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Tooth loss as a predictor of shortened longevity: exploring the hypothesis
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.
... In addition to sociodemographic, genetic, and lifestyle factors [6], tooth loss-the ultimate outcome of oral diseases and a surrogate for overall health status-is essential for healthy aging as well. The retention of natural teeth over a lifetime is a fundamental aspect of overall well-being [7]. Tooth loss can be a potential risk factor for longevity that is independently related to the onset of disability and mortality in old age [7][8][9]. ...
... The retention of natural teeth over a lifetime is a fundamental aspect of overall well-being [7]. Tooth loss can be a potential risk factor for longevity that is independently related to the onset of disability and mortality in old age [7][8][9]. For instance, the 6-year mortality rate of individuals with edentulousness (the lack of teeth) who do not use dentures was significantly higher than that of the individuals with ≥20 teeth [10]. ...
... Previous studies indicated an association between the number of teeth and masticatory function [21], and reduced chewing ability was related to premature death [22]. Individuals with edentulousness may have an unbalanced food selection, consuming inadequate amounts of fruits and vegetables, and their nutritional status may dispose these individuals to more chronic diseases [7,23], as the dietary intake pattern influences the microbial compositions and systemic inflammation [24]. ...
Background
In recent decades, the global life expectancy has risen notably to approximately 73.5 years worldwide, coinciding with a rapid growth in the older adult population, which presents a significant public health challenge in promoting healthy aging and longevity.
Objective
This study aimed to prospectively investigate the link between edentulousness and the likelihood of reaching centenarian status among individuals aged 80 years and older.
Methods
Data from the Chinese Longitudinal Healthy Longevity Survey were analyzed. Logistic regression models were used to assess the relationship between edentulousness and the likelihood of becoming a centenarian. Demographic characteristics, lifestyle habits, and disease histories were adjusted as confounding factors. Several sensitivity analyses, including propensity score matching and 2-year lag analyses, were conducted to further assess the association between edentulousness and the likelihood of becoming a centenarian. The correlation between the number of natural teeth as a continuous variable and the likelihood of becoming a centenarian was evaluated as well.
Results
The study included 4239 participants aged 80-100 years. After adjusting for all covariates, the likelihood for becoming a centenarian increased in the nonedentulous group compared to the edentulous group (odds ratio [OR] 1.384, 95% CI 1.093‐1.751). The relationship persisted after propensity score matching analysis (OR 1.272, 95% CI 1.037‐1.561). The association remained statistically significant after excluding participants with a follow-up duration of less than 2 years (OR 1.522, 95% CI 1.083‐2.140; P =.02). Furthermore, a significant positive association between the number of natural teeth and the likelihood of becoming a centenarian was found after adjusting for all covariates (OR 1.022, 95% CI 1.002‐1.042; P =.03), which aligned with the main results of the study.
Conclusions
The findings revealed that the presence of natural teeth was linked to an increased probability of becoming a centenarian, underscoring the importance of maintaining oral health even in advanced age.
... Additionally, behavioral factors such as smoking and poor oral hygiene exacerbate periodontal disease and contribute to tooth loss [5]. Education, body mass index, and fasting blood glucose levels can also contribute to neglecting oral health, increasing the risk of tooth loss and systemic disease [6]. Notably, tooth loss strongly predicts longevity and life expectancy, with multifactorial systemic interactions involving underlying factors such as osteoporosis and cognitive impairment [6]. ...
... Education, body mass index, and fasting blood glucose levels can also contribute to neglecting oral health, increasing the risk of tooth loss and systemic disease [6]. Notably, tooth loss strongly predicts longevity and life expectancy, with multifactorial systemic interactions involving underlying factors such as osteoporosis and cognitive impairment [6]. Understanding these connections is crucial for developing integrated healthcare approaches that effectively bridge dental and medical disciplines. ...
... The psychosocial dimensions of oral health cannot be overlooked [6]. Mental health issues such as depression and stress are closely associated with bruxism, which can lead to fractured teeth and accelerated tooth loss [6]. ...
Introduction
Tooth loss, often perceived as a localized dental issue, has profound implications for systemic health. It is frequently associated with underlying factors such as periodontal disease, smoking, poor dietary habits, and psychological stress. These factors contribute to tooth loss locally and are linked to various systemic conditions, including diabetes and cardiovascular disease. This study explores the predictive value of tooth loss as a biomarker for systemic health conditions, emphasizing its potential to serve as an early warning indicator for broader health risks and highlighting the interconnected nature of oral and systemic health.
Background
The interconnection between oral and systemic health has received significant attention in recent years. Chronic oral conditions, particularly periodontal disease, contribute to systemic inflammation, a key factor in the development of diseases such as atherosclerosis and diabetes. Tooth loss, often resulting from severe oral pathology, reflects a history of chronic inflammation, poor oral hygiene, and adverse lifestyle choices. Despite its clinical relevance, tooth loss remains underutilized as a marker for systemic health status. This study seeks to address this gap by evaluating the systemic health trajectories of patients with significant tooth loss over a 15-year period.
Materials and methods
This study retrospectively analyzed the chart records of 35 patients who experienced significant tooth loss (321 teeth in total) due to factors such as age, smoking, dietary deficiencies, psychological stress, bruxism, fractures, and periodontal infections. Medical and dental records spanning a 15-year period were reviewed to monitor the progression of systemic health conditions. Statistical analyses, including correlation and logistic regression, were performed to evaluate the relationships between tooth loss and systemic health outcomes. Kaplan-Meier survival analysis assessed the time to disease onset in relation to oral health deterioration. A health score prediction equation was developed.
Results
The findings revealed that tooth loss was strongly associated with systemic conditions such as cardiovascular disease, diabetes, and respiratory disorders. A significant positive correlation was observed between tooth loss and diabetes (r = 0.72, p < 0.01) and cardiovascular disease (r = 0.68, p < 0.01). Logistic regression demonstrated that patients with severe periodontal disease had significantly higher odds of developing cardiovascular disease (OR = 3.5) and diabetes (OR = 2.8). Kaplan-Meier survival curves indicated that patients with extensive tooth loss experienced earlier onset of systemic conditions than those with minimal tooth loss (median time: 7 vs. 12 years, p = 0.03). Smoking, poor diet, and psychological stress emerged as exacerbating factors.
Conclusions
Tooth loss is a significant biomarker for systemic health conditions, reflecting the cumulative effects of chronic oral and systemic inflammation, adverse lifestyle factors, and psychological health. This study highlights the importance of integrating dental and medical care to address the root causes of both oral and systemic diseases. Proactive oral health interventions, with systemic disease prevention strategies, can improve overall health outcomes. Further research involving larger cohorts is recommended to validate the findings and enhance predictive models for clinical application.
... GIC has also been reported to include various malignancies, such as esophageal, gastric, colorectal, hepatic and Pancreatic cancers [7]. According to 2023 Chinese statistics, the incidence rates per 100,000 population were 43.09 for gastric cancer, 42.74 for colorectal cancer, 19.55 for esophageal cancer, and 14.80 for hepatic cancer. The corresponding mortality rates were 29.04 for gastric cancer, 18.40 for colorectal cancer, 18.09 for esophageal cancer, and 13.20 for hepatic cancer, significantly surpassing those of the other malignancies in China [8]. ...
... Furthermore, periodontal preventive interventions have been associated with a significant reduction in GIC incidence, although the underlying mechanisms remain unclear [18]. For these reasons, periodontitis may serve as a key health indicator influencing GIC development [19]. ...
Background
With low early detection rates and high incidence and mortality, Gastrointestinal cancer (GIC) imposes a significant global health burden. Emerging evidence indicates that periodontitis may be a potential risk factor for GIC development; however, epidemiological data remains inconclusive.
Objective
This study aimed to examine the impact of periodontitis on the incidence, recurrence, and metastasis of GIC in Southwest China, thereby offering epidemiological evidence to support GIC prevention and management.
Methods
Between September 2022 and August 2024, a case–control study was conducted at the Affiliated Hospital of North Sichuan Medical College. Five hundred GIC patients were included as the case group based on the predefined inclusion and exclusion criteria, while 1005 healthy individuals were recruited for the control group. Multivariate analyses were performed to examine the associations between periodontitis and GIC incidence, recurrence, and metastasis while controlling for potential confounding factors.
Results
The results of this study demonstrated that periodontitis was significantly associated with the incidence of esophageal, gastric, and colorectal cancer. Even after adjusting for potential confounders, it remained a significant risk factor for esophageal cancer (OR = 2.810, 95% CI 1.032–7.649, P = 0.043), colon cancer (OR = 2.330, 95% CI 1.072–5.067, P = 0.033), and rectal cancer (OR = 2.730, 95% CI 1.247–5.379, P = 0.012). Compared to non-periodontitis subjects, periodontitis showed a significant association with distant metastasis of rectal cancer (aHR = 5.332, 95% CI 1.406–20.220, P = 0.014). Moreover, severe periodontitis was identified as an risk factor for distant metastasis in rectal cancer (aHR = 10.138, 95% CI 1.824–56.354, P = 0.008).
Conclusion
This study highlights significant associations between periodontitis and an increased risk of esophageal and colorectal cancers. Additionally, patients with rectal cancer and periodontitis exhibited an increased risk of distant metastasis compared to those without periodontitis.
... Tooth loss is a global problem that not only impacts the daily lives of patients but is also associated with various systemic diseases [1][2][3]. Clinical evidence suggests that, in addition to the third molar (M3), the second molar (M2) is one of the most frequently removed permanent teeth in adults [4,5]. Similar to other teeth, many factors may affect an M2's life span, such as oral hygiene, occlusal condition, trauma and smoking [6][7][8][9]. ...
... Tooth loss can not only affect the daily quality of life of patients but is also associated with a variety of systemic diseases, including patient longevity [1,2]. Therefore, clarifying the patterns of tooth loss may help dentists protect teeth more efficiently. ...
Third molars (M3s) can increase the pathological risks of neighboring second molars (M2s). However, whether the M3 presence affects M2 loss remains unknown. This retrospective study aimed to reveal the reasons for M2 loss and how M2 loss relates to neighboring M3s. The medical records and radiographic images of patients with removed M2(s) were reviewed to analyze why the teeth were extracted and if those reasons were related to adjacent M3s. Ultimately, 800 patients with 908 removed M2s were included. In the included quadrants, 526 quadrants with M3s were termed the M3 (+) group, and the other 382 quadrants without M3s were termed the M3 (−) group. The average age of patients in the M3 (+) group was 52.4 ± 14.8 years and that of the M3 (−) group was 56.7 ± 14.9 years, and the difference between the two groups was statistically significant (p < 0.001). Of the 908 M2s, 433 (47.7%) were removed due to caries and sequelae and 300 (33.0%) were removed due to periodontal diseases. Meanwhile, 14.4% of the M2s with adjacent M3s were removed due to distal caries and periodontitis, which were closely related to the neighboring M3s; this percentage was much lower when M3 were absent (1.8%). Additionally, 42.2% of M3s were removed simultaneously with neighboring M2s. The presence of M3s, regardless of impaction status, was associated with an earlier loss of their neighboring M2s.
... 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. ...
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.
... Furthermore, periodontal preventive interventions have been associated with a signi cant reduction in GIC incidence, although the underlying mechanisms remain unclear [18]. For these reasons, periodontitis may serve as a key health indicator in uencing GIC development [19]. ...
Background With low early detection rates and high incidence and mortality, Gastrointestinal cancer (GIC) imposes a significant global health burden. Emerging evidence indicates that periodontitis may be a potential risk factor for GIC development; however, epidemiological data remains inconclusive. Objective This study aimed to examine the impact of periodontitis on the incidence, recurrence, and metastasis of GIC in Southwest China, thereby offering epidemiological evidence to support GIC prevention and management. Methods Between September 2022 and August 2024, a case-control study was conducted at the Affiliated Hospital of North Sichuan Medical College. Five hundred GIC patients were included as the case group based on the predefined inclusion and exclusion criteria, while 1,005 healthy individuals were recruited for the control group. Multivariate analyses were performed to examine the associations between periodontitis and GIC incidence, recurrence, and metastasis while controlling for potential confounding factors. Results The results of this study demonstrated that periodontitis was significantly associated with the incidence of esophageal, gastric, and colorectal cancer. Even after adjusting for potential confounders, it remained a significant risk factor for esophageal cancer (OR = 2.810, 95%CI: 1.032–7.649, P = 0.043), colon cancer (OR = 2.330, 95%CI: 1.072–5.067, P = 0.033), and rectal cancer (OR = 2.730, 95%CI: 1.247–5.379, P = 0.012). Compared to non-periodontitis subjects, periodontitis showed a significant association with distant metastasis of rectal cancer (aHR = 5.332, 95%CI: 1.406–20.220, P = 0.014). Moreover, severe periodontitis was identified as an risk factor for distant metastasis in rectal cancer (aHR = 10.138, 95%CI: 1.824–56.354, P = 0.008). Conclusion This study highlights significant associations between periodontitis and an increased risk of esophageal and colorectal cancers. Additionally, patients with rectal cancer and periodontitis exhibited an increased risk of distant metastasis compared to those without periodontitis.
... Previous studies have suggested the significant associations of tooth loss and impaired chewing capacity (ICC) with mortality (Friedman and Lamster 2016). Despite the available evidence, these studies have several methodological and theoretical limitations, such as the methods adopted to measure chewing capacity. ...
Aim: Masticatory dysfunction due to tooth loss is a potentially modifiable risk for mortality, but the pathway behind that remains to be investigated. This prospective study aimed to examine the role of diet and ageing in the associations between chewing capacity and long-term mortality.
Methods: Data were obtained from participants (aged ≥ 20) in the National Health Nutritional and Health Survey (NHANES 1999–2010, n = 22,900). The mortality follow-up ended on 31 December 2019. Chewing capacity was determined by the number of functional tooth units (FTUs). Diet information in NHANES was collected using a 24-h-recall questionnaire, and diet quality was measured by three index-based dietary patterns, namely the nutrition index (NI), energy-adjusted dietary inflammatory index (E-DII) and healthy eating index-2015 (HEI-2015). The biological ageing process was reflected using phenotypic age acceleration (PhenoAgeAccel) and frailty index. Mediation analyses were conducted to assess the role of diet quality in the association between FTUs and ageing, as well as the role of ageing in the association between impaired chewing capacity (ICC) and mortality.
Results: Participants with more FTUs were found to have a slower biological ageing process. Diet quality scores were estimated to mediate 9.0%–23.0% of the association between chewing capacity and biological ageing. Multivariable Cox proportional hazards regression models found a positive association between ICC and all-cause mortality (hazard ratio = 1.282 [95% confidence interval: 1.189–1.382]). Also, ICC was significantly associated with a 28.9% higher risk of mortality due to cardiovascular disease (CVD) and a 32.7% higher risk of mortality due to cancer. Mediation analyses indicated that PhenoAgeAccel mediated the effect of ICC on all-cause, CVD and cancer mortality with proportions of 18.1%, 17.3% and 12.5%, respectively. Similar mediating proportions were observed in the frailty index (range: 11.6%–23.5%).
Conclusions: ICC was associated with poorer diet quality and accelerated ageing, resulting in higher mortality risk. Therefore, it is plausible that dietary interventions and oral rehabilitation would promote healthy longevity, although further investigations are needed.
... Measurement imprecision can also compromise research findings, hindering the efforts of various disciplines to contribute to the long-term retention of natural teeth in the dentition, ensuring proper function and esthetics. 30 The need for precise recession measurements becomes more pertinent, when considering the multifactorial etiology of the condition, and the several factors that may confound research outcomes. Imprecision introduces noise to the findings, hindering the identification of potentially significant factors through multivariate model analyses, especially when the studied samples are of relatively limited size. ...
In an era of increasing life expectancy and growing patient demands towards lifelong natural tooth retention, accurate assessment of gingival recessions is crucial for diagnosing periodontal diseases, planning preventive or restorative interventions, and evaluating their outcomes. The traditional two‐dimensional (2D) methods, while useful, often fall short in capturing the complex topography of gingival tissue margins and their changes over time. By examining relevant published studies, this review highlights the transition from 2D to 3D techniques, analyzing the limitations of widely used 2D approaches, while emphasizing the potential of novel 3D tools and techniques. It discusses their comparative effectiveness, accuracy, and application challenges in clinical and research settings. Advancements in three‐dimensional (3D) imaging regarding methodologies for the precise evaluation and quantification of free gingival margin changes and gingival recessions are explored and critically evaluated. The review underscores the potential for these technologies to enhance patient outcomes through more precise diagnosis and data generation. It also identifies gaps in current research and suggests directions for future investigation. Overall, this review provides a comprehensive overview of the state of the art in 3D evaluation methods for gingival recessions and gingival margin changes, offering valuable insights for clinicians and researchers.
... The mechanism between tooth loss and frailty could be explained by malnutrition, dietary pattern, and social isolation. Tooth loss potentially impairs masticatory performance (Friedman & Lamster, 2016), and previous research suggests that masticatory dysfunction is associated with malnutrition and dietary pattern (Ishimiya et al., 2018;Suzuki et al., 2019). Indeed, a study has shown that tooth loss is related to mortality mediating weight loss (Kusama et al., 2023). ...
... Oral health is a modifiable factor that can improve systemic health. Previous studies have demonstrated that poor oral health, characterized by tooth loss, is associated with an elevated risk of chronic diseases and mortality [9,10]. Periodontitis is a chronic inflammation caused by oral bacteria and is a major cause of tooth loss in adults [11]. ...
Objective
Uncoupling protein 2 (UCP2) is an ion/anion transporter in the mitochondrial inner membrane that plays a crucial role in immune response, regulation of oxidative stress, and cellular metabolism. UCP2 polymorphisms are linked to chronic inflammation, obesity, diabetes, heart disease, exercise efficiency, and longevity. Daily step count and number of teeth are modifiable factors that reduce mortality risk, although the role of UCP2 in this mechanism is unknown. This study aimed to assess the possible effects of UCP2 polymorphisms on the association between daily step count and number of teeth with all-cause mortality.
Methods
This study was conducted as a cohort project involving adult Japanese outpatients at Sado General Hospital (PROST). The final number of participants was 875 (mean age: 69 y). All-cause mortality during thirteen years (from June 2008 to August 2021) was recorded. The functional UCP2 genotypes rs659366 and rs660339 were identified using the Japonica Array®. Survival analyses were performed using multivariate Cox proportional hazard models.
Results
There were 161 deaths (mean observation period: 113 months). Age, sex, daily step count, and the number of teeth were significantly associated with mortality. In females, UCP2 polymorphisms were associated with mortality independent of other factors (rs659366 GA compared to GG + AA; HR = 2.033, p = 0.019, rs660339 C T compared to CC + TT; HR = 1.911, p = 0.029). Multivariate models, with and without UCP2 genotypes, yielded similar results. The interaction terms between UCP2 genotype and daily step count or number of teeth were not significantly associated with mortality.
Conclusion
The effects of UCP2 polymorphisms on the association between daily step count or the number of teeth and all-cause mortality were not statistically significant. In females, UCP2 polymorphisms were significantly associated with all-cause mortality. Our findings confirmed the importance of physical activity and oral health and suggested a role of UCP2 in mortality risk independently with those factors.
... Several similar results regarding an association between tooth loss and total mortality have also been reported (34)(35)(36)(37). As a mechanism, it has been suggested that the assessment of oral health, such as tooth loss, may reflect the nutritional status, smoking, cognitive decline, quality of life, and other quality of life issues (such as social isolation, disability, withdrawal, and neglect) that affect mortality (38). In all of these possibilities, the results of this study suggest that improved oral hygiene may contribute to the prognosis of esophageal cancer surgery cases. ...
Background/aim:
We investigated the influence of the preoperative Oral Health Assessment Tool (OHAT) score on the outcomes of patients with esophageal cancer after curative surgery.
Patients and methods:
This study included 90 patients with esophageal cancer who underwent curative surgery and who were screened with the OHAT between 2008 and 2021. The OHAT consists of eight categories with three possible scores. The risk factors for 5-year overall survival (OS) and recurrence-free survival (RFS) were identified.
Results:
Patients were divided into healthy (n=42) and unhealthy (n=48) groups. The OHAT score was identified as a significant risk factor for postoperative pneumonia (11.9% vs. 43.8%, p=0.001) and postoperative hospital stay (20.5 days vs. 50.1 days, p=0.042). The 5-year OS rate after surgery was 71.2% in the healthy group and 43.2% in the unhealthy group, which was a significant difference (p=0.015). A multivariate analysis showed that a high OHAT score was a significant independent factor for 5-year OS (p=0.034).
Conclusion:
The OHAT score was a useful prognostic marker in patients who underwent curative surgery for esophageal cancer. To improve the oncological outcomes of patients with esophageal cancer, it is necessary to carefully plan perioperative oral/dental care using the OHAT score.
... A healthy life expectancy is influenced by oral health [1], and adequate oral health and functioning are crucial for maintaining a good quality of life [2]. The relationship between oral health and well-being is particularly evident in geriatric patients who have lost their teeth [3]. ...
In regions where preventive dentistry is widespread, tooth loss due to root fracture occurs approximately 10 times more frequently than that due to caries and periodontal disease. Root fracture is most likely to occur in non-vital teeth, where the dental pulp has been removed, often through a procedure known as pulpectomy. However, super minimally invasive pulp (SMIP) therapy has recently been reported as a novel treatment approach for pulpitis of any degree. In this study, SMIP therapy was performed to preserve the vitality of teeth in two patients with severe pulpitis.
Case one involved a 35-year-old man with a history of hypertension who presented with intense spontaneous pain in tooth #34. The pain was particularly severe while sleeping at night and on exposure to cold water or heat, but it was absent on percussion. Following the detection of cervical caries and severe pulp exposure, SMIP therapy was administered, and the tooth was subsequently restored using glass ionomer cement.
Case two involved an 18-year-old woman with no significant medical history who had deep caries in tooth #46. She experienced mild tooth pain when exposed to cold water, and examination revealed pulp exposure. We applied mineral trioxide aggregate over the dental pulp and restored the tooth using composite resin. The vitality of both teeth was maintained at the three-month follow-up.
To our knowledge, this is the first report of SMIP therapy for teeth with severe pulpitis. SMIP therapy is an innovative treatment that may cause a paradigm shift from conventional dental treatment.
... Global awareness of developing strategies for improving quality of life and reducing health costs among elderly people has increased attention due to the association between systemic bone mass and oral health [1]. Low bone mineral density (BMD) and higher fracture risk probability in ten years (FRAX) have been associated with periodontal disease, which is one of the main causes of tooth loss among adults [2][3][4]. ...
Introduction:
Studies have shown that an impaired bone condition, represented by osteoporosis and increased fracture risk, may potentially aggravate periodontal disease and, consequently, the risk of tooth loss. This 5-year prospective study aimed to investigate whether systemic bone condition represents risk factor for tooth loss due to periodontal disease amongst elderly women.
Material and methods:
Seventy-four participants, aged ≥ 65 years, who attended the 5-years recall for periodontal evaluation were involved. Baseline exposures were osteoporosis and fracture risk probabilities (FRAX). Women were grouped according to bone mineral density (BMD) and years of bone treatment for osteoporosis. The primary outcome at a 5-year follow-up was the number of tooth loss due to periodontal disease. Periodontitis staging and grading, and causes of tooth loss were recorded.
Results:
The multivariate Poisson regression models showed that women with untreated/shortly treated osteoporosis were 4 times more likely to present higher number of tooth loss due to periodontal disease than those with normal BMD or treated for ≥ 3 years (risk ratio (RR) = 4.00, 95% CI 1.40-11.27). Higher FRAX was also linked to tooth loss (RR = 1.25, 95% CI 1.02-1.53). Receiver-operating characteristic (ROC) curve suggested that women with history of ≥ 1 tooth losses have higher chances of worse major FRAX (sensitivity = 72.2%; specificity = 72.2%).
Conclusion:
In this 5-year study, higher FRAX and untreated osteoporosis were risk factors for tooth loss. Women with normal BMD or treated for osteoporosis for ≥ 3 years did not show increased risk. Management of skeletal conditions should be emphasized with periodontal care for the prevention of tooth loss in elderly women.
... Friedman & Lamster [5] proposed that tooth loss may be a surrogate for systemic health and aging. Previous studies have reported lower rates of tooth loss among centenarians than younger members of the birth cohort aged 65-74 years [6]. ...
Background
Tooth loss may be a surrogate for systemic health and aging. However, no previous studies have systematically assessed multiple outcomes relevant to aging trajectory in this area, and many important confounders were not adjusted in most previous studies. This study aims to prospectively evaluate the associations of complete tooth loss (edentulism) with broad markers of sarcopenia, cognitive impairment and mortality.
Methods
Data were derived from the China Health and Retirement Longitudinal Study, a nationally representative household study of the Chinese population aged 45 years and older. Multivariate Weibull proportional hazards regression was used to assess the association between edentulism with sarcopenia and all-cause mortality. Average changes in cognitive function by edentulism was estimated by mixed-effects linear regression models.
Results
During the 5-year follow-up, the prevalence of edentulism among adults aged 45 and over was 15.4%. Participants with edentulism had a greater decline in cognitive function compared to those without (β=-0.70, 95%CI:-1.09, -0.31, P < 0.001). The association of edentulism and all-cause mortality for 45–64 age group (HR = 7.50, 95%CI: 1.99, 28.23, P = 0.003), but not statistically significant for the ≥ 65 age group (HR = 2.37, 95%CI: 0.97, 5.80, P = 0.057). Effects of edentulism on sarcopenia are statistically significant for all age groups (45–64 age group: HR = 2.15, 95%CI: 1.27, 3.66, P = 0.005; ≥65 age group: HR = 2.15, 95%CI: 1.27, 3.66, P = 0.002).
Conclusions
These findings could have important clinical and public health implications, as tooth loss is a quick and reproducible measurement that could be used in clinical practice for identifying persons at risk of accelerated aging and shortened longevity, and who may benefit most from intervention if causality is established.
... However, after root canal therapy, the tooth becomes brittle and is prone to fracture due to the lack of pulp tissue, resulting in tooth loss. 1,2 Hence, maintaining the pulp tissue is very important for oral health. ...
The regeneration of dental pulp tissue is very important, but difficult, in dentistry. The biocompatibility, water content, and viscoelastic properties of pulp-like tissue must be optimized to achieve the efficient transfer of metabolites and nutrients, a suitable degradation rate, distribution of encapsulated cells, injectability, and gelation in situ under physiological conditions. As promising materials for pulp regeneration, hydrogel scaffolds have been produced to simulate the extracellular matrix and transmit signaling molecules. It is imperative to develop hydrogels to effectively regenerate pulp tissue for clinical application. Here, two injectable double-network (DN) hydrogel-based three-dimensional (3D) cell culture systems were developed for regenerating dental pulp. The microstructure, mechanical property, rheology property, and degradation behavior of the injectable DN glycol chitosan-based hydrogels in a simulated root canal model were characterized and compared to a single-network (SN) glycol chitosan-based hydrogel. Human dental pulp stem cells (hDPSCs) were then encapsulated into the GC-based hydrogels for the regeneration of pulp tissue, and the biological performance was investigated both in vitro and in vivo. The results showed that the DN hydrogels had ideal injectability under physiological conditions due to the dynamic nature of the crosslinks. Besides, the DN hydrogels exhibited better mechanical properties and longer degradation duration than the corresponding SN hydrogel. As a 3D cell culture system, the characteristics of the DN hydrogel facilitated odontogenic differentiation and mineralization of hDPSCs in vitro. Further in vivo analysis confirmed that the chemical composition, matrix stiffness, and degradation rate of the DN hydrogel matched those of pulp-like fibrous connective tissue, which might be related to Smad3 activation. These findings demonstrate that DN glycol chitosan-based hydrogels are suitable for the regeneration of pulp tissue.
... Existen condiciones de vida, acumulativas durante el proceso de envejecimiento, que llevan a elevar la prevalencia de la pérdida de dientes, debido a que constituye el resultado final de un proceso multifactorial que involucra la biología (patología dental previa, caries, enfermedad periodontal, patología pulpar, trauma, cáncer oral), así como factores no biológicos relacionados con procedimientos dentales (preferencias del paciente, opciones de tratamiento, etc.) y lo social (acceso a seguridad social, estrato socioeconómico, nivel educativo, renta familiar, ingresos, política pública, capital social, redes de apoyo, acceso a servicios odontológicos, posibilidad de transporte para recibir tratamiento dental); un evento que es altamente inequitativo para la población (Creugers, 1999;Colares et al., 2020;Farmer et al., 2016;Friedman y Lamster, 2016;Kim et al., 2018). ...
El edentulismo es una condición irreversible. La pérdida dental encuentra conexión con los discursos positivos del envejecimiento, así como unas amplias repercusiones en estos, que han cobrado fuerza hacia finales del siglo XX y principios del siglo XXI, limitando procesos de participación social, generando cambios en la calidad de vida, teniendo una articulación fuerte con las relaciones biológicas de las personas y siendo altamente inequitativo entre grupos sociales. Dado lo anterior, el presente artículo pretende desarrollar y argumentar tres ideas clave para sustentar que el envejecimiento desde el discurso positivo se ve limitado cuando la persona no tiene dientes: la primera es que la vida sin dientes restringe el desarrollo personal y social, la siguiente es que la conexión de la cavidad oral con las condiciones biológicas es muy estrecha y la tercera es la estereotipación y el juzgamiento del viejo edéntulo en la sociedad actual. Las ideas sustentadas argumentaron y soportaron la necesidad de dar importancia a la condición de ser edéntulo en el marco de un envejecimiento positivo y como interven- ción en salud pública. Envejecer bien es la bandera de las políticas mundiales, incluyendo la Década del Envejecimiento Saludable (2020-2030); el entender y la cohesión de la salud en todas sus disciplinas es trascendental en pro del viejo actual y del logro de su gerotrascen- dencia. La geriatría, la gerontología, la salud pública e incluso la misma odontología, hoy más que nunca, deben trabajar en favor de la mitigación de la aparición del edentulismo en las sociedades actuales.
... Oral well-being and functions are important for health and quality of life [1]. The teeth play an important role in mastication, speech, and aesthetics. ...
In aging humans, tooth loss is a predictor of decreased longevity. Tooth loss is mainly caused by dental caries and periodontal disease. Pulpitis refers to inflammation of the dental pulp caused by bacterial infection secondary to dental caries. It is accompanied by severe toothache and has infectious disease-associated pathophysiology. Pulpitis is mainly treated by pulpectomy, which is aimed at removing the infected dental pulp and controlling pain by removing nociceptive nerve fibers. However, teeth without dental pulp have a poor prognosis. In this report, we proposed a novel "super minimally invasive pulp" therapy for treating pulpitis without pulpectomy, which combines antibiotics, steroids, and ultrasound-guided trigeminal nerve block (UGTNB) to protect the dental pulp. UGTNB is used as an analgesic for severe pain, antibiotics for pulp infections, and steroids as antiinflammatory drugs. This novel therapy could improve the longevity of the tooth and thereby oral health.
... An ideal CVH profile is associated with a reduced risk of cardiovascular events and mortality in older adults [26]. In the New England Centenarian Study, the edentulism rate in centenarians was lower than that of the controls in the 65-74 age range [27]; therefore, a functional dentition may indicate healthy aging [28]. Either fixed or removable dentures have long been reported to have a crucial role in maintaining the chewing capacity of edentulous patients. ...
Objectives
Life's Simple 7 (LS7) metrics provide insight into improving cardiovascular health (CVH) and help reduce mortality risks. Edentulous older adults have a higher mortality risk than dentulous ones, probably due to worse oral function. It is reported that wearing dentures will decrease the mortality risk factor by improving oral function. This prospective study aimed to investigate if denture wearing could modify the association between CVH profile and mortality risk among edentulous elderly.
Methods
From the Third National Health and Nutrition Examination Survey (NHANES III), 1,735 edentulous older adults (mean age 69.4 years old) with CVH profiles and data on denture wearing status were selected for this study. CVH profiles according to LS7 metrics were classified into poor, intermediate, or ideal. Denture wearers were defined as those wearing complete dentures in both arches all the time or only when awake. Multivariable Cox proportional-hazards regression was conducted to estimate the association of CVH profiles with all-cause and cardiovascular mortality. Stratified analyses and the testing of interaction terms were used to evaluate the difference between the association in edentulous patients with and without dentures.
Results
A total of 1,420 (81.8%) older adults died during the 27-year follow-up, with 475 (27.6%) cases attributable to heart disease. After controlling for potential confounders, edentulous patients with an ideal CVH (LS7 = 10–14) had a lower mortality risk than those with poor CVH (LS7 = 0–4). Furthermore, we observed an effect modification by denture use (P interaction = 0.046), with the role of ideal CVH in mitigating mortality among the denture wearers (Hazard Ratio = 0.440 [0.329–0.588]), while no significant association among those without dentures. Similar results were achieved for cardiovascular mortality, but there was no effect modification of denture use (P interaction = 0.352).
Conclusion
In this study, a favorable cardiovascular health profile presents a protective effect on all-cause mortality only among edentulous patients wearing dentures instead of non-wearer.
... 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. ...
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.
... The number of remaining teeth in elderly persons is closely linked to problems with mastication and occlusion and maintaining the number of remaining teeth contributes to increased healthy life expectancy 1) . Of the reasons for tooth loss, root fracture is the third most common after periodontal disease and caries 2) . ...
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.
... Tooth loss interferes with the quality of life, including eating process because most foods require a perfect masticatory function. 12 Many studies have analyzed the relationship between malnutrition and oral health in the elderly. Malnutrition and poor oral health are a major concern for global health, especially among the older population, while in the pediatric population studies are still rare. ...
Background: To maintain oral health, the body needs good nutrition. The relationship between nutritional status and oral health conditions is very complex, influenced by many factors, both internal and external. Inadequate nutrition can increase the risk of oral disease. Purpose: To analyze the association between malnutrition and oral diseases. Methods: This study used the cross-sectional analytic observational design. Data were collected from the Manarul Huda Islamic Boarding School in Bandung, which 38 participants were selected based on criteria. Body mass index perform to asses nutritional status, while oral disease was collected through form data. Analysis’s data using chi-square and SPSS 23 version. Results: Classification of body mass index the highest in undernutrition group (47.4%) and oral disease the highest for tooth staining (52.6%), there was no significant association between malnutrition and oral disease with p value >0.05. Conclusion: Early analysis of nutritional assessment reduced oral disease. Further assessment will be needed to determine the long-term oral health effect of malnutrition.
... 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]. ...
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.
... Periodontitis is the main cause of tooth loss in adults that affects the overall health (Friedman and Lamster 2016). The pathogenesis of periodontitis involves a complex interplay between pathogens and host immunity. ...
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.
... 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. ...
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.
... 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]. ...
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).
Background and objective
Global aging is becoming a pressing concern, with a heightened focus on the mental well-being of the elderly population. The mental health of the elderly is influenced by a plethora of factors such as physical health, social support, lifestyle, and psychological aspects. This study investigates the influence of oral health and eating behaviors on depression, anxiety, and dementia in elderly individuals aged 65 and older in China. The aim is to determine the effect sizes of these factors and establish a foundation for implementing tailored intervention strategies.
Study design and methods
The cross-sectional survey study employed data from the 2020 follow-up of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) released in April 2020. The study included a cohort of 3,188 eligible older adults. Seven aspects of oral health were assessed, encompassing the evaluation of the number of teeth, dental restorations, tooth brushing habits, occurrence of tooth pain, as well as cheek or jaw pain. Additionally, 17 items pertaining to eating behaviors were examined, covering dietary aspects such as staple foods, vegetables, fruits, tastes, and the use of cooking oils. The study assessed depression and sleep through 11 items, with higher scores reflecting a predisposition toward depression. A scoring threshold of over 27 identified individuals in the group prone to depression. Anxiety levels were assessed through seven items, where higher scores denoted a predisposition toward anxiety. Participants scoring above 0 were categorized into the anxiety-prone group. Cognitive function was assessed through seven items, with higher scores suggestive of a propensity toward dementia. Participants with scores exceeding 8 were categorized into the dementia-prone group. Rank-sum tests and chi-square tests were employed for the univariate analysis of variations in depression, anxiety, and dementia among elderly individuals with varying oral health and eating behaviors. Variables demonstrating statistical significance in the univariate analysis were further examined in logistic regression analysis.
Results
This study uncovered a correlation between the oral health and dietary behaviors of middle-aged and elderly individuals and their vulnerability to depression, anxiety, and dementia. Our findings showed that about 7.62% of middle-aged and elderly individuals in China were prone to depression. Meanwhile, around 49% of this population had inadequate teeth to chew and digest properly, and nearly 10% lacked dental restorations. Elderly individuals who had dental surgery had a 50% lower risk of depression compared to those who did not (OR = 0.58). Additionally, 36.7% of this group were prone to anxiety, and 7.53% were at risk of developing dementia. Elderly individuals who brushed their teeth at least twice a day and maintained oral hygiene were less likely to develop anxiety and dementia, with odds ratios of 0.72 and 0.78, respectively. This study conducted in China revealed that among individuals aged 65 and older, 22% reported experiencing tooth pain, while 11% reported experiencing cheek or jaw pain. Controlling tooth, cheek, or jaw pain significantly diminished the likelihood of anxiety in elderly population, with odds ratios of 0.79 and 0.69, respectively. The study also uncovered that consuming an adequate amount of fresh vegetables on a daily basis was highly advantageous in preserving the mental well-being of elderly individuals, and might reduce the risk of depression by 32.5%, anxiety by 50.3%, and dementia by 50%. Elderly individuals could potentially prevent anxiety and dementia by consuming an adequate amount of fruits daily. Conversely, a diet high in salt and spice was potentially associated with an increased risk of anxiety in this population. Furthermore, middle-aged elderly individuals (under 80) exhibited a potentially higher susceptibility to anxiety compared to older elderly individuals (aged 80 and above).
Conclusion
An immediate imperative exists to enhance oral health education, elevate oral hygiene standards, and guarantee prompt dental restoration among middle-aged and elderly populations in order to mitigate their susceptibility to depression, anxiety, and dementia. Safeguarding the mental health of elderly individuals necessitates the coordination of diverse disciplines, encompassing dentistry, nutrition, and public health expertise.
BACKGROUND Tooth avulsion, a severe dental trauma in adolescents, results from physical aggression, road traffic accidents (RTAs), or falls. Effective management, including proper storage and prompt replantation, is vital but often hindered by inadequate parental knowledge.
AIM This study explores associations between tooth avulsion, aggressive behavior, parental knowledge, and management practices among adolescents.
MATERIALS AND METHODS A cross-sectional study evaluated 99 adolescents (aged 9-14) presenting with traumatic dental injuries at a tertiary care hospital. Data collection included validated parental and adolescent questionnaires and clinical examinations. Descriptive statistics summarized demographic data. Chi-square tests assessed associations between aggression, socioeconomic status, and parental knowledge. Pearson and Spearman correlation analyses evaluated relationships between aggression dimensions and tooth avulsion. Statistical significance was set at p<0.05 to ensure robust conclusions.
RESULTS Tooth avulsion prevalence was 58.6%. Strong correlations were identified between physical aggression (r=0.896) and avulsion. Only 42% of parents demonstrated adequate emergency knowledge. Socioeconomic status (SES) influenced awareness (p<0.001). Poor outcomes (52.5%) were frequent due to delayed interventions.
CONCLUSION Aggressive behaviors significantly increase the risk of dental trauma, while parental knowledge gaps hinder effective management. Educational programs targeting caregivers, schools, and communities are imperative to improve outcomes.
Background
Predictors of tooth loss in Indonesians have not been identified. This prediction is very useful for tooth loss prevention in middle-aged and elderly.
Objective
The study aimed to predict tooth loss in the middle-aged and elderly populations based on sociodemographic and systemic disease.
Methods
A cross-sectional study of secondary data from the National Basic Health Research was conducted on a sample of 17,095 respondents following the inclusion criteria. Sociodemographic and systemic diseases as independent variables and tooth loss as a dependent variable were assessed. Data were analyzed using a logistic regression model.
Results
Respondents with at least one missing tooth were 20.6%. Among them, 55.6% were females, and 68.1% belonged to the pre-elderly age group (49.0% lived in urban areas and 51.0% lived in rural areas). Only 30.5% had tertiary education, and 61.2% held a formal job. History of systemic diseases like diabetes, heart disease, hypertension, stroke, and cancer were found to be in 5.4%, 3.7%, 17.3%, 2.3%, and 0.4% of respondents. The predictive value of tooth loss was 0.976, and the range was > 0.5. In this study, the predictive value of the respondents' tooth loss was 1.
Conclusion
Indonesian tooth loss predictor value in middle-aged and elderly populations based on sociodemographic and systemic disease was found to be 1. This value indicates a risk of tooth loss. The predictive factor influencing tooth loss of 80.2% can be predicted based on age, occupation, and history of diabetes mellitus and heart disease. Tooth loss can be predicted if the sample is in the elderly group who are still working and have a history of diabetes and heart disease.
Aim of the study This study aimed to evaluate the time efficiency and accuracy of digital scanning compared to traditional impression methods in dentistry, as well as their impact on patient comfort and satisfaction. Materials and methods Bibliographic searches were conducted in databases (PubMed, Scopus, Web of Science), applying relevant keywords to identify studies comparing digital and conventional impression techniques in dentistry. The data was extracted and graphically represented. Results Data from clinical studies indicated mixed conclusions regarding accuracy and impression parameters. Time spent on impressions seems to be less for digital techniques, but results are conflicting. Patients reported increased comfort and a clear preference for digital scans due to their less invasive nature and reduced discomfort. Conclusions Integrating digital scanning technology into modern dental practices offers significant benefits in terms of procedural efficiency and patient satisfaction, while accuracy and time depend by circumstances such as edentulism type and length of scan.
Aim of the study This study aimed to evaluate the time efficiency and accuracy of digital scanning compared to traditional impression methods in dentistry, as well as their impact on patient comfort and satisfaction. Materials and methods Bibliographic searches were conducted in databases (PubMed, Scopus, Web of Science), applying relevant keywords to identify studies comparing digital and conventional impression techniques in dentistry. The data was extracted and graphically represented. Results Results from clinical studies indicated mixed conclusions regarding accuracy and impression parameters. Time spent on impressions seems to be less for digital techniques, but results are conflicting. Patients reported increased comfort and a clear preference for digital scans due to their less invasive nature and reduced discomfort. Conclusions Integrating digital scanning technology into modern dental practices offers significant benefits in terms of procedural efficiency and patient satisfaction, while accuracy and time depend by circumstances such as edentation type and length of scan.
Keywords: Intraoral scanner, Digital impression, Traditional impression, Edentulous patients
In population-based longitudinal studies, bias caused by nonresponse among eligible participants and attrition during follow-up thwarts conclusions. As this issue is not commonly addressed in dental studies, it is the aim of this study to examine the consequences of attrition with respect to tooth loss and mortality in a 10-y follow-up study. From the Study of Health in Pomerania (SHIP-0), a biological age (BA) score was constructed from 10 systemic biomarkers and related to one’s actual chronological age (CA). The 3,417 dentate participants were stratified according to their BA-CA scores into tertiles: individuals with younger BA than their CA, those with concurrent BA and CA, and those with older BA than their CA. Baseline characteristics and propensity of leaving or remaining in the study were compared across these tertiles. We compared the characteristics within BA strata in the remainers of SHIP-2 (10-y follow-up) and their impact on tooth loss. Besides dropout by those who died, the attrition propensity of baseline study participants was dose dependent as related to BA-CA scores and socioeconomic factors. BA younger participants were underrepresented in dropouts but overrepresented in remaining follow-up participants. BA younger participants had a more favorable risk profile, better oral health, and a lower mortality rate than BA older participants. For the BA older participants, the opposite was observed. Remainers attaining the follow-up SHIP-2 were healthier and more health conscious. After 10 y, their tooth retention was still directed by BA constructed at baseline. The results support the assumption that individual risk profiles aggregated in BA constitute characteristic susceptibility patterns affecting perseverance or attrition in long-term follow-up studies. Attrition, which is common to follow-up studies, changes the study composition of participants depending on their BA and hence the transferability of results to the baseline population. The baseline BA gradient persists even after a long time.
Objectives
This study aimed to analyze the risk factors of tooth loss in the elderly, and to compare the structure and composition of the salivary microbiota between the low residual tooth group and the high residual tooth group, providing theoretical basis for the development of professional and effective preventive and management strategies to improve tooth loss in the elderly.
Materials and methods
A sexual cross-sectional study was conducted in 310 elderly people over 60 years old. Through clinical examination and questionnaire survey, the risk factors of tooth loss were collected. Monomial and polynomial logistic regression models were used to estimate the data. Non-irritant saliva samples were collected from people in low residual tooth group and high residual tooth group (n = 25/each group) for 16S rRNA sequencing analysis.
Results
310 elderly people were categorized into two groups based on their residual teeth count: low residual teeth group (n = 87) and high residual teeth group (n = 223). Tooth loss in the elderly is closely related to age, root caries, frequency of eating dessert and candies, toothpick use, self-rated oral health, and frailty according to the multifactorial analysis. In terms of microbial composition, the proportion of Porphyromonas, Treponema, Asticcacaulis, Filifactor and Prevotella in the low residual tooth group were significantly lower than that in the high residual tooth group.
Conclusion
Tooth loss is closely related to the aging, poor living habits, and poor oral and physical conditions of the elderly. The proportion of pathogenic bacteria in the elderly population with more tooth is higher.
Clinical relevance
This study provides some risk factors that can be directly assessed through clinical examination and chairside questionnaires, and provides guidance for subsequent laboratory testing of the microbiota composition of patients' saliva, which is conducive to timely knowledge popularization and long-term help for elderly patients.
Aim
Although poor oral health has been a potentially modifiable risk for mortality, the precise association between functional tooth units (FTUs) and premature death as well as the underlying mechanisms remains unclear.
Methods
This study used data from the National Health and Nutrition Examination Survey (NHANES) 2009–2018. Mortality details were obtained from the National Death Index (NDI). The number of FTUs was defined as pairs of opposing natural and artificial teeth in the premolar and molar area. Weighted logistic regression models were employed to assess the relationship between FTU and premature death. Demographic characteristics, lifestyle habits, and disease histories were adjusted as confounding factors. The propensity score matching (PSM) was conducted to further assess the association between FTU and premature death. Mediation analyses were conducted to assess the role of diet‐related diseases in the association between FTU and premature death.
Results
The analysis included 4169 individuals aged between 60 and 74 years. Participants with 0 ≤ FTUs ≤ 3 had a significantly higher odds of premature death compared to the 10 ≤ FTUs ≤ 12 group (OR = 2.142, 95% CI 1.091–4.208). After missing data imputation, 0 ≤ FTUs ≤ 3 was still significantly associated with increased odds of premature death (OR = 2.115, 95% CI 1.125–3.975). The relationship between 0 ≤ FTUs ≤ 3 and reference group persisted (OR = 2.196, 95% CI 1.296–3.721) after PSM analyses. For mechanism, mediation analysis showed that diet‐related diseases, including diabetes and hypertension, partially mediated the association between FTU and premature death with proportions of 5.089% and 8.437%, respectively.
Conclusion
The findings revealed a link between impairment of masticatory function and a heightened odds of premature death among older adults. Notably, 0 ≤ FTUs ≤ 3 is significantly correlated to premature death among this demographic, with diabetes and hypertension partially mediating the effect of FTU on premature death. Further longitudinal studies are required to validate the findings.
Aims:
To investigate the efficiency and abrasiveness of air-polishing on different types of denture base acrylic resins and whether air-polishing can be an effective technique to clean dentures chairside.
Materials and methods:
A total of 60 specimens were prepared (n = 20/group); heat-polymerized polymethyl methacrylate (PMMA) (G1), subtractive manufacturing (SM) (G2) and additive manufacturing (AM) denture base resins (G3). Equal number of specimens in each group were stained with permanent marker or nail polish and pumice mixture to mimic calcified biofilm. All specimens were treated using EMS Airflow® Prophylaxis Master with two different powders; erythritol or sodium bicarbonate powder, following manufacturer instructions. Efficacy of the powders and surface roughness of the specimens were measured. Scanning electron microscopy imaging was captured for qualitative observation.
Results:
The highest efficacy for stain removal was found in erythritol powder on G1 (98.06% ± 1.304%). The lowest was found in the erythritol powder on G3 (91.83% ± 3.611%). The highest efficacy for biofilm removal was found in sodium bicarbonate powder on G3 (71.49% ± 8.607%), and the lowest was found in erythritol powder on G2 (11.64% ± 4.68%). Only AM resins had statistically significant increases in surface roughness with the use of erythritol powder (p < 0.001). The use of sodium bicarbonate powder significantly increases surface roughness of heat-polymerized (p < 0.025) and AM resins (p < 0.724).
Conclusions:
Air-polishing technology has shown to be effective and suitable for cleaning dentures. The sodium bicarbonate powder showed superior efficacy in cleaning dentures compared to the erythritol powder. Both powders show varyingly increase roughness depending on denture resin.
Background:
Oral health is a major global public health problem, but its risk factors have not been fully identified. The limited evidence suggests that AL may affect oral health conditions, but most of these studies focus only on middle-aged western populations.
Objectives:
To examine whether allostatic load is associated with oral health conditions later in life among middle-aged and older adults in China and there there is a correlation in both middle-aged and older people.
Materials and methods:
Data were collected from the China Health and Retirement Longitudinal Study 2011-2018 (N = 10 890) and were analysed using logistic regressions for the overall sample and subsamples by age.
Results:
Results showed that higher inflammation load significantly increased the odds of edentulism (OR = 1.358, 95% CI = 1.020-1.809, p < .05). Higher metabolic load significantly increased the odds of denture use (OR = 1.375, 95% CI = 1.154-1.640, p < 0.001) and difficulty in chewing solid foods (OR = 1.100, 95% CI = 1.035-1.169, p < .01). These associations were manifested in older adults over 60 years of age, while in the middle-aged subsample, the associations were not significant.
Conclusion:
The findings suggested that higher allostatic load was associated with poorer oral health conditions later in life. It is critical to lower allostatic load and improve oral health conditions, especially for older adults over 60 years of age. Prospective studies and intervention trials help to better understand whether allostatic load is causally linked to oral health.
The increase in the expectation at birth of the population contributes to the phenomenon of population aging in the world. From the perspective of oral health, a high frequency of edentulism has been reported in older adults. The objective was to review the prevalence of edentulism in older adults. The research had a documentary design based on the principles of exploratory systematic reviews. PubMed, ScienceDirect, Scopus, SemanticScholar, SciELO, LILACS, and Google Scholar were searched. Articles published from 2014 that study edentulism was included. The literature review revealed that the prevalence of edentulism varies in different contexts, ranging from 3% to 21.7%. Figures of 25% total edentulism and 75% partial edentulism are also reported. In some research, edentulism has been associated with social inequalities, with some causes of mortality, and as a predictor of myocardial infarctions, heart failure, and cerebrovascular accidents. Health education, early diagnosis and early treatment of tooth decay and periodontal disease are essential to prevent edentulism from occurring. This represents a public health problem that requires attention to increase the quality of life of older adults
Antimicrobial surfactants contained in mouthrinse have excellent efficacy, but are not retained on the tooth surface (are rinsed away) due to their low water resistance and thus do not exhibit sustained antibacterial activity. We have developed a new coating method using graphene oxide (GO) that retains the surfactant on the tooth surface even after rinsing with water, thus providing a sustained antibacterial effect. Ultra-thin films of GO and an antimicrobial agent were prepared by (1) applying GO to the substrate surface, drying, and thoroughly rinsing with water to remove excess GO to form an ultrathin film (almost a monolayer, transparent) on the substrate surface, then (2) applying antimicrobial cationic surface active agents (CSAAs) on the GO film to form a composite coating film (GO/CSAA). GO/CSAA formation was verified by scanning electron microscopy, Raman spectroscopy, X-ray photoelectron spectroscopy, and ζ-potential and contact angle measurements. GO/CSAA was effective at inhibiting the growth of oral pathogens for up to 7 days of storage in water, and antibacterial activity was recovered by reapplication of the CSAA. Antibacterial GO/CSAA films were also formed on a tooth substrate. The results suggest that GO/CSAA coatings are effective in preventing oral infections.
Antimicrobial surfactants contained in mouthrinse have excellent efficacy but are not retained on the tooth surface (are rinsed away) due to their low water resistance and thus do not exhibit sustained antibacterial activity. We have developed a new coating method using graphene oxide (GO) that retains the surfactant on the tooth surface even after rinsing with water, thus providing a sustained antibacterial effect.
Ultra-thin films of GO and antimicrobial agent were prepared by (1) applying GO to the substrate surface, drying, and thoroughly rinsing with water to remove excess GO to form an ultrathin film (almost a monolayer, transparent) on the substrate surface, then (2) applying antimicrobial cationic surface active agents (CSAAs) on the GO film to form a composite coating film (GO/CSAA).
GO/CSAA formation was verified by scanning electron microscopy, Raman spectroscopy, X-ray photoelectron spectroscopy, and ζ-potential and contact angle measurements. GO/CSAA was effective at inhibiting the growth of oral pathogens even after up to 7 days of storage in water, and antibacterial activity was recovered by reapplication of the CSAA. Antibacterial GO/CSAA films were also formed on a tooth substrate. The results suggest that GO/CSAA coatings are effective in preventing oral infections.
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.
Diabetes and periodontal disease have been shown to have a bidirectional relationship in which poor outcomes in one often translate to poor outcomes in the other. Dentists may be valuable in providing an additional diabetes screening service for patients presenting with symptoms of chronic periodontitis. Similarly, diabetic patients should be encouraged to seek guidance from dental professionals for the detection of undiagnosed chronic periodontitis. Improving communication between the two professions may improve patient outcomes in both diseases, where periodontal assessment with a dentist forms a part of a diabetic patient’s annual screening. This article aims to highlight the relationship between the two diseases and the overlap between professions.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Tooth loss can be considered a failure of current oral health care strategies. Knowing how soon this failure will occur can help clinicians enhance preventive strategies for preventing tooth loss and minimizing its impact. The authors conducted a study to detail tooth survival patterns in an older cohort.
The authors conducted a retrospective longitudinal study of 491 participants aged 43 to 102 years. They treated the participants' dental conditions before they entered the study. They also collected participants' sociodemographic, medical, functional, cognitive and dental data when they first arrived at the clinic. The authors used Fisher exact tests, χ(2) tests and analysis of variance to examine the association between baseline characteristics and tooth survival. They generated Kaplan-Meier estimates and used Cox proportional hazards regression models to detail tooth survival and associated risk factors.
The authors found that tooth survival patterns differed among participants who had different numbers of carious teeth or retained roots (carious or broken teeth that were missing most of their coronal structures) when they first arrived at the clinic (P < .001) and between participants who wore removable prostheses and those who did not (P = .02). Participants' tooth loss at different times differed by sex, number of medications being taken and number of carious teeth or retained roots. The authors found that after they adjusted for other factors, tooth survival was associated with the number of carious teeth or retained roots (P = .01), as well as the interaction between the number of carious teeth or retained roots and use of prostheses (P = .02).
Caries and the use of removable prostheses synergistically compromised tooth survival in older patients. Patients who wore prostheses and had multiple active carious teeth or retained roots at arrival had the highest risk of losing teeth soon after their existing conditions were treated.
These findings highlight the need for preventing tooth loss in older adults who wear removable prostheses and have poor oral health. Knowing the groups at the highest risk of experiencing tooth loss soon after dental treatment is received can help dentists better target and design preventive strategies.
Aging is one of the major health challenges today. Most of the diseases related to aging, lead to significantly increased morbidity and mortality and higher public expenditure of funds. The interconnection between socio-economic conditions and social vulnerability is reflected in precarious states of health with prominence of high rates of osteoporosis and periodontal disease.Both these diseases have been highlighted in public health because of the impact caused by bone fracture and tooth loss. Thus, the elderly could help live a healthier and more meaningful life with the prevention of these diseases.
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.
We examine the relationship between complete edentulism prior to the age of 65 years and all-cause mortality after adjustment for socioeconomic characteristics.
Using data from 41,000 adult participants in the 1986 National Health interview Survey with mortality follow-up data on each cohort member through December 31, 2002 (16 years follow-up), we estimated the relative odds of all-cause mortality among adults (age > or =18 years) with complete edentulism prior to the age of 65 years compared with that among those without the condition. Multivariable-adjusted logistic regression analyses were repeated for complete edentulism at any age.
The age-standardized prevalence of complete edentulism was 12.3 percent [95 percent confidence interval (CI), 12.0-12.6]. Among persons aged <65 years, the risk of death from all causes was 19 percent for persons with complete edentulism compared to 10 percent for persons without. Compared with those without complete tooth loss, the risk of death from all causes was 1.5 (95 percent CI, 1.3-1.7) (P < 0.001) times greater for persons with complete edentulism prior to the age of 65 years after multivariable adjustment. Similar results were observed for complete edentulism among persons aged > or =65 years.
Complete edentulism prior to the age of 65 years was associated with all-cause mortality after multivariable adjustment for several socioeconomic characteristics. These results provide further evidence supporting the notion that poor oral health as evidenced by complete edentulism is an important public health issue across the lifespan.
The aim of this cross-sectional study was to analyze the relationship between chronic periodontitis and ischemic heart disease (IHD).
A cross-section of women aged 38 to 84 years were examined in 1992-93 (analysis based on n=1056). Medical and dental examinations were included in the analysis specifically with regard to IHD and periodontitis. Other well-known risk factors for IHD were used as covariates in multivariable statistical analysis.
Among the dentate women in this study (n=847), 74 had IHD and 773 did not. There was no statistically significant difference between numbers of pathological gingival pockets between these groups (58.1% had one or more pathological pockets in the IHD group compared to 57.6% in the non-IHD group). Bivariate analysis of dentate individuals showed significant associations between IHD and number of missing teeth, age, body mass index, waist/hip ratio, life satisfaction, hypertension, and levels of cholesterol and triglycerides. However, in the final multivariable logistic regression model, with the exception of age, only number of teeth (<17 teeth) OR = 2.13 (CI 1.20; 3.77) was found to be significantly associated with IHD. Moreover, edentulous women had an OR of 1.94 (CI 1.05; 3.60) in relation to IHD (age-adjusted model).
In the present study, periodontitis did not seem to have a statistically significant relationship with IHD. The number of missing teeth showed a strong association with IHD, and this may act as a proxy variable tapping an array of different risk factors and behaviors.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Background:
Due to the increasing number of older people, there is a need for studies focused on this population. The aims of the present study are to assess oral and systemic conditions in individuals aged 60 to 95 years with access to dental insurance.
Methods:
Probing depths (PDs), tooth loss, alveolar bone levels, and systemic health were studied among a representative cohort of older individuals.
Results:
A total of 1,147 individuals in young-old (aged 60 or 67 years), old (aged 72 or 78 years), and old-old (aged ≥81 years) age groups were enrolled, including 200 individuals who were edentulous, in this study. Annual dental care was received by 82% of dentate individuals. Systemic diseases were common (diabetes: 5.8%; cardiovascular diseases: 20.7%; obesity: 71.2%; elevated C-reactive protein [CRP]: 98.4%). Serum CRP values were unrelated to periodontal conditions. Rates of periodontitis, defined as ≥30% of sites with a distance from cemento-enamel junction to bone of ≥5 mm, were 11.2% in women in the young-old age group and 44.9% in men in the old-old age group. Individuals in older age groups had a higher likelihood of periodontitis defined by bone loss and cutoff levels of PD ≥5 mm (odds ratio: 1.8; 95% confidence interval: 1.2 to 2.5; P <0.01). A total of 7% of individuals in the old-old age group had ≥20 teeth and no periodontitis. Systemic diseases, dental use, or smoking were not explanatory, whereas age and sex were explanatory for periodontitis.
Conclusions:
The prevalence of periodontitis increased with age. Sex seems to be the dominant explanatory factor for periodontitis in older individuals. Despite frequent dental visits, overall oral health in the oldest age cohort was poor.
To assess the oral health status of community-dwelling adults aged 60 years and older from southern Brazil and to determine demographics, socioeconomic, behavioural and dental risk indicators.
This cross-sectional study used a multistage, probability sampling method to draw a representative sample of the metropolitan area of Porto Alegre, Brazil. A subsample of 217 subjects was included in this analysis. Oral mucosal lesions, dental caries, tooth loss and periodontal status (full-mouth, six sites per tooth exam) were assessed by calibrated examiners.
Prevalence of edentulism was 39.5%, and mean tooth loss was 20.2 (SE = 0.6). Older individuals [Odds Ratio (OR) = 2.2], women (OR = 2.3), white people (OR = 5.9), individuals of lower socioeconomic status (OR = 5.6) and smokers (OR = 3.5) had higher likelihood of being edentulous. Approximately 36% of dentate individuals had caries and/or restoration affecting, in average, 5.0 teeth. Periodontitis affected 79% of subjects, and it was associated with older age (OR = 4.0), men (OR = 3.4) and large amounts of supragingival plaque (OR = 3.0).
Poor oral health was observed in this elderly population from South Brazil. Sociodemographic disparities accounted for most of the burden of disease and treatment needs.
The aim of this study was to evaluate partial and complete tooth loss and some related demographic factors, and oral health behaviors among Turkish elderly. According to recent censuses, elderly population of Turkey is rapidly growing. There is no nationwide information related to edentulism and natural teeth retention among 65-74 year-old people in Turkey. In this nationwide representative cross-sectional study, 1545 subjects aged 65-74 years were evaluated using the proportional stratified cluster sampling method. The data were collected via a structured, pre-tested face to face administered questionnaire and an oral examination. Chi-square test and binary logistic regression analyses were used to determine the significance of explanatory variables. 48.0% of elderly were edentate. The mean DMF-T was 25.8±8.5. These values were higher in women (p=0.016), older age (p<0.001) and rural individuals (p<0.001). Only 12.4% of the subjects had functional dentition. Age, visiting dentist, and health security were associated with edentulism. Female sex (OR=1.37), 70-74 age group (OR=2.08) and illiteracy (OR=3.25) were the independent factors of not having functional dentition. A reduction in edentulism in elderly may be achieved by the implementation of community programs promoting oral health for the prevention and treatment.
We analyze the relationship between age of survival, morbidity, and disability among centenarians (age 100-104 years), semisupercentenarians (age 105-109 years), and supercentenarians (age 110-119 years). One hundred and four supercentenarians, 430 semisupercentenarians, 884 centenarians, 343 nonagenarians, and 436 controls were prospectively followed for an average of 3 years (range 0-13 years). The older the age group, generally, the later the onset of diseases, such as cancer, cardiovascular disease, dementia, and stroke, as well as of cognitive and functional decline. The hazard ratios for these individual diseases became progressively less with older and older age, and the relative period of time spent with disease was lower with increasing age group. We observed a progressive delay in the age of onset of physical and cognitive function impairment, age-related diseases, and overall morbidity with increasing age. As the limit of human life span was effectively approached with supercentenarians, compression of morbidity was generally observed.
To examine whether oral health in hospitalised elderly was associated with body cell mass (BCM) measured with Bioimpedance spectroscopy.
Body cell mass is the tissue producing the metabolic work necessary for all body functions. BCM is mainly muscle tissue. Low BCM is associated with diseases, ageing and poor nutritional status. Reduced oral health is also associated with these parameters; thus, BCM and oral health may be related.
Body cell mass was measured using Bioimpedance spectroscopy in 138 acutely hospitalised elderly ≥70 years. The number of own teeth, posterior occluding tooth pairs and decayed teeth were registered. Oral hygiene was registered with Mucosal-Plaque Score, an index based on assessment of plaque accumulation and mucosal/gingival inflammation. Mini Nutritional Assessment-Short Form, body mass index and handgrip strength were used as nutritional indicators. Comorbidity was assessed with Cumulative Index Rating Scale.
Mean age was 83.2 ± 5.9 years, ranging from 70 to 101 years. Dentition status was significantly and positively associated with BCM. Reduced oral hygiene was significantly associated with low BCM. These findings remained significant after adjusting for confounders.
These results show that compromised oral health was significantly associated with reduced BCM in hospitalised elderly.
To determine the oral health status and treatment needs of subjects aged 65 years and older residing in different districts of Ankara.
A total of 1300 patients, 751 females and 549 males, age 65 and over with a mean age of 72.8 ± 6.34 were included in this study. The subjects were visited at home and toothbrushing habits, visiting the dentist, tooth loss, denture needs were questioned and body mass index values were recorded.
52.5% of the subjects were completely edentulous, 83.3% subjects reported wearing a removable denture. Females had a higher total tooth loss frequency when compared to males (p < 0.05). Total tooth loss between 65 and 69 ages was 47.3%, and increased to 62.4% among those aged 75 and over (p < 0.05). 16.2% of the subjects had not visited a dentist in the last 10 years, and only 3% visited a dentist for control check-ups; no gender-based difference was observed as to the frequency of dental visits (P > 0.05). No significant relationship was found between tooth loss and BMI values (P > 0.05). 46.3% of the subjects had chewing problems.
The subjects included in this study showed high tooth loss frequency and poor oral hygiene habits. Education regarding maintenance of oral hygiene and regular dental check up should be stressed for the elderly.
In general, ageing is a risk factor for sensory and motor deterioration, with the rate of decline varying amongst individuals. Concerning masticatory function, missing teeth along with oral disease seem to accelerate the dysfunction. Here, we aimed to confirm whether masticatory dysfunction by ageing is inevitable. This study investigated the effect of age, gender, number of natural teeth, occlusal force and salivary flow on the masticatory performance in a large sample of elderly adults.
The study sample consisted of 1288 independently living people aged 60-84 years. Masticatory performance was determined by the comminuted particles of test food. Bilateral maximal occlusal force in the intercuspal position was measured with pressure sensitive sheets. Stimulated whole saliva was collected.
Masticatory performance was significantly correlated to age, number of residual teeth, occlusal force and stimulated salivary flow rate by Pearson's correlation test. The multiple linear regression analysis showed that, with other variables controlled, masticatory performance was significantly associated with the number of residual teeth (β=0.456, P<0.001), occlusal force (β=0.244, P<0.001) and stimulated salivary flow rate (β=0.069, P=0.003). Age was not related to masticatory performance (β=-0.007, P=0.753).
Declines in the number of residual teeth, occlusal force and salivary flow were associated with a reduction of masticatory performance in older adults. If tooth loss is not considered as an attribute of physiological ageing, then ageing by itself may not be a risk factor for masticatory dysfunction.
To assess the strength of association between graded groups of oral health status and self-reported functional dependence in community-dwelling older adults.
Population-based cross-sectional study.
National Health and Nutritional Examination Survey (NHANES) 1999 to 2004.
Three thousand eight hundred fifty-six participants aged 60 and older (mean age 71.2) without missing values in the examined correlates.
Oral health status was evaluated according to edentulism, severity of periodontal disease, and recommendation of periodontal care and compared with that of healthy controls. Self-reported functional dependence was assessed according to 19 questions in five domains: activities of daily living (ADLs), instrumental activities of daily living (IADLs), leisure and social activities (LSAs), lower extremity mobility (LEM), and general physical activities (GPAs).
After controlling for demographic and dental variables, health-related behaviors, C-reactive protein, and comorbidities, edentulism was significantly associated with disability in IADLs (odds ratio (OR)=1.58), LSAs (OR=1.63), LEM (OR=1.31), and GPAs (OR=1.45) compared with healthy controls. Likewise, severe periodontitis was associated with disability in IADLs (OR=1.58), LSAs (OR=1.70), and LEM (OR=1.63). The trends toward disability in IADLs, LSAs, LEM, and GPAs were statistically significant across increasing severity of oral health problems.
Poor oral health, specifically edentulism and severe periodontitis, is associated with multiple domains of late-life disability, but a causal relationship cannot be established based on current study design.
To determine whether rates of tooth loss, periodontal disease progression, and caries incidence predict cognitive decline in men.
Prospective study.
Community-dwelling men enrolled in the Veterans Affairs Dental Longitudinal Study.
Five hundred ninety-seven dentate men aged 28 to 70 at study baseline who have been followed up to 32 years.
Oral examinations were conducted approximately every 3 years. Periodontal disease measures included probing pocket depth and radiographic alveolar bone height. Participants underwent cognitive testing beginning in 1993. Low cognitive status was defined as less than 25 points or less than 90% of the age- and education-specific median on the Mini-Mental State Examination (MMSE) and less than 10 points on a spatial copying task.
Each tooth lost per decade since the baseline dental examination increased the risks of low MMSE score (hazard ratio (HR)=1.09, 95% confidence interval (CI)=1.01-1.18) and low spatial copying score (HR=1.12, CI=1.05-1.18). Risks were greater per additional tooth with progression of alveolar bone loss (spatial copying: HR=1.03, CI=1.01-1.06), probing pocket depth (MMSE: HR=1.04, CI=1.01-1.09; spatial copying: HR=1.04, CI=1.01-1.06), and caries (spatial copying: HR=1.05, CI=1.01-1.08). Risks were consistently higher in men who were older than 45.5 at baseline than in younger men.
Risk of cognitive decline in older men increases as more teeth are lost. Periodontal disease and caries, major reasons for tooth loss, are also related to cognitive decline.
The objective of this investigation was to describe the dental disease (dental caries and alveolar bone loss) experience in a sample of community-dwelling older adults who regularly utilize dental services in New York City.
Public financing for dental care directed at older adults in the United States is minimal. Improved preventive methods, primarily the use of fluorides, have resulted in declines in tooth loss, and concomitant increase in risk for dental diseases among older adults. While the oral disease burden in institutionalized elderly and those unable to access services is well-documented, the dental care needs of older adults who access dental services are not well documented.
Radiographic and record review were used to determine prevalence of dental caries, alveolar bone loss, frequency of service utilization, and medical status in this cross-sectional investigation of a sample of older adults (N = 200) using dental services at Columbia University College of Dental Medicine.
Only 9% of the sample was completely edentulous, the mean DMFT was 19.9 and mean alveolar bone loss was 3.6 mm. Missing and Decayed Teeth accounted for 57.8% and 6.5% of the total caries burden respectively. Missing Teeth and alveolar bone loss increased with increasing age, but there was no increase in Decayed Teeth.
While access to and utilization of dental services may result in improved tooth retention, older adults who use dental services continue to have dental care needs, especially periodontal care needs.
Dementia is a common geriatric syndrome. It is unclear how best to predict survival among dementia patients, which leaves clinicians, patients, and families uncertain as to how to proceed with medical decisions and reassessing goals.
We performed a MEDLINE systematic review of studies that evaluated dementia prognosis and survival; 48 studies (cohort, cross-sectional, retrospective, and case-control studies) were included.
Increased age, male gender, decreased functional status, and medical comorbidities such as diabetes, cardiovascular disease, and malignancy were associated with a higher mortality rate in dementia patients. Patients' baseline education level showed no influence on survival. There was no consensus regarding the association among dementia type, baseline cognitive function, and neuropsychiatric symptoms with dementia prognosis.
Despite much data, we lack a unifying guideline for dementia prognostication. Moving forward, the creation of a risk score for dementia could be helpful for patients and families in reassessing goals of care and possible enrollment in services such as hospice or palliative care.
Oral health is an integral part of general health; oral health contributes to and is influenced by a nexus of inputs from biological, psychological, and social functioning. Little is known about the relationship between markers of oral health and subsequent survival in late life. Objectives: The aim of this study was to examine the relative importance of oral health indicators in the context of demographic and psychosocial variables on subsequent survival during an 8-year period in a population-based sample of the oldest-old.
The study sample comprised 357 individuals with a median age of 86 years who were selected from participants in the comprehensive longitudinal Origins of Variance in the Old-Old: Octogenarian Twins (OCTO-Twin) study, which examined monozygotic and dizygotic twins aged 80 years and older on five occasions at 2-year intervals. The OCTO-Twin study includes a broad spectrum of biobehavioural measures of health and functional capacity, personality, well-being, and interpersonal functioning. Oral health variables were number of teeth, per cent decayed and filled surfaces (DFS%), and periodontal disease experience. A longevity quotient (LQ), the ratio between years actually lived and those statistically expected, was determined. The survival categories were shorter than expected, as expected, or longer-than-expected. Multivariate analyses and the Kaplan-Meier method were used in the survival analyses.
No associations between LQ and number of teeth, edentulousness, and periodontal disease experience were found. But survival of men with severe periodontal disease experience was shorter than expected. DFS% was significantly associated with survival. Individuals with a low number of decayed and filled surfaces (DFS) had a shorter-than-expected survival time compared with those with high DFS scores. The overall predictor of survival was cognitive status, independent of age and gender when dental variables were analysed in the context of psychosocial factors. In addition, number of teeth, smoking, and better financial status in childhood and during working life were also significant predictors.
Oral health was significantly associated with subsequent survival in a sample of oldest-old individuals, although psychosocial factors were stronger predictors.
To analyse the importance of caries, periodontitis, and medical and psychosocial factors for risk of becoming edentulous across their lifespan and to examine factors critical for retaining functional dentition into very old age.
From the longitudinal population-based Octogenarian Twin study which analysed psychosocial and health variables, 357 individuals aged 82 + in 1995-1998 were collected. Information about number of teeth, decayed and filled surfaces percentage and periodontal disease experience were drawn from dental records. Reasons for and time of edentulousness were recorded.
Outcome varied - depending on perspective and factors for losing or retaining teeth. Significant factors for losing teeth varied over the lifespan. Losing teeth early in life was related to lower social class; in middle age, to lower education; and in old age, to poor lifestyle factors and low social class. Caries constituted the main reason for tooth loss (about 55%). This increased substantially in the >80 year age-group (75%). Maintaining a functional dentition into old age was significantly associated with non-smoking, more education, being married and good periodontal health.
It is important to apply life-span and cohort perspectives to oral health and disease. In our sample of persons born before World War I, caries was the main reason for losing all teeth, with substantially increased prevalence by age. Lifestyle factors were significant for losing and for retaining teeth. Periodontal condition had a significant influence on the likelihood of retaining functional dentition, and also when taking psychosocial variables into account.
Chronic subclinical inflammation may elevate the risk of cognitive impairment. Periodontitis is associated with subclinical inflammation and accounts in part for tooth loss. The hypothesis was tested that periodontitis and tooth loss as a proxy of chronic periodontitis is associated with cognitive impairment in the elderly.
The population-based Study of Health in Pomerania comprises 1336 subjects (60-79 years). Cognitive impairment was assessed with the Mini-Mental Status Examination (MMSE). Tobit regression analyses were adjusted for potential confounders.
A decreased number of teeth was associated with lower MMSE scores in females (p<0.001) and males (p=0.007) in age-adjusted models. In the fully adjusted models, tooth loss was associated with cognitive impairment in females (p=0.002) but not in males (p=0.825).
A significant association between tooth loss and cognitive impairment was found in females that was not accounted for by potential confounders. Former periodontitis may account for this association as periodontitis was frequently the cause for tooth extractions.
The purposes of this study were (1) to examine differences in dental status among various age groups, particularly, focusing on whether subjects retained 20 or more natural teeth, and (2) to investigate the relationship among dental status, the number and categories of functional tooth units (FTUs), and masticatory ability. A dental examination and self-administered questionnaire were conducted in a total of 2,164 residents aged 40 to 75 years who dwelt in Japan. The percentage of subjects with 20 and more natural teeth and their number of posterior teeth decreased with age. There was not much difference in the mean number of FTUs in subjects with and without 20 or more natural teeth, but those with 20 natural teeth had fewer numbers of FTUs than those with more than 20 natural teeth. The categories of the FTUs were extremely different. Subjects with 20 or more natural teeth had FTUs consisting mostly of natural to natural teeth. Subjects with 19 or fewer natural teeth had many FTUs consisting of removable prosthetic teeth. The subjective chewing ability test was significantly correlated with the number of natural teeth. Subjects could chew the higher number of test foods as the number of natural teeth increased. Not only the number of natural teeth but the categories of FTUs appear to be key factors of chewing ability. It is important to keep as many natural teeth as possible so that the person's categories of FTUs are mainly composed of natural to natural teeth to maintain better oral function.
To assess the relative incidence of age-related diseases in a group of centenarian offspring who have thus far been considered to be predisposed to "healthy" aging.
Longitudinal study.
Nationwide sample.
Four hundred forty centenarian offspring and 192 referent cohort subjects who met inclusion criteria of having initial and follow-up health questionnaire data available. Median age of both cohorts was 72 at the initial health questionnaire.
Initial health questionnaires were collected from 1997 to 2006. Follow-up questionnaires were collected from 2004 to 2007. The mean period of follow-up was 3.5+/-1.7 years for the centenarian offspring and 3.9+/-2.2 years for the referent cohort.
During the follow-up period, centenarian offspring had a 78% lower risk of myocardial infarction (P<.04), 83% lower risk of stroke (P<.004), and 86% lower risk of developing diabetes mellitus (P<.005) than the referent cohort. There were no significant differences in new onset of other age-related diseases. Additionally, centenarian offspring were 81% less likely to die (P<.01) than the referent cohort during the follow-up.
These findings suggest that centenarian offspring retain some important cardiovascular advantages over time over similarly aged referent cohort subjects. These findings reinforce the notion that there may be physiological reasons that longevity runs in families and that centenarian offspring are more likely to age in better cardiovascular health and with a lower mortality than their peers.
Oral health is important to general health because stomatologic disease affects more than the mouth. Increasing preservation of teeth among present and future cohorts of older people has increased their risk for serious disease from oral pathogens. The intent of this paper is twofold: first, to alert non-dental health personnel to the significance of oral health and oral disease in the older adult; and second, to recruit the assistance of non-dental professionals in helping patients to achieve and maintain an optimal oral condition. Normative aging processes alone have little effect on the oral cavity, but common disease processes affecting oral health include tooth loss, dental caries, periodontal diseases, and oral mucosal diseases (including candidiasis and squamous cell carcinoma). Systemic diseases and their treatments frequently affect salivary, oral motor, and oral sensory functions. As a result of bacteremia or aspiration of oral contents, organisms of oral origin can be responsible for serious nonstomatological infections. Clinicians caring for older people need to recognize the importance of stomatological health, include an oral component in the multidisciplinary geriatric assessment, support the education of patients on aspects of dental health, and advocate the expansion of personal and public oral health benefits for older adults.
The purpose of this report was to use a particular clinical trial, the Preventive Geriatric Trial (PGT), as a starting point to discuss whether treatment efficacy can be evaluated by means of tooth mortality. In the PGT, 296 subjects were recruited and randomly assigned to five treatment groups: (1) usual procedures (UP); (2) UP + a cognitive-behavioral intervention (CB); (3) UP + CB + weekly chlorhexidine rinse (CHX); (4) UP + CB + CHX + semi-annual fluoride varnish (F); and (5) UP + CB + CHX + F + semi-annual prophylaxis, including scaling (P). Exploratory analyses revealed that tooth mortality after the 1st year was lower in treatment groups 3, 4, and 5 than in groups 1 and 2. A one-year exposure resulted in a 45% reduction in tooth mortality (p < 0.05); a two-year exposure resulted in a 59% reduction (p-value < 0.04). The PGT findings suggested that it is possible to design trials based on clinically relevant endpoints, such as tooth mortality. For the detection of moderate treatment effects, such trials could take the form of Large, Simple Trials (LST), where many subjects are recruited with minimally restrictive entry criteria, and data are collected only on essential baseline characteristics and tooth mortality. LSTs have provided "reliable answers to important clinical questions" for other chronic diseases, and several arguments suggest that they could play a similar critical role in dental research: (1) Periodontitis and caries are among the most common and costly chronic diseases affecting humans, and the identification of even moderately effective treatments by LSTs can have a large socio-economic impact; (2) the identification of low-cost widely practicable treatments that lend themselves to be investigated in LSTs is likely to benefit more people than the identification of high-cost complex treatments; and (3) tooth mortality is simple to assess and more relevant than the unvalidated surrogate endpoints that have largely failed for more than 20 years to provide reliable answers to certain controversial issues regarding treatment efficacy. The cost of not reliably establishing the safety and the efficacy of treatments may be far greater than the cost of conducting LSTs.
Recent research suggests that osteopenia may be a predisposing factor for periodontal tissue destruction. If so, then a relationship should exist between measures of systemic bone mineral density and periodontal tissue destruction. The purpose of the present cross-sectional study was to evaluate the association between systemic bone mineral density and the clinical signs of periodontal tissue destruction in a large population of elderly dentate women.
A total of 292 dentate women (average age 75.5 years) were randomly selected for a cross-sectional periodontal substudy from participants at the Pittsburgh Field Center of the Study of Osteoporotic Fractures (SOF), a prospective study of a cohort of elderly women (age > or =65 years at baseline) to determine risk factors for fractures. Bone mineral density (BMD) was measured using single photon absorptiometry (radius, calcaneus) and dual energy x-ray absorptiometry (hip, spine). Oral health examinations, including periodontal probings and an assessment of bleeding on probing, were made using an NIDR probe at 3 buccal sites of all teeth. Multiple regression models were used to assess the association between bone mineral density and measures of periodontal disease status while controlling for potential confounders. Periodontal status variables examined included: average loss of periodontal attachment (LOA); number of sites with at least 4 mm LOA; number of sites with at least 6 mm LOA; number of sites with bleeding on probing; and deepest probing depth per person.
This study found no statistically significant association between the 5 indicators of periodontal disease and measures of systemic BMD at 8 anatomic sites after controlling for age, smoking, and number of remaining natural teeth. Some suggestive findings support a weak association between generalized osteopenia and periodontal disease.
Systemic osteopenia is, at best, only a weak risk factor for periodontal disease in older non-black women.