Tooth Loss and Edentulism Are Associated With Poorer Quality of Life: A Systematic Review and Meta-Analyses

Tooth loss and edentulism are common consequences of oral diseases and may compromise quality of life, yet population-level evidence remains heterogeneous. This systematic review and meta-analysis evaluated the association between tooth loss, edentulism, and quality of life outcomes in adults using population-based epidemiological studies.

MEDLINE, Embase, Scopus, and CENTRAL were searched for observational studies of representative adult populations assessing associations between tooth loss or edentulism and oral health-related quality of life (OHRQoL) or general quality of life (QoL), measured using validated instruments. Risk of bias was assessed using the Newcastle-Ottawa Scale (including adaptations for cross-sectional studies), and certainty of evidence was evaluated using GRADE. Random-effects meta-analyses were conducted for comparable adjusted effect estimates, stratified by estimand and exposure definition. For binary OHRQoL outcomes, pooling was based on study-specific dichotomizations reported by the original studies.

Fifty articles comprising 55 population-based cohorts (287 750 participants from 37 countries) were included. Among these, four were prospective cohort studies, and the remaining had cross-sectional designs. Thirteen articles contributed to the quantitative synthesis. Individuals with nonfunctional dentition had approximately twice the odds of impaired OHRQoL compared with those with functional dentition [pooled adjusted odds ratio (OR) = 2.08; 95% CI 1.72-2.52; I² = 70.6%]. This association remained robust in analyses restricted to studies using the OHIP-14 instrument (OR = 2.03; 95% CI 1.65-2.50; I² = 65.9%). Overall associations between edentulism and impaired OHRQoL were heterogeneous; however, when restricted to OHIP-14-based studies, edentulism was associated with impaired OHRQoL (OR = 3.99; 95% CI 2.62-6.10; I² = 0.0%). Reduced posterior occlusal support was also associated with worse OHRQoL, although the supporting evidence remains limited. Certainty of evidence for OHRQoL outcomes was rated as moderate.

In population-based adult samples, tooth loss, particularly when resulting in nonfunctional dentition or reduced occlusal support, is consistently associated with poorer OHRQoL. Associations with general QoL are less consistent, reflecting broader determinants and instrument sensitivity. Preserving functional dentition and access to effective prosthetic rehabilitation may yield meaningful quality-of-life benefits at the population level.