Tooth loss in older adults

Adult tooth loss by population characteristics:

• Age group 
• Income
• Education
• Disability status

Tooth loss by health behavior and disease:

• Past year dental visit
• Smoking status
• Diabetes status
• Heart disease status

We analyzed the prevalence of older adult tooth loss by sex, age group, race and ethnicity, income, education, health literacy, disability status, smoking status, diabetes, heart disease and chronic kidney disease. Below we report on factors in Minnesota that are statistically significant.

Tooth loss affects overall health and quality of life

Teeth play an important role in speech, eating ability, facial appearance and quality of life.  Losing a tooth can cause surrounding teeth to shift and bacteria to accumulate under the gum line, resulting in further gum disease and loss of bone and tissue. Significant bone and tissue loss leads to changes in facial appearance including facial shortening and protrusion of the upper lip and chin.   

Studies have found that complete tooth loss (edentulism) or impaired dental function results in the inability to eat certain foods and is associated with poor nutrition. People with complete tooth loss eat fewer healthful fruits and vegetables, and less fiber, vitamin C and carotene. They also eat more unhealthy foods containing cholesterol and saturated fats. This may lead to increased obesity, cardiovascular disease, diabetes, gastrointestinal disease, kidney disease, cancer, disability and death. Poor quality of life is also seen among individuals with complete tooth loss, including low self-esteem and poor emotional well-being. Individuals with tooth loss may avoid social activities because they are embarrassed to speak, smile, or eat in front of others, leading to isolation. 

Additionally, studies of denture use find an increased risk of disorders of the mouth or mucous membranes such as angular chelitis (inflammation and red swollen patches at the corners of the mouth), oral thrush (oral fungal infection), and traumatic ulcers. 

Gum disease is the leading cause of tooth loss

Gum disease is the leading cause of the loss of permanent and natural teeth. Injuries and oral-dental trauma may also cause tooth loss. Risk factors for tooth loss include poor oral hygiene, dry mouth, hormonal changes, some prescription medications, and tobacco use. Many of these risk factors are associated with aging and disability (e.g. poor oral hygiene, changes in hormones, prescription medication use), though tooth loss is preventable in almost all cases.  

In 2016, compared to Minnesota adults aged 18-64 years, adults 65 years and older were:

• 5.5 times more likely to have complete tooth loss (1.8% versus 9.9%), and
• 1.9 times more likely to have partial tooth loss (26.6% versus 49.8%).

In the United States, compared to adults aged 18-64 years, adults 65 years and older were:

• 5.3 times more likely to have complete tooth loss (2.6% versus 13.9%), and
• 1.6 times more likely to have partial tooth loss (34.5% versus 54.2%).

A higher percentage of Minnesota adults aged 18 to 64 years (70.9%, 95% CI = 69.9 to 71.9) had no tooth loss, compared to U.S. adults aged 18 to 64 years (61.7%, 95% CI = 61.3 to 62.0). 

Overall, 10% of Minnesota adults aged 65 years and older (9.9%, 95% CI = 8.8 to 10.9) had complete tooth loss compared to 14% of older adults in the United States (13.9%, 95% CI = 13.5 to 14.2).

In 2016, Minnesota adults aged 65 years and older with a household income less than $35K (16.8%) were 3.3 times more likely to have complete tooth loss compared to older adults with a household income of $35K or more (5.1%). However, there was no difference in partial tooth loss by household income.

In the United States older adults with a household income less than $35K (21.5%) were 3.1 times more likely to have complete tooth loss compared to older adults with a household income of $35K or more (7.0%). However, there was no difference in partial tooth loss by household income.

In 2016, Minnesota adults aged 65 and older with less than a high school degree (25.8%) were 10.3 times more likely to have complete tooth loss compared to older adults with a college degree (2.5%). However, there was no difference in partial tooth loss by education level.

In the United States adults aged 65 years and older with less than a high school degree (29.2%) were 8.1 times more likely to have complete tooth loss compared to older adults with a college degree (3.6%). U.S. adults aged 65 years and older with less than a high school degree (48.5%) were 1.1 times more likely to have partial tooth loss compared to older adults with a college degree (51.9%).

In 2016, Minnesota adults aged 65 years and older with a disability (19.0%) were 2.1 times more likely to have complete tooth loss compared to older adults without a disability (9.2%). However, there was no difference in partial tooth loss by disability.

In the United States older adults with a disability (25.0%) were 2.0 times more likely to have complete tooth loss compared to older adults without a disability (12.6%). U.S. older adults with a disability (51.7%) were 1.1 times more likely to have partial tooth loss compared to U.S. older adults without a disability (56.7%).

In 2016, Minnesota adults aged 65 years and older who reported not visiting a dentist or dental clinic within the past year (28.5%) were 7.3 times more likely to have complete tooth loss compared to older adults who reported having at least one past year dental visit (3.9%). Minnesota older adults who reported not visiting a dentist or dental clinic within the past year (45.7%) were 1.1 times more likely to have partial tooth loss compared to older adults who reported having at least one past year dental visit (51.4%).

In the United States older adults who reported not visiting a dentist or dental clinic within the past year (30.9%) were 6.2 times more likely to have complete tooth loss compared to older adults who reported having at least one past year dental visit (5.0%). U.S. older adults who reported not visiting a dentist or dental clinic within the past year (46.7%) were 1.2 times more likely to have partial tooth loss compared to older adults who reporting having at least one past year dental visit (58.3%).

Older adults with complete tooth loss should still visit the dentist regularly to be fitted with dentures and screen for oral health problems such as mouth and throat cancers. 

In 2016, Minnesota adults aged 65 years and older who were current smokers (21.0%) were 3.0 times more likely to have complete tooth loss compared to older adults were never smokers (7.1%). There was no statistical difference in partial tooth loss by smoking status in Minnesota.

In the United States older adults who were current smokers (29.1%) were 3.1 times more likely to have complete tooth loss compared to older adults who were never smokers (9.4%). Also, current smokers were 1.8 times more likely to have complete tooth loss compared to older adults who were former smokers (16.0%). 

Smokers are at increased risk for tooth decay, infections, periodontal disease (gum infection that destroys bone that leads to tooth loss) and oral and pharyngeal (mouth and throat) cancers. Regular visits to the dentist are important for early detection and treatment of these oral diseases.     

In 2016, Minnesota adults aged 65 years and older with diabetes (13.6%) were 1.5 times more likely to have complete tooth loss compared to older adults without diabetes (8.9%). There was no statistical difference in partial tooth loss by diabetes status in Minnesota. 

United States adults aged 65 and older with diabetes (18.8%) were 1.5 times more likely to have complete tooth loss compared to older adults without diabetes (12.4%). There was no statistical difference in partial tooth loss by diabetes status in the United States. 

People with uncontrolled diabetes have decreased saliva flow, increased thickening of blood vessels, and consistently higher blood sugar that weakens the body’s defense against bacterial infections. As a result, people with uncontrolled diabetes experience an increased risk of dry mouth, gum inflammation, thrush (fungal infection of the mouth and tongue) and periodontal disease (gum infection that destroys bone that leads to tooth loss). 

Inflammation is a shared risk factor of both diabetes and periodontal disease (gum infection that destroys bone that leads to tooth loss). Reducing inflammation by preventing or treating tooth decay and gum disease may prevent tooth loss and improve diabetes management.   

In 2016, Minnesota adults aged 65 years and older with cardiovascular disease (18.0%) were 2.0 times more likely to have complete tooth loss compared to older adults without cardiovascular disease (9.2%). There was no statistical difference in partial tooth loss by cardiovascular disease status in Minnesota.

In the United States adults aged 65 years and older with cardiovascular disease (24.1%) were 1.9 times more likely to have complete tooth loss compared to older adults without cardiovascular disease (13.0%). There was no statistical difference in partial tooth loss by cardiovascular disease status in the United States.

Inflammation is a shared risk factor of both cardiovascular disease and periodontal disease (gum infection that destroys bone that leads to tooth loss). Reducing inflammation by preventing or treating tooth decay and gum disease may prevent tooth loss and improve cardiovascular health.  

Related Links:

• Diabetes
• Heart attacks
• Poverty & income
• Smoking