Smokers at higher risk of losing their teeth, research shows

A new study has confirmed that regular smokers have a significantly increased risk of tooth loss.

Male smokers are up to 3.6 times more likely to lose their teeth than non-smokers, whereas female smokers were found to be 2.5 times more likely.

The research, published in the Journal of Dental Research, is the output of a long-term longitudinal study of the EPIC Potsdam cohort in Germany carried out by researchers at the University of Birmingham and the German Institute of Human Nutrition.

Tooth loss remains a major public health problem worldwide. In the UK, 15% of 65-74 year olds and over 30% of 75+ year olds are edentate (have lost all of their natural teeth). Globally, the figure is closer to 30% for 65-74 year olds.

Lead author Professor Thomas Dietrich, from the University of Birmingham, explained, "Most teeth are lost as a result of either caries (tooth decay) or chronic periodontitis (gum disease). We know that smoking is a strong risk factor for periodontitis, so that may go a long way towards explaining the higher rate of tooth loss in smokers."

Smoking can mask gum bleeding, a key symptom of periodontitis. As a result, the gums of a smoker can appear to be healthier than they actually are.

Professor Dietrich added, "It's really unfortunate that smoking can hide the effects of gum disease as people often don't see the problem until it is quite far down the line. The good news is that quitting smoking can reduce the risk fairly quickly. Eventually, an ex-smoker would have the same risk for tooth loss as someone who had never smoked, although this can take more than ten years."

Kolade Oluwagbemigun, from the German Institute of Human Nutrition, said, "Gum disease and consequential tooth loss may be the first noticeable effect on a smoker's health. Therefore, it might give people the motivation to quit before the potential onset of a life-threatening condition such as lung disease or lung cancer."

The findings were independent of other risk factors such as diabetes, and are based on data from 23,376 participants which aimed to evaluate the associations between smoking, smoking cessation and tooth loss in three different age groups.

The association between smoking and tooth loss was stronger among younger people than in the older groups. In addition, the results clearly demonstrated that the association was dose-dependent; heavy smokers had higher risk of losing their teeth than smokers who smoked fewer cigarettes.

Professor Heiner Boeing, also from the German Institute of Human Nutrition, added, "In addition to the many noted benefits for cardiovascular health, and risk of lung disease and cancer, it is clear that dental health is yet another reason not to take up smoking, or to quit smoking now."

Supervised tooth brushing and floride varnish schemes benefit kids and the health economy

Action to prevent tooth decay in children, such as supervised tooth brushing and fluoride varnish schemes, are not just beneficial to children's oral health but could also result in cost savings to the NHS of hundreds of pounds per child, so says a leading dental health researcher.

Professor Elizabeth Kay, Foundation Dean of the Peninsula Dental School from Plymouth University Peninsula Schools of Medicine and Dentistry, has carried out the first economic evaluation of public health measures to reduce tooth decay in children at high risk, in association with the National Institute for Health and Care Excellence (NICE) and the York Health Economic Consortium. She will present her findings at this year's British Society for Oral and Dental Research Annual Meeting in Cardiff, 14th to 16th September.

Almost 26,000 children a year aged between five and nine are admitted to hospital for dental treatment under general and local anaesthetic in the UK, for conditions which are on the whole preventable through better understanding and adoption of good oral health routines.

In her study Professor Kay found that, taking the threshold value used by NICE of £20,000 per Quality Adjusted Life Year (QALY), preventive schemes targeted at high risk children would be considered to be cost-effective even if they cost £46 per year per child for tooth brushing or £62 per child per year for fluoride varnish schemes. This would represent a saving of hundreds of pounds per child when compared with the cost of surgical treatments in hospital.

QALY is used in assessing the value for money of a medical intervention.

The model showed that for children at high risk of oral disease, supervised brushing and fluoride varnish schemes are cost-effective options.

Said Professor Kay: "We have more work to do here to translate the results of our study into policy, but I must stress that this is about more than making better use of NHS funds, and demonstrating that oral health promotion programmes offer extremely good value for money. I think it is a national outrage that so many children in the UK are admitted to hospital for surgical procedures for conditions which are by and large preventable. If there was a health issue that resulted in this number of children having another body part removed under general or local anaesthetic there would be a justifiable national outcry, yet for many reasons tooth extraction appears to have become accepted in some circles. This study demonstrates that it is also economically viable and sensible to prevent tooth decay"

She added: "By showing sound economic reasons for increasing the use of preventative measures, such as tooth brushing and fluoride varnishing, I hope that they can now compete for resource against other less cost-effective interventions."