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Observational Study
. 2018 Dec;46(6):555-562.
doi: 10.1111/cdoe.12391. Epub 2018 Jun 29.

Tooth Loss Is a Complex Measure of Oral Disease: Determinants and Methodological Considerations

Free PMC article
Observational Study

Tooth Loss Is a Complex Measure of Oral Disease: Determinants and Methodological Considerations

Simon Haworth et al. Community Dent Oral Epidemiol. .
Free PMC article


Objectives: Counts of missing teeth or measures of incident tooth loss are gaining attention as a simple way to measure dental status in large population studies. We explore the meaning of these metrics and how missing teeth might influence other measures of dental status.

Methods: An observational study was performed in 2 contrasting adult populations. In total, 62 522 adult participants were available with clinically assessed caries and periodontal indices from the Swedish arm of the Gene-Lifestyle Interactions and Dental Endpoints Study (GLIDE) and the Korea National Health and Nutrition Examination Survey (KNHANES) in the Republic of Korea. Longitudinal measures of tooth loss were available for 28 244 participants in GLIDE with median follow-up of 10.6 years.

Results: In longitudinal analysis, hazard for tooth loss was associated with baseline dental status (previous tooth loss, periodontal status and caries status) and socio-demographic variables (age, smoking status and highest educational level). Analysis of cross-sectional data suggested that indices of caries exposure were not independent of periodontal status. The strength and direction of association varied between groups, even for measures specifically intended to avoid measuring tooth loss. Individuals with impaired periodontal health (community periodontal index [CPI] 3 or higher in any sextant) had higher standardized decayed and filled surfaces (DFS; number of DFS divided by total number of tooth surfaces) in GLIDE (incidence risk ratio [IRR] 1.05 [95% CI: 1.04, 1.07], but lower standardized DFS in KNHANES (IRR: 0.95 [0.92, 0.98]) than individuals with better periodontal health (CPI <3 in all sextants).

Conclusions: Incident tooth loss is a complex measure of dental disease, with multiple determinants. The relative importance of dental caries and periodontal disease as drivers of tooth loss differs between age groups. Measures of dental caries exposure are associated with periodontal status in the studied populations, and these associations can be population-specific. Consideration of the study-specific properties of these metrics may be required for valid inference in large population studies.

Keywords: caries; epidemiology; periodontal diseases; tooth loss.

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    1. Joshy G, Arora M, Korda RJ, Chalmers J, Banks E. Is poor oral health a risk marker for incident cardiovascular disease hospitalisation and all‐cause mortality? Findings from 172 630 participants from the prospective 45 and up study BMJ Open. 2016;6:e012386. - PMC - PubMed
    1. Vedin O, Hagstrom E, Budaj A, et al. Tooth loss is independently associated with poor outcomes in stable coronary heart disease. Eur J Prev Cardiol. 2016;23:839‐846. - PubMed
    1. Naorungroj S, Schoenbach VJ, Wruck L, et al. Tooth loss, periodontal disease, and cognitive decline in the atherosclerosis risk in communities (aric) study. Community Dent Oral Epidemiol. 2015;43:47‐57. - PMC - PubMed
    1. Asai K, Yamori M, Yamazaki T, et al. Tooth loss and atherosclerosis: the Nagahama study. J Dent Res. 2015;94:52S‐58S. - PMC - PubMed
    1. Liljestrand JM, Havulinna AS, Paju S, Mannisto S, Salomaa V, Pussinen PJ. Missing teeth predict incident cardiovascular events, diabetes, and death. J Dent Res. 2015;94:1055‐1062. - PubMed

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