Midlife Cognitive Ability, Education, and Tooth Loss in Older Danes.

OBJECTIVE: To examine the possible influence of cognitive ability and education at age 50 or 60 on number of teeth at age 70. SETTING: Community-dwelling population in Copenhagen, Denmark. PARTICIPANTS: Men and women born in 1914 (N = 302). MEASUREMENTS: Cognitive ability was assessed using the Wechsler Adult Intelligence Scale at age 50 or 60. A global cognitive ability measure was used as a continuous measure and according to tertile. Information on education was gathered using a questionnaire at age 50 or 60. A clinical oral examination took place at age 70, and oral health was measured according to number of teeth (<6 vs ≥6). Baseline covariates were smoking, alcohol, sex, and income. RESULTS: Logistic regression analyses revealed that greater cognitive ability and educational attainment had a protective effect against risk of tooth loss. The associations were significant and persisted after adjusting for confounders and a two-way interaction between cognitive ability and education. CONCLUSION: Higher education level and cognitive ability measured at age 50 or 60 were associated with having more teeth at age 70. Whether these findings are due to the interaction of these factors with oral health, related socioeconomic factors, or other factors remains to be studied.

Smoking and drinking as risk indicators for tooth loss in middle-aged Danes.

OBJECTIVES: To investigate tobacco and alcohol consumption as risk indicators for missing teeth in late middle-aged Danes. METHOD: In all, 1,517 Copenhagen Aging and Midlife Biobank (CAMB) participants received a clinical oral examination that included number of teeth. Information on smoking, drinking, and various covariates was obtained using self-administered, structured questionnaires. Descriptive statistics and logistic regression (dependent variable: 6+ vs. <6 missing teeth) were used to investigate smoking and drinking in relation to missing teeth. RESULTS: Current smokers, persons who currently or previously smoked >15 tobacco units/day, and persons who had smoked for 27+ years had elevated mean scores of missing teeth and associated odds ratios (OR) compared with never smokers. Relative to nondrinkers, alcohol consumption was associated with reduced odds of missing 6+ teeth. DISCUSSION: Our findings suggest that smoking is positively associated, while alcoholic beverage consumption is inversely related to tooth loss in middle-aged Danes.

Intakes of calcium, vitamin D, and dairy servings and dental plaque in older Danish adults.

BACKGROUND: To investigate whether intakes of calcium and dairy-servings within-recommendations were associated with plaque score when allowing for vitamin D intakes. METHODS: In this cross-sectional study, including 606 older Danish adults, total dietary calcium intake (mg/day) was classified as below vs. within-recommendations and dairy intake as <3 vs. ≥3 servings/ d. Dental plaque, defined as the percentage of tooth surfaces exhibiting plaque, was classified as < median vs. ≥median value (9.5%). Analyses were stratified by lower and higher (≥6.8 µg/d) vitamin D intake. FINDINGS: Intakes of calcium (OR = 0.53; 95% CI = 0.31-0.92) and dairy servings (OR = 0.54; 95% CI = 0.33-0.89) within-recommendations were significantly associated with lower plaque score after adjustments for age, gender, education, intakes of alcohol, sucrose and mineral supplements, smoking, diseases, number of teeth, visits to the dentist, use of dental floss/tooth pick and salivary flow, among those with higher, but not lower, vitamin D intake. CONCLUSION: Intakes of calcium dairy-servings within-recommendations were inversely associated with plaque, among those with higher, but not lower, vitamin D intakes. Due to the cross-sectional nature of the study, it is not possible to infer that this association is causal.

Findings from the oral health study of the Danish Health Examination Survey 2007-2008.

OBJECTIVE: The aims of the oral part of the Danish Health Examination Survey (DANHES 2007-2008) were (1) to establish an oral health database for adult Danes and (2) to explore the influence of general diseases and lifestyle on oral health. This paper presents the study population, examination methods, questionnaire and baseline results. MATERIALS AND METHODS: The study population comprised 4402 subjects, aged 18-96, consecutively enrolled from 18 065 DANHES participants from 13 municipalities in Denmark. The oral part consisted of a validated questionnaire and a clinical examination, carried out in mobile units by three trained and calibrated dental hygienists. The data were processed with descriptive statistics and mono- and bivariate analyses. RESULTS: The mean age was 54.1 years and 60% were women. The mean number of natural teeth was 26.6; the mean DMFT/DMFS values were 18.9 and 61.0, and varied with age (DMFT 8.7-24.3). A higher proportion of females suffered from dental erosion in the younger age groups. Forty per cent of all subjects had a mean clinical attachment loss ≥ 3 mm, varying from 4% among those aged 18-34 to 80% in those over 75. A sub-optimal saliva secretion rate was more common among females than males (17.7% vs 10.4%) and this was reflected by the reported frequency of dry mouth. CONCLUSION: This extensive cross-sectional study provides a platform for obtaining future knowledge of the impact of health- and lifestyle-related factors on oral diseases. The validated questionnaire and the clinical characteristics enable robust analyses, although the conclusions may be hampered by limited external validity.

Intake of dairy products in relation to periodontitis in older Danish adults.

This cross-sectional study investigates whether calcium intakes from dairy and non-dairy sources, and absolute intakes of various dairy products, are associated with periodontitis. The calcium intake (mg/day) of 135 older Danish adults was estimated by a diet history interview and divided into dairy and non-dairy calcium. Dairy food intake (g/day) was classified into four groups: milk, cheese, fermented foods and other foods. Periodontitis was defined as the number of teeth with attachment loss ≥3 mm. Intakes of total dairy calcium (Incidence-rate ratio (IRR) = 0.97; p = 0.021), calcium from milk (IRR = 0.97; p = 0.025) and fermented foods (IRR = 0.96; p = 0.03) were inversely and significantly associated with periodontitis after adjustment for age, gender, education, sucrose intake, alcohol consumption, smoking, physical activity, vitamin D intake, heart disease, visits to the dentist, use of dental floss and bleeding on probing, but non-dairy calcium, calcium from cheese and other types of dairy food intakes were not. Total dairy foods (IRR = 0.96; p = 0.003), milk (IRR = 0.96; p = 0.028) and fermented foods intakes (IRR = 0.97; p = 0.029) were associated with reduced risk of periodontitis, but cheese and other dairy foods intakes were not. These results suggest that dairy calcium, particularly from milk and fermented products, may protect against periodontitis. Prospective studies are required to confirm these findings.

Indicators for root caries in Danish persons with recently diagnosed Alzheimer's disease.

OBJECTIVE: To identify indicators of root caries among persons with newly diagnosed Alzheimer's disease (AD). BACKGROUND: Few studies have investigated dental caries in older adults with AD. Previously we found that persons with AD had significantly more root caries compared to persons with dementia other than AD. METHODS: Participants were recruited from two university hospital clinics in Copenhagen, Denmark. A team of neurologists/geriatricians carried out the diagnostic screening. The study included an interview, oral examination and medical records. RESULTS: We evaluated potential indicators of root decay across subjects with 3+ decayed surfaces vs. <3 decayed surfaces. Variables associated with increased odds of root caries were age over 80 years, 2+ decayed coronal surfaces and 5+ filled root surfaces. Among the social variables, living with someone was associated with a nearly 70% reduction in the odds of having 3+ surfaces of untreated caries. DISCUSSION: Root caries is highly prevalent among individuals with new AD and there is still a strong need for active assessment of and attention to oral problems in persons with AD. Our findings document that recently diagnosed AD cases with multiple coronal caries lesions are at elevated risk of having more root caries. Also persons 81+ years and those with multiple root fillings are more likely to have numerous untreated root lesions.

Periodontal inflammation in relation to cognitive function in an older adult Danish population.

Inflammation plays a significant role in Alzheimer's disease (AD) pathogenesis. Studies have shown that systemic, peripheral infections affect AD patients. Cognitive dysfunction is a consistent finding in AD and periodontal disease is a chronic, peripheral infection often resulting in tooth loss. We hypothesized that older adults with periodontal inflammation (PI) or many missing teeth would show impaired cognition compared to subjects without PI or with few missing teeth, and among subjects with PI, those with many missing teeth would show impaired cognition compared to those with few missing teeth. The effect of PI/tooth loss on cognitive function [measured by Digit Symbol (DST) and Block Design (BDT) tests] was assessed in 70-year old Danish subjects. We found: 1) subjects with PI obtained lower mean DST scores compared to subjects without PI (p < 0.05); 2) subjects with many missing teeth had lower mean DST and BDT scores compared to subjects with few missing teeth (p < 0.05); 3) the association of PI with DST and BDT scores was dependant on the number of missing teeth (interaction: p = 0.03 and p = 0.06); and 4) education and previous cognitive scores (age 50) were important covariates. Subjects with PI had significantly lower adjusted mean DST scores compared to subjects without PI. However for adjusted BDT, the significance held only for subjects with few missing teeth. No difference in the adjusted DST and BDT scores was seen between subjects with many missing teeth compared to those with few missing teeth. These results support the hypothesis that PI may affect cognition.

Number of teeth and fatigue in older adults.

OBJECTIVES: To examine whether tooth loss at age 70 is associated with fatigue in a nondisabled community-dwelling population cross-sectionally at age 70 and with onset of fatigue longitudinally at 5-, 10-, and 15-year follow-ups. SETTING: Community-based population in Copenhagen. PARTICIPANTS: Five hundred seventy-three nondisabled 70-year-old individuals in 1984. MEASUREMENTS: Data from interviews and a medical and oral examination. Oral health was measured according to number of teeth (0, 1-9, 10-19, ≥ 20). Fatigue was measured using the Avlund Mobility-Tiredness Scale on six mobility activities. Covariates, all measured at baseline, were sex, education, income, comorbidity, and smoking. RESULTS: Bivariate logistic regression analyses showed significant cross-sectional and longitudinal associations between number of teeth at age 70 and onset of fatigue at 5- and 10- but not 15-year follow-up. The associations between having no teeth and fatigue were attenuated when adjusted for socioeconomic position and smoking. CONCLUSION: Tooth loss is associated with onset of fatigue in old age, but the estimates are attenuated when adjusting for socioeconomic position and smoking. Tooth loss may be an early indicator of frailty.

Amount and type of alcohol consumption and missing teeth among community-dwelling older adults: findings from the Copenhagen Oral Health Senior study.

OBJECTIVES: To study if an association between total weekly intake of alcohol, type-specific weekly alcohol intake, alcoholic beverage preference, and the number of teeth among older people exists. METHODS: A cross-sectional study including a total of 783 community-dwelling men and women aged 65-95 years who were interviewed about alcohol drinking habits and underwent a clinical oral and dental examination. Multiple regression analyses were applied for studying the association between total weekly alcohol consumption, beverage-specific alcohol consumption, beverage preference (defined as the highest intake of one beverage type compared with two other types), and the number of remaining teeth (≤ 20 versus >20 remaining teeth). RESULTS: The odds ratio (OR) of having a low number of teeth decreased with the total intake of alcohol in women, with ORs for a low number of teeth of 0.40 [95 percent confidence interval (CI) 0.22-0.76] in women drinking 1-14 drinks per week and 0.34 (95 percent CI 0.16-0.74) in women with an intake of more than 14 drinks per week compared with abstainers. Similar relations could also be obtained for type-specific alcohol intake of wine and for wine and spirits preference among women. Men who preferred beer showed a decreased risk for a low number of teeth compared with men with other alcohol preferences. CONCLUSION: In this study, alcohol consumption, wine drinking, and wine and spirits preference among women were associated with a higher number of teeth compared with abstainers. Among men, those who preferred beer also had a higher number of teeth.

The Copenhagen Oral Health Senior Cohort: design, population and dental health.

BACKGROUND: In order to study the way old age influence oral health, the Copenhagen Oral Health Senior Cohort (COHS) has been established. OBJECTIVES: To describe the design, measurement procedures, and baseline values for COHS including spatial distribution of restorations and dental caries as well as reasons for non-participation. MATERIALS AND METHODS: Seven hundred and eighty-three individuals aged 65 years or older, from a total of 1918 invited elderly people, underwent an interview regarding oral health-related behaviour and a clinical oral examination including measurement of unstimulated whole saliva flow rate. RESULTS: Twelve percent of the COHS was edentulous. The number of dental restorations was higher for women compared to men; however, men had more caries than women. Coronal caries was most frequent on mesial and distal surfaces and on the maxillary incisors and canines; root caries was most frequent on labial surfaces and evenly distributed within the dentition. Only 41% of all invited elderly people accepted the invitation, with old age and poor health being the primary reasons for non-participation. CONCLUSION: The baseline values for COHS show that a substantial proportion of the participants had retained a natural dentition and that dental caries was prevalent with the anterior maxillary teeth being most affected.

Assessing caries increments in elderly patients with and without dementia: a one-year follow-up study.

BACKGROUND: The authors conducted a study to determine one-year coronal and root caries increments in patients newly diagnosed as having Alzheimer disease (AD), other dementia (OD) or no dementia. METHODS: The authors recruited patients from two hospital memory clinics in Copenhagen. The oral examination included an assessment of dental status and dental caries. The authors used a structured questionnaire to obtain information regarding demographic, social and functional variables. RESULTS: In the baseline study, 106 dentate patients participated. Of these, 77 completed the follow-up study. The participants' mean age was 81.9 years at baseline and 82.5 years at follow-up. At baseline, 87 (82 percent) of 106 participants had dementia and at follow-up, 64 (83 percent) of 77 participants had dementia. The mean number of decayed tooth surfaces was significantly higher at follow-up than at baseline for all participants, and the number was highest for the OD group. The one-year adjusted caries and filling increments (ADJCIs) were high for participants with and without dementia but were highest for participants in the AD and OD groups. Baseline risk factors for developing elevated coronal and root ADJCIs included having caries, having many teeth and being older than 80 years. CONCLUSIONS: Elderly people referred to a memory clinic were at an elevated risk of developing high levels of coronal and root-surface caries during the first year after referral, and those with a dementia diagnosis other than AD appeared to be at a particularly high risk of developing multiple carious lesions during the first year after diagnosis. CLINICAL IMPLICATIONS: These findings underscore the importance of addressing the oral health needs of elderly people suspected of having experienced cognitive decline.

Effect of inflammation in the periodontium in early old age on mortality at 21-year follow-up.

OBJECTIVES: To analyze whether inflammatory processes in the periodontium in early old age are related to subsequent mortality during 21 years of follow-up in a nondisabled 70-year-old population. SETTING: Community-based population in Copenhagen. DESIGN: The study was based on the Glostrup Aging Study of the 1914 population, with baseline in 1984 when the participants were 70 years old and follow-up 21 years later. PARTICIPANTS: Three hundred thirty-five dentate men and women participated in the clinical oral health examination. MEASUREMENTS: Severe periodontal inflammation was measured for all teeth present as the number of teeth with inflammation and periodontal pockets 6 mm deep or more. Mortality data were obtained from the Danish Death Register at 21-year follow-up. The Cox proportional hazards regression model was used. Covariates were measured at baseline and included number of teeth, caries, sex, education, income, hypertension, diabetes mellitus, osteoarthritis, arteriostenosis, myocardial infarction, comorbidity, fatigue, and ability to brush teeth. RESULTS: The analyses showed that severe periodontal inflammation in at least three teeth at age 70 was marginally related to mortality during 21-year follow-up (crude hazard ratio (HR)=1.17, 95% confidence interval (CI)=0.91-1.78). The estimate increased slightly when adjusted for sex, income, fatigue, and smoking (adjusted HR=1.37, 95% CI=0.97-1.92). The estimates were attenuated when adjusted for the specific diseases, especially arteriostenosis and osteoarthritis. CONCLUSION: Inflammation in the periodontium in early old age tends to be associated with mortality in older age.

Tooth loss and subsequent disability and mortality in old age.

OBJECTIVES: To examine whether tooth loss at age 70 is associated with onset of disability at 5-, 10-, 15-, and 20-year follow-up and to mortality at 21-year follow-up. SETTING: Community-based population in Copenhagen. DESIGN: A baseline study of a random sample of 70-year-old people born in 1914 and follow-up 5, 10, 15, and 20 years later. PARTICIPANTS: A total of 573 nondisabled individuals participated in the study of 70-year-olds in 1984, 460 participated in the 5-year follow-up, 292 in the 10-year follow-up, 150 in the 15-year follow-up, and 78 in the 20-year follow-up. MEASUREMENTS: Data from interviews and a medical and oral examination. Oral health was measured according to number of teeth (0, 1-9, 10-19, > or = 20). Disability was measured using the Avlund Mob-H scale at age 75, 80, 85, and 90. Mortality data were obtained from the National Death Register. RESULTS: Being edentulous or having one to nine teeth was associated with onset of disability at age 75 and 80. Health-related variables and education attenuated the associations between edentulism and onset of disability, although they remained marginally significant, whereas the association between having one to nine teeth and onset of disability remained unchanged and statistically significant at 10-year follow-up (odds ratio=3.02, 95% confidence interval (CI)=1.26-7.24). Persons who were edentulous at age 70 were at significantly higher risk of mortality 21 years later, also in the adjusted analysis (hazard ratio=1.26, 95% CI=1.03-1.55). CONCLUSION: Tooth loss is independently associated with onset of disability and mortality in old age. The findings indicate that tooth loss may be an early indicator of accelerated aging.

Development and evaluation of two root caries controlling programmes for home-based frail people older than 75 years.

OBJECTIVES: (i) Initially, to devise and examine the validity of a system for determining lesion activity on root surfaces, and (ii) compare the effectiveness of two preventive programmes in controlling root caries in elderly people using the devised system. MATERIALS AND METHODS: (i) Four clinical variables: texture, contour, location and colour of root caries lesions were selected to evaluate lesion activity. The intraexaminer reproducibility of the scoring system was assessed on 28 elderly patients. The accuracy was assessed on 10 of these persons using an impression material (Clinpro, 3M ESPE). (ii) Of total, 215 homebound 75+ year olds were randomly assigned to one of three groups: group 1, once a month a dental hygienist brushed the teeth of the participants and applied Duraphat vanish to active root caries lesions. The participants in groups 2 and 3 received 5000 and 1450 ppm F-toothpaste, respectively, to use twice a day. This study included an interview, a baseline examination and a final follow-up examination after 8 months. RESULTS: (i) Intraexaminer reproducibility of the root caries scoring system was 0.86 (Kappa). The sensitivity and specificity was 0.86 and 0.81. (ii) Data from those 189 (88%) who completed the study disclosed that there were no inter-group differences at the baseline examination concerning relevant conditions. At the end of the study, the root caries status of participants in groups 1 and 2 had improved significantly when compared with group 3 (p < 0.02). No significant difference was observed between groups 1 and 2 (p = 0.14). CONCLUSION: The data suggest that the root caries scoring system is reliable. Both the intervention programmes controlled root caries development; the hygienist in eight of 10 persons, the 5000 ppm F-toothpaste in seven of 10. In contrast, five of 10 participants who only brushed with 1450 ppm F-toothpaste had root caries progression.

The overtime effect of social position on dental caries experience in a group of old-aged Danes born in 1914.

OBJECTIVES: The purpose of this study was to analyze the life-course effects of education, occupation, and income at ages 70, 75, 80, and 85 years, respectively, on dental caries experience of 85-year-olds. METHODS: The present study includes follow-up data from a population-based study, which comprised a sample of 176 individuals aged 85 years. Data on social position were collected at ages 70, 75, 80, and 85 years by means of structured personal interviews. Clinical oral health examinations were conducted to obtain data on dental caries at age 85. Dental caries was recorded at tooth surface level and caries experience was expressed by the DMF Index: the decayed tooth surfaces (D component), missing tooth surfaces (M component), and filled tooth surfaces (F component). RESULTS: The participants in the present study demonstrated a high level of dental caries experience; the prevalence rate for active dental caries (D-S) was 80 percent. Older adults with low education, low occupational status, and poor income tended to have more active dental caries compared to their counterparts. In contrast, individuals with high education (F-S = 35.5) and high occupational status (F-S = 36.0) had significantly more filled surfaces than persons with low education (F-S = 24.0) and low occupational status (F-S = 25.6). Individuals with high income at ages 75, 80, and 85 years had more filled surfaces (F-S = 31.9, 33.2, 34.1) compared to persons with low income (F-S = 25.5, 23.5, 22.8). CONCLUSION: The study identified social inequalities across age among the very old individuals in relation to dental caries experience.

Caries prevalence in older persons with and without dementia.

OBJECTIVES: To examine the prevalence of coronal and root caries in a memory clinic-based population of elderly patients with and without a diagnosis of dementia and to examine the influence of age, sex, social relations, social position, and functional ability. DESIGN: Cross-sectional. SETTING: Patients referred with possible cognitive dysfunction were recruited from two university hospital dementia clinics. PARTICIPANTS: In total, 106 dentate persons participated in the study. Mean age was 82, 69 were women, and 87 had a diagnosis of dementia. MEASUREMENTS: Data from interviews and a clinical examination were collected. The diagnosis of dementia was made at the dementia clinics according to the criteria of International Classification of Diseases, Tenth Revision. Active coronal and root caries was assessed using previously defined diagnostic criteria from the National Institute of Dental and Craniofacial Research. RESULTS: The mean number of coronal and root surfaces with caries was statistically significantly higher in subjects with a diagnosis of dementia (7.0 vs 2.7, P<.05). Subjects with a diagnosis of Alzheimer's disease had a significantly higher mean number of root surfaces with caries (4.9, P<.05) than subjects with other dementia diagnoses (2.3) and those without dementia (1.7). People with Alzheimer's disease also had significantly more mean total caries than subjects without dementia (7.8 vs 2.7, P<.05). Participants with a Mini-Mental State Examination (MMSE) score less than 24 had significantly more caries than participants with a MMSE-score of 24 or higher (7.6 vs 4.3, P<.05). CONCLUSION: Patients with newly diagnosed dementia already had a high level of active dental caries when they were referred to the memory clinic. The high caries prevalence was related to dementia type and severity.

What are the longevities of teeth and oral implants?

OBJECTIVE: To analyse tooth loss and to evaluate the longevity of healthy teeth and teeth compromised by diseases and influenced by therapy as well as that of oral implants. MATERIAL AND METHODS: On the basis of an electronic and manual search using key words for survival, success, longevity of teeth, longevity of implants, epidemiology, periodontally compromised, endodontically compromised, risk for tooth extraction 49 full-text articles were identified to construct a traditional review. Among these, six systematic reviews addressing longevity were found. RESULTS: Tooth loss is a complex outcome, it is influenced by the extent of dental caries and its sequelae and/or the presence or absence of periodontitis as well as the decisions taken by dentists when evaluating possible risk factors for rendering successful therapy. In addition, tooth loss is related to behavioural and socio-economic factors and associated morbidity and cultural priorities. Generally, teeth surrounded by healthy periodontal tissues yield a very high longevity (up to 99.5% over 50 years). If periodontally compromised, but treated and maintained regularly, the survival of such teeth is still very high (92-93%). Likewise, endodontically compromised, but successfully treated devital teeth yield high survival and success rates. The survival of oral implants after 10 years varies between 82% and 94%. CONCLUSIONS: Teeth will last for life, unless they are affected by oral diseases or service interventions. Many retained teeth thus may be an indicator of positive oral health behaviour throughout the life course. Tooth longevity is largely dependent on the health status of the periodontium, the pulp or periapical region and the extent of reconstructions. Multiple risks lead to a critical appraisal of the value of a tooth. Oral implants when evaluated after 10 years of service do not surpass the longevity of even compromised but successfully treated natural teeth.

Dental status and dental caries in 85-year-old Danes.

OBJECTIVES: This study reports findings on the dental status and the prevalence of dental caries among a group of 85-year-old Danes from the Glostrup 1914 Cohort, Denmark. The purpose of the study was to analyse whether caries experience was related to number of teeth and to indicators of functional ability and cognitive function. METHODS: A total of 191 individuals (78 men and 113 women) participated in a cross-sectional population study conducted in 2000. Using mobile dental equipment, a clinical oral examination and an interview were administered to all participants in their homes. Functional ability was measured by the Mob-H scale and cognitive function was assessed by the Mini-Mental State Examination. RESULTS: Fifty-nine per cent of the participants had their own natural teeth and for the dentate participants, the mean number of teeth was 13 (range 1-27). A high prevalence of active caries on coronal and root surfaces was observed. Older adults with few natural teeth had a higher prevalence of active coronal and root caries and a higher unmet treatment need than older adults with many teeth. Further, the study showed that 85-year-old persons with reduced functional ability and cognitive impairment tended to have more active caries than 85-year-olds with no impairment. CONCLUSIONS: A substantial proportion of 85-year-old individuals had retained a natural dentition; however, active dental caries is a problem of concern among the most elderly.