Older adults who do not undergo dental checkups have a 1.5 times higher mortality risk
Data for 940,000 patients in Osaka shows dental checkups may save lives
It is known that oral health conditions, such as the number of teeth, are associated with mortality risk. In Japan, where the population is rapidly aging, the Dental Health Checkup Program for the Elderly (hereinafter referred to as "dental checkup") has been started in fiscal 2018 with the aim of extending healthy life expectancy for people aged 75 and over. However, there are no examples anywhere in the world of public dental checkups for the elderly, and their effectiveness is unclear.
A collaborative research group consisting of Assistant Professor Naoko Otsuki, at the Graduate School of Nursing of Osaka Metropolitan University, and Professor Ryohei Yamamoto, at Health and Counseling Center of the University of Osaka, conducted a survival analysis to examine the association between whether or not they have had a dental checkup or dental visit, and mortality in 946,709 people aged 75 or older who were continuously enrolled in the Osaka Prefecture Medical Care System for the Elderly Aged 75 and Over between October 2017 and March 2019. The subjects were divided into four groups, 1) with dental checkups and dental visits, 2) with dental checkups but no dental visits, 3) without dental checkups and dental visits, and 4) without dental checkups or no dental visits. Analysis was then conducted for subjects with matching background factors such as age and underlying diseases. The results showed that the mortality risk of male in group 4 was 1.45 times higher and that of female was 1.52 times higher than that of group 2 (Fig. 1).
Fig. 1 Dental checkups and dental visits and cumulative all-cause mortality rates among elderly people
Credit: Ryohei Yamamoto
Research Background
The World Health Organization (WHO) has stated that oral health is a critical concern for the elderly and is an important factor in extending healthy lifespan. In Japan, dental checkups for the elderly aged 75 and over have been started in fiscal 2018 with the aim of extending their healthy life expectancy. However, public dental checkups for the elderly are rare worldwide, and their effectiveness as health screening for the elderly are unclear. Therefore, it is essential to consider the benefits of dental checkups in order to actively promote dental checkup attendance.
Research Contents
This research was conducted as part of the Oral Health Screening to Assess Keys of Aging well (OHSAKA) study. Of the 1,078,729 people who were enrolled in the Osaka Prefecture Medical Care System for the Elderly Aged 75 and Over as of October 2017, 946,709 people aged 75 years or over who had been continuously enrolled in the system from October 2017 to March 2019 were analyzed. Using data on whether or not they had undergone dental checkups and dental visit, and medical claims data, the research group examined the relationship between dental checkups/dental visits and subsequent mortality.
The approximately one million subjects had different background factors, such as age and underlying diseases, so in order to adjust these, propensity score matching method was used, which statistically selects and analyzes only people with similar background factors, and a survival analysis was used to examine the relationship between dental checkups/dental visits and mortality. The results showed that the risk of death for elderly people who did not receive either a dental checkup, or a dental visit was 1.45 times higher for male and 1.52 times higher for female compared to elderly people who received a dental checkup (but did not visit a dentist).
Social Impact of the Research
The reason why this study showed a higher risk of death in the group that did not undergo dental checkups may be that regular dental maintenance is effective for preventing tooth loss and maintaining oral hygiene. It also revealed that elderly people who undergo regular dental maintenance are generally more health-conscious and more likely to engage in healthy behaviors that reduce their mortality risk.
The "8020 Campaign" is a Japanese national initiative promoting oral health, with the goal of having people retain at least 20 of their own teeth by the age of 80, and has taken root among the public (51.6% achieved the target in 2022), and it is believed that the Japanese have a higher level of awareness of oral health than other countries.
Although the dental checkup program for the elderly over 75 is still not well known, based on the results of this research, it is hoped to encourage as many elderly people as possible to visit the dentist, and by getting effective dental checkups, not only to maintain and improve oral hygiene but also to appropriately refer elderly people at risk of health problems to medical care, it may be possible to extend the healthy life expectancy of the Japanese from both a dental and medical perspective.
Notes
The article, “Dental checkups and all-cause mortality in older adults aged ≥75 years: a large retrospective cohort study,” was published in Journal of Gerontology: Medical Sciences (The Journal of Gerontology series A) at DOI: https://doi.org/10.1093/gerona/glaf100.
