Total Tooth Loss Among Persons Aged [greater than or equal to] 65 Years - Selected States, 1995-1997

Morbidity and Mortality Weekly Report, March 19, 1999

Loss of all natural permanent teeth (edentulism) substantially reduces quality of life, self-image, and daily functioning [(1)]. Although loss of teeth results from oral diseases such as dental caries and periodontitis, it also reflects patient and dentist attitudes, availability and accessibility of dental care, and the prevailing standard of care [(2)]. One of the national health objectives for 2000 is to reduce to no more than 20% the proportion of persons aged [greater than or equal to]65 years who have lost all their natural teeth (objective 13.4) [(3)]. Edentulism has been declining in the United States since the 1950s [(2)], but few state-specific data are available on adult tooth loss. To estimate the prevalence of edentulism among persons aged [greater than or equal to]65 years, CDC analyzed data from the 46 states that participated in the oral health module of the 1995-1997 Behavioral Risk Factor Surveillance System (BRESS). This report summarizes the findings from this analysis, which indicate a large state-specific variation in edentulism and that many states have not yet achieved the national health objective for preventing total tooth loss.

BRFSS is a state-based, random-digit-dialed telephone survey of the U.S. civilian, noninstitutionalized population aged [greater than or equal to]18 years. During 1995-1997, 46 states administered the optional oral health module during at least 1 year. Participants were asked how many of their permanent teeth were removed because of tooth decay or gum disease. Of the 28,979 persons aged [greater than or equal to]65 years who were asked this question, 27,736 (95.7%) responded. Edentate persons were those who reported having lost all their teeth. Data were aggregated and weighted according to state population estimates, and prevalence estimates and standard errors were calculated using SUDAAN [(4)]. To increase the precision of prevalence estimates within age groups, data from multiple years were aggregated for states that administered the BRFSS oral health module during [greater than] 1 year.

The prevalence of edentulism among persons aged [greater than or equal to]65 years ranged from 13.9% (Hawaii) to 47.9% (West Virginia) (Table 1). In five states (Arizona, California, Hawaii, Oregon, and Wisconsin), [less than]20% of persons were edentate; in three states (Kentucky, Louisiana, and West Virginia), [greater than]40% were edentate.

In 1997, edentulism was more common among persons aged [greater than or equal to]75 years (26.7%) than among those aged 65-74 years (22.9%) (Table 2). Edentulism was more prevalent among persons with less than a high school education (42.1%) than among those with more education (10.1%-25.1%); among those without dental insurance (27.0%) than among those who had insurance (18.3%); among non-Hispanic blacks (31.9%) than. among Hispanics (18.2%) and non-Hispanic whites (24.1%); and among current every day cigarette smokers (41.3%) than among occasional smokers (28.9%), former smokers (25.7%), or persons who had never smoked (19.9%).

Reported by: State Behavioral Risk Factor Surveillance System coordinators. Surveillance, Investigations, and Research Br, Div of Oral Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note: The findings in this report indicate that most states have not yet achieved the national health objective for edentulism prevention. However, edentulism among older persons probably reflects total tooth loss that occurred many years earlier. Because younger birth cohorts seem less likely than persons born earlier in the 20th century to lose all their teeth [(2)], the prevalence of edentulism among persons aged [greater than or equal to]65 years will probably continue to decline in succeeding birth cohorts.

Dental caries and its complications are the primary reasons for tooth extraction for persons of all ages [(2)]. Dental caries is largely preventable, and community water fluoridation remains the most effective and cost-effective prevention method [(5)]. The destruction of tooth-supporting structures from advanced periodontitis is also a substantial etiologic factor for tooth loss [(6)].

The approximately fourfold range in total tooth loss among states and sociodemographic variations in edentulism supports the contention that total tooth loss is not an inevitable consequence of aging. Changes in attitudes toward dentistry, advancements in dental restorative technologies, periodontal treatment, and effectiveness of water fluoridation and other preventive measures have helped ensure tooth retention.

The association between edentulism and educational attainment may reflect differences in access to preventive and restorative dental services and attitudes toward oral health. Racial/ethnic differences in the prevalence of edentulism may reflect varying disease experiences, cultural differences in attitudes toward oral health and dentistry, or socioeconomic status, which can influence use of dental care and type of treatment received. In addition, the higher prevalence of total tooth loss among persons without dental insurance than among those with dental insurance may, in part, result from reduced use of preventive and restorative dental services [(7)]. However, dental insurance in the United States is almost entirely employment-based, and Medicare does not cover most dental procedures; therefore, relatively few persons aged [greater than or equal to]65 years have dental insurance.