Abstract
BackgroundTooth loss has been shown to correlate with multiple systemic comorbidities. However, the associations between the number of remaining natural teeth (NoT) and all-cause mortality have not been explored extensively. We aimed to investigate whether having fewer NoT imposes a higher risk in mortality. We tested such hypotheses using three groups of NoT (20–28,10–19, and 0–9), edentulism and without functional dentition (NoT < 19).MethodsThe National Health and Nutrition Examination Survey in the United States (NHANES) (1999–2014) conducted dental examinations and provided linkage of mortality data. NHANES participants aged 20 years and older, without missing information of dental examination, age, gender, race, education, income, body-mass-index, smoking, physical activities, and existing systemic conditions [hypertension, total cardiovascular disease, diabetes, and stroke (N = 33,071; death = 3978), or with femoral neck bone mineral density measurement (N = 13,131; death = 1091)] were analyzed. Cox proportional hazard survival analyses were used to investigate risks of all-cause, heart disease, diabetes and cancer mortality associated with NoT in 3 groups, edentulism, or without functional dentition.ResultsParticipants having fewer number of teeth had higher all-cause and disease-specific mortality. In fully-adjusted models, participants with NoT0-9 had the highest hazard ratio (HR) for all-cause mortality [HR(95%CI) = 1.46(1.25–1.71); p < .001], mortality from heart diseases [HR(95%CI) = 1.92(1.33–2.77); p < .001], from diabetes [HR(95%CI) = 1.67(1.05–2.66); p = 0.03], or cancer-related mortality [HR(95%CI) = 1.80(1.34–2.43); p < .001]. Risks for all-cause mortality were also higher among the edentulous [HR(95%CI) = 1.35(1.17–1.57); p < .001] or those without functional dentition [HR(95%CI) = 1.34(1.17–1.55); p < .001].ConclusionsHaving fewer NoT were associated with higher risks for all-cause mortality. More research is needed to explore possible biological implications and validate our findings.
Highlights
Tooth loss has been shown to correlate with multiple systemic comorbidities
In fully-adjusted models, participants with NoT0-9 had the highest hazard ratio (HR) for all-cause mortality [HR(95%Confidence interval (CI)) = 1.46(1.25–1.71); p < .001], mortality from heart diseases [HR(95%CI) = 1.92(1.33–2.77); p < .001], from diabetes [HR(95%CI) = 1.67(1.05–2.66); p = 0.03], or cancer-related mortality [HR(95%CI) = 1.80(1.34–2.43); p < .001]
Risks for all-cause mortality were higher among the edentulous [HR(95%CI) = 1.35(1.17–1.57); p < .001] or those without functional dentition [HR(95%CI) = 1.34(1.17–1.55); p < .001]
Summary
Tooth loss has been shown to correlate with multiple systemic comorbidities. the associa‐ tions between the number of remaining natural teeth (NoT) and all-cause mortality have not been explored exten‐ sively. A decreasing trend of edentulism has been detected in the United States, the improvement is not evenly distributed between the poor and the non-poor populations [16]. Socioeconomic status such as education and income levels that were highly correlated with access to dental care were demonstrated to be very predictive of tooth loss [17, 18]. Our goal for this study is to examine whether the number of remaining natural teeth (NoT), i.e., the severity of tooth loss, could be a predictor for the all-cause or disease-specific mortality in a representative general population. We used data from the United States National Health and Nutrition Examination Survey (NHANES) and its publicly linked mortality for this analysis
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