Oral Health and Mortality: Examining the Connection

Health advocates and dentists alike are increasingly interested in the connection between oral health and mortality. There are several oral health factors that have been correlated with mortality including the number of missing teeth, subjective mastication function, periodontal disease and oral care habits. Here are a few studies that have examined the connection between oral health and mortality and their results.

Name Author Country Subjects Follow-up Period Main results (mortality), HR, OR (95% CI)
Dental status, quality of life, and mortality in an older community population: a multivariate approach. J Am Geriatr Soc 1997 Nov; 45(11): 1315-1323 Appollonio et al. Italy Aged 70-75 years, n=1,303 [followers: 1,201] 10 years All-cause mortality
Naturally adequate dental status group VS.
denture wearing group
HR 1.34 (95%CI 1.06-1.70)
Naturally inadequate dental status and subjects without dentures HR 1.51 (95%CI 1.11-2.05)
Influence of dentition status on physical disability, mental impairment, and mortality in institutionalized elderly people, J Dent Res 2001; 80: 340- 345 Shimazaki et al. Japan Aged 79.7± 7.5 years n=1,929 6 years 20 teeth group VS.
edentate without denture wearing group OR 1.8 (95%CI 1.1-2.8)
Relationship between oral health and mortality rate. Journal of Clinical Periodontol 2002; 29: 1029-1034 Jansson et al. Sweden Aged 18-66 years n=1,393 26 years All-cause mortality
comparison the means for number of remaining teeth (aged 18-30, 31-40, 41-50, 51-60, 61-66 years) between survival and death during the 26 years,
For all groups of age, median for number of remaining teeth survival death
Relationship between dental health and 10-year mortality in a cohort of community-dwelling elderly people. Eur J Oral Sci 2003; 111: 291-296 Hämäläinen et al. Finland Aged 80 years, n=226 10 years Number of missing teeth HR 1.026 (95%CI: 1.002-1.051)
Oral health indicators poorly predict coronary heart disease deaths. J Dent Res 2003 Sep; 82(9): 713-718 Tuominen et al. Finland Aged 30- 39years, n=6,527 12 years CHD mortality

Group of 25 natural functional teeth VS.

Male

11-24 teeth RR 0.8 (95%CI 0.5-1.3) , 0-10 teeth RR 0.9 (95%CI 0.5-1.6)

Female

11-24 teeth RR 0.5 (95%CI 0.2-1.8) , 0-10 teeth RR 0.3 (95%CI 0.1-1.0)

Loss of teeth and coronary heart disease. Int J Prosthodont 2004 Jul- Aug; 17(4): 441-446 Ragnarsson et al. Iceland Aged 25-74 years, n=2,613 8-15 years All-cause mortality

Number of teeth HR 0.987 (95%CI 0.975-0.999
edentate HR 1.30 (95%CI 1.05-1.64) CVD mortality
number of teeth NS
edentate HR 1.70 (95%CI 1.03-2.81)

Relationship between survival rates and numbers of natural teeth in an elderly Japanese population. Gerodontology 2006, 23: 214-218 Morita et al Japan Aged 80 years n=118 10 years All-cause mortality

20 teeth group VS. <20 teeth group
78-month follow-up
Male HR2.71 95%CI: 1.05-7.05)

Female NS

Dental status and mortality in institutionalized elderly people. Geriatr Gerontol Int 2006, 6: 101-108 Ohrui et al. Japan Aged 82.8± 7.7 years n=403 5 years All-cause mortality
Natural teeth only or natural teeth with partial denture group VS. edentate with or without dentures group2-year follow-up HR 1.84 (95%CI 1.01-3.36)5-year follow-up HR 1.30 (95%CI 0.90-1.88)
Denture use, malnutrition, frailty, and mortality among older women living in the community. J Nutr Health Aging. 2006 Mar-Apr; 10(2): 161-167 Semba et al. USA Aged 70-79 years n=826 female 5 years All-cause mortality
no denture group VS.
denture wearer group with difficulty chewing or swallowing HR 1.43 (95%CI 1.05-1.97)
Functional tooth number and 15-year mortality in a cohort of community-residing older people, Geriatr Gerontol Int 2007; 7: 341-347 Fukai et al. Japan Aged 40-89 years n=5,830  15 years All-cause mortality
10 functional teeth group VS.
<10 functional teeth group
Male HR 1.33 (95%CI 1.11-1.59), Female NS
CVD mortality
Male p<0.05, Female NS
Cancer mortality, pneumonia mortality, cerebrovascular mortality Male NS
Female NS
Number of teeth–a predictor of mortality in the elderly? A population study in three Nordic localities. Acta Odontol Scand 2007 Nov; 65(6): 335-340 Osterberg et al. Denmark Aged 75 years n=1,004 7 years All-cause mortality
Female HR 0.87 (95%CI 0.78-0.97)Male NS
Associations between tooth loss and mortality patterns in the Glasgow Alumni Cohort. Heart

2007; 93(9): 1098-1103. (Epub 2006 Dec 12.)

Tu et al. UK Aged 16-30 years (median age 19 years) n=12,223 57 years All-cause mortality
Number of missing teeth as either continuousHR1.01(95%CI: 1.00-1.02)CVD mortality
number of 0-4 missing teeth group VS.number of 9 teeth group HR 1.35 (95%CI 1.03-1.77)Cancer mortality NS
The association between tooth loss and coronary heart disease in men and women. J Public Health Dent 2004 Fall; 64(4): 209-215 Hung et al. USA Male Aged 40- 75years n=41,407 Female Aged 30- 55years n=58,974 Male
12 years Female 6 years
CHD mortality
Group of 25-32 functional teeth VS. Male
17-24 teeth HR 1.26 (95%CI 1.01-1.57) 11-16 teeth HR 1.19 (95%CI 0.79-1.80) 0-10 teeth HR 1.79 (95%CI 1.34-2.40) Female
17-24 teeth HR 1.02 (95%CI 0.66-1.55) 11-16 teeth HR 1.07 (95%CI 0.55-2.05) 0-10 teeth HR 1.6 (95%CI 1.11-2.46)
Tooth loss is associated with increased risk of total death and death from upper gastrointestinal cancer, heart disease, and stroke in a Chinese population-based cohort. Int J of Epidemiol 2005; 34: 467-474 Abnet et al. China Aged 40-69 years n=29,584 [followers: 28,790] 15 years Number of age-specific missing teeth (median) group VS Number of age-specific missing teeth (median) group All-cause mortality RR 1.13 (95%CI: 1.09-1.18)

Heart disease mortality RR 1.28 (95%CI 1.17-1.40)
Stroke mortality RR 1.11 (95%CI 1.01-1.23)

Can the relation between tooth loss and chronic disease be explained by socio-economic status? A 24-year follow-up from the population study of women in Gothenburg, Sweden. Eur J Epidemiol 2005; 20(3): 229-236 Cabrera et al. Sweden Aged 38-60 years n=1,462 female 24 years All-cause mortality

<=10 missing teeth group VS. >=11 missing teeth group
HR 1.27 (95%CI: 1.09-1.47)

CVD mortality
HR 1.34 (95%CI 1.05-1.71)

Cancer mortality
NS

Hämäläinen P, Meurman JH, Kauppinen M, Keskinen M. Oral infections as predictors of mortality. Gerodontology 2005 Sep; 22(3): 151-157 Hämäläinen et al. Finland Aged 85 years n=94 5 years All-cause mortality
Small number of remaining teeth group VS. high number of remaining teeth group
HR 0.939 (95%CI 0.884-0.998)
Eight-year mortality associated with dental occlusion and denture use in community-dwelling elderly persons. Gerodontology 2005 Dec; 22(4): 234- 237 Yoshida et al. Japan Aged 65 years n=1,030 8 years All-cause mortality
No occlusal contact group VS.
functionally adequate occlusal contact group HR 0.78(95%CI: 0.60-0.99)
No occlusal contact with denture group VS. no occlusal contact with no denture group HR 1.52 (95%CI: 1.25-1.83)
Number of teeth–a predictor of mortality in 70-year-old subjects. Community Dent Oral Epidemiol 2008; 36(3):

258-268

Osterberg et al. Sweden Aged 70 years 7-year follow-up n=1803 18-year follow-up n=1,381 7 years and 18 years Edentulous no teeth group VS.

All-cause mortality

7 years follow-up, Female HR 0.97

Male HR 0.96 (95%CI 0.94-0.98)

18 years follow-up, Female NS
Male HR 0.97(95%CI: 0.97-0.99)

Number of teeth and mortality risk in the Baltimore Longitudinal Study of Aging. J Gerontol A Biol Sci Med Sci 2008 Jul; 63(7): 739-744 Pdiha et al. USA Aged 57.46 ±17.37 years n=500 15-year 5- month(±90 months) All-cause mortality

>= 20 teeth group VS.1-19 teeth group HR 2.17 (95%CI 1.50-3.13)

0 teeth HR 1.76 (95%CI 1.04-2.98)

Tooth loss and subsequent disability and mortality in old age. J Am Geriatr Soc 2008, 56: 429-435 Holm-Pedersen et al. Denmark Aged 70, 75, 80, 85, 90 years
n=573
21 years All-cause mortality

>= 20 teeth group VS.0 teeth edentulous
HR 1.26(95%CI: 1.03-1.55)

Mortality rates of community-
residing adults with and without dentures, Geriatr Gerontol Int 2008; 8 152-159
Fukai et al. Japan Aged 40 89 years n=5,688 15 years All-cause mortality

<=10 teeth without denture wearing group VS. <=10 teeth with denture wearing group
Male NS
Female HR 0.72(95%CI: 0.58-0.91)

Oral health and mortality risk from pneumonia in the elderly. J Dent Res 2008 Apr; 87(4): 334-339 Awano et al. Japan Aged 80 years

N = 697

4 years All-cause mortality

Edentulous group VS.

1-9 teeth NS

10-19 teeth NS

>20 teeth NS

Pneumonia mortality

1-9 teeth, >10 teeth and no periodontal pocket VS.

1-9 teeth (periodontal pocket)

HR 3.9 (95%0 1.1-13.9)

>10 teeth (periodontal pocket)

HR3.9(95%C1 :1.1 -13.9)

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