On average, older adults in the Special Region of Yogyakarta still have approximately 22 natural teeth in their mouths. That figure sounds fairly encouraging—until researchers began examining its relationship with body weight, and the results proved to be more complex than expected.
A study published in the April 2022 edition of Majalah Kedokteran Gigi Klinik (MKGK) UGM found that body mass index (BMI) was closely associated with oral and dental conditions in older adults, ranging from the number of remaining teeth and oral hygiene to periodontal tissue health. The study involved 186 older adults aged 60–84 years from eight elderly community health posts (Posyandu Lansia) in the Special Region of Yogyakarta—four in rural areas and four in urban areas.
More Than Just Body Weight
The research team, consisting of Fitrina Rachmadanty Siregar, Lisdrianto Hanindriyo, Elastria Widita, Dr. drg. Rini Widyaningrum, M.Biotech., Bambang Priyono, and Dewi Agustina, examined six aspects of each participant's oral health: number of teeth, Oral Hygiene Index (OHI), caries index (DMFT), bleeding on probing (BOP), periodontal pocket depth (PPD), and clinical attachment loss (CAL).
The results revealed an interesting pattern. Older adults with higher BMI tended to have more remaining teeth (r = 0.233). This makes biological sense: having an adequate number of teeth enables individuals to chew nutritious foods more effectively, helping maintain adequate nutritional intake and preventing excessive weight loss. Conversely, older adults who have lost many teeth often avoid hard-textured foods such as meat and nuts, which are rich in protein and essential nutrients.
However, one finding was somewhat surprising. Oral hygiene showed a negative association with BMI (r = -0.384). In other words, older adults with higher BMI tended to have better oral hygiene rather than poorer hygiene. The researchers suggest that this may be related to access: urban residents, who had a higher average BMI (25.0), may have easier access to dental health facilities and information than rural residents (mean BMI of 22.7).
Body Fat, Inflammation, and Periodontal Pockets
The relationship between BMI and periodontal tissues offers another important perspective. In overweight individuals, fat cells (adipocytes) release pro-inflammatory cytokines such as TNF-α and IL-6. These substances not only trigger systemic inflammation but also stimulate the production of osteoclasts, which directly contribute to the destruction of alveolar bone and the connective tissues supporting the teeth.
The study found a positive association between BMI and the percentage of tooth sites with pocket depths greater than 4 mm (r = 0.177). Pocket depths exceeding this threshold are a marker of periodontitis, a chronic infection of the tissues supporting the teeth that can eventually lead to tooth loss if left untreated. As people age, their cumulative exposure to periodontal bacteria also increases, making this risk difficult to ignore.
“Poor oral health among older adults can affect their nutritional status and overall health. Disorders of the oral cavity contribute to discomfort during eating.” — Siregar et al., MKGK UGM, 2022
Caries Does Not Tell the Same Story
One finding that was not supported by the study was an association between BMI and dental caries (p = 0.063, not statistically significant). This finding is consistent with several previous studies that have also failed to identify a consistent correlation between the two variables.
The explanation lies in the complexity of dental caries itself. Genetic susceptibility, individual dietary habits, toothbrushing frequency, and salivary conditions vary considerably between individuals, meaning that BMI alone cannot explain caries risk. A decade-long longitudinal study in Sweden even showed that caries prevalence among older adults did not increase significantly, suggesting that older adults can maintain good dental health when they practice proper oral hygiene.
Dentures Are Not a Last Resort
This study carries an important practical message, particularly for healthcare workers serving older adults through community health posts: tooth loss is not merely an aesthetic problem. It is directly associated with chewing ability, food choices, nutritional intake, and ultimately body weight and quality of life.
Replacing missing teeth with dentures is not a luxury but a functional intervention that can affect the nutritional status of older adults. At the same time, the finding that access to dental health information differs between urban and rural populations reminds us that oral health among older adults is also a matter of equitable healthcare access.
At an age when the body can no longer fully compensate on its own, keeping natural teeth in place may be one of the best investments a person can make—long before the weighing scale begins telling a more serious story.
Source DOI: doi: 10.1111/idh.12490
Authors: Anny Anggraini; drg. Achmad Zam Zam Aghasy, M.Kes.
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