Poor oral health and age-related health outcomes : epidemiological cohort studies of older people in the United Kingdom and United States of America

Abstract

Oral health problems have been found to be associated with disability, poor physical function, and mortality. However, cross-sectional and prospective associations are not well-established in older people, especially for self-reported oral health problems. Diet and inflammation are potential mediators in the association between poor oral health and risk of disability. However, evidence is limited. Additionally, gaps exist in the associations of poor oral health with different inflammatory markers. Inconsistent findings have also been reported for the associations between oral health and diet in older people. This thesis uses data from two population-based studies of older people, the British Regional Heart study (BRHS) and the US Health, Aging and Body Composition (HABC) Study. Data have been used to investigate cross-sectional associations of oral health problems with disability, physical function, inflammatory, haemostatic, and cardiac biomarkers, diet quality and dietary intake, and prospective associations of oral health with risk of disability, all-cause, cardiovascular disease (CVD), and respiratory mortality in older people. Oral health problems included objective (tooth loss, periodontal disease), and subjective (dry mouth, self-rated oral health) assessments and accumulation of oral health problems. Causal mediation was performed to test mediation through diet and inflammation. The main findings are that oral health problems were cross-sectionally associated with disability and poor physical function. Poor oral health (tooth loss, periodontal disease, dry mouth, cumulative oral health problems) was also associated prospectively with greater risk of developing disability, and all-cause, CVD and respiratory mortality. Some oral health problems were associated with increased inflammation, poor diet quality and poor nutritional intake. However, inflammation and diet did not appear to mediate the association of poor oral health with risk of developing disability. Finally, poor oral health is potentially an important risk factor for the onset of disability and all-cause and cause specific mortality in older people.