Edentulism is defined as the absence or complete loss of all natural dentition (teeth). While tooth loss has long been considered an inevitable part of the aging process, significant changes in oral disease patterns have occurred in the twentieth century relative to the rate of edentulism in the United States. Until the mid–twentieth century, much of dental care was devoted to tooth extraction. Prevention of dental decay was unknown, and attempts to restore cavities were often painful. However, data from the third National Health and Nutrition Examination Survey (NHANES III) in 1996 reported that just 10.5 percent of adults aged 18 or older were completely edentulous. There are significant age-cohort differences in edentulism rates that continue to reflect changes in treatment patterns from the early twentieth century. As of 1996, just 1 percent of 25-to 34-year-olds are were edentulous, compared to 44 percent of those aged 75 or over. It has been estimated that by 2024, 10 percent of Americans between 65 and 74 will be edentulous, compared to nearly 28 percent edentulous in this age group in 1988 to 1991.
Tooth loss results from dental decay, gum disease (periodontitis), or accident. It can also reflect attitudes of the patient or provider, accessibility to dental care, or prevailing societal attitudes regarding oral health care. Edentulism is considerably less prevalent in higher than lower socioeconomic segments of the population. In the United States, whites have demonstrated higher rates of edentulism than African Americans. This difference may be attributed to better access to dental care among whites, who then are at greater risk for tooth extraction. Women have consistently displayed higher rates of edentulism and become edentulous at earlier ages than men. This difference, while difficult to explain, may be representative of differences in the dentist-patient relationship, rather than differences in disease patterns. The dentally uninsured have consistently shown higher levels of edentulism, which may be a result of limited use of preventive and restorative dental services. Within the United States, dental insurance is employment based, and Medicare does not cover routine or preventive services for adults over the age of 65, those most likely to be completely edentulous.
Risk factors for edentulism include socioeconomic status, income, education level, and smoking. Edentulous individuals have been identified as being at greater risk for cardiovascular disease than are dentate individuals. Retention of fewer teeth in older adults has been correlated with poorer health, in contrast to greater tooth retention among people of the same age who report better general health. Replacement of missing teeth has historically focused on the fabrication of complete dentures. Materials used in the earliest dentures ranged from carved ivory to animal bones. Often the results were only slightly better than
As the trend for retention of teeth increases, more natural teeth are at risk for dental caries (decay) and periodontal (gum) disease. Public health preventive strategies aimed at preventing tooth loss include the continuation of optimal levels of water fluoridation; expansion of dental insurance, particularly for older adults; and the appropriate use of fluoride-containing or antibacterial agents, such as dentifrices, topical gels, and mouth rinses. Increased tobacco-control educational activities, expanded access to affordable oral health care, more positive attitudes toward tooth retention, and more conservative dental treatment decisions are additional strategies for decreasing total tooth loss.
MICHAEL S. STRAYER
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