Tooth Loss Among Older Adults with Chronic Conditions

This page summarizes a CDC analysis of national survey data from 1999–2004 and 2011–2016.

Losing many teeth can lead to a poor diet and with it weight loss or obesity. It can also change a person's appearance and speech in ways that limit social contact, inhibit intimacy and lower self-esteem. Chronic diseases and oral diseases share risk factors, and people with chronic conditions are more likely to have untreated dental disease, which can end in tooth loss. Older adults are also more likely to see a doctor each year than a dentist.

CDC researchers used the National Health and Nutrition Examination Survey (NHANES), which assesses the health of the U.S. population through interviews and physical exams, to compare tooth loss among adults aged 50 and older, with and without chronic conditions, in 1999–2004 and 2011–2016.

Three measures of tooth loss

• Edentulism: having no teeth.
• Severe tooth loss: having eight or fewer teeth, which causes major difficulty eating meat, fruits and vegetables.
• Lacking functional dentition: having fewer than 20 of 28 teeth, the number NHANES counts as a full set. This measure is the most useful for action, because it catches tooth loss at its earliest symptomatic stage.

Tooth loss, uncontrolled diabetes and obesity were measured in the exam; other conditions were self-reported. The sample was 6,283 adults in 1999–2004 and 7,443 in 2011–2016, all of whom had a dental exam.

What was found

In 2011–2016, among adults 50 and older, 10.8% had no teeth, 16.9% had severe tooth loss and 31.8% lacked functional dentition.

Edentulism and severe tooth loss were more common among people with every condition studied except obesity. Edentulism was at least twice as common among adults with fair or poor general health, emphysema, heart disease or a history of stroke as among those without. Severe tooth loss was at least 50% more common among those with fair or poor general health, rheumatoid arthritis, asthma, diabetes, uncontrolled diabetes, emphysema, heart disease, a liver condition or stroke.

Change over time. Lacking functional dentition fell by 11.7 percentage points overall, from 43.5% in 1999–2004 to 31.8% in 2011–2016. It improved among people with fair or poor general health, any arthritis, diabetes and obesity, most of all among people with diabetes (down 16.6 points) and uncontrolled diabetes (down 18.8 points). Among people with rheumatoid arthritis it rose by 11.2 points. In 2011–2016 it was still at least 50% more common among adults with fair or poor general health, rheumatoid arthritis, emphysema or heart disease.

Adults aged 50 and older lacking functional dentition (fewer than 20 teeth), by chronic condition, 1999–2004 and 2011–2016. CDC, MMWR.

The reason for the rise among people with rheumatoid arthritis is unknown. Reported rheumatoid arthritis fell by more than 60% between the two periods, so the rise may reflect a change in who was in the sample.

Why people with chronic conditions lose teeth

Tooth decay and gum (periodontal) disease are the leading causes of tooth loss, and both are preventable: decay with fluoride applied at home or by a dentist or added to drinking water, and with fillings; gum disease with scaling and root planing in a dental office. A 2009 analysis of 1999–2004 NHANES data found that people with chronic conditions had more unmet dental treatment needs, with obesity, diabetes, emphysema and stroke linked to untreated decay, and diabetes and obesity to untreated gum disease.

Access is part of the problem. Traditional Medicare (Parts A and B) does not cover routine dental care, though some Medicare Advantage (Part C) plans do. In 2019 only 18 states and the District of Columbia offered extensive dental services to adults on Medicaid. Chronic conditions can also limit mobility, making both dental visits and home care harder. In 2017, more than 40% of adults 65 and older had seen a physician in the past year but not a dentist.

What can be done

Tooth loss can be prevented with self-care and regular dental visits. The authors suggest that:

• public health professionals and nonprofit organizations teach people that chronic conditions raise the risk of tooth loss
• health care providers explain that higher risk to patients with chronic conditions and stress preventive care at home and at the dentist
• primary care providers screen for common dental conditions and refer patients for care; a 2011 Institute of Medicine report found that trained health professionals can do this, and the Smiles for Life curriculum teaches oral health to medical providers

Of the conditions studied, only diabetes has routine dental visits as part of the standard of care, and a Cochrane review found some evidence that treating periodontitis can improve blood sugar control in people with diabetes. People with diabetes also showed the largest gains in keeping functional teeth. From 2016 to 2018, CDC funded programs in six states to better understand the links between chronic disease and oral health, and it supports efforts to connect dentists and primary care providers caring for patients with prediabetes, diabetes and hypertension.

Limitations: most conditions were self-reported; some were uncommon enough that real differences may have been missed, and changes for emphysema, liver conditions and stroke may be statistically unreliable; and factors such as race, ethnicity and income were not controlled for.

Sources

• Parker ML, Thornton-Evans G, Wei L, Griffin SO. "Prevalence of and Changes in Tooth Loss Among Adults Aged ≥50 Years with Selected Chronic Conditions — United States, 1999–2004 and 2011–2016." MMWR 69(21). https://www.cdc.gov/mmwr/volumes/69/wr/mm6921a1.htm
• Supplementary table: https://stacks.cdc.gov/view/cdc/88330; NHANES: https://www.cdc.gov/nchs/nhanes.htm