Risk factors for tooth loss in postmenopausal women

Problem statement. Tooth loss diminishes quality of life by causing loss of function, esthetics and consequently self-esteem. About {dollar}1.5 billion is spent annually in the United States for replacement of missing teeth. Postmenopausal women represent a subpopulation with unique factors that may influence tooth loss differently compared to general population such as estrogen deficiency, hormone therapy and lower bone mineral density.; Methods. The aims of this cohort study were to describe the incidence of tooth loss and determine baseline variables associated with incident tooth loss in postmenopausal women. Study population consisted of white postmenopausal women with at least 6 teeth at baseline who participated in a cross-sectional study of risk factors for periodontal disease between 1989 and 1991. Exclusion criteria included history of cancer and age at menopause <40 years. Participants completed self-report questionnaires on medical and dental histories as well as demographics, life style and health at both baseline and follow-up. Assessment of baseline periodontal status was performed clinically by trained and calibrated dentists and included mean alveolar bone loss (mm), mean clinical attachment loss (mm), number of sites with probing depth ≥5 mm, and presence or absence of eight subgingival microorganisms. Covariates included age (years), household income (<{dollar}10,000, {dollar}10,000--29,999, >{dollar}30,000), smoking status (never, former, current), hormone therapy (never, ever), number of systemic diseases (history of osteoporosis, diabetes, hypertension, myocardial infarction or stroke), number of snacks (<2/day, ≥2/day) and number of teeth with decayed or filled root. At follow-up, number of teeth lost was assessed clinically by a periodontist and was defined as 0 versus ≥1.; Results. A total of 61 (57.5%) out of 106 subjects lost at least one tooth during follow-up. Mean number of tooth loss during follow-up was 1.81 +/- 2.77 and the median was 1. Multiple logistic regression analyses showed that mean alveolar bone loss (OR = 2.79; 95% CI: 1.36--5.73), current smoking (OR = 2.38; 95% CI: 1.01--5.60), household income ≥30,000 (OR = 2.81; 95% CI: 1.08--8.84) and 2 or more snacks per day (OR = 1.81; 95% CI: 1.04--3.14) were related with increased risk of incident tooth loss; hormone therapy (OR = 0.44; 95% CI: 0.23--0.86) and household income {dollar}10,000--29,999 (OR = 0.28; 95% CI: 0.13--0.62) were related with decreased risk of incident tooth loss. There was a significant interaction between Bacteroides forsythus and number of systemic diseases (OR = 4.18; 95% CI: 1.02--17.16).; Conclusions. We can conclude that periodontal disease at baseline, especially measured by alveolar bone loss, hormone therapy, smoking, household income and snacks are important independent predictors for incident tooth loss in postmenopausal women.