Severe Tooth Loss, Diabetes-Range HbA1c, and Heart Disease Mortality in US Adults

Background. Severe tooth loss and diabetes are common in dental practice, but whether co-occurrence marks increased heart disease mortality remains unclear. We evaluated associations with heart disease and all-cause mortality in US adults. Methods. We analyzed 13,222 adults from the National Health and Nutrition Examination Survey 1999–2006 linked to 2019 mortality data. Severe tooth loss was defined as 8 or fewer teeth. Survey-weighted models estimated associations, interactions, and 10-year risk. Results. Over 15.1 years, 1,178 heart disease deaths occurred. Severe tooth loss remained associated with heart disease mortality after adjustment for diabetes-range glycated hemoglobin A1c and covariates (hazard ratio, 1.44; 95% confidence interval, 1.22 to 1.71). Adults with both conditions had a hazard ratio of 2.40 (95% confidence interval, 1.83 to 3.16) versus the reference group (>8 teeth; glycated hemoglobin A1c <6.5%). Standardized 10-year risk was 52.5 versus 26.2 per 1,000; difference, 26.3 per 1,000. All-cause mortality was elevated. The combined group was not clearly different from the diabetes-range-only group, and interaction estimates were not statistically clear. Conclusions. Severe tooth loss remained associated with heart disease mortality after glycemic and covariate adjustment. Co-occurrence marked the highest absolute heart disease mortality burden, although added risk beyond diabetes-range glycemia and statistical interaction were not demonstrated. Practical Implications. Severe tooth loss is readily recognized during dental examination and may help dentists place oral status within a broader cardiometabolic context, reinforcing medical-history review and interprofessional communication when clinically indicated. Tooth count alone should not guide cardiovascular screening or referral.