Tooth Loss and Nutritional Status in Older Adults: A Systematic Review and Meta-analysis

Abstract

Background/Objective: Older adults are at risk for tooth loss and compromised nutritional status. Our objective was to conduct a systematic review and meta-analysis to answer the following question: Among adults aged ≥60 y living in developed countries, what are the associations between tooth loss and nutritional status as assessed by a validated nutrition screening or assessment tool? Methods: PRISMA guidelines were followed. PubMed, Scopus, CINAHL, Web of Science, and MEDLINE were searched for studies published in English between 2009 and 2019 that met inclusion criteria. Data extracted included study and participant characteristics, dentition, and nutritional status. Risk of bias was assessed with a modified Newcastle-Ottawa Scale. Random effects meta-analysis was used. Results: Of the 588 unduplicated articles identified, 78 were reviewed in full text, and 7 met inclusion criteria. Six studies were combined for a meta-analysis, which revealed that individuals who were completely edentulous or who lacked functional dentition had a 21% increased likelihood of being at risk of malnutrition or being malnourished, as compared with those who were dentulous or had functionally adequate dentition (risk ratio, 1.21; 95% CI, 1.11 to 1.32; I2 = 70%). Whether the article statistically adjusted for medical history explained most of the heterogeneity in the pooled effect. Conclusions and Implications: Findings suggest that older adults with tooth loss are at greater risk of malnutrition than those with functionally adequate dentition. Use of validated tools to assess risk of malnutrition in older adults with tooth loss is important to promote early intervention and referral to optimize nutrition and oral health status. Findings were limited by heterogeneity, risk of bias, and overall quality of the studies reviewed. Cohort studies that adjust for known confounders and use consistent approaches to assess tooth loss and nutritional status are needed. Knowledge Transfer Statement: The results of this study suggest that older adults with tooth loss are at greater risk of malnutrition than those with functionally adequate dentition. Screening of this population for malnutrition by health care professionals, including dentists and dietitians, may result in corresponding referrals to optimize nutrition and oral health status. Further research is needed with consistent approaches to assess tooth loss and nutritional status.

Tooth loss, dental prostheses use and cognitive performance in older Brazilian adults: The SABE cohort study

“…The attenuation of the within-person differences in cognitive decline between individuals with and without dentures after adjusting for BMI could be supported by the aforementioned nutritional pathway. Tooth loss has been associated with nutrient intake and nutritional status, 4 and although the use of dental prostheses might not fully compensate for the masticatory function, it can mitigate its impact on nutrition by favoring food selection and nutrient intake. 23 Besides difficulties in eating, tooth loss without replacement can affect social aspects of daily living, such as embarrassment when smiling, laughing or showing their teeth, and speech problems.…”

“…2 The associated significant financial and human costs to countries, societies, families and individuals pave the way to the need for further research aimed at identifying potential modifying risk factors to prevent or minimize cognitive decline and dementia. 1 A growing body of evidence suggests a relationship between cognitive impairment and dementia with tooth loss, as the latter is associated with various general health outcomes, such as diabetes 3 and nutrition, 4 that are known risk factors affecting cognitive decline. 5 However, previous systematic reviews found that this relationship is inconclusive, [6][7][8] highlighting the low-grade level of evidence and the need for further well-designed longitudinal studies.…”

Tooth Loss Is Associated with Disease-Related Parameters in Patients with Rheumatoid Arthritis and Ankylosing Spondylitis—A Cross-Sectional Study

“…However, tooth loss is a complex problem, potentially causing different effects. Nutrition is especially affected by the presence of remaining teeth, and tooth loss increases risk of malnutrition [ 26 ]. This might also increase RA disease activity, which is influenced by dietary factors as well [ 27 ].…”

Common Medical and Dental Problems of Older Adults: A Narrative Review

“…Missing front teeth affects aesthetics and speech while multiple missing teeth affects chewing function [68]. Tooth loss resulted in edentulism or lack of functional dentition affects nutritional intake and poses an increased risk of malnutrition by 21% [71]. Tooth loss can provoke negative impacts on social status, self-esteem and oral health-related quality of life [72].…”