Comment on “Association between tooth loss and geriatric syndromes in older adults: a cohort study from a rural area in eastern China”

Abstract

I found the study by He et al. quite engaging, as it offers substantial longitudinal evidence linking dental health with various geriatric syndromes in a cohort of 1,094 individuals, specifically sarcopenia, malnutrition risk, frailty, and falls. The authors conducted rigorous clinical evaluations, including assessments of handgrip strength and body composition. They also utilized validated tools, such as the Mini Nutritional Assessment Short-Form (MNA-SF) and the FRAIL scale. The study's findings are significant: individuals with fewer than 10 teeth or those whose tooth loss has affected their daily activities demonstrated markedly increased odds of sarcopenia (OR 1.87–3.25), malnutrition risk (OR 2.31–3.64), and frailty. The absence of proper dentures significantly exacerbated these health risks, highlighting the importance of prosthetic rehabilitation, which, while beneficial, has its limitations in fully restoring oral function. This research strongly advocates for the prioritization of comprehensive oral health assessments and accessible denture provision as essential components of elderly care. The findings are particularly relevant to this rural cohort, emphasizing the need for targeted interventions in geriatric oral health, especially in resource-constrained environments where access to dental care might be limited. To further strengthen the study's relevance and scientific rigor, I propose several constructive recommendations that could enhance the research's overall impact.

Dear Editor,

I found the study by He et al. [1] quite engaging, as it offers substantial longitudinal evidence linking dental health with various geriatric syndromes in a cohort of 1,094 individuals, specifically sarcopenia, malnutrition risk, frailty, and falls. The authors conducted rigorous clinical evaluations, including assessments of handgrip strength and body composition. They also utilized validated tools, such as the Mini Nutritional Assessment Short-Form (MNA-SF) and the FRAIL scale. The study's findings are significant: individuals with fewer than 10 teeth or those whose tooth loss has affected their daily activities demonstrated markedly increased odds of sarcopenia (OR 1.87–3.25), malnutrition risk (OR 2.31–3.64), and frailty. The absence of proper dentures significantly exacerbated these health risks, highlighting the importance of prosthetic rehabilitation, which, while beneficial, has its limitations in fully restoring oral function. This research strongly advocates for the prioritization of comprehensive oral health assessments and accessible denture provision as essential components of elderly care. The findings are particularly relevant to this rural cohort, emphasizing the need for targeted interventions in geriatric oral health, especially in resource-constrained environments where access to dental care might be limited. To further strengthen the study's relevance and scientific rigor, I propose several constructive recommendations that could enhance the research's overall impact.

First, categorizing all individuals with ten or fewer teeth collectively may obscure critical distinctions between partial and complete edentulism, each of which has specific implications for oral function, dietary capacity, and systemic health. A systematic review has demonstrated that masticatory efficiency significantly diminishes when the number of functional occluding pairs falls below a critical threshold, typically around ten teeth or fewer, particularly in the posterior region [2]. The therapeutic considerations for individuals with one to nine remaining teeth (partial edentulism) differ substantially from those of complete edentulism. Individuals retaining a minimal number of functional teeth may still achieve a limited yet significant level of chewing ability, especially when supplemented by removable partial dentures. Conversely, completely edentulous individuals rely exclusively on prosthetic replacements, frequently resulting in decreased occlusal force and stability [2]. The number of missing teeth and the condition of edentulism are critical factors in preserving oral function, dietary habits, systemic health, and overall frailty. Moreover, categorizing all participants with ten or fewer teeth into a single analytical group may reduce the sensitivity of response evaluations and impair our understanding of how different thresholds affect dental functional decline. Therefore, it is advisable to categorize the study population into more specific categories, such as 1–4 teeth, 5–9 teeth, and edentulous, to produce more clinically meaningful risk profiles and facilitate the development of tailored therapeutic interventions.

And second, Although the study examined the presence or absence of dentures as a binary variable, it neglected important qualitative factors such as the type of denture (e.g., fixed or removable), functional quality (e.g., retention, occlusion, fit), and frequency of use (e.g., how many hours they are worn daily). These factors significantly impact nutritional status and health-related quality of life for older adults. Simply having a denture does not guarantee better chewing efficiency or patient satisfaction. Poorly fitting removable dentures may not enhance chewing ability; instead, they can cause discomfort, reduce food variety, and lead to social embarrassment, ultimately worsening malnutrition and increasing psychosocial vulnerability [3]. Effective prosthetic rehabilitation, especially with well-fitting complete dentures or implant-supported dentures, is associated with increased intake of protein and micronutrients, as well as improvements in self-reported dental health and psychological well-being [2]. In contrast, removable dentures that lack sufficient retention or are poorly adjusted may fail to restore proper function. This inadequacy can lead to a reduced inclination to consume high-fiber or protein-rich foods, further perpetuating a diet that is low in texture and high in carbohydrates. Additionally, adherence to the regular use of dentures is often inconsistent; some elderly individuals may remove their dentures for extended periods or choose not to use them due to discomfort, cognitive decline, or difficulty understanding proper usage and hygiene [4]. The binary classification of "with or without dentures" employed in the study by He et al. fails to capture these nuances [1]. Therefore, future research should incorporate validated instruments for assessing the quality of prostheses, such as the Oral Health Impact Profile for Edentulous Patients (OHIP-EDENT) or evaluations of chewing performance, alongside daily usage patterns and subsequent prosthesis maintenance [5]. This approach will provide a more comprehensive understanding of the effects of prosthetic rehabilitation on systemic health outcomes.

In conclusion, this well-designed study significantly enriches our understanding of the interplay between oral and systemic health in aging populations. It highlights the critical need to integrate dental care into geriatric evaluations and public health initiatives, especially in underserved communities. The study's longitudinal design, focus on rural settings, and consideration of subjective (impact on daily life) and objective (number of teeth, denture status) oral health variables considerably enhance its validity and practical relevance. Furthermore, the authors' exploration of denture presence and its potential preventive role adds substantial complexity to a frequently overlooked aspect of geriatric care. With the support of the recommendations provided, I am confident that this study will serve as a robust foundation for interventions aimed at improving the quality of life for elderly patients.

Author Contributions

E.S. wrote the main manuscript text and reviewed the manuscript.

Funding

The author received no specific funding for this work.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Conflict of interest

The authors declare no competing interests.

Ethical approval

Not applicable. This article does not involve any studies with human participants or animals performed by the author.

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Not applicable.

Consent for publication

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