ArticlePDF Available

Tooth loss and dietary intake

Authors:
  • Thai Nguyen University of Medicine and Pharmacy, Vietnam

Abstract and Figures

Several studies have reported that impaired dentition status is associated with poor nutritional intake. However, most of these studies are cross-sectional and thus are unable to clarify the temporal sequence. We assessed the longitudinal relation between tooth loss and changes in consumption of fruits and vegetables and of nutrients important for general health among 31,813 eligible male health professionals. Subjects who lost five or more teeth had a significantly smaller reduction in consumption of dietary cholesterol and vitamin B12, greater reduction in consumption of polyunsaturated fat and smaller increase in consumption of dietary fiber and whole fruit than did subjects who had lost no teeth. Men who had lost teeth also were more likely to stop eating apples, pears and raw carrots. The results support the temporal association between tooth loss and detrimental changes in dietary intakes, which could contribute to increased risk of developing chronic diseases. Dietary evaluation and recommendations can be incorporated into dental visits to provide a greater benefit to patients.
Content may be subject to copyright.
Background. Several studies have
reported that impaired denti-
tion status is associated
with poor nutritional
intake. However, most of
these studies are cross-
sectional and thus are
unable to clarify the tem-
poral sequence.
Methods. We assessed the
longitudinal relation between tooth loss
and changes in consumption of fruits and
vegetables and of nutrients important for
general health among 31,813 eligible male
health professionals.
Results. Subjects who lost five or more
teeth had a significantly smaller reduction
in consumption of dietary cholesterol and
vitamin B12, greater reduction in consump-
tion of polyunsaturated fat and smaller
increase in consumption of dietary fiber and
whole fruit than did subjects who had lost
no teeth. Men who had lost teeth also were
more likely to stop eating apples, pears and
raw carrots.
Conclusions. The results support the
temporal association between tooth loss and
detrimental changes in dietary intakes,
which could contribute to increased risk of
developing chronic diseases.
Practice Implications. Dietary evalu-
ation and recommendations can be incorpo-
rated into dental visits to provide a greater
benefit to patients.
Tooth loss and dietary
intake
HSIN-CHIA HUNG, D.D.S., Dr.P.H.; WALTER
WILLETT, M.D., Dr.P.H.; ALBERTO ASCHERIO, M.D.,
Dr.P.H.; BERNARD A. ROSNER, Ph.D.; ERIC
RIMM, Sc.D.; KAUMUDI J. JOSHIPURA, B.D.S., Sc.D.
The relationship between tooth loss and nutri-
tional intake is important. Diet has a role in
the cause and prevention of several systemic
diseases such as cardiovascular diseases,1and
detrimental changes in dietary intake caused
by poor dental status are proposed as one of the media-
tors for poor oral health as a risk factor for cardiovas-
cular disease.2-15 Because of the high prevalence of tooth
loss among older adults,16-18 even a small excess risk of
developing chronic diseases owing to dental disease
would have a significant impact.
Tooth loss reduces masticatory ability
and, hence, can alter food selection. The
Veterans Administration Dental Longi-
tudinal Study conducted in Boston
among 1,231 men enrolled between 1963
and 1968 found tooth loss to be associ-
ated with decreases in masticatory per-
formance, perceived ease of chewing and
acceptability of some specific foods.19-21
Several studies also reported an inverse
association between progressively
impaired dentition and intake of several
nutrients and of fruits and vegetables.22-
27 However, many studies did not adjust for total calorie
intake as well as other potential confounders, which lim-
ited the interpretation of the results.23 These studies
also measured dietary intake and dental status at the
same time and were unable to clarify the temporal
sequence.
Joshipura and colleagues23 observed that edentulous
subjects in a cohort of 49,501 men had significantly
lower intake of vegetables, fiber and carotenoids and
higher intake of cholesterol and saturated fat than did
those with 25 or more teeth. The associations were inde-
pendent of age, caloric intake, smoking status, profes-
ABSTRACT
JADA, Vol. 134, September 2003 1185
Dietary
evaluation and
recommendations
can be
incorporated
into dental visits
to provide a
greater benefit
to patients.
J
A
D
A
C
O
N
T
I
N
U
I
N
G
E
D
U
C
A
T
I
O
N
®
TRENDS
A
R
T
I
C
L
E
1
J
A
D
A
C
O
N
T
I
N
U
I
N
G
E
D
U
C
A
T
I
O
N
®
sion and physical activity. Longitudinal
analysis suggested that detrimental
changes in dietary intake followed inci-
dence of tooth loss, but there was insuf-
ficient power to detect significance.
After an extended period of follow-up
with the same cohort, we now have sub-
stantially more power to examine the
relationship between tooth loss and
dietary changes. In this article, we pre-
sent the longitudinal analyses between
tooth loss and the consumption of spe-
cific foods and nutrients that have been
associated with cardiovascular and
other systemic diseases. These specific
foods and nutrients include fruits, veg-
COVER STORY
Copyright ©2003 American Dental Association. All rights reserved.
etables, vitamins B6, B12, C, D and E, carotene,
beta-carotene, folic acid, fiber, flavonoids, potas-
sium, cholesterol and specific types of fat.
SUBJECTS, MATERIALS AND METHODS
Study population. The Health Professionals’
Follow-up Study was designed as a prospective
cohort study initiated in 1986 with 51,529 male
health professionals aged 40 to 75 years: 29,683
dentists, 3,745 optometrists, 4,185 pharmacists,
2,218 osteopathic physicians, 1,600 podiatrists
and 10,098 veterinarians. Study participants
answered detailed mailed questionnaires that
included a comprehensive diet survey, questions
on lifestyle practices and a medical history. The
number of teeth present was
assessed on the 1986 baseline ques-
tionnaire and questions on recent
tooth loss were added to biennial
questionnaires starting from 1988,
which were used to update the
information on potential risk fac-
tors and medical conditions. Semi-
quantitative food frequency ques-
tionnaires, or FFQs, were sent out
in 1986, 1990 and 1994. This study
has been approved by the human
subjects committee of Harvard
School of Public Health, Boston,
and subjects’ completion of self-
administered questionnaires constituted informed
consent.
Assessment of dietary intake. The assess-
ment of dietary intake was described in detail
previously.28 We assessed dietary intake by semi-
quantitative FFQs, in which a commonly used
unit or portion for all items of food was specified
(such as one tomato, one glass of orange juice),
and subjects indicated how often, on average,
they had consumed that food over the past year.
The validity and reproducibility of this FFQ have
been published in previous studies.28,29 The fre-
quencies were reported in nine categories,
ranging from less than once a month to six or
more times per day. We computed nutrient
intakes, excluding supplements, by multiplying
the frequency with which each food was con-
sumed by the nutrient content of the specified
portions,30 and we adjusted for total calorie intake
by the residual method.31
We also calculated the total daily intakes of all
fruits (with or without juice) and vegetables for
each respondent from his reported consumption
frequencies of individual fruits and vegetables.
Compared with one-week diet records and cor-
rected for within-person weekly variation, the
Pearson correlation coefficients ranged from 0.35
for vitamin B12 without supplements to 0.5 for
vegetables, 0.7 for fruits and 0.77 for vitamin C
without supplements.28,31
Exposure measure. In biennial question-
naires, we asked the number of teeth lost in the
previous two years in the categories of zero, one,
two, three, four, five to nine, and 10 or more. We
do not have information on the validity of self-
reported incidence of tooth loss, but self-reported
residual number of teeth was highly correlated
with the actual number of teeth on clinical exami-
nation in the general population
(r= 0.97),32 hence, we expected a
high validity for self-reported inci-
dent tooth loss.
Data analysis. In the analyses,
we only included participants who
answered all four questionnaires
(1988, 1990, 1992 and 1994). We
further excluded participants who
reported an extreme daily energy
intake (< 800 kilocalories or > 4,200
Kcal) or who left blank 70 or more
questions in dietary questionnaires.
Participants who did not report the
baseline number of teeth or infor-
mation on potentially confounding variables were
further excluded. Since baseline number of teeth
was reported in categories of zero, one to 10, 11 to
16, 17 to 24 and 25 to 32 teeth, and men with no
teeth or one to 10 teeth might not have enough
teeth to lose five or more teeth during follow-up,
we included in the analyses only men who had 11
or more teeth at baseline. There were 31,813 eli-
gible participants.
We used SAS software (Version 8, SAS Insti-
tute, Cary, N.C.) for the analyses. We summed
the reported number of teeth lost every two years
from four questionnaires, and categorized it into
three groups of zero, one to four, and five or more
teeth lost during this eight-year period from 1986
to 1994. We computed mean baseline intakes in
1986 and changes (intakes in 1994 minus intakes
in 1986) in specific foods and nutrients of interest.
We computed the least-square means of dietary
change for the three categories of teeth lost using
analysis of covariance with a general linear model
adjusting for change in total energy intake, base-
line dietary intake and number of teeth and age.
1186 JADA, Vol. 134, September 2003
TRENDS
By 1994, all subjects
reduced their intakes
of saturated fat and
cholesterol and
increased their
intakes of most
beneficial nutrients
and fruits and
vegetables.
Copyright ©2003 American Dental Association. All rights reserved.
Since tooth loss and dietary intake both might
be associated with healthy behavior and attitude
and socioeconomic status, we evaluated other
potential confounders, such as smoking, body
mass index, physical activity, diabetes, hyperten-
sion, hypercholestermia, alcohol drinking,
vitamin use and profession. However, adjusting
for some of these factors did not influence the
results appreciably. Hence, the final models only
adjusted for change in total energy intake, base-
line dietary intake, number of teeth, age, smoking
status (current, former or nonsmoker), physical
activity (five categories from lowest quintile to
highest quintile) and profession (dentist or non-
dentist) in the analyses.
For testing the linear trends across number of
teeth lost, we summed number of teeth lost in
each two-year period. For those who indicated
having lost five to nine teeth or 10 or more teeth,
we assumed they lost seven and 10 teeth, respec-
tively. Trends in the change of nutrients and
foods intake across total number of teeth lost in
an eight-year period were tested using an ordinal
variable (zero, one, two, three, four or seven for
five to nine teeth lost and 10 for 10 or more teeth
lost). Since the changes in nutrient and food
intake might not fit the assumption of normality,
we performed similar analyses using the rank-
transformation of the change in calorie-adjusted
nutrients intake and daily intake of fruits and
vegetables. The results showed very similar pat-
terns. Hence, we present results only from para-
metric analyses.
We also examined the percentages of men con-
suming specific fruits and vegetables (bananas,
cantaloupes, apples, pears and carrots) in 1994
among participants who reported consuming
these foods at least once per week in 1986. With
the Mantel-Haenszel test, we evaluated whether
men with more tooth loss would have greater
changes in their intake of harder foods after we
adjusted for confounders.
RESULTS
Table 1 shows the distribution of tooth loss
during an eight-year period by potential con-
founding variables among 31,813 men with at
least 11 teeth in 1986. There were 78.3 percent of
the men without any tooth loss, 18.8 percent who
had lost one to four teeth and 2.8 percent who lost
five or more teeth in the period from 1986
through 1994. Men who had lost more teeth were
older than those who had had no tooth loss (mean
age 52.5 for men who had lost no teeth, 57.3 for
men who had lost one to four teeth and 60.2 for
men who had lost five or more teeth). After
adjusting for age, we found that subjects with
tooth loss appeared to have worse profiles of
potentially confounding variables than those
without tooth loss. Among men who had lost five
or more teeth, approximately 24 percent were cur-
rent smokers, while only 7 percent of men
without tooth loss were smokers in 1986. Number
of teeth at baseline was associated negatively
with tooth loss. Almost one-half of the men with
11 to 16 teeth experienced tooth loss, while only
20 percent of men with 25 to 32 teeth had tooth
loss during the eight years.
Table 2 (page 1189) presents the crude means
of baseline intakes in 1986 and differences in
calorie-adjusted nutrients and fruits and vegeta-
bles from 1994 through 1986 among participants
who had lost zero, one to four and five or more
teeth. The three groups had similar average base-
line dietary intake of these nutrients and fruits
and vegetables. All groups seemed to have
improved their dietary pattern over this eight-
year period. By 1994, they reduced their intakes
of saturated fat and cholesterol and increased
their intakes of most beneficial nutrients and
fruits and vegetables.
In the model adjusting for change in total
energy intake and baseline age, dietary intake
and teeth number (Table 3, page 1190), those who
did not lose any teeth seemed to have greater
improvement in dietary pattern during this eight-
year period compared with men who lost teeth.
There was no difference in the change of total
energy intake. Men without tooth loss had
greater reductions in daily dietary intake of satu-
rated fat, cholesterol and vitamin B12 and greater
increases in dietary fiber, carotene and fruits
compared with men who lost teeth. However,
when we additionally adjusted for smoking
status, physical activity and profession, the
results showed fewer differences among tooth loss
groups. Participants who had lost one to four
teeth were not significantly different from those
without tooth loss in the changes of these dietary
variables except for cholesterol and dietary fiber.
Participants who had lost five or more teeth
appeared to have a smaller reduction in dietary
cholesterol (–36.7 milligrams per day versus
–47.8 mg/day) and vitamin B12 (–0.64 micrograms
per day versus –1.34 μg/day), and more reduction
in polyunsaturated fat (–1.47 grams per day
JADA, Vol. 134, September 2003 1187
TRENDS
Copyright ©2003 American Dental Association. All rights reserved.
versus –1.21 g/day) and vitamin E (–0.54 mg/day
versus –0.14 mg/day) than those without any
teeth lost, but the test for linear trend for vitamin
E across number of lost teeth was of only border-
line significance (P = .07). They also had a
smaller increase in dietary fiber (1.16 g/day) and
solid fruit (0.06 serving per day) than did partici-
pants without tooth loss, who increased dietary
fiber intake by 1.69 g/day
and consumption of whole
fruits by 0.17 serving/day.
Table 4 (page 1191)
shows, by number of teeth
lost, the percentage of
men who had consumed
these specific food items at
least once a week in 1986
and still consumed the
items at least once per
week in 1994. There was
no association between
tooth loss and change in
consumption in bananas
and cantaloupes, which
we considered easy to
chew. For participants
who consumed apples or
pears weekly in 1986,
those who had lost five or
more teeth were signifi-
cantly more likely to stop
eating apples or pears
than were the other two
groups; 79 percent of those
without tooth loss, 78 per-
cent of those who had lost
one to four teeth and 70
percent of those who had
lost five or more teeth
remained frequent con-
sumers. Among those who
ate carrots at least once
per week in 1986, a signif-
icantly higher percentage
of those who lost teeth did
not consume raw carrots
frequently compared with
those who had not lost any
teeth. Although men with
greater tooth loss were
more likely to consume
cooked carrots, the differ-
ence was not significant
after we adjusted for other variables.
DISCUSSION
The results of this study support the detrimental
impact of tooth loss on dietary intake. Although,
in general, participants in these three groups
changed their diet in a healthier manner over this
eight-year period, men who lost five or more teeth
1188 JADA, Vol. 134, September 2003
TRENDS
TABLE 1
AGE STANDARDIZED BASELINE FACTORS BY NUMBER
OF TEETH LOST 1986-1994.
BASELINE FACTOR
Number of Participants (%)
Mean Age in Years (± SD*)
Physical Activity (METs)
Occupation
Dentist
Nondentist
Total Number of Teeth
11–16
17–24
25–32
Cigarette Smoking Status
Never
Past
Current
Body Mass Index (%)
< 21
21–22.99
23–24.99
25–29.99
30+
Unknown
Alcohol Intake (Grams/Day)
None
> 0–4.99
5–14.99
15–20.99
30+
Regular Dietary Supplement Use
None
Multivitamin
Other supplements
Diabetes
Yes
No
Hypertension
Yes
No
Elevated Cholesterol Level
Yes
No
0 1-4 5
NO. OF TEETH LOST
24,921 (78.3)
52.5 (9.2)
20.7
15,006 (60.9)
9,915 (39.1)
322 (1.6)
2,141 (9.8)
22,458 (88.6)
12,707 (49.5)
10,383 (43.5)
1,832 (7.0)
993 (3.9)
4,067 (16.0)
7,282 (29.1)
10,557 (42.8)
1,542 (6.1)
480 (2.0)
5,421 (21.9)
6,077 (23.9)
7,079 (28.2)
3,486 (14.1)
2,858 (11.9)
10,296 (40.1)
10,495 (42.8)
4,130 (17.0)
493 (2.3)
24,428 (97.7)
4,811 (21.5)
20,110 (78.5)
2,930 (12.7)
21,991 (87.3)
5,992 (18.8)
57.3 (9.2)
19.0
2,973 (49.3)
3,019 (50.7)
237 (3.7)
1,129 (17.7)
4,626 (78.6)
2,326 (39.7)
2,902 (47.2)
764 (13.1)
209 (3.5)
789 (13.2)
1,568 (26.2)
2,754 (45.8)
534 (9.1)
138 (2.2)
1,346 (22.3)
1,438 (24.3)
1,622 (27.1)
793 (13.3)
793 (12.9)
2,513 (42.9)
2,476 (40.7)
1,003 (16.4)
219 (3.4)
5,773 (96.6)
1,524 (23.7)
4,468 (76.3)
865 (13.9)
5,127 (86.1)
900 (2.8)
60.2 (8.6)
15.9
401 (43.6)
499 (56.4)
133 (14.1)
326 (33.6)
441 (52.3)
263 (31.1)
431 (45.0)
206 (23.9)
42 (4.6)
100 (11.3)
212 (23.6)
403 (44.4)
109 (12.6)
34 (3.5)
220 (24.0)
203 (23.2)
236 (26.4)
97 (11.0)
144 (15.3)
353 (41.5)
389 (41.8)
158 (16.7)
47 (4.5)
853 (95.5)
249 (23.7)
651 (76.3)
140 (14.3)
760 (85.7)
* SD: Standard deviation.
METs: Metabolic equivalents.
Copyright ©2003 American Dental Association. All rights reserved.
changed their dietary intake differently than did
those who had no tooth loss during the eight-year
period. They had greater reductions in intake of
dietary polyunsaturated fat and vitamin E,
smaller reductions in intake of dietary cholesterol
and vitamin B12 and smaller increases in intake
of dietary fiber and whole fruits than did those
who did not lose any teeth. Men who had lost
teeth were more likely to reduce consumption of
apples or pears and raw carrots, which are consid-
ered as hard to chew. We did not find significant
differences in the change of dietary intake
between men who lost one to four teeth and men
who lost no teeth except in intake of dietary
cholesterol.
Our results are consistent with the findings of
several cross-sectional studies that reported that
perceived ease of chewing would be altered only
when severe dentition losses occur.20,21,33 Partici-
pants with tooth loss might increase intake in
foods that do not require a lot of chewing to sub-
stitute for other foods as resources of calories. We
found no differences in change in total calorie
intake among those with or without tooth loss. We
also found that men who had lost more teeth were
more likely to stop eating hard-to-chew foods such
as apples, pears and raw carrots while they main-
tained similar or increased consumption of soft
foods such as bananas, cantaloupes and cooked
carrots.
When compared with our findings, previous
studies have reported substantially stronger
cross-sectional associations after the researchers
controlled for total energy intakes and several
JADA, Vol. 134, September 2003 1189
TRENDS
TABLE 2
NUTRIENTS, FRUITS AND
VEGETABLES CONSUMED
0 (24,921) 1-4 (5,992) 5 (990)
NO. OF LOST TEETH (NO. OF PARTICIPANTS)
Mean (± Standard Deviation) Baseline Intake and Difference
Total Calories (Kilocalories)
Carbohydrates (Grams)
Fats
Saturated fat (g)
Trans fat (g)
Monounsaturated fat (g)
Polyunsaturated fat (g)
Cholesterol (milligrams)
Dietary Fiber (g)
Vitamins and Nutrients
Vitamin C (mg)
Carotene (international
units)
Beta-carotene
(micrograms)
Vitamin E (mg)
Vitamin B6(mg)
Vitamin B12 (μg)
Folate (μg)
Potassium (mg)
Flavonoids (mg)
Fruits and Vegetables
Fruits (servings)
Fruits excluding juices
and sauces (servings)
Vegetables (servings)
Baseline
intake
1994 (604)
230 (45)
24.4 (6.0)
2.82 (1.11)
27.2 (6.0)
13.3 (3.5)
299 (106)
21.1 (7.0)
166 (79)
9,659 (7,557)
4,940 (3,386)
8.11 (4.76)
2.23 (0.60)
8.77 (5.34)
359 (118)
3,375 (644)
20.3 (14.5)
2.42 (1.61)
1.62 (1.26)
3.32 (1.83)
Baseline
intake
1,996 (603)
234 (43)
24.5 (6.3)
2.86 (1.17)
27.3 (6.1)
13.1 (3.5)
305 (111)
21.0 (7.0)
167 (83)
9,849 (8,370)
5,056 (3,693)
8.17 (4.87)
2.23 (0.60)
9.00 (5.48)
353 (114)
3,396 (660)
21.1 (15.3)
2.49 (1.75)
1.70 (1.39)
3.33 (1.87)
Baseline
intake
2,015 (624)
235 (42)
25.3 (6.5)
2.92 (1.24)
27.8 (6.5)
12.8 (3.6)
318 (120)
20.2 (7.3)
164 (82)
9,659 (8,641)
4,976 (3,874)
7.98 (4.64)
2.20 (0.62)
9.37 (5.75)
344 (112)
3,383 (692)
21.8 (18.7)
2.42 (1.76)
1.65 (1.41)
3.28 (1.93)
Difference
20.1 (550.7)
22 (44)
2.69 (5.80)
0.49 (1.35)
0.85 (6.81)
1.22 (3.91)
53.0 (103.7)
2.22 (6.84)
1.14 (76.99)
1,418 (8,323)
116 (3,524)
0.03 (6.79)
0.13 (0.65)
1.55 (6.48)
14.1 (128.8)
71.8 (606.6)
3.03 (15.6)
0.21 (1.57)
0.19 (1.22)
0.24 (1.89)
Difference
16.3 (571.8)
21 (42)
2.47 (5.98)
0.52 (1.42)
0.81 (6.97)
1.16 (4.02)
50.5 (113.1)
2.20 (6.84)
1.90 (83.06)
1,419 (9,248)
132 (3,897)
0.03 (6.56)
0.12 (0.65)
1.35 (6.74)
14.9 (126.4)
64.9 (638.1)
2.45 (16.7)
0.25 (1.88)
0.22 (1.50)
0.22 (1.96)
Difference
7.8 (625.8)
21 (41)
2.32 (6.22)
0.58 (1.44)
0.89 (6.92)
1.19 (3.87)
47.8 (120.0)
1.98 (7.07)
5.24 (82.08)
1,266 (9,655)
129 (4,264)
0.22 (5.82)
0.15 (0.63)
0.76 (7.27)
20.6 (123.7)
94.2 (669.7)
1.86 (19.93)
0.21 (1.80)
0.12 (1.46)
0.13 (2.23)
* In 31,813 men with 11 or more teeth in 1986.
BASELINE (1986) AND DIFFERENCES (1994) FOR DAILY INTAKE OF
CALORIE-ADJUSTED NUTRIENTS, FRUITS AND VEGETABLES BY
NUMBER OF TEETH LOST 1986-1994.*
Copyright ©2003 American Dental Association. All rights reserved.
potential confounding factors.23,27 Healthy
behavior and socioeconomic status may confound
the association between nutrition and oral health,
and their confounding effects are unlikely to
be eliminated completely, especially in cross-
sectional studies. These previous studies indicate
that a change in dietary pattern and oral health
may be affected by not only dentition status, but
also by intake of several nutrients such as vita-
mins A, B6, C and D, calcium, niacin and
thiamin.34 When adjusted for number of teeth and
dietary intake at baseline, and when evaluated
for within-person change, our results would be
less susceptible to these biases. However, we col-
lected data on dietary intake in the past year by
FFQ, which might not be able to reflect the effect
of the tooth loss occurring at the end of the follow-
up period. Also, loss of five or more teeth may not
be severe enough to alter the dietary intake in
this population. Furthermore, since we calculated
change of dietary intake from two measurements
of diet, the attenuation of associations caused by
1190 JADA, Vol. 134, September 2003
TRENDS
TABLE 3
LEAST-SQUARE MEANS OF DIFFERENCES FOR DAILY INTAKE OF
CALORIE-ADJUSTED NUTRIENTS, FRUITS AND VEGETABLES BY
NUMBER OF LOST TEETH 1986-1994.*
NUTRIENTS, FRUITS AND
VEGETABLES CONSUMED
Least-Square Means: Model 1Least-Square Means: Model 2
LEAST-SQUARE MEANS OF DIFFERENCES IN DAILY INTAKE BY NO. OF LOST TEETH
No. of lost teeth Pvalue
for trend
Pvalue for
trend§
No. of lost teeth
Total Calories (Kilocalories)
Carbohydrates (Grams)
Fats
Saturated fat (g)
Trans fat (g)
Monounsaturated fat (g)
Polyunsaturated fat (g)
Cholesterol (milligrams)
Dietary Fiber (g)
Vitamins and Nutrients
Vitamin C (mg)
Carotene (international
units)
Beta-carotene
(micrograms)
Vitamin E (mg)
Vitamin B6(mg)
Vitamin B12 (μg)
Folate (μg)
Potassium (mg)
Flavonoids (mg)
Fruits and Vegetables
Fruits (servings)
Fruits excluding juices
and sauces (servings)
Vegetables (servings)
0
26.4
21.6
2.51
0.58
0.79
1.28
52.1
2.03
0.10
1,294
70.5
0.12
0.11
1.49
8.94
57.2
2.42
0.24
0.21
0.14
1-4
21.9
20.2
2.30#
0.60
0.65
1.24
46.1#
1.72#
0.98
1,106
23.3
0.23
0.09
1.38
4.76
40.2
2.22
2.24
0.21
0.12
5
19.0
18.3#
1.93#
0.64
0.47
1.43
36.6#
1.15#
0.19
775#
62.3
0.63
0.10
0.67#
6.89
63.0
2.16
0.14#
0.08#
0.06
.74
< .001
< .001
< .001
.22
.04
.49
< .001
< .001
.14
.001
.02
.005
.05
< .001
.08
.11
.20
.001
< .001
.09
0
29.2
18.9
2.19
0.63
0.45
1.21
47.8
1.69
2.91
1,074
15.3
0.14
0.09
1.34
4.41
37.4
2.15
0.18
0.17
0.11
1-4
20.6
18.7
2.14
0.62
0.45
1.21
43.6#
1.53
2.04
1,035
1.49
0.19
0.09
1.28
3.12
29.1
2.11
0.21
0.19
0.11
5
16.4
18.2
1.96
0.61
0.49
1.47#
36.7#
1.16#
0.94
880
17.3
0.54
0.11
0.64#
8.51
65.4
2.23
0.15
0.06#
0.08
.63
.38
.22
.21
.69
.046
< .001
.004
.12
.27
.83
.07
.81
< .001
.49
.51
.85
.46
.01
.72
* 31,813 men.
Model 1: Least-square means adjusted for change in total energy intake and for baseline dietary intake, age and number of teeth.
Model 2: Least-square means adjusted for change in total energy intake and for baseline dietary intake, age, number of teeth, smoking status,
physical activity and profession.
§Pvalue for trend across men with zero, one, two, three, four, five to nine, and 10 or more teeth lost.
P< .10 for testing differences of least-square means of men with one to four or five or more teeth lost compared with men who had no tooth loss
for dietary variables with Pvalue < .05 for linear trend across number of teeth lost.
# P< .05 for testing differences of least-square means of men with one to four or five or more teeth lost compared with men who had no tooth loss
for dietary variables with Pvalue < .05 for linear trend across number of teeth lost.
Copyright ©2003 American Dental Association. All rights reserved.
nondifferential measure-
ment errors in both FFQs
would be higher than in
cross-sectional studies,
which only use a single
measurement.
The pattern of dietary
change of men with five or
more teeth lost is
unhealthier than that of
men who lost no teeth, even
though the longitudinal
effects of tooth loss were
relatively small in absolute
terms. The combined detri-
mental effects from various
foods and nutrients could
lead to higher risk of devel-
oping chronic diseases. This
cohort of health professionals is less susceptible to
potential confounding owing to their homogeneity
in socioeconomic status and health awareness.
Also, the effect of tooth loss might be smaller, as
these participants would be more likely to seek
dental care to restore their chewing function than
would general populations and also would be more
likely to maintain a healthy consumption in nutri-
ents by modifying food sources thanks to their rela-
tively high socioeconomic status. Compared with
the findings of the Third National Health and
Nutritional Examination Survey, in which only 90
percent of completely edentulous people had both
upper and lower dentures and 81 percent of people
who were edentulous in the lower arch had den-
tures,35 the participants in this cohort who had 17
or fewer teeth all had prostheses. Hence, we expect
that the effect of tooth loss on dietary intake might
be greater in the general population. Also, this
cohort consisted of only men, and the associations
may be different among women. We need further
studies among women.
In our cohort, men with 11 to 16 teeth at base-
line were more likely to lose teeth than men with
25 to 32 teeth. This result might suggest that risk
factors causing initial tooth loss could be associ-
ated with continuing tooth loss. Clinicians need a
better understanding of the factors underlying a
patient’s risk of experiencing oral diseases and
take appropriate preventive strategies to elimi-
nate the risk factors and thus stop continuing
tooth loss.
We did not collect data on the location of teeth
lost and their replacement status in this study.
We expect that most of these health professionals
who lost a substantial number of teeth had
prosthodontic treatment. Previous studies also
have reported only small and inconsistent differ-
ences in dietary intake comparing different types
of prosthetic treatments: implant-supported den-
tures versus conventional mandibular dentures,
or dentures versus no dentures.36-42 Hence, lack of
information of prosthetic treatments is unlikely to
affect our findings significantly.
CONCLUSION
We found significant associations between
changes in dental status and dietary intake of
specific nutrients. Our results suggest that
changes in diet owing to tooth loss could con-
tribute to the increased risk of chronic disease
that has been associated with poor dentition.
Dr. Hung is a research fellow, Department of Epidemiology, Harvard
School of Public Health, Boston; a research fellow, Department of Oral
Health Policy and Epidemiology, Harvard School of Dental Medicine,
Boston; and an assistant professor, College of Dental Medicine, Kaoh-
siung Medical University, Kaohsiung, Taiwan.
Dr. Willett is a professor, Department of Epidemiology, Harvard
School of Public Health, Boston; a professor and the chair, Department
of Nutrition, Harvard School of Public Health, Boston; and a professor,
Channing Laboratory, Department of Medicine, Harvard Medical
School and Brigham and Women’s Hospital, Boston.
Dr. Ascherio is an associate professor, Department of Epidemiology,
Harvard School of Public Health, Boston; and an associate professor,
Department of Nutrition, Harvard School of Public Health, Boston.
Dr. Rosner is a professor, Department of Biostatistics, Harvard
School of Public Health, Boston; and a professor, Channing Laboratory,
Department of Medicine, Harvard Medical School and Brigham and
Women’s Hospital, Boston.
Dr. Rimm is an associate professor, Department of Epidemiology,
JADA, Vol. 134, September 2003 1191
TRENDS
TABLE 4
PARTICIPANTS’ CONSUMPTION OF SELECTED FRUIT
AND VEGETABLE ITEMS, 1986 AND 1994.
FRUITS AND
VEGETABLES CONSUMED
TOTAL NO. OF
PARTICIPANTS
CONSUMING SPECIFIED
FOOD ITEMS ONCE PER
WEEK OR MORE IN 1986
% OF THOSE PARTICIPANTS STILL
CONSUMING THOSE FOOD ITEMS IN
1994, BY NO. OF TEETH LOST
0 1-4 5
Banana
Cantaloupe
Apple or Pear*
Cooked Carrot
Raw Carrot*
19,438
8,457
21,376
19,399
19,399
87.0
49.2
79.3
49.7
70.2
86.6
50.7
77.9
53.1
62.5
85.1
49.8
69.9
56.7
55.5
*Pvalue for trend < .05 after adjustment for baseline dietary intake, age, number of teeth, smoking status,
physical activity and profession.
Copyright ©2003 American Dental Association. All rights reserved.
Harvard School of Public Health, Boston; an associate professor,
Department of Nutrition, Harvard School of Public Health, Boston; and
an associate professor, Channing Laboratory, Department of Medicine,
Harvard Medical School and Brigham and Women’s Hospital, Boston.
Dr. Joshipura is an assistant professor, Department of Epidemiology,
Harvard School of Public Health, Boston; and an associate professor,
Department of Oral Health Policy and Epidemiology, Harvard School of
Dental Medicine, 188 Longwood Ave., Boston, Mass. 02115, e-mail
“Kaumudi_Joshipura@hsdm.harvard.edu”. Address reprint requests to
Dr. Joshipura.
This research was supported by grants HL35464, CA 55075 and
DE12102 from the Office of Dietary Supplements, National Institutes
of Health, Bethesda, Md., and by the State of Florida Department of
Citrus, Lake Alfred, Fla.
The authors are indebted to the participants in the Health Profes-
sionals’ Follow-up Study for their continued cooperation and participa-
tion; to Al Wing, M.B.A., Mira Kaufman, Karen Corsano and Marcia
Goetsch for computer assistance; to Jill Arnold, Betsy Frost-Hawes,
Kerry Demers, Mitzi Wolff, Gary Chase and Barbara Egan for their
assistance in the compilation of data; and to Laura Sampson, R.D., for
maintaining the food composition tables.
1. Willett WC. Diet and health: what should we eat? Science 1994;
264(5158):532-7.
2. Mattila KJ, Nieminen MS, Valtonen VV, et al. Association between
dental health and acute myocardial infarction. BMJ 1989;298(6676):
779-81.
3. Syrjanen J, Peltola J, Valtonen V, Iivanainen M, Kaste M, Hut-
tunen JK. Dental infections in association with cerebral infarction in
young and middle-aged men. J Intern Med 1989;225(3):179-84.
4. Mattila KJ, Valle MS, Nieminen MS, Valtonen VV, Hietaniemi KL.
Dental infections and coronary atherosclerosis. Atherosclerosis
1993;103(2):205-11.
5. Paunio K, Impivaara O, Tiekso J, Maki J. Missing teeth and
ischaemic heart disease in men aged 45-64 years. Eur Heart J
1993;14(supplement K):54-6.
6. DeStefano F, Anda RF, Kahn HS, Williamson DF, Russell CM.
Dental disease and risk of coronary heart disease and mortality. BMJ
1993;306(6879):688-91.
7. Mattila KJ, Valtonen VV, Nieminen M, Huttunen JK. Dental infec-
tion and the risk of new coronary events: prospective study of patients
with documented coronary artery disease. Clin Infect Dis 1995;20(3):
588-92.
8. Beck J, Garcia R, Heiss G, Vokonas PS, Offenbacher S. Periodontal
disease and cardiovascular disease. J Periodontol 1996;67(supplement
10):1123-37.
9. Joshipura KJ, Rimm EB, Douglass CW, Trichopoulos D, Ascherio
A, Willett WC. Poor oral health and coronary heart disease. J Dent Res
1996;75(9):1631-6.
10. Grau AJ, Buggle F, Ziegler C, et al. Association between acute
cerebrovascular ischemia and chronic and recurrent infection. Stroke
1997;28(9):1724-9.
11. Loesche WJ, Schork A, Terpenning MS, Chen YM, Dominguez
BL, Grossman N. Assessing the relationship between dental disease
and coronary heart disease in elderly U.S. veterans. JADA 1998;129
(3):301-11.
12. Loesche WJ, Schork A, Terpenning MS, Chen YM, Kerr C,
Dominguez BL. The relationship between dental disease and cerebral
vascular accident in elderly United States veterans. Ann Periodontol
1998;3(1):161-74.
13. Morrison HI, Ellison LF, Taylor GW. Periodontal disease and risk
of fatal coronary heart and cerebrovascular diseases. J Cardiovasc Risk
1999;6(1):7-11.
14. Joshipura KJ, Douglass CW, Willett WC. Possible explanations
for the tooth loss and cardiovascular disease relationship. Ann Peri-
odontol 1998;3(1):175-83.
15. Ritchie CS, Joshipura K, Hung HC, Douglass CW. Nutrition as a
mediator in the relation between oral and systemic disease: associa-
tions between specific measures of adult oral health and nutrition out-
comes. Crit Rev Oral Biol Med 2002;13:291-300.
16. Douglass CW, Jette AM, Fox CH, et al. Oral health status of the
elderly in New England. J Gerontol 1993;48(2):M39-46.
17. Steele JG, Walls AW, Ayatollahi SM, Murray JJ. Major clinical
findings from a dental survey of elderly people in three different
English communities. Br Dent J 1996;180(1):17-23.
18. Marcus SE, Drury TF, Brown LJ, Zion GR. Tooth retention and
tooth loss in the permanent dentition of adults: United States, 1988-
1991. J Dent Res 1996;75(special number):684-95.
19. Chauncey HH, Muench ME, Kapur KK, Wayler AH. The effect of
the loss of teeth on diet and nutrition. Int Dent J 1984;34(2):98-104.
20. Wayler AH, Chauncey HH. Impact of complete dentures and
impaired natural dentition on masticatory performance and food choice
in healthy aging men. J Prosthet Dent 1983;49(3):427-33.
21. Wayler AH, Muench ME, Kapur KK, Chauncey HH. Masticatory
performance and food acceptability in persons with removable partial
dentures, full dentures and intact natural dentition. J Gerontol
1984;39(3):284-9.
22. Johansson I, Tidehag P, Lundberg V, Hallmans G. Dental status,
diet and cardiovascular risk factors in middle-aged people in northern
Sweden. Community Dent Oral Epidemiol 1994;22(6):431-6.
23. Joshipura KJ, Willett WC, Douglass CW. The impact of edentu-
lousness on food and nutrient intake. JADA 1996;127(4):459-67.
24. Appollonio I, Carabellese C, Frattola A, Trabucchi M. Influence of
dental status on dietary intake and survival in community-dwelling
elderly subjects. Age Ageing 1997;26(6):445-56.
25. Papas AS, Joshi A, Giunta JL, Palmer CA. Relationships among
education, dentate status, and diet in adults. Spec Care Dentist
1998;18(1):26-32.
26. Papas AS, Palmer CA, Rounds MC, Russell RM. The effects of
denture status on nutrition. Spec Care Dentist 1998;18(1):17-25.
27. Krall E, Hayes C, Garcia R. How dentition status and masticatory
function affect nutrient intake. JADA 1998;129(9):1261-9.
28. Rimm EB, Giovannucci EL, Stampfer MJ, Colditz GA, Litin LB,
Willett WC. Reproducibility and validity of an expanded self-
administered semiquantitative food frequency questionnaire among
male health professionals. Am J Epidemiol 1992;135(10):1114-26;
discussion 1127-36.
29. Willett WC, Howe GR, Kushi LH. Adjustment for total energy
intake in epidemiologic studies. Am J Clin Nutr 1997;65(4 supple-
ment):1220S-8S; discussion 1229S-31S.
30. Agricultural Research Service. Consumer and Food Economics
Institute. Composition of foods: Raw, processed, prepared. Washington:
U.S. Dept. of Agriculture, Agricultural Research Service; 1989.
31. Feskanich D, Rimm EB, Giovannucci EL, et al. Reproducibility
and validity of food intake measurements from a semiquantitative food
frequency questionnaire. J Am Diet Assoc 1993;93(7):790-6.
32. Douglass CW, Berlin J, Tennstedt S. The validity of self-reported
oral health status in the elderly. J Public Health Dent 1991;51(4):
220-2.
33. Carlsson GE. Masticatory efficiency: the effect of age, the loss of
teeth and prosthetic rehabilitation. Int Dent J 1984;34(2):93-7.
34. Pla GW. Oral health and nutrition. Prim Care 1994;21(1):121-33.
35. Redford M, Drury TF, Kingman A, Brown LJ. Denture use and
the technical quality of dental prostheses among persons 18-74 years of
age: United States, 1988-1991. J Dent Res 1996;75(special issue):
714-25.
36. Gordon SR, Kelley SL, Sybyl JR, Mill M, Kramer A, Jahnigen
DW. Relationship in very elderly veterans of nutritional status, self-
perceived chewing ability, dental status, and social isolation. J Am
Geriatr Soc 1985;33(5):334-9.
37. Gunne HS, Wall AK. The effect of new complete dentures on mas-
tication and dietary intake. Acta Odontol Scand 1985;43(5):257-68.
38. Gunne HS. The effect of removable partial dentures on mastica-
tion and dietary intake. Acta Odontol Scand 1985;43(5):269-78.
39. Rosenstein DI, Chiodo G, Ho JW, Westover K, Shearer TR. Effect
of proper dentures on nutritional status. Gen Dent 1988;36(2):127-9.
40. Sebring NG, Guckes AD, Li SH, McCarthy GR. Nutritional ade-
quacy of reported intake of edentulous subjects treated with new con-
ventional or implant-supported mandibular dentures. J Prosthet Dent
1995;74(4):358-63.
41. Garrett NR, Kapur KK, Hasse AL, Dent RJ. Veterans Adminis-
tration Cooperative Dental Implant Study: comparisons between fixed
partial dentures supported by blade-vent implants and removable par-
tial dentures, part V—comparisons of pretreatment and posttreatment
dietary intakes. J Prosthet Dent 1997;77(2):153-61.
42. Ettinger RL. Changing dietary patterns with changing dentition:
how do people cope? Spec Care Dentist 1998;18(1):33-9.
1192 JADA, Vol. 134, September 2003
TRENDS
Copyright ©2003 American Dental Association. All rights reserved.
... [5] Several large cross-sectional studies have reported that impaired dentition status is associated with poor dietary intake. [6] The intakes of vegetable, fish, shellfish and their products were significantly lower among subjects with fewer teeth. [6] Besides correlation with the foods, large cross-sectional study in elderly Japanese also suggested that the number of teeth present had a significant relationship with the intake of several nutrients, in particular, total protein, animal protein, sodium, vitamin D, vitamin B1, vitamin B6, niacin, and pantothenic acid. ...
... [6] The intakes of vegetable, fish, shellfish and their products were significantly lower among subjects with fewer teeth. [6] Besides correlation with the foods, large cross-sectional study in elderly Japanese also suggested that the number of teeth present had a significant relationship with the intake of several nutrients, in particular, total protein, animal protein, sodium, vitamin D, vitamin B1, vitamin B6, niacin, and pantothenic acid. [7] Furthermore, previous studies indicated that drinking different waters, such as tap water rich in fluoride, may also affect oral health by the prevention of caries. ...
Article
Full-text available
Background The relationship between dietary and drinking water habits and oral health are still unclear. We aimed at evaluating the association of dietary and drinking water habits with number of teeth in the elderly adults. Methods We conducted a longitudinal study based on the Chinese Longitudinal Healthy Longevity Survey from 1998 to 2018. The data of dietary and drinking water habits at baseline were collected using a questionnaire. The number of teeth at baseline and follow-up was collected for each subject. We used the linear mixed-effect model to analyze the associations of dietary habits and drinking water sources with tooth number. Results Among 19,896 participants at baseline, the mean age of the participants was 83.87 years, with the average number of natural teeth of 9.37, 8.26, 8.38, 8.68, 4.05, 1.92, 1.12, 2.20 for the first to eighth waves of survey. Compared with subjects drinking tap water, 1.036 (95 % CI: -1.206, -0.865), 0.880 (95 % CI: -1.122, -0.637) and 1.331 (95 % CI: -1.715, -0.947) fewer natural teeth were reported for those drinking well, surface water and spring at baseline survey. Compared with participants with rice intake as the staple food, those with wheat intake (β = -0.684; 95 % CI: -0.865, -0.503) tended to have fewer natural teeth. Compared with participants with fresh fruit intake almost every day, those with quite often intake of fresh fruit tended to have fewer teeth with a significant dose-response trend (Ptrend <0.001). Similar decreased trend for number of teeth was also indicated for increased frequency of vegetable intake (Ptrend <0.001). Fewer number of teeth was found for subjects with less frequency of meat and fish intakes. Conclusions The study suggested that drinking well, surface water, and spring, intakes of wheat as staple food, as well as less frequency of fresh fruit, vegetable, meat and fish intakes were associated with significantly fewer number of teeth in the Chinese elderly population.
... Substantial mastication induces histamine production in the hypothalamus and insulin secretion from the pancreas, thereby preventing overeating and increasing blood glucose levels [15][16][17][18]. In previous studies, patients who lost their teeth suffered from malnutrition and preferred soft meals mainly composed of fats and carbohydrates [19][20][21][22][23][24][25]. An epidemiological study indicated that chewing slowly and steadily reduced the risk of diabetes [26]. ...
Article
Full-text available
Introduction Chewing well is essential for successful diet therapy and control of blood glucose level in patients with diabetes. In addition, long-term hyperglycemia is a risk factor for microvascular complications, which are the main cause of morbidity and mortality in these patients. Hence, it is plausible that masticatory disorder may be relevant to diabetic microvascular complications which is caused by long-term hyperglycemia. The aim of this study was to investigate whether masticatory disorders are relevant to diabetic microvascular complications. Methods This cross-sectional study included 172 patients with type 2 diabetes who underwent educational hospitalization in the Department of Endocrinology and Diabetic Medicine, Hiroshima University Hospital, from April 2016 to March 2020. Masticatory efficiency was determined quantitatively by using the GLUCO SENSOR GS-Ⅱ. Multivariable linear regression models were constructed to examine which factors were related to masticatory efficiency. Statistical significance was defined as a two-sided p value of < 0.05. Results According to the bivariable analysis, masticatory efficiency was significantly correlated with duration of diabetes ( p = 0. 049), number of remaining teeth ( p < 0.0001), the number of moving teeth ( p = 0.007) and condition of diabetic neuropathy ( p < 0.0001). Moreover, the number of remaining teeth ( p < 0.0001) and diabetic neuropathy ( p = 0.007) remained significantly correlated with masticatory efficiency in the multivariable analysis. Conclusions For the first time, we demonstrated that patients with type 2 diabetes who developed diabetic neuropathy had significantly reduced masticatory efficiency. Effective mastication is an important factor in successful diet therapy for diabetes. To prevent the progression of diabetic complications, especially in patients with diabetic neuropathy, it may be necessary to combine individualized therapies from dentists and nutritionists with consideration for the level of masticatory dysfunction.
... In addition to severe caries, periodontal disease is also a major cause of adult tooth loss. 1 High-sugar diets may be linked indirectly to periodontitis-associated tooth loss. 5,12,14,16 People with poorly controlled diabetes are 3 times more likely to develop chronic periodontal disease than those with normoglycemic levels. 15 An extensive body of literature describes a bidirectional relationship between periodontitis and diabetes. ...
Article
Full-text available
Background: The objective of this study was to analyze the association between tooth loss and uncontrolled diabetes among US adults. Methods: The authors used National Health and Nutrition Examination Survey data from 2011 through 2018. The sample included 16,635 participants 20 years and older who represent 187,596,215 people in the United States in a probability weighted sample. The authors used bivariate analysis and multiple regressions to analyze factors associated with edentulism and number of missing teeth. Results: The multiple logistic regression model significantly predicted edentulism using diabetes status (adjusted odds ratio controlled diabetes, 1.44 [95% CI, 1.12 to 1.86]; adjusted odds ratio uncontrolled diabetes, 2.26 [95% CI, 1.33 to 3.85]), missing annual dental visits, seeing a dentist only for treatment, family income below 200% of the federal poverty guideline, being female, being 65 years or older, tobacco smoking, and no college education. After controlling for the same covariates, multiple Poisson regression analysis showed that dentate adults with controlled and uncontrolled diabetes had higher relative risk of tooth loss than those without diabetes (adjusted risk ratio controlled diabetes, 1.52 [95% CI, 1.35 to 1.71]; adjusted risk ratio uncontrolled diabetes, 1.57 [95% CI, 1.35 to 1.83]). Conclusions: US adults with uncontrolled (glycated hemoglobin ≥ 9%) and controlled diabetes (glycated hemoglobin < 9%) were more likely to be edentulous and experience tooth loss than adults without diabetes. Practical implications: US health policy officials should adopt benefits policies to provide regular dental examinations to people who have diabetes, have low income (< 200% of the federal poverty guideline), or are 65 years or older to reduce tooth loss and improve their quality of life. Dentists should work with physicians to help patients control glycemic levels.
... As variações na dieta derivadas da perda dentária poderão contribuir para o risco acrescido de doenças crónicas como diabetes, hipertensão e nível de colesterol elevado. 44 Devemos ter em conta que os Médicos de Família estão numa posição privilegiada para informar, educar e motivar os seus utentes a alterarem os seus hábitos dietéticos. Devem aconselhar os seus pacientes a: reduzir o consumo de açúcar, especialmente entre as refeições e na forma adesiva; encorajar o consumo de água e restringir o consumo de bebidas açucaradas; estimular o consumo de vegetais, frutos frescos e produtos lácteos, especialmente o queijo, que parece ter um papel importante na prevenção das cáries 45,46 e fomentar uma alimentação equilibrada e diversificada, tendo em conta as necessidades nutricionais dos mais idosos, contribuindo assim para melhorar a sua Saúde Oral e geral. ...
Article
Full-text available
Um dos critérios para a identificação de um idoso bem sucedido é a manutenção, durante toda a vida, de uma dentição natural, saudável e funcional, incluindo todos os aspectos sociais e benefícios biológicos, tais como a estética, conforto, capacidade para mastigar, sentir sabor e falar. A fraca Saúde Oral dos idosos tem sido particularmente evidente através de elevados níveis de perdas dentárias, doença periodontal, cáries, xerostomia, lesões da mucosa associadas ao uso de próteses dentárias mal adaptadas e cancro oral. A prevenção é uma aposta neste grupo etário e alguns aspectos, como o controlo da placa bacteriana, uso de agentes antimicrobianos, uso de flúor nas mais diversas formas de apresentação e uma dieta adequada, são os métodos a preconizar. O impacto negativo das fracas condições orais na qualidade de vida dos idosos é um importante problema de Saúde Pública, que deve ser tratado a vários níveis e valorizado pelos responsáveis nacionais pelos programas de saúde.
... However, the prevalence of chewing ability is difficult to compare and depends on the diagnostic criteria for each study. On the other hand, as age increases, it is more likely to experience difficulty in chewing [24][25][26]. In this study, the prevalence of chewing discomfort in older adults aged 65 and over was 57.1%, which was much higher than the 28.9% in the middle-aged population, aged 40 to 64, and the 17.9% in the young-adult population, under the age of 40. ...
Article
Full-text available
Using 4 years of pooled data from the Korean Health Panel (2010–2013), the prevalence of food-chewing discomfort in adults over the age of 19 was investigated and the cross-sectional relationship between food-chewing discomfort and health behaviors and cognitive and physical health was identified. The prevalence of food-chewing discomfort was 31%: young adults (<40 years), 17.9%; middle-aged adults (40–64 years), 28.9%; and older adults (≥65 years), 57.1% (p < 0.0001). When food-chewing discomfort was sometimes, often, or always rather than never, odds ratios (ORs) were analyzed after controlling for sociodemographic characteristics. Significant OR results of target variables were smoking (OR 1.15, 1.37, 1.50), drinking (1.08, 0.87, 0.73), problem drinking (1.87, 1.67, 1.34), abstinence from drinking (1.23, 1.34, 1.42), nonphysical activity (OR 0.87 only significant, 0.94 nonsignificant, 1.10 nonsignificant), memory decline (2.07, 2.56, 3.31), decision-making difficulty (1.76, 2.78, 4.37), limitation of daily life due to illness (2.29, 3.60, 3.92), and the presence of a chronic disease (1.28, 1.62, 1.73), respectively. In conclusion, there were associations of food-chewing discomfort with increased smoking and decreased alcohol consumption, with increased difficulty in decision-making and memory decline, limitations in daily life due to disease, and the presence of chronic diseases. Therefore, it is necessary to investigate the causal relationship between chewing and health behaviors and cognitive and physical health through longitudinal studies.
Chapter
This chapter discusses the mechanisms of neuroplasticity and briefly summarizes the advantage of neuroimaging in studying brain plasticity. It looks into how individuals adapt to oral sensory stimuli. The chapter highlights the role of the brain in such an adaptive process. The functional adaptation of mastication and swallowing, which aim to improve the performance of feeding under environmental challenges (e.g. tooth loss), may be associated with complicated mechanisms of sensorimotor, cognitive and affective processing of oral functions. This chapter discusses recent neuroimaging evidence of brain plasticity associated with the adaptation of oral functions. Research design of this topic is discussed. The chapter also discusses the association between mastication and masticatory muscle pain, in which adaptation may play a key role. It provides information on the association between brain plasticity, functional adaptation and the approaches to improve oral functions.
Article
Full-text available
Despite clinical evidence of poor oral health and hygiene in Parkinson’s disease (PD) patients, the mouth is often overlooked by both patients and the medical community, who generally focus on motor or psychiatric disorders considered more burdensome. Yet, oral health is in a two-way relationship with overall health—a weakened status triggering a decline in the quality of life. Here, we aim at giving a comprehensive overview of oral health disorders in PD, while identifying their etiologies and consequences. The physical (abnormal posture, muscle tone, tremor, and dyskinesia), behavioral (cognitive and neuropsychiatric disorders), and iatrogenic patterns associated with PD have an overall detrimental effect on patients’ oral health, putting them at risk for other disorders (infections, aspiration, pain, malnutrition), reducing their quality of life and increasing their isolation (anxiety, depression, communication issues). Interdisciplinary cooperation for prevention, management and follow-up strategies need to be implemented at an early stage to maintain and improve patients’ overall comfort and condition. Recommendations for practice, including (non-)pharmacological management strategies are discussed, with an emphasis on the neurologists’ role. Of interest, the oral cavity may become a valuable tool for diagnosis and prognosis in the near future (biomarkers). This overlooked but critical issue requires further attention and interdisciplinary research.
Article
Background Periodontal treatment may be a useful adjunct to medical management of diabetes; however, oral health has not been integrated into multidisciplinary diabetes care in Australia. This study aimed to understand the needs of patients and staff at a diabetes clinic to inform a prototype of integrated dental and diabetes care. Methods Quantitative and qualitative data were collected from patients and staff at West Moreton Diabetes Clinic (WMDC) between September‐October 2019. Clinical information, survey responses and dental screening results were analysed for 41 patients. Semi‐structured interviews were held with six patients and a focus group with seven staff. Results Most patients (83%) had not seen a dentist in the previous year. Of the 37 patients with remaining natural teeth, 84% required periodontal assessment and 46% had multiple carious lesions. Unmet treatment needs and rates of access were similar for private and public dental patients. Staff and patients reported high levels of support for incorporation of dental care at WMDC. Conclusions Integrating oral health into diabetes management is well‐supported by patients and staff to address significant unmet dental needs for both public and private dental patients. Incorporating dental screening/services within diabetes clinics may increase uptake and improve awareness of its importance in diabetes management.
Article
Full-text available
Aim: Periodontal treatment is reported to be associated with an improved periodontal condition in diabetic patients. Therefore, a comprehensive review of meta-analyses was conducted to evaluate whether periodontal treatment can improve glycemic control in patients with type 2 diabetes. Materials and methods: The search on electronic databases included PubMed-Medline, Cochrane Library, Scopus, and LILACS databases. The methodological quality of the systematic reviews was evaluated using AMSTAR, and primary studies were performed in accordance with PRISMA guidelines. The weighted mean difference (WMD) was calculated, nested in a random-effects model with corresponding Z scores, p-values, and 95% confidence intervals. Results: A total of 11 meta-analyses were included, and a meta-analysis of 11 primary studies comprising a total of 1341 participants was carried out. All the studies evaluated glycosylated hemoglobin (Hb1Ac), and 6 of the 11 publications evaluated fasting plasma glucose (FPG). The AMSTAR scores ranged between 9 and 11, with a median of 10.3. Statistically significant reductions were observed in HbA1c values [-0.32% (3.5 mmol/ mol); 95%CI: -0.50 to -0.15] and FPG values (-11.59 mg/dl; 95%CI: -15.16 to -8.01). Conclusion: The review of currently available clinical studies concludes that periodontal treatment is associated with improved glycemic control in patients with type 2 diabetes. New guidelines, including periodontal treatment as a routine public health measure to improve glycemic control in diabetic patients, would be of great value.
Article
Full-text available
The authors assessed the reproducibility and validity of an expanded 131-item semiquantitative food frequency questionnaire used in a prospective study among 51,529 men. The form was administered by mail twice to a sample of 127 participants at a one-year interval. During this interval, men completed two one-week diet records spaced approximately 6 months apart. Mean values for intake of most nutrients assessed by the two methods were similar. Intraclass correlation coefficients for nutrient intakes assessed by questionnaires one year apart ranged from 0.47 for vitamin E without supplements to 0.80 for vitamin C with supplements. Correlation coefficients between the energy-adjusted nutrient intakes measured by diet records and the second questionnaire (which asked about diet during the year encompassing the diet records) ranged from 0.28 for iron without supplements to 0.86 for vitamin C with supplements (mean r = 0.59). These correlations were higher after adjusting for week-to-week variation in diet record intakes (mean r = 0.65). These data indicate that the expanded semiquantitative food frequency questionnaire is reproducible and provides a useful measure of intake for many nutrients over a one-year period.
Article
Full-text available
Known risk factors for coronary heart disease do not explain all of the clinical and epidemiological features of the disease. To examine the role of chronic bacterial infections as risk factors for the disease the association between poor dental health and acute myocardial infarction was investigated in two separate case-control studies of a total of 100 patients with acute myocardial infarction and 102 controls selected from the community at random. Dental health was graded by using two indexes, one of which was assessed blind. Based on these indexes dental health was significantly worse in patients with acute myocardial infarction than in controls. The association remained valid after adjustment for age, social class, smoking, serum lipid concentrations, and the presence of diabetes. Further prospective studies are required in different populations to confirm the association and to elucidate its nature.
Article
Abstract The aim of the present study was to compare the dietary intake and the levels of traditional cardiovascular (CVD) risk factors in edentulous middle-aged individuals and individuals of the same age and sex who still had natural teeth. The study was performed within the framework of the MONICA-project. Population registers were used to sample randomly 1287 men and 1330 women aged 25–64 yr. Data were collected from a mailed questionnaire, blood analyses, registrations of blood pressure and anthropometric measures. The estimated daily energy intake did not differ between the two groups, but edentulous men and women ate more sweet snacks compared to those who still had teeth. Edentulous men also ate less fruits, vegetables and fibre and edentulous women ate more fat than dentates. Edentulous men and women were more obese and had lower serum HDL-cholesterol concentrations than those with remaining teeth. Edentulous women also had significantly higher concentrations of total cholesterol and triglycerides in serum than dentate women. Edentulous men and women were more often regular smokers, but not snuff users, than dentates of the same age and sex. Thus, the presence of two or more cardiovascular risk factors was more common in edentulous individuals than in those who still had natural teeth. In summary, these results support the hypothesis that edentulous middle-aged individuals have a more unfavourable risk factor profile for CVD. Counselling on balanced dietary habits and non-smoking given by dental personnel to orally diseased patients – recommendations given to improve resistance to dental caries or periodontitis – might therefore improve general health and possibly also improve risk factors for CVD.
Article
Food plays a significant and essential role in the survival of all people. There has been a suggestion that there is a strong association between changes in dental status such as loss of teeth and denture wearing and low intake of essential nutrients. This paper explores the relationship between diet and nutrition and a change from (A) an old complete denture to an implant-sup ported denture, from (6) the dentate status to an immediate complete denture, and from (C) an old complete denture to a functionally corrected new complete denture. A summary of the findings is that loss of teeth influences masticatory efficiency and function and that a replacement prosthesis may improve function but does not significantly change dietary intake.
Article
Several recent studies have shown a link between dental disease and coronary heart disease. The authors studied 320 U.S. veterans in a convenience sample to assess the relationship between oral health and systemic diseases among older people. They present cross-sectional data confirming that a statistically significant association exists between a diagnosis of coronary heart disease and certain oral health parameters, such as the number of missing teeth, plaque benzoyl-DL-arginine-naphthylamide test scores, salivary levels of Streptococcus sanguis and complaints of xerostomia. The oral parameters in these subjects were independent of and more strongly associated with coronary heart disease than were recognized risk factors, such as serum cholesterol levels, body mass index, diabetes and smoking status. However, because of the convenience sample studied, these findings cannot be generalized to other populations.
Article
The validity of self-reported number of teeth was assessed in a random sample of 50 individuals aged 70+ by comparing self-reports in a telephone interview with results of a subsequent in-home examination by a dentist. There were no significant differences between self-report and examination data, nor was there any systematic under- or over-counting of teeth as the actual number of teeth increased. These data support the validity of self-reported dentition.
Article
The association between dental infections and cerebral infarction was investigated in a case-control study involving 40 patients with ischaemic cerebral infarction under the age of 50, and 40 randomly selected community controls matched for sex and age. Poor oral health, as assessed by two indices measuring the severity of infections of teeth and periodontium, or by the presence of subgingival calculus or the presence of suppuration in the gingival pockets, were more common in male patients than in male controls, but no difference was observed in females. If severe dental infections were combined with other probable bacterial infections there were altogether 16 patients (40%) but only two controls (5%) who had suffered from a probable bacterial infection within 1 month or at the time of the stroke or when examined as a control (P < 0.01). Our results suggest an association between bacterial infection and ischaemic cerebrovascular disease in patients under 50 years of age. Severe chronic dental infection seems to be an important type of infection associated with cerebral infarction in males.
Article
Masticatory efficiency, the subjective experience of masticatory performance, and dietary intake were evaluated in 19 subjects who were treated with a removable partial denture in the lower jaw. The subjects were tested on three occasions: before treatment, with the dentures when free from symptoms, and about 4 months after the dentures were inserted. Masticatory efficiency and the subjective experience of masticatory performance increased significantly after the subjects were provided with the dentures, but no changes were found in the dietary intake.