Welcome to visit Zhongnan Medical Journal Press Series journal website!
Zhongnan Medical Journal Press Series of Journals Center for Evidence-Based and Translational Medicine of Wuhan University

The title
  • The title
  • The keywords
  • The author
Submit
Home Articles Vol 39,2026 No.10 Detail

Association between solid fuel use and tooth loss trajectories among the elderly: the mediating role of PM2.5 exposure and oral health behaviors

Published on Oct. 28, 2026Total Views: 33 times Total Downloads: 7 times Download Mobile

Author: DING Lifang 1 YANG Xu 2 CAO Shiyi 3 XIA Yu 3 JIANG Qingqing 4

Affiliation: 1.Department of Stomatology, Hospital of Huazhong University of Science and Technology, Wuhan 430071, China 2.Wuhu Blood Center, Wuhu 241000, Anhui Province, China 3.School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China 4.School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China

Keywords: The elderly Solid fuel use Tooth loss trajectories PM2.5 exposure Oral health behaviors Mediating role

DOI: 10.12173/j.issn.1004-4337.202607029

Reference: Ding LF, Yang X, Cao SY, et al. Association between solid fuel use and tooth loss trajectories among the elderly: the mediating role of PM2.5 exposure and oral health behaviors[J]. Journal of Mathematical Medicine, 2026, 39(10): 715-724. DOI: 10.12173/j.issn.1004-4337.202607029.[Article in Chinese]

  • Abstract
  • Full-text
  • References
Abstract

Objective To evaluate the association between solid fuel use and tooth loss trajectories in the elderly, and to explore the mediating role of PM2.5 exposure and oral health behaviors.

Methods Data were derived from three waves of longitudinal data of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), including 2011—2012, 2014, and 2017—2018. First, the group-based trajectory model (GBTM) was adopted to identify distinct tooth loss trajectory groups. Next, multivariate Logistic regression model was used to analyze the association between solid fuel use and tooth loss trajectories. Finally, mediation analysis was performed to quantify the mediating effects of PM2.5 exposure and tooth-brushing behavior in the above association.

Results A total of 4 335 participants aged 65 and above were enrolled. Three tooth loss trajectories were identified: slow-progress (40.6%), rapid-progress (39.1%), and edentulism (20.3%). Compared with clean fuel use, solid fuel use was associated with an increased risk of adverse tooth loss trajectories (rapid-progress OR = 1.14, 95%CI: 1.07-1.33; edentulism: OR = 1.40, 95%CI: 1.15-1.71). PM2.5 exposure explained 51.2% of the total association. Regular tooth brushing exerted a protective effect with a negative mediating proportion of -18.8%.

Conclusion Solid fuel use increased the risk of adverse tooth loss trajectories in the elderly. PM2.5 exposure serves as a critical mediating factor, while regular tooth brushing plays a protective role. The promotion of clean fuel utilization and healthy oral hygiene habits is essential for the protection of oral health of the elderly.

Full-text
Please download the PDF version to read the full text: download
References

1. JinH, DengAP, TianH, et al. The association between solid fuel use and oral health: the mediating effect of depressive symptom[J]. Front Oral Health, 2025, 6: 1583685. DOI: 10.3389/froh.2025.1583685.

2. BaijuRM, PeterE, VargheseNO, et al. Oral health and quality of life: current concepts[J]. J Clin Diagn Res, 2017, 11(6): ZE21-ZE26. DOI: 10.7860/JCDR/2017/25866.10110.

3. 荣文笙, 胡德渝, 冯希平, 等. 我国城市地区成人牙本质敏感的流行病学调查[J]. 中华口腔医学杂志, 2010, 45(3): 141-145.RongWS, HuDY, FengXP, et al. A national survey on dentin hypersensitivity in Chinese urban adults[J]. Chinese Journal of Stomatology, 2010, 45(3): 141-145. DOI: 10.3760/cma.j.issn.1002-0098.2010.03.004.

4. GuoJ, BanJH, LiG, et al. Status of tooth loss and denture restoration in Chinese adult population: findings from the 4th national oral health survey[J]. Chin J Dent Res, 2018, 21(4): 249-257. DOI: 10.3290/j.cjdr.a41083.

5. LiL, ZhangQ, YangD, et al. Tooth loss and the risk of cognitive decline and dementia: a meta-analysis of cohort studies[J]. Front Neurol, 2023, 14: 1103052. DOI: 10.3389/fneur.2023.1103052.

6. KomiyamaT, GallagherJE, HattoriY. Relationship between tooth loss and progression of frailty: findings from the English longitudinal study of aging[J]. Arch Gerontol Geriatr, 2024, 127: 105572. DOI: 10.1016/j.archger.2024.105572.

7. GerritsenAE, AllenPF, WitterDJ, et al. Tooth loss and oral health-related quality of life: a systematic review and meta-analysis[J]. Health Qual Life Outcomes, 2010, 8: 126. DOI: 10.1186/1477-7525-8-126.

8. SmithKR, PillarisettiA. Household air pollution from solid cookfuels and its effects on health. In: Mock CN, Nugent R, Kobusingye O, Smith KR, editors. Injury prevention and environmental health. 3rd ed. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2017 Oct 27. Chapter 7. DOI: 10.1596/978-1-4648-0522-6_ch7.

9. DengY, GaoQ, YangT, et al. Indoor solid fuel use and incident arthritis among middle-aged and older adults in rural China: a nationwide population-based cohort study[J]. Sci Total Environ, 2021, 772: 145395. DOI: 10.1016/j.scitotenv.2021.145395.

10. HeY, LiuX, ZhengY, et al. Lower socioeconomic status strengthens the effect of cooking fuel use on anemia risk and anemia-related parameters: findings from the Henan Rural Cohort[J]. Sci Total Environ, 2022, 831: 154958. DOI: 10.1016/j.scitotenv.2022.154958.

11. SheikhM, PoustchiH, PourshamsA, et al. Household fuel use and the risk of gastrointestinal cancers: the Golestan Cohort Study[J]. Environ Health Perspect, 2020, 128(6): 67002. DOI:  10.1289/EHP5907.

12. IslamR, ShebaNH, SiddiqueRF, et al. Association of household fuel use with hypertension and blood pressure among adult women in rural Bangladesh: a cross-sectional study[J]. Am J Hum Biol, 2023, 35(8): e23899. DOI: 10.1002/ajhb.23899.

13. WangYL, GaoW, LiY, et al. Concentration-dependent effects of PM2.5 mass on expressions of adhesion molecules and inflammatory cytokines in nasal mucosa of rats with allergic rhinitis[J]. Eur Arch Otorhinolaryngol, 2017, 274(8): 3221-3229. DOI: 10.1007/s00405-017-4606-8.

14. RomandiniP, MarrugantiC, RomandiniWG, et al. Are periodontitis and dental caries associated? A systematic review with meta-analyses[J]. J Clin Periodontol, 2024, 51(2): 145-157. DOI: 10.1111/jcpe.13910.

15. SocranskySS, HaffajeeAD, GoodsonJM, et al. New concepts of destructive periodontal disease[J]. J Clin Periodontol, 1984, 11(1): 21-32. DOI: 10.1111/j.1600-051x.1984.tb01305.x.

16. HuangK, FengLF, LiuZY, et al. The modification of meteorological factors on the relationship between air pollution and periodontal diseases: an exploration based on different interaction strategies[J]. Environ Geochem Health, 2023, 45(11): 8187-8202. DOI: 10.1007/s10653-023-01705-6.

17. MarrugantiC, ShinHS, SimSJ, et al. Air pollution as a risk indicator for periodontitis[J]. Biomedicines, 2023, 11(2): 443. DOI: 10.3390/biomedicines11020443.

18. PetersenPE, OgawaH. The global burden of periodontal disease: towards integration with chronic disease prevention and control[J]. Periodontol, 2000, 60(1): 15-39. DOI: 10.1111/j.1600-0757.2011.00425.x.

19. McCarronA, UnyI, CaesL, et al. Solid fuel users' perceptions of household solid fuel use in low-and middle-income countries: a scoping review[J]. Environ Int, 2020, 143: 105991. DOI: 10.1016/j.envint.2020.105991.

20. LvX, LiW, MaY, et al. Cognitive decline and mortality among community-dwelling Chinese older people[J]. BMC Med, 2019, 17(1): 63. DOI: 10.1186/s12916-019-1295-8.

21. ZengY, FengQ, HeskethT, et al. Survival, disabilities in activities of daily living, and physical and cognitive functioning among the oldest-old in China: a cohort study[J]. Lancet, 2017, 389(10079): 1619-1629. DOI: 10.1016/S0140-6736(17)30548-2.

22. LvYB, GaoX, YinZX, et al. Revisiting the association of blood pressure with mortality in oldest old people in China: community based, longitudinal prospective study[J]. BMJ, 2018, 361: k2158. DOI: 10.1136/bmj.k2158.

23. DengY, ZhaoH, LiuY, et al. Association of using biomass fuel for cooking with depression and anxiety symptoms in older Chinese adults[J]. Sci Total Environ, 2022, 811: 152256. DOI: 10.1016/j.scitotenv.2021.152256.

24. LiuY, ShaoJ, LiuQ, et al. Association between household fuel combustion and diabetes among middle-aged and older adults in China: a cohort study[J]. Ecotoxicol Environ Saf, 2023, 258: 114974. DOI: 10.1016/j.ecoenv.2023.114974.

25. ZhangX, ZengR, YeD, et al. Tooth loss trajectories and their association with all-cause mortality among older Chinese adults[J]. Front Oral Health, 2025, 6: 1535708. DOI: 10.3389/froh.2025.1535708.

26. GengG, XiaoQ, LiuS, et al. Tracking air pollution in China: near real-time PM2.5 retrievals from multisource data fusion[J]. Environ Sci Technol, 2021, 55(17): 12106-12115. DOI: 10.1021/acs.est.1c01863.

27. GengG, ZhangQ, TongD, et al. Chemical composition of ambient PM2. 5 over China and relationship to precursor emissions during 2005–2012[J]. Atmos Chem Phys, 2017, 17(14): 9187-9203. DOI: 10.5194/acp-2016-1187.

28. ZhangXM, JiaoJ, CaoJ, et al. The association between the number of teeth and frailty among older nursing home residents: a cross-sectional study of the CLHLS survey[J]. BMC Geriatr, 2022, 22(1): 1007. DOI: 10.1186/s12877-022-03688-y.

29. TemplM, AlfonsA, FilzmoserP. Exploring incomplete data using visualization techniques[J]. Adv Data Anal Classi, 2012, 6(1): 29-47. DOI: 10.1007/s11634-011-0102-y.

30. ZhangZ. Multiple imputation with multivariate imputation by chained equation (MICE) package[J]. Ann Transl Med, 2016, 4(2): 30. DOI: 10.3978/j.issn.2305-5839.2015.12.63.

31. NaginDS. Group-based trajectory modeling: an overview[J]. Ann Nutr Metab, 2014, 65(2-3): 205-210. DOI: 10.1159/000360229.

32. NaginDS, OdgersCL. Group-based trajectory modeling in clinical research[J]. Annu Rev Clin Psychol, 2010, 6: 109-138. DOI: 10.1146/annurev.clinpsy.121208.131413.

33. GengT, ZhuK, LuQ, et al. Healthy lifestyle behaviors, mediating biomarkers, and risk of microvascular complications among individuals with type 2 diabetes: a cohort study[J]. PLoS Med, 2023, 20(1): e1004135. DOI: 10.1371/journal.pmed.1004135.

34. ZieroldKM, HagemeyerAN, SearsCG. Health symptoms among adults living near a coal-burning power plant[J]. Arch Environ Occup Health, 2019, 75(5): 289-296. DOI: 10.1080/19338244.2019.1633992.

35. ZouW, WangX, HongW, et al. PM2.5 induces the expression of inflammatory cytokines via the Wnt5a/Ror2 pathway in human bronchial epithelial cells[J]. Int J Chron Obstruct Pulmon Dis, 2020, 15: 2653-2662. DOI: 10.2147/COPD.S270762.

36. HashimD, SartoriS, BrennanP, et al. The role of oral hygiene in head and neck cancer: results from International Head and Neck Cancer Epidemiology (INHANCE) consortium[J]. Ann Oncol, 2016, 27(8): 1619-1625. DOI: 10.1093/annonc/mdw224.

37. Reyes GaritaP, TranVT, ChatzopoulouE, et al. Oral hygiene behaviors and periodontitis among patients with chronic diseases and its impact on tooth loss and oral health-related quality of life: a cross-sectional study of data from the ComPaRe e-cohort[J]. Clin Oral Investig, 2024, 28(10): 518. DOI: 10.1007/s00784-024-05903-z.

38. YangBI, ParkJA, LeeJY, et al. Effects of lingual and palatal site toothbrushing on periodontal disease in the elderly: a cross-sectional study[J]. Int J Environ Res Public Health, 2021, 18(10): 5067. DOI: 10.3390/ijerph18105067.

39. LiA, ChenY, DuM, et al. Healthy lifestyles ameliorate an increased risk of periodontitis associated with polycyclic aromatic hydrocarbons[J]. Chemosphere, 2024, 364: 143086. DOI: 10.1016/j.chemosphere.2024.143086.

Popular papers
Last 6 months