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Association between dental visit behavior and mortality: a nationwide longitudinal cohort study from NHANES

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Abstract

Objectives

The benefits of professional dental treatment for oral diseases have been widely investigated. However, it is unclear whether professional dental treatment provides additional benefits for improving general health.

Materials and methods

Data were obtained from the US National Health and Nutrition Examination Survey (NHANES) 1999 to 2004 and 2011 to 2018 cycles. A total of 36,174 participants were included and followed-up for mortality until December 31, 2019. Dental visit behavior was defined as the time interval of last dental visit (TIDV, < 0.5 year, 0.5–1 year, 1–2 years, 2–5 years, and > 5 years) and the main reasons of the last dental visit (treatment, examination, and other reasons). The Cox proportional risk model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI).

Results

Compared with participants with time interval of less than 0.5 year, the multivariate-adjusted HRs and 95%CI for participants with time interval of more than 5 years were 1.45 (1.31, 1.61) for all-cause mortality (P trend < 0.0001), 1.49 (1.23, 1.80) for cardiovascular diseases mortality (P trend = 0.0009) and 1.53 (1.29, 1.81) for cancer mortality (P trend = 0.013). Compared with dental visit for examination, participants who had their dental visit for treatment had higher risk for mortality. For participants with dental visit for examination, TIDV of less than 1 year showed lower risk for mortality, whereas TIDV of less than 0.5 year is recommend for population with dental visit for treatment.

Conclusions

Poor dental visit behavior is associated with an increased risk of mortality. Further well-designed studies are needed to confirm the association between professional dental visit and mortality.

Clinical relevance

This study highlights the potential benefits of regular dental visits in maintaining general health.

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References

  1. Bernabe E, Marcenes W, Hernandez CR et al (2020) Global, regional, and national levels and trends in burden of oral conditions from 1990 to 2017: a systematic analysis for the global burden of disease 2017 study. J Dent Res 99(4):362–373

    Article  PubMed  CAS  Google Scholar 

  2. Marcenes W, Kassebaum NJ, Bernabé E et al (2013) Global burden of oral conditions in 1990–2010: a systematic analysis. J Dent Res 92(7):592–597

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  3. Loe H, Theilade E, Jensen SB (1965) Experimental gingivitis in man. J Periodontol 36:177–187

    Article  CAS  Google Scholar 

  4. Sanz M, Beighton D, Curtis MA et al (2017) Role of microbial biofilms in the maintenance of oral health and in the development of dental caries and periodontal diseases: consensus report of group 1 of the joint EFP/ORCA workshop on the boundaries between caries and periodontal disease. J Clin Periodontol 44(Suppl 18):S5–S11

    PubMed  Google Scholar 

  5. Kleinstein SE, Nelson KE, Freire M (2020) Inflammatory networks linking oral microbiome with systemic health and disease. J Dent Res 99(10):1131–1139. https://doi.org/10.1177/0022034520926126

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  6. Sanz M, Marco Del Castillo A et al (2020) Periodontitis and cardiovascular diseases: consensus report. J Clin Periodontol 47(3):268–288. https://doi.org/10.5334/gh.400

    Article  PubMed  PubMed Central  Google Scholar 

  7. Xu K, Yu W, Li Y et al (2022) Association between tooth loss and hypertension: a systematic review and meta-analysis. J Dent 123:104178. https://doi.org/10.1016/j.jdent.2022.104178

    Article  PubMed  Google Scholar 

  8. Maisonneuve P, Amar S, Lowenfels AB (2017) Periodontal disease, edentulism, and pancreatic cancer: a meta-analysis. Ann Oncol 28(5):985–995. https://doi.org/10.1093/annonc/mdx019

    Article  PubMed  CAS  Google Scholar 

  9. Romandini M, Baima G, Antonoglou G et al (2021) Periodontitis, edentulism, and risk of mortality: a systematic review with meta-analyses. J Dent Res 100(1):37–49. https://doi.org/10.1177/0022034520952401

    Article  PubMed  CAS  Google Scholar 

  10. Weijden van der F, Slot DE (2011) Oral hygiene in the prevention of periodontal diseases: the evidence. Periodontol 2000 55:1:104–123. https://doi.org/10.1111/j.1600-0757.2009.00337.x

  11. Newton JT, Asimakopoulou K (2015) Managing oral hygiene as a risk factor for periodontal disease: a systematic review of psychological approaches to behavior change for improved plaque control in periodontal management. J Clin Periodontol Suppl 16:S36–S46. https://doi.org/10.1111/jcpe.12356

    Article  Google Scholar 

  12. Hujoel PP, Hujoel MLA, Kotsakis GA (2018) Personal oral hygiene and dental caries: a systematic review of randomised controlled trials. Gerodontology 35(4):282–289. https://doi.org/10.1111/ger.12331

    Article  PubMed  Google Scholar 

  13. Gholami M, Pakdaman A, Virtanen JI (2012) Common perceptions of periodontal health and illness among adults: a qualitative study. ISRN Dent 2012:671879. https://doi.org/10.5402/2012/671879

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  14. Park SY, Kim SH, Kang SH et al (2019) Improved oral hygiene care attenuates the cardiovascular risk of oral health disease: a population-based study from Korea. Eur Heart J 40(14):1138–1145. https://doi.org/10.1093/eurheartj/ehy836

    Article  PubMed  Google Scholar 

  15. Tonetti MS, D’Aiuto F, Nibali L et al (2007) Treatment of periodontitis and endothelial function. N Engl J Med 356(9):911–920. https://doi.org/10.1056/NEJMoa063186

  16. Taylor HL, Rahurkar S, Treat TJ et al (2021) Does Nonsurgical Periodontal Treatment Improve Systemic Health? J Dent Res 100(3):253–260. https://doi.org/10.1177/0022034520965958

    Article  PubMed  CAS  Google Scholar 

  17. D’Aiuto F, Parkar M, Andreou G et al (2004) Periodontitis and systemic inflammation: control of the local infection is associated with a reduction in serum inflammatory markers. J Dent Res 83(2):156–160. https://doi.org/10.1177/154405910408300214

  18. Di Mario S, Spettoli D, Alessandrini C et al (2011) Periodontal infection and preterm birth: successful periodontal therapy reduces the risk of preterm birth. BJOG 118(5):635–636. https://doi.org/10.1111/j.1471-0528.2011.02913.x

    Article  PubMed  Google Scholar 

  19. D’Aiuto F, Gkranias N, Bhowruth D et al (2018) Systemic effects of periodontitis treatment in patients with type 2 diabetes: a 12 month, single-centre, investigator-masked, randomised trial. Lancet Diabetes Endocrinol 6(12):954–965. https://doi.org/10.1016/S2213-8587(18)30038-X

  20. Bellissimo-Rodrigues WT, Menegueti MG, Gaspar GG et al (2014) Effectiveness of a dental care intervention in the prevention of lower respiratory tract nosocomial infections among intensive care patients: a randomized clinical trial. Infect Control Hosp Epidemiol 35(11):1342–1348. https://doi.org/10.1086/678427

    Article  PubMed  Google Scholar 

  21. Zhou X, Han J, Liu Z et al (2014) Effects of periodontal treatment on lung function and exacerbation frequency in patients with chronic obstructive pulmonary disease and chronic periodontitis: a 2-year pilot randomized controlled trial. J Clin Periodontol 41(6):564–572. https://doi.org/10.1111/jcpe.12247

    Article  PubMed  Google Scholar 

  22. Liu J, Zong X, Vogtmann E et al (2022) Tooth count, untreated caries and mortality in US adults: a population-based cohort study. Int J Epidemiol 51(4):1291–1303. https://doi.org/10.1093/ije/dyac072

    Article  PubMed  PubMed Central  Google Scholar 

  23. Gupta A, Felton DA, Jemt T, Koka S (2019) Rehabilitation of edentulism and mortality: a systematic review. J Prosthodont 28(5):526–535. https://doi.org/10.1111/jopr.12792

    Article  PubMed  Google Scholar 

  24. Sabbah W, Slade GD, Sanders AE, Bernabé E (2020) Denture wearing and mortality risk in edentulous American adults: a propensity score analysis. J Dent 100:103360. https://doi.org/10.1016/j.jdent.2020.103360

    Article  PubMed  Google Scholar 

  25. Dai J, Li A, Liu Y et al (2022) Denture wearing status, cardiovascular health profiles, and mortality in edentulous patients: a prospective study with a 27-year follow-up. J Dent 126:104287. https://doi.org/10.1016/j.jdent.2022.104287

    Article  PubMed  Google Scholar 

  26. Engebretson SP, Hyman LG, Michalowicz BS et al (2013) The effect of nonsurgical periodontal therapy on hemoglobin A1c levels in persons with type 2 diabetes and chronic periodontitis: a randomized clinical trial. JAMA 310(23):2523–2532. https://doi.org/10.1001/jama.2013.282431

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  27. Janket SJ, Wightman A, Baird AE et al (2005) Does periodontal treatment improve glycemic control in diabetic patients? A meta-analysis of intervention studies. J Dent Res 84(12):1154–1159. https://doi.org/10.1177/154405910508401212

    Article  PubMed  Google Scholar 

  28. Centers for Disease Control and Prevention. 2019 Public-Use Linked Mortality Files. https://www.cdc.gov/nchs/data-linkage/mortality-public.htm. Acaccessed 9 Sept 2022

  29. Zhao H, Pan Y, Wang C et al (2021) The effects of metal exposures on charlson comorbidity index using zero-inflated negative binomial regression model: NHANES 2011–2016. Biol Trace Elem Res 199(6):2104–2111. https://doi.org/10.1007/s12011-020-02331-4

  30. Martinez-Herrera M, López-Domènech S, Silvestre FJ et al (2018) Dietary therapy and non-surgical periodontal treatment in obese patients with chronic periodontitis. J Clin Periodontol 45:1448–1457. https://doi.org/10.1111/jcpe.13030

    Article  PubMed  Google Scholar 

  31. Erciyas K, Sezer U, Ustun K et al (2013) Effects of periodontal therapy on disease activity and systemic inflammation in rheumatoid arthritis patients. Oral Dis 19:394–400. https://doi.org/10.1111/odi.12017

    Article  PubMed  CAS  Google Scholar 

  32. Teeuw WJ, Slot DE, Susanto H et al (2014) Treatment of periodontitis improves the atherosclerotic profile: a systematic review and meta-analysis. J Clin Periodontol 41:70–79. https://doi.org/10.1111/jcpe.12171

    Article  PubMed  CAS  Google Scholar 

  33. Lee K, Lee JS, Kim J et al (2020) Oral health and gastrointestinal cancer: a nationwide cohort study. J Clin Periodontol 47:796–808. https://doi.org/10.1111/jcpe.13304

    Article  PubMed  CAS  Google Scholar 

  34. Nishide A, Fujita M, Sato Y, Nagashima K, Takahashi S, Hata A (2017) Income-related inequalities in access to dental care services in Japan. Int J Environ Res Public Health 14(5):524. https://doi.org/10.3390/ijerph14050524

    Article  PubMed  PubMed Central  Google Scholar 

  35. Simon L, Choi SE, Ticku S, Fox K, Barrow J, Palmer N (2020) Association of income inequality with orthodontic treatment use. J Am Dent Assoc 151(3):190–196. https://doi.org/10.1016/j.adaj.2019.11.021

    Article  PubMed  Google Scholar 

  36. Green CA, Gender PCR (1999) Psychosocial factors and the use of medical services: a longitudinal analysis. Soc Sci Med 48(10):1363–1372. https://doi.org/10.1016/s0277-9536(98)00440-7

    Article  PubMed  CAS  Google Scholar 

  37. Wamala S, Merlo J, Boström G (2006) Inequity in access to dental care services explains current socioeconomic disparities in oral health: the Swedish National Surveys of Public Health 2004–2005. J Epidemiol Community Health 60(12):1027–1033. https://doi.org/10.1136/jech.2006.046896

    Article  PubMed  PubMed Central  Google Scholar 

  38. Locker D, Maggirias J, Quiñonez C (2011) Income, dental insurance coverage, and financial barriers to dental care among Canadian adults. J Public Health Dent 71(4):327–334. https://doi.org/10.1111/j.1752-7325.2011.00277.x

    Article  PubMed  Google Scholar 

  39. Christian B, Chattopadhyay A, Kingman A, Boroumand S, Adams A, Garcia I (2013) Oral health care services utilisation in the adult US population: medical expenditure panel survey 2006. Community Dent Health 30(3):161–167

    PubMed  CAS  Google Scholar 

  40. Bisquera A, Turner EB, Ledwaba-Chapman L, Dunbar-Rees R, Hafezparast N, Gulliford M et al (2021) Inequalities in developing multimorbidity over time: a population-based cohort study from an urban, multi-ethnic borough in the United Kingdom. Lancet Reg Health Eur 12:100247. https://doi.org/10.1016/j.lanepe.2021.100247

    Article  PubMed  PubMed Central  Google Scholar 

  41. Martin LJ, Chen Y, Serrano-Lomelin J, Talbot J, Yasui Y (2020) Higher levels of social and material deprivation are associated with higher rates of influenza-like illness-related emergency department visits: Edmonton, Alberta, 2004–2014. Public Health 189:117–122. https://doi.org/10.1016/j.puhe.2020.06.039

    Article  PubMed  CAS  Google Scholar 

  42. Wu Y, Qi D (2020) Material deprivation, parenting practices, and children’s psychological health and wellbeing in China. J Community Psychol 48(8):2644–2662. https://doi.org/10.1002/jcop.22441

  43. Bui FQ, Almeida-da-Silva CLC, Huynh B et al (2019) Association between periodontal pathogens and systemic disease. Biomed J 42:27–35. https://doi.org/10.1111/jcpe.13304

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  44. Kitamoto S, Nagao-Kitamoto H, Hein R et al (2020) The bacterial connection between the oral cavity and the gut diseases. J Dent Res 99:1021–1029. https://doi.org/10.1177/0022034520924633

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  45. van der Meulen TA, Harmsen H, Bootsma H et al (2016) The microbiome-systemic diseases connection. Oral Dis 22:719–734. https://doi.org/10.1111/odi.12472

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors acknowledge the financial support from grant number 2019KB01 from the State Key Laboratory of Military Stomatology, China, grant LCA202004 and LCB202209 from National Clinical Research Centre for Oral Diseases, and grant 2020TD-033 from the Shaanxi Key Scientific and Technological Innovation Team and by the Youth Innovation Team of Shaanxi Universities.

Funding

Financial support from grant number 2019KB01 from the State Key Laboratory of Military Stomatology, China, grant LCA202004 from National Clinical Research Centre for Oral Diseases, grant LCB202209 from National Clinical Research Centre for Oral Diseases and grant 2020TD-033 from the Shaanxi Key Scientific and Technological Innovation Team and by the Youth Innovation Team of Shaanxi Universities.

Author information

Author notes

  1. Kehui Xu, Sai Ma and Junting Gu contributed equally to this work.

Authors and Affiliations

  1. State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Prosthodontics, School of Stomatology, the Fourth Military Medical University, Xi’an, 710032, Shaanxi, China

    Kehui Xu, Sai Ma, Junting Gu, Qing Liu, Zikang He, Yuanyuan Li, Shuailin Jia & Lina Niu

  2. Department of General Dentistry, Chenggong Hospital Affiliated to Medical School of Xiamen University, Xiamen, 361000, Fujian, China

    Yuanyuan Li

  3. The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, 453003, Hena, China

    Shuailin Jia

  4. Department of Epidemiology, Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, the Fourth Military Medical University, Xi’an, 710032, China

    Zhaohua Ji

  5. The Graduate School, Augusta University, Augusta, GA, 30912, USA

    Franklin Tay

  6. Department of Stomatology, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China

    Tong Zhang

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  1. Kehui Xu
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Contributions

Contributions are as follows: design, L.N.N., K.H.X., S.M., S.L.J.; analysis: K.H.X., J.T.G., Q.L.; methodology: L.N.N., K.H.X; project administration: L.N.N., T.Z., F.T.; resources: K.H.X., S.M., Y.Y.L.; software: S.L.J., Z.H.J., Q.L.; supervision: L.N.N., T.Z., F.T.; writing (original draft): K.H.X., S.M. All authors participated in the decision to submit.

Corresponding authors

Correspondence to Tong Zhang or Lina Niu.

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The NHANES data is publicly available data from the National Center for Health Statistics, and thus, the work was deemed to be exempt.

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The authors declare no competing interests.

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Xu, K., Ma, S., Gu, J. et al. Association between dental visit behavior and mortality: a nationwide longitudinal cohort study from NHANES. Clin Oral Invest 28, 37 (2024). https://doi.org/10.1007/s00784-023-05471-8

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