ArticleLiterature Review

Tooth loss as a predictor of shortened longevity: exploring the hypothesis

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Abstract

Many factors contribute to human tooth loss, including oral hygiene practices, trauma, smoking, health status, socio-economic status and individual preferences. Loss of teeth impairs quality-of-life measures, including the eating of most foods that require full masticatory function. A recent study of centenarians found that at age 65–74 years, those who lived to be 100 had a lower rate of edentulism than did younger members of their birth cohort at ages 65–74 years. Oral health was consistent with compression of morbidity toward the end of life. This article explores the hypothesis that factors associated with oral disease and noncommunicable diseases may increase the risk of tooth loss and lead to diminished longevity as a result of multifactorial interactions. It specifically addresses two critical questions. The first is: ‘Can we conclude that the number of teeth in aging humans can affect longevity and life expectancy?’ The answer is yes. The second is: ‘Is tooth loss a predictor of shortened longevity?’ Again, the answer is yes. Edentulism and partial edentulism are discussed as a disability, and how the philosophy/belief systems of dental providers and patients toward retaining teeth influences the outcome of tooth loss is also examined. Osteoporosis and cognitive impairment provide examples of modifying risk factors.

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... However, a study of 28 patients diagnosed with SS in the period between 1982 and 2002 in Turkey showed individuals with a mean age of 48.2±10.5 years (12). The presence teeth is considered a reliable indicator of oral and systemic health (13), and some authors have observed that longevity/life expectancy may be affected by the number of teeth present and that tooth loss is a predictive factor shortening of longevity (14). A dentition with various dental absences attenuates masticatory efficiency and causes a subsequent high limiting food selection with a low diet in fruits, vegetables and other essential nutrients (15). ...
... Over the last few years, sociodemographic variables have been considered important factors are contributing to tooth loss (19), with emphasis on educational and socioeconomic levels (14). According to Rozier et al. (20), low socioeconomic status was the most consistent predictive factor of missing teeth in the US population. ...
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Background: Sheehan's syndrome (SS) is one of the leading causes of hypopituitarism in developing countries. It occurs after postpartum necrosis of the pituitary gland, and it is considered a significant public health problem. This paper, apparently unpublished, aimed to perform an analysis on oral aspects in patients with SS. Material and methods: A cross-sectional study was performed with 23 women diagnosed with SS at the Division of Endocrinology and Diabetes (Walter Cantídio University Hospital, Fortaleza, Brazil). Results: Data on sociodemographic, dental and salivary flow aspects were collected through a clinical approach and a panoramic radiograph request. The mean age was 64 ± 11.5 years old, with the sample consisting mainly of married women (56.5%), socioeconomic class C2 or D / E (78.2%) and years of education up to 8 years (69.5%). The presence of horizontal bone loss (p<0.001) and bilateral pneumatization of the maxillary sinus (p=0.015) were significant data. The mean number of absent teeth considering all subjects was 23.17±9.7, being statistically significant (p<0.001). In relation to age, the mean number of missing teeth was higher in individuals over 65 years old (p=0.048). Reduced salivary flow was observed in 78.3% of the patients. In a bivariate analysis, considering the outcome variables "missing teeth" and "reduced salivary flow", it was observed that economic class (p<0.001), family income (0.037) and maxillary sinus pneumatization (0.032) were statistically significant. Conclusions: In brief, patients with SS showed severe teeth loss, reduced salivary flow, and low educational status. This study addressed important aspects regarding oral findings in SS and highlighted the importance of researches in oral medicine.
... Tooth loss substantially impacts the quality of life and mental health [13,14]. Tooth loss has been identified as a predictor of shortened longevity [15], and is associated with the risk of developing systemic diseases, such as cardiovascular disease [16], cerebrovascular disease [17], cancer [18], and cognitive impairment [19]. Considering that the causes of tooth loss were mainly dental caries and periodontitis, the number of remaining teeth could be a possible predictor of the state of oral hygiene. ...
... The number of remaining teeth continues to increase in the 70 years and above age group in Japan, and the mean residual number of teeth in older adults was 14.0 and the percentage of the 70 years and above age group with ≥20 teeth was 52.3% in 2016 [32]. Tooth loss is now shown to affect longevity and life expectancy [15]. Octogenarians with ≥20 teeth had higher daily activity and life satisfaction [33]. ...
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Background: The changed disease landscape in Japan because of an increasing aging population has contributed to an increase in convalescent inpatients, warranting important considerations of their oral care needs. However, information on the oral state of these inpatients is scarce. We evaluated the correlation between the number of residual teeth and tongue hygiene state in these inpatients. Methods: This cross-sectional study included convalescent-ward inpatients, aged 34-100 years. The study was conducted between April 2017 and March 2018 in Kitakyushu, Japan. Data regarding age, sex, number of residual teeth, odontotherapy requirement, medications with oral side effects, and the reason for hospitalization, were collected. Oral hygiene level was assessed using the Oral Health Assessment Tool (OHAT). The correlation between each element of OHAT and the number of residual teeth was analyzed using Pearson's correlation analysis. The risk of a remarkable tongue state was analyzed using binominal logistic regression analysis. Results: Correlations were observed between the number of residual teeth and OHAT subscales, including tongue, saliva, and dentures. A significantly higher percentage of inpatients with ≤19 teeth had a tongue state score of 1 or higher, compared with those with ≥20 teeth. (78.6% vs 57.7%, p = 0.047). In inpatients with ≥20 teeth, the remarkable saliva state significantly increased the risk of the remarkable tongue state by 10.49-fold (95% confidence interval = 2.86-38.51), after adjusting for potential confounders. Conclusion: Poor tongue hygiene is associated with the number of teeth and salivary state in convalescent-ward inpatients. Inpatients with ≤19 teeth had a higher risk of poor tongue hygiene, regardless of the salivary condition, as assessed using OHAT.
... Hence, there are several ways for the rehabilitation of the edentulous arch, the most important being the endosseous dental implants. [1][2][3] Friedman PK (2000) has established the conventional loading of implant. [1,4] Authors suggested a waiting period of 3-6 months for the proper osseointegration. ...
... [1][2][3] Friedman PK (2000) has established the conventional loading of implant. [1,4] Authors suggested a waiting period of 3-6 months for the proper osseointegration. [5] Loading before this healing phase will ultimately lead to hindrance in stability and implant failure. ...
Article
Aim: The aim of this study was to assess the marginal bone level changes at dental implants after 1 year in function. Methods: Detailed searches from PubMed databases were made. A MEDLINE search (PubMed) published in the English language from 1980 to December 2018 was included in this study. Results: The electronic database research (MEDLINE) produced 166 corresponding articles. One hundred and twenty studies were excluded on the basis of abstract while the 46 researches were used chosen for full-text examination after the title and abstract testing, and 41 studies were excluded that did not meet the requirements of our inclusion and exclusion criteria. A total of 5 studies for a quantitative analysis were taken into account. Conclusion: Within the limits of the study, the mean marginal bone loss (MBL) was found to be 0.56 mm. A statistically significant difference in the MBL was found between the various studies.
... Tooth loss and edentulism are among the main oral changes found in the elderly 15 . Tooth loss is one of the causes of negative impact on the general oral health and quality of life of individuals, causing chewing impairment and affecting food selection, dietary quality, and nutritional contribution, which may increase the risk of various systemic diseases and contribute to weight changes 16 . Overweight and aging are some of the risk factors of the metabolic syndrome (MS) 17 . ...
... Additionally, being a woman and having less than 10 teeth in the oral cavity were risks for developing MS. Studies have shown a relationship among tooth loss and obesity, nutritional deficit, hypertension, cognitive dysfunction, and higher mortality risk 16 . Oral health measured by tooth loss is associated with negative impacts on general quality of life 22 . ...
Article
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Introduction Tooth loss is a health disorder of the elderly population that may lead to masticatory deficiency and nutritional risks, inducing the biochemical changes of metabolic syndrome (MS). Objective To verify the relationship among number of teeth, anthropometric measurements, and MS in a group of elderly people. Material and method The study was developed in Porto Alegre, RS, Brazil, and it was divided into three phases. The first phase collected information from the database of all project participants and the second one collected sociodemographic, anthropometric, and biochemical data. The third phase was divided into two other phases: first, oral health interviews were applied to the elderly (281 patients evaluated by telephone and 23 visited at home) and second, 45 patients were randomly selected and invited to validate the data obtained by telephone with oral clinical examinations performed by a trained dental surgeon. The sample consisted of 304 individuals. The data collected were tabulated and analyzed using statistical tests. Result Elderly women with severe tooth loss present a significantly higher risk of developing MS. Thus, the maintenance of natural teeth in the elderly is a protective factor for the syndrome. Conclusion The findings support the hypothesis that the oral health of individuals, expressed by the number of teeth, may compromise and increase the risk of MS in the elderly.
... The idea for the campaign was based on a study showing that people with at least 20 teeth can eat almost any kind of food. The number of pairs of occluding teeth is significantly associated with an increased sense of chewing effectiveness [34] while a low number of masticatory units is associated with an increased risk of CV mortality [35]. In addition, incomplete chewing or rapid swallowing may contribute to esophageal cancer risk [36]. ...
... Complete or partial edentulism has also been described as a clinical marker of social disadvantage: Peres, in fact, reported that oral conditions disproportionally affect impoverished and socially disadvantaged members of the society [42,43]. It can, in addition, be considered a summative measure of stress (social, emotional, economic, medical, psychological, educational) [34]. Nevertheless, it is still under-recognized as a physical disability although it works together with other more acknowledged impairing conditions in impacting quality of life and longevity. ...
Article
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Background Oral health is closely related to both physical and psychological well-being, as it enables individuals to eat, speak, and socialize. The number of teeth is the most used indicator of oral health. Several reports document a relationship of dental status with a variety of indicators of general health but longitudinal studies employing standardized physical performance tests are infrequent in the scientific literature. Subjects and methods The Italian elderly participating in the Pro.V.A. longitudinal Study (3099 subjects aged 65+ at baseline, 2196 at the 5-year follow-up 1 and 1641 at the 7-year follow- up 2) underwent detailed interview and extensive clinical and instrumental examination that included validated physical performance measures. Participants were classified into 4 groups according to the number of remaining teeth: 0, 1–7, 8–19, and 20+. To explore the association of the number of remaining teeth with physical function and disability, we performed logistic regression analyses with models progressively adjusted for a wide number of covariates, namely anthropometric (gender, age, BMI), comorbidity (cardio-vascular, osteoarticular, and neurological diseases including depression), muscle strength (assessed for upper and lower limbs), lifestyle (smoking status, alcohol use, leisure time activities) and socioeconomical status (education, income, marital status, loneliness). Results Dental status correlated with most comorbidities, lifestyle, and socio-economic variables at the univariate analysis at baseline and at follow-ups. A good dental status was significantly associated with better physical functioning and lower disability. The presence of 20+ teeth resulted significantly protective (reference group: 0 teeth) versus mobility-related disability (OR = 0.67), disability (OR = 0.54) and inability to perform heavy duties (OR = 0.62), at follow up 1 and low physical performance score (OR = 0.59) at follow up 2. Conversely, the detrimental effect of edentulism, explored in subjects with or without dentures, was present but not as straightforward. Conclusion. The assessment of a geriatric patient should include an oral evaluation as a good dental status is a crucial component of successful aging.
... However, a study of 28 patients diagnosed with SS in the period between 1982 and 2002 in Turkey showed individuals with a mean age of 48.2±10.5 years (12). The presence teeth is considered a reliable indicator of oral and systemic health (13), and some authors have observed that longevity/life expectancy may be affected by the number of teeth present and that tooth loss is a predictive factor shortening of longevity (14). A dentition with various dental absences attenuates masticatory efficiency and causes a subsequent high limiting food selection with a low diet in fruits, vegetables and other essential nutrients (15). ...
... Over the last few years, sociodemographic variables have been considered important factors are contributing to tooth loss (19), with emphasis on educational and socioeconomic levels (14). According to Rozier et al. (20), low socioeconomic status was the most consistent predictive factor of missing teeth in the US population. ...
Article
Full-text available
Background: Sheehan's syndrome (SS) is one of the leading causes of hypopituitarism in developing countries. It occurs after postpartum necrosis of the pituitary gland, and it is considered a significant public health problem. This paper, apparently unpublished, aimed to perform an analysis on oral aspects in patients with SS. Material and Methods: A cross-sectional study was performed with 23 women diagnosed with SS at the Division of Endocrinology and Diabetes (Walter Cantídio University Hospital, Fortaleza, Brazil). Results: Data on sociodemographic, dental and salivary flow aspects were collected through a clinical approach and a panoramic radiograph request. The mean age was 64 ± 11.5 years old, with the sample consisting mainly of married women (56.5%), socioeconomic class C2 or D / E (78.2%) and years of education up to 8 years (69.5%). The presence of horizontal bone loss (p<0.001) and bilateral pneumatization of the maxillary sinus (p=0.015) were significant data. The mean number of absent teeth considering all subjects was 23.17±9.7, being statistically significant (p<0.001). In relation to age, the mean number of missing teeth was higher in individuals over 65 years old (p=0.048). Reduced salivary flow was observed in 78.3% of the patients. In a bivariate analysis, considering the outcome variables "missing teeth" and "reduced salivary flow", it was observed that economic class (p<0.001), family income (0.037) and maxillary sinus pneumatization (0.032) were statistically significant.
... A perda dentária, consequência da doença periodontal, tem sido considerada um preditor de menor longevidade (25). Os principais agravos da saúde bucal, em todas as faixas etárias, podem ser prontamente evitados pela higiene oral diária, adesão a uma dieta saudável e hábitos saudáveis como, por exemplo, evitar fumar (26). ...
Article
Full-text available
Resumo O objetivo deste estudo foi traçar o perfil do usuário do Sistema de Saúde da Marinha atendido na Odontoclínica Central da Marinha, além de investigar a possível associação do número de dentes com fatores de risco sistêmicos. Foram analisados 1.123 questionários e 750 exames clínicos realizados pelo Serviço de Odontologia Preventiva durante consulta odontológica. Avaliaram-se dados subdividindo a população em três faixas etárias: 20 a 39 anos, 40 a 59, e 60 anos ou mais. Uma análise estratificada visou esclarecer se a média do número de dentes de pacientes com idade superior a 50 anos, fumantes, diabéticos, com osteoporose e/ou hipercolesterolemia, era menor que a média encontrada em pacientes sem os referidos riscos. A associação do número de fatores de risco sistêmicos com o número de dentes foi investigada usando o teste de correlação de Spearman. Os resultados mostraram que a prevalência de doenças crônicas e a ausência de dentição funcional foram mais frequentes em indivíduos idosos. A média do número de dentes de indivíduos com mais fatores de risco sistêmico foi significativamente menor quando comparada a de indivíduos sem os referidos fatores (15,96 ± 7,58 e 19,44 ± 8,03, respectivamente, p=0,01). A análise de Spearman revelou que, quanto maior o número de fatores de risco sistêmicos, menor o número de dentes (rho=-0,113, p=0,01). Idade avançada e comorbidades foram associadas ao menor número de dentes na amostra estudada. Estratégias de prevenção são fundamentais para que os usuários alcancem bom estado de saúde oral e uma dentição funcional, em idades mais avançadas. Palavras-chave: Abstract The aim of this study was to describe the profile of the patients of the Sistema de Saúde da Marinha attending the Brazilian Navy's Dental Center (Odontoclínica Central da Marinha), in addition to investigate the possible association of number of teeth and systemic risk factors. More than one thousand anamnesis charts and 750 clinical examinations performed by the Preventive Dentistry Service were evaluated. Data were evaluated by subgrouping the study population into the following age groups: 20 to 39 years, 40 to 59, and 60 years or more. A stratified analysis aimed to clarify whether the mean number of teeth of patients aged over 50, smokers, diabetics, with osteoporosis and / or hypercholesterolemia, was lower when compared to those without such risks. The association of number of systemic risk factors and number of teeth was investigated using Spearman correlation test. The results have shown that the prevalence of chronic disease and the absence of functional dentition were more frequent in the elderly. The mean number of teeth of individuals with more systemic risk factors was significantly lower when compared to individuals without these factors (15.96 ± 7.58 and 19.44 ± 8.03, respectively, p = 0.01). Spearman analysis revealed that the higher the number of systemic risk factors, the lower the number of teeth (rho=-0,113, p = 0.01). In conclusion, advanced age and comorbidities were associated with the lower number of teeth in the studied sample. Prevention strategies are fundamental for reaching good oral health and a functional dentition at more advanced ages.
... 33 A study recently indicated that a number of chronic inflammatory diseases such as periodontitis could participate in the etiopathogenesis of edentulism and cognitive impairment and could even affect an individual's longevity. 34 A study with murine models also showed that the consequences at the brain level of losing molars are accentuated as this condition continues over time and that, conversely, the consequences significantly attenuate when restoring the lost molars with artificial crowns. 35 This finding could justify the results of various studies that concluded that cognitive impairment in the elderly increases when they are edentulous and do not use dental prostheses. ...
Article
Background Studies on the elderly have reported that the risk of cognitive impairment is affected by chewing difficulty. Objective To determine whether there is a relationship between the number of pairs of antagonist teeth that come into contact when the mouth is closed (functional masticatory units [FMUs]) and the level of cognitive impairment. Methods We conducted a cross‐sectional observational study with 502 institutionalized white individuals older than 65 years, living in the northwest of Spain and Portugal. Through a direct visual inspection, we recorded the number of FMUs. Cognitive impairment was assessed by applying the Mini‐Cognitive Examination (MCE), a test derived from the Mini‐Mental State Examination. To describe the statistical relationship between the FMUs and the MCE values, a generalized linear model (GLM) was applied. We assessed the GLM predictive capacity for detecting cognitive impairment (MCE ≤23) in a new study group consisting of 156 elderly individuals. Results A large number of FMUs was significantly associated with a lower probability of cognitive impairment, regardless of the nature of the contact and its location (explained deviance, 30.1%). The model's discriminatory capacity for cognitive impairment based on the FMUs was “good” (0.820). The model's predictive capacity for cognitive impairment was “acceptable” (sensitivity, 0.786; positive predictive value, 0.900; accuracy, 0.729). Conclusion In white, elderly institutionalized individuals, the absolute number of FMUs is significantly related to their MCE scores. This article is protected by copyright. All rights reserved.
... 14 In addition, Friedman et al. reviewed many articles on numerous variables that contribute to tooth loss and suggested that tooth loss is a predictive factor for reduced longevity. 15 The next evaluation involved collection of all reports on relationships between the number of teeth and deaths as a result of conditions such as cancer, cardiovascular disease (CVD) and respiratory disease. In comparison with the group with ≥20 teeth, the edentulous group showed an HR for mortality as a result of upper gastrointestinal cancer of 1.35 (95% CI 1.14-1.59). ...
Article
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Oral frailty is defined as a decrease in oral function accompanied by a decrease in mental and physical functions. Studies showing that people with oral frailty are at high risk of physical frailty, sarcopenia, severe conditions requiring nursing care and death have been reported in Japan. An increase in life expectancy and maintenance of teeth result in a decrease in the effect of the number of teeth. In contrast, a decrease in oral function as a result of aging has been suggested to have major effects on dysfunction and mortality risk. The present report is a narrative review of major clinical studies on the relationships of the number of teeth, dentures, occlusion and oral function with longevity, with the aim of providing information for future studies centered on oral function in Japan or overseas. This review clearly shows the relationships of the number of teeth, dentures, and occlusion with health and longevity. Recent studies have shown that, besides maintenance of the number of teeth, attempting to maintain or increase oral function, having a good diet and maintaining nutritional status are all linked to general health. Decreased oral function is a major risk factor for developing malnutrition and sarcopenia. Oral frailty, a new concept that has been recently introduced in Japan, is considered to have major effects on dental and oral health policies in Japan, in the old‐age group, and is expected to be reflected in the dental and oral health policies of various countries, as they also predict increased life expectancies. Geriatr Gerontol Int 2020; ••: ••–••.
... In the BRHS, we also found associations between tooth loss (complete and partial) and high fibrin D-dimer. Tooth loss, which can be a result of chronic periodontal disease and root carries (40), could be linked with oral infections and inflammation (3). Oral bacteria entering the circulatory system could indirectly influence thrombosis and the formation of atherosclerotic plaques and, in turn, contribute to inflammation associated with cardiovascular disease (41). ...
Article
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Background We examined the association of objective and subjective oral health markers with inflammatory, haemostatic and cardiac biomarkers in older age. Methods Cross-sectional analyses were based on the British Regional Heart Study (BRHS) comprising British men aged 71-92 years (n=2147), and the Health, Aging and Body Composition (HABC) Study comprising American men and women aged 71-80 years (n=3075). Oral health markers included periodontal disease, tooth count, dry mouth. Inflammatory biomarkers included C-reactive protein (CRP), interleukin-6 (IL-6) in both studies, and tissue plasminogen activator (t-PA), von Willebrand Factor (vWF), fibrin D-dimer, high sensitivity Troponin T (hsTnT) and N-terminal pro-brain natriuretic peptide (NTproBNP) only in the BRHS. Results In both studies, tooth loss, was associated with the top tertile of CRP – odds ratios (95%CI) are 1.31 (1.02-1.68) in BRHS; and 1.40 (1.13-1.75) in the HABC Study, after adjusting for confounders. In the HABC Study, cumulative (≥3) oral health problems were associated with higher levels of CRP (OR (95%CI) =1.42 (1.01-1.99)). In the BRHS, complete and partial tooth loss were associated with haemostatic factors, in particular with the top tertile of fibrin D-dimer (OR (95%CI) = 1.64 (1.16-2.30) and 1.37 (1.05-1.77) respectively). Tooth loss and periodontal disease were associated with increased levels of hsTnT. Conclusions Poor oral health in older age, particularly tooth loss, was consistently associated with some inflammatory, haemostatic and cardiac biomarkers. Prospective studies and intervention trials could help understand better if poor oral health is causally linked to inflammatory, haemostatic and cardiac biomarkers.
... Periodontal disease, tooth loss and longevity may be related. 68 Challenges facing the field of periodontology in the 21st Century: concluding remarks a. Promote adequate communication between general dentists and periodontists, so that they know in which periodontal affections the patient could require a more specialized treatment, especially in those cases when non-surgical therapy does not achieve periodontal health. b. ...
Article
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Gingivitis and periodontitis are associated with a negative impact on Oral Health Related Quality of Life (OHRQoL), exerting a significant influence on aspects related to the patients' function and esthetics. Periodontitis has been associated with several systemic conditions, including adverse pregnancy outcomes, cardiovascular diseases, type 2 diabetes mellitus (DM), respiratory disorders, fatal pneumonia in hemodialysis patients, chronic renal disease and metabolic syndrome. The aim of this paper was to review the results of different periodontal treatments and their impacts on patients' OHRQoL and systemic health. Non-surgical and surgical periodontal treatments are predictable procedures in terms of controlling infection, reducing probing pocket depth and gaining clinical attachment. In addition, the treatment of periodontitis may significantly improve OHRQoL and promote a reduction in the levels of systemic markers of inflammation, including some cytokines associated with cardiovascular diseases. Studies have also suggested that periodontal treatment may improve glycemic control in patients with DM. Strategies and actions for preventing the onset and recurrence of periodontitis, and the challenges facing the field of periodontology in the XXI century are presented in this review.
... An earlier research among the elderly in Kenya found that over 80% had carious teeth [13]. Dental caries can trigger toothache and affect mastication of food with the resulting nutritional implications [5], and, if left untreated, lead to eventual tooth loss further deteriorating health and wellbeing of the elderly [14,15]. Dental self-care compass actions taken up by individuals to promote or protect oral health and include, among other things, brushing, use of dentifrices and dental visits [16]. ...
... 11,12 Poor oral health can influence chronic diseases, including cardiovascular disease, diabetes, cognitive function, and mortality. [13][14][15] In older populations, bidirectional associations exist between poor oral health and disability, with both health outcomes influencing one another. One potential direction is that poor oral health, specifically tooth loss, can influence the development of disability, including activities of daily living (ADL), instrumental activities of daily living (IADL), and mobility limitations, in older age. ...
Article
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Background: Preventing oral health problems can be crucial for maintaining physical independence in older adults. We aimed to examine the associations of a range of oral health problems with incidence of disability in older adults. Methods: We used prospective data from the British Regional Health Study (BRHS) (N = 2147, 71-92 years), and the Health, Aging and Body Composition (HABC) study (USA) (N = 3075, 71-80 years). Oral health measures included tooth loss, periodontal disease, self-rated oral health, and self-reported dry mouth. Participants were followed for onset of disability over a follow-up period of 3 years. Onset of disability was assessed through new cases of mobility limitations, activities of daily living (ADL), and instrumental activities of daily living (IADL). Logistic regression was performed to calculate the odds of incident disability. Results: In the BRHS, tooth loss was associated with greater odds of mobility limitations and ADL difficulties. Periodontal disease was associated with greater incidence of mobility limitations. Self-report of ≥3 dry mouth symptoms was associated with increased odds of incident mobility limitations and ADL difficulties (OR = 2.08, 95% CI 1.27-3.42; OR = 1.73, 95% CI 1.03-2.90). Fair/poor self-rated oral health was associated with greater incidence of IADL difficulties. In the HABC study, complete tooth loss was associated with greater incidence of mobility limitations (OR = 1.86, 95% CI 1.13-3.06), and fair/poor self-rated oral health was associated with increased odds of incident ADL difficulties (OR = 1.42, 95% CI 1.04-1.94). Conclusions: Oral health problems in older adults, particularly tooth loss, self-reported dry mouth and self-rated oral health were associated with greater incidence of disability. Poor oral health plays a potentially important role in the development of disability in older populations, which in turn is an essential part of quality of life and healthy aging.
... More recently, Oliveira et al 23 Despite its recognised negative effects on general health 9,12,14,16,18,22 and longevity, 24 there are no studies that directly assesses the burden of any clinical oral health measurement on life expectancy. Healthy life expectancy measures could be useful to guide public policies, providing information on demand, monitoring trends over time and among population groups, 3 and planning dental care. ...
Article
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Aim: To assess edentulism-free life expectancy (EFLE) and the related inequalities by sex and schooling among older Brazilian adults from 2006 to 2016. Background: Tooth loss is related to shortened longevity and unhealthy life expectancy in old age. Materials and methods: The outcome of the study was EFLE, assessed by age, sex and schooling. EFLE was estimated using the Sullivan method, considering the years and proportion of remaining life and the prevalence of edentulism-assessed in the Health, Well-being, and Aging cohort study, as well as the official mortality data for adults aged 60 years or older living in São Paulo, Brazil. Results: EFLE increased from 10.9 (95% CI: 10.4-11.5) to 13.8 (95% CI: 13.2-14.5) years, considering data from 2006 to 2016, among 60-year-old individuals. In relative terms, these individuals expected to live 50.7% (95% CI: 48.1-53.2) of their remaining life free of edentulism in 2006, while this expectation was 62.8% (95% CI: 60.0-65.6) in 2016. Within both years, women and the less educated had lower EFLE than men and the higher educated. Conclusion: EFLE increased from 2006 to 2016. However, inequalities concerning sex and education remained significant, thereby highlighting the need to continuously address inequalities in tooth loss throughout life to contribute to a healthy ageing.
... Outros aspectos importantes e complementares para o diagnóstico situacional do edentulismo no Brasil e para o planejamento e avaliação dos serviços de saúde bucal são o impacto da perda dentária na saúde geral e bucal e na qualidade de vida e a necessidade e demanda por tratamento protético. 4,9,12,32,33 Apesar dos avanços proporcionados pela Política Nacional de Saúde Bucal, permanece um quadro de alta prevalência de perda dentária entre os idosos. Diante disso, é necessário o desenvolvimento e monitoramento de indicadores epidemiológicos e sócio-odontológicos, associados a estratégias efetivas de prevenção e tratamento desse agravo e a medidas para enfrentamento das desigualdades sociais e das iniquidades em saúde. ...
Article
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Introdução: A retenção de uma dentição natural funcional e estética com pelo menos 20 dentes é uma meta global de saúde bucal da Organização Mundial de Saúde. Apesar da redução expressiva das perdas dentárias entre adolescentes e adultos, isso não vem ocorrendo entre idosos, indicando um acúmulo da necessidade de reabilitação protética nessas populações.Objetivo: Identificar os fatores individuais e contextuais associados ao edentulismo funcional em idosos no Brasil.Métodos: Trata‑se de um estudo transversal tendo como amostra os idosos de 65 a 74 anos investigados no levantamento epidemiológico Pesquisa Nacional de Saúde Bucal de 2010 (SBBrasil 2010). O desfecho investigado foi o edentulismo funcional – presença de menos de 20 dentes naturais. As variáveis independentes foram organizadas em modelo multinível, considerando o ambiente externo, características socioeconômicas dos indivíduos, o comportamento relacionado à saúde bucal e suas características demográficas.Resultados: A prevalência de edentulismo funcional foi de 73,3% (IC95%= 69,7‑76,9). Ser do sexo feminino, possuir menores níveis de renda familiar e maior tempo transcorrido desde a última visita ao dentista, e ter realizado a última consulta odontológica por motivos não relacionados à revisão, prevenção ou check‑up, extração, dor ou tratamento foram fatores associados ao edentulismo funcional.Conclusão: Os fatores de risco associados ao edentulismo funcional em idosos reforçam o impacto das desigualdades sociais. Estratégias para melhoria das condições de vida e promoção de comportamentos saudáveis têm o potencial de reduzir a prevalência de perda dentária.
... INTRODUCTION L oss of teeth may impair masticatory function, speech, aesthetics, and quality of life. 1 In addition, loss of permanent teeth in the posterior region may cause supraeruption of opposing teeth and tipping or rotation of the adjacent teeth toward the site of loss. [2][3][4] Treatment options to replace a single missing tooth include a toothsupported fixed dental prosthesis or an implant-supported single crown (ISC). ...
Article
Some authors have recommended that implant-supported single crowns should only contact during heavy clenching. However, a lack of occlusal contact with moderate clenching may cause supra-eruption of antagonist natural teeth. The main objective of this study was to assess changes in the occlusal contacts of posterior implant-supported single crowns with natural antagonist teeth two years after placement. The occlusal schemes of 14 patients who received 16 implant-supported single crowns in molar and premolar regions were assessed in this prospective study. Just after crown placement, at 6 months and after 2 years a silicone maxillomandibular relationship and T-scan records were obtained during the intercuspal position with light and heavy clenching, determined using near half of the maximum force and maximum force respectively. Occlusal contacts were assessed quantitatively and qualitatively in the implant-supported single crowns, contralateral tooth and adjacent tooth; the latter two were used as controls. After six months and two years, no significant variations were observed in any region of the occlusal scheme in any assessments, including silicone record or T-Scan, using light or heavy clenching, and qualitative or quantitative occlusal contact assessment. In this preliminary study, the occlusal scheme did not vary at the intercuspal position two years after placing posterior implant-supported single crowns.
... Golestan and Linxian (42) compared with the United States and United Kingdom, and the greater degree of variation in tooth loss may have made risk associations easier to detect in these high-risk areas. It is also possible that the primary reasons for tooth loss vary, and some populations may experience tooth loss due to other reasons besides periodontal status and poor oral hygiene (e.g., trauma, lack of access to dental services; ref. 43). Moreover, the suboptimal levels of drinking water fluoride concentrations in Golestan province may contribute to poor oral health (44,45), but additional studies are required to explore this possibility. ...
Article
Tooth loss and periodontal disease have been associated with several cancers, and poor oral health may be an important risk factor for upper gastrointestinal (UGI, i.e., esophageal and gastric) cancers. We assessed the relationship between oral health and UGI cancers using a large prospective study of over 50,000 adults living in Golestan Province, Iran, a high-incidence area for these cancers. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for the association between three different measures of oral health [frequency of tooth brushing; number of missing teeth; and the sum of decayed, missing, and filled teeth (DMFT)] and UGI cancers. During a median follow-up duration of 13 years, there were 794 incident UGI cancers (396 esophageal and 398 gastric cancers). Daily tooth brushing was associated with a decreased risk of developing both esophageal (HR = 0.670; 95% CI: 0.486, 0.924) and gastric (HR = 0.741; 95% CI: 0.544, 1.01) cancers (combined UGI cancer HR = 0.697; 95% CI: 0.558, 0.871) compared to never brushing. Tooth loss in excess of the loess smoothed, age- and sex-specific median number of teeth lost was significantly associated with esophageal (HR = 1.64; 95% CI: 1.08, 2.47) and gastric cancers (HR = 1.58; 95% CI: 1.05, 2.38). There were some adverse associations between DMFT and UGI cancers but most were not statistically significant. These results suggest increased risk of developing UGI cancers among individuals with poor oral health, and those who do not perform regular oral hygiene.
... Individuals with poor oral health, such as tooth loss, may have trouble eating and swallowing, have inadequate nutritional intake, and experience increased struggles to speak and smile effectively. These consequences all affect their general health, quality of life, and longevity [8,9]. Thus, improving oral health among this rapidly increasing population group has become a priority for public health. ...
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The role of health behaviors in oral health conditions in individuals of extremely old age remains understudied. This study included 185 participants aged 100 years or older from the Nan-jing Centenarians Study (NCS) to examine the associations between health behaviors and oral health and investigate the potential moderating role of education and living arrangements in such relationships. The oral health status as an outcome included the self-reported oral health status and edentu-lous status. Health behavior variables included smoking, eating fruits, eating vegetables, participating in leisure activities, and practicing oral hygiene behaviors. Sociodemographic characteristics and health status were considered as confounders. Descriptive statistics, ordinal regression, and logistic regression models were used to address the research questions. Results showed that better oral health was reported by centenarians who were non-smokers, participated in more leisure activities, and practiced higher frequency of oral hygiene behaviors. Those who ate fruits daily and practiced more frequently oral hygiene behaviors were more likely to be dentate. The positive association of oral hygiene behaviors was stronger for centenarians who were formally educated and co-resided with family members. The results suggest that effective interventions should consider health behaviors and living arrangements in this growing population to improve their oral health status.
... Chronic oral inflammation, and particularly bacteria from the mouth, can travel through circulation to other parts of the body and may influence the development or severity of chronic diseases 4 . Tooth loss as a reflection of accumulating chronic conditions and declining health can contribute to the increased risk of mortality through its interaction with co-morbidities 5,44 . ...
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Preventing deterioration of oral health in older age can be crucial for survival. We aimed to examine associations of oral health problems with all-cause, cardiovascular disease (CVD), and respiratory mortality in older people. We used cohort data from the British Regional Health Study (BRHS) (N = 2147, 71–92 years), and the Health, Aging and Body Composition (HABC) Study (USA) (N = 3075, 71–80 years). Follow-up was 9 years (BRHS) and 15 years (HABC Study). Oral health comprised tooth loss, periodontal disease, dry mouth, and self-rated oral health. Cox regression was performed for all-cause mortality, competing risks for CVD mortality, and accelerated failure time models for respiratory mortality. In the BRHS, tooth loss was associated with all-cause mortality (hazard ratio (HR) = 1.59, 95% CI 1.09, 2.31). In the HABC Study, tooth loss, dry mouth, and having ≥ 3 oral problems were associated with all-cause mortality; periodontal disease was associated with increased CVD mortality (subdistribution hazard ratio (SHR) = 1.49, 95% CI 1.01, 2.20); tooth loss, and accumulation of oral problems were associated with high respiratory mortality (tooth loss, time ratio (TR) = 0.73, 95% CI 0.54, 0.98). Findings suggest that poor oral health is associated with mortality. Results highlight the importance of improving oral health to lengthen survival in older age.
... Next, edentulousness can limit social interaction and lead to avoidance of social activities [14]. Considering the above aspects, several researchers have suggested that edentulousness should be viewed as a disability and that it may even be a predictor of various health issues and shortened longevity [17,18]. ...
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Background Cross-sectional studies have shown that elderly with a natural dentition have better general health than edentulous elderly, but this has not been confirmed in studies with longitudinal design. Methods This prospective longitudinal study with a follow-up of 8 years aimed to assess differences in general health, healthcare costs and dental care use between elderly with a natural dentition and edentulous elderly wearing implant-retained or conventional dentures. Based on data of all national insurance claims for dental and medical care from Dutch elderly (aged ≥75 years) general health outcomes (chronic conditions, medication use), healthcare costs and dental care use could be assessed of three groups of elderly, viz. elderly with a natural dentition, elderly with conventional dentures and elderly with implant-retained overdentures. Results At baseline (2009), a total of 168,122 elderly could be included (143,199 natural dentition, 18,420 conventional dentures, 6503 implant-retained overdentures). Here we showed that after 8 years follow-up elderly with a natural dentition had more favorable general health outcomes (fewer chronic conditions, less medication use), lower healthcare costs and lower dental costs – but higher dental care use – than edentulous elderly. At baseline the general health of elderly with an implant-retained overdentures resembled the profile of elderly with a natural dentition, but over time their general health problems became comparable to elderly with conventional dentures. Conclusions It was concluded that elderly with a natural dentition had significant better health and lower healthcare costs compared to edentulous elderly (with or without dental implants).
... and sarcopenia, 7 functional disability, 8 sleep disorder, 9 poorer health-related quality of life, 10 and higher risk of all-cause and cause-specific mortality. [11][12][13] The hypothesized mechanism is that translocation of oral microbiota could lead to persistent inflammation which contributes to chronic illnesses. 14,15 While most of the epidemiological evidence has come from industrialized countries, the situation in developing countries is not clear. ...
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Objectives Information on the association between edentulism and chronic medical conditions in developing countries is lacking. We investigated such information among adults aged ≥45 years in China. Methods A national longitudinal data set from the China Health and Retirement Longitudinal Study (CHARLS) 2011-2018 was analysed. A multilevel logistic regression model was applied to analyse the association between edentulism and select chronic diseases. Results There were 74 240 Chinese adults aged ≥45 years in this study. The prevalence of self-reported edentulism was 8.8% in 2011 and had increased to 16.4% by 2018. Conclusion Edentulism was a factor associated with a higher risk of various self-reported chronic diseases among adults aged ≥45 years in China. Edentulism is one of the comorbidities among ageing people with chronic conditions. Preventive public health policy should consider controlling shared risk factors at an earlier age.
... Literature suggests that underweight is associated with all-cause of mortality, poor quality of life, cognition and poor self-rated health (Petersen et al. 2005;Pednekar et al. 2008;Sauvaget et al. 2008;Wang and Arah 2015). Similarly, poor oral health adversely affects longevity, gait speed, physical function, oral health-related quality of life (Emami et al. 2013;Friedman and Lamster 2016;LaMonte et al. 2017;Welmer et al. 2017;Arokiasamy and Selvamani 2018). ...
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In India, more than one third of older adults are underweight. The prevalence of edentulism is higher among older adults. Yet, the role of underweight in determining edentulism is remains unclear. This study examined the association between underweight and self-reported edentulism among older men and women in India. Nationally representative cross-sectional data from the first wave WHO's Study on global AGEing and adult health (SAGE) survey was used (n = 6366). The association between underweight and edentulism was examined using multivariable logistic regression analysis adjusting for age, residence, marital status, years of schooling, wealth quintile, tobacco use, self-rated health, chronic diseases, and state/province. The overall prevalence of underweight in the study population was 38%. The prevalence of edentulism was higher among women (16%) respondents compared to men (14%). Further, underweight women had a 51% higher risk of edentulism (OR = 1.51; CI: 1.12, 2.43; p < .001) than the normal weight women. The result of this study suggests a significant positive relationship between underweight and edentulism among the older women in India. Interventions to improve the nutritional status in life course may enhance the oral health conditions of the older population in India.
... periodontal disease, tooth mobility, and caries, which renders the individual incapable of chewing properly due to pain or discomfort. 7,8 . Patients with 5-7 missing teeth for a longer period of time; which has been deemed a disability on its own, would have compromised chewing ability and hence are at a risk of being cognitively impaired as opposed to patients getting restorative and prosthodontic rehabilitation done by a dental professional 6,9,10 . ...
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Loss of teeth and chewing ability has been associated with cognitive decline in individuals at an older age, which is attributed to either the loss of the chewing reflex and its subsequent stimulation of brain centres or due to the absence of nutrition because of poor chewing ability. This can be aggravated by the lack of education, poor socioeconomic status, age, and female gender. We administered a questionnaire for our sample that consisted of individuals with more than 10 missing teeth, over the age of 45 to notice the associations between these aforementioned factors and cognitive ability, which was assessed using the Mini-Mental State Examination on these respondents. It was observed that gender, education levels, and socioeconomic status played a crucial role in cognitive decline whereas age and a further loss of tooth did not play any role in further loss of cognition, in our cross-sectional study. Given these results, it was concluded that our sample size demonstrated very clear trends of cognitive loss in individuals of the female gender, who were not educated or had primary level of education and came lower-class economic backgrounds. Furthermore, due to the nature of the study, it was noted that age and tooth loss did not have a major effect on the cognitive abilities of these individuals at the time, which is subject to change as their life progresses‎. https://annalsofdentalspecialty.net.in/storage/models/article/Cf0ypPjYRZ9fkzCRIy6eIYTKEpmv3F4SY2awnPQH2jBCiW9PYtOHVhtl59Ay/factors-affecting-cognition-in-individuals-with-tooth-loss.pdf
... Research links poor oral health to a multitude of diseases, such as diabetes [1], arthritis [2], cancer [3], and cardiovascular disorders [4][5][6]. The occurrence of periodontitis and gum inflammation, for example, is among the most frequent causes of tooth loss [7], and possessing fewer teeth is correlated to a shorter life expectancy [8]. Remarkably, the incidence of dental caries is virtually preventable with proper dental care [9], and long-term clinical studies have shown that periodontitis can also be inhibited utilizing dentistry interventions [10][11][12]. ...
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Access to general dental care is essential for preventing and treating oral diseases. To ensure adequate spatial accessibility for the most vulnerable populations, New York State mandates a ratio of one general dentist to 2000 Medicaid recipients within 30 min of public transportation. This study employed geospatial methods to determine whether the requirement is met in Manhattan by verifying the online directories of ten New York managed care organizations (MCOs), which collectively presented 868 available dentists from 259 facilities. Our survey of 118 dental facilities representing 509 dentists revealed that significantly fewer dentists are available to treat Medicaid recipients compared to MCO directories. The average dentist-to-patient ratio derived from the MCO listings by the Two-Step Floating Catchment Area (2SFCA) method was 1:315, while the average verified ratio was only 1:1927. "Phantom networks", or inaccurate provider listings, substantially overstated Medicaid dental accessibility. Surprisingly, our study also discovered additional Medicaid providers unlisted in any MCO directory, which we coined "hidden networks". However, their inclusion was inconsequential to the overall dental supply. We further scrutinized dental care access by uniquely applying six "patient-centered characteristics", and these criteria vastly reduced accessibility to an average ratio of merely 1:4587. Our novel evaluation of the spatial association between poverty, dental care access, and phantom networks suggests that Medicaid dental providers wish to be located in wealthier census tracts that are in proximity to impoverished areas for maximum profitability. Additionally, we discovered that poverty and phantom networks were positively correlated, and phantom providers masked a lack of dental care access for Medicaid recipients.
... The analysis of the periodontal condition of inhabitants is important for diagnosis purposes because it can cause harmful effect on general health [17]. Social, physical, and psychological impacts can be observed in edentulous individuals [26]. The high values of not examined sextants confirm the impact of the periodontal disease. ...
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Introduction: The epidemiological surveys aim to evaluate the distribution and state determinants or events in health in given populations. Objective: To conduct an epidemiological survey on the socioeconomic condition, use of dental services, referred oral morbidity, self-perception, and oral health of inhabitants of the Teixeira Island, Paraná, Brazil. Material and methods: The studyfollowed the statements of the World Health Organization and the Brazilian National Epidemiological Survey (SB Brazil 2010). Questionnaires were applied, and in the clinical examination the following data were collected: dental trauma, edentulism, fluorosis, caries in deciduous teeth (dmft), caries in permanent teeth (DMFT), Community Periodontal Index (CPI) and Loss of Periodontal Insertion Index (LPII). The data were analyzed with Statistical Package for Social Sciences software, version 21.0, and expresses in frequency tables. Results: Of the 108 inhabitants, 90 participated in the study. The socioeconomics conditions unfavorable were: low income and low schooling. The water supplying was not fluoridated. The perception of oral problems was reported by 82.2%; 48.9% declared to have had toothache in last the six months; the reason of search for care was predominantly for curative treatments. Almost 30% of the participants declared to be unsatisfied with their oral health. The values of DMFT and dmtf indexes were 13.9 and 1.2, respectively. The greater demand for maxillary prosthesis occurred in 39.7% of the sample, while 34.2% needed mandibular prosthesis. Conclusion: The oral diseases illnesses and need of treatment were evidenced in the sample, as well as risk factors that deserve attention of the public power.
... The association between dental status and mortality in community-dwelling older adults has been documented by several studies [1][2][3]. Older adults with adequate dental status have a lower relative mortality risk than those with an inadequate dental status [4]. Two biological pathways have been proposed. ...
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Background: The association between dental status and mortality in community-dwelling older adults has been documented by several studies. The aim of this study was to analyze the contribution of self-assessed chewing ability, number of remaining teeth and serum albumin levels to mortality and the interactions between the three factors. Methods: A 20-year follow-up study was conducted with 666 subjects aged 80 years (from 1996 to 2017) who resided in the 8 areas served by one health center in Iwate Prefecture. Health check-ups including physical fitness measurements were conducted at a meeting place or gymnasium. Medical interview and blood sampling were conducted by physician. Oral examination was examined by dentist. The number of remaining teeth, serum albumin levels, and self-assessed chewing ability were used as predictors of mortality. Results: Among the 608 subjects (233 men and 375 women) included in this study, only 12 subjects (1.97%) survived after 20 years of follow-up. For men, dental status and serum levels of albumin were significantly associated with mortality. The hazard ratios of self-assessed chewing ability calculated by item response theory analysis and the inability to chew at least one food adjusted for serum albumin and tooth conditions were statistically significant in men. When adjusted by health status evaluated by blood tests, self-assessed chewing ability was statistically significant in men. According to path analysis, self-assessed chewing ability and serum albumin independently affected mortality in men. Conclusion: Masticatory dysfunction may be an important risk factor for mortality in men, even though it was self-assessed. Retaining chewing ability might be a useful predictor of longevity in older male adults.
Article
La compréhension des acteurs du vieillissement est nécessaire pour adapter nos stratégies thérapeutiques et de prévention lorsque la démographie s’oriente vers une augmentation importante du nombre des plus âgés. En ce qui concerne le parodonte, le vieillissement s’additionne au risque de maladies parodontales déjà présent chez une personne sur deux, et reste au cœur des problématiques du vieillissement bucco-dentaire et de santé. Une meilleure compréhension des effets de l’âge et de ses conséquences permettrait une meilleure prise en charge thérapeutique pour rester en bonne santé plus long-temps.
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This longitudinal study aimed to elucidate whether systemic bone fragility predicts severe periodontal clinical attachment loss (CAL) and tooth loss over the years and to test the influence of bone medication and periodontal maintenance in these relationships. Elderly women were evaluated for bone mineral density (BMD) and for fracture risk assessment (FRAX) in a cross-sectional analysis and retrospective follow-up (6- and 10-y periods). Data on BMD and FRAX were used as indicators of bone fragility in structural equation modeling. Periodontal examination and data on postmenopausal tooth loss were recorded. Multivariate Poisson regression models with robust covariance were used to estimate relative risk (RR) and 95% CI of BMD and FRAX for sites with CAL ≥6 mm and for tooth loss. The cross-sectional analysis included 134 women aged 65 to 80 y, and from them 71 and 49 women had available data for analysis in the 6- and 10-y follow-up periods, respectively. Bone fragility predicted severe CAL over 10 y (e.g., femoral neck: 10-y analysis, β = −0.389, P = 0.005; cross-sectional, β = −0.190, P = 0.004); however, this association did not remain significant when the use of bone medication was evaluated. Poisson regression showed that a better skeletal condition was associated with a lower risk of severe periodontal disease and tooth loss (cross-sectional femoral neck: RR = 0.08, P < 0.001; RR = 0.03, P < 0.001, respectively) when not adjusted for bone medication and periodontal maintenance. The receiver operating characteristic curve suggested that women with osteoporosis should be referred for periodontal assessment (sensitivity = 71.0%, specificity = 70.0%). Bone fragility is a relevant longitudinal predictor of severe periodontal disease and tooth loss among elderly women. The use of bisphosphonates improved the bone condition as well as the periodontal status. Periodontal maintenance also minimized the negative impact of low BMD on teeth-supportive tissues in the studied population.
Article
The aim of this study was to analyse the influence of different loading protocols on marginal bone loss (MBL). The outcomes of different implant loading protocols were assessed at 1year after implantation, with focus on MBL; protocols included immediate, immediate non-occlusal, early, and conventional loading. The search strategy resulted in 889 studies. Twenty-two of these studies fulfilled the inclusion criteria. Among the included studies, the lowest MBL was for immediately loaded implants (0.05±0.67mm) and the highest for immediate non-occlusally loaded implants (1.37±0.5mm). The results of the meta-analysis showed an estimated mean MBL of 0.457mm (95% confidence interval (CI) 0.133-0.781) for immediate loading, 0.390mm (95% CI 0.240-0.540) for immediate non-occlusal loading, 0.488mm (95% CI 0.289-0.687) for early loading (>2 days to <3 months), and 0.852mm (95% CI 0.429-1.275) for conventional loading (>3 months) implant protocols. The lowest decrease in 1-year implant survival per millimetre increase in MBL was observed for immediate loading and the highest for conventional loading. Conventional loading showed a significantly higher MBL than the other three loading protocols. This systematic review and meta-analysis indicates that the immediate loading protocol is a reasonable alternative to the conventional loading protocol.
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Aim: This study aimed to identify the factors influencing the changes in the number of teeth present, and the number of healthy or filled surfaces between two time-points. Materials and methods: Repeated cross-sectional data from population-based studies, i.e., the German Oral Health Studies (DMS-III vs DMS-V), the Studies of Health in Pomerania (SHIP-START-0 vs. SHIP-TREND-0), and the Jönköping study (2003 vs. 2013), were analysed. Oaxaca decomposition models were constructed for the outcomes (number of teeth, number of healthy surfaces and number of filled surfaces). Results: The number of teeth increased between examinations [DMS: +2.26 (adults), +4.92 (seniors), SHIP: +1.67, Jönköping: +0.96]. Improvements in education and dental awareness brought a positive change in all outcomes. An increase in powered toothbrushing and interdental cleaning showed a great impact in DMS (adults: +0.25 tooth, +0.78 healthy surface, +0.38 filled surface; seniors: +1.19 teeth, 5.79 healthy surfaces, +0.48 filled surface). Interdental cleaning decreased by 4% between SHIP-START-0 and SHIP-TREND-0, which negatively affected the outcomes. Conclusion: From this study, it can be concluded that education may be the most important factor having a direct and indirect effect on the outcomes. However, for better oral health, powered toothbrushing and interdental cleaning should not be neglected.
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This chapter describes the increase of chronic illness, multimorbidity, care dependency, and related polypharmacy as a consequence of ageing. Moreover, a focus has been put on drug-related oral health problems since clear associations have been found between the medication intake and the oral status of older people. Prescribing physicians must be aware of the potential oral complications caused by medications in order to be able to develop an appropriate and tailored treatment plan that also considers oral health-related complications. Approaches to identify potential drug-related problems and to optimize medication use comprise medication reconciliation followed by medication review and criteria to assess quality of prescribing, preferably incorporated in computer-based prescribing systems and as a part of comprehensive geriatric assessment (CGA) and management.
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Objective: The objective was to analyze the role of health literacy (HL) as a factor associated with tooth loss among users of the Brazilian Health System with chronic non-communicable diseases. Methods: The cross-sectional analytical study was conducted with adult and elderly users chosen at ten Family Health Clinics in a draw in the town of Piracicaba, São Paulo State, Brazil. A questionnaire was applied with sociodemographic data (sex, age, skin color and education), behavioral data (brushing and flossing), determinants in health (type of dental health services and how often) and clinical data (pain). Mouth conditions were collected by intraoral examination of visible dental biofilm and community Pediodontal Index. The systemic clinical conditions (blood glucose, glycated hemoglobin and blood pressure) were extracted from the medical records. The explanatory variable was HL (low, medium and high), measured with the Health Literacy Scale (HLS-14). Results: The outcome was tooth loss measured by the index of decayed, missing and filled teeth. Logistic regression was performed using a conceptual model for HL (p < 0.05). For the 238 subjects, the mean age was 62.7 years (± 10.55). Tooth loss was associated with HL in regression models adjusted by type of dental service, dental frequency, and dental floss. In the final model, the factors associated with tooth loss are older age (OR = 1,12; 95%CI: 1,07-1,17), a lower education (OR = 3,43; 95%CI: 1,17-10,10), irregular use of dental floss (OR = 4,58; 95%CI: 1.75 in-7,31), irregular use of dental services (n = 2,60; 95% 1,32-5,12), periodontal pocket (> 4 mm) (n = 0,31; 95%CI: 0,01-0,08), having visible dental biofilm (OR = 7,23; 95%CI: 3,19-16,41) and a higher level of blood sugar (glucose) (n = 1,98; 95%CI: 1.00-3,92). Conclusions: tooth loss was associated with HL when adjusted by health behaviors; when sociodemographic variables and clinical conditions were included, it was less significant. In the final model, behaviors, determinants in health and clinical conditions were risk indicators of tooth loss, showing the multifactorial nature of this phenomenon.
Article
This study aimed to clarify the effects of vertical bone defect width and a ferrule on fracture of the fragments of fractured tooth reattached with adhesive resin cement (reattached tooth). The reattached tooth was built up by a fiber post and composite resin core for abutment and formed to the abutment with or without a ferrule. The vertical bone defect was fabricated with a V-shaped defect in different widths. The fracture load was evaluated using a universal testing machine. The vertical bone defect did not affect the fracture load, but a ferrule increased the root fracture load. For the specimens without a ferrule, debonding between the composite resin core and the root at the coronal loading side and fractures at the apical side of the root were found. In conclusion, the ferrule at abutment could affect fracture load and modes, and the bone defect width did not.
Article
Aging is a universal process in all life forms. The most current and widely accepted definition of human aging is a progressive loss of function and energy production that is accompanied by decreased fertility and increased mortality with advancing age. The most obvious and commonly recognized consequence of aging and energy decline is a decrease in skeletal muscle function, which affects every aspect of human life from the ability to walk and run, to chew, and swallow and digest food. Some crucial factors responsible for aging and longevity include genetics, environment, and nutrition, serious disease disorders such as cancer and cardio-vascular diseases, sarcoma and cell senescence. Oxidative damage caused due to the accumulation of molecular waste-by-products of the body’s metabolic processes, which our bodies are unable to break down or excrete, is chiefly responsible for aging and diseases. Regular physical activity, consumption of foods rich in phytochemicals and anti-oxidants, cessation of smoking, avoiding foods high in saturated and hydrogenated fats are some of the strategies that should be taken into account to delay aging and prolong longevity.
Article
Background Prior reports of positive associations between edentulism and all-cause mortality have been limited by onetime assessments of edentulism and inadequate control of known confounding variables. The authors aimed to assess the association between edentulism and mortality using a longitudinal clinical oral health cohort. Methods The authors used data from the Department of Veterans Affairs Dental Longitudinal Study, an ongoing, closed-panel cohort study from 1968 through 2019 (N = 1,229). Dentition status was evaluated through triennial clinical examinations. Mortality was assessed via the National Death Registry. The authors used Cox regression models to estimate the association between edentulism and all-cause mortality after covariate adjustment. Furthermore, the authors calculated propensity scores and assessed hazard ratios (HRs) in a trimmed, matched, and inverse probability weighted sample. Results Participants who were edentulous (N = 112) had 1.24 (95% CI, 1.00 to 1.55) times the hazard of all-cause mortality compared with those who were nonedentulous, after adjustment with time-varying covariates. Use of propensity scores in the model resulted in slightly elevated HRs compared with the standard Cox model, regardless of propensity score method; adjusted HRs were 1.35 (95% CI, 1.01 to 1.80) after matching, 1.26 (95% CI, 1.00 to 1.59) after trimming, and 1.29 (95% CI, 1.18 to 1.42) after inverse probability weighting. Conclusions Edentulism was associated with an increased risk of all-cause mortality in a cohort that captured incident edentulism. This association was consistent after multiple methods to account for confounding. Practical Implications The findings of this study suggest that edentulism is associated with an increase in risk of mortality, after accounting for salient confounding variables using multiple approaches. Efforts to improve equitable access to tooth-preserving treatments are critical.
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OBJETIVO O objetivo foi analisar o papel da Literacia em Saúde (LS) como fator associado às perdas dentárias entre usuários do Sistema Único de Saúde com doenças crônicas não transmissíveis. MÉTODOS O estudo transversal e analítico foi conduzido com usuários adultos e idosos selecionados em dez Unidades de Saúde da Família sorteadas, em Piracicaba – SP, Brasil. Foi aplicado um questionário com dados sociodemográficos (sexo, idade, cor da pele e escolaridade), comportamentais (escovação e uso de fio dental), determinantes em saúde (tipo e frequência de uso de serviço de saúde médico e odontológico) e clínica (dor). As condições bucais foram coletadas por exame intrabucal do biofilme dental visível e Índice Pediodontal Comunitário. As condições clínicas sistêmicas (glicemia, hemoglobina glicada e pressóricas) foram extraídas dos prontuários. A variável explanatória foi a LS (baixa, média e alta), medida pelo Health Literacy Scale (HLS-14). RESULTADOS O desfecho foi à perda dentária medida pelo Índice de dentes permanentes cariados, perdidos e obturados. Foi realizada regressão logística com uso de um modelo conceitual para a LS (p < 0,05). Para os 238 indivíduos, a média de idade foi 62,7 anos (± 10,55). A perda dentária esteve associada à LS nos modelos de regressão ajustados por tipo de serviço odontológico, frequência odontológica e uso de fio dental. No modelo final, a perda dentária teve como fatores associados a maior idade (OR = 1,12; IC95% 1,07–1,17), menor escolaridade (OR = 3,43; IC95% 1,17–10,10), ao uso irregular de fio dental (OR = 4,58; IC95% 1,75–7,31), uso irregular do serviço odontológico (OR = 2,60; IC95% 1,32–5,12), bolsa periodontal (> 4mm) (OR = 0,31; IC95% 0,01–0,08), ter biofilme dental visível (OR = 7,23; IC95% 3,19–16,41) e maior índice de glicemia (OR = 1,98; IC95% 1,00–3,92). CONCLUSÕES A perda dentária esteve associada à LS quando ajustada por comportamentos em saúde, a partir da inclusão das variáveis sociodemográficas e condições clínicas ela perdeu a significância. No modelo final, comportamentos, determinantes em saúde e condições clínicas foram indicadores de risco da perda dentária, demonstrando a multifatorialidade envolvida neste fenômeno.
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This chapter begins with an introduction to the structural and functional features related to healthy aging. Subsequently, it outlines clinical implications of the age‐related brain mechanisms and discusses the methodological considerations of the research on the aging brain. The chapter provides a brief introduction to the concept of ‘healthy aging’ and its association with general physical and mental conditions. The age‐related differences in the stomatognathic system, including the structural aspects (e.g. tooth loss) and the functional aspects (e.g. pain and mastication), are outlined. The chapter focuses on the sensorimotor aspects regarding feeding behaviour, including teeth and dentition, orofacial muscles and salivary secretion. It reviews more evidence between the brain and oral functions in elderly people, focusing on mastication and swallowing. The chapter discusses the recent findings of the association between neurodegenerative disorders and oral functions.
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The concept of oral health-related quality of life (OHRQoL) delineates how oral outcomes impact on an individual’s physical, psychological, and social functioning and hence overall quality of life. It explains how compromised oral health can negatively impact on quality of life through impairing daily activities, social interactions, and self-esteem. Factors that contribute to OHRQoL are in the areas of: oral health (mostly tooth loss, periodontal disease, and pain), general health (especially chronic conditions and cognitive impairments causing deficient oral health behaviour), personal traits (including the ability to cope and adapt), demographic factors (age, gender, socioeconomic status, ethnicity, culture), social (support, integration), and environmental factors (lifestyle, place of residence). In order to assess OHRQoL outcomes, a number of specific instruments, mostly questionnaires, have been developed.
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Periodontitis is a chronic inflammatory condition characterized by destruction of nonmineralized and mineralized connective tissues. This study evaluated the role of Trem1 (triggering receptors expressed on myeloid cells 1) in periodontitis by influencing polarization of M1 macrophages through the STAT3/HIF-1α signaling pathway. Trem1 was significantly upregulated in the gingival tissues of patients with periodontitis, as identified by high-throughput RNA sequencing, and positively correlated with levels of M1 macrophage-associated genes. The results of flow cytometry, Western blotting, and reverse transcription quantitative polymerase chain reaction showed that knockdown of Trem1 in RAW 264.7 cells decreased polarization of M1 macrophages and increased polarization of M2 macrophages, while overexpression of Trem1 exerted an opposite effect. Furthermore, a mouse model of Trem1 knockout periodontitis exhibited limited infiltration of macrophages and decreased expression levels of M1 macrophage-associated genes in periodontitis lesions and bone marrow-derived macrophages. Importantly, we found that Trem1 could regulate polarization of M1 macrophages through STAT3/HIF-1α signaling as evidenced by RNA sequencing. Moreover, inhibition of Trem1 and HIF-1α could suppress the expression level of proinflammatory cytokine (interleukin 1β) and upregulate the expression level of anti-inflammatory cytokine (interleukin 10) in periodontitis. Collectively, we identified that the Trem1/STAT3/HIF-1α axis could regulate polarization of M1 macrophages and is a potential candidate in the treatment of periodontitis.
Article
Introduction Older adults are more susceptible to a common respiratory infection: pneumonia. Nearly 1 million older adults per year are hospitalized for community-acquired pneumonia in the United States. Objective To examine whether wearing removable dentures are associated with an increased risk of pneumonia incidence in a geriatric population. Methods We conducted a retrospective cohort study among patients >65 y of age within a large academic health system (University of Rochester Medical Center). The medical and dental electronic records from 2010 to 2018 were reviewed and used for data collection. The exposure was removable denture wearing. The main outcome variables were the incidence of pneumonia and time to event of pneumonia. A Cox proportional hazards regression was used to examine the association between pneumonia onset and wearing removable dentures, adjusting for demographics, socioeconomic status, and medical and dental conditions. Results A total of 2,364 patients were included, with 1,189 (50.29%) in the denture-wearing group and 1,175 (49.70%) in the non–denture wearing group. The annual pneumonia incidence rate per 100,000 persons was 1,191 in the denture-wearing group and 128 per 100,000 persons in the non–denture wearing group, with a crude incidence rate ratio of 9.33 (95% CI, 5.41 to 18.81; P < 0.0001). The mean ± SD age of the pneumonia onset was 78.0 ± 10.0 and 78.6 ± 9.0 y among denture-wearing and nonwearing groups (P = 0.84). The time to event of pneumonia was associated with removable denture wearing (yes/no; hazard ratio, 7.68 [95% CI, 3.91 to 15.08]; P < 0.001) after adjusting for covariates. Conclusions Wearing removable dentures was found to be a risk predictor for pneumonia incidence among the geriatric population even after accounting for other risk factors. Knowledge Transfer Statement Wearing removable dentures was found to be a risk predictor of pneumonia incidence among older adults. Although the current study does not imply a causal relationship between denture wearing and pneumonia, clinicians and older patients could reference the study results when choosing dental prostheses to restore missing teeth.
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Eating alone is reported to deteriorate health; however, the relationship between eating alone and poor dental health remains unclear. This cross-sectional study aimed to investigate the association between poor dental health and eating alone. Data of participants (n = 156,287) aged ≥65 years from the Japan Gerontological Evaluation Study were evaluated using logistic regression to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the association between dental status, including prosthesis use, and eating status. Differences in these associations according to living status were also examined. The mean age of participants was 73.7 (SD = 6.0) years. The percentages of participants eating alone with 20 or more teeth, 10–19 teeth with dental prostheses, 0–9 teeth with dental prostheses, 10–19 teeth without dental prostheses, and 0–9 teeth without dental prostheses were 13.8%, 16.0%, 18.6%, 18.9%, and 27.0%, respectively. After adjusting for covariates, participants with 0–9 teeth without any dental prosthesis showed a significantly higher odds ratio for eating alone (OR = 1.81, 95% CI = 1.58–2.07) than those with 20 or more teeth. Among participants with poorer dental status, the probability of eating alone was higher in those living alone than in those living with others. Among older adults, poor dental status was significantly associated with eating alone, and this association was stronger among those living alone. Maintaining better dental status by using a dental prosthesis might reduce the risk of eating alone, especially for those living alone.
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s Periodontitis is the sixth most prevalent diseases around the globe, which is closely related to many systemic diseases and affects general health. As the leading cause of tooth loss, periodontitis is characterized by irreversible alveolar bone loss and activated osteoclastogenic process, which might be closely related to the activated intracellular reactive oxygen species (ROS) in osteoclasts. Here, we demonstrated triggering receptor expressed on myeloid cells 2 (Trem2) as a key regulator of osteoclastogenesis with the regulation of intracellular ROS signals in periodontitis. In the present study, the expression of Trem2 was significantly upregulated in human alveolar bones diagnosed with chronic periodontitis, as assessed by RNA-seq. In the mice model of periodontitis, the alveolar bone resorption was impeded in the presence of the conditional knockout of Trem2 in osteoclasts. Furthermore, we identified Trem2/DAP12/Syk-dependent cascade as a vital intracellular signaling for the amplification of reactive oxygen species (ROS) signals in osteoclastogenesis, while the accumulation of soluble Aβ42 oligomers (Aβo) in periodontitis microenvironment further strengthened the signals and enhanced osteoclastogenesis through direct interactions with Trem2. Collectively, Trem2 mediated ROS signal amplification cascade was crucial in the process of osteoclastogenesis in periodontitis, suggesting the potential of Trem2 as a target for the prevention and treatment of bone destruction in periodontitis.
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Oral impairments can affect overall health and life expectancy in older adults. Our study evaluates the life expectancy with negative physical oral health impact on quality of life (POHIQoL) among older adults. Life expectancy with negative POHIQoL was estimated by the Sullivan method, using the prevalence of POHIQoL - obtained in the Health, Well-being and Ageing (SABE Study); and official mortality data for adults aged 60 years or older living in São Paulo, Brazil. Between 2000 and 2010, negative POHIQoL increased from 23.4% (95%CI: 20.2-26.9) to 30.4% (95%CI: 27.0-34.3) among older adults; total life expectancy increased from 22 and 17.5 to 23.7 and 19.4 years among 60-year-old women and men, respectively; and the proportion of remaining years to be lived with negative POHIQoL increased from 25.1% to 32.1% for the same age group. In both years, individuals aged 60 years with lower education level were expected to live more years with negative POHIQoL when compared with the most schooled ones (2000: 15.9 [95%CI: 15.0-16.8] vs. 14.3 [95%CI: 13.7-14.8]; 2010: 16.3 [95%CI: 15.1-17.4] vs. 14.1 [95%CI: 13.2-15.1]). Similarly, women were expected to live more years with negative POHIQoL than men. Within ten years, life expectancy with negative POHIQoL increased, as well as the existence of inequalities in sex and education level among Brazilian older adults. Expansion in coverage and focus on equity in dental care are still necessary to overcome persistent dental-related problems and inequalities and, therefore, contribute to healthy ageing.
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We assessed the association between edentulism and all–cause mortality among community–dwelling older adults from São Paulo, Brazil, from 2006 to 2017. This prospective cohort study used data from the Health, Well–being and Aging Study (SABE, Portuguese acronym). Edentulism was evaluated by means of clinical oral examination and all–cause mortality data were obtained from state official records. Covariates included socioeconomic factors (age, sex, and schooling); health behavior (smoking, alcohol intake, and physical activity); dental care (prostheses use); general health (multimorbidity); and nutritional status (underweight). Kaplan–Meier survival curves were stratified by edentulism and compared using the log–rank test. Cox proportional hazards model was applied to calculate hazard ratios (HRs) for the association between edentulism and mortality after adjusting for covariates. The study sample included 1,687 participants (age, 60–102 years; edentulous: 47.2%). In the 11 years of follow–up, we analyzed 10,494 person–years and 566 deaths. In bivariate analysis, edentulous older adults were found to be at a higher risk of dying from all causes than the dentate participants (HR: 1.81; 95%CI: 1.53–2.15). After sequential adjustment for socioeconomic factors, health behavior, dental care, general health, and nutritional status, this association was attenuated, but remained significant (HR: 1.34; 95%CI: 1.10–1.63). In conclusion, edentulism is a significant predictor of all–cause mortality among older adults.
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The perception of sensory and internal texture qualities of food, released during chewing and swallowing contribute to food choices and variety of diet. The older adults are vulnerable in food intake quality due to reduced hedonic perception, lower food appeal and appetite that limit food choices. Teeth are vital for chewing and oral health, but also for maintaining general health. A significant number of elders suffer from tooth loss and edentulism. The result is impaired chewing ability leading to food choice restriction and reduced intake of essential macronutrients and micronutrients, increasing the risk for malnutrition and health burden. The number, distribution and functional occluding tooth units of remaining teeth are of essential clinical significance regarding chewing performance and efficiency. Oral indicators for assessing chewing difficulties are critical for dietary interventions and dietary advice for increasing food awareness, variety in texture, cooking methods and food preparation especially to those with compromised dentitions, tooth loss and denture wearing. By applying meaningful interventions, such as providing regular oral screenings, individualised dietary and oral hygiene advise, skills are developing for health professionals with regard to oral health and its links to nutritional evaluation. Establishing practical guidelines and identifying roles in promoting oral health in an interdisciplinary environment contribute to the maintenance of older persons’ oral health in terms of chewing ability and secure balanced diet, optimal nutritional status, systemic health and overall well-being.
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Tooth loss is the final consequence of poor oral health behaviors and oral diseases throughout the life-course. Tooth loss substantially deteriorates quality of life and general health. The burden of tooth loss is greatest in oral conditions, causing a loss of 7.6 million disability-adjusted life years throughout the world. Among 310 diseases and injuries, edentulism and severe tooth loss were the 28th most prevalent condition in 2015. The age-standardized prevalence rate of total tooth loss was 4.1%, affecting 276 million people worldwide. Tooth loss is relatively easy to measure. In addition to clinical dental examination, self-reported questionnaires for tooth loss are widely used, even in non-dental-oriented surveys. There are various proximal, intermediate, and distal factors influencing tooth loss. Caries and periodontal disease are major proximal causes for tooth loss. Health behaviors and health conditions such as diabetes are known to be intermediate risk factors for tooth loss. Socioeconomic status and social environmental factors such as fluoridated water supply, accessibility of dental care, and social capital affect tooth loss as distal factors. Prevention of oral diseases, changes in oral health behaviors, and improvement of the social environment may reduce the risk of tooth loss.
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Background: Both osteoporosis (OP) and periodontitis are chronic inflammatory diseases associated with bone loss mediated by local and systemic factors. The two diseases share common risk factors. Previous studies have suggested that OP in itself is a predisposing factor for periodontal tissue destruction in postmenopausal women. However, only a moderate correlation has been shown between the two conditions. In this study, we compared the severity of periodontal disease in postmenopausal osteoporotic women and postmenopausal women without OP. Materials and methods: The study group consisted of 100 postmenopausal women in the age group of 50-65 years: Group 1 (50 osteoporotic) and Group 2 (50 non-osteoporotic women). Periodontal parameters included sulcus bleeding index, oral hygiene index simplified, probing pocket depth (PPD), and clinical attachment loss (CAL), interproximal alveolar bone loss (ABL), and number of missing teeth. The correlation of periodontal disease status with systemic bone mineral density (BMD) was evaluated by dual-energy X-ray absorptiometry. Results: The results indicated that osteoporotic (Group 1) women had a significantly greater PPD, CAL, and ABL when compared with the non-osteoporotic Group 2 (P < 0.0001). There was no significant correlation between BMD and various parameters between the groups. Conclusions: Within the limitations of the present study it was noted that postmenopausal OP is associated with an increased incidence and severity of periodontal disease. Educating postmenopausal osteoporotic women regarding the importance of good oral care should be part of their management regime. Hence, it could be inferred a possibility of a probable relationship between OP and periodontal disease, but long-term prospective studies are warranted in the future in order to provide definitive evidence.
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Osteoporosis is a systemic bone disorder characterized by decreased bone mass and increased risk for fracture. It has been proposed as a possible risk factor for periodontal disease progression. Recent literature has shown periodontitis to be a risk indicator for osteoporosis, suggesting a possible two way relationship. However the association between these two diseases still remains unclear leading to a scope of further research in this area. The aim of the present study was to assess and Correlate the severity of osteoporosis and periodontitis by using variables like probing pocket depth, clinical attachment loss, plaque index, body mass index and bone mineral density. A total of 65 subjects aged between 45-75 years suffering from periodontitis were considered. All subjects were assessed for periodontal disease severity by plaque index (PI), probing pocket depth (PPD) and clinical attachment loss (CAL). The bone mineral density (BMD) of patients was assessed using dual energy X- ray absorptiometry (DXA) at lumbar spine (L1 - L4). The severity of periodontal disease was correlated with severity of osteoporosis. Descriptive statistics like frequency and percentage were calculated for all the variables. Chi-square test was performed to assess the association between the study variables. Among the entire group 78.46% had high plaque index score, and the severity of periodontitis increased with increase in plaque index score showing a statistical significance. Osteopenia was observed in 25.33% of the subjects, out of whom 63.15% suffered from severe periodontitis. Osteoporosis was observed in 17.33% of the subjects, and all the subjects (100%) suffered from severe periodontitis. The results of the present study suggest that increasing severity of periodontitis increased the risk of osteoporosis and vice versa. We conclude that there is a definite association between periodontitis and osteoporosis.
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Periodontitis, the main cause of tooth loss in the middle-aged and elderly, associates with the risk of atherosclerotic vascular disease. The objective was to study the capability of the number of missing teeth in predicting incident cardiovascular diseases (CVDs), diabetes, and all-cause death. The National FINRISK 1997 Study is a Finnish population-based survey of 8,446 subjects with 13 y of follow-up. Dental status was recorded at baseline in a clinical examination by a trained nurse, and information on incident CVD events, diabetes, and death was obtained via national registers. The registered CVD events included coronary heart disease events, acute myocardial infarction, and stroke. In Cox regression analyses, having ≥5 teeth missing was associated with 60% to 140% increased hazard for incident coronary heart disease events (P < 0.020) and acute myocardial infarction (P < 0.010). Incident CVD (P < 0.043), diabetes (P < 0.040), and death of any cause (P < 0.019) were associated with ≥9 missing teeth. No association with stroke was observed. Adding information on missing teeth to established risk factors improved risk discrimination of death (P = 0.0128) and provided a statistically significant net reclassification improvement for all studied end points. Even a few missing teeth may indicate an increased risk of CVD, diabetes, or all-cause mortality. When individual risk factors for chronic diseases are assessed, the number of missing teeth could be a useful additional indicator for general medical practitioners. © International & American Associations for Dental Research 2015.
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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 having 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 help to identify areas for further exploration and targets for intervention.
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Objective: Different studies have reported contradictory results about the effect of osteoporosis on periodontal status. We performed this study to evaluate the periodontal status of menopausal women by methods with enough accuracy and confidence. Materials and Methods: This study was performed based on the evaluation of bone mineral density using dual energy X-ray absorptiometry in 2010. A total of 60 patients who met the inclusion criteria were selected and divided into three groups of osteoporosis, osteopenia, and normal. Then, evaluation of periodontal markers such as pocket depth (DP), attachment loss (AL), and tooth loss (TL) was performed by a dental student. A panoramic radiography was performed for those who were suspicious of periodontal disease and bone decline. Finally, evaluation of the periodontal indexes was compared among the three groups using ANOVA with 95% confidence interval. Results: Mean bone decline was higher in the osteoporosis group compared to the other two groups, but the difference was not significant (P=0.065). In addition, mean of plaque index (P=0.123), pocket depth (P=0.856), attachment loss (p=0.525), and tooth loss (p=0.884), the number of people with attachment loss ≥ 2millimeter (P=0.866) and the number of people with alveolar bone loss ≥ 2 millimeter (P=0.348) were not significantly different between the three groups. Conclusion: In this study, no significant difference was observed between the three groups in terms of plaque index, pocket depth, attachment loss, or tooth loss. However, further studies are required that could control all the possible confounding variables.
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Objectives: Few studies have investigated the effect of long-term routine dental attendance on oral health between middle-aged and older adults, using a prospective cohort design. This study aimed to assess routine dental attendance (attending dentist in the previous 12 months for dental checkups) from age 50 to 65 years. Moreover, this study examined whether long-term routine dental attendance contributes to oral health-related quality of life, OHRQoL, and major tooth loss independent of social factors and the type of treatment sector utilized. Whether oral health impacts of long-term routine attendance varied with type of treatment sector utilized was also investigated. Method: In 1992, a census of the 1942 cohort in two counties of Sweden participated in a longitudinal questionnaire survey conducted at age 50 and again after 5, 10, and 15 years. Information was collected on a wide range of health- and oral health-related aspects. Of the 6346 subjects who completed the 1992 survey, 4143 (65%) completed postal follow-ups in 1997, 2002, and 2007. Results: Routine dental attendance decreased from 69.1% at age 50-64.2% at age 65. Adjusted logistic regression analyses revealed that individuals reporting long-term routine attendance (routine attendance in both 1992 and 2007) were 0.3 (95% CI 0.2-0.5) times less likely than their counterparts who were nonroutine attenders to report oral impacts. According to generalized estimating equations (GEE), individuals who reported long-term routine attendance were 0.6 (95% CI 0.4-0.7) times less likely than nonroutine attenders to have major tooth loss across the survey years. The effect of long-term routine attendance on OHRQoL was stronger in public than in private dental healthcare attenders. Conclusion: Routine attendance decreased from age 50-65 years. Long-term routine attendance had positive impact on major tooth loss and OHRQoL supporting the principle of encouraging annual dental attendance for preventive checkups among older people.
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To investigate the correlation between postmenopausal osteoporosis (PMO) and the pathogenesis of periodontitis, ovariectomized rats were generated and the experimental periodontitis was induced using a silk ligature. The inflammatory factors and bone metabolic markers were measured in the serum and periodontal tissues of ovariectomized rats using an automatic chemistry analyzer, enzyme-linked immunosorbent assays, and immunohistochemistry. The bone mineral density of whole body, pelvis, and spine was analyzed using dual-energy X-ray absorptiometry and image analysis. All data were analyzed using SPSS 13.0 statistical software. It was found that ovariectomy could upregulate the expression of interleukin- (IL-)6, the receptor activator of nuclear factor- κ B ligand (RANKL), and osteoprotegerin (OPG) and downregulate IL-10 expression in periodontal tissues, which resulted in progressive alveolar bone loss in experimental periodontitis. This study indicates that changes of cytokines and bone turnover markers in the periodontal tissues of ovariectomized rats contribute to the damage of periodontal tissues.
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The main conditions of interest when considering the epidemiology of oral diseases among older people are tooth loss, dental caries, periodontitis, dry mouth and oral pre-cancer/cancer, along with oral-health-related quality of life (OHRQoL). This article presents an overview of what is known about the epidemiology of each of the main conditions of interest among older populations.
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Background: There is evidence to suggest osteoporosis may result in premature tooth loss. The pathology behind this relationship is poorly understood. A correlation with osteoporosis and greater susceptibility to periodontal disease has been suggested. Objectives: To investigate the association between osteoporosis and periodontal disease, accounting for the effect of confounding variables of age, smoking status and oral hygiene.Setting Three hundred and fifty-nine postmenopausal women aged 45-70 years were recruited from the Greater Manchester area between March 2008 and June 2010.Subjects and methods Data were collected on osteoporosis status, smoking status, pocket probing depths, suppuration, plaque, bleeding and calculus indices. Dental panoramic tomographs were taken and periodontal bone support assessed on all teeth. Data were analysed using SPSS software (version 20). Results: Complete data were available for 348 patients. Twenty-six percent (91) of individuals were osteoporotic. Logistic regression was used. The relationship between osteoporosis status and moderate to severe periodontal disease of both molar teeth and the whole mouth was not significant (p = 0.088 and p = 0.296 respectively). Conclusions: Osteoporosis is not a causal factor in the development of moderate to severe chronic periodontitis.
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In COPD patients, fatal and non-fatal respiratory-related events are influenced by age, severity of respiratory disease, and comorbidities. Analyze the effects of edentulism, periodontal disease and systemic biomarkers of inflammation on the occurrence of serious fatal and non-fatal respiratory-related events among subjects with COPD. Cases were identified from Dental Atherosclerosis Risk in Communities study. Edentulism was defined as study participants without any natural teeth or implants. Participants with one or more natural teeth (comprising 11,378 subjects) were studied as dentate subjects. Periodontal disease status among dentate individuals was determined using the consensus definitions published by the joint Center for Disease Control/American Association of Periodontology working group). Adjusted Hazard Models are developed to evaluate the relationship between edentulism/periodontal disease and COPD Related Events. Models were then stratified by GOLD Stage I, II and III/IV. Serum biomarkers were also evaluated to explore the effect of systemic inflammation. A statistically significant association was found between oral health status and COPD-related events, even adjusting for conditions such as hypertension, smoking and diabetes. Edentulous individuals who had been diagnosed with COPD had a higher incidence and were at greater risk of having a COPD related event (hospitalization and death) than individuals who had teeth and whose mouths had healthy periodontal status. However, being edentulous did not convey excess risk for COPD-related events for those study participants who were classified as GOLD III/IV at baseline. Finally, we showed that individuals who had levels of serum IL-6 in the highest two quartiles were at even higher risk for COPD-related events. These findings suggest that the risk for COPD-related events after adjusting for potential confounders may be attributable to both edentulism and elevated serum IL-6 levels.
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Objectives: There are limited data on the epidemiology of pelvic fractures. The purpose of this study was to calculate incidence rates of pelvic fractures leading to hospital admission and to compare incidence rates between residents of nursing homes and community-dwelling persons with and without care need. Methods: Data were retrieved from a database of the largest health insurance company in Bavaria, Germany. Between 2004 and 2009, 10,170 pelvic fractures were observed in 751,101 women and 491,098 men. Age- and gender-specific incidence rates were calculated. Incidence rates were further stratified by setting (nursing home versus community) and functional status (no care need versus care need for those in the community). In addition, the average cumulative risk for a pelvic fracture at different ages was calculated. Results: The incidence rate increased from 0.54 and 0.38 per 1000 person-years in women and men aged 65 to 69 years to 9.35 and 4.45 per 1000 person-years in women and men aged 90 years and older, respectively. Persons living in a nursing home or living at home with care need had considerably higher incidence rates than community-dwelling older persons without care need. The average cumulative risk at the age of 65 years for an incident pelvic fracture until the age of 90 years was 6.9% in women and 2.8% in men. Conclusion: The incidence of pelvic fractures leading to hospital admission is higher in women than in men and rises dramatically with increasing age. Persons with care need have a particularly high risk for pelvic fracture.
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Background: Previous studies have shown conflicting results as to whether low bone mineral density (BMD) is associated with severe clinical attachment loss (AL). The effect of dental restoration on AL was not considered in most studies. In addition, studies of this association in Japanese individuals are limited. The aim of this cross-sectional study is to evaluate the possible association between BMD and AL with dental restoration information in Japanese community-dwelling postmenopausal females. Methods: The participants were 397 females (average age: 68.2 years). BMDs of the lumbar spine and right proximal femur were measured by the dual-energy x-ray absorptiometry method. Based on lower BMD/young adult mean (YAM) among the two sites measured, participants were classified into three groups: 1) normal: BMD = 80% YAM or higher (n = 161); 2) osteopenia: BMD = 70% to 80% YAM (n = 136); and 3) osteoporosis: BMD = <70% YAM (n = 100). Multivariable analyses of the differences in AL values among three BMD groups was conducted using general linear models. Adjustments for the percentage of teeth restored and other covariates were considered. Results: Individuals with osteopenia had significantly higher average AL than individuals with normal BMD (P = 0.022). Additionally, the osteoporosis group displayed significantly higher average AL (P = 0.003) and higher percentages of sites with AL ≥ 4 mm (P = 0.007). Conclusion: The results of the present study indicate that low systemic BMD was associated with severe AL in Japanese community-dwelling postmenopausal females.
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Background: Osteopenia and osteoporosis are conditions characterised by a reduction in bone mineral density. There is contradictory evidence whether osteoporotic patients have greater tooth loss than non-osteoporotic patients. Objective: To investigate the association between tooth number and osteoporotic status, taking into account the effect of other confounding variables such as age, smoking status, alcohol consumption and the use of hormone replacement therapy. Setting: Three hundred and fifty-nine patients were recruited from the Manchester region between March 2008 and June 2010. Subjects and methods: Data were collected on osteoporotic status, smoking status, alcohol consumption, age and the use of hormone replacement therapy. Dental panoramic tomographs were taken for each patient and the teeth present were charted and counted. Data were analysed using SPSS software (version 19). Results: Complete data was available for 333 patients. Twenty-seven percent of individuals (90) were classified as osteoporotic. There was a significant relationship between molar tooth number and osteoporotic status (p = 0.017, 95% CI -1.339 to -0.137). Conclusion: Clinicians should inform osteoporotic patients they may be at greater risk of tooth loss and instigate more intensive preventive regimens for these individuals.
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To investigate the relationship between periodontal disease and cognitive decline. Analysis of a prospective cohort study. The Health, Aging and Body Composition (Health ABC) Study. One thousand fifty-three participants who were administered the Modified Mini-Mental State Examination (3MS) at Year 1 (baseline) and Year 3 and had participated in a comprehensive periodontal examination at Year 2. The prospective association between a range of oral health parameters and cognitive function was examined. Decline in 3MS score from Year 3 to 5 was investigated in 947 (89.9%) participants. Covariates included age, sex, education, race, cardiovascular disease and risk, and depressive symptoms. Most indicators of adverse oral health at Year 2 were associated with cognitive impairment based on averaged 3MS scores less than 80 for Years 1 and 3, but education and race substantially confounded these associations. Higher gingival index, a measure of gingival inflammation, at Year 2 remained independently associated with this definition of cognitive impairment and, in fully adjusted analyses, was also an independent predictor of a more-than-5-point cognitive decline from Year 3 to 5. Periodontitis may be a risk factor for cognitive decline. Gingivitis is reversible, and periodontitis to some degree is preventable and controllable when manifest. Therefore, further research is needed to clarify potential underlying mechanisms and oral health interventions that might ameliorate cognitive decline.
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doi: 10.1111/j.1741-2358.2011.00502.x Tooth loss and dental caries in community-dwelling older adults in northern Manhattan Objective: To examine tooth loss and dental caries by sociodemographic characteristics from community-based oral health examinations conducted by dentists in northern Manhattan. Background: The ElderSmile programme of the Columbia University College of Dental Medicine serves older adults with varying functional capacities across settings. This report is focused on relatively mobile, socially engaged participants who live in the impoverished communities of Harlem and Washington Heights/Inwood in northern Manhattan, New York City. Materials and Methods: Self-reported sociodemographic characteristics and health and health care information were provided by community-dwelling ElderSmile participants aged 65 years and older who took part in community-based oral health education and completed a screening questionnaire. Oral health examinations were conducted by trained dentists in partnering prevention centres among ElderSmile participants who agreed to be clinically screened (90.8%). Results: The dental caries experience of ElderSmile participants varied significantly by sociodemographic predictors and smoking history. After adjustment in a multivariable logistic regression model, older age, non-Hispanic Black and Hispanic race/ethnicity, and a history of current or former smoking were important predictors of edentulism. Conclusion: Provision of oral health screenings in community-based settings may result in opportunities to intervene before oral disease is severe, leading to improved oral health for older adults.
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The aim of this study was to obtain a deeper understanding of the social factors driving New Zealand's historic 'epidemic of edentulism' and how they operated. In-depth, semi-structured interviews with 31 older New Zealanders were analysed using applied grounded theory. Universal factors present in the data were: (a) the way in which New Zealand society accepted and indeed encouraged edentulism without stigma for those who had a 'sub-optimal' natural dentition; (b) how the predominant patterns of dental care utilisation (symptomatic and extraction-based) were often strongly influenced by economic and social disadvantage; and (c) the way in which lay and professional worldviews relating to 'calcium theory' and dental caries were fundamental in decisions relating to the transition to edentulism. Major influences were rural isolation, the importance of professional authority and how patient-initiated transitions to edentulism were ultimately facilitated by an accommodating profession. The combined effects of geography, economics, the dental care system and the professional culture of the day, in the context of contemporary (flawed) understandings of oral disease, appear to have been the key drivers. These were supported (in turn) by a widespread acceptance by the profession and society alike of the extraction/denture philosophy in dealing with oral disease.
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To determine the cross-sectional association of the osteoporotic status of patients with the number of their teeth, with and without taking into account age and/or smoking. At four centres, the study recruited 665 females aged 45-70 years and the number of teeth was counted for 651 subjects. Bone density was measured at the total hip, femoral neck and lumbar spine. The mean number of teeth in the osteoporotic subjects was 3.3 fewer than normal subjects and 2.1 fewer if those with no teeth were excluded. The association between osteoporosis and having <6 or having <28 teeth remained significant after adjusting for age, smoking and centre with p-values of 0.016 and 0.011, respectively. A single regression model for tooth count with normal errors would not fit all the data. By fitting mixture regression models to subjects with tooth count >0, three clusters were identified corresponding to different degrees of tooth loss. The overall effect of osteoporosis was as follows: -1.8 teeth before and after adjusting for smoking, -1.2 teeth after adjusting for age, and -1.1 teeth after adjusting for both age and smoking. We have established a significant association between osteoporosis and tooth loss after adjusting the effect for age and smoking.
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Findings from several studies suggested an association between oral health and several health outcomes including cardiovascular disease, aspiration pneumonia, malnutrition, poor quality of life, and mortality. Using data from the Baltimore Longitudinal Study of Aging (BLSA), we tested the hypothesis that number of teeth is indicative of mortality risk independent of other confounders. Dentists conducted a standardized oral examination that included tooth count, tooth with coronal and cervical caries count, and gingival and periodontal index. Blood tests used in the analysis included fasting glucose, oral glucose tolerance test, serum low-density lipoprotein (LDL), high-density lipoprotein (HDL) cholesterol, triglycerides, and white blood cell counts. Physical activity, skin fold thickness, body mass index and chronic diseases were also evaluated. Of the 500 BLSA participants evaluated, 198 died an average of 130 (+/-75) months postdental evaluation, and 302 survivors were followed for a mean of 185 (+/-90) months. Based on multivariate Cox regression models, being edentulous or having than 20 teeth was independently associated with mortality. The results of this study support the notion that number of teeth is a significant and independent risk indicator for early mortality. These findings suggest that the improvement of oral health may have a positive impact on general health and may delay mortality.
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It has been reported that postmenopausal women with osteoporosis have a higher than expected number of dentures and fewer teeth than women without osteoporosis. The relationship between self-reported tooth loss and bone mineral density (BMD) at the hip and spine in 608 men and 874 women, aged 65-76 years, was examined in a cross-sectional study. BMD was measured using dual X-ray absorptiometry. Twenty-four per cent of men and 27% of women had no natural teeth. There was a consistent decrease in BMD with increasing numbers of teeth lost in men. This relationship was independent of age, body mass index and smoking habit (trochanter r = -0.14, p < 0.0005; Ward's triangle r = -0.1, p < 0.005; and lumbar spine r = -0.07, p < 0.05) with between 5% and 9% difference in mean BMD at various sites between men who had all their teeth and men who had no teeth. There was no significant association between self-reported tooth loss and BMD in women. Tooth loss is associated with lower BMD in men; this relationship is less consistent in women.
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Oral diseases, such as caries and periodontitis, not only have local effects on the dentition and on tooth-supporting tissues but also may impact a number of systemic conditions. Emerging evidence suggests that poor oral health influences the initiation and/or progression of diseases such as atherosclerosis (with sequelae including myocardial infarction and stoke), diabetes mellitus and neurodegenerative diseases (such as Alzheimer's disease, rheumatoid arthritis and others). Aspiration of oropharyngeal (including periodontal) bacteria causes pneumonia, especially in hospitalized patients and the elderly, and may influence the course of chronic obstructive pulmonary disease. This article addresses several pertinent aspects related to the medical implications of periodontal disease in the elderly. There is moderate evidence that improved oral hygiene may help prevent aspiration pneumonia in high-risk patients. For other medical conditions, because of the absence of well-designed randomized clinical trials in elderly patients, no specific guidance can be provided regarding oral hygiene or periodontal interventions that enhance the medical management of older adults.
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Background: Periodontitis and osteoporosis are two diseases found worldwide having the main characteristic of increasing intensity with age. Periodontitis is associated with resorption of the alveolar bone. Osteoporosis is characterized by bone loss leading to structural bone transformation. The association between periodontitis and osteoporosis is continually being examined. The aim of this study is to examine the condition of periodontal tissues in patients suffering from osteoporosis and establish a possible link. Materials and methods: Cross-sectional study with 200 samples having test (n = 100) and control group (n = 100) were checked for periodontal condition. A total of 100 patients diagnosed as having osteoporosis based on bone mineral density at distal end of radius were regarded as test group and 100 subjects included in control group were healthy. Periodontal parameters measured were plaque index (PI), gingival index (GI), probing depth (PD), and clinical attachment loss (CAL). Statistical test performed were Student's paired t-test and unpaired t-test and Pearson's correlation coefficient. Results: Probing depth and CAL were significantly negatively co-related with T-score in test group when compared with control group. This meant an inverse relationship in between the T-score and the clinical parameters, PD and CAL. Furthermore, some difference was noted in test group in PI, GI and PD, CAL and T-score when compared with the controls. Conclusion: Thus, we conclude that there is a definite relationship between osteoporosis and periodontitis based on PD and CAL.
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Progress has been made in reducing dental caries and edentulism in older adults, but disparities continue to exist related to race, ethnicity, socioeconomic level, and sex. Lack of training in treating medically complex patients, economic factors including absence of coverage for oral health services in Medicare and as a required service for adults in Medicaid, and attitudinal issues on the part of patients, caregivers, and providers contribute to barriers to care for older adults. In addition to the impact of oral health on overall health, oral health impacts quality of life and social and employment opportunities.
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Objectives: To determine whether oral health is better in centenarians than in a published birth cohort-matched sample and to compare oral health in centenarian offspring with a case-controlled reference sample. Design: Observational cross-sectional study. Setting: New England Centenarian Study (NECS). Participants: Seventy-three centenarians, 467 offspring, and 251 offspring generation-reference cohort subjects from the NECS. Measurements: A self-report questionnaire was administered to measure oral health in all three groups, with edentulous rate as the primary outcome measure. The NECS made information on sociodemographic characteristics and medical history available. Centenarian results were compared with published birth cohort-matched results. Data from offspring and reference cohorts were analyzed to determine differences in oral health and associations between oral health measures and specific medical conditions. Results: The edentulous rate of centenarians (36.5%) was lower than that of their birth cohort (46%) when they were aged 65 to 74 in 1971 to 1974 (according to National Center of Health Statistics). Adjusting for confounding factors, the reference cohort was more likely to be edentulous (adjusted odds ratio (AOR) = 2.78, 95% confidence interval CI = 1.17-6.56), less likely to have all or more than half of their own teeth (AOR = 0.48, 95% CI = 0.3-0.76), and less likely to report excellent or very good oral health (AOR = 0.65, 95% CI = 0.45-0.94) than the centenarian offspring. Conclusion: Centenarians and their offspring have better oral health than their respective birth cohorts. Oral health may prove to be a helpful marker for systemic health and healthy aging.
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The relationship between mastication and cognitive function remains unclear, but both animal and experimental human studies suggest a possible causal relationship. In the present study it was hypothesized that natural teeth are of importance for hippocampus-based cognitive processes, such as episodic long-term memory. A population-based sample of 273 participants (55-80 yr of age; 145 women) was investigated in a cross-sectional study. The participants underwent health assessment, completed a battery of cognitive tests, and took part in an extensive clinical oral examination. The number of natural teeth contributed uniquely and significantly to explaining variance (3-4%) in performance on measures of episodic memory and semantic memory over and above individual differences in age, years of education, gender, occupation, living conditions, and medical history. The number of natural teeth did not have an influence on the performance of measures of working memory, visuospatial ability, or processing speed. Within the limitations of the current study, a small, but significant, relationship between episodic memory and number of natural teeth is evident.
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If prosthodontic treatment is considered after periodontal therapy, the questions arise i) does prosthodontic treatment affect the treatment outcome of the dentition in general and ii) which type of prosthesis is related to best treatment outcome of abutment teeth? Our goal was to compare long-term tooth loss after comprehensive periodontal therapy in patients with or without prosthodontic treatment. Ninety patients' charts with a total of 1937 teeth who had received comprehensive periodontal treatment 5-17 years ago by the same periodontist were retrospectively evaluated. Sixty-five patients received fixed dental prostheses (FDP; n = 29) and/or removable partial dentures anchored with clips (RPDC; n = 25) or double crowns (RPDD; n = 25). Twenty-five patients were also periodontally compromised but treated without prosthodontic treatment and served as a control group. A total of 317 teeth and 70 abutment teeth were lost during 9·7 ± 4·1 years of observation. Thereof, 273 teeth and 48 abutment teeth were lost due to periodontal reasons. Mean tooth loss amounted to 1·2 ± 1·5 (controls) and 4·4 ± 3·4 (partial dentures). Abutment tooth loss was 0·4 ± 1·1 (FDP), 1·0 ± 1·2 (RPDC) and 1·3 ± 1·0 (RPDD). Poisson regressions identified prosthodontic treatment, age, socio-economic status, diabetes mellitus, mean initial bone loss and aggressive periodontitis as factors significantly contributing to tooth loss. Age, diabetes and non-compliance contributed to abutment tooth loss. Not considering biomechanical factors, patients with prosthodontic reconstructions under long-term supportive periodontal therapy were at higher risk for further tooth loss than patients without prostheses. Not only the type of partial denture but also the patient-related risk factors were associated with abutment tooth loss.
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The definition of osteoporosis has evolved beyond low bone mineral density to include impaired bone morphology and matrix properties. As such, the subsequent bone density insufficiencies extend beyond the skeletal risks of fracture and have implications for oral health management patients. As our population ages there is a worldwide increase in the risk of decreased bone mineral density and its subsequent morbidity. This makes age an independent risk factor for fracture and decreased bone mineral density. Multiple examinations and diagnostic tests are currently used in combination to develop an algorithm to assess osteoporotic risk. Oral health care professionals should follow these principles and caution should be used in applying a single independent assessment to determine a patient's osteoporotic or bone metabolism risk. Therapeutic approaches for osteoporosis are often divided into nonpharmacological interventions and pharmacological therapies. The periodontist and other oral health care professionals should have a full understanding of the therapeutic options, benefits and implementation of preventive therapies. Bone turnover is a coupled event of bone formation and bone resorption and it is the imbalance of this homeostasis that results in osteoporosis. Based on this uncoupling of bone resorption and formation, osteoporosis or decreased bone mineral density and osteopenia, may be a risk factor for alveolar bone loss in periodontitis. The role of prevention and maintenance with a history of periodontitis and oesteopenia extends beyond biofilm control and should include management of bone mineral density. The chronic periodontal infection in a patient with osteopenia may place the patient at greatly increased risk for alveolar bone loss, gingival recession and root caries. A key component in the management is the oral health professional's knowledge of the interrelationship between skeletal health and periodontal health.