Key messages:
- Tooth loss is significantly associated with an increased risk of all-cause, circulatory, and respiratory hospitalizations in Canadian adults.
- After adjusting for age and other risk factors, no significant relationship was found between missing teeth and mortality.
Introduction
Tooth loss is a significant indicator of long-term oral health decline, primarily caused by dental caries and periodontitis, although trauma and other factors can also contribute. Studies have shown that there are no major differences in tooth loss rates between sexes. However, tooth loss progressively increases with age. Edentulism is an important measure of oral health.
Mortality and hospitalization rates serve as crucial indicators of population health and disease burden. In Canada, statistics indicate a gradual increase in overall deaths, driven by population growth and aging, with cancer and heart disease being the leading causes of death.
Tooth loss has been linked to systemic conditions, including cardiovascular disease, diabetes, and certain cancers. International studies suggest an association between tooth loss and higher risk of mortality and hospitalization. However, results from nationally representative Canadian data have been limited.
Objective
This study utilized Canadian data to examine associations between tooth loss and subsequent mortality and hospitalization outcomes.
Methods
This used Canadian Health Measures Survey (CHMS) Cycle 1 data (2007 to 2009), including clinical tooth counts, linked to national mortality and hospitalization databases through 2019. Cox proportional hazards models examined associations between tooth loss and mortality and hospitalization outcomes after adjustment for socioeconomic and health-related factors. The linked samples included 3,454 participants for mortality analyses and 2,252 for hospitalization analyses.
Results
In participants aged 20 to 79 years, 3,450 records were linked to mortality data (n=300 deaths) and 2,250 to hospitalization data (n=650 with at least one hospital stay). Tooth loss was associated with elevated all-cause and cancer mortality in unadjusted models, but not after covariate adjustment. After adjusting for key risk factors, including age and sex, participants with five or more missing teeth had a 76% higher risk of all-cause hospitalization and a 120% higher risk of circulatory-related hospitalization. Respiratory hospitalizations were also associated with tooth loss. No significant associations were found with hospitalizations for digestive diseases or cancer.
Conclusion
Using nationally linked Canadian data, this study found that tooth loss was associated with higher risks of all-cause, circulatory, and respiratory hospitalization after adjustment for key risk factors. However, adjusted associations with mortality were not significant. The findings support tooth loss as a potential marker of broader health status and health service use among Canadian adults. Longer follow-up and additional longitudinal research are needed to clarify its predictive value for mortality and hospitalization outcomes.
