Severe Tooth Loss Research Articles

Multimorbidity and tooth loss: data from Chilean National Health Survey 2016–2017

BackgroundOral diseases are a significant global public health challenge. Current evidence indicates that several chronic conditions are individually associated with tooth loss. People are living with more than one chronic condition, known as multimorbidity (MM). Considering the common risk factors for oral and chronic diseases, this study aimed to evaluate the association between MM and tooth loss in the Chilean population.MethodsCross-sectional study with secondary data from the latest Chilean National Health Survey (ENS 2016-17). The number of remaining teeth was classified into four groups: functional dentition (≥ 20 remaining teeth), moderate tooth loss (10 to 19), severe tooth loss (1 to 9), and edentulism (0). MM was defined based on the number of chronic conditions as a binary variable (MM≥ 2) and as a 4-level categorical variable (MMG0−G3), G0: none, G1: 1, G2: 2–4, and G3: ≥5 conditions. Stratified analysis by age group (< 65, ≥ 65 years) was performed. Mean and SD were calculated for crude and adjusted remaining teeth. Significance level was set to 0.05. Prevalence ratios were estimated with Poisson regression models with robust variance, crude and adjusted for sex, age, geographic area, and educational level. Logistic regressions models were fitted to calculate odds ratios as a sensitivity analysis.ResultsOf 4,151 adults aged 17–98, 54.9% had MM and the prevalence of moderate, severe tooth loss and edentulism was 25.4%, 6.9% and 4.8% respectively. Adults aged ≥ 65 years with MM≥ 2 were 1.66 [1.04–2.66] times more likely to have severe tooth loss than those without MM. Adults aged < 65 years with MMG3 were 1.76 [1.12–2.77] times more likely to have moderate tooth loss and 2.55 [1.02–6.36] times more likely to have severe tooth loss than those without MM.ConclusionsIn this study, we found statistically significant associations between the number of chronic conditions and moderate/severe tooth loss in both analyzed age groups. These findings highlight the need to provide oral health care for adults with multimorbidity using a person-centred model and to seek strategies to prioritize health care.

Oral health in patients with inflammatory bowel disease: A cross-sectional survey in Sweden.

The aim of this cross-sectional survey was to assess oral health, including prevalence of periodontitis and rate of tooth loss, in a Swedish cohort of patients with inflammatory bowel disease (IBD). A questionnaire on general anamnestic and socio-economic aspects, IBD diagnosis, and various oral health aspects was distributed online. The analyses focused on the comparison between patients diagnosed with ulcerative colitis (UC) or Crohn's disease (CD) as well as on factors associated with self-reported severe periodontitis and tooth loss. Analyses were based on answers from 786 patients; 415 with UC, 371 with CD, 74% female. In both disease entities, high prevalence of severe periodontitis (i.e., 38.5%) was reported, and about 19% of the population had less than 20 remaining teeth and 6.5% a poor oral health-related quality of life. CD patients tended to be more severely affected than UC patients (p > 0.05 in the adjusted analysis). Almost 90% of CD patients were aware of being entitled to a bi-annual governmental financial support for dental care due to IBD; however, 1 out of 4 UC patients did not. Furthermore, IBD patients largely believe that the interest of their physicians in any oral lesions due to IBD diagnosis is low. Severe periodontitis and high rate of tooth loss are frequent in Swedish IBD patients. Even though IBD patients receive bi-annually some special financial support for dental care, it seems this is still not sufficient and more preventive measures appear necessary.

Association between tooth loss and depression mediated by lifestyle and Inflammation- a cross-sectional investigation

BackgroundDepression and tooth loss are associated with the occurrence of systemic disease or the progression of multi-factorial disease, and both are considered important public health issues by World Health Organization (WHO). Previous research just suggested that tooth loss can generate psychological stress, low self-esteem, anxiety and other emotional disturbances. However, the precise correlation and underlying mechanisms between depression and tooth loss remains poorly understood. ​Consequently, we aim to explore the association between depression and tooth loss through a cross-sectional study, as well as investigate potential pathways of influence.MethodsWe analyzed data from the National Health and Nutrition Examination Survey (NHANES). Logistic regression models were employed to examine the relationship between depression and tooth loss, as well as the associations among healthy lifestyle, systemic immune-inflammation index (SII), depression and tooth loss. Through the mediating effect analysis by bootstrapping analysis, we evaluated the mediating effects of healthy lifestyle and SII between depression and tooth loss.ResultsDepressed patients were more likely to be toothless, and at the same time showed a tendency to have more missing teeth, with odds ratio (OR) = 1.305 (1.098, 1.551), p = 0.003 for 1–7 missing teeth, OR = 1.557 (1.166, 2.079), p = 0.003 for 8–14 missing teeth, and OR = 1.960 (1.476, 2.603), p<0.001 for 15–28 missing teeth. Lower healthy lifestyle scores and higher SII were both associated with more tooth loss. Healthy lifestyle and SII played a partial mediating role in this relationship, with a mediating effect ratio of 41.691% and 3.289%, respectively.Conclusions​Depression was positively associated with more severe tooth loss, which was partly mediated by lifestyle and SII. Therefore, attention should also be paid to the effects of depression as a mental disorder on physical health, such as depression and tooth loss. Adopting a healthier lifestyle and controlling systemic inflammation may be potential ways to reduce the impact of depression and tooth loss.

Tobacco smoking and tooth loss in adults and elderly in Brazil: a populational-based cross-sectional study.

To determine the association between smoking and tooth loss in individuals aged 18 years or more living in Brazil. Secondary analysis of the 2019 Brazilian National Health Survey data. The outcome was self-reported tooth loss, and the main independent variable was tobacco smoking. Family income, schooling, sex and age were covariates. Multiple linear regression analysis determined the association between tobacco smoking and the number of missing teeth and then the average number of missing teeth was predicted according to smoking status. The mean number of missing teeth in 88,531 individuals aged 18 or more was 7.7 (95%CI: 7.6-7.8). At least one missing tooth was identified in 72.0% (95%CI: 71.4-72.6) of the population, 21.3% (95%CI: 20.9-21.7) had a non-functional dentition, 14.2% (95%CI: 13.9-14.6) had severe tooth loss and 10.3% (95%CI: 10.0-10.6) were edentulous. The adjusted regression coefficients for number of missing teeth showed that current or former smokers, individuals with low family income and schooling, older age and females exhibited higher tooth loss. Current and former smokers had 1.40 (95%CI: 1.35-1.46) and 1.13 (95%CI: 0.54-0.98) times more lost teeth than never smokers, respectively. Both tooth loss and smoking are common in Brazilians and are associated. Unfavorable socioeconomic status and demographic factors also predict tooth loss.

Associations of tooth loss with risk of all-cause and cause-specific mortality among US adults with diabetes mellitus

ObjectivesTo determine whether tooth loss affects all-cause and cause-specific mortality in a nationally representative sample of adults with diabetes mellitus (DM) in the United States. MethodsThis prospective cohort study involved 8207 participants aged 30 years or older at baseline, all diagnosed with diabetes mellitus and enrolled in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. Tooth loss was stratified into 28 teeth (complete), 20–27 teeth (tooth loss), 9–19 teeth (lacking functional), 1–8 teeth (severe tooth loss) and edentulism. To estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for all-cause and specific-cause mortality in diabetes mellitus participants according to tooth loss, multivariate cox proportional hazards regression models were used. Relationships between mortality and quartiles of mean tooth loss levels were analyzed, with the lowest quartile as the baseline for comparisons. ResultsDuring a median of 6.92 years of follow-up, 2317 deaths were documented. After multivariate adjustments, higher tooth loss levels were significantly and non-linearly associated with higher risks of all-cause, CVD-related and DM-related mortality among participants with DM. When compared with the reference group of mean tooth loss levels, the highest quartile showed significantly increased risks: all-cause mortality (HR, 2.11; 95 % CI, 1.53–2.91, P-trend < 0.001), CVD-related mortality (HR, 3.24, 95 % CI, 1.54–6.85, P-trend < 0.001) and DM-related mortality (HR, 2.78, 95 % CI, 1.15–6.68, P-trend < 0.001). ConclusionsTooth loss is associated with an increased risk of all-cause, CVD-related and diabetes mellitus mortality among adults with diabetes mellitus in the US. Clinical SignificanceThis study presents evidence for physicians and dentists that higher tooth loss was significantly associated with increased risk of all-cause, CVD-related and diabetes mellitus mortality in a dose-response manner among adults with diabetes mellitus. Therefore, assessment of survival in individuals with diabetes mellitus could pay attention to the tooth loss.

Social Network Size and Severe Tooth Loss among Persons With Diabetes: Findings From the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

Aims: The aims of this study were to examine the association of social network size with severe tooth loss and the number of missing teeth among Hispanic adults with diabetes in the United States and to assess whether the association varied by glycemic control. Methods: Data obtained from 1,007 adults who participated in the Hispanic Community Health Study were analyzed. Structural social support was measured with the Social Network Index (SNI), which assessed network size and frequency of social contacts. Tooth loss was measured by a count of the number of missing teeth and categorically as severe tooth loss (<9 remaining teeth). Descriptive statistical analyses were conducted to examine the sample characteristics. Logistic and negative binomial regression analyses were performed to examine the independent association between SNI and tooth loss and to test whether the association was modified by the glycemic target. Results: The prevalence of severe tooth loss was 5.91%. For each one-unit increase in SNI, the expected log count of the number of missing teeth was reduced by 3.3% (p-value: 0.037). Conclusions: In this study, a larger social network size was associated with fewer missing teeth among Hispanic persons living with diabetes. Further examination of social support and oral health is warranted.

Factors associated with severe tooth loss in Korean adults

Factors associated with severe tooth loss in Korean adults

Data-driven prediction model for periodontal disease based on correlational feature analysis and clinical validation

ObjectivesThis study aimed to investigate the performance and reliability of data-driven models employing correlational feature analysis and clinical validation for predicting periodontal disease. MethodsThe 7th Korea National Health and Nutrition Examination Survey (n = 10,654) was used for correlation analysis to identify significant risk factors for periodontitis. Periodontal prediction models were developed with the selected factors and database, followed by internal validation with 5-fold cross-validation and 1000 bootstrap resampling. External validation was conducted with clinical data (n = 120) collected through self-reported questionnaires, clinical periodontal parameters, and radiographic image analysis. Predictive performance was assessed for logistics regression, support vector machine, random forest, XGBoost, and neural network algorithms using the area under the receiver operating characteristic curves (AUC) and other performance metrics. ResultsCorrelation analysis identified 16 features from over 1000 potential risk factors for periodontitis. The best data-driven model (XGBoost) showed AUC values of 0.823 and 0.796 for internal and external validations, respectively. Modeling with clinical data revealed those same measures to be 0.836 and 0.649, respectively. In addition, the data-driven model could predict other clinical periodontal parameters including severe bone loss (AUC = 0.813), gingival bleeding (AUC = 0.694), and tooth loss (AUC = 0.734). A patient case study about prognostic predictions revealed that the probability of periodontitis can be reduced by 6.0 % (stop smoking) and 0.6 % (stop drinking) on average. ConclusionsData-driven models for predicting periodontitis and other periodontal parameters were developed from 16 risk factors, demonstrating enhanced prediction performance and reproducibility in internal–external validations.

Disparities of Delayed Dental Visits and Severe Tooth Loss Among Older Native Hawaiians and Other Pacific Islanders in Hawai'i: A Cross-Sectional Study of Behavioral Risk Factor Surveillance System Data from 2012 to 2020.

Oral health is a major health concern in the US and globally, particularly among communities of color and low-income/low-education groups. General health disparities have been reported among Native Hawaiians (NHs) and Other Pacific Islanders (OPIs), although less is known about the specific racial/ethnic and socioeconomic trends that are relevant to oral health disparities for NHOPIs. We examined delayed dental visits and severe tooth loss among older NHOPI adults in relation to sociodemographic factors and community level disparities using five waves of data from the Hawai'i Behavioral Risk Factor Surveillance System collected between 2012 and 2020. Weighted Poisson regression was used to estimate the unadjusted and adjusted prevalence ratio of delayed dental service utilization and severe tooth loss. Relative to other racial/ethnic groups, older NHs had higher rates of delayed dental service utilization and severe tooth loss after adjusting for sociodemographic factors, and disparities were also found in rural communities.Awareness of the unique challenges and inequities faced by older Indigenous and racially/ethnically marginalized populations is critical for policymakers to develop strategies to achieve health equity.

Tooth Loss and Chronic Pain: A Population-based Analysis of the National Health and Nutrition Examination Survey

Poor oral health conditions in adults are associated with chronic pain. A nationwide cross-sectional study was conducted to investigate the link between tooth loss and chronic pain. The study involved 8,662 participants from the National Health and Nutrition Examination Survey. Tooth count was categorized into 4 groups, and chronic pain was defined as persistent pain lasting over 3 months despite treatment. Location of the chronic pain, demographics, comorbidities, lifestyle determinants, and dietary intake were retrieved. Univariate and multivariate logistic regression were used to explore cross-sectional associations between tooth count and chronic pain. Compared to participants with more than 20 teeth, those with severe tooth loss presented greater odds of chronic pain (adjusted odds ratio [aOR] = 2.111, 95% confidence intervals (CI) = 1.213–3.676 for patients with 1–8 teeth). Edentulous participants presented with significantly higher odds of chronic pain in the lower extremities (78.4%) and buttocks (49.5%). In the multivariate model, apart from rheumatic arthritis (aOR = 4.004, 95% CI = 2.766–5.798), variables of higher chronic pain included smoking (aOR = 1.518, 95% CI = 1.228–1.878), and hypertension (aOR = 1.463, 95% CI = 1.013–2.112). On the contrary, being Mexican American (aOR = .603, 95% CI = .414–.880) was associated with lower odds of chronic pain. The findings suggested a significant link between chronic pain and tooth loss, independent of ethnicity, lifestyle determinants, and immune-mediated inflammatory diseases including rheumatoid arthritis. PerspectiveA U.S. nationwide study examined tooth loss and chronic pain. Those with severe tooth loss had increased odds of chronic pain. Edentulous individuals presented higher odds of pain in lower extremities and buttocks. This study highlighted the link between tooth loss and chronic pain, independent of comorbidities and lifestyle factors.

Association between tea types and number of teeth: a cross-sectional study of the Chinese Longitudinal Healthy Longevity Survey

BackgroundPrevious studies have suggested that tea consumption may have a positive impact on oral health. However, the effects of different tea types on oral health remain unclear. Therefore, this study aimed to determine the association between residual teeth and consumption habits of different types of tea (green tea, black tea, oolong tea, and scented tea) in older adults.MethodsWe conducted a secondary analysis using data from the Chinese Longitudinal Healthy Longevity Survey in 2018. In a sample of 6,387 older adults, we performed logistic regression analysis to examine the relationship between persistent tea consumption and oral health according to sex and brushing frequency. The indices for particularly healthy oral health and relative health were set at more than 20 teeth and more than 10 teeth, respectively.ResultsThe study included 2,725 males and 3,662 females, both aged 65 and older. Among individuals with more than 20 teeth, drinking green tea significantly improved oral health in men (adjusted odds ratio [ORs]: 1.377; 95% confidence interval [CI]: 1.082–1.752) and drinking black tea significantly improved the oral health of women (ORs: 2.349, 95%CI: 1.028–5.366). In the daily brushing group, green tea had a significant beneficial effect on increasing the number of teeth in men and black tea had a significant beneficial effect in women. Among individuals with more than 10 teeth, drinking green tea significantly improved oral health in men (ORs: 1.539; 95% CI: 1.209–1.959) and drinking green tea and scented tea significantly improved the oral health of women (ORs: 1.447, 95%CI: 1.052–1.991; ORs: 1.948, 95%CI: 1.137–3.340). In the daily brushing group, consumption of green tea and black tea had significant beneficial effects on increasing the number of teeth in men, whereas that of green tea, black tea, and scented tea had significant beneficial effects in women.ConclusionLong-term green tea consumption in males and black tea consumption in females were significantly associated with maintaining functional dentition (≥20 teeth). Similarly, long-term green tea consumption in males and green tea and scented tea consumption in females were associated with avoiding severe tooth loss (≥10 teeth). Furthermore, in the daily tooth brushing group, long-term consumption of black tea was associated with avoiding severe tooth loss in both sexes. However, tea consumption alone had no effect on oral health without good brushing habits.

Frailty mediated the association between tooth loss and mortality in the oldest old individuals: a cohort study.

Tooth loss is associated with increased mortality risk; however, the mechanism underlying this is still not clear. The objective of this study was to explore whether frailty mediates the association between tooth loss and mortality risk among the oldest old individuals. The participants were followed up from 1998 to 2018 in the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Frailty was constructed following a standard procedure. Mortality, frailty, and tooth loss were applied as the outcome, mediator, and independent variables, respectively. The Cox model was fitted, including possible confounders, for causal mediation analysis. A total effect (TE), an average causal mediation effect (ACME), an average direct effect (ADE), and a proportion mediated (PM) effect were calculated. During the 129,936 person-years at risk, 31,899 individuals with a mean age of 91.79 years were included. The TE and ADE of severe tooth loss on mortality were 0.12 (95% CI: 0.08, 0.15) and 0.09 (95% CI: 0.05, 0.13); the ACME of frailty was 0.03 (95% CI: 0.02, 0.03) with 21.56% of the TE being mediated. This study illustrated that tooth loss is associated with mortality, and frailty appeared to mediate the relationship. It is recommended that oral health indicators and frailty status be incorporated into routine geriatric assessments to promote optimal oral health and non-frailty status.

Dietary oily fish intake is inversely associated with moderate-to-severe intracranial artery stenosis in older adults of indigenous Ecuadorian ancestry

Background and aimsInformation on the association between dietary oily fish intake and intracranial atherosclerosis is limited and contradictory. Inconsistencies might be in part related to heterogeneous designs and differences in race/ethnicity of study populations. We aim to assess whether oily fish intake is inversely associated with intracranial artery stenosis (ICAS) in frequent fish consumers of indigenous ancestry living in coastal Ecuador. MethodsThe study included 384 participants aged ≥60 years enrolled in the Atahualpa Project Cohort. Dietary oily fish intake was quantified systematically via validated surveys and all participants received a time-of-flight MRA of intracranial vessels. Poisson regression models, adjusted for demographics, level of education, traditional risk factors and severe tooth loss, were fitted to assess the association between amounts of oily fish intake and the number of intracranial arteries with moderate-to-severe (≥50 %) stenosis. ResultsParticipants had a mean age of 67.7 ± 7 years, and 56 % were women. The mean oily fish intake was 8.9 ± 5.2 servings/week; 283 (74 %) participants consumed ≥5.2 servings/week (2nd to 4th quartiles of fish intake). Forty-three (11 %) participants had at least one major intracranial artery with moderate-to-severe stenosis. Both univariate and multivariate models showed a significant inverse association between consumption of oily fish in the 2nd to 4th quartiles and ≥50 % stenosis in at least one artery (β: 0.46; 95 % C.I.: 0.27–077, and β: 0.52; 95 % C.I.: 0.30–0.90, respectively). ConclusionsConsumption of more than five oily fish servings/week is associated with lower prevalence of moderate-to-severe ICAS in indigenous Ecuadorians.

Dental prosthesis use moderates association between tooth loss and risk of depressive symptoms in older adults with severe tooth loss: The JAGES cohort trial.

Depression is a leading cause of disability. Although tooth loss increases the risk of depressive symptoms, it is unclear whether dental prosthesis use moderates this risk. This study aimed to investigate whether dental prosthesis use moderates the association between tooth loss and new depressive symptoms in older adults. This cohort study used data from the 2016 and 2019 Japan Gerontological Evaluation Study (JAGES). The participants were independent older adults aged ≥65 years without depressive symptoms in 2016. The onset of depressive symptoms in 2019 was the outcome variable. The explanatory variables were dental status (≥20 teeth, 10-19 teeth with or without dental prostheses, and 0-9 teeth with or without dental prostheses) in 2016. Risk ratios (RRs) and 95% confidence intervals (CIs) were estimated using Poisson regression models with potential confounders as covariates. The analysis included 50,169 participants (mean age: 72.8 [standard deviation, 5.4] years). During follow-up, the incidence of depressive symptoms was 11.3%. Compared to those who had ≥20 teeth, the RR of depressive symptom onset was highest among those who had 0-9 teeth without dental prostheses (RR, 1.27; 95% CI, 1.04-1.56), after the adjustment for confounders. However, this risk was lower in those with 0-9 teeth and dental prostheses (RR, 1.08; 95% CI, 1.01-1.15). These data highlight the potential of dental prostheses as an important factor in reducing the risk of depressive symptoms among individuals with severe tooth loss.

Oral Rehabilitation with Removable Partial Denture in a Patient with a Maxillary Defect Caused by a Firearm

The use of Removable Partial Denture (RPD) for the oral rehabilitation of patients who have suffered facial trauma and consequent tooth loss of several elements, serves as an alternative for replacing hard and soft tissues, as well as providing aesthetic and functional support. Facial trauma related to firearm injuries is a challenge for the surgical team, both in planning and during surgery, due to the destruction of anatomical planes and the multifragmentation of soft tissues and bone. The aim of this study is to report on the oral rehabilitation using removable prostheses of a patient who had suffered firearm trauma. Patient F. B. C., 30 years old, male, normosystemic, attended the postgraduate dental prosthesis clinic at Unichristus with the aim of rehabilitation after a firearm trauma. During the clinical assessment, a bone defect was observed in the anterior region of the maxilla, with the loss of several teeth and part of the alveolar bone structure. The plan was designed to rehabilitate the extensive bone loss caused by the trauma, through the use of an RPD, to promote the return of masticatory function, the patient's facial aesthetics and soft tissue support. The prosthesis was designed to use the remaining posterior teeth as a support and means of retention, aided by full coverage of the palate in order to bring more stability and comfort to the patient. At the end of the treatment, the aesthetic and functional aspects were restored, showing that this type of prosthesis is an alternative for rehabilitation in this type of case

Experimental study on new structure teeth in a high-temperature environment.

In high-temperature drilling, especially in high-temperature geothermal drilling, cone bits often experience common and severe tooth loss. This issue significantly reduces the cone bit's service life and has a detrimental impact on drilling efficiency. The quality of the fixed teeth plays a crucial role in the performance of the cone bit. In high-temperature environments, conventional methods fail to meet the requirements for securing the cone bit's teeth. Therefore, to address the tooth loss problem in high-temperature drilling, a new tapered tooth structure is proposed. Laboratory experiments were conducted to secure teeth with varying tapers at both normal and high temperatures. The results revealed that the maximum fastening force increased progressively with the degree of taper, reaching its peak at C50. Compared to conventional cylindrical teeth, the maximum fastening force increased by approximately 88.6%-271.1% at different temperatures. The tapered structure demonstrated superior tooth-fixing strength. The maximum fastening force is the smallest at 300 °C, approximately 23.7%-61.2% lower than at normal temperature. Under the same interference conditions, the maximum fastening force increased with greater taper. With interference values of 0.075, 0.095, and 0.115, the maximum fastening force increased by 48.9%-175.1%, 14%-141.6%, and 53%-271.1%, respectively, when compared to cylindrical teeth with C300, C200, C100, and C50 tapers. The tapered structure exhibited superior tooth-fixing strength and significantly enhanced tooth retention strength at high temperatures.

Diagnosis and minimally invasive management of erosive tooth wear

Tooth wear is a very common dental condition. The extent of wear sometimes can be catastrophic with severe tooth tissue loss which may result in poor esthetics. Main three types of wear are attrition, abrasion, erosion. Attrition is wear of teeth by the opposing teeth. Abrasion is wear of teeth by faulty tooth brushing. Erosion is wear of teeth by some acids. The aim of this article is diagnosis and prevention to avoid loss of tooth tissue, structural damage and which may lead to extensive restorative treatment.

Last dental visit and severity of tooth loss: a machine learning approach

The aims of the present study were to investigate last dental visit as a mediator in the relationship between socioeconomic status and lack of functional dentition/severe tooth loss and use a machine learning approach to predict those adults and elderly at higher risk of tooth loss. We analyzed data from a representative sample of 88,531 Brazilian individuals aged 18 and over. Tooth loss was the outcome by; (1) functional dentition and (2) severe tooth loss. Structural Equation models were used to find the time of last dental visit associated with the outcomes. Moreover, machine learning was used to train and test predictions to target individuals at higher risk for tooth loss. For 65,803 adults, more than two years of last dental visit was associated with lack of functional dentition. Age was the main contributor in the machine learning approach, with an AUC of 90%, accuracy of 90%, specificity of 97% and sensitivity of 38%. For elders, the last dental visit was associated with higher severe loss. Conclusions. More than two years of last dental visit appears to be associated with a severe loss and lack of functional dentition. The machine learning approach had a good performance to predict those individuals.

Cognitive performance and all-cause mortality in community dwellers of Amerindian ancestry living in rural Ecuador: A population-based, longitudinal prospective study

ObjectiveThere is limited information on mortality risk in individuals with cognitive impairment living in rural Latin America. In this study, we assess the association between cognitive impairment and all-cause mortality in adults of Amerindian ancestry living in rural Ecuador. Patients and methodsMiddle-aged and older adults enrolled in the population-based Three Villages Study cohort were followed prospectively in order to estimate mortality risk according to their baseline cognitive performance as determined by the Montreal Cognitive Assessment (MoCA). Results were adjusted for demographics, level of education, traditional cardiovascular risk factors, symptoms of depression, severe tooth loss, and oily fish intake (factors previously associated with mortality in the study population). ResultsAnalysis included 1022 individuals followed for an average of 7.8 ± 3.4 years. Mean MoCA score was 21.2 ± 5.4 points (median: 22 points), with 334 (32.7%) individuals showing cognitive impairment, as evidenced by a MoCA score ≤ 19 points (the cutoff for poor cognitive performance based on previous studies in the same population). A total of 150 (14.7%) individuals died during the follow-up. Crude mortality rate was 2.87 per 100 person-years (95% C.I.: 2.08 – 3.96). For individuals with normal cognition, the mortality rate was 1.21 (95% C.I.: 0.92 – 1.50) while for those with cognitive impairment the rate increased to 3.48 (95% C.I.: 2.73 – 4.23). A multivariate Cox-proportional hazards model, confirmed that individuals with cognitive impairment had a significantly higher mortality risk than those without cognitive impairment (HR: 1.52; 95% C.I.: 1.05 – 2.18). ConclusionsCognitive impairment is associated with mortality in the study population.

Association between tooth loss and frailty among Chinese older adults: the mediating role of dietary diversity

BackgroundThis study aimed to examine the association between tooth loss and frailty among Chinese older adults and the mediating role of dietary diversity in this association.MethodsData from five waves of the Chinese Longitudinal Healthy Longevity Survey conducted between 2005 and 2018 were used. Path analyses were employed to assess both concurrent and cross-lagged relationships between tooth loss and frailty index while accounting for intrapersonal correlation. Furthermore, the mediation effect of dietary diversity was also examined.ResultsIn concurrent models, severe tooth loss was associated with frailty after adjusting for demographic characteristics (odds ratio [OR] = 1.82, p < 0.001). The OR of frailty for severe tooth loss was only slightly decreased to 1.74 (p < 0.001) when dietary diversity was added to the model and to 1.64 (p < 0.001) when socioeconomic status, family support, and healthy lifestyles were further adjusted. In the cross-lag or longitudinal models, the ORs were mildly or moderately reduced to 1.29, 1.27, and 1.23, respectively, yet remained statistically significant (p < 0.001 or p < 0.01). The mediation analyses showed that dietary diversity had some small yet significant effects on the relationship between tooth loss and frailty in both concurrent and longitudinal settings.ConclusionsThis study improves current knowledge regarding the impact of tooth loss on frailty among Chinese older adults. Future intervention strategies designed to improve healthy diets may have preventive effects against the risk of frailty among Chinese older adults with severe tooth loss.