Applied nutritional investigationIntake of dairy calcium and tooth loss among adult Danish men and women
Introduction
In recent years, a growing interest in diets and foods that may benefit oral health and well-being has emerged [1]. In this context, the intake of calcium and other nutrients from dairy products has been proposed [2]. Calcium can be obtained in the diet from various sources, but milk provides large amounts of calcium and phosphorus and components such as lactose and casein phosphopeptides, which may increase calcium absorption and mineral retention [3].
It has been suggested that high concentrations of calcium and phosphate in the plaque or saliva may decrease the adherence of caries-associated bacteria to the enamel [4], and that a high calcium intake may be associated with an increased enamel remineralization (tissue repair), a decreased demineralization, the prevention of alveolar bone loss, and, hence, the retention of natural dentition [5], [6].
Many factors are associated with the risk of tooth loss and existing data suggest that in adults the strongest risk factors are dental caries and periodontal disease [7]. Interestingly, oral health status may be influenced by gender and consistent results have shown that periodontal disease is more severe and prevalent in men than in women [8]. In contrast, there has been less consistent results for tooth loss, with studies variously reporting that men have a higher incidence of tooth loss than women [9], that women are more likely to lose teeth than men [10], or even that gender plays no significant role in the prediction of tooth loss [11].
It remains unclear whether this gender variation reflects differences between men and women in the exposure to risk factors for oral disease, such as poor oral hygiene, smoking, alcohol consumption, hormonal factors, or a low socioeconomic status [12]. It is known that women brush their teeth more often, they have more frequent dental care visits for preventive purposes, and they are more concerned with the preservation of their natural dentition than men [13]. Men are generally more receptive to tooth extraction than women, especially of the posterior teeth [7].
Using longitudinal data on diet and tooth loss in an adult Danish population, we previously found that a low dietary calcium intake was related to tooth loss in adult men, but not in women, even after controlling for dental care visits [14]. We also found that the absolute intake of dietary calcium was significantly lower in women compared with men [14] and the same finding has been observed in other ethnic groups [15]. However, the consumption of dairy products is generally higher in women than in men [16]. Therefore, the lack of association between calcium intake and tooth loss in women might be related to the source of the calcium consumed by men and women or partly confounded by gender differences in oral health-related behaviors.
The aim of this study therefore was to explore how gender differences in tooth loss relate to selected indicators of caries risk and dental care and the source of dietary calcium intake (dairy versus non-dairy calcium).
Section snippets
Design
The Danish Monitoring Trends and Determinants in Cardiovascular Disease (MONICA) study is a longitudinal study in which random equal-sized samples of 30-, 40-, 50-, and 60-y-old men and women living in Copenhagen County were drawn from the National Central Person Registry and invited to participate in the study in 1982 and 1983. The design of the survey has been described in detail previously [17]. Briefly, 4581 individuals born in Denmark were invited to a health examination, and 3608 (79%)
Results
The general characteristics of the study population according to gender are listed in Table 1. Men had higher mean intakes of total, dairy, and non-dairy calcium than women; however, after an adjustment for energy intake, women had higher intakes of total and dairy calcium than men. Dairy foods were the major sources of dietary calcium, accounting for 58.7% and 62.6% of total calcium intake in men and women, respectively. No significant differences were found in energy-adjusted non-dairy
Discussion
The results of this study showed that dairy calcium intake was associated with a decreased risk of tooth loss in men and women. In men, this was the case even after an adjustment for the initial tooth count, age, education, civil status, smoking, alcohol consumption, sucrose intake, the use of vitamin and/or mineral supplements, dental visits, oral dryness, and the Lactobacillus count. In women, the associations became statistically significant only after an adjustment for the Lactobacillus
Acknowledgments
The authors thank Claus Holt for statistical advice.
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This study was supported by the Danish Dairy Research Foundation and the Copenhagen Capital Region.