Tooth Loss and Cardiovascular Disease: A 17-Year Australian Cohort Study

Background: Cardiovascular disease (CVD) is highly prevalent, affecting 1 in 6 Australians. Tooth loss has consistently been associated with an increased risk of CVD, influenced by social determinants of health as well as effects on chewing function and diet. However, there is little evidence regarding the role of diet in the relationship between tooth loss and CVD. This study aimed to determine the impact of retaining a functional dentition (minimum of 20 teeth) on the risk of incident CVD and the role of diet in this relationship. Methods: This prospective cohort study recruited Australian women from the 1946 to 1951 cohort of the Australian Longitudinal Study on Women’s Health. Tooth loss and diet quality were assessed from survey 5 (2007) and incident CVD from linked data over a 17-y follow-up period (2024). Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for known risk factors (age, sociodemographic, lifestyle, and medical history factors). Results: A total of 8,306 women, average age 58.5 ± 1.5 y, 69.2% with a functional dentition, were included. Over the 17-y follow-up period, 1,432 (17.2%) women developed incident CVD. The presence of a functional dentition was associated with a lower risk of incident CVD compared to women with a nonfunctional dentition, 15.5% versus 21.1%, respectively (HR = 0.83; 95% CI, 0.74–0.93). A greater proportion of women with a functional dentition had a high-quality diet score compared to those with a nonfunctional dentition (42% vs. 36%, P < 0.001). Even after controlling for diet quality, a statistically significant association was observed (HR = 0.82; 95% CI, 0.73–0.92). Conclusion: Although tooth loss negatively impacts diet quality, dietary changes alone do not explain why tooth loss is a marker of incident CVD, and loss of a functional dentition should prompt cardiovascular prevention action. Knowledge transfer statement: This study demonstrates that loss of a functional dentition in women increases the risk of developing cardiovascular disease, independent of changes in diet quality. Policymakers and clinicians should promote cardiovascular preventive action for women with significant tooth loss.