Length of tooth survival in older adults with complex medical, functional and dental backgrounds

• Published in: The Journal of the American Dental Association (1939) Vol. 143; no. 6; pp. 566 - 578
• Main Authors: Chen, Xi, BMed, PhD, Clark, Jennifer J.J., BS, Naorungroj, Supawadee, DDS, MS
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01-06-2012; American Dental Association
• Subjects: ADS: Anticholinergic drug scale; Aged; Aged, 80 and over; caries; Chi-Square Distribution; Cholinergic Antagonists - therapeutic use; Dental care; Dental Care for Aged; Dental caries; Dental Caries - complications; Dental Caries - epidemiology; Dental health; Dental roots; Dentistry; Denture, Complete - adverse effects; Female; Geriatric Assessment; Geriatrics; Humans; Independent Living; Kaplan-Meier Estimate; Longitudinal Studies; LTC: Long-term care; Male; Middle Aged; NHANES III: National Health and Nutrition Examination Survey; Nursing Homes; Older people; oral health; Proportional Hazards Models; prostheses; Prosthetics; Retrospective Studies; Risk Factors; Survival; Teeth; tooth extraction; Tooth Extraction - adverse effects; Tooth Loss - epidemiology; Tooth Loss - etiology; Tooth Root - pathology; United States - epidemiology; United States; prostheses; oral health; ADS: Anticholinergic drug scale; LTC: Long-term care; NHANES III: National Health and Nutrition Examination Survey; tooth extraction; Geriatrics; caries
• ISSN: 0002-8177; 1943-4723
• DOI: 10.14219/jada.archive.2012.0235

ABSTRACT Background Tooth loss can be considered a failure of current oral health care strategies. Knowing how soon this failure will occur can help clinicians enhance preventive strategies for preventing tooth loss and minimizing its impact. The authors conducted a study to detail tooth survival patterns in an older cohort. Methods The authors conducted a retrospective longitudinal study of 491 participants aged 43 to 102 years. They treated the participants' dental conditions before they entered the study. They also collected participants' sociodemographic, medical, functional, cognitive and dental data when they first arrived at the clinic. The authors used Fisher exact tests, χ2 tests and analysis of variance to examine the association between baseline characteristics and tooth survival. They generated Kaplan-Meier estimates and used Cox proportional hazards regression models to detail tooth survival and associated risk factors. Results The authors found that tooth survival patterns differed among participants who had different numbers of carious teeth or retained roots (carious or broken teeth that were missing most of their coronal structures) when they first arrived at the clinic ( P N/A .001) and between participants who wore removable prostheses and those who did not ( P = .02). Participants' tooth loss at different times differed by sex, number of medications being taken and number of carious teeth or retained roots. The authors found that after they adjusted for other factors, tooth survival was associated with the number of carious teeth or retained roots ( P = .01), as well as the interaction between the number of carious teeth or retained roots and use of prostheses ( P = .02). Conclusions Caries and the use of removable prostheses synergistically compromised tooth survival in older patients. Patients who wore prostheses and had multiple active carious teeth or retained roots at arrival had the highest risk of losing teeth soon after their existing conditions were treated. Clinical Implications These findings highlight the need for preventing tooth loss in older adults who wear removable prostheses and have poor oral health. Knowing the groups at the highest risk of experiencing tooth loss soon after dental treatment is received can help dentists better target and design preventive strategies.