title: Association between Number of Teeth and Chronic Systemic Diseases: A Cohort Study Followed for 13 Years.
abstract: BACKGROUND
  There is growing evidence of an association between oral health, specifically dental status, and chronic systemic diseases. However, varying measures of dental status across different populations and low study sample has made comparison of studies and conclusion of findings unclear. Our aim is to examine whether the number of teeth as a measure of dental status is associated with incident chronic diseases in a cohort setting.
  
  
  METHODS
  We conducted a cohort study among 24,313 middle-aged Germans followed up for 13 years. Data on number of teeth as a measure of dental status were obtained through self-reports. Outcomes were clinically-verified incident non-fatal myocardial infarction, stroke, type 2 diabetes mellitus, and cancer. Hazard ratio (HR) and 95% confidence intervals (CI) were obtained from Cox regression models.
  
  
  RESULTS
  Increasing number of teeth is inversely related to risk of myocardial infarction (HR: 0.97; 95% CI: 0.96, 0.99). The full multivariate model of teeth groups showed a strong linear trend for myocardial infarction, a less strong trend for stroke, and no relation with type 2 diabetes mellitus and cancer in a competing risk model. Participants with 18-23 teeth and those without teeth were at 76% (95%CI: 1.04, 3) and 2.93 times (95%CI: 1.61, 5.18) higher risk of myocardial infarction compared to those with nearly all teeth (28-32 teeth).
  
  
  CONCLUSIONS
  Number of teeth is specifically associated with myocardial infarction and not with other chronic disease indicating that dental status further strengthens the link between oral health and cardiovascular diseases.
authors.affiliation: Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Nuthetal, Germany.
authors.forename: Kolade
authors.initials: K
authors.lastname: Oluwagbemigun
authors.affiliation: Department of Oral Surgery, the School of Dentistry, University of Birmingham, Birmingham, United Kingdom.
authors.forename: Thomas
authors.initials: T
authors.lastname: Dietrich
authors.affiliation: Department of Periodontology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Nicole
authors.initials: N
authors.lastname: Pischon
authors.affiliation: Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Nuthetal, Germany.
authors.forename: Manuela
authors.initials: M
authors.lastname: Bergmann
authors.affiliation: Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Nuthetal, Germany.
authors.forename: Heiner
authors.initials: H
authors.lastname: Boeing
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D009909:Oral Health; D016016:Proportional Hazards Models; D014076:Tooth Diseases / Q000453:epidemiology*