Natural tooth loss and the risk of dying

Losing natural teeth to disease or decay was associated with a higher risk of dying in women.

Where you stand

Wu 2021 is an all-women cohort. That is a marker, not a treatment effect that has been shown. The question is tooth loss, not gum disease — gum disease in the same cohort was not significant.

Each row is one study of death risk from tooth loss. The bright line is what that study found. The band around it is the range the data still supports — it fades where the evidence thins. Left of the centre line is lower risk.

what the study foundstill plausibleno change

self-reported tooth loss due to disease/decay vs no loss

Wu et al. 2021

15% higher

range 5–26% higher

periodontal disease vs no periodontal disease (mostly clinical diagnosis)

Guo et al. 2023

31% higher

range 7–61% higher

What it is

Whether any natural adult teeth have been lost to disease or decay. That is tooth loss, not gum disease — gum disease in the same cohort was not significant.

How it is modeled (not scored)

Technical notes

The curve uses Wu 2021 (Sister Study, 50,884 women, self-reported disease/decay-related tooth loss): all-cause mortality HR 1.15 (1.05–1.26). Same-cohort self-reported periodontal disease was NS (HR 1.08, 0.98–1.19) — that is why the question is tooth loss, not gum health. No matching-construct all-cause mortality meta-analysis of binary any-vs-none self-report is available; Peng 2019 is the nearest tooth-loss pool and is a graded count (Table 3: RR 1.15 per 10 missing, 1.57 at 32), and it dropped binary papers. Romandini 1.46 / 1.66 and Guo 1.31 are clinical periodontitis or edentulism, not this UI. Peng’s own conclusion is risk marker, not a proven treatment effect.

How to improve it

See a dentist/hygienist regularly
Treat bleeding gums or decay early, before a tooth is lost
Discuss replacement options (implant/bridge/denture) if a tooth is already missing

What the studies found

Endpoint	Grade	Finding
All-cause mortality (per 10 teeth lost)	B	Nearest meta is graded, not binary (Peng 2019) Technical notes Table 3 all-cause mortality RR 1.15 per 10 missing teeth, 1.57 at 32. Dropped seven binary any-vs-none papers. Per-10 1.15 is not Wu’s binary 1.15. No matching-construct meta-analysis is available.
All-cause mortality (periodontitis / edentulism)	C	1.46 / 1.66 is not this score (Romandini 2020) Technical notes Clinical periodontitis RR 1.46; edentulism (total loss) RR 1.66. Different construct from None Lost / 1+ Lost. Those do not carry over to the curve’s 1.15.
All-cause mortality (periodontal disease)	C	Treating PD vs death is untested (Guo 2023) Technical notes PD pool RR 1.31 is mostly clinical exam. Self-report PD did not raise all-cause mortality. Authors: unknown whether treating PD lowers the risk of death. Marker, not a treatment effect.
All-cause mortality (self-reported tooth loss, women only)	C	1.15 in Women Only, From the Sister Study (Wu 2021) Technical notes Primary source: the Sister Study followed 50,884 women aged 35–74 (each with a sister who had breast cancer), mean 10.9 years, 2,058 deaths. Self-reported disease- or decay-related tooth loss carried all-cause mortality HR 1.15 (95% CI 1.05–1.26); self-reported periodontal disease alone was not significant (HR 1.08, 0.98–1.19). An all-women cohort, not the general population this calculator serves.

What argues against this

Romandini 2020 (57 studies/48 cohorts, 5.71 million people) is the strongest opposing number in this set, though it disagrees on construct and magnitude rather than direction: it reports clinical periodontitis all-cause mortality RR 1.46 and edentulism (total tooth loss) RR 1.66 — both notably larger than the curve's self-reported any-tooth-loss HR of 1.15 from Wu 2021 — because it measures a more severe, clinically confirmed construct rather than the self-reported binary this calculator asks about. It does not argue the direction is wrong, only that pasting its larger numbers onto this calculator's construct would overstate the risk.

Last reviewed 12 October 2026

Sources

5 cited

Wu et al. (2021) — Journal of Clinical Periodontology
Associations of periodontal disease and tooth loss with all-cause and cause-specific mortality in the Sister Study
View source
Peng et al. (2019) — Bioscience Reports
The relationship between tooth loss and mortality from all causes, cardiovascular diseases, and coronary heart disease in the general population: systematic review and dose-response meta-analysis of prospective cohort studies
View source
Romandini et al. (2020) — Journal of Dental Research
Periodontitis, Edentulism, and Risk of Mortality: A Systematic Review with Meta-analyses
View source
Guo et al. (2023) — PLOS ONE
Periodontal disease and subsequent risk of cardiovascular outcome and all-cause mortality: A meta-analysis of prospective studies
View source
Kotronia et al. (2021) — Scientific Reports
Oral health and all-cause, cardiovascular disease, and respiratory mortality in older people in the UK and USA
View source

Not part of your score

Tooth Loss is tracked here for its research. It does not count toward the 8-marker MarkerScore. See what does in the calculator.

Open calculator

Educational content only — not medical advice, diagnosis, or treatment. Not a medical device; not FDA evaluated. Consult a qualified healthcare professional about your own health, and call emergency services for urgent symptoms. Full medical disclaimer →