Edentulism, denture use, and self-reported pain in Chinese older adults: a population-based study using CHARLS

Abstract Background Edentulism remains a substantial public health burden worldwide, particularly among older adults. Although emerging evidence suggests an association between tooth loss and self-reported pain, temporal trends and site-specific associations between edentulism and pain, particularly headache, remain insufficiently characterized. Furthermore, whether denture use and chewing ability are associated with pain among edentulous individuals has not been clearly established. Methods Data were obtained from three waves (2011, 2015, and 2018) of the China Health and Retirement Longitudinal Study (CHARLS). After exclusions, 17,052 participants were included in the analysis of edentulism and any pain, and 16,781 participants were included in the analysis of edentulism and headache. Weighted generalized linear models with cluster-robust standard errors were used to evaluate the associations between edentulism and pain outcomes, with stepwise adjustment for unadjusted (Model 1), age and sex (Model 2), and lifestyle factors, socioeconomic status, and chronic diseases fully adjusted for age, sex, marital status, drinking, smoking, education, and chronic diseases including hypertension, dyslipidemia, diabetes or high blood sugar, cancer or malignant tumor, chronic lung diseases, liver disease, heart attack, stroke, kidney disease, stomach or other digestive diseases, emotional, nervous, or psychiatric problems, memory-related disease, arthritis or rheumatism, and asthma(Model 3). Among edentulous participants in 2018, the associations of denture use and chewing difficulty with pain outcomes were further assessed. Results Edentulism was significantly associated with increased odds of any pain (OR = 1.63, 95% CI: 1.41–1.89, P < 0.001) and headache (OR = 1.42, 95% CI: 1.18–1.71, P < 0.001) in fully adjusted models across the CHARLS 2011–2018 waves. Among edentulous participants, denture use without chewing difficulty was associated with lower odds of any pain in Model 1 (OR = 0.53, 95% CI: 0.37–0.74, P < 0.001) and Model 2 (OR = 0.47, 95% CI: 0.32–0.70, P < 0.001), although the association was attenuated in the fully adjusted Model 3 (OR = 0.39, 95% CI: 0.14–1.08, P = 0.072). For headache, denture use without chewing difficulty was consistently associated with lower odds across all three models (Model 3: OR = 0.067, 95% CI: 0.008–0.55, P = 0.013). Denture use with chewing difficulty showed no significant association with either any pain or headache in any model. Conclusions Edentulism is significantly associated with pain, with particularly strong and persistent associations with headache. Among edentulous participants, denture use without self-reported chewing difficulty was associated with lower odds of pain, particularly headache. These findings suggest a potential association between oral health status, masticatory function, and pain perception.