Preventive Dentistry Clinic, Niigata University Medical and Dental Hospital, Niigata, Japan.
Department of Oral Health Science, Division of Preventive Dentistry, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
Gerodontology. 2019 Jun;36(2):163-170. doi: 10.1111/ger.12394. Epub 2019 Feb 15.
The influence of occlusal deterioration on mortality may be incorrectly estimated due to improvements in the occlusal condition with prosthetics or deterioration without prosthetics. The purpose of this study was to evaluate the influence of occlusion cross-sectional status and longitudinal changes considering prosthetics for subsequent all-cause mortality in an elderly population.
Two dental examinations, in 1999 and 2003, were conducted in 378 subjects aged 71 years old in 1999. Annual follow-ups to check survival information were performed until 2011. The Eichner index (EI), based on tooth contacts between the maxilla and mandible in the bilateral molar regions, was used as a measurement of occlusal condition. Three modified EIs, EI-o (ie, original EI), EI-f adding contacts by fixed prosthetic appliances, and EI-r adding contacts by all prosthetics, were used. For survival analysis, the survival period was calculated from the last dental examination (in 2003) to death or censoring.
In Cox proportional hazards regression analysis, a deterioration in EI-f was a significant risk factor for stability (HR = 2.56, P = 0.018) after adjusting for potential confounders. However, occlusal conditions in 2003 did not have an influence on subsequent mortality and the occlusal losses of almost all subjects were at least partially recovered by removable prosthetics.
This study clarified that prosthetic dental care may reduce the influence of occlusal loss on mortality and that an event such as a large occlusal loss unrecoverable with fixed prosthesis alone at an older age may increase risk of death in Japanese elderly subjects.
由于修复治疗或未经修复治疗导致的咬合恶化，咬合恶化对死亡率的影响可能被错误估计。本研究旨在评估在考虑修复治疗的情况下，咬合横断面积状态和纵向变化对老年人群随后全因死亡率的影响。
1999 年对 378 名 71 岁的受试者进行了两次牙科检查，分别在 1999 年和 2003 年进行。每年进行随访以检查生存信息，直至 2011 年。采用 Eichner 指数（EI）作为咬合状况的测量指标，EI 基于上颌和下颌双侧磨牙区之间的牙齿接触。使用了三种改良的 EI，即 EI-o（即原始 EI）、EI-f（添加固定修复体的接触点）和 EI-r（添加所有修复体的接触点）。对于生存分析，生存期间从最后一次牙科检查（2003 年）到死亡或删失进行计算。
在 Cox 比例风险回归分析中，在调整了潜在混杂因素后，EI-f 的恶化是稳定性的一个显著危险因素（HR=2.56，P=0.018）。然而，2003 年的咬合状况对随后的死亡率没有影响，几乎所有受试者的咬合丧失都至少部分通过可摘局部义齿得到了恢复。
本研究表明，牙科修复治疗可以降低咬合丧失对死亡率的影响，并且在老年人群中，年龄较大时单独使用固定修复体无法恢复的大的咬合丧失等事件可能会增加死亡风险。
