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Chen X, Cheng Z, Xu J, Wang Q, Zhao Z, Jiang Q. Causal effects of denture wearing on epigenetic age acceleration and the mediating pathways: a mendelian randomization study. BMC Oral Health 2024; 24:788. [PMID: 39003475 PMCID: PMC11246574 DOI: 10.1186/s12903-024-04578-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 07/05/2024] [Indexed: 07/15/2024] Open
Abstract
BACKGROUND The epigenetic-age acceleration (EAA) represents the difference between chronological age and epigenetic age, reflecting accelerated biological aging. Observational studies suggested that oral disorders may impact DNA methylation patterns and aging, but their causal relationship remains largely unexplored. This study aimed to investigate potential causal associations between dental traits and EAA, as well as to identify possible mediators. METHODS Using summary statistics of genome-wide association studies of predominantly European ancestry, we conducted univariable and multivariable Mendelian randomization (MR) to estimate the overall and independent effects of ten dental traits (dentures, bleeding gums, painful gums, loose teeth, toothache, ulcers, periodontitis, number of teeth, and two measures of caries) on four EAA subtypes (GrimAge acceleration [GrimAA], PhenoAge acceleration [PhenoAA], HannumAge acceleration [HannumAA] and intrinsic EAA [IEAA]), and used two-step Mendelian randomization to evaluate twelve potential mediators of the associations. Comprehensive sensitivity analyses were used to verity the robustness, heterogeneity, and pleiotropy. RESULTS Univariable inverse variance weighted MR analyses revealed a causal effect of dentures on greater GrimAA (β: 2.47, 95% CI: 0.93-4.01, p = 0.002), PhenoAA (β: 3.00, 95% CI: 1.15-4.85, p = 0.001), and HannumAA (β: 1.96, 95% CI: 0.58-3.33, p = 0.005). In multivariable MR, the associations remained significant after adjusting for periodontitis, caries, number of teeth and bleeding gums. Three out of 12 aging risk factors were identified as mediators of the association between dentures and EAA, including body mass index, body fat percentage, and waist circumference. No evidence for reverse causality and pleiotropy were detected (p > 0.05). CONCLUSIONS Our findings supported the causal effects of genetic liability for denture wearing on epigenetic aging, with partial mediation by obesity. More attention should be paid to the obesity-monitoring and management for slowing EAA among denture wearers.
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Affiliation(s)
- Xin Chen
- Department of Oral and Maxillofacial Surgery, Jiangyin People's Hospital Affiliated to Nantong University, No.163, Shoushan Road, Jiangyin, 214400, Jiangsu Province, China
| | - Zheng Cheng
- Department of Oral and Maxillofacial Surgery, Jiangyin People's Hospital Affiliated to Nantong University, No.163, Shoushan Road, Jiangyin, 214400, Jiangsu Province, China
| | - Junyu Xu
- Department of Oral and Maxillofacial Surgery, Jiangyin People's Hospital Affiliated to Nantong University, No.163, Shoushan Road, Jiangyin, 214400, Jiangsu Province, China
| | - Qianyi Wang
- Department of Cardiology, Jiangyin People's Hospital Affiliated to Nantong University, No.163, Shoushan Road, Jiangyin, 214400, Jiangsu Province, China.
| | - Zhibai Zhao
- Department of Oral Mucosal Diseases, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China
| | - Qianglin Jiang
- Department of Oral and Maxillofacial Surgery, Jiangyin People's Hospital Affiliated to Nantong University, No.163, Shoushan Road, Jiangyin, 214400, Jiangsu Province, China.
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Kragh Ekstam A, Andersson P. Oral Health Status Using the Revised Oral Assessment Guide and Mortality in Older Orthopaedic Patients: A Cross-Sectional Study. Clin Interv Aging 2023; 18:1103-1113. [PMID: 37489127 PMCID: PMC10363347 DOI: 10.2147/cia.s410577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/27/2023] [Indexed: 07/26/2023] Open
Abstract
Purpose Orthogeriatric hospitalised patients with fractures of the lower limb constitute a vulnerable population with increased risk of morbidity, polypharmacy, and mortality as well as impaired oral health. The aim of this cross-sectional study was to investigate whether any relationship existed between oral health issues in older orthopaedic patients and mortality. Material and Methods The study population consisted of older orthopedic patients emergently admitted to a hospital in southern Sweden due to mainly fractures of the hip. Their oral health at admission was assessed by trained nurses using the revised oral assessment guide (ROAG), as well as examined by dental hygienists. Medical and demographic data were collected from medical records and mortality from the national population registry. Comorbidity was assessed using the Charlson Comorbidity Index (CCI). Data were analysed using foremost dichotomized data derived from mean values and then processed using multiple logistic regression adjusted for identified probable confounders. Results Of the 187 study patients (≥65 years) with a mean age of 81 (SD 7.9) years, 71% were women, mean CCI score was 6.7 and 90-days mortality 12.3%. Oral health issues (ROAG >8, 73%) consisted mainly of problems with teeth/dentures (41%), tongue (36%), lips (35%), and saliva (28%). In patients with any oral health impairment (ROAG >8) the 90-days mortality was significantly increased (p=0.040), using logistic regression analysis adjusted for age, gender, comorbidity, and use of ≥5 drugs. In patients with a ROAG score ≥10 (≥mean) the association remained at 90-days (p=0.029) and 180-days (p=0.013). Decayed teeth were present in 24% and was significantly associated with ROAG >8 (p=0.020). Conclusion The main finding of this study was a possible relationship between oral health impairment at admission and early mortality in orthogeriatric hospitalised patients. The opportunity to identify their oral health problems can help improving further care planning and care.
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Affiliation(s)
- Annika Kragh Ekstam
- Department of Orthopaedics, Region Skåne Office for Hospitals in North-Eastern Skåne, Kristianstad, SE-291 85, Sweden
| | - Pia Andersson
- Department of Health Sciences, Kristianstad University, Kristianstad, SE-291 88, Sweden
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He F, Luo H, Yin L, Roosaar A, Axéll T, Zhao H, Ye W. Poor Oral Health as a Risk Factor for Dementia in a Swedish Population: A Cohort Study with 40 Years of Follow-Up. J Alzheimers Dis 2023; 92:171-181. [PMID: 36710668 DOI: 10.3233/jad-215177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Whether poor oral health is associated with dementia risk remains unclear. OBJECTIVE We conducted a cohort study of 14,439 participants who were followed up for up to 40 years in Uppsala County, central Sweden, aiming to explore the association between poor oral health, namely the number of tooth loss, dental plaque status, and oral mucosal lesions, and the risk of dementia. METHODS We used Cox proportional hazards regression model to derive cause-specific hazard ratios (HR) and corresponding 95% confidence intervals (CI), while adjusting for baseline potential confounders as well as a time-varying covariate, Charlson's Comorbidity Index score. RESULTS Dementia risk was substantially higher among those with a higher number of tooth loss; compared to the group with tooth loss 0-10, the HRs were 1.21 (95% CI: 1.02, 1.42), 1.17 (95% CI: 0.97, 1.40), and 1.30 (95% CI: 1.09, 1.54) respectively for groups with increasing number of tooth loss. There was some evidence of dose-risk association in this study, with a HR of 1.10 (1.04, 1.18) comparing adjacent groups (ptrend = 0.001). In a stratified analysis by attained age, tooth loss was more pronouncedly associated with the risk of dementia onset before age 80 (those with 21-32 versus 0-10 lost teeth, HR = 1.82, (95% CI: 1.32, 2.51); HR = 1.22 (95% CI: 1.10, 1.35) comparing adjacent groups, ptrend < 0.001). CONCLUSION In summary, there are some indications that poor oral health, as indicated by more tooth loss, is positively associated with an increased risk of dementia, especially for dementia onset before age 80.
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Affiliation(s)
- Fei He
- Department of Epidemiology and Health Statistics, Fujian Medical University, Fuzhou, China.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Huizi Luo
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Li Yin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ann Roosaar
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Tony Axéll
- Maxillofacial Unit, Halland Hospital Halmstad, Halmstad, Sweden
| | - Hongwei Zhao
- Department of Epidemiology and Biostatistics, Texas A & M University, College Station, TX, USA
| | - Weimin Ye
- Department of Epidemiology and Health Statistics, Fujian Medical University, Fuzhou, China.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Jagroep W, Cramm JM, Denktaş S, Nieboer AP. Health behaviours and well-being among older adults with a Surinamese migration background in the Netherlands. BMC Public Health 2022; 22:2006. [PMID: 36324120 PMCID: PMC9628019 DOI: 10.1186/s12889-022-14414-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/21/2022] [Indexed: 11/05/2022] Open
Abstract
Background This study aims to identify the relationships between health behaviours (healthy diet, physical activity, not smoking and social activity) and well-being among older adults with a Surinamese background. Methods Community-dwelling older adults (≥ 70 years) with a Surinamese background living in Rotterdam, the Netherlands, were identified by the municipal register. A survey study was conducted to assess background information, health behaviours (healthy diet, physical activity, not smoking and social activity) and well-being. Multiple regression analyses were performed to assess the relationships of health behaviours with well-being while controlling for background characteristics. Results Average age of participants was 76.2 (4.9) years, slightly more than half of them were female (54.2%). Almost half of the participants had a low-income level (49.6%). More than half of the participants met the Dutch guidelines of fruit intake (63.0%) and vegetable intake (62.8%). Less than half of the participants met the guidelines of fish intake (40.9%) and physical activity (39.8%). The majority of the participants were non-smokers (87.9%). Most of the participants had daily contact with family/friends (90.9%) and slightly more than half of the participants visited family/friends often (53.6%). Looking at the health behaviours, a positive relationship was found between eating enough fruit (β = .109; p ≤ 0.05) and vegetables (β = .135; p ≤ 0.01), physical activity (β = .164; p ≤ 0.001) and often visiting family/friends (β = .158; p ≤ 0.001) with well-being. Conclusion This study suggests that next to traditional health behaviours also social activity is an essential health behaviour for the well-being of older Surinamese adults. Research about health promotion should expand its focus by including social activity as health behaviour. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14414-z.
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Affiliation(s)
- Warsha Jagroep
- Department of Socio-Medical Sciences, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands.
| | - Jane M Cramm
- Department of Socio-Medical Sciences, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Semiha Denktaş
- Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Anna P Nieboer
- Department of Socio-Medical Sciences, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
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Gibney JM, Naganathan V, Lim MAWT. Oral health is Essential to the Well-Being of Older People. Am J Geriatr Psychiatry 2021; 29:1053-1057. [PMID: 34246517 DOI: 10.1016/j.jagp.2021.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/06/2021] [Accepted: 06/07/2021] [Indexed: 01/27/2023]
Abstract
Although the highest attainable standard of health is a fundamental human right, oral health is often not considered an important component of overall health. Older people experience poorer quality of life due to discomfort and uncleanliness of their mouth and there continue to be barriers within health systems that contribute to this poor oral health. This paper advocates for oral health to be considered part of the basic human right to good health care and discusses how stakeholders can collaborate and work together to begin to meet the needs of this population, proposing solutions and recommendations to bring about change.
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Affiliation(s)
- Jennifer Mary Gibney
- Centre for Education and Research on Ageing, Concord Hospital, Sydney, New South Wales, Australia; Nepean Hospital, Sydney, New South Wales, Australia.
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, Concord Hospital, Sydney, New South Wales, Australia
| | - Mathew Albert Wei Ting Lim
- Dental Services, Alfred Health, Melbourne, Victoria, Australia; Maxillofacial and Dental Clinic, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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6
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Li A, Chen Y, Visser A, Marks LAM, Tjakkes GHE. Combined association of cognitive impairment and poor oral health on mortality risk in older adults: Results from the NHANES with 15 years of follow-up. J Periodontol 2021; 93:888-900. [PMID: 34533839 PMCID: PMC9298999 DOI: 10.1002/jper.21-0292] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/22/2021] [Accepted: 09/08/2021] [Indexed: 12/14/2022]
Abstract
Background Cognitive impairment and poor oral health are frequently seen among older adults. Both conditions have been identified as risk factors for mortality. However, the combined associations of cognitive impairment and poor oral health with mortality have not been well studied and are therefore the aim of this cohort study. Methods We analyzed data from the National Health and Nutrition Examination Survey (1999–2002) linked with mortality data obtained from the 2015 public‐use linked mortality file. Cognitive impairment was defined as a digit symbol substitution test score lower than the lowest quartile. Oral health status was assessed based on presence of untreated caries, moderate to severe periodontitis, and edentulism. The combined effects of caries/periodontitis or edentulism and cognitive impairment on all‐cause and cardiometabolic mortality were examined using the Cox proportional hazard models after adjusting for potential confounders including demographic characteristics, lifestyle, biomarkers, and comorbidities. Results In total, 1973 participants were enrolled in the prospective study. At a median follow‐up of 13.4 years, 978 participants had died (264 deaths because of cardiometabolic disease). Cognitive impairment, periodontitis, and edentulism were each found to be significant predictors of all‐cause mortality. Caries, however, was not significantly related to mortality. When analyzing these predictors in combination, a diagnosis of cognitive impairment and periodontitis was associated with an 83.1% increase in all‐cause mortality risk and an 87.7% increase in cardiometabolic mortality risk compared with healthy controls. Similarly, the risk for all‐cause mortality was highest in cases where impaired cognition and edentulism co‐occurred (adjusted hazard ratio = 1.701, 1.338–2.161). Conclusion Concomitant presence of cognitive impairment and periodontitis or edentulism can be associated with a higher risk of mortality among older U.S. adults.
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Affiliation(s)
- An Li
- Center for Dentistry and Oral Hygiene, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Stomatological Hospital, Southern Medical University, Guangzhou, China
| | - Yuntao Chen
- Medical Statistics and Decision-Making, Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Anita Visser
- Center for Dentistry and Oral Hygiene, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Department of Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Luc A M Marks
- Center for Dentistry and Oral Hygiene, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Geerten-Has E Tjakkes
- Center for Dentistry and Oral Hygiene, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Yun JH, Ki SK, Kim J, Chon D, Shin SY, Lee Y. Relationships between cognitive function and frailty in older Korean adults: The moderating effect of the number of teeth. Arch Gerontol Geriatr 2020; 91:104213. [PMID: 32805701 DOI: 10.1016/j.archger.2020.104213] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/22/2020] [Accepted: 07/26/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cognitive function and physical frailty are known to be closely related. Among older adults with dementia, those who wear dentures have a higher mortality rate than those who do not wear them. This suggests the possibility that oral health may affect the cognitive-frailty relationship. This study aims to investigate whether the number of teeth present, acts as a moderating variable in the cognitive function-frailty relationship. METHODS Data were obtained from the cross-sectional baseline study of the Korean Frailty Aging Cohort Study (2016-2017). Cognitive function was assessed using the Mini-Mental State Examination. Frailty score was based on the Cardiovascular Health Study Index. Oral condition was evaluated by the number of teeth present and analyzed using categories of 0-9 teeth, 10-19 teeth, and ≥20. The moderation effect was analyzed using the ordinary least squares (OLS) regression. RESULTS Data on 2,310 older adults (1,110 men; mean age 75.9 ± 3.9 years) was analyzed. Adjusting for age, sex, income, education, alcohol drinking, body mass index, and number of comorbidities, cognitive function and frailty showed a negative association (B=-.030, p = .011). In the 10-19 teeth category, compared to the 0-9 teeth category, a negative association with frailty was found (B=-.152, p = .026). A significant interaction effect between the number of teeth and cognitive function was detected (p = .007). CONCLUSION The number of teeth may modify the degree of the association between cognitive function and frailty. For effective frailty management of older persons, cognitive function management and oral management should be considered and performed together.
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Affiliation(s)
- Ji-Hye Yun
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Republic of Korea; Institute on Aging, Ajou University Medical Center, Suwon, Republic of Korea
| | - Seung-Kook Ki
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Republic of Korea; Institute on Aging, Ajou University Medical Center, Suwon, Republic of Korea
| | - Jinhee Kim
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Republic of Korea; Institute on Aging, Ajou University Medical Center, Suwon, Republic of Korea
| | - Doukyoung Chon
- Department of Preventive Medicine, School of Medicine, Korea University, Seoul, Republic of Korea
| | - Seung-Yun Shin
- Department of Periodontology, Periodontal-Implant Clinical Research Institute, Kyung Hee University School of Dentistry, Seoul, Republic of Korea
| | - Yunhwan Lee
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Republic of Korea; Institute on Aging, Ajou University Medical Center, Suwon, Republic of Korea.
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van de Rijt LJM, Weijenberg RAF, Feast AR, Vickerstaff V, Lobbezoo F, Sampson EL. Oral health and orofacial pain in people with dementia admitted to acute hospital wards: observational cohort study. BMC Geriatr 2018; 18:121. [PMID: 29792172 PMCID: PMC5966900 DOI: 10.1186/s12877-018-0810-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 05/07/2018] [Indexed: 11/14/2022] Open
Abstract
Background Orofacial pain in people with dementia is difficult to detect, and often under-treated. Our aim was to investigate the prevalence of orofacial pain in people with dementia in acute hospitals in the UK. Secondary aims were to examine oral health status and explore associations between orofacial pain and oral health factors. Methods This cross-sectional observational study was carried out in two UK hospitals. Using the Orofacial Pain Scale in Non-Verbal Individuals (OPS-NVI) to identify orofacial pain, 101 participants with dementia, admitted to acute medical wards, were observed for at least 3 min during rest and chewing. Verbal participants were then asked about presence of orofacial pain, using self-report pain scales. Finally, a brief oral assessment was performed. Results Orofacial pain, assessed with the OPS-NVI, was present in 11.9% (95% C.I. 5.9, 18.8) of participants at rest and 21.9% (95% C.I. 14.6, 31.3) whilst chewing. Participants who were no longer able to self-report pain were significantly more likely to experience orofacial pain. Oral health in both dentate and edentate participants was poor. Brush frequency, indication of chewing quality, consistency of the food, presence of extra-oral abnormalities, person who performed mouth care, and oral hygiene in dentate participants were significant predictors for the presence of orofacial pain. Conclusion Improving oral care in acute hospital patients with dementia, particularly those who cannot self-report pain, may significantly reduce pain and suffering in this population. Electronic supplementary material The online version of this article (10.1186/s12877-018-0810-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Liza J M van de Rijt
- Faculty of Dentistry, Department of Oral Kinesiology, Academic Centre of Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Roxane A F Weijenberg
- Faculty of Dentistry, Department of Oral Kinesiology, Academic Centre of Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Alexandra R Feast
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Victoria Vickerstaff
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.,The Research Department of Primary Care and Population Health, University College London, London, UK
| | - Frank Lobbezoo
- Faculty of Dentistry, Department of Oral Kinesiology, Academic Centre of Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.,Barnet Enfield and Haringey Mental Health Trust Liaison Psychiatry Team, North Middlesex University Hospital, London, UK
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Koka S, Gupta A. Association between missing tooth count and mortality: A systematic review. J Prosthodont Res 2017; 62:134-151. [PMID: 28869174 DOI: 10.1016/j.jpor.2017.08.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 06/29/2017] [Accepted: 08/04/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this review was to analyze existing literature on the relationship between tooth count and mortality by evaluating the findings in the context of methodological variations. We aimed at addressing the question of whether preserving natural teeth can impact mortality. STUDY SELECTION PubMed, Web of Science and CINAHL databases were systematically searched using various combinations of related and synonymous keywords for "tooth count" and "mortality". The references of included articles were also evaluated for inclusion. Overall 49 studies found to be eligible were critically evaluated and their key findings were summarized. RESULTS Studies were conducted in various continents and differed substantially in regards to their sample size, population, methodology, the definition of the tooth count variable, the confounders as well as the mediators accounted for in the analysis. Follow-up period ranged from 1 to 56 years. CONCLUSIONS Although high variability in the studies precludes a definite conclusion about the relationship between number of teeth and mortality, the overall finding from this review is that reduced tooth count is associated with higher mortality. However the impact of factors such as smoking, health-care access, baseline co-morbidity and risk profile, dental and periodontal health, the presence of dental prosthesis as well as socio-economic status, in mediating whole or part of the association cannot be overlooked and needs further investigation using more standard methodologies. Any differences in males vs. females, as well as among different age groups, will also need further consideration in the future studies.
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Affiliation(s)
- Sreenivas Koka
- Clinical Professor, Advanced Prosthodontics, Loma Linda University, Loma Linda, USA; Interim Chair, Restorative Dentistry, UCLA, Los Angeles, USA; Private Practice Limited to Removable and Implant Prosthodontics, Koka Dental Clinic, San Diego, USA
| | - Avni Gupta
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Harvard T.N. Chan School of Public Health, One Brigham Circle, 1620 Tremont Street 4-020, Boston, MA 02120, USA.
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Iinuma T, Arai Y, Takayama M, Abe Y, Ito T, Kondo Y, Hirose N, Gionhaku N. Association between maximum occlusal force and 3-year all-cause mortality in community-dwelling elderly people. BMC Oral Health 2016; 16:82. [PMID: 27586200 PMCID: PMC5009498 DOI: 10.1186/s12903-016-0283-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 08/23/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Among the very elderly, poor oral health reduces life expectancy. In this study, differences in the magnitude of the maximum occlusal force (MOF) in the very elderly were examined in terms of effects on all-cause mortality in a 3-year follow-up. METHODS We evaluated 489 community-living elderly individuals aged 85 years or older. MOF was measured using an occlusal force measuring device, and participants were classified into three groups according to gender- and dental status-sensitive tertiles. Demographic variables, cognitive, physical function, psychological status, oral health, comorbidity, and blood chemistry factors were assessed. One-way analyses of variance, χ (2) tests, and the Kruskal-Wallis test were used for statistical analyses. The relationship between MOF tertiles and 3-year all-cause mortality was examined using a multivariate Cox model analysis after adjusting for confounding factors. RESULTS MOF tertiles were significantly associated with cognitive impairment, number of teeth, limitations on chewable foods, handgrip strength, timed up-and-go test, and diabetes mellitus. During the follow-up period, 74 subjects died. Subjects with the highest MOF had a significantly lower mortality rate than other groups (log rank P = 0.031). In the univariate Cox model, MOF tertiles were independently associated with a lower risk of death (HR = 0.69, 95 % CI = 0.51-0.91). Even after adjusting for various confounders in the multivariate Cox model (Model 1), MOF was independently associated with a lower risk of death (HR = 0.67, 95 % CI = 0.50-0.91). In model 2, we added handgrip strength as a confounder and found that the HR for MOF was attenuated (HR = 0.73, 95 % CI = 0.54-0.99), but still statistically significant. CONCLUSIONS In a cohort of the very elderly, MOF was independently associated with all-cause mortality after adjusting for various health issues. Moreover, this independent association remained after a further adjustment for handgrip strength; however, the HR was attenuated. This suggests that MOF and handgrip strength may share a common mechanism of a general decrease in muscle strength, possibly sarcopenia, which is a significant cause of mortality in the very old.
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Affiliation(s)
- Toshimitsu Iinuma
- Department of Complete Denture Prosthodontics, Nihon University School of Dentistry, Tokyo, Japan.
| | - Yasumichi Arai
- Center for Supercentenarian Medical Research, Keio University School of Medicine, Tokyo, Japan
| | - Michiyo Takayama
- Center for Preventive Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yukiko Abe
- Center for Supercentenarian Medical Research, Keio University School of Medicine, Tokyo, Japan
| | - Tomoka Ito
- Department of Complete Denture Prosthodontics, Nihon University School of Dentistry, Tokyo, Japan
| | - Yugaku Kondo
- Department of Complete Denture Prosthodontics, Nihon University School of Dentistry, Tokyo, Japan
| | - Nobuyoshi Hirose
- Center for Supercentenarian Medical Research, Keio University School of Medicine, Tokyo, Japan
| | - Nobuhito Gionhaku
- Department of Complete Denture Prosthodontics, Nihon University School of Dentistry, Tokyo, Japan
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Sjögren P, Girestam CC, Skott P, Marsson N, Nova R, Zimmerman M, Wårdh I. Professional Domiciliary Oral Care for Elderly in Nursing Homes—A Randomized Controlled Pilot Trial. Health (London) 2016. [DOI: 10.4236/health.2016.811116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Devanand DP, Lee S, Manly J, Andrews H, Schupf N, Masurkar A, Stern Y, Mayeux R, Doty RL. Olfactory identification deficits and increased mortality in the community. Ann Neurol 2015; 78:401-11. [PMID: 26031760 DOI: 10.1002/ana.24447] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 04/28/2015] [Accepted: 05/25/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To examine the association between odor identification deficits and future mortality in a multiethnic community cohort of older adults. METHODS Participants were evaluated with the 40-item University of Pennsylvania Smell Identification Test (UPSIT). Follow-up occurred at 2-year intervals with information on death obtained from informant interviews and the National Death Index. RESULTS During follow-up (mean = 4.1 years, standard deviation = 2.6), 349 of 1,169 (29.9%) participants died. Participants who died were more likely to be older (p < 0.001), be male (p < 0.001), have lower UPSIT scores (p < 0.001), and have a diagnosis of dementia (p < 0.001). In a Cox model, the association between lower UPSIT score and mortality (hazard ratio [HR] = 1.07 per point interval, 95% confidence interval [CI] = 1.05-1.08, p < 0.001) persisted after controlling for age, gender, education, ethnicity, language, modified Charlson medical comorbidity index, dementia, depression, alcohol abuse, head injury, smoking, body mass index, and vision and hearing impairment (HR = 1.05, 95% CI = 1.03-1.07, p < 0.001). Compared to the fourth quartile with the highest UPSIT scores, HRs for mortality for the first, second, and third quartiles of UPSIT scores were 3.81 (95% CI = 2.71-5.34), 1.75 (95% CI = 1.23-2.50), and 1.58 (95% CI = 1.09-2.30), respectively. Participant mortality rate was 45% in the lowest quartile of UPSIT scores (anosmia) and 18% in the highest quartile of UPSIT scores. INTERPRETATION Impaired odor identification, particularly in the anosmic range, is associated with increased mortality in older adults even after controlling for dementia and medical comorbidity.
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Affiliation(s)
- Davangere P Devanand
- Division of Geriatric Psychiatry, Department of Psychiatry, Columbia University, New York, NY
| | - Seonjoo Lee
- Division of Biostatistics, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Jennifer Manly
- Department of Neurology, Gertrude H. Sergievsky Center, and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Howard Andrews
- Department of Neurology, Gertrude H. Sergievsky Center, and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Nicole Schupf
- Department of Neurology, Gertrude H. Sergievsky Center, and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Arjun Masurkar
- Department of Neurology, Gertrude H. Sergievsky Center, and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Yaakov Stern
- Department of Neurology, Gertrude H. Sergievsky Center, and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Richard Mayeux
- Department of Neurology, Gertrude H. Sergievsky Center, and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Richard L Doty
- Smell and Taste Center, University of Pennsylvania, Philadelphia, PA
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Gaszynska E, Szatko F, Godala M, Gaszynski T. Oral health status, dental treatment needs, and barriers to dental care of elderly care home residents in Lodz, Poland. Clin Interv Aging 2014; 9:1637-44. [PMID: 25284997 PMCID: PMC4181440 DOI: 10.2147/cia.s69790] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objectives To determine oral health status, dental treatment needs, and to identify barriers that prevent easy access to dental care by elderly care home residents in Lodz. Background Studies in many countries show that oral health status of elderly care home residents is poor and there is an urgent need to improve it. Methods The study included 259 care home residents, aged 65 years and older. The oral examination was performed. In face-to-face interviews, subjects were asked about frequency of cleaning teeth and/or dentures, whether they needed assistance, and whether the assistance was available; they were also asked about the perceived dental needs, and about the time since their last visit to a dentist and the purpose of the visit. If they had not visited the dentist in the past 12 months, they were asked about reasons for failing to visit the dentist. Results Forty-six percent of the subjects were edentulous. Only 5.8% of all participants had a sufficient number of functional natural teeth. Dental treatment was found to be necessary in 59.8% of the respondents. One in four subjects reported reduced ability of correctly cleaning teeth and dentures themselves, of whom only one-third were helped by others. An insufficient level of hygiene was found in every other subject. About 42% of residents had not visited a dentist for over 5 years, mainly due to organizational reasons. Conclusion Expanding the current scope of medical care for the elderly care home residents to include dental care would improve their currently poor oral health status.
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Affiliation(s)
- Ewelina Gaszynska
- Department of Hygiene and Health Promotion, Medical University of Lodz, Lodz, Poland
| | - Franciszek Szatko
- Department of Hygiene and Health Promotion, Medical University of Lodz, Lodz, Poland
| | - Malgorzata Godala
- Department of Nutrition and Epidemiology, Medical University of Lodz, Lodz, Poland
| | - Tomasz Gaszynski
- Department of Emergency Medicine and Disaster Medicine, Medical University of Lodz, Lodz, Poland
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Solemdal K, Møinichen-Berstad C, Mowe M, Hummel T, Sandvik L. Impaired taste and increased mortality in acutely hospitalized older people. Chem Senses 2014; 39:263-9. [PMID: 24448597 DOI: 10.1093/chemse/bjt116] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Taste ability is known to be impaired in elderly and even more so in acutely hospitalized elderly people. To our knowledge, no study has investigated the association between taste impairment and mortality. Our aim was to examine this association in acutely hospitalized older people. In a prospective study, 200 acutely hospitalized elderly people ≥70 years of age were included between November 2009 and October 2010 at the Oslo University Hospital, Norway. Exclusion criteria were cognitive impairment, nursing home residency, and terminal diseases. Comorbidity was registered with the Cumulative Illness Rating Scale, in addition to recording of age, gender, smoking, education, and number of medications. Taste ability was assessed quantitatively with the "taste strips method" in 174 patients (mean age: 84 years). Mortality until 1 January 2012 was obtained from hospital records. Fifty-six patients died during the observation period. The relative risk of death in total taste score quartile 4 compared with total taste score quartile 1 was 0.31 (95% confidence interval [95% CI]: 0.14-0.69, P = 0.004), after adjusting for age, gender, smoking, education, and Cumulative Illness Rating Scale. Adjusted 1-year mortality decreased from 30% in total taste score quartile 1 to 9% in total taste score quartile 4. Thus, impaired taste appears to be strongly associated with mortality in acutely hospitalized elderly people.
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Affiliation(s)
- Kirsten Solemdal
- The Faculty of Dentistry, University of Oslo, PO Box 1109, Blindern, 0317 Oslo, Norway.
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