Abstract 3393: Tooth count, untreated caries, and all-cause and cause-specific mortality
Authors: Liu Jie , Li Zitong , Vogtmann Emily , Cao Chao , Zong Xiaoyu , Chan Andrew , Rimm Eric , Hayes Richard , Colditz Graham , Michaud Dominique , Joshipura Kaumudi , Abnet Christian , Cao Yin 
Published: September 2020

Abstract
Introduction: Tooth loss increases the risk of cardiovascular disease (CVD). However, its association with overall and cancer mortality, especially according to social gradient and smoking status, remains underexplored. Dental caries has recently emerged as a risk factor for CVD, but its association with mortality has not been well studied. This study aims to evaluate the associations between untreated caries, tooth count, and all-cause and cause-specific mortality in the US population.
Methods: A prospective cohort of nationally representative samples from the National Health and Nutrition Examination Survey (NHANES) 1999-2010 containing 15,242 adults 30 years or older without heart disease, stroke, and cancer at baseline was included in analyses. Exposures were the total number of permanent teeth (including the third molar) and untreated caries assessed by trained and standardized dentists or health technologists. All-cause and cause-specific (CVD and cancer) mortality were ascertained via linkage to the National Death Index (NDI) through December 31, 2015. A series of weighted Cox proportional-hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).
Results: During up to 16 years of follow-up (1,818,040 person-years), 1,850 total deaths were identified (388 from CVD and 428 from cancer). Significant inverse associations between the number of permanent teeth and all-cause, CVD, and cancer mortality were observed. Compared to individuals with 25-32 teeth, the multivariable-adjusted HRs (95% CIs) for participants with 17-24, 1-16, and 0 teeth and all-cause mortality were 1.22 (1.04-1.43), 1.37 (1.13-1.66), and 1.62 (1.37-1.90) (P for trend &lt;.001). For CVD mortality, the corresponding HRs were 1.17 (0.85-1.59), 1.22 (0.82-1.82), and 1.69 (1.16-2.48) (P for trend =.012), and 1.12 (0.77-1.62), 1.23 (0.81-1.86), and 2.09 (1.40-3.11) (P for trend &lt;.001) for cancer mortality. After adjusting for socioeconomic status, healthcare access, lifestyle factors, as well as tooth count, untreated caries were significantly associated with increased risk of all-cause (HR = 1.27, 95%CI = 1.11-1.46) and CVD mortality (HR = 1.67, 95%CI = 1.23-2.28) but not cancer mortality. These findings were robust while restricted to individuals without diabetes at baseline, and also similar according to baseline age (&lt;70/≥70), sex, family income poverty ratio (≤1.3/&gt;1.3), and smoking status (never/ever).
Conclusions: Lower number of permanent teeth was associated with increased all-cause, CVD, and cancer mortality. Untreated caries is linked with an increased risk of all-cause and CVD mortality.
Citation Format: Jie Liu, Zitong Li, Emily Vogtmann, Chao Cao, Xiaoyu Zong, Andrew Chan, Eric Rimm, Richard Hayes, Graham Colditz, Dominique Michaud, Kaumudi Joshipura, Christian Abnet, Yin Cao. Tooth count, untreated caries, and all-cause and cause-specific mortality [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 3393.