Association Between Tooth Loss, Body Mass Index, and All-Cause Mortality Among Elderly Patients in Taiwan

Abstract

To date, the effect of tooth loss on all-cause mortality among elderly patients with a different weight group has not been assessed. This retrospective cohort study evaluated the data obtained from a government-sponsored, annual physical examination program for elderly citizens residing in Taipei City during 2005 to 2007, and follow-up to December 31, 2010. We recruited 55,651 eligible citizens of Taipei City aged ≥65 years, including 29,572 men and 26,079 women, in our study. Their mortality data were ascertained based on the national death files. The number of missing teeth was used as a representative of oral health status. We used multivariate Cox proportional hazards regression analysis to determine the association between tooth loss and all-cause mortality. After adjustment for all confounders, the hazard ratios (HRs) of all-cause mortality in participants with no teeth, 1 to 9 teeth, and 10 to 19 teeth were 1.36 [95% confidence interval (CI): 1.15–1.61], 1.24 (95% CI: 1.08–1.42), and 1.19 (95% CI: 1.09–1.31), respectively, compared with participants with 20 or more teeth. A significant positive correlation of body mass index (BMI) with all-cause mortality was found in underweight and overweight elderly patients and was represented as a U-shaped curve. Subgroup analysis revealed a significant positive correlation in underweight (no teeth: HR = 1.49, 95% CI: 1.21–1.83; 1–9 teeth: HR = 1.23, 95% CI: 1.03–1.47; 10–19 teeth: HR = 1.20, 95% CI: 1.06–1.36) and overweight participants (no teeth: HR = 1.37, 95% CI: 1.05–1.79; 1–9 teeth: HR = 1.27, 95% CI: 1.07–1.52). The number of teeth lost is associated with an increased risk of all-cause mortality, particularly for participants with underweight and overweight.

Poor oral health affects survival in head and neck cancer

“…In a study of 21,700 elderly Japanese, tooth brushing and regular dental visits were associated with survival after controlling for age, sex, education level, smoking, drinking, and medical history. 26 Other studies have found an association between tooth loss and overall mortality in Danish, 27 Taiwanese, 28 Scottish, 29 French 30 and Chinese populations. 31 The mechanism is unclear and it has been suggested that markers of oral health such as tooth loss, visits to the dentist, and tooth brushing may serve as a proxy for life and health stressors that can affect mortality.…”

Having fewer than 21 teeth associated with poorer general health among South Australians

“…reported that tooth loss was positively associated with cognitive decline . The effect of tooth loss on body mass index and all‐cause mortality has also been demonstrated among elderly citizens in Taiwan . In a Finnish population‐based survey of over 8,000 persons with 13 years of follow‐up data, Liljestrand et al .…”

Number of natural teeth, denture use and mortality in Chinese elderly: a population-based prospective cohort study

“…A number of prospective studies have found an association between tooth loss and all-cause mortality, cardiovascular and cancer mortality [5][6][7][8][9][10][11]. Wearing dentures may reduce the mortality in older adults [7,12,13].…”