Clinical and community risk models of incident tooth loss in postmenopausal women from the Buffalo Osteo Perio Study

Bole C, Wactawski-Wende J, Hovey KM, Genco RJ, Hausmann E. Clinical and community risk models of incident tooth loss in postmenopausal women from the Buffalo Osteo Perio Study. Community Dent Oral Epidemiol 2010; 38: 487-497. 2010 John Wiley & Sons A/S Abstract-Objective: While risk factors for tooth loss in adults have been identified, limited studies describing factors associated with incident tooth loss in postmenopausal women exist. This study assessed both clinical and non-clinical risk factors for incident tooth loss. Methods: Postmenopausal women (N=1341) were recruited between 1997 and 2000 from 1847 eligible Observational Study participants of the Buffalo, NY center of the Women's Health Initiative who had complete dental examinations to assess alveolar bone height, soft tissue attachment and general oral health, and completed questionnaires concerning demographics, general health, lifestyle and oral health (72.6% participation rate). Five years later (2002-2005), 1021 women (76.1%) repeated these examinations and questionnaires. Incident tooth loss was determined by oral examination. Results: After an average 5.1years of follow-up (SD, 0.38), a total of 323 teeth were lost in 293 women, resulting in 28.7% of women with incident loss of at least one tooth. In multivariable models, diabetes history, gum disease history, smoking, previous tooth loss, BMI and plaque index, baseline clinical measures including alveolar crestal height (ACH) (OR=1.22per mm loss, 95% CI 1.11, 1.35), clinical attachment loss (CAL) (OR=1.13 per mm loss, 95% CI 1.05, 1.23), and pocket depth (PD) (OR=1.26 per mm loss, 95% CI 1.13, 1.41) were significant risk factors of incident tooth loss. In a community model that included no clinical measures, diabetes history (OR=2.45, 95% CI 1.26, 4.77), prior gum disease (OR=1.97, 95% CI 1.43, 2.70), ever smoking (OR=1.42, 95% CI 1.06, 1.89), number of teeth lost at baseline (OR=1.05 per tooth, 95% CI 1.02, 1.08), and BMI (OR=1.15 per 5km/m² increase, 95% CI 1.01, 1.33) were associated with an increased risk of incident tooth loss. Conclusions: Clinical and questionnaire-based models were found to provide similar risk estimates for incident tooth loss in postmenopausal women. These models identified high-risk postmenopausal women where preventive strategies may be targeted.