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Dental Implant Rehabilitation Mitigates the Increased Mortality Risk Associated With Tooth Loss: A Population-Based
John Rong Hao Tay1,2, Gustavo G Nascimento3, Mario Romandini4
1Health Services Research and Population Health Programme, Duke-NUS Medical School, Singapore.
Journal of Periodontal Research
|March 19, 2026
Summary
Losing natural posterior masticatory units (PMUs) increases mortality risk, partly due to diet quality. Implant-supported prostheses may restore survival rates, mitigating this risk.
Area of Science:
- Oral health research
- Gerontology
- Public health
Background:
- Posterior masticatory unit (PMU) loss is common and may impact overall health.
- The relationship between PMU loss, mortality, and potential mediating factors like diet and BMI requires further investigation.
- The role of prosthetic rehabilitation in mitigating mortality risk associated with PMU loss is not fully understood.
Purpose of the Study:
- To evaluate the association between posterior masticatory unit (PMU) loss and all-cause mortality.
- To quantify the mediating roles of dietary intake, nutritional biomarkers, and body mass index (BMI) in this association.
- To assess whether prosthetic rehabilitation modifies the relationship between PMU loss and mortality.
Main Methods:
- Analysis of data from 17,109 adults (NHANES 1999-2004 and 2011-2014) with mortality follow-up.
- Classification of PMUs based on natural teeth and prosthetic rehabilitation (none, conventional, implant-supported).
- Weighted Cox regression and causal mediation models were used to analyze mortality risk and mediation effects.
Main Results:
- Compared to individuals with ≥5 natural PMUs, mortality risk was higher for those with <5 PMUs without rehabilitation (aHR 1.60) and those with <5 PMUs despite restorations (aHR 1.29).
- Individuals with ≥5 PMUs from removable or fixed prostheses also showed increased mortality risk (aHR 1.27), while ≥5 implant-supported PMUs showed no excess risk (aHR 1.00).
- Diet quality mediated 6%-11% of the association; fruit, fiber, protein, nutritional biomarkers, and BMI had smaller contributions.
Conclusions:
- Loss of natural PMUs is linked to increased all-cause mortality, with partial mediation by diet quality.
- Prosthetic rehabilitation, particularly implant-supported prostheses, appears to attenuate or eliminate this excess mortality risk.
- Implant-supported rehabilitation may be a beneficial option for individuals with lost posterior teeth, potentially improving survival.
