{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T20:54:51Z","timestamp":1788209691951,"version":"build-2803163510"},"reference-count":40,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Epidemiol Community Health"],"accepted":{"date-parts":[[2026,2,9]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>We evaluated the impact of the number of teeth on health expectancy, measured as years of life without limitations in activities of daily living (ADLs) and physical function, among adults aged \u226560 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data from 3384 older adults in a nationally representative longitudinal study in Singapore were analysed. Health expectancy was estimated using an inverse probability-weighted multistate life table approach with microsimulation. Number of teeth (time-varying) was the exposure, and baseline removable dental prostheses use was the modifier.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among older adults without removable dental prostheses, those with 20\u201332 teeth lived significantly more years without limitations than those with no teeth: 5.3 (95% CI 2.4 to 8.6), 4.2 (95% CI 1.9 to 6.5) and 2.6 (95% CI 1.3 to 4.0) additional years without ADL limitations, and 3.7 (95% CI 0.4 to 6.8), 2.5 (95% CI 0.3 to 4.3) and 1.3 (95% CI 0.2 to 2.2) additional years without physical function limitations, at ages 60, 70 and 80, respectively. Stratified analysis among non-prosthesis users detected the largest differences among males and participants with primary or less education. Among prosthesis users with secondary or higher education, those with 20\u201332 teeth had longer ADL limitation-free life expectancy, while those with 10\u201319 teeth had longer physical function limitation-free expectancy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Retaining more teeth may be associated with more years of independent living, without ADLs or physical function limitations. Removable dental prostheses were linked with health expectancy across sexes, highlighting the importance of both tooth retention and prosthetic rehabilitation in promoting healthy ageing.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/jech-2025-224814","type":"journal-article","created":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T18:20:25Z","timestamp":1771438825000},"page":"710-718","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Link between tooth loss and health expectancy: findings from a prospective Singaporean population-based cohort study of older adults"],"prefix":"10.1136","volume":"80","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7864-1401","authenticated-orcid":false,"given":"Huihua","family":"Li","sequence":"first","affiliation":[{"name":"National Dental Centre, Singapore"},{"name":"Health Services and Population Health Research Programme (HSPHR), Duke-NUS Graduate Medical School, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina P C","family":"Sim","sequence":"additional","affiliation":[{"name":"National Dental Centre, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhijit","family":"Visaria","sequence":"additional","affiliation":[{"name":"United Nations Population Fund, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Ma","sequence":"additional","affiliation":[{"name":"Government of Singapore Ministry of Health, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9978-4276","authenticated-orcid":false,"given":"Rahul","family":"Malhotra","sequence":"additional","affiliation":[{"name":"Health Services and Population Health Research Programme (HSPHR), Duke-NUS Graduate Medical School, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco Aurelio","family":"Peres","sequence":"additional","affiliation":[{"name":"National Dental Centre, Singapore"},{"name":"Health Services and Population Health Research Programme (HSPHR), Duke-NUS Graduate Medical School, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,2,18]]},"reference":[{"key":"2026081002300736000_80.9.710.1","unstructured":"World Health Organization . Ageing and health. Geneva, Switzerland, 2022."},{"key":"2026081002300736000_80.9.710.2","first-page":"2133","article-title":"Diseases and Injuries Collaborators. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021","volume":"403","year":"2021","journal-title":"Lancet"},{"key":"2026081002300736000_80.9.710.3","unstructured":"Oral Health . World health organization. 2025."},{"key":"2026081002300736000_80.9.710.4","first-page":"1","article-title":"Prevalence of Tooth Loss Among Older Adults: United States, 2015-2018","volume":"2020","author":"Fleming","year":"2020","journal-title":"NCHS Data Brief"},{"key":"2026081002300736000_80.9.710.5","doi-asserted-by":"crossref","DOI":"10.1111\/jicd.12459","article-title":"Dental status of the Iranian elderly: A systematic review and meta-analysis","volume":"10","author":"Rabiei","year":"2019","journal-title":"J Investig Clin Dent"},{"key":"2026081002300736000_80.9.710.6","doi-asserted-by":"publisher","DOI":"10.1177\/00220345010800020201"},{"key":"2026081002300736000_80.9.710.7","first-page":"4","article-title":"Tooth Loss and Nutritional Status in Older Adults: A Systematic Review and Meta-analysis","volume":"7","author":"Zelig","year":"2022","journal-title":"JDR Clin Trans Res"},{"key":"2026081002300736000_80.9.710.8","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.13190"},{"key":"2026081002300736000_80.9.710.9","doi-asserted-by":"crossref","first-page":"2336","DOI":"10.1111\/jgs.14324","article-title":"Tooth Loss and Decline in Functional Capacity: A Prospective Cohort Study from the Japan Gerontological Evaluation Study","volume":"64","author":"Sato","year":"2016","journal-title":"J Am Geriatr Soc"},{"key":"2026081002300736000_80.9.710.10","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1177\/00220345241226957","article-title":"Heterogeneous Association of Tooth Loss with Functional Limitations","volume":"103","author":"Matsuyama","year":"2024","journal-title":"J Dent Res"},{"key":"2026081002300736000_80.9.710.11","doi-asserted-by":"crossref","first-page":"101771","DOI":"10.1016\/j.jebdp.2022.101771","article-title":"Tooth Loss Trajectories and Their Association with Functional Disability among Older Chinese Adults: Results from the Chinese Longitudinal Healthy Longevity Survey","volume":"22","author":"Huang","year":"2022","journal-title":"J Evid Based Dent Pract"},{"key":"2026081002300736000_80.9.710.12","doi-asserted-by":"publisher","DOI":"10.1177\/0022034520952401"},{"key":"2026081002300736000_80.9.710.13","first-page":"4","article-title":"Exploring Oral Function, Protein Intake, and Risk of Sarcopenia: A Scoping Review","volume":"9","author":"Moynihan","year":"2024","journal-title":"JDR Clin Trans Res"},{"key":"2026081002300736000_80.9.710.14","doi-asserted-by":"crossref","DOI":"10.1186\/s12877-022-03350-7","article-title":"Nutrition mediates the relationship between number of teeth and sarcopenia: a pathway analysis","volume":"22","author":"Xia","year":"2022","journal-title":"BMC Geriatr"},{"key":"2026081002300736000_80.9.710.15","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1093\/gerona\/glac052","article-title":"Large Contribution of Oral Status for Death Among Modifiable Risk Factors in Older Adults: The Japan Gerontological Evaluation Study (JAGES) Prospective Cohort Study","volume":"78","author":"Nakazawa","year":"2023","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"2026081002300736000_80.9.710.16","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.54.7.1063"},{"key":"2026081002300736000_80.9.710.17","doi-asserted-by":"crossref","first-page":"105258","DOI":"10.1016\/j.jamda.2024.105258","article-title":"Number of Teeth and Dementia-free Life Expectancy: A 10-Year Follow-Up Study from the Japan Gerontological Evaluation Study","volume":"25","author":"Kiuchi","year":"2024","journal-title":"J Am Med Dir Assoc"},{"key":"2026081002300736000_80.9.710.18","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0130747","article-title":"A Systematic Literature Review of Studies Analyzing Inequalities in Health Expectancy among the Older Population","volume":"10","author":"Pongiglione","year":"2015","journal-title":"PLoS One"},{"key":"2026081002300736000_80.9.710.19","unstructured":"Singapore Po . Notice Paper No.2782: Notice of Question for Written Answer for the Sitting of Parliament on 7 May 2024. Singapore: Parliament of Singapore, 2024."},{"key":"2026081002300736000_80.9.710.20","doi-asserted-by":"crossref","first-page":"104287","DOI":"10.1016\/j.jdent.2022.104287","article-title":"Denture wearing status, cardiovascular health profiles, and mortality in edentulous patients: A prospective study with a 27-year follow-up","volume":"126","author":"Dai","year":"2022","journal-title":"J Dent"},{"key":"2026081002300736000_80.9.710.21","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39335.541782.AD"},{"key":"2026081002300736000_80.9.710.22","doi-asserted-by":"crossref","first-page":"1750","DOI":"10.1093\/ije\/dyz172","article-title":"Cohort Profile: Panel on Health and Ageing of Singaporean Elderly (PHASE)","volume":"48","author":"Chan","year":"2019","journal-title":"Int J Epidemiol"},{"key":"2026081002300736000_80.9.710.23","doi-asserted-by":"crossref","first-page":"105518","DOI":"10.1016\/j.jdent.2024.105518","article-title":"Tooth loss explains income inequalities in dementia","volume":"153","author":"Shimada","year":"2025","journal-title":"J Dent"},{"key":"2026081002300736000_80.9.710.24","doi-asserted-by":"publisher","DOI":"10.2307\/3349677"},{"key":"2026081002300736000_80.9.710.25","unstructured":"Chiu C-T . The space program. 2018."},{"key":"2026081002300736000_80.9.710.26","doi-asserted-by":"publisher","DOI":"10.4054\/DemRes.2010.22.6"},{"key":"2026081002300736000_80.9.710.27","doi-asserted-by":"publisher","DOI":"10.7326\/M16-2607"},{"key":"2026081002300736000_80.9.710.28","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1177\/0022034517713166","article-title":"Dental Status and Compression of Life Expectancy with Disability","volume":"96","author":"Matsuyama","year":"2017","journal-title":"J Dent Res"},{"key":"2026081002300736000_80.9.710.29","doi-asserted-by":"crossref","DOI":"10.1017\/S0007114521000878","article-title":"Poor oral health and the association with diet quality and intake in older people in two studies in the UK and USA - CORRIGENDUM","volume":"126","author":"Kotronia","year":"2021","journal-title":"Br J Nutr"},{"key":"2026081002300736000_80.9.710.30","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2005.00540.x"},{"key":"2026081002300736000_80.9.710.31","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2010.03145.x"},{"key":"2026081002300736000_80.9.710.32","doi-asserted-by":"crossref","first-page":"104767","DOI":"10.1016\/j.jdent.2023.104767","article-title":"A longitudinal study of self-report tooth loss impacting functional status among Chinese older adults: moderated mediation of social relationships and psychological resilience","volume":"2023","author":"Ma","year":"2023","journal-title":"J Dent"},{"key":"2026081002300736000_80.9.710.33","doi-asserted-by":"publisher","DOI":"10.1177\/0022034511421931"},{"key":"2026081002300736000_80.9.710.34","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0287856","article-title":"Onset of ADL and IADL limitation among Chinese middle-aged and older adults","volume":"18","author":"Zheng","year":"2023","journal-title":"PLoS One"},{"key":"2026081002300736000_80.9.710.35","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2024.1485732","article-title":"Longitudinal trends and predictors of limitations in activities of daily living in community-dwelling older adults: evidence from the KLoSA study","volume":"12","author":"Oh","year":"2024","journal-title":"Front Public Health"},{"key":"2026081002300736000_80.9.710.36","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1300\/J031v17n03_04","article-title":"Long-term care insurance in Japan","volume":"17","author":"Ozawa","year":"2005","journal-title":"J Aging Soc Policy"},{"key":"2026081002300736000_80.9.710.37","first-page":"100893","article-title":"Healthier SG: for a healthier Singapore and beyond","volume":"37","year":"2023","journal-title":"Lancet Reg Health West Pac"},{"key":"2026081002300736000_80.9.710.38","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1057\/s41271-025-00592-8","article-title":"Singapore\u2019s health reforms in response to an aging society","volume":"46","author":"Panesar","year":"2025","journal-title":"J Public Health Policy"},{"key":"2026081002300736000_80.9.710.39","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1097\/00001648-200009000-00012","article-title":"Marginal Structural Models to Estimate the Causal Effect of Zidovudine on the Survival of HIV-Positive Men","volume":"11","author":"Hern\u00e1n","year":"2000","journal-title":"Epidemiology (Sunnyvale)"},{"key":"2026081002300736000_80.9.710.40","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1111\/cdoe.12961","article-title":"Findings from the 2019 nationally representative oral health survey for adults in Singapore","volume":"52","author":"Sim","year":"2024","journal-title":"Comm Dent Oral Epid"}],"container-title":["Journal of Epidemiology and Community Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jech-2025-224814","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T09:30:55Z","timestamp":1786354255000},"score":1,"resource":{"primary":{"URL":"https:\/\/jech.bmj.com\/lookup\/doi\/10.1136\/jech-2025-224814"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,18]]},"references-count":40,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,8,10]]},"published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1136\/jech-2025-224814"],"URL":"https:\/\/doi.org\/10.1136\/jech-2025-224814","relation":{},"ISSN":["0143-005X","1470-2738"],"issn-type":[{"value":"0143-005X","type":"print"},{"value":"1470-2738","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,18]]}}}