Lower Number of Teeth Is Related to Higher Risks for ACVD and Death-Systematic Review and Meta-Analyses of Survival Data

Abstract

Tooth loss reflects the endpoint of two major dental diseases: dental caries and periodontitis. These comprise 2% of the global burden of human diseases. A lower number of teeth has been associated with various systemic diseases, in particular, atherosclerotic cardiovascular diseases (ACVD). The aim was to summarize the evidence of tooth loss related to the risk for ACVD or death. Cohort studies with prospective follow-up data were retrieved from Medline-PubMed and EMBASE. Following the PRISMA guidelines, two reviewers independently selected articles, assessed the risk of bias, and extracted data on the number of teeth (tooth loss; exposure) and ACVD-related events and all-cause mortality (ACM) (outcome). A total of 75 articles were included of which 44 were qualified for meta-analysis. A lower number of teeth was related to a higher outcome risk; the pooled risk ratio (RR) for the cumulative incidence of ACVD ranged from 1.69 to 2.93, and for the cumulative incidence of ACM, the RR ranged from 1.76 to 2.27. The pooled multiple adjusted hazard ratio (HR) for the incidence density of ACVD ranged from 1.02 to 1.21, and for the incidence density of ACM, the HR ranged from 1.02 to 1.30. This systematic review and meta-analyses of survival data show that a lower number of teeth is a risk factor for both ACVD and death. Health care professionals should use this information to inform their patients and increase awareness on the importance of good dental health and increase efforts to prevent tooth loss.

Keywords: atherosclerosis; cardiovascular disease; meta-analysis; mortality; number of teeth; risk; systematic review; tooth loss.

Figure 1

Flow diagram of the study selection process.

Figure 2

(A) Forest plots for meta-analysis of cumulative incidence for categorical data of the number of teeth, ACVD, and all-cause mortality. (B) Forest plots for meta-analysis of incidence density for categorical data of the number of teeth, atherosclerotic cardiovascular disease (ACVD) and all-cause mortality. (C) Forest plots for meta-analysis of incidence density for continuous data of the number of teeth, ACVD, and all-cause mortality. ACVD, Atherosclerotic Cardiovascular Disease; vs., versus; ref., reference group; Ne, number of events; Nt, number of total included study participants; N.A., Not Applicable. The Hazard Ratio (HR) in the Forest Plot which was based only on one study, was obtained directly from the included study.