Association of tooth loss with morbidity and mortality by diabetes status in older adults: a systematic review

Abstract

Objective This systematic review assesses the association of tooth loss (TL), as the exposure, with morbidity and mortality by diabetes mellitus (DM) status, as the outcome, in older adults. Background Individuals with DM have higher prevalence of severe TL and increased risk of developing morbidities and mortality. No systematic review has evaluated the association between TL with morbidity and mortality by DM status. Material and methods Comprehensive searches used multiple publication databases containing reports published between 01/01/2000 and 04/21/2021. Two authors independently evaluated included studies for quality and risk of bias using the Critical Appraisal Skills Programme (CASP) checklist for cohort and Center for Evidence-Based Medicine (CEBM) critical appraisal sheet for cross-sectional studies, while a third author arbitrated decisions to resolve disagreements. Results Thirteen studies met the inclusion criteria: eight cross-sectional and five cohort. Qualitative review of the included studies indicated TL is associated with increased incidence and prevalence of DM. TL is also associated with DM-related morbidities including greater prevalence of heart disease, diabetic retinopathy, metabolic syndrome; poorer health-related quality of life; poorer survival of participants with chronic kidney disease; and increased medical expenditure. Overall, the quality of the evidence reviewed was medium, as per the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence. Conclusions/practical implications This review found significant associations of TL with prevalence and incidence of DM and adverse DM-related outcomes. An interprofessional team-care approach that includes an oral health component could benefit the prevention and management of DM.

Tooth Loss and Caries Experience of Elderly Chileans in the Context of the COVID-19 Pandemic in Five Regions of Chile

“…Even though our study did not find other associations with a lack of functional dentition through the logistical regression of our data, systematic and longitudinal studies related tooth loss with obesity [ 13 , 62 , 63 ], depression [ 64 ] and diabetes [ 14 ]. It is noteworthy that the prevalence of socioeconomic vulnerability, whether measured in net terms (personal or family economic income) or multidimensional (RSH), continues to be a constant in studies that measure the severity of tooth loss.…”

“…Maintaining optimal oral health by preserving a natural, healthy and functional dentition contributes to the survival of older adults [ 9 ], since missing unreplaced teeth has been associated with an increase in the risk of malnutrition, frailty and cardiovascular mortality [ 10 ]. Likewise, an association with the decline in cognitive function, dementia, obesity, diabetes and hypertension has been reported [ 11 , 12 , 13 , 14 , 15 ]. In this sense, the WHO’s Oral Health Program has encouraged national planners to strengthen the implementation of systematic programs aimed at improving healthy aging, oral health and a better quality of life for the elderly [ 16 ].…”

Protein Intake and Oral Health in Older Adults—A Narrative Review

“…There is a two-way relationship between low food intake and oral health problems, such as tooth loss, tooth decay and periodontitis [ 38 ]. Additionally, an unhealthy diet and hyperglycemia also lead to tooth loss, dental caries and periodontal diseases [ 16 , 53 , 54 ]. Low protein and energy intake caused by inadequate food intake directly leads to protein–energy malnutrition (PEM) in older adults [ 55 ].…”

Tooth loss is associated with prevalent diabetes and incident diabetes in a longitudinal study of adults in Ireland

“…Our findings support the bi-directional relationship between tooth loss and incident diabetes, and the study found that having fewer than 20 teeth was associated with an incident diagnosis of diabetes over a 4-year follow-up, supporting findings from other studies. [48][49][50] In this study, the oldest age group was at higher risk of tooth loss for any reason, but diabetes was a risk indicator for tooth loss following adjustment for age. The clinical significance of this relationship needs further investigation because, as reported by Haworth and colleagues, the reasons for tooth loss in older adults are difficult to determine.…”