State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, PR China.
Department of Prosthodontics, School of Stomatology, China Medical University, Shenyang, Liaoning, PR China.
J Dent. 2024 Oct;149:105304. doi: 10.1016/j.jdent.2024.105304. Epub 2024 Aug 17.
To determine whether tooth loss affects all-cause and cause-specific mortality in a nationally representative sample of adults with diabetes mellitus (DM) in the United States.
This prospective cohort study involved 8207 participants aged 30 years or older at baseline, all diagnosed with diabetes mellitus and enrolled in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. Tooth loss was stratified into 28 teeth (complete), 20-27 teeth (tooth loss), 9-19 teeth (lacking functional), 1-8 teeth (severe tooth loss) and edentulism. To estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for all-cause and specific-cause mortality in diabetes mellitus participants according to tooth loss, multivariate cox proportional hazards regression models were used. Relationships between mortality and quartiles of mean tooth loss levels were analyzed, with the lowest quartile as the baseline for comparisons.
During a median of 6.92 years of follow-up, 2317 deaths were documented. After multivariate adjustments, higher tooth loss levels were significantly and non-linearly associated with higher risks of all-cause, CVD-related and DM-related mortality among participants with DM. When compared with the reference group of mean tooth loss levels, the highest quartile showed significantly increased risks: all-cause mortality (HR, 2.11; 95 % CI, 1.53-2.91, P-trend < 0.001), CVD-related mortality (HR, 3.24, 95 % CI, 1.54-6.85, P-trend < 0.001) and DM-related mortality (HR, 2.78, 95 % CI, 1.15-6.68, P-trend < 0.001).
Tooth loss is associated with an increased risk of all-cause, CVD-related and diabetes mellitus mortality among adults with diabetes mellitus in the US.
This study presents evidence for physicians and dentists that higher tooth loss was significantly associated with increased risk of all-cause, CVD-related and diabetes mellitus mortality in a dose-response manner among adults with diabetes mellitus. Therefore, assessment of survival in individuals with diabetes mellitus could pay attention to the tooth loss.
在美国具有全国代表性的糖尿病（DM）成年人群体中，确定牙齿缺失是否会影响所有原因和特定原因的死亡率。
本前瞻性队列研究共纳入 8207 名年龄在 30 岁及以上的参与者，所有参与者均在 1999 年至 2018 年期间被诊断患有糖尿病并参加国家健康和营养检查调查（NHANES）。牙齿缺失被分为 28 颗牙（完整）、20-27 颗牙（缺失）、9-19 颗牙（缺失功能）、1-8 颗牙（严重缺失）和无牙。为了根据牙齿缺失估计糖尿病参与者的全因和特定原因死亡率的危险比（HR）和 95％置信区间（CI），使用了多变量 Cox 比例风险回归模型。分析了死亡率与平均牙齿缺失水平四分位数之间的关系，将最低四分位数作为比较的基线。
在中位数为 6.92 年的随访期间，共记录了 2317 例死亡。经过多变量调整后，更高的牙齿缺失水平与糖尿病参与者的全因、心血管疾病相关和糖尿病相关死亡率的风险显著且呈非线性相关。与平均牙齿缺失水平的参考组相比，最高四分位数显示出显著增加的风险：全因死亡率（HR，2.11；95％CI，1.53-2.91，P 趋势<0.001），心血管疾病相关死亡率（HR，3.24，95％CI，1.54-6.85，P 趋势<0.001）和糖尿病相关死亡率（HR，2.78，95％CI，1.15-6.68，P 趋势<0.001）。
在美国患有糖尿病的成年人中，牙齿缺失与全因、心血管疾病相关和糖尿病死亡率的风险增加有关。
本研究为医生和牙医提供了证据，表明在具有糖尿病的成年人中，更高的牙齿缺失与全因、心血管疾病相关和糖尿病死亡率的风险增加呈剂量反应关系。因此，对糖尿病患者的生存评估可能需要注意牙齿缺失。
