Lower Number of Teeth Is Related to Higher Risks for ACVD and Death—Systematic Review and Meta-Analyses of Survival Data

Nicky G F M Beukers,Geert J M G Van Der Heijden,Naichuan Su,Bruno G Loos

doi:10.3389/fcvm.2021.621626

Abstract

Tooth loss reflects the endpoint of two major dental diseases: dental caries and periodontitis. These comprise 2% of the global burden of human diseases. A lower number of teeth has been associated with various systemic diseases, in particular, atherosclerotic cardiovascular diseases (ACVD). The aim was to summarize the evidence of tooth loss related to the risk for ACVD or death. Cohort studies with prospective follow-up data were retrieved from Medline-PubMed and EMBASE. Following the PRISMA guidelines, two reviewers independently selected articles, assessed the risk of bias, and extracted data on the number of teeth (tooth loss; exposure) and ACVD-related events and all-cause mortality (ACM) (outcome). A total of 75 articles were included of which 44 were qualified for meta-analysis. A lower number of teeth was related to a higher outcome risk; the pooled risk ratio (RR) for the cumulative incidence of ACVD ranged from 1.69 to 2.93, and for the cumulative incidence of ACM, the RR ranged from 1.76 to 2.27. The pooled multiple adjusted hazard ratio (HR) for the incidence density of ACVD ranged from 1.02 to 1.21, and for the incidence density of ACM, the HR ranged from 1.02 to 1.30. This systematic review and meta-analyses of survival data show that a lower number of teeth is a risk factor for both ACVD and death. Health care professionals should use this information to inform their patients and increase awareness on the importance of good dental health and increase efforts to prevent tooth loss.

Highlights

A lower number than 32 natural teeth in adults reflects the endpoint of dental caries and periodontitis
Any study that evaluated the relationship between the number of teeth and atherosclerotic cardiovascular diseases (ACVD)-related morbidity, ACVD-related mortality, or all-cause mortality (ACM) was retrieved from PubMed-Medline (National Library of Medicine, Washington, D.C.) and EMBASE (Excerpta Medical Database by Elsevier)
This systematic review and meta-analyses containing 75 prospective cohort studies from all over the world, including a diversity of populations of both men and women of all ages, is the largest to date providing evidence that tooth loss is related to an increased risk for ACVD-related events and ACM

Summary

Introduction

A lower number than 32 natural teeth in adults reflects the endpoint of dental caries and periodontitis. Tooth loss at a younger age is mainly due to caries, and in older ages, it is due to periodontitis. The cumulative incidence for caries peaks before the age of 30, while for periodontitis, it peaks between 20 and 40 years of age. The worldwide prevalence of severe tooth loss (≤9 remaining teeth) is 2.4% [1, 2]. Tooth loss leads to reduced masticatory function, poorer nutritional status and unhealthy dietary changes, low self-esteem and quality of life, and negative general health. The burden of disease of severe caries, severe periodontitis, and the consequent tooth loss comprises 2% of the global burden of human diseases [6]

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Conclusion