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      Is Open Access

      Number of functional teeth more strongly predicts all‐cause mortality than number of present teeth in Japanese older adults

      research-article
      1 , 2 , 3 , 3 , 3 , 1 , 4 , 1 , 5 , 1 , 6 , 1 , 2 , , Kusatsu ISLE Study Working Group Collaborators, 1 , 7 , 1 , 8 , 1 , 9 , 1 , 10 , 1 , 6 , 1 , 11 , 1 , 12 , 1 , 6 , 13 , 3 , 14 , 3 , 3 , 3 , 15 , 4 , 16 , 16 , 4 , 4 , 16 , 17 , 18 , 12
      Geriatrics & Gerontology International
      John Wiley & Sons Australia, Ltd
      functional teeth, mortality, present teeth, risk factor

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          Abstract

          Aim

          Previous studies on the association between intraoral conditions and mortality in community‐dwelling older individuals reported that fewer present teeth (PT) are significant risk factors for mortality. However, how the number of PT relative to the number of functional teeth (FT), including both present and rehabilitated teeth, influences mortality has not been investigated fully. This study examined the impact of the number of FT on mortality among community‐dwelling Japanese older adults.

          Methods

          This study was a retrospective, observational and population‐based follow‐up study, which examined 1188 older individuals who participated in an annual geriatric health examination from 2009 to 2015. The average follow‐up period was 1697.0 ± 774.5 days. The primary outcome was all‐cause mortality at follow‐up. The numbers of PT and FT of each participant were counted during an oral examination. In addition, demographics, clinical variables, blood nutrient markers, physical functions and perceived masticatory function were measured.

          Results

          Kaplan–Meier analysis, followed by a log‐rank test, revealed that fewer PT ( P < 0.001) and FT ( P = 0.002) were significantly associated with a reduced survival rate. Cox's proportional hazard analysis indicated that the number of FT, but not the number of PT, was a significant independent mortality risk factor after adjusting for demographics, clinical variables, nutrient markers and physical functioning ( P = 0.036, hazard ratio: 2.089).

          Conclusions

          Current results suggest that the number of FT more strongly predicts all‐cause mortality than the number of PT among community‐dwelling older adults. Further studies are necessary to consider the confounding of socioeconomic status and disability status. Geriatr Gerontol Int 2020; ••: ••–••.

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          Most cited references22

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          BMI and risk of dementia in two million people over two decades: a retrospective cohort study.

          Dementia and obesity are increasingly important public health issues. Obesity in middle age has been proposed to lead to dementia in old age. We investigated the association between BMI and risk of dementia. For this retrospective cohort study, we used a cohort of 1,958,191 individuals derived from the United Kingdom Clinical Practice Research Datalink (CPRD) which included people aged 40 years or older in whom BMI was recorded between 1992 and 2007. Follow-up was until the practice's final data collection date, patient death or transfer out of practice, or first record of dementia (whichever occurred first). People with a previous record of dementia were excluded. We used Poisson regression to calculate incidence rates of dementia for each BMI category. Our cohort of 1,958,191 people from UK general practices had a median age at baseline of 55 years (IQR 45-66) and a median follow-up of 9·1 years (IQR 6·3-12·6). Dementia occurred in 45,507 people, at a rate of 2·4 cases per 1000 person-years. Compared with people of a healthy weight, underweight people (BMI 40 kg/m(2)) having a 29% lower (95% CI 22-36) dementia risk than people of a healthy weight. These patterns persisted throughout two decades of follow-up, after adjustment for potential confounders and allowance for the J-shape association of BMI with mortality. Being underweight in middle age and old age carries an increased risk of dementia over two decades. Our results contradict the hypothesis that obesity in middle age could increase the risk of dementia in old age. The reasons for and public health consequences of these findings need further investigation. None. Copyright © 2015 Elsevier Ltd. All rights reserved.
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            Oral health and mortality risk from pneumonia in the elderly.

            Although poor oral health influences the occurrence of pulmonary infection in elderly people, it is unclear how the degree of oral health is linked to mortality from pulmonary infection. Therefore, we evaluated the relationship between oral health and four-year mortality from pneumonia in an elderly Japanese population. The study population consisted of 697 (277 males, 420 females) of the 1282 individuals who were 80 years old in 1997. Data on oral and systemic health were obtained by means of questionnaires, physical examinations, and laboratory blood tests. One hundred eight of the study persons died between 1998 and 2002. Of these, 22 deaths were due to pneumonia. The adjusted mortality due to pneumonia was 3.9 times higher in persons with 10 or more teeth with a probing depth exceeding 4 mm (periodontal pocket) than in those without periodontal pockets. Therefore, the increase in teeth with periodontal pockets in the elderly may be associated with increased mortality from pneumonia.
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              Oral infections and cardiovascular disease.

              Oral infections are the most common diseases of mankind. Numerous reports have implicated oral infections, particularly periodontitis, as a risk factor for atherosclerotic cardiovascular disease (CVD). In this review we examine the epidemiology and biologic plausibility of this association with an emphasis on oral bacteria and inflammation. Longitudinal studies of incident cardiovascular events clearly show excess risk for CVD in individuals with periodontitis. It is likely that systemic exposure to oral bacteria impacts upon the initiation and progression of CVD through triggering of inflammatory processes. Given the high prevalence of periodontitis, any risk attributable to future CVD is important to public health. Unraveling the role of the oral microbiome in CVD will lead to new preventive and treatment approaches.
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                Author and article information

                Contributors
                kuboki@md.okayama-u.ac.jp
                Journal
                Geriatr Gerontol Int
                Geriatr Gerontol Int
                10.1111/(ISSN)1447-0594
                GGI
                Geriatrics & Gerontology International
                John Wiley & Sons Australia, Ltd (Kyoto, Japan )
                1444-1586
                1447-0594
                29 March 2020
                June 2020
                : 20
                : 6 ( doiID: 10.1111/ggi.v20.6 )
                : 607-614
                Affiliations
                [ 1 ] Research Planning and Promotion Committee Japan Prosthodontic Society Tokyo Japan
                [ 2 ] Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Okayama Japan
                [ 3 ] Tokyo Metropolitan Institute of Gerontology Tokyo Japan
                [ 4 ] Tokyo Dental College Tokyo Japan
                [ 5 ] Kanagawa Dental University Graduate School Yokosuka Japan
                [ 6 ] Osaka University Graduate School of Dentistry Osaka Japan
                [ 7 ] Okayama University Hospital Okayama Japan
                [ 8 ] The Nippon Dental University Tokyo Japan
                [ 9 ] Showa University School of Dentistry Tokyo Japan
                [ 10 ] Kyushu University Faculty of Dental Science Fukuoka Japan
                [ 11 ] Tohoku University Graduate School of Dentistry Sendai Japan
                [ 12 ] Meikai University School of Dentistry Sakado Japan
                [ 13 ] Hokkaido University Faculty of Dental Medicine Sapporo Japan
                [ 14 ] National Institute for Environmental Studies Ibaraki Japan
                [ 15 ] Tokyo Medical and Dental University Tokyo Japan
                [ 16 ] Nihon University School of Dentistry at Matsudo Chiba Japan
                [ 17 ] Nihon University School of Dentistry Tokyo Japan
                [ 18 ] Tokushima University Graduate School Institute of Biomedical Sciences Tokushima Japan
                Author notes
                [*] [* ] Correspondence

                Takuo Kuboki, Department of Oral Rehabilitation and Regenerative Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2‐5‐1 Shikata‐cho, Okayama 700‐8525, Japan.

                Email: kuboki@ 123456md.okayama-u.ac.jp

                [†]

                The Kusatsu Working Group for Intraoral Status and Life Expectancy (ISLE) was established by Japan Prosthodontic Society (Contributing Presidents: Hideo Matsumura [2015–2017], Tetsuo Ichikawa [2017–2019], Shuji Ohkawa [2019–2021]; Committee Chairs: Hirofumi Yatani [2015–2017], Takuo Kuboki [2017–2019]) and Tokyo Metropolitan Institute of Gerontology (Committee Chairs: Shoji Shinkai, Hirohiko Hirano)

                Author information
                https://orcid.org/0000-0002-6388-2288
                https://orcid.org/0000-0003-0817-2299
                https://orcid.org/0000-0003-3756-2835
                Article
                GGI13911
                10.1111/ggi.13911
                7317780
                32227400
                058ce79c-44aa-416b-9d2f-5e78f3e7c056
                © 2020 The Authors. Geriatrics & Gerontology International published by John Wiley & Sons Australia, Ltd on behalf of Japan Geriatrics Society

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 29 July 2019
                : 11 February 2020
                : 03 March 2020
                Page count
                Figures: 2, Tables: 2, Pages: 8, Words: 5220
                Funding
                Funded by: Japan Prosthodontic Society
                Categories
                Original Article: Epidemiology, Clinical Practice and Health
                Original Articles: Epidemiology, Clinical Practice and Health
                Custom metadata
                2.0
                June 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.4 mode:remove_FC converted:26.06.2020

                functional teeth,mortality,present teeth,risk factor
                functional teeth, mortality, present teeth, risk factor

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