Bad Teeth in Old Age Linked to Earlier Death, Study Finds

<p>Oral health is an essential part of general health and well-being and is particularly important for older populations. As life expectancy increases and more individuals retain their natural teeth into old age, the risk of rapid deterioration in oral health status may increase due to age-related physiological changes, a challenge that may be exacerbated in individuals with more remaining teeth. Understanding changes in oral health status in older individuals and its potential association with mortality is therefore of importance. The overall aim of this thesis was to investigate changes in oral health status over time in older populations through population-based studies and to explore the association between periodontitis and mortality. The specific aims were: I) to analyze the oral health status of four different birth cohorts: two cohorts of 60-year-olds born in 1941–1943 and 1954–1955 and two cohorts of 81-year-olds born in 1920–1922 and 1933–1934; II) to investigate the oral health status in 60-year-old individuals over 12 years; III) to compare periodontal status in an older population during an 18-year follow-up period; and IV) to investigate the association between periodontitis and mortality among an older population over a 23-year period. The sample was based on the participants in the Swedish National Study on Aging and Care in Karlskrona, Blekinge (SNAC-B). All studies (I–IV) used clinical and radiographic data obtained from examinations performed by dental hygienists in SNAC-B. The clinical data were number of teeth and intact teeth, dental implants, removable prosthesis, root residuals, buccal/lingual manifest caries, bleeding on probing (BOP), periodontal pocket depths (PPD) and mucosal plaque index (MPI). Radiographic panoramic data were used to identify and record the number of teeth, presence of root residuals, root fillings, approximal manifest caries and the distance between alveolar bone level and cementoenamel junction (CEJ). Radiographic images were evaluated by periodontists. The definition of periodontitis was consistent across all four studies as follows: BOP ≥ 10% + PPD ≥ 5 mm at ≥ 2 surfaces + bone loss ≥5 mm in at least 10% of the surfaces. Age and sex were included as background variables in Studies I and II. In Study III, education level and smoking status were also included and in Study IV, medication use (polypharmacy) and financial resources (cash margin) were included as covariates. In Study I, a cross-sectional design was employed, comparing oral health status between cohorts of 60- and 81-year-olds in 2001- 2003 and corresponding cohorts examined in 2014–2015. In Studies II–IV, a prospective longitudinal study design was applied, in which the same individuals were followed for 12, 18 and 23 years, respectively. In Study IV, periodontal status data were obtained at baseline only, while participants were followed longitudinally for mortality over a 23-year period.</p><p>Cross-sectional analyses in Study I showed that, in both the 60- and 81-year-old groups, a higher proportion of participants retained their natural teeth in 2014– 2015 compared with 2001–2003. This was accompanied by an increase in the mean number of remaining teeth, as well as intact teeth in both age groups. Among individuals aged 81 years, later examinations also demonstrated a marked reduction in the use of removable prostheses, together with a higher prevalence of deep PPD ≥ 6 mm and radiographically assessed alveolar bone loss ≥ 5 mm. In the longitudinal follow-up of the same participants (Studies II and III), the mean number of remaining teeth declined by approximately 1.5 teeth. In Study II, the proportion of individuals with at least 20 teeth or more also significantly decreased between the ages of 60 and 72 years, while the mean number of dental implants significantly increased. Manifest buccal/lingual and approximal caries showed only a minor but significant increase at 72 years of age. Periodontal variables, including BOP, alveolar bone level ≥ 5 mm and periodontitis, significantly increased in both Study II and III. In Study III, regression analyses demonstrated, independent of age and sex, that education ≤ 9 years and smoking were significantly associated with higher odds of periodontitis. In Study IV, Cox regression analysis was applied, with adjustment for covariates and periodontitis definition. Over a 23-year follow-up, individuals with periodontitis at baseline had a significantly increased risk of mortality, an association that persist after controlling for sex, medication use and cash margin.</p><p>In summary, cross-sectional analyses show that older individuals increasingly retain their natural teeth into advanced age; however, periodontal conditions tend to deteriorate with age. Longitudinal findings indicate that although tooth loss remains relatively limited, the number of dental implants increases over time. Caries prevalence shows only a minor increase with age, whereas periodontal deterioration becomes more pronounced. Lower educational level (≤ 9 years) and smoking are independently associated with poorer periodontal status. Furthermore, periodontitis at baseline is associated with an increased risk of mortality during long-term follow-up, independent of sex, medication use, and financial resources.</p>