Abstract
ObjectivesCounts of missing teeth or measures of incident tooth loss are gaining attention as a simple way to measure dental status in large population studies. We explore the meaning of these metrics and how missing teeth might influence other measures of dental status.MethodsAn observational study was performed in 2 contrasting adult populations. In total, 62 522 adult participants were available with clinically assessed caries and periodontal indices from the Swedish arm of the Gene‐Lifestyle Interactions and Dental Endpoints Study (GLIDE) and the Korea National Health and Nutrition Examination Survey (KNHANES) in the Republic of Korea. Longitudinal measures of tooth loss were available for 28 244 participants in GLIDE with median follow‐up of 10.6 years.ResultsIn longitudinal analysis, hazard for tooth loss was associated with baseline dental status (previous tooth loss, periodontal status and caries status) and socio‐demographic variables (age, smoking status and highest educational level). Analysis of cross‐sectional data suggested that indices of caries exposure were not independent of periodontal status. The strength and direction of association varied between groups, even for measures specifically intended to avoid measuring tooth loss. Individuals with impaired periodontal health (community periodontal index [CPI] 3 or higher in any sextant) had higher standardized decayed and filled surfaces (DFS; number of DFS divided by total number of tooth surfaces) in GLIDE (incidence risk ratio [IRR] 1.05 [95% CI: 1.04, 1.07], but lower standardized DFS in KNHANES (IRR: 0.95 [0.92, 0.98]) than individuals with better periodontal health (CPI <3 in all sextants).ConclusionsIncident tooth loss is a complex measure of dental disease, with multiple determinants. The relative importance of dental caries and periodontal disease as drivers of tooth loss differs between age groups. Measures of dental caries exposure are associated with periodontal status in the studied populations, and these associations can be population‐specific. Consideration of the study‐specific properties of these metrics may be required for valid inference in large population studies.
Highlights
Associations between oral health and health status are of interest to the public, clinicians and the research community
Observational studies report dental caries and periodontal disease are the most common indications for the extraction of permanent teeth, but the relative importance may change between studies with evidence for effects of age, period, and population.[8,9,10,11,12,13]
Studies examining tooth loss would ideally be designed to allow the relative importance of dental caries and periodontal disease to vary between populations and older and younger participants in the same population
Summary
Associations between oral health and health status are of interest to the public, clinicians and the research community. Epidemiological studies investigating these relationships require measures of oral disease, which ideally would be comprehensive, specific and validated. Several studies have reported that having fewer teeth at baseline or losing teeth during study follow-up increases the risk of a range of adverse health outcomes.[1,2,3,4,5,6,7] While there is growing interest in tooth loss as an epidemiological measure of dental status, valid inference from these studies requires an understanding of what is represented by tooth loss. Observational studies report dental caries and periodontal disease are the most common indications for the extraction of permanent teeth, but the relative importance may change between studies with evidence for effects of age (the reasons for tooth loss differ between age groups), period (the reasons for tooth loss change with time), and population (the reasons for tooth loss differ by socioeconomic-status and culture).[8,9,10,11,12,13] studies examining tooth loss would ideally be designed to allow the relative importance of dental caries and periodontal disease to vary between populations and older and younger participants in the same population
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