Research paperRisk factors for tooth loss in middle and older age after up to 10 years: An observational cohort study
Introduction
The retention or loss of permanent teeth is of major importance with respect to patients’ oral function and aesthetics and, therefore, oral health-related quality of life (Tan, Peres, & Peres, 2016). Altogether, tooth loss is an important epidemiologic indicator of oral health (Mojon, Thomason, & Walls, 2004). The causes of tooth loss are variable; oral and systemic diseases as well as sociodemographic factors can contribute to it (Baelum, van Palenstein Helderman, Hugoson, Yee, & Fejerskov, 2007; Beck, Sharp, Koch, & Offenbacher, 1997; Koyama et al., 2016; Machtei et al., 1999; Petersen, Bourgeois, Ogawa, Estupinan-Day, & Ndiaye, 2005). Oral diseases, especially periodontal disease – the sixth most prevalent chronic disease in the world – and untreated caries are associated with tooth loss (Baelum et al., 2007, Marcenes et al., 2013). These factors, in turn, are heightened by lifestyle (e.g., unhealthy nutrition, smoking), attitudes toward dental care and patients’ educational and socioeconomic backgrounds (Avlund, Schultz-Larsen, Christiansen, & Holm-Pedersen, 2011; Baelum et al., 2007, Koyama et al., 2016, Machtei et al., 1999. Because some contributing factors may accumulate throughout the life span, aging subsequently correlates with tooth loss (Chambrone & Chambrone, 2006; Müller, Naharro, & Carlsson, 2007). Overall, however, tooth loss in many industrialised countries is decreasing as a consequence of preventive measures such as periodic dental visits, including professional tooth cleaning, and raising awareness of the importance of oral health and nutrition counselling in young people (Dye et al., 2007, Kassebaum et al., 2015). Moreover, patients have diseased teeth treated more frequently, avoiding the progression of periodontal disease or endodontic problems. Even older communities subsequently preserve a substantial number of remaining teeth (Dye et al., 2007, Hugoson et al., 2005). However, the World Health Organization’s goal of preserving more than 20 teeth by the age of 80 has not yet been realised (World Health Organization, 2003). In Germany, for example, people between the ages of 65 and 74 years and between 75 and 100 years have approximately 11–18 missing natural teeth, respectively, and missing teeth are nearly ubiquitously recovered by prosthetic restorations. The level of refurbishment due to caries in the same age groups is stated to be 90% and 83%, respectively (Micheelis & Schiffner, 2005). Similar outcomes were found in other developed countries (Bernabé & Sheiham, 2014). However, especially periodontal disease is still a major dental threat worldwide and leads to tooth loss. In older people, the prevalence is nearly two-thirds of the population (Kassebaum et al., 2014, Marcenes et al., 2013). Nevertheless, if patients are subjected to periodontal therapy with subsequent maintenance, tooth loss rates are estimated to be less than one tooth over ten years, which corresponds to a tooth-related loss rate of 1.8% (Chambrone & Chambrone, 2006). Beyond institutional studies, using comprehensive therapies in highly compliant patients, only a few longitudinal studies have focused on tooth loss and associated confounders in the general older population. A previous community-based study looked at tooth loss in people aged 27–67 years over two years. The authors projected a loss of 0.2 teeth per patient per year (estimated 10-year loss: two teeth). In this study, evident risk factors were high periodontal pocket depths, systemic diseases and smoking (Machtei et al., 1999). Another study, with the same observation time, found an incidence of 3% for tooth loss. Molars, teeth with periodontal attachment loss, tooth mobility and untreated caries were at higher risk for loss (Gilbert et al., 1999). For people aged 65 years and older, a mean loss of 0.4 from 21 teeth over 18 months (estimated 10-year loss: three teeth per patient) was detected (Hunt, Drake, & Beck, 1995). A prolonged follow-up of the same source population revealed a tooth-related loss rate of 18% after 5 years. Attachment loss, periodontal probing depths >3 mm and being a member of the black race as well as rural residence were independent predictors for tooth loss in this study (Beck et al., 1997). A further study of 73 older adults living in a rural environment, which observed the participants for up to 15 years, revealed a moderate tooth loss rate of 11% (2.1 tooth lost per participant). Accordingly, attachment loss and untreated caries were associated with tooth loss (Warren et al., 2001). On the contrary, this rural sample showed a lower tooth loss rate after a longer observation time than the urban sample of Beck (Beck et al., 1997) showed. However, to the knowledge of the authors, no longitudinal data on the extent and the determinants of tooth-related losses for quinquagenarians and septuagenarians in an urban region exist. Such study would be relevant to consider risk factors in dental treatment planning and to estimate the extent of dental treatment needs coming with demographic changes.
The objective of this prospective cohort study, therefore, was to identify risk factors for tooth loss in two birth cohorts, quinquagenarians and septuagenarians, after up to 10 years of clinical observation. The research hypothesis was that tooth loss in both birth cohorts is comparable over the study period.
Section snippets
Sample
Prior to the start of the study, ethical approval for both the baseline and the follow-up examinations was gathered from the local review board of the University of Heidelberg (registration numbers 181/2005 and 371/2013). A sub-sample of the Interdisciplinary Longitudinal Study of Adult Development (ILSE) (Sattler et al., 2015) was recruited. The ILSE study was designed as a longitudinal observational cohort study with two birth cohorts: older (OC; born in 1930/32) and younger cohort (YC; born
Results
Data sets of 123 participants with a total of 2784 teeth were available for longitudinal analysis. At baseline, mean age of the participants was 73.8 (1.0), range 71–75 years, and 54.9 (0.9), range 53–57 years, in OC and YC, respectively. Half of the study sample was female. In mean (SD), participants in the YC had 24.9 (4.9) natural remaining teeth, significantly more than participants in the OC (p < 0.001). Bivariate comparisons further revealed cohort-specific differences regarding tooth
Discussion
This study aimed to evaluate the extent of tooth loss and possible risk factors in quinquagenarians and septuagenarians within a mean observation time of eight years. The research hypothesis that there are no differences between tooth losses in the two birth cohorts has to be rejected. Quinquagenarians and septuagenarians lost 5% and 14% of their teeth, correspondingly one and three teeth, respectively. These observations are similar but slightly more positive than that found in previous
Conclusion
Within the limitations of this study quinquagenarians and septuagenarians, show clinically relevant tooth loss. Incidence of tooth loss over eight years seems to be substantially higher for septuagenarians than for quinquagenarians. The predominant predictor for tooth loss seems to be greater tooth mobility. With the rising challenges due to aging in several societies, knowing the risks might help clinicians when weighing treatment strategies. The results also should be an encouragement to
Conflict of interest
The authors report no conflict of interest regarding this manuscript.
Disclosure
Andreas Zenthöfer and Alexander Jochen Hassel designed the study, undertook the statistical analysis and wrote the manuscript. Sabine Katharina Grill and Volkan Safaltin performed the dental examinations and performed data input and plausibility checks. Peter Rammelsberg, Johannes Schröder and Hans-Werner Wahl were involved in the design of the study, data interpretation and critical revision of the manuscript. Anna-Luisa Klotz and Edriss Habibi contributed to drafting and revision of the
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Ethical approval
All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Acknowledgement
The authors are grateful to all participants in this study for their patience and cooperation. Further, the authors thank Elsevier Language Editing Services for English proof reading.
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