Older Adults with Chronic Diseases are More Likely to Suffer Tooth Loss

People suffering from chronic diseases often report many associated health problems. A new surveillance report from Centers for Disease Control and Prevention has now reveled that adults more than 50 years old who have chronic health conditions are more likely to suffer tooth loss.

These findings were published today in the weekly Morbidity and Mortality Weekly Report (MMWR).

These findings are significant as tooth loss is associated with many adverse effects like poor diet that can cause weight loss or obesity, unpleasant physical appearance, impeded speech, restricted social contact, inhibition in intimacy, and lowered self-esteem.


The study took data from the National Health and Nutrition Examination Survey (NHANES). The NHANES is a survey designed to gauge health and nutritional status of American citizens through participant interviews and physical examinations.

In the current examination of data, the researchers took the data from the NHANES of the people above the age of 50 years old who had a dental checkup as part of the survey.

For the purposes of the study, the researchers defined three measures of tooth loss between two periods; 1999–2004 and 2011–2016. The measures included edentulism meaning no teeth, severe tooth loss meaning only eight or fewer teeth remaining, and lacking functional dentition meaning a person having more than 20 teeth.

The chronic conditions defined in the study participants were all self-described except diabetes, obesity, and the number of teeth lost, which were clinically assessed.

The primary finding of the study was that during the 2011-2016 period prevalence of edentulism and severe tooth loss were more than 50 percent higher among adults with poor general health. People with chronic health conditions were also more likely to lack functional dentition.

The data in the study from thousands of participants all over the United States showed that in 2016 people suffering from chronic conditions had prevalence at 21.7 percent for poor health, 45 percent for arthritis, 17.7 percent for diabetes, 13.4 percent for heart disease, and 5.4 percent for stroke.

During the same period the prevalence of edentulism, severe tooth loss, and lack of functional dentition were at 10.8%, 16.9%, and 31.8%, respectively.

The data also showed that people were twice more likely to suffer from total tooth loss if they had poor general health.

It is important to note that during the two periods under study the overall prevalence of lack of functional dentition decreased 11.7 percentage points from 43.5% to 31.8% in 2016, in all categories.

However, prevalence of lack of functional dentition increased by 11.2 percentage points among people with rheumatoid arthritis during this period.

The analysis of data from same survey in 2009 had revealed that people with chronic conditions have higher levels of unmet dental treatment needs than did persons without chronic conditions.

A 2017 Medical Expenditure Panel Survey also indicated that more than 40 percent of adults age more than 65 years had a past-year visit to a physician’s office but no visit to a dentist.

This can be perhaps because of the fact that Medicare in United States does not cover routine dental care, which many of these older adults rely upon to receive medical care.

The researchers suggest that there should be better integration and collaboration between all providers so that these at-risk population can be helped to keep their natural teeth.  They also highlight the need to educate this particular population regarding oral health.

Health Units reached out to Cassie Brailer, of Policy and Communications Team, Division of Oral Health,

National Center for Chronic Disease Prevention and Health Promotion, and asked her following questions:

How do you think this population can be better protected against tooth loss?

About 6 in 10 Americans live with at least one chronic disease. The relationship between oral health and chronic disease is well documented. Oral health is also critical to overall health, and you cannot be healthy without a healthy mouth. When people with chronic conditions visit their medical providers, these providers are uniquely positioned to educate them about their increased risk for tooth loss and the importance of healthy behaviors, including brushing with fluoride toothpaste. Primary care providers can also screen patients for oral diseases and refer them to dental professionals for needed dental care.

Why do you think there was an increase in prevalence of lack of functional dentition by 11.2 percentage points in people with rheumatoid arthritis, compared to the decrease seen in other categories?

The increase in the prevalence of a lack of functional dentition for rheumatoid arthritis (11.2%) in comparison to the other chronic conditions is unknown. In Table 1, the prevalence of rheumatoid arthritis decreased substantially (>60%) from 1999-2004 to 2011-2016, so the increase in the prevalence of lack of functional dentition among people with rheumatoid arthritis could possibly be attributable to the changes in the sample size between surveys.

Any other significant finding you would like to share with us?

Among the chronic conditions included in this review, the only one with recommendations for routine dental visits as the standard of care is diabetes. A Cochrane review found some evidence that treating periodontitis can improve outcomes (i.e., glycemic control) among persons with diabetes. In this study, improvements in maintaining functional dentition were notably high among persons with diabetes.

The most common cause of tooth loss is dental caries and periodontal (gum) disease. According to data from CDC, 42% of American adults have some form of periodontitis and in adults above the age of 65 years 59.8% have periodontitis.


According to CDC, there are some simple ways in which adults can ensure the health of their teeth and mouth. This includes:

  • Using fluoride-based toothpaste
  • Practice good oral hygiene brushing teeth twice a day and flossing daily
  • visiting a dentist at least once a year
  • avoiding tobacco products
  • limiting alcoholic drinks
  • controlling diabetes if you have it. Diabetes increases risk of gum disease
  • consulting a dentist if you have dry mouth
  • consulting a dentist in cases of sudden changes in taste and smell
  • remembering to brush teeth of any adults that you are providing care for everyday

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