How many teeth one loses with age might reveal more about one’s health than previously thought. A new study from China shows: Those who lose teeth more quickly in older age have a significantly increased risk of death–regardless of how many teeth they originally had. This brings an often underestimated health factor into focus: tooth loss. The findings could have important implications for prevention, care, and public health strategy.
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Is Tooth Loss More Than an Inevitable Evil of Aging?
Tooth loss is often accepted as a normal part of aging. However, it can have far-reaching consequences: It not only makes chewing difficult but is also associated with poor nutrition, inflammation in the body, social withdrawal, and higher mortality. Many previous studies have only considered a single point in time–namely, how many teeth a person had at the start of the respective study.1
The new study took it a step further: It analyzed how tooth loss developed over time–that is, how many teeth were lost per year–and whether this was related to the mortality risk of older adults. Crucially, the relationship was examined independently of how many teeth people had at the beginning.
The data comes from the Chinese Longitudinal Healthy Longevity Survey (CLHLS)–one of the largest long-term studies on older people worldwide. Given the aging global population and the fact that tooth loss is influenced by modifiable factors such as smoking, dental care, or dental treatment, the findings are also of great importance for prevention and health policy.
Study Design: How Was It Conducted?
The researchers used data from 8,073 older individuals aged 65 and above (average age: 83 years; 47 percent men). The number of natural teeth was recorded for participants at two consecutive surveys–depending on when they participated in the study. For some, this was in 1998 and 2000, for others in 2014 and 2018. Important: Only real teeth were counted, and dentures were not included.2
From the difference between the two measurements, the researchers calculated the average annual tooth loss. Depending on the result, participants were divided into four groups:
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Stable: no tooth loss per year
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Slow loss: more than 0 but less than 2 teeth per year
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Moderate loss: 2 to less than 4 teeth per year
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Rapid loss: 4 or more teeth per year
Subsequently, over a period of 3.5 years, it was documented how many people in each group died. Many other influencing factors were considered, such as age, gender, health status, lifestyle, and the original number of teeth. The statistical calculations were performed using so-called Cox regressions. This is a method that determines the relationships between risk factors and mortality.
Additionally, so-called spline analyses were conducted. This is a statistical method that allows for a very precise graphical and computational examination of whether there is a linear (consistent) relationship between tooth loss and mortality.
Also interesting: Which additives influence mortality
Rapid Tooth Loss Is Associated With Significantly Increased Mortality
During the 3.5-year observation period, 5,176 of the 8,073 participants died–about 64 percent. The key finding: The faster the tooth loss, the higher the risk of death. And this was true even when all other health factors were accounted for.
Specifically, it was found:
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People who lost teeth slowly (less than two teeth per year) had about an 11 percent higher risk of dying than those who lost no teeth.
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With moderate tooth loss (two to four teeth per year), the risk was about 20 percent higher.
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Those who lost four or more teeth per year had about a one-third higher risk of death compared to those with no tooth loss.
Additionally, a graphical analysis showed: With each additional tooth lost per year, the risk of death increased by about 4 percent.
And independently of the progression, it was found: People who had more of their own teeth–both at the beginning and at the second measurement point–lived longer on average.
These relationships held true for all groups studied, regardless of gender, age, lifestyle, or existing conditions.
What Do the Results Mean?
The study clearly indicates: Not only the current dental status but especially the speed of tooth loss over time is a strong indicator of mortality risk in old age. This shows how important regular dental check-ups and good oral hygiene are, even in advanced age.
The reasons for the connection are varied:
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Poor oral health can lead to inflammation in the body, which in turn can strain the cardiovascular system.
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Missing teeth make chewing difficult, which can affect food intake and thus nutrition.
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Tooth loss can also cause social isolation or psychological stress–for example, through shame or withdrawal.
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There are also connections to other health problems, such as frailty, obesity, or cognitive decline–all known risk factors for higher mortality.
How Should the Study Be Classified–and What Are Its Limitations?
The study is the first large-scale investigation to examine the relationship between the speed of tooth loss and mortality in older adults over several years. The methodology is robust, the number of participants is high, and the results have been thoroughly validated.
Nevertheless, there are some limitations:
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Transferability: The data comes exclusively from China. Whether the results can be transferred to other countries or populations is uncertain.
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Self-reported tooth count: The number of teeth was self-reported by participants. This can lead to minor inaccuracies–although previous studies have shown that such reports are usually quite reliable.
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No data on gum health (periodontal status) or the quality of dental prostheses. These factors could also have an impact.
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Over 4,000 people with “tooth gain” between the two time points were excluded. This could lead to some bias–but was considered in further analyses.
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Limited statement on cause-and-effect relationship: The study shows a clear connection but no proof that tooth loss directly affects mortality. It is quite possible that tooth loss is more of an indicator of generally poorer health–such as due to chronic diseases, poor nutrition, or inadequate medical care.
Tooth loss is therefore very likely a warning signal–whether it is also a direct cause remains open.
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