Global population ageing has emerged as one of the most significant demographic transitions of the twenty-first century. According to the World Health Organization (WHO), the proportion of individuals aged 60 years and above is expected to double by 2050, reaching approximately 2.1 billion people. As longevity increases, maintaining oral health becomes increasingly important because it directly influences nutrition, communication, psychological well-being, and social participation.1 Tooth loss represents the cumulative consequence of oral diseases such as dental caries, periodontal disease, trauma, and failed restorative treatment. Although largely preventable, partial and complete edentulism remain common among older adults worldwide.2 The Global Burden of Disease Study consistently ranks severe tooth loss among the most prevalent chronic conditions affecting adults, contributing substantially to disability-adjusted life years.2

The functional consequences of tooth loss are profound. Adequate mastication requires a sufficient number of functional teeth. Reduction in occluding tooth pairs decreases chewing efficiency, forcing individuals to avoid hard, fibrous, and nutrient-rich foods including fruits, vegetables, nuts, and lean meats. Consequently, older adults often shift towards soft, highly processed, carbohydrate-rich diets that provide adequate calories but insufficient essential nutrients.3 Poor dietary choices associated with tooth loss may lead to protein-energy malnutrition, vitamin deficiencies, reduced muscle mass, frailty, sarcopenia, osteoporosis, and impaired immune function. Studies have demonstrated that edentulous individuals consume significantly less dietary fiber, calcium, iron, vitamins A, C, E, and folate compared with dentate individuals.4 Such nutritional inadequacies increase susceptibility to chronic diseases including cardiovascular disease, diabetes mellitus, osteoporosis, and cognitive decline.5

Beyond nutrition, tooth loss substantially affects oral health-related quality of life (OHRQoL). Missing teeth alter facial appearance, speech articulation, self-esteem, and social confidence. Many older adults report embarrassment while smiling, avoiding social gatherings, reduced interpersonal interactions, and symptoms of anxiety and depression due to compromised oral function and aesthetics. These psychosocial consequences may further contribute to social isolation and reduced life satisfaction.6 The relationship between oral health and general health is bidirectional. Malnutrition accelerates periodontal breakdown and delays tissue healing, whereas poor oral function limits dietary diversity. This vicious cycle becomes increasingly detrimental among frail older adults with multiple chronic illnesses.7 Despite the recognized importance of oral health, many healthcare systems continue to separate dental care from general medical services. Consequently, oral diseases often remain untreated until functional impairment becomes severe. Preventive interventions, regular dental assessments, prosthetic rehabilitation, and nutritional counseling may significantly improve both oral and systemic health outcomes.8

Therefore, this study aimed to evaluate the impact of tooth loss on nutritional status and quality of life among older adults.

A descriptive cross-sectional study was conducted among older adults aged 60 years and above attending dental outpatient departments between January and June 2026 after obtaining the ethical approval # ERC-I8901-D. Individuals who were able to communicate effectively and provided written informed consent were included in the study. Participants with severe cognitive impairment, terminal illness, recent maxillofacial trauma, or those undergoing chemotherapy or radiotherapy were excluded to minimize potential confounding factors that could affect nutritional status or quality of life. The sample size was calculated using Cochran's formula for prevalence studies, assuming a 95% confidence level, a 5% margin of error, and an anticipated prevalence of tooth loss-related nutritional impairment of 30%. After accounting for a 10% non-response rate, a total of 320 participants was included. Participants were selected using a systematic random sampling technique from eligible patients attending the selected healthcare facilities during the study period. Data were collected through face-to-face interviews using a structured and pretested questionnaire administered by trained investigators. Information regarding participants' sociodemographic characteristics, medical history, smoking status, oral hygiene practices, dietary habits, prosthetic status, and dental service utilization was obtained. A comprehensive clinical oral examination was performed by calibrated examiners under standard infection control procedures to record the number of remaining natural teeth, the number of missing teeth, functional occluding pairs, prosthetic replacements, and the presence of complete or partial edentulism. Nutritional status was assessed using the validated Mini Nutritional Assessment (MNA), a widely accepted screening instrument for evaluating nutritional health among older adults. Based on the MNA scoring criteria, participants were categorized as having normal nutritional status, being at risk of malnutrition, or being malnourished. Oral health-related quality of life was evaluated using the validated 14-item Oral Health Impact Profile (OHIP-14) questionnaire, which measures functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap. Higher OHIP-14 scores indicated poorer oral health-related quality of life. All collected data were entered into Microsoft Excel and analyzed using the Statistical Package for the Social Sciences (SPSS) version 29. Continuous variables were summarized as means and standard deviations, whereas categorical variables were presented as frequencies and percentages. Comparisons between groups were performed using independent t-tests or one-way analysis of variance (ANOVA) for continuous variables and Chi-square tests for categorical variables, as appropriate. Pearson correlation analysis was conducted to determine the relationships between the number of missing teeth, nutritional status, and OHIP-14 scores. Multiple linear regression analysis was performed to identify independent predictors of nutritional status and oral health-related quality of life after adjusting for potential confounding variables. Statistical significance was established at a p-value of less than 0.05.

The study included 320 older adults aged 60 years and above. Table 1 presents the demographic characteristics of the study participants, including age distribution and gender. These variables provide an overview of the study population and serve as the baseline characteristics for subsequent analyses (Table 1).

Table 1. Demographic Characteristics

The oral health profile of the participants was assessed by recording the number of missing teeth and the presence of complete edentulism. Table 2 summarizes the distribution of tooth loss among the study participants, illustrating the varying levels of dental status observed within the sample.

Table 2. Oral Health Characteristics

Nutritional status was evaluated using the Mini Nutritional Assessment (MNA), which classifies participants into normal nutritional status, at risk of malnutrition, and malnourished categories. Table 3 presents the nutritional profile of the study population according to the MNA classification.

Table 3. Nutritional Status

To investigate the relationship between oral health and nutrition, the mean MNA scores were compared across different levels of tooth loss. Table 4 illustrates the association between the extent of tooth loss and nutritional status, enabling assessment of whether increasing tooth loss is associated with poorer nutritional outcomes.

Table 4. Association Between Tooth Loss and Nutrition

Oral health-related quality of life was measured using the Oral Health Impact Profile (OHIP-14). Table 5 presents the mean OHIP-14 scores according to the degree of tooth loss, demonstrating how oral health-related quality of life varies with increasing tooth loss among older adults.

Table 5. Quality of Life

P<0.001

This study demonstrates that tooth loss has a substantial adverse effect on both nutritional status and oral health-related quality of life among older adults. Participants with greater numbers of missing teeth experienced significantly poorer nutritional outcomes and higher OHIP-14 scores, indicating greater impairment in daily functioning and psychosocial well-being. These findings reinforce the growing evidence that oral health is a fundamental component of healthy ageing. The observed association between extensive tooth loss and reduced nutritional status is biologically plausible. Loss of functional dentition diminishes masticatory efficiency, making it difficult to chew fibrous vegetables, fruits, whole grains, and protein-rich foods such as meat and legumes9. As a result, older adults frequently substitute these nutrient-dense foods with softer, processed alternatives that are often high in refined carbohydrates and lower in essential vitamins, minerals, and dietary fiber. Such dietary changes contribute to protein-energy malnutrition, micronutrient deficiencies, and frailty. Similar findings have been reported in population-based studies from Europe, Asia, and North America, where edentulous individuals exhibited lower intakes of vitamins A, C, D, calcium, and iron, along with reduced dietary diversity.10-13 Our results also showed that oral health-related quality of life deteriorated progressively with increasing tooth loss. Participants with extensive tooth loss reported greater functional limitation, pain, psychological discomfort, social disability, and reduced confidence. These findings are consistent with previous studies using the OHIP-14 instrument, which have demonstrated that missing teeth negatively affect speech, facial aesthetics, social interactions, and emotional well-being. In many cultures, tooth loss is associated with ageing and poor health, potentially contributing to embarrassment, social withdrawal, and diminished self-esteem.14 Interestingly, prosthetic rehabilitation has been shown in previous studies to partially restore masticatory function and improve quality of life. Complete dentures, removable partial dentures, and implant-supported prostheses can enhance chewing efficiency, expand food choices, and improve nutritional intake when appropriately fitted and maintained. Nevertheless, prosthetic replacement does not fully replicate the functional capacity of natural dentition, underscoring the importance of preventive strategies aimed at preserving teeth throughout life.15 The relationship between tooth loss and nutrition is multifactorial. Socioeconomic status, educational level, chronic systemic diseases, medication use, and access to dental care may influence both oral health and nutritional status. Although multivariable regression identified tooth loss as an independent predictor of poor nutrition and reduced quality of life in this study, future longitudinal studies are needed to clarify causal pathways and explore potential mediating factors such as dietary behavior, inflammatory burden, and frailty.16 From a public health perspective, these findings emphasize the need to integrate oral healthcare into routine geriatric services. Regular dental examinations, periodontal therapy, preventive oral hygiene programs, timely prosthetic rehabilitation, and individualized nutritional counseling should form essential components of comprehensive care for older adults. Such multidisciplinary approaches may reduce the burden of malnutrition, improve functional independence, and enhance overall well-being in ageing populations.17

Tooth loss significantly impairs nutritional status and oral health-related quality of life among older adults. Individuals with extensive tooth loss are more likely to experience malnutrition, reduced dietary diversity, impaired mastication, and diminished psychosocial well-being. Preserving natural teeth through preventive dental care, ensuring timely prosthetic rehabilitation, and integrating oral health services into geriatric healthcare are essential strategies to promote healthy ageing and improve the quality of life of older adults.

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