OBJECTIVE: This study investigated the bidirectional longitudinal association between subjective oral health (SOH) and subjective well-being (SWB) over time. METHODS: This cohort study was based on a four-wave surveys conducted by the English Longitudinal Study of Aging. SOH was measured by oral impacts on daily performance (OIDP), self-rated oral health (SROH), and SWB was measured by the Center for Epidemiologic Studies-Depression (CES-D) scale, Control, Autonomy, Self-Realization, and Pleasure (CASP-19), and satisfaction with life scale (SWLS). To evaluate the bidirectional associations between SOH and SWB, separate models were created using SOH and SWB as the outcome and exposure, respectively. Additionally, the synchronous and lagged effects of exposure on outcomes were checked by employing exposures measured at different time points. A generalized estimating equation model was fitted, including the exposure variables, outcome variables in the previous wave, and baseline covariates. RESULTS: Among 4,510 participants (mean age=61.7 years [1SD=7.9], men=43.1 %), 8.1 %, 18.2 %, 14.3 %, 30.5 %, and 25.0 % had poor SOH and SWB as measured by OIDP, SROH, CES-D, CASP-19, and SWLS at baseline, respectively. The results of the regression models with all combinations of SOH and SWB measures showed that poor conditions of SOH or SWB were significantly associated with poor conditions of the other measures (all p < 0.05). In almost all combinations of SOH and SWB measures, the synchronous effect was stronger than the lagged effect. CONCLUSION: SOH and SWB are closely linked, and comprehensive care that considers oral health could contribute to well-being later in life.

BACKGROUND: The influence of the coronavirus disease (COVID-19) pandemic on dental care utilization may have differed according to individual characteristics or type of dental care provision. This study aimed to evaluate the changes in dental care utilization and per-attendance costs by age group and type of dental care during the COVID-19 pandemic in Japan. METHODS: This time-series study used healthcare insurance claims data from 01/07/2019 to 09/27/2021 (143 weeks) from nine municipalities in Japan. Dental care utilization rate per week and average dental care cost per attendance by age groups (0-19y/20-64y/65-74y/≥ 75y) and types of dental care (outpatient/visiting) were used as outcome variables. COVID-19 pandemic waves in Japan were used as predictors: 1st (03/23/2020-05/17/2020), 2nd (06/22/2020-09/27/2020), 3rd (10/26/2020-02/21/2021), 4th (02/22/2021-06/07/2021), and 5th (07/05/2021-09/13/2021) waves. Fixed effect models were employed to estimate the proportional changes. RESULTS: In the fixed effect model, we observed large declines in dental care utilization during the 1st (17.0-22.0%) and 2nd waves (3.0-13.0%) compared to the non-pandemic wave period in all age groups. In contrast, the average dental care cost per attendance increased in all age groups by 5.2-8.6% during the 1st wave. CONCLUSIONS: During the initial wave of the COVID-19 pandemic in Japan, dental care utilization decreased in all age groups, whereas the average dental care cost per attendance increased. The COVID-19 pandemic may have changed the dental care provision pattern towards less frequent and more concentrated dental care to avoid the risk of infection.

Anorexia of aging is a risk factor for malnutrition among older adults. This study aimed to evaluate the association between objective and subjective oral health and anorexia among independent older adults. This cross-sectional study targeted independent older adults aged ≥65 years who participated in the Japan Gerontological Evaluation Study conducted in 2022. The outcome variable was the presence of anorexia, as assessed by the Simplified Nutritional Appetite Questionnaire. Exposure variables were dental status (≥20 teeth, 10-19 teeth with/without dentures, and 0-9 teeth with/without dentures) as objective oral health and oral health-related quality of life measured by five items of the short version of the Oral Impacts on Daily Performances (OIDP) (eating, speaking, smiling, emotional stability, and enjoying with others) as subjective oral health. We fitted the Poisson regression model, including possible confounders, and estimated prevalence ratios (PRs) and 95% confidence intervals. Among 19,787 participants (mean age: 74.6 years [1SD = 6.2], male: 48.5%), 9.0% were classified as having anorexia. After adjusting possible confounders, those with ≤19 teeth had a higher proportion of experiencing anorexia compared to those with ≥20 teeth; however, the association was less pronounced among those with dentures (0-9 teeth with dentures: PR = 1.48 [1.31-1.68], and 0-9 teeth without dentures: PR = 2.08 [1.65-2.63]). Even after adjusting for dental status, each item of OIDP was significantly associated with the presence of anorexia (all p < 0.05). The results showed that both objective and subjective poor oral health were significantly associated with a higher probability of developing anorexia of aging. Therefore, improving both objective and subjective oral health through appropriate dental care could contribute to maintaining appetite in later life.

AIM: Tooth loss has various causes; however, its cause-specific effects on health outcomes remain unclear. This study evaluated whether the association between past/current smoking and risk of dementia was mediated by tooth loss. MATERIALS AND METHODS: This 9-year-follow-up prospective cohort study targeted adults aged ≥65 years. Dementia incidence during 2013-2019, smoking status (never, past/current) in 2010 and the number of remaining teeth (≤19, ≥20) in 2013 were the outcome, exposure and mediator, respectively. We used causal mediation analysis to fit the Cox proportional hazards model and estimated the hazard ratio (HR) and 95% confidence interval (CI) of the natural indirect effect (NIE) of smoking on dementia incidence through tooth loss and their mediated proportions. RESULTS: Among 32,986 participants (mean age 72.6 years [1 SD = 5.4]; men 48.4%), the dementia incidence during follow-up was 2.11/100 person-years. Tooth loss significantly mediated the association between past/current smoking and dementia incidence; the NIE of fewer remaining teeth for past/current smokers compared to never smokers was HR = 1.03 (95% CI: 1.02-1.05), and the mediated proportion was 18.0%. CONCLUSIONS: Tooth loss significantly mediates the association between past/current smoking and an increased risk of dementia among older adults.

BACKGROUND: Bidirectional association between oral health, including tooth loss and oral hypofunction, and cognitive impairment can induce time-varying confounding in association with dementia. This study aimed to investigate the association between oral health and the development of dementia among older adults, considering cognitive impairment as a time-varying confounder. METHODS: This nine-year follow-up cohort study targeted independent older adults aged ≥65 years who participated in the Japan Gerontological Evaluation Study. The exposure variables were self-reported poor oral health (≤19 remaining teeth, edentulousness, chewing difficulty, swallowing problems, and xerostomia), which were assessed in 2010 and 2013. The outcome variable was the incidence of dementia between 2013 and 2019, which was obtained from the municipalities' administrative database. Furthermore, in 2010 and 2013, we considered cognitive impairment as a time-varying confounder and treated it based on a marginal structural model (MSM), including possible baseline confounders. Oral health and cognitive impairment were assessed using the items of Kihon checklist. We employed a Cox proportional hazards model with a stabilized inverse probability weight and estimated hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: Among 37,556 participants (mean age: 72.8 years [1 SD = 5.5], males: 46.8%), the dementia incidence rate was 2.2/100 person-year. The proportions of those with ≤19 remaining teeth, edentulousness, chewing difficulty, swallowing problems, and xerostomia were 61.3%, 11.0%, 24.4%, 14.7%, and 19.2%, respectively. From the regression analysis based on MSM, ≤19 remaining teeth (HR = 1.12, 95% CI = 1.03-1.23), edentulousness (HR = 1.20, 95% CI = 1.09-1.32), chewing difficulty (HR = 1.11, 95% CI = 1.02-1.21), and xerostomia (HR = 1.10, 95% CI = 1.01-1.20) were significantly associated with an increased risk of dementia; however, swallowing problems were not significantly associated with dementia onset (p > 0.05). CONCLUSIONS: Even after considering time-varying confounding by cognitive function at baseline and follow-up, we observed significant associations between poor oral health and increased risk of dementia among older adults.

COVID-19 remains a global health threat. Compliance with nonpharmaceutical interventions is essential because of limited effectiveness of COVID-19 vaccines, emergence of highly contagious variants, and declining COVID-19 antibody titers over time. We evaluated compliance with 14 nonpharmaceutical intervention-related COVID-19 preventive behaviors, including mask wearing, ventilation, and surface sanitation, in a longitudinal study in Japan using 4 waves of Internet survey data obtained during 2020-2022. Compliance with most preventive behaviors increased or remained stable during the 2-year period, except for surface sanitation and going out behaviors; compliance with ventilation behavior substantially decreased in winter. Compliance patterns identified from latent class analysis showed that the number of persons in the low compliance class decreased, whereas those in the personal hygiene class increased. Our findings reflect the relaxation of mobility restriction policy in Japan, where the COVID-19 pandemic continues. Policymakers should consider behavioral changes caused by new policies to improve COVID-19 prevention strategies.

BACKGROUND: Tooth loss is associated with reduced protein intake, which leads to sarcopenia and frailty in older adults. OBJECTIVE: To evaluate the protective effect of dental prostheses on decreased protein intake in older adults with tooth loss. METHODS: This cross-sectional study was based on a self-reported questionnaire targeting older adults. Data were obtained from the Iwanuma Survey of the Japan Gerontological Evaluation Study. We used % energy intake (%E) of total protein as the outcome and the use of dental prostheses and number of remaining teeth as explanatory variables. We estimated the controlled direct effects of tooth loss by fixing the use/non-use of dental prostheses based on a causal mediation analysis, including possible confounders. RESULTS: Among 2095 participants, the mean age was 81.1 years (1SD = 5.1), and 43.9% were men. The average protein intake was 17.4%E (1SD = 3.4) of the total energy intake. Among participants with ≥20, 10-19 and 0-9 remaining teeth, the average protein intake was 17.7%E, 17.2%E/17.4%E and 17.0%E/15.4%E (with/without a dental prosthesis), respectively. Compared to participants with ≥20 remaining teeth, those with 10-19 remaining teeth without a dental prosthesis did not have a significantly different total protein intake (p > .05). Among those with 0-9 remaining teeth without a dental prosthesis, total protein intake was significantly low (-2.31%, p < .001); however, the use of dental prostheses mitigated the association by 79.4% (p < .001). CONCLUSION: Our results suggest that prosthodontic treatment could contribute to maintaining protein intake in older adults with severe tooth loss.

High free sugar intake is associated with an increased risk of various non-communicable diseases. We aimed to systematically review articles investigating the association between free sugar intake and periodontal diseases. This systematic review was conducted according to PRISMA guidelines and was registered in the PROSPERO database (CRD42022337828). We obtained articles from PubMed, Web of Science, and Scopus in April 2022. The study selection was performed according to predefined eligibility criteria based on the following PECOS: (P) general population, (E/C) free-sugar-containing food/beverage intake, (O) clinically measured periodontal diseases, and (S) observational study and clinical trial. Of the 839 screened records, 13 studies were included in the review. Most studies (n = 12) had a cross-sectional design. The age groups in the included studies were children/adolescents (n = 5) and adults (n = 8). Among the included studies, 11 reported a significant association between the frequent intake of free-sugar-containing food or beverages and a higher prevalence or incidence of periodontal diseases. The quality of most of the included studies was scored "fair" based on the Newcastle-Ottawa Quality Assessment Scale. Although the majority of the included studies reported a significant positive association between high free sugar intake and periodontal diseases, the evidence is considered to be limited due to the study designs.

The influence of different types of information sources on individual preventive behaviors remains unclear. We aimed to investigate the associations between individual information usage to obtain information about COVID-19 and compliance with preventive behaviors. This longitudinal study was based on an Internet survey conducted in August-September 2020 and February 2021. We used compliance with four preventive behaviors for COVID-19, "wearing a mask", "ventilation", "social distancing", and "avoiding crowds" as outcome variables, and 20 types of information sources based on people or institutions (Medical worker, Government, etc.) and media (TV news, Twitter, etc.) as predictors. Absolute differences and 95% confidence intervals were estimated using generalized estimating equations adjusted for possible confounders. Among the 18,151 participants aged 20-79, the mean age was 51.7 (SD = 15.9) in 2020, and 51.3% were male. In total, compliance with "wearing a mask", "ventilation", "social distancing", and "avoiding crowds" was seen in 86.2%, 46.9%, 45.4%, and 62.6% of individuals in 2020, and 89.3%, 38.2%, 47.2%, and 61.6% of individuals in 2021, respectively. In the multivariate analysis, "medical workers", "professionals", "the government", "Twitter", "news websites", and "TV news" were positively associated with compliance with two or more preventive behaviors (p &lt; 0.05). The type of information source may play an important role in providing information for COVID-19 prevention.

OBJECTIVE: the present study aimed to investigate the relationship between the frequency of eating together and the risk of weight loss in older adults. METHODS: this was a three-year follow-up prospective cohort study based on a self-reported questionnaire. We used data from the Japan Gerontological Evaluation Study (JAGES) conducted in 2016 and 2019. The participants were independent older adults aged ≥65 years in Japan. We used >5% weight loss during follow-up as the outcome variable and frequency of eating together as the explanatory variable. The relative risks (RRs) and 95% confidence intervals (95% CIs) were estimated based on the Poisson regression model with a Huber-White sandwich estimator for standard errors, including possible confounders. RESULTS: among 56,919 participants, the mean age was 73.0 years (1SD = 5.5) at baseline, and 47.9% were male. About 15.1% (n = 8,596) of the participants experienced >5% weight loss during follow-up. The proportion of each category of the eating together frequency was 36.6% for 'every day', 10.3% for 'several times a week', 26.8% for 'several times a month', 20.5% for 'several times a year' and 5.8% for 'seldom'. Compared to 'every day', only 'several times a year (RR = 1.07, 95% CI = 1.01-1.13)' and 'seldom (RR = 1.17, 95% CI = 1.08-1.27)' were significantly associated with the increased risk of >5% weight loss. CONCLUSION: there is a temporal association between less frequent opportunities to eat together and the increased risk of weight loss among independent older adults.

OBJECTIVES: Weight loss is a critical health issue in older adults. Oral function is essential for nutrient intake and can be restored using dental prosthetic treatments in patients with tooth loss. This study aimed to investigate the relationship between tooth loss and weight loss among the older adults and to evaluate the magnitude of its risk reduction by dental prosthetic treatment. DESIGN: Three-year follow-up longitudinal study based on a self-reported questionnaire. SETTING: Community-dwelling older adults in Japan. PARTICIPANTS: Adults aged 65 and older (n = 53,690). MEASUREMENTS: We used >10% weight loss during follow-up, the number of remaining teeth, and the use of dental prostheses as the outcome variable, exposure variable, and mediator, respectively. We fitted the logistic regression model including possible confounders and calculated the odds ratios (ORs) and 95% confidence intervals (95% CIs) of the controlled direct effect (CDE) at the level of use or nonuse of the dental prosthesis based on a causal mediation analysis framework. Additionally, we calculated the proportion eliminated by the dental prosthesis. RESULTS: The mean age of participants was 72.6 years (1 SD = 5.5), and 47.4% were males. About 5.8% (n = 3132) of them experienced >10% weight loss during the follow-up. Weight loss was observed in 6.8% of the participants with 0-19 remaining teeth and in 4.3% of them with ≥20 remaining teeth. The CDE of 0-19 remaining teeth was greater when no one used dental prosthesis (OR = 1.41; 95% CI = 1.26-1.59) compared with that when all participants used dental prosthesis (OR = 1.26; 95% CI = 1.08-1.46). This indicated that dental prosthesis decreased the risk of weight loss by 37.3%. CONCLUSION: Our study revealed that tooth loss increased the risk of clinically critical levels of weight loss among community-dwelling older adults. However, this risk was reduced by dental prosthetic treatment.

Extending life expectancy is a major public health priority. Oral frailty is closely associated with systemic health. However, the association between oral functions and systemic health, particularly nailfold capillary parameters, remains unclear. We analyzed data from 311 participants (mean age: 55.66 ± 12.54 years) to examine the associations between oral function parameters (number of remaining teeth, tongue pressure, and oral mucosal moisture) and nailfold capillary parameters (number, length, width, and turbidity). The results showed that the number of remaining teeth was significantly associated with capillary number. Additionally, oral mucosal moisture was significantly associated with capillary turbidity and width; notably, these two capillary parameters were moderately correlated with each other. These associations did not remain statistically significant after adjusting the P-values using the Holm-Bonferroni correction for multiple comparisons, and should therefore be interpreted as preliminary, hypothesis-generating findings. Overall, these findings may contribute to the growing body of evidence linking oral and systemic health and provide preliminary insights for future research on potential diagnostic applications. Examining oral functions and dental findings in the context of interconnected disease pathways, rather than individual diseases may improve our understanding of the relationship between oral and systemic health.

OBJECTIVES: To examine whether multiple routine oral health practices reduce all-cause mortality, and how these associations are modified by sociodemographic, behavioral, and health related factors. METHODS: Data were derived from the Japan Gerontological Evaluation Study (JAGES), with participants enrolled between 3 October and 14 November 2016. Participants who were not certified for long-term care insurance and completed the questionnaire version including oral health practice items were eligible; edentulous or not functionally independent individuals were excluded. Participants were categorized according to engagement in seven routine practices: toothbrushing ≥twice/day, use of interdental cleaner, tongue cleaner, toothpaste, mouthwash, and dental visits for treatment or checkups in the past 12 months. The outcome was all-cause mortality through 20 June 2023. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using inverse probability weighted Cox proportional hazard models, adjusting for confounding. For oral health practices exhibiting significant association, moderator wide analyses were conducted to explore potential effect modification by age, sex, education, income, smoking, alcohol consumption, body mass index, walking time, living status, self-rated health, number of teeth, and depression. RESULTS: During the 6-year follow-up, the mortality incidence rate was 17.3/1000 person-year among 9,676 participants (46.5% male; mean age=73.7±5.9 years). Significant risk reductions in all-cause mortality were observed for interdental cleaner use (HR=0.89; 95% CI=0.80-0.99) and tongue cleaner use (HR=0.77; 95%CI=0.68-0.87). No significant effect modification was detected. CONCLUSIONS: In this nationwide cohort study, the use of interdental and tongue cleaners was associated with lower all-cause mortality among community-dwelling Japanese older adults during 6 years of follow-up. CLINICAL SIGNIFICANCE: The results suggest that simple and low-cost practices may contribute to healthy longevity in ageing societies, and support further investigation into potential mechanisms, including pathways related to aspiration and respiratory infections.

BACKGROUND: Administrative claims data are increasingly used in oral health research, but their validity for identifying denture use has not been established. OBJECTIVE: To evaluate the accuracy of algorithms based on dental claims codes for identifying denture users, dentist-reported oral health screening records were used as the reference standard. METHODS: We analyzed data from 4,053 adults aged ≥65 y in the Longevity Improvement and Fair Evidence (LIFE) Study in Japan. Twelve algorithms incorporating 56 denture-related diagnosis and procedure codes were developed from claims in the 12 mo preceding the screening. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Sensitivity analyses used a 6-mo claims window. A post hoc bias analysis was also performed. RESULTS: During screening, 59.9% of the participants were classified as denture users. Algorithms based solely on diagnosis codes showed very high specificity (98.3%-100%) but low sensitivity (1.4%-20.8%). Among the procedure-based definitions, oral rehabilitation codes (algorithm f; denture adjustment or instruction) had the highest sensitivity (63.6%). The combined algorithm using both diagnosis and procedure codes (algorithm C) achieved the best balance, with 65.3% sensitivity, 96.6% specificity, 96.6% PPV, and 65.1% NPV. Similar findings were observed using the 6-mo claims data. Bias analysis indicated that the risks for denture use could be underestimated by 26% to 59%, with algorithm C showing the least bias. CONCLUSIONS: Denture use can be identified from dental claims data with moderate accuracy. Algorithms combining denture-related diagnosis and procedure codes or using oral rehabilitation codes provide practical definitions for research on oral and systemic health outcomes.Knowledge Transfer Statement:The result of this validated study can be identified as denture use from dental claims with moderate accuracy. In combination with validated denture use and the number of remaining teeth, it can expand opportunities to assess oral health status and its relationship with systemic health outcomes in large-scale epidemiologic studies using claims data.

BACKGROUND: Stroke remains a leading cause of mortality and disability worldwide, requiring modifiable risk factors for prevention. Oral health, particularly posterior occlusal contact that supports mastication, may influence systemic vascular outcomes; however, its role in stroke remains unclear. This study investigated whether reduced posterior occlusal contact independently predicts stroke in Japanese adults. METHODS: We conducted a retrospective cohort study using data collected from April 2016 to March 2022 from a nationwide health insurance database in Japan. Adults aged 40 to 74 years without a history of stroke were included. Posterior occlusal status was categorized as Eichner A (full posterior occlusal contact), B (partial contact), or C (no contact). The primary outcome was stroke incidence, identified using validated insurance claims. Cox proportional hazards models were used to estimate hazard ratios (HRs), adjusting for demographics, health behaviors, comorbidities, and tooth counts. RESULTS: Among 981 543 participants (mean age 49.6±7.0 years; 57.5% male) followed for 2 712 815 person-years, 7086 strokes occurred. In adjusted Cox models, Eichner B was significantly associated with higher stroke risk than Eichner A (HR, 1.26 [95% CI, 1.10-1.44], P<0.001). Eichner C showed elevated risk, although not statistically significant (HR, 1.17 [95% CI, 0.91-1.50], P=0.229). Associations were observed in both sexes and across age groups. CONCLUSIONS: Reduced posterior occlusal support was associated with higher stroke risk independent of tooth count and conventional vascular risk. These findings highlight that posterior occlusal support may represent a potential marker of cerebrovascular risk and warrant further investigation into its clinical relevance.

BACKGROUND: This study aimed to investigate whether healthcare expenditures (HCEs) differed depending on whether the patients left periodontal disease (PD) untreated, despite the need for treatment. METHODS: This study used public PD screening data from a municipality in Japan to identify adults aged ≥ 40 years who were found to require treatment of PD by dentists at PD screening. The presence or absence of periodontal treatment was determined by a dental visit within 180 days after the date of PD screening based on medical claims data. Annual HCE were calculated from cumulative expenditures over 2 years from the date of the presence or absence of periodontal treatment. A generalized linear model with a gamma distribution and log link function was used to calculate the relative cost ratios (RCRs) and 95% confidence intervals (95% CI), and a two-part model was used to predict annual HCEs and the difference in predicted HCEs based on dental treatment. RESULTS: Among 652 people (mean age: 62.6 years [1 SD = 9.0], 65.5% women), 9.0% were untreated. After adjusting for the covariates, the RCR for medical, pharmaceutical, and dental costs in the untreated group compared with the treated group were 1.56 (95% CI: 1.02-2.38), 0.95 (95% CI: 0.53-1.70), and 0.14 (95% CI: 0.10-0.19), respectively. The differences in predicted HCEs were $593.5 (95% CI: -280.6, 1467.6) higher for medical, $79.9 (95% CI: -363.6, 523.4) higher for pharmaceutical, and $323.9 (95% CI: -397.3, -250.6) lower for dental. CONCLUSION: Leaving PD untreated was associated with increased HCEs, particularly medical expenditures. PLAIN LANGUAGE SUMMARY: This study looked at whether people who were told by a dentist that they needed care for periodontal disease actually received treatment, and how this affected their healthcare costs. The research followed more than 600 adults in Japan for 2 years, comparing the cumulative healthcare costs of those who received dental care with those who did not. The results showed that people who did not treat their periodontal disease ended up spending more on medical care, even though they spent less on dental care. On average, untreated individuals had medical expenses that were around $600 higher than those who received treatment. This suggests that avoiding dental care for periodontal disease might lead to more serious health problems down the line, which can increase overall healthcare costs. Although skipping dental visits may seem like a way to save money, it could actually lead to higher medical bills in the future. These findings highlight the importance of early dental treatment not just for oral health, but also for managing overall healthcare costs and preventing other health complications.

AIM: Steatotic liver disease (SLD), including metabolic dysfunction-associated SLD (MASLD) and metabolic dysfunction-associated alcohol-related liver disease (MetALD), is a growing global health burden. Although impaired mastication is linked to metabolic disorders, its role in SLD remains unclear. We examined whether objectively assessed posterior occlusal support predicts incident MASLD and MetALD. METHODS: We analyzed nationwide medical, dental, and health checkup claims from the JMDC database in Japan (2016-2021), including 997,332 adults aged ≥ 40 years. SLD was defined as a fatty liver index ≥ 60, with MASLD and MetALD distinguished according to cardiometabolic abnormalities and estimated alcohol intake. Posterior occlusal support was classified using the Eichner system based on dental claims. Odds ratios (ORs) were estimated using generalized estimating equations to account for within-individual correlations, with multivariable adjustment for demographic, lifestyle, and clinical factors. RESULTS: Reduced posterior occlusal support was independently associated with higher odds of incident MASLD, with stronger associations in women. In fully adjusted models, women with partial (Eichner B) or absent (Eichner C) posterior support had higher odds of MASLD (OR 1.15, 95% CI 1.02-1.29; OR 1.55, 95% CI 1.11-2.16) than those with complete support (Eichner A). In men, the associations were weaker but remained significant. No robust association was observed between occlusal support and MetALD after adjustment. CONCLUSIONS: Loss of posterior occlusal support independently predicted MASLD, particularly in women, suggesting that impaired mastication may contribute to SLD.

BACKGROUND: Smoking and alcohol consumption are major risk factors for oral and pharyngeal cancer (OPC) mortality. However, the interaction between these risks and tooth loss, as an indicator of cumulative consequences of oral health disadvantages, has not been investigated. METHODS: We used data from the Japan Gerontological Evaluation Study, which included functionally independent Japanese adults aged ≥ 65 years. The baseline survey was conducted in 2010 and followed up until 2022. The outcome was OPC mortality. The exposures were smoking, drinking, and the number of teeth. To estimate the hazard ratio (HR) and 95% confidence interval (CI) of OPC mortality, the Cox proportional hazards model was applied. We also assessed multiplicative and additive interactions by calculating the relative excess risk due to interaction (RERI). RESULTS: A total of 39,882 participants were included (men: 46.8%). The mean age at baseline was 73.7 years (SD = 6.0). The mean follow-up was 3,689 days. Among them, 0.2% had OPC mortality. Both smoking and drinking were associated with a higher risk of OPC mortality compared with none (HR, 2.87; 95%CI, 1.26-6.55). Those with 0-19 teeth were associated with a higher risk of OPC mortality than those with ≥ 20 teeth (HR, 1.96; 95%CI, 1.11-3.46). Interaction analysis showed higher OPC mortality risk among those with both smoking and drinking and 0-19 teeth (multiplicative interaction; HR, 5.02; 95%CI, 1.09-23.21, additive interaction; RERI, 2.97; 95%CI, 0.06-5.88). CONCLUSIONS: Both smoking and drinking were associated with a higher risk of OPC mortality, particularly among those with fewer teeth.

AIM: Recent studies have suggested that masticatory function may influence frailty progression. However, the relationship between posterior occlusal support and frailty remains underexplored. We aimed to evaluate the association between the loss of posterior occlusal support and frailty in a large cohort of Japanese adults. METHODS: This retrospective cohort study used data from the JMDC Claims Database. We included 386 270 individuals aged ≥ 40 years who underwent both specific health checkups and dental visits in 2016, with follow-up data available through 2020. We categorized posterior occlusal support using the Eichner classification (A, all support zones intact; B, partial support zones; C, no functional support zones). We assessed frailty annually using the claims-based frailty index (CFI) (a deficit accumulation-type frailty measure). We used generalized estimating equations to evaluate the association between occlusal support and frailty after adjusting for potential confounders. RESULTS: At baseline, the mean age was 49.6 (standard deviation, 7.2) years, and 47.4% of the participants were women. The prevalence of frailty was 4.9%, 9.5%, and 12.1% in the Eichner A, B, and C groups, respectively. Compared to Eichner A, the adjusted odds ratios (ORs) for frailty were 1.21 (95% confidence interval [CI], 1.13-1.30) for Eichner B and 1.39 (95% CI, 1.21-1.59) for Eichner C. This relationship was stronger among women than men. CONCLUSIONS: Reduced posterior occlusal support is independently associated with an increased risk of frailty. These findings underscore the importance of oral health in preventing physical debilitation and suggest incorporating early dental interventions into health strategies for older populations.

BACKGROUND: Functional capacity (FC) is a key determinant of healthy aging. Oral health deterioration, particularly tooth loss, has been associated with FC decline among older adults. Although dental prostheses may mitigate functional deterioration by restoring oral function, longitudinal evidence on their protective effects on FC, especially across specific domains, remains limited. This study investigated the association between dental prosthesis use and the decline in overall and domain-specific FC among older Japanese adults experiencing tooth loss. METHODS: We conducted a 3-year prospective cohort study using data from the Japan Gerontological Evaluation Study (JAGES). Participants were living independently older adults aged ≥65 years with <20 teeth at baseline (2016), followed up in 2019. Dental prosthesis use (removable dentures, fixed prostheses, and/or implants) was assessed by self-report at baseline and dichotomized as use vs. non-use. FC was measured using the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC), including total score and subdomains: instrumental activities of daily living (IADL), intellectual activity, and social role. FC decline was defined as a decrease of ≥1 point in the TMIG-IC score during follow-up. Modified Poisson regression with robust variance was used to estimate the relative risks (RRs) and 95% confidence intervals (CIs), adjusting for sociodemographic factors, health behaviors, comorbidities, and number of remaining teeth. RESULTS: Among 22,632 eligible participants (mean age at baseline: 74.0 years, SD = 5.7; 51.4% male), 7,573 participants (33.5%) experienced a decline in total FC. Dental prosthesis use was significantly associated with a lower risk of decline in the total TMIG-IC score [RR = 0.91 (95% CI: 0.86-0.97)] compared with no use. For the TMIG-IC subdomain, we observed a significant association between dental prosthesis use and a lower risk of decline in intellectual activity [RR = 0.87 (95% CI: 0.80-0.96)]. CONCLUSIONS: This large-scale cohort study demonstrated that the use of dental prostheses was associated with a reduced risk of FC decline in older adults, particularly in the intellectual activity domain. Because prosthesis use and FC were assessed by self-reported and residual confounding may remain, further studies are warranted to clarify the potential role of prosthodontic rehabilitation in maintaining FC in later life.

INTRODUCTION: Severe periodontitis is a major global health concern, yet the impact of switching from combustible cigarettes to dual use of combustible cigarettes and heated tobacco products on periodontal status remains unclear. This study aimed to examine whether changes in smoking status influence the risk of severe periodontitis among Japanese adults. METHODS: We conducted a longitudinal analysis using panel data from the Japan COVID-19 and Society Internet Survey. Participants were daily combustible cigarette smokers with periodontitis in 2021 and were followed through 2023. Smoking trajectories between 2021 and 2022 were categorized as: (1) continuous combustible cigarette smokers, (2) dual users (heated tobacco product-dominant), (3) dual users (combustible cigarette-dominant), and (4) quitters/reduced smokers. Severe periodontitis in 2023 was defined using validated self-reported criteria. Modified Poisson regression with robust variance was applied to estimate risk ratios and 95% confidence intervals (95% CIs), adjusting for potential confounders (age, sex, educational attainment, occupational status, marital status, equivalent income, alcohol consumption, diabetes mellitus status, periodontal pain, and smoking frequency). RESULTS: A total of 193 participants (mean age 57.6 years; men 67.9%) were analyzed. Over 2 years, 61.1% developed severe periodontitis. Compared to continuous combustible cigarette smokers, the adjusted risk of severe periodontitis was 1.19 times (95% CI: 0.67-2.11), 1.41 times (95% CI: 1.04-1.91), and 0.99 times (95% CI: 0.76-1.28) higher for dual users (heated tobacco product-dominant), dual users (combustible cigarette-dominant), and quitters/reduced smokers, respectively. Sensitivity analyses using inverse probability weighting yielded consistent findings. CONCLUSION: Switching from daily combustible cigarette smoking to dual use with heated tobacco products may increase the risk of severe periodontitis. Combining combustible cigarettes with heated tobacco products, regardless of the frequency of combustible cigarette smoke, should not be considered a harm-reduction strategy in dental and public health practice.

OBJECTIVE: Cardiovascular health (CVH), defined by the American Heart Association, aims to reduce cardiovascular disease (CVD) deaths and improve overall health. Poor oral health, including tooth loss, is increasingly linked to higher CVD risk. However, the effects of specific partial tooth loss patterns on CVH remain unclear. This study aimed to identify clinically relevant tooth loss patterns and evaluate their association with CVH in a large Japanese population. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: Health insurance claims data were obtained from the JMDC database between 2016 and 2019. The study included 215,750 adults aged 40-75 years who had at least 20 remaining teeth and underwent both dental and general health examinations. METHODS: CVH scores were calculated based on 4 behavioral metrics (smoking status, body mass index [BMI], physical activity, and dietary habits) and 3 biological metrics (blood pressure, fasting glucose, and total cholesterol), following American Heart Association guidelines. K-median clustering was applied to identify patterns of partial tooth loss. Associations between tooth loss patterns and CVH scores were analyzed using fixed-effects models, including sex-stratified analyses. RESULTS: Six distinct partial tooth loss patterns were identified, including maxillary and mandibular molar loss, unilateral molar loss, and minor anterior tooth loss. Compared with individuals with all 28 teeth, those with partial tooth loss exhibited significantly lower CVH scores. The greatest reduction was observed in the maxillary molar loss group (β = -0.28; 95% CI, 0.34 to -0.22). Sex-stratified analyses showed that the associations were stronger in women than in men. Partial tooth loss was more strongly associated with behavioral metrics, particularly BMI and dietary habits, than with biological metrics. CONCLUSIONS AND IMPLICATIONS: Specific partial tooth loss patterns, especially molar loss, were associated with poorer CVH scores. These findings underscore the importance of preserving molar occlusion and integrating dental and cardiovascular prevention.

Poor oral health, particularly tooth loss, is associated with increased risk of all-cause mortality. However, the impact of dental prosthesis use on these associations remains unclear. This study evaluated the relationship between the number of remaining teeth, dental prosthesis use, and mortality from specific causes using seven-year follow-up data from the Japan Gerontological Evaluation Study (JAGES). All-cause mortality and ten cause-specific mortality outcomes were assessed. The number of remaining teeth and use of dental prostheses were the main exposures. Cox proportional hazard models were used to estimate hazard ratios (HRs). Among 43,774 participants (mean age 73.7 years [SD 5.9]; 53.2% women), 5,707 (13.0%) died during follow-up, corresponding to 20.7 deaths per 1,000 person-years. Participants with 0-9 or 10-19 teeth without dental prostheses exhibited higher cause-specific mortality rates than those with ≥ 20 teeth. Specifically, those with 0-9 teeth without dental prostheses had a significantly elevated risk of mortality from cancer, cardiovascular disease, respiratory disease, and injury (HRs ranging from 1.31 to 1.91; all p < 0.05). These associations were attenuated among dental prostheses users. Tooth loss was associated with increased risk of mortality from multiple specific causes; however, dental prostheses may mitigate this risk.

STATEMENT OF PROBLEM: Understanding the determinants of willingness to pay (WTP) for missing tooth replacement is essential for promoting oral health. PURPOSE: This study aimed to examine the factors associated with both the WTP and WTP amount for replacing missing anterior and posterior teeth among older Japanese adults. MATERIAL AND METHODS: This cross-sectional study used data from the Japan Gerontological Evaluation Study (JAGES) conducted in 2022, which targeted independent adults aged ≥65 years. Thirty-two explanatory variables were used, including demographic, socioeconomic, oral health-related, and general health indicators, and 2 primary outcome variables for both anterior and posterior teeth: whether participants were willing to pay for missing tooth replacement and the amount they were willing to pay. Dominance analysis was used to determine the relative importance of all candidate variables. RESULTS: A total of 4616 participants were included (men: 57.9%). The mean ±standard deviation age was 71.9 ±4.8 years. Of the participants, 95.6% and 94.9% expressed WTP to replace missing anterior and posterior teeth. The mean WTP amounts for anterior and posterior teeth were 71 300 Japanese Yen (JPY) and 61 100 JPY (544 and 466 USD). Dominance analysis showed that the absence of depressive symptoms was the strongest positive predictor of WTP (18.3% of the total explained variance for anterior teeth and 22.4% for posterior teeth). Wealth was the most influential factor in WTP amount (21.3% for anterior teeth and 19.2% for posterior teeth). Other key predictors included educational level, preventive dental visit, income, population density, and frequency of meeting friends. CONCLUSIONS: While the absence of depressive symptoms emerged as the strongest predictor of whether individuals expressed WTP to replace missing teeth among older adults, wealth emerged as the most influential factor in determining the amount they were willing to pay for both anterior and posterior teeth. WTP is largely explained by economic, psychological, and social factors. These findings suggest that promoting oral health may require integrated strategies addressing financial barriers, mental health support, and social engagement.

OBJECTIVES: Tooth loss was longitudinally associated with social isolation. The absence of dental prosthesis use was an additional risk factor. However, the mediating pathways for this association are unknown. The aim of this cohort study was to estimate the mediating effect of three oral functions: speaking, smiling and chewing observed at baseline on the association between oral health at baseline and social isolation after 6 years of follow-up. METHODS: The 2010-2016 panel data from 6103 functionally independent participants aged ≥ 65 years who were not socially isolated at baseline was used from the Japan Gerontological Evaluation Study (JAGES). Causal mediation analysis using parametric logistic regression models was used to calculate the natural direct effect (NDE), the natural indirect effect (NIE), and the total effect. Social isolation was derived from a 5-point index and dichotomised (0/3 = not isolated, 4/5 = isolated). The confounders observed at baseline were age, sex, educational attainment, income, activities of daily living, living area, and having depressive symptoms assessed using the geriatric depression scale (GDS-15). RESULTS: The mean age of the participants was 72.4 years (SD = ±5.1), and 44.7% were males. Social isolation was observed at follow-up among 3.6% of participants (n = 220). The cumulative incidence rate of socially isolated participants among those with ≥ 20 teeth was 2.9% increasing gradually to 3.2%, 3.5%, 3.7% and 7.2% among those with 10-19 teeth and used dental prosthesis, 10-19 teeth and did not use the dental prosthesis, 0-9 teeth and used dental prosthesis, and 0-9 teeth and did not use the dental prosthesis respectively. Compared with those with ≥ 20 teeth, having difficulty in speaking [NIE odds ratio (OR) = 1.02, 95% confidence interval (CI) = 0.93-1.11], problems in smiling (NIE OR = 1.02, 95% CI = 0.93-1.10) and difficulty in chewing (NIE OR = 1.04, 95% CI = 0.94-1.14) might have mediated the association for those with 10-19 teeth and used dental prosthesis as well as for those with 10-19 teeth without dental prosthesis (NIE OR = 1.02, 95% CI = 0.94-1.10), (NIE OR = 1.02, 95% CI = 0.93-1.11) and (NIE OR = 1.02, 95% CI = 0.93-1.11) respectively. While they might not have mediated the association for those with 0-9 teeth with and without dental prosthesis use. CONCLUSION: With low precision and uncertain estimates, limited oral function might have mediated the association between tooth loss (10-19 with and without dental prosthesis use groups) and social isolation over 6 years. It was uncertain whether a mediation effect of oral functions was observed for those with 0-9 teeth with and without dental prosthesis use.

IMPORTANCE: In Japan, the public assistance (PA) system for low-income individuals provides medical aid that covers all health care costs (no cost sharing). However, little is known about how health care service utilization changes after PA certification. OBJECTIVE: To examine the trajectories of outpatient medical and dental care utilization among PA recipients before and after PA certification. DESIGN, SETTING, AND PARTICIPANTS: Longitudinal data from a municipality in Japan participating in the Longevity Improvement Fair Evidence Study from 2017 to 2022 were used. Generalized estimating equations were used to calculate absolute differences and relative ratios in health care service utilization before and after PA certification. An interrupted time-series analysis (ITSA) was performed to examine the trends in health care service use based on monthly panel data. The elasticity of each health care service was also calculated. The participants were individuals who switched from National Health Insurance to PA and were 20 years and older. The analysis was performed in 2024. EXPOSURE: PA certification. MAIN OUTCOMES AND MEASURES: Outpatient medical and dental care expenditures, visits, and unit costs per month from 1 year before to 1 year after PA certification. RESULTS: Overall, 2893 study participants were analyzed (mean [SD] age, 54.2 [15.3] years; 1501 women [51.9%]). For outpatient medical care, the mean (SD) expenditures per month before and after PA certification were \16 565 (\53 159) and \22 442 (\53 443), respectively (converting to US dollars using the rate of \100 = $0.68 based on 2025 rates). For outpatient dental care, the mean (SD) expenditures per month before and after PA certification were \1727 (\3726) and \3978 (\6894), respectively. The ITSA showed significant increases in outpatient expenditure immediately after PA certification: \2681 (95% CI, 317-5046) and \2330 (95% CI, 1896-2764) in medical and dental care, respectively. CONCLUSIONS AND RELEVANCE: This study found that eliminating cost sharing under a PA system was associated with increased outpatient health service use, particularly for dental care. These findings highlight financial barriers to care among low-income populations and suggest that no cost-sharing policies can improve access but may require policy measures to address overuse.

OBJECTIVES: Social isolation and loneliness each have negatively affect various health outcomes. No studies have examined the combined association of social isolation and loneliness on frailty onset. This study aimed to investigate both the objective and subjective aspects of isolation by evaluating social isolation and loneliness and to determine their interaction effects on frailty onset. METHODS: This cohort study used data from the 2019 and 2022 Japan Gerontological Evaluation Study. The eligible participants were independent older adults aged ≥65 years without frailty in 2019. The outcome variable was frailty onset in 2022. The exposure variables were social isolation and loneliness in 2019. Risk ratios (RR) and 95 % confidence intervals (CI) were estimated using modified Poisson regression models, with potential confounders as covariates. Moreover, a multiplicative scale and relative excess risk due to interaction (RERI) was used to assess the interaction. RESULTS: The analysis included 8440 participants (mean age: 73.2 [standard deviation, 5.5] years). During the follow-up, 15.1 % of participants experienced frailty onset. After adjusting for all covariates, the "severe isolation" & "severe loneliness" group had the highest risk of frailty onset (RR = 2.09 [95 % CI: 1.60-2.73]) compared to "no isolation" & "no loneliness" group. However, there were no significant multiplicative and additive interaction between social isolation and loneliness on frailty onset (multiplicative scale: 0.75 [95 % CI: 0.50-1.11]; RERI:0.29 [95 % CI:1.02-0.44]). DISCUSSION: These findings highlight the importance of considering social factors such as interaction with others and loneliness, to prevent frailty.

BACKGROUND: Although social inequalities in oral health have been suggested, the link between socioeconomic status (SES) and oral frailty (OF) remains unclear. We aimed to investigate the inequalities in OF according to SES and the extent to which inequalities are mitigated by preventing tooth loss. METHODS: We used cross-sectional data from 21 542 functionally independent participants aged ≥ 65 (48.5% men) from the Japan Gerontological Evaluation Study. The prevalence of OF, number of teeth, and educational attainment (EA) and equivalent income (EI) were used as outcome, mediator and explanatory variables, respectively. A Poisson regression model was used to examine the association between SES and OF. Causal mediation analysis was performed to calculate the prevalence ratios (PRs) and 95% confidence intervals (CIs) of the controlled direct effects (CDEs) of the number of teeth. The proportion eliminated (PE) of the ≥ 20 remaining teeth was calculated. RESULTS: Overall 7984 participants had OF. The prevalence of OF was 1.45 times higher in participants with ≤ 9 years of EA and 1.38 times higher in participants with an EI of < $20.000. The estimated total effect (TE) of low EA or low EI on the prevalence of OF was mediated by the number of teeth (TE PR, 1.30 [95% CI, 1.25-1.35]; CDE PR, 1.22 [95% CI, 1.10-1.33]; PE, 28.2%) or (TE PR, 1.26 [95% CI, 1.22-1.31]; CDE PR, 1.23 [95% CI, 1.14-1.32]; PE, 12.9%). CONCLUSION: OF showed a clear social gradient based on SES. However, this association could be mediated by the remaining ≥ 20 teeth.

Oral frailty is a key factor in maintaining nutritional status, yet its impact on weight loss remains unclear. This study aimed to (1) evaluate the longitudinal association between oral frailty and the onset of weight loss among independent older adults and (2) explore how oral frailty components contribute to this association. Data were sourced from 2016 to 2022 of the Japan Gerontological Evaluation Study (JAGES). As a 6-y follow-up cohort study, the onset of >10% weight loss was used as the dependent variable, reflecting the significant threshold for older adults at ≥6-mo follow-up. Oral frailty was assessed as independent variables in 4 ways: (a) count score (sum of 5 components: fewer teeth, chewing difficulty, swallowing difficulty, dry mouth, and pronunciation difficulty), (b) individual 5 components, (c) a latent variable structured from 5 components, and (d) a refined latent variable incorporating additional paths from fewer teeth to chewing difficulty and pronunciation difficulty. Structural equation models (SEMs) were applied to examine the effect of oral frailty on weight loss, estimating standardized coefficients (SCs) and 95% confidence intervals (CIs). The construct validity of oral frailty was assessed using confirmatory factor analysis within the SEM framework. Model fit was evaluated using the standardized root mean squared residual (SRMR) and coefficient of determination (CD). Among 3,305 participants (47.4% women; mean age at baseline: 72.0 ± 4.9 y), 8.9% experienced >10% weight loss. Model d, which incorporated a refined latent structure of oral frailty, demonstrated the strongest association with weight loss (SC = 0.09; 95% confidence interval [CI] = 0.01; 0.16) among all models, with chewing difficulty showing the highest standardized factor loading (0.45; 95% CI = 0.35; 0.55). Model d also showed the best model fit (SRMR = 0.013; CD = 0.217), providing the high explanatory power and appropriateness of this model. Oral frailty significantly increases the risk of weight loss among independent older adults and its components have interrelationships.

OBJECTIVES: The longitudinal association between oral health and self-reported happiness among older population and its mediating pathways were unknown. This study investigated the aforementioned association and the role of three oral functions (having difficulty in speaking, problems in smiling and difficulty in chewing) as causal mediating pathways. METHODS: In this 3-year cohort study, the 2016-2019 panel data on 65 years or older independent participants from Japan Gerontological Evaluation Study (JAGES) was used (N = 53,863). Poisson regression was used to calculate risk ratio (RR) of developing self-reported unhappiness (≤ 6 points on a 10 points scale) according to number of remaining teeth and dental prosthesis use after adjusting for confounders. Causal mediation was employed to investigate the effect of oral functions on this association. RESULTS AND CONCLUSION: Overall, 45.2 % (n = 24,371) of participants were males. Mean age was 73.3 years (SD± 5.7 years) and 17.1 % (n = 9,195) became unhappy at follow-up. The incidence of unhappy participants was 24.9 % (n = 127) from those who had 0-9 teeth and no dental prosthesis declining to 15.4 % (n = 5034) from those who had ≥20 teeth. In the adjusted model and compared to the participants who had 0-9 teeth and no dental prosthesis, those with better oral health (i.e, having more teeth and used dental prosthesis) tended to have lower risk of being unhappy at follow-up (≥20 teeth RR = 0.80, 95 %CI = 0.68-0.95). The interaction analysis showed reduced risk of unhappiness for those who used a dental prosthesis. Having difficulty in speaking and chewing partially explained 4.7 %-16.3 % of the association depending on the number of remaining teeth.

PURPOSE: To investigate the association of removable partial denture (RPD)/complete denture (CD) and fixed partial denture (FPD) use with health-related quality of life (HRQoL), evaluated using the EuroQol 5-dimension, 5-level instrument (EQ-5D-5L) among older adults with tooth loss. METHODS: Cross-sectional data from the 2022 Japan Gerontological Evaluation Study. Participants were classified as RPD/CD users, FPD users, or nonusers. Generalized linear regression models stratified by the number of teeth were used to explore the association of RPD/CD and FPD use with the HRQoL evaluated using the EQ-5D-5L. The interactions among the number of teeth, RPD/CD, and FPD use were examined. RESULTS: After adjusting for all covariates, RPD/CD and FPD users with 5-19 teeth had higher predicted HRQoL utility scores than nonusers (RPD/CD [n=14,297]: 0.837 vs. 0.850; FPD [n=7,476]: 0.858 vs. 0.861 [nonusers vs. users]). The interaction between number of teeth and RPD/CD and FPD use revealed that differences in HRQoL between users and nonusers were greater among those with 1-14 teeth for RPD/CD use and among those with 10-14 teeth for FPD use (RPD/CD: β = -0.008, P < 0.01; FPD: β = -0.008, P = 0.183). CONCLUSIONS: RPD/CD and FPD users with 5-19 teeth had a higher HRQoL than nonusers, with differences appearing to depend on the number of teeth. The World Health Organization has promoted the incorporation of oral health into universal health coverage (UHC). Given the minimal HRQoL difference between CD users and nonusers among edentulous individuals, unconventional dentures may merit inclusion in UHC.

Cardiovascular disease (CVD) is a global health concern; however, its association with the posterior occlusal contact remains unexplored. This study investigated the association between posterior occlusal contact and CVD risk in a large Japanese cohort and examined whether the loss of posterior occlusal contact in individuals with at least 20 teeth was a distinct CVD risk factor. Using Japanese health insurance claims data from 1,209,997 adults aged ≥ 40 years without prior CVD history (April 2016-March 2022), participants were categorized using the Eichner classification to assess posterior occlusal contact. Over an average follow-up period of 36.2 months, 51,471 participants developed CVD. Compared with individuals with full occlusal contact (Eichner A), those with reduced contact (Eichner B and C) demonstrated significantly higher CVD risks, with hazard ratios of 1.25 (95% confidence interval [CI]: 1.19-1.32) and 1.31 (95% CI: 1.17-1.46), respectively. In a subgroup analysis of participants with ≥ 20 teeth, reduced occlusal contact from Eichner A2 to B2 was associated with an increased risk of CVD, especially in those aged 40-59 years. These findings suggest that reduced posterior occlusal contact may contribute to increased CVD risk, emphasizing the importance of preserving natural occlusal support for CVD prevention.

BACKGROUND: To investigate the differences in health care expenditure (HCE) due to the comorbidity status of periodontal disease (PD) and diabetes mellitus (DM). METHODS: This cohort study used health care claims and oral health screening data to identify participants with PD or DM and followed them for 1 year to assess their HCE. PD and DM were determined based on PD screening and medical claims data, respectively. The study participants were divided into four groups: participants without PD and DM (PD-/DM-), participants with PD and without DM (PD+/DM-), participants without PD and with DM (PD-/DM+), and participants with PD and DM (PD+/DM+). Covariates included age, sex, smoking status, and Charlson Comorbidity Index (CCI) score. A generalized linear model (GLM) with a gamma distribution and log link function was used to examine the association between comorbidity and annual HCE, and a two-part model was used to assess the differences in annual HCE. RESULTS: In total, 790 participants (mean age: 63.1, 30.3% male) were included. Compared with the PD-/DM- group, the relative cost ratio (RCR) for the PD+/DM+, PD-/DM+, PD+/DM- groups were 1.31 (95% confidence interval [CI]: 1.06-1.62), 1.27 (95% CI: 0.99-1.64), 1.01 (95% CI: 0.89-1.14) times higher, respectively. The adjusted mean annual HCE for the PD+/DM+, PD-/DM+, PD+/DM- groups were \59,328 (95% CI: 14,171-104,484), \50,228 (95% CI: -15,801-116,256), \-2,162 (95% CI: -24,598-20,274) higher than the PD-/DM- group, respectively. CONCLUSION: This study provides a significant contribution of PD to the increase in HCE, particularly in individuals with DM. PLAIN LANGUAGE SUMMARY: The association between periodontal disease (PD) and diabetes mellitus (DM) has commonly been described in previous literature, but the health expenditure incurred when PD and DM coexist is not clear. This study investigates the differences in health care expenditure (HCE) due to the comorbidity status of PD and DM. HCE is calculated from medical, dental, and pharmacy-dispensing expenditures from the claims data. PD was defined by periodontal pocket scores, and DM was determined based on medical records. Study participants were divided into four groups based on whether they had PD, DM, both, or neither. The results showed that people with both PD and DM had higher HCE compared with those without PD and DM. These findings may suggest the importance of cooperation between medical and dental professionals in the treatment of DM in terms of HCE.

OBJECTIVES: The prevalence of dental caries is high in Japan, leading to a huge burden of overall expenditure on dental caries treatment for the population. School-based fluoride mouth-rinse (S-FMR) has been implemented as a public health intervention. However, its cost-effectiveness remains unclear, where universal health insurance covers a broad range of dental treatments at relatively low cost. The aim of the study was to determine whether S-FMR is associated with lower dental caries treatment expenditure in Japan, where the universal health insurance system widely covers dental treatments. In addition, the cost-benefit of S-FMR was estimated. METHODS: This ecological study examined the association between S-FMR coverage and dental caries treatment expenditure in all 47 prefectures of Japan. Data were obtained from the National Database of Health Insurance Claims and Specific Health Checkups of Japan open data (NDB Open Data Japan), national survey data on the prevalence of S-FMR, and other census data for each prefecture. The outcome variable was the average annual treatment expenditure of for children aged 5-14 per child. The explanatory variable was the S-FMR coverage of children per prefecture, divided into quartiles: (Q1) 0.0%-0.48%, (Q2) 0.54%-6.9%, (Q3) 7.2%-25.0% and (Q4) 26.9%-80.4%. Linear regression analysis was performed with adjustment for the number of dental clinics per 100 000 individuals, per capita prefectural income, and percentage of the population aged between 5 and 14 years. RESULTS: The dental caries treatment expenditure was lower in prefectures with higher S-FMR coverage: (Q1) 2378 JPY, (Q2) 2215 JPY, (Q3) 2217 JPY and (Q4) 2065 JPY. Linear regression analysis showed that, compared to the prefectures with the lowest S-FMR coverage, the prefectures with the highest coverage exhibited significantly lower per person dental caries treatment expenditure by 186.0 (95% CI = 96.6, 275.4) JPY. When annual cost of S-FMR per person was lower, 200 JPY, S-FMR would save 0.9 billion JPY if all prefectures change from Q1 to Q4 (approximately 8.2 million USD). CONCLUSIONS: Although public healthcare insurance in Japan covers most dental treatments at a relatively low cost, the current findings suggest that S-FMR could still be a cost-effective public health intervention.

Introduction: A public oral health screening, periodontal disease screening, has been implemented in Japan, but it remains unclear whether screening encourages subsequent regular dental visits. This study aimed to examine whether people who underwent periodontal disease screening were more likely to regularly visit dentists after undergoing the screening than before using a difference-in-differences (DID) approach. Methods: This study used health care claims data of municipality residents who underwent periodontal disease screening in 2017 or 2018. For each screening recipient, 4 individuals were extracted from those who did not undergo screening as controls. In the DID analysis, we assessed the change in the proportion of dentist visits at least once every 180 d after undergoing screening. Results: A total of 4,050 participants were included in the analysis. The proportion of participants visiting dentists was consistent throughout the study period (approximately 45%) among the participants who did not undergo the screening. However, among the participants who underwent the screening, while the proportion who visited dentists was consistent before screening (approximately 60%), the proportion was higher after screening (1–180 d after, 81.2%). DID analysis indicated that the proportion increased by 12.9% after the screening. In addition, the age-subgroup DID estimates were higher in the younger population (aged 20–35 y, 13.9%; 40–55 y, 12.8%; 60 y, 12.6%). Conclusions: Among people who underwent periodontal disease screening, a higher proportion visited dentists after undergoing the screening than before, suggesting that periodontal disease screening was associated with an increase in subsequent regular dental visits. Knowledge Transfer Statement: Our results provide evidence that a public oral health screening could increase regular dental visits, which has the potential to improve and maintain people’s oral health, especially in the younger population.

OBJECTIVES: Previous studies have reported that tooth loss is associated with an increased risk of dementia; however, few have explored the association between number of teeth and dementia-free and total life expectancies. We investigated whether having more teeth is associated with longer dementia-free and total life expectancies. DESIGN: A 10-year follow-up prospective cohort study from 2010 to 2020. SETTING AND PARTICIPANTS: Functionally independent older adults aged ≥65 years living in 9 municipalities in Japan. METHODS: The exposure was the number of teeth (≥20, 10-19, 1-9, and 0). Dementia onset and mortality within the 10-year follow-up were used as the outcome. Dementia-free and total life expectancies according to the number of teeth were derived from multistate modeling estimates. RESULTS: A total of 44,083 participants were included (men: 46.8%). The mean age was 73.7 years (standard deviation [SD] = 6.0). During follow-up, 17.3% and 21.4% of the participants experienced the onset of dementia and death, respectively. Having fewer teeth was associated with dementia (hazard ratio [HR], 1.14; 95% confidence interval [CI], 1.07-1.22, 10-19 teeth; HR, 1.15; 95% CI, 1.08-1.22, 1-9 teeth; HR, 1.13; 95% CI, 1.05-1.21, 0 teeth) and death (HR, 1.13; 95% CI, 1.05-1.22, 10-19 teeth; HR, 1.27; 95% CI, 1.19-1.37, 1-9 teeth; HR, 1.47; 95% CI, 1.36-1.59, 0 teeth) compared with having ≥20 teeth. Dementia-free life expectancies at the age of 65 years were 16.43 years and 18.88 years with ≥20 teeth, and 14.40 years and 17.12 years with 0 teeth for men and women, respectively. The total life expectancies at the age of 65 were 17.84 years and 22.03 years with ≥20 teeth, and 15.42 years and 19.79 years with 0 teeth for men and women, respectively. CONCLUSIONS AND IMPLICATIONS: Having more teeth was associated with longer dementia-free and total life expectancies.

BACKGROUND: Long-term care (LTC) costs create burdens on aging societies. Maintaining oral health through dental visits may result in shorter LTC periods, thereby decreasing LTC costs; however, this remains unverified. We examined whether dental visits in the past 6 months were associated with cumulative LTC insurance (LTCI) costs. METHODS: This cohort study of the Japan Gerontological Evaluation Study targeted independent adults aged ≥65 years in 2010 over an eight-year follow-up. We used data from a self-reported questionnaire and LTCI records from the municipalities. The outcome was cumulative LTCI costs, and exposure was dental visits within 6 months for prevention, treatment, and prevention or treatment. A two-part model was used to estimate the differences in the predicted cumulative LTCI costs and 95% confidence intervals (CIs) for each dental visit. RESULTS: The mean age of the 8,429 participants was 73.7 years (standard deviation [SD]=6.0), and 46.1% were men. During the follow-up period, 17.6% started using LTCI services. The mean cumulative LTCI cost was USD 4877.0 (SD=19082.1). The predicted cumulative LTCI costs were lower among those had dental visits than among those who did not. The differences in predicted cumulative LTCI cost were -USD 1089.9 (95%CI = -1,888.5 - -291.2) for dental preventive visits, -USD 806.7 (95%CI = -1,647.4 - 34.0) for treatment visits, and -USD 980.6 (95%CI = -1,835.7 - -125.5) for preventive or treatment visits. CONCLUSIONS: Dental visits, particularly preventive visits, were associated with lower cumulative LTCI costs. Maintaining oral health through dental visits may effectively reduce the LTCI costs.

Abstract Background Oral Squamous Cell Carcinoma (OSCC) presents significant diagnostic challenges in its early and late stages. This study aims to utilize preoperative MRI and biochemical indicators of OSCC patients to predict the stage of tumors. Methods This study involved 198 patients from two medical centers. A detailed analysis of contrast-enhanced T1-weighted (ceT1W) and T2-weighted (T2W) MRI were conducted, integrating these with biochemical indicators for a comprehensive evaluation. Initially, 42 clinical biochemical indicators were selected for consideration. Through univariate analysis and multivariate analysis, only those indicators with p-values less than 0.05 were retained for model development. To extract imaging features, machine learning algorithms in conjunction with Vision Transformer (ViT) techniques were utilized. These features were integrated with biochemical indicators for predictive modeling. The performance of model was evaluated using the Receiver Operating Characteristic (ROC) curve. Results After rigorously screening biochemical indicators, four key markers were selected for the model: cholesterol, triglyceride, very low-density lipoprotein cholesterol and chloride. The model, developed using radiomics and deep learning for feature extraction from ceT1W and T2W images, showed a lower Area Under the Curve (AUC) of 0.85 in the validation cohort when using these imaging modalities alone. However, integrating these biochemical indicators improved the model’s performance, increasing the validation cohort AUC to 0.87. Conclusion In this study, the performance of the model significantly improved following multimodal fusion, outperforming the single-modality approach. Clinical relevance statement This integration of radiomics, ViT models, and lipid metabolite analysis, presents a promising non-invasive technique for predicting the staging of OSCC.

Eating out of home (EOH), with its diverse food options, can benefit those with difficulty preparing their meals, especially older adults. Oral health status may be a determinant of EOH, as food accessibility is influenced by oral health, but this association remains unclear. This cross-sectional study used merged data from two national statistical surveys conducted in 2019. Participants were individuals aged ≥ 65 years who responded to both surveys. The frequency of EOH (<once/week or ≥once/week) was the dependent variable. The number of teeth was used as the independent variable (≥20, 10-19, 1-9, and 0). Prevalence ratios (PRs) and 95% confidence intervals (CIs) were calculated using multivariate Poisson regression analysis to identify the association between EOH and the number of teeth, adjusting for possible confounders. We analyzed 2164 participants (mean age = 74.0, women 52.4%). Of these, 456 (21.1%) participants were EOH ≥ once/week; 1142 (52.8%) participants had ≥20 teeth. Compared to those with ≥20 teeth, those with <20 teeth had a lower prevalence of EOH ≥ once/week (10-19: PR = 0.89, 95% CI = 0.72-1.09, 1-9: PR = 0.67, 95% CI = 0.51-0.89, and 0: PR = 0.53, 95% CI = 0.36-0.77, respectively). We observed an association between fewer teeth and a lower frequency of EOH.

PURPOSE: Depression is a leading cause of disability. Although tooth loss increases the risk of depressive symptoms, it is unclear whether dental prosthesis use moderates this risk. This study aimed to investigate whether dental prosthesis use moderates the association between tooth loss and new depressive symptoms in older adults. METHODS: This cohort study used data from the 2016 and 2019 Japan Gerontological Evaluation Study (JAGES). The participants were independent older adults aged ≥65 years without depressive symptoms in 2016. The onset of depressive symptoms in 2019 was the outcome variable. The explanatory variables were dental status (≥20 teeth, 10-19 teeth with or without dental prostheses, and 0-9 teeth with or without dental prostheses) in 2016. Risk ratios (RRs) and 95% confidence intervals (CIs) were estimated using Poisson regression models with potential confounders as covariates. RESULTS: The analysis included 50,169 participants (mean age: 72.8 [standard deviation, 5.4] years). During follow-up, the incidence of depressive symptoms was 11.3%. Compared to those who had ≥20 teeth, the RR of depressive symptom onset was highest among those who had 0-9 teeth without dental prostheses (RR, 1.27; 95% CI, 1.04-1.56), after the adjustment for confounders. However, this risk was lower in those with 0-9 teeth and dental prostheses (RR, 1.08; 95% CI, 1.01-1.15). CONCLUSIONS: These data highlight the potential of dental prostheses as an important factor in reducing the risk of depressive symptoms among individuals with severe tooth loss.

OBJECTIVE: To examine the association between rheumatoid arthritis (RA) and oral hypofunction (OHF) using propensity score matching (PSM) to adjust for differences between older adults with RA and the general older adult population. METHODS: We conducted a cross-sectional survey among 189 older adults with RA in 2019 (mean age, 71.9 ± 3.6) and 47 178 independent older adult residents in 2016 (mean age, 71.6 ± 4.0), respectively. The questionnaire covered information on socio-demographic characteristics and OHF for both groups. Age, sex, educational level and smoking history were used to determine PSM. Prevalence ratios (PRs) and 95% confidence intervals (CIs) of self-reported OHF (fewer remaining teeth, decreased masticatory function, deterioration of swallowing function and oral dryness) were estimated using Poisson regressions. RESULT: OHF was observed in 44.4% of patients with RA and 27.5% of residents. Before PSM, the prevalence of OHF among patients with RA was higher than that of residents (PR, 1.75; 95% CI, 1.50-2.05). After PSM, there were 189 patients with RA and residents, and the prevalence of OHF among patients with RA was still higher (PR, 1.61; 95% CI, 1.22-2.13). Poisson regression showed that the prevalence of 19 or fewer teeth (PR, 1.06; 95% CI, 0.82-1.36), difficulties eating tough foods (PR, 1.18; 95% CI, 0.90-1.55), difficulties swallowing tea or soup (PR, 1.77; 95% CI, 1.19-2.63), and dry mouth (PR, 2.79; 95% CI, 1.90-4.07) was higher among patients with RA than residents. CONCLUSION: Compared with the general older adult population, patients with RA have a higher prevalence of self-reported OHF.

BACKGROUND: Bivalent COVID-19 vaccines have been implemented worldwide since the booster vaccination campaigns of autumn of 2022, but little is known about their effectiveness. Thus, this study holistically evaluated the effectiveness of bivalent vaccines against infection in older adults in Japan. METHODS: We adopted the test-negative design using COVID-19 test data of individuals, aged ≥ 65 years, residing in three municipalities in Japan, who underwent tests in medical institutions between October 1 and December 30, 2022. Logistic regression analyses were conducted to estimate the odds of testing positive according to vaccination status. Vaccine effectiveness was defined as (1 - odds ratio) × 100%. RESULTS: A total of 3,908 positive and 16,090 negative results were included in the analyses. Receiving a bivalent dose in addition to ≥ 2 monovalent doses was 33.6% (95% confidence interval [CI]: 20.8, 44.3%) more effective than receiving no vaccination, and 18.2% (95% CI: 9.4, 26.0%) more effective than receiving ≥ 2 monovalent doses but not receiving a bivalent vaccination. In addition, the effectiveness peaked at 14-20 days after administration and then gradually declined over time. Furthermore, a bivalent booster dose provided 18.6% (95% CI: 9.9, 26.5%) additional protection among those vaccinated with ≥ 2 monovalent doses, in the absence of a previous infection history. However, we did not find sufficient evidence of effectiveness of bivalent vaccines among previously infected older adults. CONCLUSIONS: Bivalent vaccines are effective against COVID-19 infections among older adults without a history of infection.

BACKGROUND: Secondary healthcare data use has been increasing in the dental research field. The validity of the number of remaining teeth assessed from Japanese dental claims data has been reported in several studies, but has not been tested in the general population in Japan. OBJECTIVES: To evaluate the validity of the number of remaining teeth assessed from Japanese dental claims data and assess its predictability against subsequent health deterioration. METHODS: We used the claims data of residents of a municipality that implemented oral health screening programs. Using the number of teeth in the screening records as the reference standard, we assessed the validity of the claims-based number of teeth by calculating the mean differences. In addition, we assessed the association between the claims-based number of teeth and pneumococcal disease (PD) or Alzheimer's disease (AD) in adults aged ≥65 years using Cox proportional hazards analyses. RESULTS: Of the 10,154 participants, the mean number of teeth assessed from the claims data was 20.9, that in the screening records was 20.5, and their mean difference was 0.5. During the 3-year follow-up, PD or AD onset was observed in 10.4% (3,212/30,838) and 5.3% (1,589/30,207) of participants, respectively. Compared with participants with ≥20 teeth, those with 1-9 teeth had a 1.29 (95% confidence interval [CI]: 1.17-1.43) or 1.19 (95% CI: 1.04-1.36) times higher risk of developing PD or AD, respectively. CONCLUSION: High validity of the claims-based number of teeth was observed. In addition, the claims-based number of teeth was associated with the risk of PD and AD.

Laughter has a protective effect on human health. The spread of coronavirus disease 2019 (COVID-19) has changed opportunities for face-to-face communication and might decrease opportunities for laughter. This cross-sectional study aimed to investigate whether the decrease in face-to-face communication during the COVID-19 pandemic is associated with a decrease in laughter. Additionally, we investigated whether an increase in online communication mitigates this association. Data from the "Japan COVID-19 and Society Internet Survey (JACSIS)," conducted between August and September 2020, were used. Participants aged 15-79 years were included in this study. The outcome was a decrease in laughter before the onset of the COVID-19 pandemic. The explanatory variables were decreased face-to-face communication with friends and increased online communication (text message, telephone, and video contact). Causal mediation analysis was used to calculate prevalence ratios (PRs) and 95 % confidence intervals (CIs) of the controlled direct effects of increased online communication. Furthermore, the proportions eliminated (PEs) by an increase in online communication were calculated. Among the 25,482 participants, 40.4 % had decreased face-to-face communication and 21.4 % had a decreased frequency of laughter. After adjusting for confounders, a decrease in face-to-face communication was significantly associated with a decrease in laughter (PR = 1.62, 95 %CI = 1.55-1.70). PEs for decrease in laughter were 27.2 % (95 %CI = -2.0 to 56.4) for text-based communication, 36.1 % (95 %CI = 12.3-59.8) for telephone-based communication, and 28.6 % (95 %CI = 0.6-56.6) for video-based communication. Although a decrease in face-to-face communication was associated with a decrease in laughter during the COVID-19 pandemic, online communication, particularly telephone-based communication, mitigated this association.

Oral health is essential for nutritional status; however, little is known about its association with weight change. This study aimed to investigate whether the risk of weight change differs according to the presence of each important component of oral hypofunction (fewer remaining teeth, low chewing efficiency, swallowing problems, and xerostomia) among independent older adults. This was a three-year follow-up cohort study based on self-reported questionnaires. The participants were independent older adults aged ≥65 from the Japan Gerontological Evaluation Study (JAGES). We used >5% weight loss/gain during follow-up as the outcome variables, and the number of remaining teeth (≥20/10-19/0-9), the presence of chewing difficulty, swallowing problems, and xerostomia (yes/no) as the exposure variables. We fitted the Poisson regression model, including possible confounders to estimate the risk ratios (RRs) and 95% confidence intervals (CIs). For weight loss, RRs were significantly higher among those with 0-9 remaining teeth (RR = 1.17; 95% CI = 1.11-1.23), chewing difficulty (RR = 1.12; 95% CI = 1.07-1.16), and xerostomia (RR = 1.11; 95% CI = 1.06-1.16), but there was no significant association with swallowing problems (RR = 1.01; 95% CI = 0.97-1.06). For weight gain, we also found similar associations with oral hypofunction. Oral hypofunction among older adults could have non-negligible health impacts on nutritional status.

PURPOSE: Laughter is expected to have health-protective effects, but the potential link between tooth loss and laughter remains unclear. Therefore, this study aimed to examine the association between tooth loss and a low frequency of laughter among older adults in Japan, to elucidate whether this association could be mitigated by dental prostheses, and to evaluate the magnitude of the association mediated by poor oral function. METHODS: We used cross-sectional data from 157,708 functionally independent participants aged ≥65 years (46.3% male) from the Japan Gerontological Evaluation Study. A modified Poisson regression model was applied to examine the association between the number of remaining teeth (≥20/10-19/0-9), dental prostheses use, and infrequent laughter (i.e., laughing never or almost never). Causal mediation analysis was performed to assess whether the association was mediated by difficulties in eating hard foods, choking, or dry mouth. RESULTS: Among the participants, 9,129 reported infrequent laughter. Participants with ≤9 and 10-19 teeth who did not use dental prostheses had a 1.29 and 1.14 times higher likelihood of infrequent laughter than those with ≥20 teeth, respectively. Furthermore, difficulty eating hard foods, choking, and dry mouth mediated 22.8%, 0.4%, and 4.3% of the association between fewer remaining teeth and infrequent laughter, respectively. Meanwhile, we did not find evidence for the differences in infrequent laughter between participants with ≤19 teeth using dental prostheses and those with ≥20 teeth. CONCLUSIONS: Tooth loss among individuals without dental prostheses was associated with infrequent laughter, and this association was mediated by poor oral function.

BACKGROUND: Poor diet can cause sleep disorders; however, this association has not been established in older populations. This study investigated the association between dietary patterns and insomnia symptoms in independent older adults. METHODS: This cross-sectional study targeted independent older Japanese adults aged ≥74 years. We used insomnia symptoms classified into three domains: difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), and insomnia. These symptoms were assessed as dependent variables by a self-reported questionnaire. Dietary patterns (DP), identified by principal component analysis of a self-administered diet history questionnaire, were used as independent variables. Poisson regression analysis was used to estimate the prevalence ratios and 95% confidence intervals with adjustment for potential confounders. RESULTS: Among 1,311 participants (mean age = 80.1; women, 48.5%), we identified three dietary patterns: DP1 was characterized by a high intake of vegetables, soy products, and fruits and a low intake of rice; DP2 was characterized by a high intake of fish, chicken, processed meat, and noodles and a low intake of soy products; and DP3 was characterized by a lower intake of fruits and confectionaries. Higher DP1 scores were significantly associated with a lower prevalence of DIS (p-for-trend = 0.012). A higher DP2 score was significantly associated with a higher prevalence of insomnia (p-for-trend = 0.032). There was no significant association between DP3 and insomnia symptoms (p-for-trend >0.05). CONCLUSION: Our results highlighted that a dietary pattern with a high intake of vegetables, soy products, and fruits may contribute to reducing insomnia symptoms among independent older adults.

Poor oral health has been linked to an increased risk of mortality. People with good cooking skills may be able to cope with problems caused by oral dysfunction, such as restricted food choice. This study investigated whether cooking skills modified the association between oral health status and mortality. A 3-year follow-up was conducted among participants of the Japan Gerontological Evaluation Study, a population-based cohort study of Japanese adults aged 65-101 years. Oral health assessment comprised number of teeth and three oral functions (awareness of swallowing difficulty, decline in masticatory function, and dry mouth). Cooking skills were assessed using a valid scale adapted for Japanese participants. Mortality from 2016 to 2019 was analysed for 10,121 respondents. Cox regression models were used to estimate hazard ratios for mortality risk adjusting for potential confounders, including sociodemographic factors and health status. During the follow-up, there were 488 deaths (4.8% of all participants). Both fewer teeth and poor oral function were associated with a greater mortality risk. Cooking skills modified the association only for oral function. Stratification by cooking skill score showed that the hazard ratios for ≥2 oral difficulties (vs. none) was 2.06 (95% confidence interval: 1.43-2.96) among those with low cooking skills and 1.25 (95% confidence interval: 0.92-1.71) among those with high cooking skills after adjusting for potential confounders. Improving cooking skills may be key to mitigating health risks owing to poor oral functions.

PURPOSE: A growing body of evidence suggests that oral health is associated with a wide range of health outcomes; however, opinions tend to vary because of inconsistent findings. This study aimed to simultaneously examine the association between oral health status and multiple health and well-being indicators using outcome-wide epidemiology. METHODS: Data were obtained from the Japan Gerontological Evaluation Study. Oral health status was categorized as: ≥20 teeth, 10-19 teeth with dental prosthesis, 0-9 teeth with prosthesis, 10-19 teeth without prosthesis, and 0-9 teeth without prosthesis. We examined the associations between oral health status in 2013 and 35 health and well-being outcomes in 2019, including physical/cognitive health, psychological distress, subjective health, social well-being, prosocial/altruistic behaviors, and health behaviors, using two databases (n=32,827 and 15,905). RESULTS: Compared to individuals with ≥20 teeth, those with <20 teeth had a 10-33% higher risk of mortality and a 7-10% higher risk of functional disability six years later. Additionally, individuals with fewer than 20 teeth tended to go out less frequently and eat fewer vegetables and fruits. Furthermore, individuals with 0-9 teeth without a prosthesis were more likely to have severe functional disability (risk ratio (RR):1.17, 95% confidence interval (CI):1.05-1.31), engage in fewer intellectual activities (standardized difference: 0.17, 95% CI: 0.10-0.24), and feel more hopeless (RR: 1.21, 95% CI: 1.04-1.41). CONCLUSIONS: The prevention of tooth loss and prosthodontic treatment may be associated with reduced mortality and functional disability, as well as maintenance of intellectual ability, frequency of going out, and improvements in dietary lifestyle.

BACKGROUND: Although the effectiveness of coronavirus disease 2019 (COVID-19) vaccines is a crucial public health concern, evidence from Western Pacific countries is limited, including Japan. This study aimed to estimate the COVID-19 vaccines effectiveness (VE) against infection during the Delta variant predominance (July-September 2021) in Japan. METHODS: We performed a test-negative study using COVID-19 test data of ≥20-year-old residents in four municipalities who were tested in medical institutions between July 1 and September 30, 2021. We extracted COVID-19 test data from healthcare claims data, and the vaccination status at the testing date was ascertained using the Vaccination Record System data. Confirmed positive cases were identified using data from the national system for COVID-19, Health Center Real-time Information-sharing System on COVID-19. Logistic regression analyses were conducted to estimate the odds of testing positive according to vaccination status. VE was calculated as (1 - odds ratio) × 100%. RESULTS: This study included 530 positive and 15,650 negative results. Adjusted manufacturer-unspecified VE was 4.1% (95% confidence interval [CI], -36.5-32.6) at 0-13 days after the first dose, 45.2% (95% CI, 13.4-65.3) at ≥14 days after the first dose, 85.2% (95% CI, 69.9-92.7) at 0-13 days after the second dose, and 79.6% (95% CI, 72.6-84.8) at ≥14 days after the second dose. In addition, the VE after the second dose was highest at 14-34 days after the dose (VE, 89.1%; 95% CI, 80.5-93.9). CONCLUSIONS: High real-world effectiveness of COVID-19 vaccines, especially two doses, against infection during the Delta variant predominance in Japan was confirmed.

AIM: To examine the mediators between lower socio-economic status (SES) in adolescence and oral health at an older age to uncover the underlying mechanisms of the association. METHODS: Participants (n = 21 536) aged ≥65 years from the Japan Gerontological Evaluation Study were evaluated. The dependent variables were self-rated chewing difficulty and having ≤19 remaining teeth. The main independent variable was self-perceived SES in adolescence. The Karlson-Holm-Breen method was used for mediation analysis. RESULTS: Mean age of the participants was 74.8 years (standard deviation = 6.4), and 51.5% were female. Overall, 5598 (26.0%) participants reported chewing difficulty and 9404 (43.7%) had ≤19 remaining teeth. Lower SES in adolescence was associated with a higher prevalence of chewing difficulty (odds ratio [OR] = 1.38, 95%confidence interval [CI] = 1.29-1.48; total effect). After controlling for mediators, OR for lower SES in adolescence was 1.22 (95%CI = 1.13-1.30; direct effect) and 1.13 (95%CI = 1.11-1.16; indirect effect). Mediators, prominently the number of teeth and income, explained 39.3% of the associations. Lower SES in adolescence increased the odds of ≤19 remaining teeth by OR = 1.23 (95% CI = 1.16-1.31; total effect). After controlling for mediators, the OR for lower SES in adolescence was 1.03 (95%CI = 0.97-1.10; direct effect) and 1.19 (95%CI = 1.16-1.23; indirect effect). Mediators, prominently educational attainment, explained 85.0% of the associations. CONCLUSIONS: Lower SES in adolescence was associated with poor oral health at an older age through mediators. Approaches that consider social determinants from the beginning of the life course are required.

INTRODUCTION: The population-attributable risk of oral status for incident functional disability remains unknown. We investigated the impact of a range of oral statuses (number of remaining teeth, chewing difficulty, dry mouth, and choking) on incident functional disability. METHODS: Participants (n = 44,083) aged ≥ 65 years from the Japan Gerontological Evaluation Study were evaluated. The outcome variable was incident functional disability, and the explanatory variables were four select oral statuses. The possible confounders were included as covariates. Using the Cox proportional hazards model, we calculated hazard ratios (HRs), 95% confidence intervals (CIs), and their population-attributable fractions (PAFs). RESULTS: The mean age of the participants was 73.7 (standard deviation=6.0) years at baseline, and 53.2% were women. A total of 8,091 participants (18.4%) developed functional disabilities during the follow-up period. Among the four oral statuses, the incidence rate of functional disability was the highest in those with chewing difficulty (3.27/100 person-years), followed by those with dry mouth (3.20/100 person-years), choking (3.10/100 person-years), and ≤19 remaining teeth (2.89/100 person-years). After adjusting for all covariates, chewing difficulty showed the highest risk of functional disability (HR=1.22, 95%CI=1.16-1.28), followed by ≤19 remaining teeth (HR=1.18, 95%CI=1.12-1.25), dry mouth (HR=1.18, 95%CI=1.12-1.24), and choking (HR=1.10, 95%CI=1.04-1.17). Regarding PAF, ≤19 remaining teeth (12.0%) were the largest, followed by chewing difficulty (7.2%), dry mouth (4.6%), and choking (1.9%). CONCLUSIONS: Maintaining a good oral status may reduce the risk of functional disability later in life. Given its population contribution, tooth loss had the largest impact among the four oral conditions.

OBJECTIVES: Japan's universal health insurance covers a wide range of dental treatments, and the co-payment rates differ by age. We investigated whether the inequality in gingival bleeding and dental visits was smaller amongst those with lower co-payment rates. METHODS: This cross-sectional study used data from the 2019 Japan Gerontological Evaluation Study. The participants were functionally independent adults aged 65 years or older. The dependent variables were current gingival bleeding as a symptom of periodontal diseases and dental nonattendance for treatment in the past year. The independent variables were ridit scores of equivalent income and educational status. For covariates, we used age, sex, and the number of remaining teeth. To evaluate the inequalities, we used the slope index of inequality (SII) and the relative index of inequality (RII). We also conducted stratified analyses by co-payment rates (30%, 20%, and 10%) to clarify the difference in inequalities by co-payment rate. RESULTS: A total of 15,389 participants were included in the analysis; their mean age was 71.8 (SD = 4.1) and 51.8% were women. There were significant absolute and relative inequalities in gingival bleeding and dental visits by equivalent income and education. With regards to educational status, inequalities were lower with a decrease in the co-payment rate. In particular, relative inequality by education in gingival bleeding was the largest amongst the 30% co-payment group (RII, 1.918; 95% confidence interval [CI], 1.386 to 2.656). For gingival bleeding, the absolute and relative inequality by equivalent income were not significant amongst the 10% co-payment group (SII, -0.003; 95% CI, -0.003 to 0.028; RII, 1.006; 95% CI = 0.676 to 1.498). CONCLUSIONS: A low co-payment rate was associated with smaller inequalities in gingival bleeding and dental visits by equivalent income and educational status.

BACKGROUND: Oral diseases are preventable and modifiable, but highly prevalent, and cause worse oral status. Particularly, tooth loss has increased in aging societies. However, studies on population-attributable risks of modifiable risk factors for mortality have neglected oral status. This study aimed to investigate the impact of modifiable risk factors on mortality, including oral status. METHODS: This cohort study used the Japan Gerontological Evaluation Study (JAGES) data, including participants aged ≥65 years. The outcome was death between August 2010 to March 2017. We calculated the hazard ratios (HRs) and population attributable fraction (PAF) of modifiable risk factors (oral status, hypertension, depression, heart disease, diabetes, physical activity, smoking status, and alcohol drinking history) for mortality. RESULTS: Analyses included 24,175 men and 27,888 women (mean age: 73.8 [6.0] and 74.2 [6.1], respectively). In men, after adjusting for covariates, having no teeth showed the highest hazard ratio (hazard ratio [HR]=1.67, 95% confidence interval [CI]=1.51-1.86) among the modifiable risk factors, and the PAF for the number of teeth (18.2%) was the second largest following age. In women, having no teeth had the third largest HR (HR=1.37, 95%CI=1.19-1.56) following current and former smoking. The PAF for the number of teeth (8.5%) was the sixth largest, which was larger than that of smoking status (4.8%). CONCLUSIONS: In the older population, the HR and PAF of the number of teeth on mortality were sufficiently large compared with other modifiable risk factors, especially in men. Therefore, maintaining good oral status should be included more in global health policies.

PURPOSE: Evaluation of the clinical performance of computer-aided design/computer-aided manufacturing-produced resin composite crowns (CAD/CAM composite crowns) on molars with a particular focus on placement location. METHODS: A retrospective cohort study was performed based on the clinical records of patients with CAD/CAM composite crowns on molars (June 2016 to March 2021). The hazard ratios (HRs) and 95% confidence intervals (95% CIs) were estimated based the Cox proportional hazard model to evaluate the effect of tooth location on complication type and occurrence. Covariates included crown location (maxilla/mandible, distalmost tooth/not distalmost tooth, and first molar/second or third molar) and endodontically treated (nonvital) or untreated (vital) tooth. RESULTS: Overall, 362 crowns were evaluated (mean follow-up: 378 days, median: 286 days), and 106 crowns (29.3%) showed complications, most frequently crown debonding. The cumulative success and survival rates were 70.9% and 93.7%, respectively, after 1 year and 49.5% and 86.5%, respectively, after 3 years. There was no significant difference in the HRs and log-rank tests in the Kaplan-Meier curves based on crown location parameters (P > 0.05). However, placement on vital teeth was associated with higher risks than on nonvital teeth (HR, 1.55; 95% CI, 1.03-2.23). In addition, the cement as a covariate yielded a high HR. CONCLUSIONS: The location of CAD/CAM composite molar crowns is unlikely a risk factor for complications; therefore, these crowns can be clinically applied to all molars. However, the application of such molar crowns to vital teeth and the use of a cement other than adhesive resin cement present risks.

Eating alone is reported to deteriorate health; however, the relationship between eating alone and poor dental health remains unclear. This cross-sectional study aimed to investigate the association between poor dental health and eating alone. Data of participants (n = 156,287) aged ≥65 years from the Japan Gerontological Evaluation Study were evaluated using logistic regression to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the association between dental status, including prosthesis use, and eating status. Differences in these associations according to living status were also examined. The mean age of participants was 73.7 (SD = 6.0) years. The percentages of participants eating alone with 20 or more teeth, 10-19 teeth with dental prostheses, 0-9 teeth with dental prostheses, 10-19 teeth without dental prostheses, and 0-9 teeth without dental prostheses were 13.8%, 16.0%, 18.6%, 18.9%, and 27.0%, respectively. After adjusting for covariates, participants with 0-9 teeth without any dental prosthesis showed a significantly higher odds ratio for eating alone (OR = 1.81, 95% CI = 1.58-2.07) than those with 20 or more teeth. Among participants with poorer dental status, the probability of eating alone was higher in those living alone than in those living with others. Among older adults, poor dental status was significantly associated with eating alone, and this association was stronger among those living alone. Maintaining better dental status by using a dental prosthesis might reduce the risk of eating alone, especially for those living alone.

BackgroundAlthough the feasibility of randomized trials for investigating the long-term association between oral health and cognitive decline is low, deriving causal inferences from observational data is challenging. We aimed to investigate the association between poor oral status and subjective cognitive complaints (SCC) using fixed-effects model to eliminate the confounding effect of unobserved time-invariant factors.MethodsWe used data from Japan Gerontological Evaluation Study (JAGES) which was conducted in 2010, 2013, and 2016. β regression coefficients (95% confidence intervals) were calculated using fixed-effects models to determine the effect of deteriorating oral status on developing SCC. Onset of SCC was evaluated using the Kihon Checklist-Cognitive function score. Four oral status variables were used: awareness of swallowing difficulty, decline in masticatory function, dry mouth, and number of teeth.Results13,594 participants (55.8% women) without SCC at baseline were included. The mean age was 72.4 (SD = 5.1) for men and 72.4 (SD=4.9) for women. Within the 6-year follow-up, 26.6% of men and 24.9% of women developed SCC. The probability of developing SCC was significantly higher when participants acquired swallowing difficulty (β= 0.088; 0.065-0.111 for men, β= 0.077; 0.057-0.097 for women), decline in masticatory function (β=0.039; 0.021-0.057 for men, β= 0.030; 0.013-0.046 for women), dry mouth (β= 0.026; 0.005-0.048 for men, β= 0.064; 0.045-0.083 for women), and tooth loss (β= 0.043; 0.001-0.085 for men, β= 0.058; 0.015-0.102 for women).ConclusionsThe findings suggest that good oral health needs to be maintained to prevent the development of SCC, which increases the risk for future dementia.