Multiple Chronic Diseases Associated With Tooth Loss Among the US Adult Population

Abstract

BackgroundHalf of US adults aged 20–64 years have lost at least one permanent tooth; one in six adults aged 65 and over in the USA is edentulous. Tooth loss and edentulism interfere with nutritional intake and quality of life. Although selected chronic diseases (e.g., diabetes) have been identified as possible risk factors for tooth loss, data on multiple chronic diseases and on having two or more concurrent chronic diseases (multimorbidity) in relation to tooth loss are lacking. Therefore, this study aimed to assess the association between multiple chronic diseases, multimorbidity, and tooth loss in US adults.MethodsWe performed a secondary data analysis using the US 2012 Behavioral Risk Factor Surveillance System (BRFSS), a national cross-sectional telephone survey studying health conditions and health behaviors among US adults (≥18 years) who are non-institutionalized residents. Variables were derived from the BRFSS Standard Core Questionnaire. Descriptive analysis including means, standard deviations (SDs), and percentages was calculated. Sample weights were applied. The stepwise multinomial logistic regression method was used to examine the relationship between several chronic diseases and tooth loss. Separate multinomial logistic regression models were used to examine the relationship between multimorbidity and tooth loss among all adults aged more than 18 years, adults aged 18–64 years, and adults aged more than 65 years, respectively.ResultsAmong the samples (n = 471,107, mean age 55 years, 60% female), 55% reported losing no tooth loss, 30% reported losing one to five teeth, 10% reported losing six or more but not all teeth, and 5% reported losing all teeth. After adjusting for demographic characteristics, socioeconomic status, smoking, BMI, and dental care, chronic diseases that were associated with edentulism were chronic obstructive pulmonary disease (COPD) [adjusted risk ratio (adj. RR) 2.18, 95% confidence interval (CI) 2.08–2.29]; diabetes (adj. RR 1.49, 95% CI 1.44–1.56); arthritis (adj. RR 1.49, 95% CI 1.44–1.54); cardiovascular disease (adj. RR 1.38, 95% CI 1.30–1.45); stroke (adj. RR 1.31, 95% CI 1.24–1.40); kidney disease (adj. RR 1.16, 95% CI 1.08–1.25); cancer (adj. RR 1.05, 95% CI 1.01–1.11); and asthma (adj. RR 1.07, 95% CI 1.02–1.12). For those who reported losing six or more teeth, the association remained significant for all the chronic diseases mentioned, albeit the magnitude of association appeared to be comparative or smaller. In addition, adults with multimorbidity were more likely to have tooth loss (loss of one to five teeth: adj. RR 1.17, 95% CI 1.14–1.19; loss of six or more teeth: adj. RR 1.78, 95% CI 1.73–1.82; edentulous: adj. RR 2.03, 95% CI 1.96–2.10).ConclusionsMultiple chronic diseases were associated with edentulism and tooth loss. People with multimorbidity are more likely to be edentulous than those with one or no chronic disease. The findings from this study will help to identify populations at increased risk for oral problems and nutritional deficits, thus the assessment of oral health should be evaluated further as an important component of chronic illness care.

Comparative Analysis of Edentulism in a Sample of Mexican Adults with and without Type 2 Diabetes

“…The present study confirmed that older age was associated with edentulism, as previously reported [ 8 , 20 , 21 , 36 ]. Tooth loss is considered an accurate marker of the population’s oral health and is therefore monitored in many countries.…”

“…This combination does not foretell the best outcomes for oral health, and it is likely/will likely be associated with a high edentulism experience [ 2 , 20 , 21 , 24 ]. In the present study, T2DM was a risk factor for edentulism as reported in other studies [ 8 , 9 , 21 , 34 , 36 ]. In recent years, the connection between oral health and systemic health has been widely recognized by the dental and medical professions.…”

“…In recent years, the connection between oral health and systemic health has been widely recognized by the dental and medical professions. Studies have been conducted revealing that oral health affects systemic health and vice versa, subject to the influence of inflammatory mechanisms [ 8 ], with molecular and immunological bases [ 22 ]. These diseases/conditions share common risk factors, so comprehensive promotion of general health and oral health focused on addressing unhealthy behaviors has the potential to reduce both dental disease rates, as well as mortality rates attributed to cardiovascular disease, cancer, and T2DM [ 19 ].…”

“…Documenting trends in tooth loss may help in planning dental care services and workforce needs [ 7 ]. Edentulism connotes a disability condition that reflects a personal history of severe oral disease and access to dental services throughout life [ 7 , 8 ]; such history is primarily driven by caries and periodontitis [ 9 , 10 , 11 ]. Tooth loss and edentulism negatively impact people’s nutritional intake.…”

“…Tooth loss and edentulism negatively impact people’s nutritional intake. People with more severe tooth loss may consume significantly fewer basic nutrients from fruits and vegetables, dietary fiber, and protein, compared to those without severe tooth loss [ 8 , 12 , 13 , 14 ]. Evidence from observational studies showed that tooth loss and edentulism may be associated with multiple adverse health effects [ 15 ].…”