Edentulism concentrates in older adults and is associated with poorer diet, elevated malnutrition risk, and adverse health trajectories. Interpretable, well-calibrated tools applicable in routine care are needed to identify those at risk and support timely, tooth-preserving management. We analyzed data from the nationally representative China Health and Retirement Longitudinal Study with baseline in 2011 to 2012 and follow-ups in 2013, 2015, and 2018. Adults with baseline dentition status and all prespecified predictors were eligible. Incident edentulism was ascertained at each wave. Predictors defined a priori included age, sex, body mass index, blood pressure, lipid profile, log-transformed C-reactive protein (ln-CRP), and estimated glucose disposal rate (eGDR). Four algorithms were trained in a development set and evaluated in an independent validation set: multivariable logistic regression, LASSO-penalized logistic regression, random forest, and extreme gradient boosting. Validation included area under the receiver-operating-characteristic curve (AUC) with nonparametric comparisons, calibration with logistic recalibration, decision-curve analysis across clinically relevant thresholds, and time-dependent AUC over follow-up. Of 6130 adults, 5231 were dentate at baseline and formed the risk set; incident edentulism occurred in 2013 (n = 338), 2015 (n = 253), and 2018 (n = 308). Logistic regression yielded the highest discrimination (AUC 0.695) with stable performance across waves and over 2-7 years. Calibration closely matched the ideal after simple recalibration, and decision curves showed consistent net benefit versus treat-all and treat-none strategies. In the final model, age and C-reactive protein (ln-CRP) were dominant independent predictors; men had lower risk, and total cholesterol showed a modest inverse association. A nomogram was derived to enable point-of-care risk stratification. In a large, nationally representative cohort, an internally validated logistic regression model based on routinely available data showed moderate discrimination, good calibration, and potential clinical utility for predicting incident edentulism. Age and low-grade systemic inflammation were the main contributors to risk stratification and may help guide early, tooth-preserving care.

Objectives: Complete tooth loss is a late-stage oral health endpoint that may reflect cumulative oral, systemic, behavioral, and social risk processes. We examined whether two-wave patterns of the modified cardiometabolic index (MCMI) from 2011 to 2015 were associated with incident edentulism from 2015 to 2018 among Chinese adults. Methods: We analyzed participants aged 45 years or older from the China Health and Retirement Longitudinal Study who reported having natural teeth in 2015 and had MCMI measured in 2011 and 2015. Using wave-specific medians, we grouped participants into four 2011–2015 MCMI patterns: stable high, high-to-low, low-to-high, and stable low. Incident edentulism was defined as self-reported complete tooth loss in 2018 among those at risk in 2015. Risk ratios were estimated using modified Poisson regression with robust variance, with stepwise adjustment for sociodemographic and behavioral factors; fully adjusted models additionally included baseline MCMI. Cumulative MCMI and simple change in MCMI were also examined as tertiles. Results: Among 3,626 adults, 231 developed edentulism by 2018, yielding a 6.4% cumulative incidence. Compared with the stable high pattern, participants who moved from high to low MCMI had a lower risk of incident edentulism in the fully adjusted model (adjusted RR, 0.57; 95% CI, 0.34 to 0.97). The low-to-high and stable low patterns showed no clear associations after adjustment. In parallel analyses, neither cumulative MCMI nor simple change tertiles demonstrated a consistent gradient in edentulism risk. Conclusions: In this longitudinal CHARLS analysis, a high-to-low MCMI change pattern was associated with lower subsequent risk of incident edentulism compared with persistently high MCMI, whereas cumulative MCMI and absolute change showed no consistent gradient. Because edentulism is a late-stage cumulative endpoint and baseline oral health measures were unavailable, these findings should be interpreted as observational associations rather than evidence of a direct cardiometabolic effect on tooth loss.

We examined whether baseline dentition status was associated with transitions to activities of daily living (ADL) disability, dementia, both ADL disability and dementia, and death in older Chinese adults, and whether denture use further distinguished risk within low-dentition groups. We analysed Chinese Longitudinal Healthy Longevity Survey data from 2008 to 2018. Participants were aged 65 years or older, had baseline natural tooth count data, and had no observed ADL disability or reported dementia at baseline. Dentition status was classified as at least 20 teeth, 1-19 teeth, and 0 teeth. Transition-specific discrete-time complementary log-log models were fitted within a cumulative five-state framework comprising Healthy, ADL disability only, dementia only, both ADL disability and dementia, and death. A total of 10,186 participants contributed 18,688 interval-level observations. The most frequent transitions were to death (n = 5,063) and ADL disability only (n = 2,048). Compared with participants with at least 20 teeth, those with 0 teeth had higher hazards of ADL disability only (HR: 1.20, 95% CI, 1.04-1.39) and death (HR: 1.18, 95% CI, 1.06-1.31). In joint analyses, those with 0 teeth and dentures had the highest hazard of ADL disability only (HR: 1.30, 95% CI, 1.10-1.53), whereas those with 0 teeth and no dentures had the highest hazard of death (HR: 1.33, 95% CI, 1.18-1.49). Dementia-related transitions were sparse. Among older Chinese adults without observed ADL disability or reported dementia at baseline, edentulism was associated with less favourable later-life transitions, most consistently to ADL disability and death. Baseline dentition status may serve as a simple marker of oral functional reserve and broader later-life vulnerability. Baseline dentition and denture status may help identify older adults who warrant broader assessment of function, nutrition, frailty, and oral rehabilitation needs.