The impact of oral health on depression: A systematic review.

INTRODUCTION: As of 2020, about 21% of adults in the United States have a diagnosable mental health disorder, excluding substance use and developmental disorders. Depression, predicted by the WHO to be the leading cause of disease burden by 2030, is linked to various systemic conditions and has been associated with poor oral health. Both behavioral factors, like poor dental hygiene and irregular visits, and biological mechanisms, such as changes in salivary immunity, contribute to this connection, which impacts overall well-being and quality of life. This systematic review aims include: (1) Does tooth loss affect depression? (2) Does oral pain, such as that experienced during chewing and speaking, impact depression? (3) Does oral functionality, including chewing and speaking, influence depression? (4) Does overall oral health affect depression? METHODS: We conducted a systematic search of PubMed, EBSCO host, Medline, and Google Scholar databases from January 2000 to June 2024 using relevant keywords. Studies examining the impact of oral health parameters (tooth loss, oral pain, oral functionality, overall oral health) on depression were included. Articles were included if (1) full text manuscripts in English were available, (2) the study described the association of oral health and depression, and (3) the independent value was an oral related factor and the dependent value was depression. The following were excluded from our analysis: (1) any articles where oral factors were not the independent value, (2) systematic reviews, (3) case reports, and (4) duplicate studies among our databases. Thirty-one studies met the inclusion criteria. RESULTS: Tooth loss, oral pain, and impaired oral functionality were consistently associated with increased depressive symptoms across the included studies. Greater tooth loss was linked to higher odds of both onset and progression of depression. Oral pain exacerbated depressive symptoms, while difficulties in chewing or speaking were associated with elevated risks of depression. CONCLUSION: There is a bidirectional relationship between oral health and depression, highlighting the urgent need for comprehensive public health initiatives. Integrating oral health assessments into routine medical care, and developing targeted interventions are crucial steps to mitigate the impact of poor oral health on mental health outcomes.

The Effect of Postural Rehabilitation on Pain, Balance, Mandibular Movement, and Posture in Temporomandibular Disorder Patients: A Comparison Between Posterior Edentulous and Dentate Groups.

Objective: Posterior edentulism reduces occlusal support, thus increasing the risk and symptoms of temporomandibular disorder. No previous study has explored its effect on the treatment of temporomandibular disorders. This study aimed to examine the relationship between neck posture, balance, and posterior edentulism in patients with temporomandibular disorder and compare the effectiveness of physical therapy. Methods: In a quasi-experimental controlled trial, 26 patients with temporomandibular disorder were divided into 13 in the partly edentulous group and 13 in the dentate group. Both groups received manual therapy, postural exercises, deep neck flexor stabilization, and Kinesio tapping for 6 weeks. Each participant completed 12 physiotherapy sessions, administered twice weekly, with a minimum interval of 48 hours between sessions. Outcomes were assessed at baseline and after the 6-week program, including pain, mandibular movement, posture, and balance. Results: The physical therapy program significantly improved all measured outcomes (P < .05). Furthermore, the partially edentulous group showed more remarkable improvement in pain and balance compared to the dentate group (P < .05). Conclusions: Postural exercises effectively alleviate symptoms in patients with temporomandibular disorder, with more significant improvements observed in the partially edentulous group than in the dentate group.

The life course and oral health in old age.

Alongside a marked increase in the population of older New Zealanders has been an increase in tooth retention: more and more older adults now have at least some of their own teeth. Understanding their oral health demands consideration of their journey along the life course. The common clinical oral conditions - dental caries ('tooth decay') and periodontitis ('gum disease') - are both chronic and cumulative, and highly socially patterned in their occurrence, being more prevalent and severe in those of lower socio-economic position. Those who have ended up with 'good oral health' in old age are those who have had the wherewithal to adapt successfully to their oral disease burden as it has accumulated over the years. In this paper, I consider the utility of the life course approach for interpreting and understanding data, and I apply its principles to a number of important observations on older people's oral health.

Tooth loss during long-term periodontal therapy in specialized practices - a retrospective cohort study from a periodontal practice-based research network (Perio-PBRN).

OBJECTIVES: To investigate tooth-specific, clinical tooth-, and patient-related factors associated with tooth loss (TL) in patients with mild to severe periodontitis treated in a periodontal practice-based research network (Perio-PBRN) over at least 5 years. MATERIALS AND METHODS: The Perio-PBRN consists of five German periodontal practices where clinical data were collected regarding patient age, tooth type, bleeding on probing (BOP), pocket probing depth (PPD), furcation involvement (FI), number of attended appointments, and other variables of interest. The data were evaluated regarding factors influencing TL. RESULTS: Data from 687 patients (aged 54.5 ± 11.1 years) with mild (N = 23, 3.35%), moderate (N = 247, 35.95%) or severe (N = 417, 60.70%) periodontitis and 15,931 teeth over a mean observation period of 6.83 ± 1.40 years per patient were gathered via the Perio-PBRN. In this period, a total of 657 teeth were lost (4.12%, overall TL: 0.14 ± 0.22 teeth/patient/y). The risk of TL was significantly increased for teeth with persistent PPD ≥ 6 mm (hazard ratio: 6.81 [95% confidence interval: 5.07-9.15] in comparison to PPD < 4 mm. Additionally, BOP (3.90 [2.46-6.19]), furcation involvement, jaw, age and tooth type showed a significant influence on TL, while number of visits were not significantly associated with TL. CONCLUSIONS: Periodontal care of patients with moderate to severe disease in specialized practices was associated with a low rate of TL. Known tooth-related prognostic factors were confirmed. However, the results must be interpreted cautiously without knowledge of risk factors such as smoking and diabetes. CLINICAL RELEVANCE: PBRNs can help gather large amounts of periodontal practice-level data. TRIAL REGISTRATION: The study was registered in the German Clinical Trials Register (DRKS 00011448).

Periodontitis adversely affects lipoprotein subfractions - results from the cohort study SHIP-TREND: Periodontitis adversely affects lipoprotein subfractions.

AIM: We aimed to investigate the medium-term associations of periodontitis and the number of missing teeth with serum lipoproteins and their plasma subfractions using follow-up data from the population-based Study of Health in Pomerania (SHIP-TREND). METHODS: A total of 2,058 participants with 7-year follow-up data underwent periodontal examinations, serum lipid panel tests, and proton nuclear magnetic resonance (1H-NMR) spectroscopy of plasma lipoproteins and their subfractions. Generalized models with gamma distribution and loglink were used to analyze associations between periodontal variables and lipoproteins and their subfractions, adjusting for confounders using propensity score weighting. RESULTS: Periodontal variables were consistently associated with elevated follow-up serum levels of triglycerides, total cholesterol, and low-density lipoprotein cholesterol levels. When plasma lipoprotein subfractions were evaluated, periodontal variables were associated with elevated levels of triglycerides and cholesterol-enriched apolipoprotein B-containing lipoprotein particles, particularly small dense low-density lipoprotein, very-low-density lipoprotein and intermediate density lipoprotein. In addition, altered high-density lipoprotein particle composition was observed, suggesting potential functional changes. CONCLUSION: This study provides evidence for causal effects of periodontitis on conventional serum lipids and plasma lipoprotein subfractions. As the underlying biological mechanisms are not fully understood, further research is needed.

Topkan's CARWL Index Efficiently Predicts the Radiation-Induced Tooth Loss Rates in Radically Treated Locally Advanced Nasopharyngeal Cancer Patients.

PURPOSE: To assess the usefulness of the novel CARWL index in predicting radiation-induced tooth loss (RITL) rates in locally advanced nasopharyngeal cancer (LA-NPC) patients undergoing concurrent chemoradiotherapy (C-CRT). METHODS: The study retrospectively examined data from 323 LA-NPC patients. The patients were divided into two groups based on cutoff values for CAR and weight loss (WL). The ideal cutoff for RITL was 3.0 g/dL [AUC: 83.0%, sensitivity: 83.6%, specificity: 81.4%, J-index: 0.650]. CARWL index was created by combining pretreatment CAR and WL status (WL ≤ 5.0% vs > 5.0%, resulting in four groups: Group 1: CAR < 3.0 and WL ≤ 5.0%, Group 2: CAR < 3.0 and WL > 5.0%, Group 3: CAR ≥ 3.0 and WL ≤ 5.0%, and Group 4: CAR > 3.0 and WL > 5.0%. RESULTS: RITL was diagnosed in 67.2% of patients. Since the RITL rates of Groups 2 and 3 were statistically indistinguishable, we combined them and created the three-tiered CARWL score groups: CARWL-0: CAR < 3.0 and WL ≤ 5.0%; CARWL-1: CAR < 3.0 and WL > 5.0%, or CAR ≥ 3.0 and WL ≤ 5.0%; and CARWL-2: CAR > 3.0 and WL > 5.0%. Comparative analysis revealed that the RITL rates gradually and significantly increased from CARWL-0 to CARWL-2 score groups (49.4% vs 64.7% vs 83.0%; P <0.001) despite similar baseline disease and patient characteristics. Results of the multivariate analysis showed that higher CARWL score groups were independent and significant predictors of increased RITL rates (p < 0.001). CONCLUSION: Present results suggest that the novel CARWL index is a reliable biomarker for predicting RITL incidence in LA-NPC patients.

Analysis of factors associated with tooth loss in older adults from 1995 to 2015: a population-based cross-sectional survey in Guangdong, China.

OBJECTIVES: The aim of this study was to detect trends and related factors in the functional dentition (FD) in 65- to 74-year-olds in Guangdong, China, while also assessing trends in education and income inequality factors. MATERIALS AND METHODS: Three large-scale cross-sectional National Oral Health Surveys (NOHS), specifically NOHS II in 1995, NOHS III in 2005, and NOHS IV in 2015, were included. Post hoc stratification was weighted for 1038 participants aged 65 to 74years. Retaining teeth ≥ 20 teeth and retaining < 20 teeth was defined as functional dentition (FD) and nonfunctional dentition (NFD), respectively. Logistic regression models were established to assess related factors. Slope index of inequality (SII) and relative index of inequality (RII) were used to analyze inequality. RESULTS: From NOHS II to IV, the FD proportion increased from 42.8 to 71.9%. Years of NOH, with caries, with periodontal pocket, high educational level, high income level, female, and those who had dental visits were associated with FD preservation. The education-related SII decreased from 0.44 to 0.20, and the income-related SII increased from 0.13 to 0.16. CONCLUSIONS: The FD proportion among 65- to 74-year-olds improved from 1995 to 2015. Years of NOHS, with caries, with periodontal pocket, high education level, and high income level were associated with higher FD proportion. Female and those who had dental visits were associated lower FD proportion. Social inequalities in FD persisted, especially economic-related inequalities. Public health policy support and respective interventions should be applied to increase FD retention.

Periodontal disease and cardiovascular disease: umbrella review.

BACKGROUND: Periodontal disease (PD) is an infectious and inflammatory condition that affects the tissues surrounding and supporting the teeth. It has been suggested that PD may be associated with cardiovascular disease (CVD), one of the leading causes of mortality worldwide. Our study aimed to investigate the association between PD and CVD through an umbrella review. METHODS: A comprehensive search was conducted until April 2024 across various electronic databases, including PubMed, Cochrane Library, Scopus, SciELO, Web of Science, Google Scholar, ProQuest Dissertations and Theses, and OpenGrey. Systematic reviews with or without meta-analysis were considered for inclusion, without any limitations on time or language, provided they examined primary studies linking PD with CVD. The AMSTAR-2 tool was employed to assess the quality and overall confidence of the included studies. RESULTS: After the initial search, a total of 516 articles were identified. Following the application of selection criteria, 41 articles remained for further consideration. All these studies indicated an association between PD and CVD, with odds ratios and risk ratios ranging from 1.22 to 4.42 and 1.14 to 2.88, respectively. CONCLUSIONS: Systematic reviews with high overall confidence support the association between PD, tooth loss, and cardiovascular diseases. However, it is crucial to interpret these results with caution due to methodological limitations. The potential public health relevance justifies preventive and corrective oral health strategies. Additionally, the need for rigorous future research is highlighted to strengthen the evidence and guide effective public health strategies.

Tooth loss in young mice is associated with cognitive decline and femur-bone mineral density.

Osteoporosis is a prevalent disease that is associated with increased hip fractures which cause significant decline in quality of life. Tooth loss affects systemic condition such as cognitive function through various mechanism, but the link between tooth loss and femoral bone mineral density is still uncertain. This study aims to investigate whether tooth loss in young mice affects memory function and femoral bone mineral density. Eight-week-old male C57BL/6 J mice were allocated randomly into the control group with sham operation and the tooth-loss group extracted all maxillary molar. Step-through passive avoidance test as cognitive function test, micro-CT analysis and western blotting analysis were performed after 1- and 2-month observation period. Step-through passive avoidance test revealed that the tooth-loss group in 2-month observation period impaired cognitive function. Additionally, micro-CT analysis revealed a significant decrease in both the length of the mandible and bone mineral density in the femur of the tooth-loss group compared to the control group. Claudin-5 level in the hippocampus, which is one of the tight junction markers in blood-brain-barrier, was significantly decreased in the tooth-loss group. The findings of our present study suggested that tooth loss impair cognitive function accompanied by reduced tight-junction marker, mandibular growth and bone mineral density of femur.

Social Relationships and Tooth Loss in Adults Aged 60 Years and Older: A Systematic Review and Meta-Analysis.

OBJECTIVE: To systematically assess current evidence on the extent to which social relationships are associated with tooth loss in adults aged 60 years and older. METHODS: A systematic literature search was conducted on PubMed, Embase, Web of Science, CINAHL and The Cochrane Library databases to identify relevant studies published from 1966 up to March 2024. Cross-sectional or cohort studies investigating the association between structural, functional and/or combined (structural and functional) components of social relationships and the number of remaining teeth or edentulism among community-dwelling or institutionalised older adults were included. Data were extracted on participants' and study characteristics, including study design, the type of measures used to assess social relationships (structural, functional, and combined), outcome measures and association estimates. The quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS) for cohort studies and the adapted NOS for cross-sectional studies. The reported association between social relationships and the number of remaining teeth or edentulism was summarised using meta-analysis with robust variance estimation. RESULTS: Twenty studies were included in the review and 12 studies (125 553 participants) in the meta-analysis. Across the 12 studies, the average odds ratio (95% confidence interval) was 1.15 (1.01-1.32), indicating a 15% higher likelihood of having a lower number of teeth or edentulism for those with weaker social relationships. The GRADE certainty of the body of evidence was low. CONCLUSIONS: Weak social relationships were associated with a lower number of teeth or edentulism in older adults. Our findings may inform potential public health approaches that target and modify social relationships to prevent and address older adults' oral diseases. Still, the directionality and the underlying mechanisms connecting social relationships and tooth loss need to be further explored by longitudinal studies with follow-up long enough for oral health outcomes or changes in social relationships to occur. TRIAL REGISTRATION: Protocol Registration: PROSPERO (CRD42023417845).

Risk of Healing Complications Following Alveolar Process Fractures in the Primary Dentition: A Retrospective Clinical Cohort Study.

BACKGROUND/AIM: Alveolar bone process fractures in preschool children are not well documented in the literature. Alveolar process fractures are located very close to primary teeth and permanent tooth germs. This study investigates the risk of healing complications following alveolar process fractures in the primary dentition and potential sequelae in the permanent dentition. MATERIALS AND METHODS: A retrospective cohort study was conducted involving 21 patients with 49 primary teeth involved in an alveolar fracture. The follow-up protocol included clinical and radiographic examinations at specified intervals up to the age of 6 years. Healing complications in the primary teeth such as pulp necrosis, pulp canal obliteration, ankylosis, infection-related resorption and premature tooth loss were examined. Sequelae in the permanent dentition was also registered when the permanent incisors had erupted. RESULTS: Over a 3-year follow-up, the incidence of premature tooth loss was 51.2% [95% CI: 34.1%-68.4%], pulp canal obliteration was 42.5% [95% CI: 27.1%-57.8%], and pulp necrosis was 8.9% [95% CI: 0.6%-17.3%] following an alveolar process fracture. No cases of ankylosis were observed. Sequelae in the permanent dentition primarily included demarcated opacities and hypoplasia with a risk estimated at 24% [95% CI: 13%-39%] and 9% [95% CI: 2%-21%] respectively. CONCLUSION: Alveolar process fractures in primary dentition are associated with several healing complications in the primary teeth. Although the likelihood of severe complications in the permanent dentition is low, young children are still susceptible to developing sequelae in their permanent teeth. These results highlight the importance of awareness of dental injuries following alveolar process bone fractures in the primary dentition.

Association of tooth loss and periodontal disease with all-cause mortality in cancer survivors: A cohort study based on NHANES.

Background: Increasing evidence supports the association between impaired oral health and elevated mortality. However, there is currently a lack of research on the impact of tooth loss and periodontal disease on survival outcomes in cancer survivors. This study aims to clarify the effect of tooth loss and periodontitis on all-cause mortality on cancer survivors. Methods: The clinical data of cancer survivors were collected from National Health and Nutrition Examination Survey (NHANES) 1999-2018. Mortality data were obtained by linking to records in the National Death Index until December 31, 2019. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal threshold for discriminating mortality based on the number of teeth lost. Kaplan-Meier survival curves and Cox regression analysis were performed to calculate hazard ratios (HRs) and 95 % confidence intervals (95 % CI) for tooth loss and periodontitis. Results: A total of 3271 cancer survivors were assessed for tooth loss status, while 1267 patients were evaluated for periodontitis status. The prevalence of any tooth loss and CDC-AAP periodontitis was 83.5 % and 47.2 %, respectively. The ROC curve showed the cut-off point of tooth loss for predicting mortality is > 5. Cancer survivors with tooth loss>5 had significantly lower bone density (1.06 vs. 1.13 g/cm2, P < 0.001), elevated C-reactive protein level (0.3 vs. 0.18 mg/dL, P < 0.001), and a trend of lower lean body mass (46.9 vs. 47.6 kg, P = 0.093). Besides, cancer survivors with severe periodontitis also exhibited elevated C-reactive protein level (0.34 vs. 0.21 mg/dL, P = 0.033). All-cause mortality significantly increased in cancer survivors with either tooth loss>5 (HR = 1.290, P = 0.001) or severe CDC-AAP periodontitis (HR = 1.682, P = 0.016) in the multivariate Cox regression analysis. Conclusion: Tooth loss and periodontitis are strong risk factors for reduced overall survival in cancer survivors. Cancer survivors should emphasize diligent oral hygiene and consistent dental check-ups to optimize long-term oral health. The causal relationship between oral health and survival rates in cancer survivors requires further validation through randomized controlled trials.

Diagnostic accuracy of salivary hemoglobin, lactate dehydrogenase and Interleukin-6 to determine chronic periodontitis and tooth loss in type 2 diabetics.

Background: Salivary Hemoglobin (SH) has emerged as the mainstay non-invasive and a practicable screening method for Chronic Periodontitis. Current research aims to comprehensively assess the diagnostic value of Salivary Hb (SH) in comparison with Salivary IL-6 (SIL-6) and levels of Salivary lactate dehydrogenase enzyme (SLDH) amongst Type II Diabetes subjects having Chronic Periodontitis (CP) and associated tooth loss. Materials and methods: In this cross-sectional comparative investigation, 240 individuals with at least 15 remaining teeth, ranging in age from 30 to 70, were chosen and Group I controls were defined as follows: healthy (HbA1c levels ≤6.4 %) with no CP; Group II included chronic periodontitis and non-T2DM (HbA1c ≤ 6.4 %); Group III included T2DM (HbA1c ≥ 6.5 %) and CP; and Group IV included T2DM (HbA1c ≥ 6.5 %) with periodontitis-related tooth loss. ELISA colorimetric assay was used to quantify the results using the unstimulated whole saliva of fasting participants. Tukey's post hoc test was used for statistical analysis following Analysis of Variance (ANOVA), and Sensitivity and Specificity were computed following the determination of the correlation coefficient. Results: One-way ANOVA comparing Biomarker levels across the four groups revealed a statistically significant difference (F = 68.013) (p = 0.0001). Tukey's multiple post hoc yielded a significant difference between groups with least mean average biomarker levels observed among the controls (Group1) and maximum with group IV. Diagnostic Accuracy to discriminate between CP in T2DM & Controls with SH surpassed that of SIL-6 & SLDH, Receiver operating characteristic (ROC) curve depicted an overall sensitivity of 67.62 %, specificity of 80 % and accuracy of 74 % in T2DM subjects with tooth loss for the identification and assessment of CP. Conclusion: Estimates of Salivary Hemoglobin can assume an important role in comparison to SIL-6 & SLDH in determining the degree of periodontitis, including tooth loss, and identifying elevated glycemic levels. Advanced detection and monitoring can be ensured by routine use in dental offices and general practice.

Effect of Discontinuation of Supportive Periodontal Therapy on Periodontal Status-A Retrospective Study.

AIM: To assess the impact of active (APT) and supportive periodontal therapy (SPT) on the change in probing depth (PD) and annual tooth loss in partially and fully compliant and drop-out patients. MATERIAL AND METHODS: Data of 280 periodontally treated partially and fully compliant (regular supportive visits, SPT duration 5.5 ± 4.5 years) and 55 drop-out patients (SPT and drop-out duration 8.3 ± 3.8 years, only drop-out duration 5.3 ± 3.7 years) were recorded. PD data and the number of teeth present at the start of APT (T1) and at the start of SPT (T2) were taken from the patient files and evaluated at the time of the final examination (T3). RESULTS: Annual tooth loss during SPT was significantly higher (p < 0.001) in drop-out patients than in partially and fully compliant patients (0.31 ± 0.50 vs. 0.19 ± 0.55, respectively). In partially and fully compliant and drop-out patients, the mean PD (all available site data) decreased significantly between T1 (3.61 ± 0.82 vs. 3.70 ± 0.73 mm) and T2 (2.68 ± 0.40 vs. 2.76 ± 0.42 mm), while the values increased again slightly up to T3 (2.74 ± 0.41 vs. 2.99 ± 0.75 mm). CONCLUSIONS: In partially and fully compliant patients, SPT had a positive impact on PD stability and medium-term tooth preservation. In contrary to expectations, drop-out patients, PD did not return to baseline values, although PD stability was not achieved.

Longitudinal association between dentition status and gait speed among older Brazilian adults: SABE cohort study.

BACKGROUND: Oral health has been associated with general health conditions, but few longitudinal studies evaluated the effect of dentition status on gait speed. OBJECTIVE: This study aimed to investigate the longitudinal association between different time-varying measures of dentition status (i.e., number of teeth, the presence of periodontal pockets and the functional impact of oral health) and gait speed (outcome) in older Brazilian adults. MATERIALS AND METHODS: This was a prospective study using data from the Health, Well-being and Aging cohort study (SABE) from 2006, 2010 and 2015. The gait speed was the dependent variable and the independent variables of interest were dentition status evaluated using the number of teeth, use of dental prostheses, presence of periodontal pocket, clinical attachment loss and self-perceived poor functional oral health. Dentition status measures were obtained through clinical oral examinations, performed by trained dentists using standardized criteria proposed by the World Health Organization. Self-perceived poor functional oral health was evaluated using the functional domain of the Geriatric Oral Health Assessment Index. The longitudinal effect of dentition status on gait speed was evaluated using mixed-effects linear models. The effect of the number of teeth/periodontal pocket/attachment loss on gait speed change over time was evaluated by including an interaction term between these variables. The effect of periodontal pocket was tested only among dentate individuals. RESULTS: Data for the complete sample included 3,306 observations from 1,964 individuals. The analyses for dentate individuals included 1,883 observations from 1,149 individuals. There was a positive association between the number of teeth and mean gait speed. Individuals using dental prostheses also had higher means of gait speed than those without dental prostheses. Gait speed was lower among individuals with periodontal pockets and with attachment loss. No interaction was found between any of the indicators of dentition status and time. CONCLUSION: Gait speed was associated with dentition status and this association was constant over time.

Tooth Loss in Periodontitis Patients-A Risk Factor for Mild Cognitive Impairment: A Systematic Review and Meta-Analysis.

BACKGROUND: Periodontal disease and tooth loss have been long suggested as risk factors of mild cognitive impairment. The underlying mechanisms could be systemic chronic inflammatory mediators, direct pathologic challenge to the nervous system, malnutrition and/or loss of neurosensory stimulation input causing brain atrophy. This review aimed to examine the existing literature studies linking the effect of periodontal disease and tooth loss on the development of mild cognitive impairment. METHODS: A systematic review using PEO was conducted. Three electronic databases, namely Embase, Medline and DOSS (UCLan), were searched for relevant articles published up to April 2023. Google Scholar and a hand search were also conducted to ensure no relevant studies had been missed. The Newcastle-Ottawa scale was used to assess the quality of studies. RESULTS: The findings showed that chronic periodontitis and tooth loss, both individually and in combination, led to an increased risk of mild cognitive decline in adults over 50 years. Within the limitations of this review, periodontitis and tooth loss both contribute to an increased risk of mild cognitive impairment and dementia, but the evidence so far is not strong. CONCLUSIONS: In future, more robustly designed studies investigating periodontal disease and tooth losslink with cognitive health decline are required with a longer follow-up duration.

Association between tooth loss and depression mediated by lifestyle and Inflammation- a cross-sectional investigation.

BACKGROUND: Depression and tooth loss are associated with the occurrence of systemic disease or the progression of multi-factorial disease, and both are considered important public health issues by World Health Organization (WHO). Previous research just suggested that tooth loss can generate psychological stress, low self-esteem, anxiety and other emotional disturbances. However, the precise correlation and underlying mechanisms between depression and tooth loss remains poorly understood. ​Consequently, we aim to explore the association between depression and tooth loss through a cross-sectional study, as well as investigate potential pathways of influence. METHODS: We analyzed data from the National Health and Nutrition Examination Survey (NHANES). Logistic regression models were employed to examine the relationship between depression and tooth loss, as well as the associations among healthy lifestyle, systemic immune-inflammation index (SII), depression and tooth loss. Through the mediating effect analysis by bootstrapping analysis, we evaluated the mediating effects of healthy lifestyle and SII between depression and tooth loss. RESULTS: Depressed patients were more likely to be toothless, and at the same time showed a tendency to have more missing teeth, with odds ratio (OR) = 1.305 (1.098, 1.551), p = 0.003 for 1-7 missing teeth, OR = 1.557 (1.166, 2.079), p = 0.003 for 8-14 missing teeth, and OR = 1.960 (1.476, 2.603), p<0.001 for 15-28 missing teeth. Lower healthy lifestyle scores and higher SII were both associated with more tooth loss. Healthy lifestyle and SII played a partial mediating role in this relationship, with a mediating effect ratio of 41.691% and 3.289%, respectively. CONCLUSIONS: ​Depression was positively associated with more severe tooth loss, which was partly mediated by lifestyle and SII. Therefore, attention should also be paid to the effects of depression as a mental disorder on physical health, such as depression and tooth loss. Adopting a healthier lifestyle and controlling systemic inflammation may be potential ways to reduce the impact of depression and tooth loss.

The multifaceted impact of missing teeth on general health: A narrative review.

Tooth loss extends beyond oral health concerns, impacting overall well-being and quality of life. It is a global issue, with approximately 7% of individuals aged 20 years or older affected. Research reveals associations between tooth loss and cardiovascular diseases, including hypertension, atherosclerosis, and peripheral arterial disease, attributed mainly to chronic inflammation and altered dietary habits. However, tooth loss has also been associated with cognitive decline, depression, and certain cancers, including lung, head and neck, pancreatic, and esophageal, suggesting the involvement of complex pathophysiological mechanisms that are increasingly the subject of experimental research. In addition, there are psychosocial consequences, such as self-esteem issues and social discomfort. Therefore, it is indisputable that comprehensive oral care is of utmost importance. Recognizing the importance of oral health for overall well-being highlights the necessity for preventative measures and enhanced dental care. As the global population ages, it is increasingly important to comprehend and address the systemic effects of tooth loss. This review aims to summarize the complex pathomechanisms underlying tooth loss and emphasize the need for a comprehensive approach to address its di- verse consequences. It advocates for preventive oral health measures to sustain general health and well-being.

Vitamin D, periodontitis and tooth loss in older Irish adults.

The aim of this study is to investigate whether 25-hydroxyvitamin D (25(OH)D) is associated with periodontitis and tooth loss in older adults. A total of 2346 adults underwent a detailed dental examination as part of the health assessment of a national population study - The Irish Longitudinal Study of Ageing. 25(OH)D analysis was performed on frozen non-fasting total plasma using LC-MS. The analysis included both multiple logistic regression and multinominal logistic regression to investigate associations between 25(OH)D concentration, periodontitis and tooth loss, adjusting for a range of potential confounders. Results of the analysis found the mean age of participants was 65·3 years (sd 8·2) and 55·3 % of the group were female. Based on the quintile of 25(OH)D concentration, participants in the lowest v. highest quintile had an OR of 1·57 (95 % CI 1·16, 2·13; P < 0·01) of having periodontitis in the fully adjusted model. For tooth loss, participants in the lowest v. highest quintile of 25(OH)D had a RRR of 1·55 (95 % CI 1·12, 2·13; P < 0·01) to have 1-19 teeth and a RRR of 1·96 (95 % CI 1·20, 3·21; P < 0·01) to be edentulous, relative to those with ≥ 20 teeth in the fully adjusted models. These findings demonstrate that in this cross-sectional study of older men and women from Ireland, 25(OH)D concentration was associated with both periodontitis and tooth loss, independent of other risk factors.

Impact of social wellbeing on tooth loss and cognition: A scoping review.

OBJECTIVE: The proposed explanations for the association between tooth loss and cognitive function have largely focused on systemic inflammation, mechanoreceptor feedback, and nutritive deficiencies. However, the role of social wellbeing in this relationship remains unknown. The aim of this scoping review is to explore the pathways linking different aspects of social function, collectively grouped under the umbrella of social wellbeing, to tooth loss and cognitive impairment. DATA AND SOURCES: An electronic database search was performed in PubMed, Scopus, and Embase. Reference lists of relevant articles were also searched. Data on the associations between social wellbeing, cognitive function and tooth loss was charted in an extraction form and summarised qualitatively. STUDY SELECTION: From the initial search of 3293 records, 71 studies were included in the present review. Forty-seven studies investigated the relationship between social wellbeing and cognition, 21 studies investigated the relationship between social wellbeing and tooth loss, and only 3 studies investigated all three variables. CONCLUSION: This review demonstrates the need for further research on tooth loss, cognition and social wellbeing in tandem and describes potential psychological, biological, cognitive, and behavioural mechanisms interlinking these factors. While substantial evidence was found for the association between social relationships and cognition, fewer studies explored the potentially bidirectional relationship of social wellbeing and tooth loss. CLINICAL SIGNIFICANCE: The implications of this review may guide clinicians to focus on the social consequences of tooth loss, which may have broader repercussions on cognitive health. The role of social support in helping older people cope with oral disease and the benefits of fostering positive lifestyle habits should not be underestimated.