EHR Data Mining to Understand Trends in Association of Systemic Health Factors and Tooth Loss

NAYANJOT KAUR RAI
Research Associate, University of Colorado School of Dental Medicine and Clinics

Tooth loss is a major contributing factor to oral health quality of life. Retaining at least 20 natural teeth is essential to maintain functional and aesthetic dentition throughout life. Tooth loss has been linked to some systemic diseases including, cardiovascular diseases (CVD) and diabetes and self-reported poor health status. We aim to evaluate the association of systemic health factors, including CVD, diabetes and tobacco use with tooth loss in patients visiting the University of Colorado School of Dental Medicine (SDM) clinics over four years. Also, we aim to analyze the trends in this association for the four consecutive years, 2017, 2018, 2019, and 2020.

Data was collected through mining the electronic health records (EHRs) by the firstyear dental students and third-year advanced degree international dental students and 2709 current patients were included (≥55 years of age). The EHRs were reviewed for age, gender, ethnicity, self-reported systemic diseases including, CVD, diabetes, and tobacco use and the number of natural teeth present in the oral cavity(<20: yes/no), which was chosen as the outcome of interest. Univariate and multivariate logistic regression analysis was performed to test the association between patients having <20 natural teeth and self-reported systemic diseases. Also, trends in the odds of having <20 teeth and percentage of <20 teeth in the oral cavity varying by reported systemic health factors were analyzed.

Of the 2709 patients, 37% had <20 natural teeth. The odds of having <20 teeth were higher in patients who reported having CVD (OR=1.3, 95% CI=1.1, 1.5, p=0.0007) and diabetes (OR=1.6, 95% CI=1.4, 2.0, p<0.0001) compared to patients who did not report CVD and diabetes respectively. Similarly, the odds of having <20 teeth were found to be more than two times greater in patients reporting tobacco use (OR=2.4, 95% CI=1.8, 3.0, p=<0.0001) compared to patients who never used tobacco. The trends analysis results demonstrated an increase in the odds of having <20 teeth from the years 2017 to 2019 in the adults who reported having diabetes followed by a decrease in 2020 (Figure 1). The odds of having <20 teeth increased in adults reporting CVD over the four years (Figure 1a). An overall increasing trend in the odds of having <20 teeth was also seen in adults reporting tobacco use.

The results have shown that patients reporting CVD, diabetes, and tobacco use are more likely to have tooth loss, and the odds have increased since 2017. The results indicate the need for educational programs to educate the SDM patients and students. The knowledge gained can lead to the design and implementation of evidence-based interventions at the school and community levels, thereby benefiting the overall health of the population.