Tooth loss extends beyond oral health concerns, impacting overall well-being and quality of life. It is a global issue, with approximately 7% of individuals aged 20 years or older affected. Research reveals associations between tooth loss and cardiovascular diseases, including hypertension, atherosclerosis, and peripheral arterial disease, attributed mainly to chronic inflammation and altered dietary habits. However, tooth loss has also been associated with cognitive decline, depression, and certain cancers, including lung, head and neck, pancreatic, and esophageal, suggesting the involvement of complex pathophysiological mechanisms that are increasingly the subject of experimental research. In addition, there are psychosocial consequences, such as self-esteem issues and social discomfort. Therefore, it is indisputable that comprehensive oral care is of utmost importance. Recognizing the importance of oral health for overall well-being highlights the necessity for preventative measures and enhanced dental care. As the global population ages, it is increasingly important to comprehend and address the systemic effects of tooth loss. This review aims to summarize the complex pathomechanisms underlying tooth loss and emphasize the need for a comprehensive approach to address its di- verse consequences. It advocates for preventive oral health measures to sustain general health and well-being.

OBJECTIVE: Health and social factors show large heterogeneity across regional cultural geographies and influence oral health as well. The purpose of this study is to confirm associations between county-level general health, behaviors, social factors, and oral health indicators and to further analyze the patterns of distribution of oral health indicators across dominant regional cultures in the United States (US) as defined by the American Nations model.
METHODS: We calculated a Lifestyle Health Index (LHI) from the 2023 PLACES database using county-level, age-adjusted health data and merged it with (a) 2020 Social Vulnerability Index (SVI) database, (b) dominant regional cultures from Nationhood Lab\'s American Nations model, (c) dentist visits and teeth lost data from the 2023 PLACES database, and (d) access to dentistry data from the County Health Rankings database.
RESULTS: Correlation coefficients between the LHI (and sub scores), SVI (and sub scores), and dental variables showed strong associations. ANOVA post-hoc test results revealed significant differences for dental visits and teeth lost for LHI, SVI and access to dentists. Prevalence of dental visits and teeth lost showed clear heterogeneity across regional cultures.
CONCLUSIONS: Oral health is strongly linked to lifestyle health factors, social vulnerability, access to dentistry, and cultural norms and belief systems. Within the US, significant heterogeneity exists in the distribution of oral health indicators across dominant regional cultural geographies. Oral health communications and policy solutions focused on health-related behaviors (e.g., tobacco, diet), disease-specific considerations (e.g., diabetes), and the social environment (e.g., poverty, housing) should be tailored to regional cultures rather than a single US-based culture to improve dental care and oral health outcomes.

OBJECTIVE: Little is known about oral hygiene habits of patients suffering from chronic diseases. This study aims to describe oral hygiene behavior (OHB) in terms of tooth brushing and professional scaling frequency among patients with chronic diseases. Secondarily, it aims to assess the association between OHB and periodontitis, tooth loss, and oral health-related quality of life (OHRQoL).
METHODS: This is a cross-sectional analysis of data of adult participants in the ComPaRe e-cohort. Participants were classified into having good, moderate, and poor OHB according to self-reported frequency of toothbrushing and professional tooth scaling. Periodontitis was assessed using the PEriodontal Screening Score (PESS). Weighted binary regression models were used to estimate the association between OHB and the following outcomes: (i) periodontitis; (ii) number of missing teeth; and (iii) OHRQoL based on the Oral Health Impact Profile-14.
RESULTS: Overall, 8553 patients were included in the analyses (52.9% females, mean age of 56.3 ± 17 years). Of these, 2907 (34%), 3953 (46%) and 1693 (20%) were considered as having good, moderate, and poor OHB, respectively. Over half (54.1%) of the patients had a PESS ≥ 5 suggestive for severe periodontitis. Moderate OHB was associated with lower odds of PESS ≥ 5 compared to poor OHB (Adjusted Odds Ratio, OR = 0.81 [95%CI: 0.70-0.92]). Good and moderate OHB were significantly associated with lower odds of ≥ 10 missing teeth (OR = 0.26 [95%CI: 0.21-0.33] and OR = 0.47 [95%CI: 0.4-0.56], respectively) and better OHRQoL than poor OHB.
CONCLUSIONS: Although, most of patients with chronic diseases reported to have good or moderate OHB, severe periodontitis is highly prevalent among this patient population in France.
CONCLUSIONS: This study describes OHB in a representative sample of patients suffering from one or more chronic diseases and provides an estimate of the prevalence of self-reported severe periodontitis, missing teeth, and OHRQoL.

BACKGROUND: Oral health has been associated with general health conditions, but few longitudinal studies evaluated the effect of dentition status on gait speed.
OBJECTIVE: This study aimed to investigate the longitudinal association between different time-varying measures of dentition status (i.e., number of teeth, the presence of periodontal pockets and the functional impact of oral health) and gait speed (outcome) in older Brazilian adults.
METHODS: This was a prospective study using data from the Health, Well-being and Aging cohort study (SABE) from 2006, 2010 and 2015. The gait speed was the dependent variable and the independent variables of interest were dentition status evaluated using the number of teeth, use of dental prostheses, presence of periodontal pocket, clinical attachment loss and self-perceived poor functional oral health. Dentition status measures were obtained through clinical oral examinations, performed by trained dentists using standardized criteria proposed by the World Health Organization. Self-perceived poor functional oral health was evaluated using the functional domain of the Geriatric Oral Health Assessment Index. The longitudinal effect of dentition status on gait speed was evaluated using mixed-effects linear models. The effect of the number of teeth/periodontal pocket/attachment loss on gait speed change over time was evaluated by including an interaction term between these variables. The effect of periodontal pocket was tested only among dentate individuals.
RESULTS: Data for the complete sample included 3,306 observations from 1,964 individuals. The analyses for dentate individuals included 1,883 observations from 1,149 individuals. There was a positive association between the number of teeth and mean gait speed. Individuals using dental prostheses also had higher means of gait speed than those without dental prostheses. Gait speed was lower among individuals with periodontal pockets and with attachment loss. No interaction was found between any of the indicators of dentition status and time.
CONCLUSIONS: Gait speed was associated with dentition status and this association was constant over time.

OBJECTIVE: To assess whether a health education video increased prosthodontic treatment demand for replacing missing teeth compared to a traditional health education (IEC) leaflet among patients visiting a university dental care center in Saudi Arabia.
METHODS: A nonrandomized educational intervention was conducted among patients with missing teeth. A total of 350 participants were divided equally into two health-education intervention groups: leaflet group and video group. Two major variants were ascertained: demand for prosthodontic dental care and awareness (knowledge) about the importance of replacing missing teeth. These two variants were studied for the difference in the scores between base line and at the end of the program (after 3 months). Bivariate analysis was done with chi-square test, McNemar chi-square test, and Wilcoxon matched-pairs tests, and finally binary logistic regression analysis was done.
RESULTS: The final analysis included 324 participants. There was improvement in both knowledge and demand for prosthodontic care in both the groups after health education, but a statistically significant improvement in demand for dental care was observed in the video group compared to the leaflet group (42.9% vs 63.2%). Logistic regression analysis identified that missing teeth in the anterior region and being in the video group were two significant factors associated with increased demand for care.
CONCLUSIONS: The health education video method was found to be a more effective method compared to leaflets in improving knowledge and demand for replacing missing teeth.

Background: Highly prevalent tooth loss is observed among populations around the world. To restore masticatory function and satisfactory aesthetics, missing teeth must be replaced. Dental implants are increasingly used for this purpose. This study aimed to assess periodontal patients\' knowledge and attitudes towards dental implants. Methods: 467 anonymous questionnaires of periodontal patients were analyzed. The population participants were divided according to gender, age, education and place of residence. In the statistical analysis, the chi-squared test of independence was used (p < 0.05). The main questions addressed patients\' knowledge about dental implants and the factors influencing their decision to undergo implantation. Results: The majority of periodontal patients were aware of dental implants and the importance of oral hygiene in their maintenance. However, the population studied had many knowledge deficits, especially on the technical and biological aspects of implants. The lack of knowledge about peri-implantitis was surprising in the group seeking professional periodontal care. Patients obtained information mainly from the internet and from family and friends, with their dentists being the third source. Good functional and aesthetic outcomes would encourage them to undergo the implantation procedure, and high cost and the possibility of complications were the most discouraging factors. Conclusions: Given the growing popularity of implant treatment, patients should be provided with evidence-based knowledge about indications and possible contraindications to implants to make informed decisions.

BACKGROUND: The study objectives were to determine tooth loss prevalence and to investigate the relationship between tooth loss and potential risk factors among adult dentate HIV+ patients on newer antiretroviral therapy (ART) regimens.
METHODS: Health records of 450 human immunodeficiency virus (HIV)-infected individuals were surveyed. Eighty-eight records of dentate HIV+ individuals with full-mouth periodontal charting and intra-oral periapical radiographs were identified. We collected data on demographics, systemic risk factors, oral health, and HIV disease measures. Caries exposure and alveolar bone loss (ABL) were radiographically assessed.
RESULTS: Eighty-eight percent of patients showed tooth loss. Patients with ABL ≥15% had a higher number of missing teeth (p < .01). Stepwise regression analyses indicated that tooth loss was positively associated with age (β = 0.45, p < .01) and ABL (β = 0.39, p < .01). By contrast number of years on ART was negatively associated with tooth loss (β = -0.28, p < .05).
CONCLUSIONS: Tooth loss remains prevalent among HIV+ patients, and periodontal disease is a significant contributor. The number of years on ART seem to improve oral health behavior and reduce tooth loss.

OBJECTIVE: To compare short-term outcomes between membrane perforation and non-perforation patients after simultaneous external elevation with implantation.
METHODS: In this retrospective observational study, 60 maxillary posterior tooth-loss patients with an insufficient amount of residual bone for direct implantation were enrolled. All patients underwent simultaneous external elevation and implantation, and were divided into perforation and non-perforation groups according to the postoperative Schneiderian membrane status.
RESULTS: Of the 60 patients, 30 cases (35 implants) were assigned to the membrane perforation group, and 30 (44 implants) were allocated to the non-perforation group. There were no statistically significant differences in baseline data (p>0.05). In the perforation group, the mean vertical bone gain (VBG) at 6 and 12 months was 6.02±2.14 mm and 5.37±2.22 mm, resp., compared to 6.78±2.59 mm and 6.42±2.64 mm in the non-perforation group, resp. (both p>0.05). Preoperative median Schneiderian membrane thickness (SMT) in the perforation group was 0.77 mm, which was statistically significantly thinner than the 1.24 mm measure in the non-perforation group (p< 0.05); however, there was no statistically significant difference between two groups at 12 months postoperatively (0.80 mm vs 1.25 mm, p>0.05). The marginal bone loss at 1 year after implant restoration in the perforation and non-perforation groups was 0.16±0.10 mm and 0.22±0.12 mm, resp. During postoperative follow-up, the implant survival rate was 100% in the two groups. The incidence of postoperative nasal bleeding in the perforation group was statistically significantly higher compared with that in the non-perforation group (50% vs 16.7%, p<0.05), whereas no statistically significant differences were observed in the incidence of facial swelling, intraoral bleeding, wound dehiscence and acute/chronic sinusitis between the two groups (p>0.05).
CONCLUSIONS: Schneiderian membrane perforation after simultaneous external elevation and implantation do not adversely affect short-term clinical and radiographic outcomes.

OBJECTIVE: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.
CONCLUSIONS: 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.

Dental caries and periodontal disease are typical oral diseases frequently observed in patients with renal diseases. Tooth loss is an outcome of dental caries and periodontal disease, and the number of existing teeth is an indicator of oral health status. However, the association between the number of existing teeth and end-stage kidney disease (ESKD) has not been investigated in detail. This study aimed to investigate the association between oral health status, expressed by the number of existing teeth, and ESKD. We analyzed data from the second survey of the Longitudinal Evaluation of Multi-phasic, Odontological, and Nutritional Associations in Dentists, a cohort study conducted among members of the Japan Dental Association. From August 2016 to July 2017, self-administered questionnaires were mailed to 16,128 male dentists and 8,722 responded. Among them, 7,479 men with complete data on age, number of existing teeth, and ESKD were included in the analysis. Multivariate logistic regression analysis was conducted, with ESKD as the dependent variable and the number of existing teeth (≥23 teeth and <23 teeth) as the independent variable. Subgroup analysis by age (<65 years and ≥65 years) was also conducted. The <23 teeth group had a significantly higher rate of ESKD than did the ≥23 teeth group. After adjusting for age, body mass index, smoking habits, hypertension, and diabetes mellitus, there was no significant association between having <23 teeth and ESKD in all participants. However, the subgroup analysis revealed a significant association after adjustment for covariates in participants aged <65 years but not in those aged ≥65 years. In conclusion, having <23 teeth was associated with the risk of requiring maintenance dialysis therapy among Japanese men aged <65 years. Therefore, tooth loss may be associated with renal function decline.