Tooth loss mediates the association between smoking and an increased risk of dementia among older adults: The JAGES prospective cohort study.

AIM: Tooth loss has various causes; however, its cause-specific effects on health outcomes remain unclear. This study evaluated whether the association between past/current smoking and risk of dementia was mediated by tooth loss. MATERIALS AND METHODS: This 9-year-follow-up prospective cohort study targeted adults aged ≥65 years. Dementia incidence during 2013-2019, smoking status (never, past/current) in 2010 and the number of remaining teeth (≤19, ≥20) in 2013 were the outcome, exposure and mediator, respectively. We used causal mediation analysis to fit the Cox proportional hazards model and estimated the hazard ratio (HR) and 95% confidence interval (CI) of the natural indirect effect (NIE) of smoking on dementia incidence through tooth loss and their mediated proportions. RESULTS: Among 32,986 participants (mean age 72.6 years [1 SD = 5.4]; men 48.4%), the dementia incidence during follow-up was 2.11/100 person-years. Tooth loss significantly mediated the association between past/current smoking and dementia incidence; the NIE of fewer remaining teeth for past/current smokers compared to never smokers was HR = 1.03 (95% CI: 1.02-1.05), and the mediated proportion was 18.0%. CONCLUSIONS: Tooth loss significantly mediates the association between past/current smoking and an increased risk of dementia among older adults.

[Current status and issues around the process of health promotion program implementation by the municipal office of health and welfare: Survey results of all municipalities of six prefectures].

Objectives We aimed to investigate the progress of health promotion program implementation. This included an examination of the current status of and issues around planning, implementation, and evaluation of health and welfare services at the municipal level; further progress through focus on the population approach emphasized in Health Japan 21 (2nd) was also discussed.Methods A questionnaire survey on health promotion and welfare services was conducted among municipal offices in charge of health promotion. The status of health promotion program implementation was classified by types and fields. For focused health and welfare services, respondents were asked to answer a self-administered questionnaire about the process of planning, implementation, and evaluation. The details of services were confirmed by browsing reference materials or website information. We distributed the questionnaires to all 260 municipalities of 6 prefectures (Miyagi, Saitama, Shizuoka, Aichi, Osaka, and Wakayama); of which, 238 municipalities responded (response rate: 91.5%).Results Health promotion programs on nutrition and diet, physical activity, dental and oral health, prevention of lifestyle-related diseases, and promotion of regular health checkups were implemented with a high rate. Among the 238 municipalities, 85.2% responded that they focused on educational activities targeting the general population; of which 27.4% were considering using incentives to promote greater health awareness. Our survey indicated that 14.8% of municipalities focused on health education and classroom-style programs. While planning programs, 52.1% of municipalities used "materials from other municipalities where such programs were already implemented" and 89.1% of municipalities used them in incentive-related programs. Although 70% of municipalities were aware of health discrepancies among the local population, approximately 90% did not consider discrepancies between different economic, living environment, and occupation groups when planning programs. Although 87.3% of municipalities used number of participants as the main indicator in evaluating the programs, approximately 30% of municipalities used coverage rate and before-and-after assessments of health conditions as the main indicators.Conclusion Findings from this study suggest that improvements in the process of health promotion program planning and implementation, reference materials, and the perspective of health discrepancies are needed, along with an evaluation in programs focusing both on educational activities targeting the general population and incentive-related programs. It is also recommended that the central government and prefectures should not only introduce precedents, but also provide information. Using this, municipalities can demonstrate applied skills, such as the rationale and preparation status of the program, and propose evaluations based on the plan-do-check-act cycle.

Health utility attributable to oral conditions in Japanese adults.

OBJECTIVE: Utility values enable relative comparisons across various health conditions, providing information for efficient allocation of healthcare resources. This study aimed to (1) quantify the utility values attributable to oral health-related quality of life (OHRQoL) in Japanese adults and (2) develop models for converting the 14-item Oral Health Impact Profile (OHIP-14) scores into EuroQoL 5-dimension 5-level (EQ-5D-5L)-based utility values. METHODS: This was a cross-sectional study. Data from a large-scale Internet survey of Japanese adults conducted in 2022 (n = 28 405; mean age 48.2 years) were analysed. Multiple linear regression models were fitted to investigate the association between OHIP-14 scores and EQ-5D-5L-based utility values, adjusting for confounders. Conversion models were developed using a random half of the participants, and the observed and predicted utility values in the other half were compared to evaluate the model performance. RESULTS: Among the participants, 55.2% scored 0, 20.9% scored 1-5 and 23.9% scored 6-56 on the OHIP-14, corresponding mean utility values of 0.93, 0.90 and 0.84, respectively. A one-point increase in the OHIP-14 score was associated with a lower utility value (coefficient: -0.0053; 95% confidence interval:health-related quality of life -0.0056, -0.0051). The estimated utility value attributable to OHIP-14 was -23.3 per 1000 individuals, greater than that for other prevalent chronic conditions, including hypertension and diabetes (-2.9 and -7.1 per 1000 individuals, respectively). The conversion model incorporated the OHIP-14 total score, age, sex and self-rated health, predicted utility scores on average and captured differences according to the number of teeth lost. However, there was a discrepancy between predicted and observed utility values in the lower utility value groups. CONCLUSION: OHRQoL substantially impacted utility values at the population level. The OHIP-14 holds the potential as a valuable tool for predicting average utility values based on oral health conditions; however, the prediction performance was relatively low for individuals with a lower health-related quality of life.

Association between Toothbrushing and Cancer Risk.

Background: Most cancers are lifestyle-related and are thus preventable. Lifestyle habits can be improved by individual efforts; for example, because oral health is suggested to play a preventive role in cancer risk, toothbrushing is considered a critical and fundamental measure for controlling oral health. This study aimed to investigate the association between toothbrushing and cancer risk. Methods: Cross-sectional data from the Japan COVID-19 and Society Internet Survey, a large-scale (n = 32,000) online survey conducted in 2022, were used. From September 12 to October 19, 2022, questionnaires were distributed to candidates selected by simple random sampling from a Japanese Internet research company's panelists to represent the Japanese population. The association between toothbrushing and cancer risk according to cancer prevalence was then analyzed. Results: Among all 32,000 participants, 2,495 (7.8%) who had any cancer previously were analyzed. Multivariable logistic regression analysis revealed a significant association between toothbrushing habit and cancer risk. Conclusion: The findings of this study suggest that daily toothbrushing is essential for maintaining oral health and preventing cancer.

Association Between Toothbrushing Habits and COVID-19 Symptoms.

OBJECTIVES: The association between toothbrushing and coronavirus disease 2019 (COVID-19) infections is unknown. The aim of this study was to test the hypothesis that the change in time and frequency of toothbrushing is associated with having COVID-19 symptoms. METHODS: In this 8-month retrospective cohort study, we used the data from the Japan COVID-19 and Society Internet Survey (JACSIS; N = 22,366), which was conducted between August and September 2020. The logistic regression analyses were used to calculate the odds ratios (ORs) of having the 3 main COVID-19 symptoms (high fever, cough, and taste and smell disorder). Confounders were age, sex, educational attainment, equivalised income level, self-rated health, health literacy, and living area. RESULTS: The mean age of the participants was 49 years (SD = ±17.3), and 49.2% were male. Overall 2704 (12.1%) participants changed (increased or decreased) the time and frequency of toothbrushing, whilst 19,662 (87.9%) did not change. Only 60 participants (0.3%) had the 3 main COVID-19 symptoms. All logistic regression models showed that those who had a change in time and frequency of toothbrushing had higher odds of having the 3 main COVID-19 symptoms compared to those who had unchanged time and frequency of toothbrushing. The ORs ranged from 6.00 (95% confidence interval [CI], 3.60-9.99) in the crude model to 4.08 (95% CI, 2.38-6.98) in the fully adjusted model. CONCLUSIONS: The change in time and frequency of toothbrushing from before to after the COVID-19 pandemic was associated with having the 3 main COVID-19 symptoms.

Dental Treatment and Risk of COVID-19 in Japan.

PURPOSE: During the Coronavirus Disease 2019 (COVID-19) pandemic, there has been concern about nosocomial infections acquired through dental practice, where machines - such as air turbines - that generate aerosols are used, and where there are many opportunities to come into contact with saliva and blood. Because there is no report to date on whether dental treatment is associated with a risk of SARS-CoV-2 infection in Japan, the aim of the present cross-sectional study was to examine the risk of SARS-CoV-2 infection associated with dental treatment. MATERIALS AND METHODS: Cross-sectional data were gathered from the Japan COVID-19 and Society Internet Survey (JACSIS), a large-scale internet survey conducted in 2021 (n=28,175). From September 27, 2021, to October 30, 2021, the questionnaires were distributed to candidates selected from the panelists of a Japanese Internet research company to represent the Japanese population regarding age, sex, and residential prefecture using a simple random sampling procedure. The risk of SARS-CoV-2 infection related to dental treatment was examined and analysed. RESULTS: Multivariable logistic regression analysis showed that younger age, male sex and living alone were statistically significant factors positively associated with SARS-CoV-2 infection, whereas the presence or absence of dental treatment was not statistically significantly correlated with SARS-CoV-2 infection. CONCLUSION: The present epidemiological study showed that dental treatment is not a positive risk factor for SARS-CoV-2 infection in Japan.

Is discontinuation of dental treatment related to exacerbation of systemic medical diseases in Japan?

Aims Since it is known that oral problems affect various medical diseases, the effects of restrictions on visits for dental treatment on exacerbations of various systemic medical diseases were examined.Method and materials The data were used from the Japan COVID-19 and Society Internet Survey, a large-scale internet survey conducted in 2021 (n = 28,175). The questionnaires were distributed to 33,081 candidates who were selected to represent the Japanese population regarding age, sex and residential prefecture using a simple random sampling procedure. Patients currently undergoing treatment for diabetes mellitus, hypertension, asthma, cardiocerebrovascular disease, hyperlipidemia, atopic dermatitis, and mental illness, such as depression, were extracted from the total participants. Then, whether discontinuation of dental treatment affected the exacerbation of their systemic disease was examined.Results Overall, 50-60% of patients with each systemic disease had continued to receive dental treatment, and 4-8% of them had discontinued dental treatment. On univariate and multivariate analyses, discontinuation of dental treatment is a risk factor in the exacerbation of diabetes mellitus, hypertensive conditions, asthma, cardiocerebrovascular disease and hyperlipidemia.Conclusion The present epidemiological study showed the relationship between oral health and systemic health, which can provide meaningful insights regarding future medical-dental collaboration in Japan.

Incidence of metachronous second primary cancers in Osaka, Japan: update of analyses using population-based cancer registry data.

Cancer survivors are at excess risk of developing second primary cancers, but the precise level of risk in Japanese patients is not known. To investigate the risk of survivors developing second primary cancers, we conducted a retrospective cohort study using data from the Osaka Cancer Registry. The study subjects comprised all reported patients aged 0-79 years who were first diagnosed with cancer between 1985 and 2004 in Osaka and who survived for at least 3 months, followed-up through to December 2005. A metachronous second primary cancer was defined as any invasive second cancer that was diagnosed between 3 months and 10 years after the first cancer diagnosis. The main outcome measures were incidence rates per 100,000 person-years, cumulative risk and standardized incidence ratios (SIR) of second primary cancer. Metachronous second primary cancers developed in 13,385 of 355,966 survivors (3.8%) after a median follow-up of 2.5 years. Sex-specific incidence rates of metachronous second primary cancer per 100,000 person-years increased with age, and were higher among men than women (except for the 0-49 years age group), but these rates did not differ over the study period. The 10-year cumulative risk was estimated as 13.0% for those who first developed cancer at 60-69 years of age (16.2% for men, 8.6% for women). The SIR among those with first cancer diagnosed at 0-39 and 40-49 years of age were 2.13 and 1.52, respectively, in both sexes, whereas the SIR among cancers of the mouth/pharynx, esophagus and larynx were much higher than one as for site relationships. We showed that cancer survivors in Osaka, Japan, were at higher risk of second primary cancers compared with the general population. Our findings indicate that second primary cancers should be considered as a commonly encountered major medical problem. Further investigations are required to advance our understanding to enable the development of effective measures against multiple primary cancers.

Smoking Status and Risk Awareness of Heated Tobacco Product Use among General Dental Practitioners Belonging to the Aichi Dental Association, Japan.

The awareness of healthcare practitioners concerning heated tobacco product (HTP) use risks has been evaluated; however, few studies have investigated general dental practitioners' awareness regarding HTP-use risks. In this cross-sectional study, we investigated dentists' awareness of the risks of smoking, particularly HTP use. A self-administered questionnaire, including eight questions on conventional cigarette and HTP smoking/using status and both knowledge and awareness of HTP-use risks, was posted to 3883 dentists belonging to the Aichi Dental Association, Japan, in August 2019. Statistical analysis was performed using the Statistical Package for Social Sciences; statistical significance was set at p < 0.05. We analyzed the data of 1317 dentists (participation rate, 41.6%). The study group included cigarette smokers (11.5%) and HTP users (8.5%), among whom 41.1% were dual users. HTP users were more likely than never smokers/users to correctly perceive HTP-use risks (p < 0.05). This study indicates that in Japan, the proportion of HTP users is higher than that of the general population. It is important to educate not only smokers/users but also never smokers/users on the risks of smoking and using HTPs. Smoking cessation, including ceasing HTP use, and aiming to quit smoking and HTP use among dentists would contribute to appropriate smoking cessation among patients.

Combustible cigarettes, heated tobacco products, combined product use, and periodontal disease: A cross-sectional JASTIS study.

BACKGROUND: Combustible cigarettes have detrimental effects on periodontal disease. However, little evidence is available regarding new heated tobacco product (HTP) use and combined product use (both combustible cigarettes and HTPs). This study aimed to examine the association of combustible cigarettes, HTPs, and combined product use with periodontal disease simultaneously. MATERIALS AND METHODS: This cross-sectional study was conducted using data from the 2019 arm of the longitudinal Japan "Society and New Tobacco" Internet Survey. Combustible cigarette users, HTP users, combined product users, never-users, and former users' data were separately obtained. In the present study, the primary outcome was self-reported periodontal disease. We estimated adjusted prevalence ratios (PRs) and confidence intervals (CIs) using multivariable modified Poisson regression analysis after adjusting for 12 confounders. RESULTS: Of the 10,439 JASTIS respondents, the numbers of users of combustible cigarettes only, HTPs only, and both products were 1,304, 437, and 1,049, respectively. Compared with never-users, HTP use was significantly associated with the prevalence of self-reported periodontal diseases (PR 1.43, 95% CI 1.03-1.62). Moreover, former users, combustible cigarette users, and combined product users also showed significant associations (PR 1.56, 95% CI 1.35-1.80; PR 1.29, 95% CI 1.03-1.62; and PR 1.55, 95% CI 1.20-1.99, respectively). CONCLUSIONS: Users of HTPs, combustible cigarettes, and combined products as well as former users were all significantly associated with a higher prevalence of periodontal diseases compared to never-users.

Excessive risk of second-cancer incidence and cancer mortality in patients with esophageal cancer.

BACKGROUND: Second primary cancers have impact on survival in patients who achieved cure for the first esophageal cancer. We, therefore, assessed the risk of incidence and mortality for second primary cancer by calculating standardized incidence ratio (SIR) and standardized mortality ratio (SMR) in patients with superficial or localized esophageal cancer without lymph node metastases as the first cancer (index cancer). METHODS: Data on cancer development and subsequent causes of deaths were collected from integrated database of the Osaka Cancer Registry and the Vital Statistics of Japan. Records with information on patients with index esophageal cancer diagnosed between 2004 and 2013 were extracted from the database. Then, SIR and SMR for second primary cancers that developed in other organ were calculated with the reference to the general population during the same period. All probability values are two-tailed. RESULTS: Of 473,784 case records, 3022 cases of patients with index esophageal cancer were identified. Significantly higher SMRs/SIRs for cancers in mouth/pharynx, larynx, pancreas, and leukemia were confirmed with the values of 10.78/16.16, 8.56/6.44, 2.33/2.31, and 3.96/4.42, respectively. Significantly, higher SIRs for stomach, lung, and skin cancers were confirmed with the values of 2.84, 2.36, and 3.38, respectively, while SMRs were not significantly higher in these cancers. CONCLUSIONS: Significantly higher risks for mouth/pharynx, larynx, pancreas, and leukemia as second cancers were clarified. Careful surveillance for these cancers is required for esophageal cancer patients.

Oral cavity cancer incidence rates in Osaka, Japan between 2000 and 2014.

BACKGROUND: We investigated trends in oral cavity cancer incidence from 2000 to 2014 in Osaka, Japan. METHODS: Using Osaka Cancer Registry (OCR) data, oral cavity cancer incidence number and age-standardized incidence rates were calculated according to three 5-year-time-periods: 2000-2004, 2005-2009 and 2010-2014. We calculated the distribution of clinical stage for each 5-year period and the proportion of oral cavity cancer among all cancers. RESULTS: A total of 6,086 oral cavity cancers were registered in OCR in 2000-2014. Across the period, between 55.6% and 65.0% were 65 years+ and approximately 60% were men. Tongue cancer accounted for 30.4% to 43.8% of the registrations, while gum accounted for 30.7% to 34.7%. 36.3% to 37.3% were regional, while 1.8% to 2.8% were distant. The age-standardized incidence rate of oral cavity cancer increased from 2.1/100,000 in 2000 to 3.8/100,000 in 2014, although the proportion of oral cavity cancer among all cancers only increased slightly from 0.71% in 2000 to 0.92% in 2014. Proportion of localized stage cancer was 60.8%-67.5% for tongue and 31.0%-49.5% for gum or floor of mouth. Proportion of distant stage cancer was 0.3%-1.0% for tongue and 2.5%-4.2% for gum or floor of mouth. CONCLUSIONS: Age-standardized incidence rate of oral cavity cancer increased, but was not higher than other countries. The proportion of localized stage tongue cancer was higher, while that of distant stage cancer was lower than other sites. Tongue cancer might be easier to detect in its earlier stages than other sites.

Does second-hand smoke associate with tooth loss among older Japanese? JAGES cross-sectional study.

OBJECTIVE: Second-hand smoke (SHS) is considered a risk factor for a number of oral diseases. However, its influence on tooth loss, which is the final consequence of periodontal disease and caries, remains unknown. We aimed to evaluate the association between SHS experience and the number of remaining teeth among non-smoking older Japanese individuals. METHODS: Cross-sectional data from the Japan Gerontological Evaluation Study (JAGES) 2013 were used. From the 27,561 people ≥65 years of age who responded to a self-reported questionnaire (response rate = 71.1%), data of 18,865 respondents who had never smoked were analysed. Multinomial logistic regression with multiple imputations was applied to estimate the odds ratio of the frequency of SHS exposures on the number of remaining teeth. RESULTS: The prevalence of participants with ≥20 teeth, 10-19 teeth, 5-9 teeth, 1-4 teeth, and no teeth were 53.2%, 20.4%, 9.9%, 6.6%, and 9.9%, respectively. The proportion of participants with SHS was 37.5%. After adjusting for sex, the SHS experience tended to be associated with a lower risk of having the fewer number of remaining teeth (P < 0.05). However, after being adjusted for age and sex, participants with SHS exposure at "a few times a week" and "almost every day" were significantly associated with the fewer number of teeth. After adding all other covariates, compared to the participants without any exposure to SHS, the odds ratio for having no teeth rather than having ≥20 teeth among the participants with daily exposure to SHS was 1.35 (P < 0.01). CONCLUSION: Daily second-hand smoke was significantly associated with fewer remaining teeth based on the self-reported survey among older Japanese people.

Trajectory of social inequalities in the treatment of dental caries among preschool children in Japan.

OBJECTIVES: The longitudinal trend of dental health inequalities among preschool children has not been described. In this study, we aimed to measure the trajectory of both relative and absolute inequalities in caries treatment among preschool children in Japan. METHODS: We used data from the Longitudinal Survey of Babies in the 21st Century (LSB21), which is an ongoing national representative longitudinal study. The target population was families residing in Japan with newborn baby/babies born between 10 January and 17 January or 10 July and 17 July 2001. Data regarding caries treatment history and socioeconomic status (SES) were collected using a self-reported questionnaire. SES was assessed on the basis of the parents' educational attainment. In total, 35 260 children were followed from 2.5 to 5.5 years through annual surveys. To evaluate absolute and relative inequalities, we calculated the slope index of inequality (SII) and relative index of inequality (RII), respectively. RESULTS: The rate of caries treatment at the age of 2.5 years was <10% for all SES groups; this increased to more than 30% at 5.5 years of age. Children with lower SES received more frequent caries treatment, and both absolute and relative social inequalities were statistically significant. SII showed a significant increase throughout the follow-up period, with values of 4.13% (95% confidence interval [CI], 3.16; 5.09) and 15.50% (95% CI, 13.68; 17.32) at 2.5 and 5.5 years of age, respectively. In contrast, RII decreased with an increase in the treatment rate for all groups, with values of 1.83 (95% CI, 1.59; 2.11) and 1.53 (95% CI, 1.46; 1.61) at 2.5 and 5.5 years of age, respectively. CONCLUSION: Our results suggest that the rate of caries treatment is higher for preschool children with lower SES in Japan, with significant widening of absolute inequalities along with the growth of the children.