Sex Differences of Tooth Loss and Obesity on Systemic Markers of Inflammation

Abstract

Sex-specific differences in the incidence of periodontitis and tooth loss may be related to different phenotypes of obesity and their associations with low-grade inflammation. The aim of this study was to evaluate associations of adiposity and lowgrade inflammation with tooth loss in men and women. Follow-up data of 2,714 participants from the cohort of Study of Health in Pomerania were analyzed for anthropometric measures, periodontitis, tooth loss, C-reactive protein (CRP), and interleukin 6. Regression analyses were used to estimate the effect of obesity on tooth loss within sex strata. During the follow-up period, men lost more teeth in relation to their obesity status than did women. In contrast, there was a steeper increase in CRP levels across obesity levels in women as compared to men. Incidence rate ratio (IRR) of tooth loss associated with elevated CRP, however, was higher in men (IRR = 1.50; 95% confidence interval [CI]: 1.27, 1.77) than women (IRR = 1.18; 95% CI: 1.02, 1.37). Negative binomial regression with number of lost teeth as outcome revealed dose-response dependencies on body mass index and waist-to-hip ratio. Adjusted for covariates, the IRR of tooth loss associated with the third tertile of waist-to-hip ratio was 1.37 (95% CI: 1.04, 1.80) and 1.53 (95% CI: 1.14, 2.05) in men and women, respectively. Tooth loss related to CRP cutoff of 2 mg/L was significant in men (IRR = 1.33; 95% CI: 1.07, 1.66; p = .006) but not in women (IRR = 0.92; 95% CI: 0.73, 1.17; p = .689). This study suggests that both adiposity and subclinical inflammation affect tooth loss, with distinct differences between men and women. Obesity as a risk factor of tooth loss is particularly related to CRP in men but not in women.

Cross‐Sectional Association Between Number of Teeth and High‐Sensitivity C‐Reactive Protein Among Middle‐Aged Germans

“…However, the relatively lower hsCRP in the present study compared to other studies might have contributed. For instance, 26.6% of present study participants had hsCRP >2 mg/L compared to 32.2% in the study population of Meisel et al, 20 whereas a respective 2.6% and 18.3% of participants had hsCRP >3 mg/L and >10 mg/L compared to 2.9% and 19.5% in the study of Linden et al 11 …”

“…Comparing those who have lost all their natural teeth to those with teeth, one study 18 showed significantly higher hsCRP among edentulous individuals, but another study 19 showed no difference. On the other hand, there is an indication that elevation of hsCRP might precede tooth loss, specifically in men, thus a dependent association between number of teeth and hsCRP is no longer seen cross‐sectionally 20 . Furthermore, risk factors for tooth loss are multifactorial and complex, 21 and some of these risk factors are also determinants of hsCRP concentrations 22 .…”

“…Furthermore, risk factors for tooth loss are multifactorial and complex, 21 and some of these risk factors are also determinants of hsCRP concentrations 22 . This might have introduced bias in studies that did not control for any of these important risk factors, such as alcohol 11 , 13 , 15 and flavonoid‐rich foods 11‐15,18‐20 . Tooth loss and hsCRP are risk factors for other chronic diseases, and thus potential mutual confounders.…”

Handgrip strength and the number of teeth among Korean population

“…demonstrated that handgrip strength is significantly associated with inflammatory markers including C‐reactive protein (CRP) and fibrinogen. Tooth loss is associated with elevated CRP . These limitations should be addressed in longitudinal study.…”

Cross‐sectional association between physical strength, obesity, periodontitis and number of teeth in a general population

“…, Meisel et al. ). Naturally, the severity of such consequences of the oral inflammation increases with the ageing process.…”