Prevalence of and Changes in Tooth Loss Among Adults Aged ≥50 Years With Selected Chronic Conditions

United States, 1999-2004 and 2011-2016

Marcia L. Parker, DMD; Gina Thornton-Evans, DDS; Liang Wei, MS; Susan O. Griffin, PhD

Disclosures

Morbidity and Mortality Weekly Report. 2020;69(21):641-646. 

In This Article

Abstract and Introduction

Introduction

Extensive tooth loss can lead to poor diet resulting in weight loss or obesity.[1] It can also detract from physical appearance and impede speech, factors that can restrict social contact, inhibit intimacy, and lower self-esteem.[1] Chronic medical conditions and oral conditions share common risk factors.[2] Persons with chronic conditions are more likely to have untreated dental disease, which can result in tooth loss. Three measures of tooth loss during 1999–2004 and 2011–2016 were estimated by comparing data from the National Health and Nutrition Examination Survey (NHANES) for each period among adults aged ≥50 years with selected chronic conditions.* The three measures were 1) edentulism (having no teeth); 2) severe tooth loss (having eight or fewer teeth);[3] and 3) lacking functional dentition (having <20 teeth out of 28, which is considered a full set for the purpose of NHANES assessments).[4] During 2011–2016, prevalences of edentulism and severe tooth loss were ≥50% higher among adults with fair or poor general health, rheumatoid arthritis, asthma, diabetes, emphysema, heart disease, liver condition, or stroke than among those with those adults without the chronic condition. Lack of functional dentition was also more prevalent among adults with chronic conditions than among persons without these conditions. Tooth loss is preventable with self-care and routine dental visits.[1] To encourage these behaviors, public health professionals can educate the public about the association between having a chronic condition and tooth loss, and primary care providers can educate their patients about the importance of healthy behaviors and screen and refer them for needed dental care.

Data obtained from CDC's NHANES, a multistage probability sample designed to assess the health and nutritional status of the noninstitutionalized U.S. population through participant interviews and physical examinations, were analyzed for all adults aged ≥50 years and those with selected chronic conditions; the analysis was limited to adults who completed a dental examination as part of NHANES. Prevalences of the three categories of tooth loss (edentulism and severe tooth loss [determined by the Global Burden of Disease to cause major difficulty in eating meat, fruits, and vegetables[3]] and lacking functional dentition), using the World Health Organization criteria[4] during 2011–2016 were estimated. Lack of functional dentition provides the most actionable information among the three measures because it detects symptomatic tooth loss in the earliest stage. Chronic conditions were self-reported except for uncontrolled diabetes, obesity, and the number of teeth lost, which were clinically assessed. Estimated prevalence of tooth loss and chronic conditions were standardized to the U.S. 2000 Census population by 5-year age increments and sex. T-tests were used to determine whether prevalence of each category of tooth loss varied by chronic disease status and whether lack of functional dentition differed from 1999–2004 to 2011–2016. All analyses were conducted using SAS-callable SUDAAN software (version 11.0.3; RTI International), which accounted for the examination sample weights and the complex, clustered design of NHANES.

The study sample comprised 6,283 adults during 1999–2004 and 7,443 during 2011–2016. During these periods, the following respective prevalences of selected chronic conditions were reported: fair or poor general health (24.5%, 21.7%), any arthritis (43.3%, 45.0%), rheumatoid arthritis (16.3%, 6.1%), asthma (5.4%, 8.9%), diabetes (13.7%, 17.7%), emphysema (4.1%, 3.7%), heart disease (16.7%, 13.4%), liver condition (1.6%, 2.6%), and history of stroke (5.4% during both periods) (Table 1).

During 2011–2016, among adults who had a dental exam, the prevalences of edentulism, severe tooth loss, and lacking functional dentition were 10.8%, 16.9%, and 31.8%, respectively (Table 2). The prevalences of edentulism and severe tooth loss were higher among persons with each selected chronic condition except obesity than they were among those who did not have the condition. The prevalence of edentulism was at least twice as high among adults with fair or poor general health, emphysema, heart disease, or stroke history as it was among those without the condition; the prevalence of severe tooth loss was ≥50% higher for adults with fair or poor general health, rheumatoid arthritis, asthma, diabetes, uncontrolled diabetes, emphysema, heart disease, liver condition, or stroke, compared with those who did not have the condition.

The overall prevalence of lack of functional dentition decreased 11.7 percentage points from 1999–2004 (43.5%) to 2011–2016 (31.8%) (Figure) (Supplementary Table, https://stacks.cdc.gov/view/cdc/88330). Improvements were detected for persons with fair or poor general health, any arthritis, diabetes, and obesity. The most notable improvements were among persons reporting diabetes (16.6 percentage-point decrease) and uncontrolled diabetes (18.8 percentage-point decrease). Prevalence of lack of functional dentition increased by 11.2 percentage points among persons with rheumatoid arthritis during this period. During 2011–2016, lack of functional dentition was ≥50% more prevalent among adults reporting fair or poor general health, rheumatoid arthritis, emphysema, or heart disease than among those not reporting the condition (Supplementary Table, https://stacks.cdc.gov/view/cdc/88330).

Figure.

Change in prevalence*,† of lack of functional dentition (<20 teeth) among U.S. adults aged ≥50 years with selected chronic conditions — National Health and Nutrition Examination Survey, United States, 1999–2004 and 2011–2016
*All estimates were standardized to the 2000 U.S. Census population by 5-year age increments and sex.
Change in prevalence is statistically significant (p<0.05) for all conditions except asthma, emphysema, heart disease, liver condition, and stroke.

*Data from three 2-year cycles of NHANES were combined for each period: 1999–2000, 2001–2002, and 2003–2004 and 2011–2012, 2013–2014, and 2015–2016, respectively.
https://www.cdc.gov/nchs/nhanes.htm.

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