Functional Tooth Units, Oral Disease Status and Dietary Quality in a Representative US Population

To investigate how functional tooth units (FTUs) and oral conditions are associated with dietary quality through multidimensional measures within a unified analytic framework.

Data were drawn from 6291 adults in the 2011-2014 National Health and Nutrition Examination Survey. Dentition status was assessed using FTUs and tooth count, and oral disease status was classified based on both untreated caries and periodontitis. Dietary outcomes derived from two 24-h dietary recalls included the Healthy Eating Index-2020 (HEI-2020), Dietary Approaches to Stop Hypertension index (DASH), alternate Mediterranean diet score (MED), Dietary Inflammation Index (DII), food groups and nutrient intakes. Distributional differences and associations between oral conditions and dietary outcomes were assessed using survey-weighted analyses.

Participants with adequate FTUs had higher dietary quality than participants with impaired FTUs or edentulous participants. In fully adjusted models, each additional FTU was associated with higher HEI-2020 scores (β = 0.41, 95% CI: 0.29-0.54), lower DII scores (β = -0.06, 95% CI: -0.09 to -0.04) and more reported food items (β = 0.09, 95% CI: 0.04-0.14). Among dentate adults, untreated caries status was linked to less favourable dietary profiles after FTUs adjustment. In disease extent analyses, Decay% was associated with higher dietary quality indices than Decay + Filling% or periodontal parameters. After full adjustment, only Decay% remained significantly associated with added sugar intake in the analyses for foods and nutrients. In addition, oral conditions were significantly associated with overall food or nutrient variation, whereas sociodemographic factors accounted for a larger proportion of overall variation.

Oral conditions show distinct associations with dietary quality. Impaired FTUs are linked to poorer dietary quality; coexisting caries and periodontitis are associated with the least favourable dietary quality. Oral conditions may help identify adults with less favourable dietary profiles, although sociodemographic factors explained greater overall dietary variation.