Impact of Teeth on Social Participation: Modified Treatment Policy Approach

Abstract

Social participation prevents social isolation and loneliness among older adults while having numerous positive effects on their health and well-being in rapidly aging societies. We aimed to estimate the effect of retaining more natural teeth on social participation among older adults in Japan. The analysis used longitudinal data from 24,872 participants in the Japan Gerontological Evaluation Study (2010, 2013, and 2016). We employed a longitudinal modified treatment policy approach to determine the effect of several hypothetical scenarios (preventive scenarios and tooth loss scenarios) on frequent social participation (1 = at least once a week/0 = less than once a week) after a 6-y follow-up. The corresponding statistical parameters were estimated using targeted minimum loss-based estimation (TMLE) method. Number of teeth category (edentate/1–9/10–19/≥20) was treated as a time-varying exposure, and the outcome estimates were adjusted for time-varying (income, self-rated health, marital status, instrumental activities of daily living, vision loss, hearing loss, major comorbidities, and number of household members) and time-invariant covariates (age, sex, education, baseline social participation). Less frequent social participation was associated with older age, male sex, lower income, low educational attainment, and poor self-rated health at the baseline. Social participation improved when tooth loss prevention scenarios were emulated. The best preventive scenario (i.e., maintaining ≥20 teeth among each participant) improved social participation by 8% (risk ratio [RR] = 1.08; 95% confidence interval [CI], 1.05–1.11). Emulated tooth loss scenarios gradually decreased social participation. A hypothetical scenario in which all the participants were edentate throughout the follow-up period resulted in a 11% (RR = 0.89; 95% CI, 0.84–0.94) reduction in social participation. Subsequent tooth loss scenarios showed 8% (RR = 0.92; 95% CI, 0.88–0.95), 6% (RR = 0.94; 95% CI, 0.91–0.97), and 4% (RR = 0.96; 95% CI, 0.93–0.98) reductions, respectively. Thus, among Japanese older adults, retaining a higher number of teeth positively affects their social participation, whereas being edentate or having a relatively lower number of teeth negatively affects their social participation.

Heterogeneous Association of Tooth Loss with Functional Limitations

“…The present study supports these results using a doubly robust estimator, which reduces the bias due to model misspecification. The null effect on the social role domain contradicts the previous study reporting that having ≥20 natural teeth was associated with increased participation in social activities (Cooray et al 2023). The TMIG social role subscale, a composite score of 4 items assessing activities such as visiting friends’ homes and conversing with younger people, might be less influenced by having <20 natural teeth.…”

Associations between psychological stress, discrimination, and oral health-related quality of life: the buffering effects of social support networks

“…One of the limitations of this study is that, as a cross-sectional analysis, we could not determine a temporal relationship between the factors. However, this does not exclude the possibility that worse oral disorders are a source of stressors and can lead to lower social participation 48 . Furthermore, our findings show the importance of including the qualitative aspects of social support networks into analyses, in addition to their sizes.…”

Estimating the effect of realistic improvements of metformin adherence on COVID-19 mortality using targeted machine learning

“…This approach obviates the necessity for arbitrarily defining a threshold value and concurrently mitigates the violation of the positivity assumption. MTPs have garnered increasing attention within the causal inference community in recent years [ 30 , [34] , [35] , [36] , [37] ]. Our investigation is among the pioneering efforts to operationalize this approach.…”