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<jats:p>Tooth loss was longitudinally associated with social isolation. The absence of dental prosthesis use was an additional risk factor. However, the mediating pathways for this association are unknown. The aim of this cohort study was to estimate the mediating effect of three oral functions: speaking, smiling and chewing observed at baseline on the association between oral health at baseline and social isolation after 6\u2009years of follow\u2010up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The 2010\u20132016 panel data from 6103 functionally independent participants aged \u2265\u200965\u2009years who were not socially isolated at baseline was used from the Japan Gerontological Evaluation Study (JAGES). Causal mediation analysis using parametric logistic regression models was used to calculate the natural direct effect (NDE), the natural indirect effect (NIE), and the total effect. Social isolation was derived from a 5\u2010point index and dichotomised (0\/3\u2009=\u2009not isolated, 4\/5\u2009=\u2009isolated). The confounders observed at baseline were age, sex, educational attainment, income, activities of daily living, living area, and having depressive symptoms assessed using the geriatric depression scale (GDS\u201015).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The mean age of the participants was 72.4\u2009years (SD\u2009=\u2009\u00b15.1), and 44.7% were males. Social isolation was observed at follow\u2010up among 3.6% of participants (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009220). The cumulative incidence rate of socially isolated participants among those with \u2265\u200920 teeth was 2.9% increasing gradually to 3.2%, 3.5%, 3.7% and 7.2% among those with 10\u201319 teeth and used dental prosthesis, 10\u201319 teeth and did not use the dental prosthesis, 0\u20139 teeth and used dental prosthesis, and 0\u20139 teeth and did not use the dental prosthesis respectively. Compared with those with \u2265\u200920 teeth, having difficulty in speaking [NIE odds ratio (OR)\u2009=\u20091.02, 95% confidence interval (CI)\u2009=\u20090.93\u20131.11], problems in smiling (NIE OR\u2009=\u20091.02, 95% CI\u2009=\u20090.93\u20131.10) and difficulty in chewing (NIE OR\u2009=\u20091.04, 95% CI\u2009=\u20090.94\u20131.14) might have mediated the association for those with 10\u201319 teeth and used dental prosthesis as well as for those with 10\u201319 teeth without dental prosthesis (NIE OR\u2009=\u20091.02, 95% CI\u2009=\u20090.94\u20131.10), (NIE OR\u2009=\u20091.02, 95% CI\u2009=\u20090.93\u20131.11) and (NIE OR\u2009=\u20091.02, 95% CI\u2009=\u20090.93\u20131.11) respectively. While they might not have mediated the association for those with 0\u20139 teeth with and without dental prosthesis use.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>With low precision and uncertain estimates, limited oral function might have mediated the association between tooth loss (10\u201319 with and without dental prosthesis use groups) and social isolation over 6\u2009years. It was uncertain whether a mediation effect of oral functions was observed for those with 0\u20139 teeth with and without dental prosthesis use.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/cdoe.70035","type":"journal-article","created":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T03:39:56Z","timestamp":1761536396000},"page":"220-230","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Oral Health and Social Isolation After 6\u2009Years: Mediation of Oral Functions"],"prefix":"10.1111","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1529-290X","authenticated-orcid":false,"given":"Hazem","family":"Abbas","sequence":"first","affiliation":[{"name":"Department of International and Community Oral Health Tohoku University, Graduate School of Dentistry  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenji","family":"Takeuchi","sequence":"additional","affiliation":[{"name":"Department of International and Community Oral Health Tohoku University, Graduate School of Dentistry  Sendai Japan"},{"name":"Division of Statistics and Data Science, Liaison Center for Innovative Dentistry Tohoku University Graduate School of Dentistry  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taro","family":"Kusama","sequence":"additional","affiliation":[{"name":"Department of International and Community Oral Health Tohoku University, Graduate School of Dentistry  Sendai Japan"},{"name":"Division of Statistics and Data Science, Liaison Center for Innovative Dentistry Tohoku University Graduate School of Dentistry  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sakura","family":"Kiuchi","sequence":"additional","affiliation":[{"name":"Department of International and Community Oral Health Tohoku University, Graduate School of Dentistry  Sendai Japan"},{"name":"Frontier Research Institute for Interdisciplinary Sciences Tohoku University  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken","family":"Osaka","sequence":"additional","affiliation":[{"name":"Department of International and Community Oral Health Tohoku University, Graduate School of Dentistry  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,26]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"World Health Organization \u201cSocial Isolation and Loneliness Among Older People: Advocacy Brief \u201d(2021 accessed July 22 2024) https:\/\/www.who.int\/publications\/i\/item\/9789240030749."},{"key":"e_1_2_10_3_1","unstructured":"World Health Organization \u201cWHO Commission on Social Connection \u201d(2025 accessed August 6 2025) https:\/\/www.who.int\/groups\/commission\u2010on\u2010social\u2010connection."},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/1745691614568352"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/gps.447"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/58.10.m954"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2016.303166"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/hsc.12311"},{"key":"e_1_2_10_9_1","unstructured":"World Health Organization \u201cGlobal Health and Aging. 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