Social isolation, loneliness and accelerated tooth loss among Chinese older adults: A longitudinal study

Abstract

Objective Social isolation and loneliness have been linked to numerous determinants of health and well‐being. However, the effects of social isolation and loneliness on oral health remain unclear. The purpose of this study was to examine the effects of social isolation and loneliness on the number of remaining teeth and the rate of tooth loss over time among Chinese older adults. Methods We used three waves of data (2011/2012, 2014 and 2018) from the Chinese Longitudinal Healthy Longevity Survey with 4268 older adults aged 65 and older who were interviewed in at least two waves. The number of remaining teeth was first evaluated at baseline and then subsequently at follow‐up visits. Mixed‐effects Poisson regression was used to examine the associations between social isolation, loneliness, and both the number of remaining teeth and the rate of tooth loss. Results Social isolation was associated with fewer remaining teeth (β = −.06, 95% CI = −0.13 to 0.00, p < .05) and accelerated tooth loss (β = −.02, 95% CI = −0.02 to −0.01, p < .01) after adjusting for sociodemographic covariates, lifestyle and oral hygiene behaviours, physical and cognitive health, and loneliness. Loneliness was neither associated with the number of remaining teeth (β = .15, 95% CI = −0.01 to 0.30, p = .06) nor with the rate of tooth loss (β = −.01, 95% CI = −0.02 to 0.00, p = .16) after adjusting for all other factors. Conclusions This study provides strong evidence that social isolation was associated with fewer remaining teeth and accelerated tooth loss among Chinese older adults. These findings expand our knowledge about the impact of social disconnection on tooth loss. More future studies are needed to further examine the associations between social connections and oral conditions using longitudinal cohort studies and intervention studies.

Poor Mental Health Days as a Risk Factor for Decreased Oral Healthcare Utilization and Poorer Oral Health Outcomes

“…The direction and mechanism behind the epidemiologic associations between poor mental health (MH) and poor oral health (OH) have historically been elusive, but recent large epidemiologic studies have shed light on the subject [1][2][3][4]. Much of the challenge lies in the diversity of classi cation of "poor MH" as well as "poor OH" across studies.…”

“…On the other hand, "poor MH" could simply be de ned as experiencing social isolation and/or loneliness [2]. A cross-sectional analysis of data from the English Longitudinal Study of Ageing (ELSA) found that after controlling for confounding, the odds of loneliness were 1.48 higher among those with at least one oral health impact on daily life (compared to no impacts), and found that increasing loneliness was associated with increasing risk of additional oral health impacts [3].…”

“…In this study, loneliness was measured through three Likert scale items, and oral health impacts were measured using the Oral Impacts on Daily Performances (OIDP) scale [3]. A very similar analysis was done using three waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) data to assess the impact of social isolation and loneliness on incident tooth loss [2]. In this study, social isolation was de ned using four criteria, and loneliness was measured using one Likert-scale item [2].…”

“…A very similar analysis was done using three waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) data to assess the impact of social isolation and loneliness on incident tooth loss [2]. In this study, social isolation was de ned using four criteria, and loneliness was measured using one Likert-scale item [2]. As the dependent variable used in regression models in this study was "number of remaining teeth", although their results clearly demonstrated that higher levels of social isolation and loneliness at baseline were statistically signi cantly associated with accelerated tooth loss in subsequent years, it is di cult to interpret their numerical results clinically [2].…”

“…Considering these ndings, Fig. 1 presents a potential explanation for the overall mechanism implicating poor MH as a cause of poor OH outcomes [2].…”