Article
Missing, unreplaced teeth predict mortality, particularly cardiovascular mortality
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Published: | September 20, 2011 |
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Outline
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Background: An inverse relationship has been reported between an individual’s number of teeth and mortality. Previous research has focused on the systemic inflammatory response to mediate this relationship and, therefore, on the number of remaining or missing teeth as the exposure; but no study has investigated whether the number of missing, unreplaced teeth affects mortality. If dental prostheses have a beneficial effect on mastication and diet, replacing missing teeth may hypothetically decrease mortality risk. Reduced masticatory efficiency can be assumed for individuals having nine or more missing, unreplaced teeth.
Methods and Results: We used data prospectively collected from participants in the population-based Study of Health in Pomerania to examine whether unreplaced teeth were associated with an increased risk of all-cause or cardiovascular mortality. 188 out of 1803 subjects had nine or more unreplaced teeth. During a median follow-up period of 9.9 years, 362 subjects died. Of those, 128 died from cardiovascular causes. Having nine or more unreplaced teeth (rate ratio 1.94 adjusted for variables according to directed acyclic graphs: number of remaining teeth [which suspended other potential confounders such as the smoking status], age, sex, education, income, marital status, partnership, and oral health behavior; reference: fewer than nine unreplaced teeth; 95% confidence interval: 1.15-3.25; P=0.013), but not the number of missing teeth itself, was related to cardiovascular mortality.
Conclusions: The masticatory efficiency rather than systemic inflammatory responses mediates the relationship between the number of teeth and mortality. Clinicians have a responsibility to consider individual chewing ability in their nutritional recommendations.