Title: Allostatic Load in Relation to Periodontal Disease, Tooth Loss, and Mortality
Description: As the proportion of adults aged 65 years and older continues to grow across the globe and edentulism rates decline, there is widespread concern about a rise in the prevalence of periodontal disease, characterized by chronic inflammation of tooth-supporting tissues induced by persistent infection. Compared to their younger counterparts, older adults experience a higher burden of periodontal disease, which can result in tooth loss, poor nutritional intake, higher prevalence of other chronic diseases, and a decrease in overall quality of life. While cross-sectional studies have underscored the role of chronic stress on periodontal disease progression in older adults, longitudinal evidence is currently lacking. This dissertation draws on prospective data from a birth cohort of older Danish adults (1914 Glostrup Aging Study) with 25 years of follow-up. Using physiological markers than span the metabolic, inflammatory, and cardiovascular systems, I developed a composite measure of allostatic load (AL) at age 80, defined as the cumulative biological damage that results from a whole-body adaptation to chronic stress.

First, I identified social and behavioral predictors of high scores on AL. In men, those with no vocational training, unskilled occupation, low income, and a sedentary lifestyle were more likely to have high AL, consistent with a "weathering" pattern of biological systems resulting from chronic adversity over the life course. To test the hypothesis that high AL is longitudinally associated with periodontal disease, I evaluated bidirectional longitudinal associations using multiple measures of AL and periodontal disease. Results showed a positive nonlinear association of AL at age 70 with periodontal disease at age 85, but no association between periodontal disease at age 70 with AL at age 80. This finding confirms previous cross-sectional data, and supports the role of chronic stress on infection-induced inflammation. To test the hypothesis that high AL is associated with mortality risk, I examined this association longitudinally from ages 70 - 95. Compared to low AL, high AL was positively associated with all-cause mortality, and even stronger when cardiovascular disease mortality was considered.

AL-mortality associations were higher among those who were dentate as compared to edentate, suggesting that dentate status modifies the relationship. Findings from this dissertation contribute to our understanding of the consequences of stress on periodontal disease in relation to aging and offer potential avenues for intervention.