Digital exclusion and incident complete tooth loss among middle-aged and older adults: evidence from CHARLS, HRS and ELSA

The health consequences of digital exclusion among older populations are increasingly recognised, yet its relationship with oral health remains poorly understood. We examined whether older adults who do not use the Internet are more likely to lose all natural teeth over time. We used data from three longitudinal ageing studies—CHARLS, HRS, and ELSA. Participants with at least one natural tooth at baseline were followed for incident complete tooth loss, defined as self-reported loss of all remaining teeth. Digital exclusion was defined as non-use of the Internet at baseline. We fitted generalised estimating equation and linear mixed-effects models, sequentially adjusting for demographic, socioeconomic, living arrangement, and behavioural factors. Among 7,219 (CHARLS), 6,199 (HRS), and 4,392 (ELSA) dentate participants at baseline, 5.4%, 4.9%, and 2.2% progressed to complete tooth loss during follow-up. In fully adjusted models, digitally excluded participants had significantly higher odds of becoming edentulous: CHARLS OR = 1.32 (95% CI = 1.00–1.73), HRS OR = 1.53 (95% CI = 1.14–2.05), and ELSA OR = 1.62 (95% CI = 1.00–2.60). Digital exclusion also predicted faster tooth loss progression across all cohorts, with significant exposure–time interactions ( P < 0.001 for all). Older adults who are digitally excluded face a substantially higher risk of progressing to complete tooth loss. While the observational design precludes causal claims, these findings point to digital inclusion as a potentially relevant consideration for oral health promotion in ageing populations.