ABSTRACT
The National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) is a database including health insurance claim and specific health checkup data. Observational studies using real-world big data attract attention because they have certain strengths, including external validity and a large sample size. This review focused on research using the dental formula of the NDB because the number of teeth is an important indicator of oral health. The number of teeth present calculated using the dental formula of periodontitis patients was similar to that from the Survey of Dental Diseases. In addition, the graphs of the presence rates of tooth types by 5-year age groups from the NDB were smoother and had less overlap than those from the Survey of Dental Diseases, and they could detect slight changes in the presence rate that reflected sugar consumption before and after World War II. Using the NDB, a low number of teeth was associated with high medical care expenditures, high risk of aspiration pneumonia, and high risk of Alzheimer's disease. Although there are some restrictions on the use of the NDB, we hope that dental research using the NDB will be further promoted in the future.
ABSTRACT
Associations of numbers of teeth present and of missing teeth with Alzheimer's disease were cross-sectionally analyzed using the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Dental care claims data of patients aged 60 years or older diagnosed with periodontitis (n = 4,009,345) or missing teeth (n = 662,182) were used to obtain information about the numbers of teeth present and of missing teeth, respectively, and they were combined with medical care claims data including the diagnosis of Alzheimer's disease. Numbers of teeth present and of missing teeth excluding third molars were calculated using the dental formula in the claims for periodontitis and missing teeth, respectively, and categorized into three groups each. Percentages of subjects treated for Alzheimer's disease with 20-28, 10-19, and 1-9 teeth present were 1.95%, 3.87%, and 6.86%, respectively, in patients diagnosed as having periodontitis, and those treated for Alzheimer's disease with 1-13, 14-27, and 28 missing teeth were 2.67%, 5.51%, and 8.70%, respectively, in patients diagnosed as having missing teeth. Logistic regression models using treatment for Alzheimer's disease as an outcome variable and adjusting for age and sex showed that odds ratios (95% confidence intervals) for patients with 10-19 and 1-9 teeth (reference: 20-28 teeth) were 1.11 (1.10-1.13) and 1.34 (1.32-1.37), respectively, (p<0.001), in patients diagnosed as having periodontitis, and odds ratios (95% confidence intervals) for patients with 14-27 missing teeth and 28 missing teeth (reference: 1-13 missing teeth) were 1.40 (1.36-1.44) and 1.81 (1.74-1.89), respectively, (p<0.001), in patients diagnosed as having missing teeth. In conclusion, the results of the present study using Japanese dental claims data showed that older people visiting dental offices with fewer teeth present and a greater number of missing teeth are more likely to have Alzheimer's disease.
