Association between tooth loss and mortality in patients with rheumatoid arthritis

Aim This study aimed to examine the association between all-cause and cardiovascular mortality in patients with rheumatoid arthritis (RA) who have missing teeth.Methods Data were obtained from RA patients aged 18 and older from the National Health and Nutrition Examination Surveys conducted between 1999-2004 and 2011-2014. Participants underwent detailed oral examinations. The relationship between the number of missing teeth and mortality risk was analysed using Cox regression models and restricted cubic splines.Results A cohort of 1,720 patients was followed for up to 187 months, during which 627 deaths occurred, including 191 attributable to cardiovascular causes. In RA patients, each additional missing tooth was associated with a 2% increase in all-cause mortality risk. Patients with 15-28 missing teeth demonstrated hazard ratios (HRs) of 4.05 (95% confidence interval [CI]: 2.94-5.57) for all-cause mortality and 2.47 (95% CI: 1.19-5.14) for cardiovascular mortality, compared to those with no missing teeth. Notably, when the number of missing teeth reached ten or more, the risk of cardiovascular mortality decreased by 14% per additional missing tooth (HR: 0.86 [95% CI: 0.81-0.91]).Conclusions In patients with RA, when the number of missing teeth is <10, cardiovascular mortality risk increased with additional tooth loss, whereas when the number is ≥10, cardiovascular mortality risk decreased with further tooth loss.