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NEW YORK, US/SHANGHAI, China: Ample evidence shows that social isolation and loneliness can affect overall health and well-being. In a new study, researchers sought to examine whether these experiences could also be detrimental to oral health. They found that older adults who are socially isolated are more likely to have missing teeth and to lose their teeth more quickly over time compared with those who have more social interaction.
According to the World Health Organization, social isolation and loneliness are widespread and could have a serious impact on older people’s physical and mental health, quality of life and longevity. Mounting evidence suggests that social isolation and loneliness are linked to depression, comorbidities, cognitive impairment, dementia and premature mortality in older adults. However, only a limited number of studies have examined the impact of social isolation and loneliness on oral health, and this was the motivation for the present research.
“The need to connect socially with others is as basic as our need for food, water and shelter,” first author Xiang Qi, a PhD candidate at New York University’s Rory Meyers College of Nursing (NYU Meyers), told Dental Tribune International (DTI). “Approximately 24% of community-dwelling older adults aged 65 and above are considered to be socially isolated in the US, and 43% of adults aged over 60 years old report feeling lonely,” he added.
According to the researchers, social isolation and loneliness are two different terms that cannot be used interchangeably. Whereas social isolation implies having few social relationships or infrequent social contact with others, loneliness is a feeling created by a lack of social connection.
Senior author Dr Bei Wu, dean’s professor in global health at NYU Meyers, explained that, although social isolation and loneliness often go hand in hand, it is possible to live alone and be socially isolated but not feel lonely. Likewise, somebody may be surrounded by people but feel lonely.
Social isolation and oral health
In China, older adults aged 65 to 74 have an average of fewer than 23 teeth and 4.5% are edentulous. Periodontal disease, smoking, lack of access to dental care and chronic illnesses such as diabetes and heart disease increase the risk of tooth loss and could eventually affect nutrition, speech and even self-esteem.
Seeking to examine the topic of social isolation and loneliness in greater detail, the researchers analysed data from the Chinese Longitudinal Healthy Longevity Survey. A total of 4,268 adults aged 65 and older completed a survey at three different time points, namely in 2011–12, 2014 and 2018. At baseline, 27.5% of the study participants were socially isolated and 26.5% reported feeling lonely, and the researchers aimed to determine the number of teeth the participants had and lost over the period.
After analysing the data, the researchers found that the participants who were socially isolated had an average of 2.1 fewer natural teeth and a rate of losing their teeth 1.4 times higher compared with those who had more social contact, thus confirming the link between social isolation and tooth loss. Qi told DTI that the evidence for the effect of social isolation on oral health was robust despite controlling for factors such as socio-demographic variables, smoking, drinking, oral hygiene and health status.
However, to the researchers’ surprise, loneliness was neither associated with the number of teeth nor the rate of tooth loss in the study. Qi hypothesises that this might be explained by the fact that lonely people still have a strong support system that helps them to maintain healthy behaviours.
“The fear of COVID-19 infection and the increased level of social isolation during the COVID-19 pandemic will have a significant impact on people’s oral health” — Dr Bei Wu, NYU Meyers
On considering the findings, the researchers noted that they are relevant to countries beyond China and highlighted the importance of developing interventions to reduce social isolation. For example, they suggested that certain programmes can foster intergenerational support within families and improve older adults’ peer and social connections within their local communities.
Additionally, Dr Wu commented that the findings from the study could help clinicians have a better understanding of the significance of social isolation and loneliness on oral health.
Social isolation and COVID-19
Social contact has decreased dramatically over the past two years. Social distancing has become the norm, and lockdowns are a new reality. As the COVID-19 pandemic hit countries around the globe, many people had no other choice but to isolate themselves at home in order to avoid becoming infected with SARS-CoV-2.
Talking about how the pandemic disrupted access to oral health services, Dr Wu told DTI: “Early in the pandemic, most dental clinics were closed by shelter-at-home orders, and even when clinics reopened, fear of COVID-19 led many people to delay both preventive cleanings and examinations as well as elective procedures.”
According to Dr Wu, social isolation during lockdowns is likely to lead to stress, anxiety, depression and other psychological disorders. She also believes that socially isolated older adults are more likely to binge drink and smoke and are less engaged in social and health-promoting behaviours such as physical activity. This could have a negative impact on their overall functioning and oral hygiene and increase their risk for systemic inflammation.
Dr Wu concluded that the public health responses to COVID-19, including quarantine and social distancing, have exacerbated the problem of social isolation and will have far-reaching consequences. She stated: “The fear of COVID-19 infection and the increased level of social isolation during the COVID-19 pandemic will have a significant impact on people’s oral health.”
The study, titled “Social isolation, loneliness and accelerated tooth loss among Chinese older adults: A longitudinal study”, was published online on 17 January 2022 in Community Dentistry and Oral Epidemiology, ahead of inclusion in an issue.
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