from baseline to 2 months was significantly greater among OH4L participants and mediated the intervention effect on flossing at 6 months. Integrating oral hygiene promotion with standard tobacco quitline services improved oral health self-care.

Decrease in posterior occlusal support area can accelerate tooth loss: The Suita study

Purpose A decrease in posterior occlusal support is considered to increase the load on remaining teeth and thus accelerate tooth loss. Therefore, a follow-up study was carried out to perform a longitudinal analysis of the association between the posterior occlusal support region and tooth loss.Methods The participants of the study were 806 Suita Study participants who underwent physical health checkups both at baseline and at follow-up. The participants were classified into three groups by posterior occlusal support area (POSA) using the Eichner Index at baseline: Perfect POSA group, Eichner A; Decreased POSA group, Eichner B1-3; and Lost POSA group, Eichner B4 and Eichner C1-2. Participants were also classified into two groups according to whether they had tooth loss during the follow-up period. Tooth loss risk factors were investigated through the construction of logistic regression models with tooth loss as the dependent variable and posterior occlusal support, sex, age, periodontal disease, stimulated salivary flow rate, smoking habit, drinking habit, denture wearing, utilization of dental services, brushing habits, diabetes mellitus, osteoporosis and number of years of follow-up as independent variables.Results In the results of the logistic regression model, the adjusted odds ratio (95%CI) for tooth loss with the Perfect POSA group as the reference was 3.19 (1.98-5.14) for the Decreased POSA group and 4.57 (1.97-10.62) for the Lost POSA group.Conclusions This study showed that decreased POSA accelerated tooth loss in the general urban population.

Racial inequities in tooth loss among older Brazilian adults: A decomposition analysis

OBJECTIVE

To determine the extent to which racial inequities in tooth loss and functional dentition are explained by individual socioeconomic status, smoking status and frequency/reason for the use of dental services.

METHODS

Data came from the Brazilian Longitudinal Study of Ageing, a nationally representative sample of community-dwelling people aged 50 years and over. Tooth loss and functional dentition (ie 20+ natural teeth) were the outcomes. The main explanatory variable was self-classified race. Covariates included dental visits in the past 12 months, dental visits for check-ups only, smoking status, self-reported chronic conditions, depression and cognitive function. Logistic regression and Blinder-Oaxaca decomposition analysis were used to estimate the share of each factor in race-related tooth loss inequities.

RESULTS

The analytical sample comprised of 7126 respondents. While the prevalence of functional dentition in White Brazilians was 37% (95% CI: 33.5;40.9), it was 29% (95% CI: 26.4;31.6) among Browns and 30% (95% CI: 25.1;35.4) among Blacks. The average number of lost teeth among Whites, Browns and Blacks were 18.7 (95% CI: 17.8;19.6), 20.4 (95% CI: 19.7;21.1) and 20.8 (95% CI: 19.5;22.0), respectively. Decomposition analysis showed that the selected covariates explained 71% of the racial inequalities in tooth loss. Dental visits in the previous year and smoking status explained nearly half of race-related gaps. Other factors, such as per capita income, education and cognitive status, also had an important contribution to the examined inequalities. The proportion of racial inequities in tooth loss that was explained by dental visits (frequency and reason) and smoking status decreased from 40% for those 50-59 years of age to 22% among participants aged 70-79 years.

CONCLUSIONS

Frequency and reason for dental visits and smoking status explained nearly half of the racial inequity in tooth loss among Brazilian older adults. The Brazilian Family Health Strategy Program should target older adults from racial groups living in deprived areas.

Sugary Snack Consumption and Tooth Retention among Middle-aged Thai Adults

Objectives:

This study investigated whether the habit of consuming sugary snacks was independently associated with the loss of permanent teeth.

Materials and Methods:

Eight hundred ninety-seven adults aged 35–65 from four communities in the lower regions of Southern Thailand completed a structured questionnaire interview and dental examinations. The independent variable was frequency of sweet snack consumption between meals in the previous week and coded as: never (0 days), occasionally (1–4 days), or frequently (≥5 days). The outcome was the number of permanent teeth (1–19 vs. ≥20 teeth). Multivariate logistic regression was used to examine the adjusted associations between sugary snack consumption and the number of retained teeth. Odds ratio (OR) and 95% confidence intervals (CI) were calculated.

Results:

Approximately 23% of participants retained fewer than 20 permanent teeth. Approximately 30% of participants reported sugary snack intake most days. Fewer teeth were positively associated with high-frequency sugary snack consumption, older age, Muslim, ≤ 6 years of education, universal healthcare, infrequent tooth brushing, smoking, and alcohol consumption, but not sugar-sweetened beverages. After adjusting for sociodemographic characteristics and other potential confounders, the odds of having fewer teeth were higher among participants who frequently consumed sugary snacks (OR = 2.03, 95% CI = 1.21–3.39), but was not significantly different from those who occasionally consumed sugary snacks (OR = 0.93; 95% CI = 0.58–1.50) compared to nonsugary snack consumers.

Conclusion:

In this study, habitual sugary snack intake was associated with fewer teeth among middle-aged Thai adults. To improve oral health and prevent further tooth loss, efforts to reduce sugary snack consumption would be needed.

Cigarette Smoking Is Associated with Increased Risk of Malignant Gliomas: A Nationwide Population-Based Cohort Study

The association between cigarette smoking and the risk of developing malignant glioma (MG) remains unclear. We aimed to evaluate this potential association in a large general population, using a well-established and validated longitudinal nationwide database. Using data from the Korean National Health Insurance System cohort, 9,811,768 people over 20 years old without any cancer history in 2009 were followed until the end of 2017. We documented 6100 MG cases (ICD-10 code C71) during the median follow-up period of 7.31 years. Current smokers had a higher risk of developing MG (HR = 1.22, CI: 1.13–1.32) compared with never-smokers, after adjusting for confounders. This association was stronger for those who smoked ≥ 20 cigarettes daily (HR = 1.50, CI: 1.36–1.64). Furthermore, having 30 or more pack-years of smoking over the course of one’s lifetime was associated with an increased risk of developing MG in a dose-dependent manner, compared with never-smokers (HR = 1.31, CI: 1.16–1.48 for 30–39 pack-years of smoking; HR = 1.36, CI: 1.17–1.59 for 40–49 pack-years of smoking; HR = 1.68; CI: 1.44–1.95 for ≥ 50 pack-years of smoking). These results suggest that cigarette smoking may be associated with developing MG. Further prospective studies could help elucidate this association.

Effect of smoking cessation on tooth loss: a systematic review with meta-analysis

BACKGROUND

Smoking is a major risk factor for periodontitis and tooth loss. Smoking cessation has a positive impact in periodontal treatment. However, so far, no systematic review has evaluated the effect of smoking cessation on tooth loss. Therefore, this review aimed to evaluate if smoking cessation reduces the risk of tooth loss.

METHODS

Observational (cross-sectional and longitudinal) studies that investigated the association between smoking cessation and tooth loss were included. MEDLINE, EMBASE and LILACS databases were searched for articles published up to November 2018. Pooled results for subgroups of current and former smokers were compared in meta-analysis. Meta-regression was used to test the influence of smoking status on estimates and explore the heterogeneity.

RESULTS

Of 230 potentially relevant publications, 21 studies were included in the qualitative review and 12 in the quantitative analysis. Meta-analysis of cross-sectional studies did not show any differences between former and current smokers in the chance of losing 1 or more teeth (OR = 1.00; 95% CI = 0.80 to 1.24, I² = 80%), losing more than 8 teeth (OR = 1.02; 95% CI = 0.78 to 1.32, I² = 0%) or being edentulous (OR = 1.37; 95% CI = 0.94 to 1.99, I² = 98%). Meta-analysis from longitudinal studies showed that, when compared to never smokers, former smokers presented no increased risk of tooth loss (RR = 1.15; 95% CI = 0.98 to 1.35, I² = 76%), while current smokers presented an increased risk of tooth loss (RR = 2.60; 95% CI = 2.29 to 2.96, I² = 61%). Meta-regression showed that, among former smokers, the time of cessation was the variable that better explained heterogeneity (approximately 60%).

CONCLUSIONS

Risk for tooth loss in former smokers is comparable to that of never smokers. Moreover, former smokers have a reduced risk of tooth loss, when compared to current smokers.

Factors Related to the Number of Existing Teeth among Korean Adults Aged 55-79 Years

This study aimed to determine the association between the number of existing teeth (NET) and socioeconomic status (SES), oral health-related behaviours, and metabolic syndrome in Korean adults aged 55-79 years. The study included 3255 adults who underwent oral health examinations and answered questionnaires regarding SES, oral health-related behaviours, and metabolic diseases in the Sixth Korea National Health and Nutrition Examination Survey (2013-2015). The dependent variable was the binary status based on the median NET in each age group. The independent variables were based on SES, oral health-related behaviours, and the presence of metabolic syndrome. The study findings showed that the factors associated with the NET were sex, household income, education level, region of residence, daily toothbrushing frequency, dental visit within 1 year, smoking, and metabolic syndrome. NET was lower in males (adjusted OR: 0.74), in low household income group (adjusted OR: 0.77), in primary school graduates (adjusted OR: 0.53), in rural residents (adjusted OR: 0.78), and in medicaid beneficiaries (adjusted OR: 0.78). The interventions aimed at preserving existing teeth in elderly population should consider their SES, oral health-related behaviours, and metabolic syndrome and overhauling current oral healthcare system and redefining the roles of oral health professionals.

Validity of self-reported number of teeth in middle-aged Finnish adults: the Northern Finland Birth Cohort Study 1966

Background

We examined the validity of self-reported number of teeth in middle-aged adults by using representative cohort data to compare corresponding self-reported and clinical values.

Methods

This validity study is part of the representative 46-year-old follow-up of the Northern Finland Birth Cohort 1966 (NFBC1966) Study. Mailed questionnaires (n = 5950) requested information on self-reported number of teeth and background variables (education, tooth brushing and smoking), while clinical oral health examinations (n = 1891) assessed the number of teeth (the ‘gold standard’). The main analyses compared the self-reported and clinical values for the number of teeth in 1669 participants. Scatterplot and Bland-Altman plot served for visual analyses, and alternative correlation coefficients (Pearson, Spearman, intraclass) for numerical comparisons separately for men and women, with stratification according to background variables.

Results

The clinical assessment revealed that the mean value for the number of teeth was 27.46 (SD = 2.38), while the corresponding value based on self-reported information was 27.48 (SD = 2.78). According to the Bland-Altman plot, the mean difference between the clinical and self-reported values was − 0.02 (95% limits of agreement, LoA: − 3.37 to 3.32). The observed ranges of intraclass correlation coefficients (ICC) among men and women were 0.72 to 0.95 and 0.72 to 0.85, respectively, depending on the background variables.

Conclusions

Self-reported number of teeth in middle-aged Finnish adults agreed closely with the corresponding clinical measure.

Impaired glucose metabolism is associated with tooth loss in middle-aged adults: The Northern Finland Birth Cohort Study 1966

AIM

We investigated the association of impaired glucose metabolism with tooth loss in adults in the Northern Finland Birth Cohort Study 1966 (NFBC1966).

METHODS

We examined 4394 participants from the 46-year follow-up of the NFBC1966. Self-reported number of teeth as well as insulin and glucose values, taken during a standard oral glucose tolerance test (OGTT), served as the primary study variables. A multinomial logistic regression model served to analyse (unadjusted, smoking-adjusted and fully adjusted) the association between number of teeth (0-24, 25-27, 28-32) and glucose metabolism in women and men.

RESULTS

Among women, type 2 diabetes - whether previously known or detected during screening - pointed to a higher likelihood of 0-24 teeth (fully adjusted OR = 2.99, 95%CI = 1.54-5.80) and 25-27 teeth (OR = 1.91, 95%CI = 1.18-3.08) than did normal glucose tolerance. Similarly, impaired fasting glucose and impaired glucose tolerance together indicated a higher likelihood of 0-24 teeth (OR = 1.71, 95%CI = 1.09-2.69) than did normal glucose tolerance. A similar, statistically non-significant, pattern emerged among men. Number of teeth associated with OGTT insulin and glucose curves as well as with the Matsuda index in both women and men.

CONCLUSIONS

Tooth loss strongly associated with impaired glucose metabolism in middle-aged Finnish women.

Impact of oral hygiene on head and neck cancer risk in a Chinese population

BACKGROUND

Although the impact of oral hygiene on head and neck cancer risk has been investigated, few studies have been conducted among the Asian population.

METHODS

We conducted a multicenter case-control study to investigate this potential association. We performed unconditional multiple logistic regression models adjusted by potential confounders.

RESULTS

We observed an inverse association of frequency of dental visits with head and neck cancer risk, with an adjusted odds ratio (OR) of 3.70 (95% CI 2.51-5.45) for never dental visits compared with ≥1 time/year (Ptrend < .001). We also observed a positive association between the number of missing teeth and head and neck cancer risk, with an adjusted OR for ≥5 missing teeth compared with <5 missing teeth of 1.49 (95% CI 1.08-2.04). Combining multiple oral hygiene indicators, poor oral hygiene scores increased head and neck cancer risk.

CONCLUSION

Poor oral hygiene may increase head and neck cancer risk in the Chinese population. Therefore, improving oral hygiene may contribute to reducing the head and neck cancer risk in the Chinese population.

Early socioeconomic conditions and severe tooth loss in middle-aged Costa Ricans

OBJECTIVE

A wide literature shows a strong social gradient in tooth loss according to income, education and occupation, in both developed and developing countries. It has been shown associations between tooth loss and parental education and occupation, independently of adult conditions. To explore the role of early socioeconomic circumstances on tooth loss, we used a lifecourse model. We analysed the direct and indirect links between early socioeconomic conditions and severe adult tooth loss.

METHODS

We used the Costa Rican Longevity and Healthy Aging Study 1945-1955 Retirement Cohort, a nationally representative longitudinal survey of Costa Rican residents born between 1945 and 1955. We used imputed data on 2796 individuals. Principal component analyses were run to integrate measures approaching the material circumstances during childhood and adulthood. We additionally examined the role of adult health behaviours and education level as potential mediators in the multivariable regression.

RESULTS

Early socioeconomic conditions were found strongly associated with severe tooth loss; 72.4% of the people who experienced the most deprived socioeconomic conditions during childhood (quartile 1) had severe tooth loss at the time of the interview; vs 43.3% in quartile 4 (most advantaged). This link diminished after adjustment for adult mediators. However, it remained a significant determinant of severe tooth loss in the final model.

CONCLUSION

The lifecourse model allowed to highlight that early socioeconomic conditions could have long-term consequences on severe tooth loss in middle ages via both direct and indirect mechanisms.

The association between diabetes mellitus, sugar-sweetened beverages, and tooth loss in adults: Evidence from 18 states

BACKGROUND

Sugar-sweetened beverages (SSBs) are dietary sources of sugar that are factors in caries development and tooth loss. Dietary sugar also is linked to diabetes mellitus (DM). There is limited research related to SSBs and tooth loss in people with DM. The authors investigated the association between SSBs and tooth loss as it related to the presence or absence of DM.

METHODS

The authors used a cross-sectional design with data reported by adults (18 years and older) who responded to the 2012 Behavior Risk Factor Surveillance System questionnaire, which was used in 18 states (N = 95,897; 14,043 who had DM and 81,854 who did not have DM). The authors conducted χ² and logistic regression analyses to determine associations related to DM status.

RESULTS

Overall, 12.3% of the survey respondents had DM, 15.5% had 6 or more teeth extracted, and 22.6% reported that they consumed 1 or more SSB daily. In the adjusted analyses, among adults who had DM, those who consumed at least 2 SSBs daily were more likely to have had 6 or more teeth extracted than those who reported that they did not consume SSBs (adjusted odds ratio, 2.35; 95% confidence interval, 1.37 to 4.01; P = .0018). Among adults who did not have DM, those who consumed more than 1 but fewer than 2 SSBs per day were more likely to have had at least 6 teeth extracted (adjusted odds ratio, 1.46; 95% confidence interval, 1.21 to 1.77; P < .0001).

CONCLUSIONS

The authors found that, among adults with DM, consuming 2 or more SSBs per day was associated with having had 6 or more teeth extracted.

PRACTICAL IMPLICATIONS

Dietary sugar is a concern for oral and systemic health; however, a strong, independent relationship between the number of teeth extracted and a single source of dietary sugar is not adequate to explain the complexity of tooth loss. Clinicians should use broadly worded dietary messages when discussing caries assessment with patients.

Long-term effects of smoking on tooth loss after cessation among middle-aged Finnish adults: the Northern Finland Birth Cohort 1966 Study

Background

Despite smoking cessation efforts, cigarette smoking remains a serious general and oral health problem. We aimed to investigate the putative benefits of smoking cessation on dentition and to analyse whether the time elapsed since smoking cessation associated positively with the remaining number of teeth.

Methods

This cross-sectional study analyses data from the 46-year follow-up of the Northern Finland Birth Cohort Study 1966 (NFBC1966). A total of 5 540 subjects participated in this cross-sectional study, which utilises both clinical dental examinations and mailed questionnaires. We used the following information on smoking: status (current, former, never), years of smoking (current, former) and years elapsed since smoking cessation (former). Self-reported and clinically measured number of teeth (including third molars) served as alternative outcomes. We used binary logistic regression models to analyse the dichotomised number of teeth (‘0–27’, ’28–32’) and then calculated unadjusted and adjusted odds ratios (OR) with 95 % confidence intervals (CI) for the smoking variables (never smoker as the reference). Gender, education, tooth brushing frequency, diabetes and alcohol use served as confounders for the adjusted models.

Results

Ten years or more of smoking associated with tooth loss; this effect was the strongest among men who reported having an ongoing smoking habit (self-reported outcome: adjusted OR = 1.74, CI = 1.40–2.16) and the weakest among women classified as former smokers (self-reported outcome: adjusted OR = 1.27, CI = 1.00–1.62).

Conclusions

This study shows that smoking has long-term effects on tooth loss even after cessation. The findings support smoking cessation efforts to reduce oral health risks.

The role of oral hygiene in head and neck cancer: results from International Head and Neck Cancer Epidemiology (INHANCE) consortium

BACKGROUND

Poor oral hygiene has been proposed to contribute to head and neck cancer (HNC) risk, although causality and independency of some indicators are uncertain. This study investigates the relationship of five oral hygiene indicators with incident HNCs.

METHODS

In a pooled analysis of 8925 HNC cases and 12 527 controls from 13 studies participating in the International Head and Neck Cancer Epidemiology Consortium, comparable data on good oral hygiene indicators were harmonized. These included: no denture wear, no gum disease (or bleeding), <5 missing teeth, tooth brushing at least daily, and visiting a dentist ≥once a year. Logistic regression was used to estimate the effects of each oral hygiene indicator and cumulative score on HNC risk, adjusting for tobacco smoking and alcohol consumption.

RESULTS

Inverse associations with any HNC, in the hypothesized direction, were observed for <5 missing teeth [odds ratio (OR) = 0.78; 95% confidence interval (CI) 0.74, 0.82], annual dentist visit (OR = 0.82; 95% CI 0.78, 0.87), daily tooth brushing (OR = 0.83, 95% CI 0.79, 0.88), and no gum disease (OR = 0.94; 95% CI 0.89, 0.99), and no association was observed for wearing dentures. These associations were relatively consistent across specific cancer sites, especially for tooth brushing and dentist visits. The population attributable fraction for ≤ 2 out of 5 good oral hygiene indicators was 8.9% (95% CI 3.3%, 14%) for oral cavity cancer.

CONCLUSION

Good oral hygiene, as characterized by few missing teeth, annual dentist visits, and daily tooth brushing, may modestly reduce the risk of HNC.