Dentition Status and Denture Use in Relation to Later-Life Health Transitions in Older Chinese Adults

Introduction and aims We examined whether baseline dentition status was associated with transitions to activities of daily living (ADL) disability, dementia, both ADL disability and dementia, and death in older Chinese adults, and whether denture use further distinguished risk within low-dentition groups. Methods We analysed Chinese Longitudinal Healthy Longevity Survey data from 2008 to 2018. Participants were aged 65 years or older, had baseline natural tooth count data, and had no observed ADL disability or reported dementia at baseline. Dentition status was classified as at least 20 teeth, 1-19 teeth, and 0 teeth. Transition-specific discrete-time complementary log-log models were fitted within a cumulative five-state framework comprising Healthy, ADL disability only, dementia only, both ADL disability and dementia, and death. Results A total of 10,186 participants contributed 18,688 interval-level observations. The most frequent transitions were to death (n = 5,063) and ADL disability only (n = 2,048). Compared with participants with at least 20 teeth, those with 0 teeth had higher hazards of ADL disability only (HR: 1.20, 95% CI, 1.04-1.39) and death (HR: 1.18, 95% CI, 1.06-1.31). In joint analyses, those with 0 teeth and dentures had the highest hazard of ADL disability only (HR: 1.30, 95% CI, 1.10-1.53), whereas those with 0 teeth and no dentures had the highest hazard of death (HR: 1.33, 95% CI, 1.18-1.49). Dementia-related transitions were sparse. Conclusion Among older Chinese adults without observed ADL disability or reported dementia at baseline, edentulism was associated with less favourable later-life transitions, most consistently to ADL disability and death. Baseline dentition status may serve as a simple marker of oral functional reserve and broader later-life vulnerability. Clinical Relevance Baseline dentition and denture status may help identify older adults who warrant broader assessment of function, nutrition, frailty, and oral rehabilitation needs.