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Tooth loss is a complex measure of oral disease: Determinants and methodological considerations.

  • Haworth, Simon1, 2
  • Shungin, Dmitry3
  • Kwak, So Young4
  • Kim, Hae-Young4
  • West, Nicola X2
  • Thomas, Steven J2
  • Franks, Paul W5, 6, 7
  • Timpson, Nicholas J1
  • Shin, Min-Jeong4
  • Johansson, Ingegerd3
  • 1 Medical Research Council Integrative Epidemiology Unit, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
  • 2 Bristol Dental School, University of Bristol, Bristol, UK.
  • 3 Department of Odontology, Umeå University, Umeå, Sweden. , (Sweden)
  • 4 Department of Public Health Sciences, BK21PLUS Program in Embodiment: Health-Society Interaction, Graduate School, Korea University, Seoul, Republic of Korea. , (North Korea)
  • 5 Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Lund University, Skåne University Hospital Malmö, Malmö, Sweden. , (Sweden)
  • 6 Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden. , (Sweden)
  • 7 Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
Published Article
Community dentistry and oral epidemiology
Publication Date
Dec 01, 2018
DOI: 10.1111/cdoe.12391
PMID: 29956852


Counts of missing teeth or measures of incident tooth loss are gaining attention as a simple way to measure dental status in large population studies. We explore the meaning of these metrics and how missing teeth might influence other measures of dental status. An observational study was performed in 2 contrasting adult populations. In total, 62 522 adult participants were available with clinically assessed caries and periodontal indices from the Swedish arm of the Gene-Lifestyle Interactions and Dental Endpoints Study (GLIDE) and the Korea National Health and Nutrition Examination Survey (KNHANES) in the Republic of Korea. Longitudinal measures of tooth loss were available for 28 244 participants in GLIDE with median follow-up of 10.6 years. In longitudinal analysis, hazard for tooth loss was associated with baseline dental status (previous tooth loss, periodontal status and caries status) and socio-demographic variables (age, smoking status and highest educational level). Analysis of cross-sectional data suggested that indices of caries exposure were not independent of periodontal status. The strength and direction of association varied between groups, even for measures specifically intended to avoid measuring tooth loss. Individuals with impaired periodontal health (community periodontal index [CPI] 3 or higher in any sextant) had higher standardized decayed and filled surfaces (DFS; number of DFS divided by total number of tooth surfaces) in GLIDE (incidence risk ratio [IRR] 1.05 [95% CI: 1.04, 1.07], but lower standardized DFS in KNHANES (IRR: 0.95 [0.92, 0.98]) than individuals with better periodontal health (CPI <3 in all sextants). Incident tooth loss is a complex measure of dental disease, with multiple determinants. The relative importance of dental caries and periodontal disease as drivers of tooth loss differs between age groups. Measures of dental caries exposure are associated with periodontal status in the studied populations, and these associations can be population-specific. Consideration of the study-specific properties of these metrics may be required for valid inference in large population studies. © 2018 The Authors. Community Dentistry and Oral Epidemiology Published by John Wiley & Sons Ltd.

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