“牙好，胃口就好，吃嘛嘛香，身体倍儿棒！”这句话可不是空穴来风。不难发现，生活中的长寿老人往往都有一口好牙。而且早有研究证实，牙不好的人，比如牙齿数量少、患有牙周病、咬合功能差等，不仅健康状况会下降，寿命也可能缩短。
口腔健康的各个方面都会增加死亡率和功能障碍风险[1]，比如牙齿数量越少，患功能障碍风险越大[2]。口腔衰弱和牙齿脱落还会增加老人身体衰弱的风险[3，4]。
日本一项涉及约2.5万人(年龄≥75岁)的研究评估了决定口腔健康状况的13个因素：剩余牙齿的数量、主观咀嚼性能、客观咀嚼性能、牙周组织状态、功能性吞咽困难、舌头活动、发音、口腔卫生、蛀牙数量、上颌和下颌假牙不适应（单独考虑）、口腔粘膜疾病和口干。结果显示，这13个因素都与死亡率的发生显著相关，而功能障碍与除口腔粘膜疾病、口干外的11个因素相关[1]。
牙齿脱落[5,6]和牙周病[7]都会加速认知功能下降，尤其若中年时期牙齿数量就较少，未来发生抑郁的风险将显著增加[8]。
日本一项为期20年的调查分析显示，40岁以后,与拥有≥20颗牙齿的参与者相比，基线时拥有10~19颗牙齿和＜10颗牙齿的参与者出现抑郁症状的风险较高，而且对男性的影响更强[8]。
刷牙频率降低[9]、缺牙数量增加[10]和咀嚼能力下降[11]都会显著提高各种死亡风险。因牙齿脱落导致的咀嚼功能障碍还会通过加速衰老导致更高的死亡风险[12]。
今年初，我国一项利用全国健康营养和健康调查数据（约2.3万人）的研究表明，咀嚼功能障碍（ICC）与全因死亡率呈正相关，其风险比为1.282。此外，ICC使心血管死亡风险和癌症死亡风险分别增加28.9%和32.7%[12]。
炎症风暴：口腔细菌激活血小板，特别是变形链球菌和血链球菌，可导致局部血栓形成，血小板本身分泌促炎细胞因子，导致炎症、动脉粥样硬化和血栓形成[13，14]。而心血管疾病风险的增加与促炎细胞因子水平的升高有关，如IL-1、IL-6和TNF-a，以及急性期蛋白如c反应蛋白[15，16]。
菌血播种：心脏瓣膜上的血链球菌中有许多与口腔菌株基因同源，牙科操作后可在血液中检出活菌。牙周微生物种类和细菌产物的系统性传播迁移到远端器官并促进全身性疾病[17-19]。
营养不良：饮食多样性对牙齿脱落和衰弱之间的关系有一些微小但显著的影响，在并发模型中，这种影响大约6-9%是由饮食多样性介导的，在纵向模型中则有3-5%[20]。也就是说，牙齿脱落会降低咀嚼性能并导致进食困难，甚至会改变饮食选择，比如增加较软、能量密度更高的食物，从而导致营养不良、肌肉减少、功能障碍以及衰弱。
坚持日常口腔卫生可能是降低心血管疾病风险的有效方法。
牙周炎的治疗可能会改善心血管疾病的风险，例如高血压[21、22]、房颤[23]、冠状动脉疾病等[24-27]。Park等人的一项研究发现，每天≥1次刷牙或每年≥1次定期牙科专业清洁，可分别降低9%和14%的心血管风险。
常规牙周治疗可以通过降低血清HbA1c水平来改善2型糖尿病患者的代谢控制，减少全身炎症。
牙齿脱落与糖尿病的发病率[28，29]和患病率[30，31]存在显著相关性。陈蕾等人发表在华西口腔医学杂志上的文章表明，牙周治疗使得糖尿病患者糖化血红蛋白（HbA1c）平均下降0.4%。而HbA1c水平每降低1%，与糖尿病相关的微血管并发症就会减少35%[32]。
改善牙周健康可能有助于改善认知障碍[33]。
牙龈卟啉单胞菌作为慢性牙周炎的关键致病菌，在阿尔茨海默病患者的大脑中被确认存在。源自该细菌的毒性蛋白酶——牙龈蛋白酶同样在阿尔茨海默病患者的大脑中被检测到，且其水平与tau蛋白（阿尔茨海默病的标志之一）相关[34]。
保留更多牙齿可有效延长老人寿命和健康寿命[35，36]。
对600名70岁以上受试者的5年死亡率数据进行分析发现，在70岁时每保留一颗牙齿，5年生存率就会增加4%[35]。另一项纳入约12.6万名65岁以上老人的研究显示，在≥85 岁的参与者中，与无牙参与者相比，拥有≥20 颗牙齿的人预期寿命（男性：+57天；女性：+15天）和健康预期寿命（男性：+92天；女性：+70天）都更长[36]。
为了大家在晚年仍能享受美食，同时更好的延长寿命，长寿之家changshou.com总结了几个科学护理口腔的小方法。
关键时间窗口：晨起后1小时内（清除夜间增殖的细菌） + 睡前最后一步（形成12小时保护膜）。
夜间唾液分泌减少，细菌分解食物产生的酸性物质容易引起牙釉质不可逆的损害，同时口腔微生态紊乱引发口臭、牙石等一系列口腔疾病[37]。
牙刷（牙面） + 牙线（邻面） + 冲牙器（龈下）立体防御。
为了改善认知障碍老年人的牙周健康，研究人员提出伴侣辅助干预、充分刷牙和使用电动牙刷。尽早开始定期口腔护理访问、个人教育、提高烹饪技能和饮食/热量限制也可能有助于改善牙周健康[6]。
定期洁牙能够保持牙齿坚固和牙周健康，建议最好每年一次到正规口腔医院进行洁牙。
牙菌斑、食物残渣、软垢在牙面上附着沉积，与唾液中的矿物质结合，逐渐钙化形成牙石。自我口腔保健方法只能清除牙菌斑，不能去除牙石。洁牙是由专业口腔医生使用洁牙器械，清除龈缘周围沉积的牙石和牙菌斑[38]。
需要提醒的是，洗牙并不会导致牙缝变大、牙齿松动等问题，出现这类症状的主要原因是牙石的长期存在掩盖了牙龈萎缩、牙槽骨吸收等牙周病的事实。洗牙后，牙齿恢复一段时间并积极治疗牙周病就可以了。
当牙刷划过齿列的声音成为生命律动，当洗牙时的酸胀感化作健康承诺，这些日常仪式正在重塑人类寿命的极限。想活到99岁还能啃苹果，首先要守护好28颗天然牙齿，至少也要保住20颗。
参考资料：
[1] Abe T, Tominaga K, Saito H, et al. Effect of oral health on functional disability and mortality in older adults in Japan: a cohort study. The Lancet Healthy Longevity. October 2024:100636.
[2] Huang G, Cao G. Tooth Loss Trajectories and Their Association with Functional Disability among Older Chinese Adults: Results from the Chinese Longitudinal Healthy Longevity Survey. Journal of Evidence Based Dental Practice. 2022;22(4):101771.
[3] Gu Y, Wu W, Bai J, et al. Association between the number of teeth and frailty among Chinese older adults: a nationwide cross-sectional study. BMJ Open. 2019;9(10):e029929.
[4] Tanaka T, Takahashi K, Hirano H, et al. Oral frailty as a risk factor for Physical frailty and Mortality in Community-Dwelling Elderly. The Journals of Gerontology Series A. 2017;73(12):1661-1667.
[5] Xu S, Huang X, Gong Y, Sun J. Association between tooth loss rate and risk of mild cognitive impairment in older adults: a population-based longitudinal study. Aging. 2021;13(17):21599-21609.
[6] Li J, Xu H, Pan W, Wu B. Association between tooth loss and cognitive decline: A 13-year longitudinal study of Chinese older adults. PLoS ONE. 2017;12(2):e0171404.
[7] Saji N, Matsushita K, Takeda A, Sakurai T. Association between periodontal disease and age-related cognitive impairment: a narrative review. BMC Oral Health. 2025;25(1).
[8] Chu WM, Nishita Y, Tange C, et al. Association of a lesser number of teeth with more risk of developing depressive symptoms among middle-aged and older adults in Japan: A 20-year population-based cohort study. Journal of Psychosomatic Research. 2023;174:111498.
[9] Zhou BJ, Jiang CQ, Jin YL, et al. Association of oral health with all-cause and cause-specific mortality in older Chinese adults: A 14-year follow-up of the Guangzhou Biobank Cohort study. Journal of Global Health. 2024;14.
[10] Koka S, Gupta A. Association between missing tooth count and mortality: A systematic review. Journal of Prosthodontic Research. 2017;62(2):134-151.
[11] Nomura Y, Kakuta E, Okada A, et al. Effects of self-assessed chewing ability, tooth loss and serum albumin on mortality in 80-year-old individuals: a 20-year follow-up study. BMC Oral Health. 2020;20(1).
[12] Du M, Deng K, Yin J, et al. Association between chewing capacity and mortality risk: The role of diet and ageing. Journal of Clinical Periodontology. January 2025.
[13] Fitzgerald JR, Foster TJ, Cox D. The interaction of bacterial pathogens with platelets. Nat Rev Microbiol 2006;4(6):445–57.
[14] Kerrigan SW, Cox D. Platelet-bacterial interactions. Cell Mol Life Sci 2010;67(4):513–23.
[15] Kaptoge S, Seshasai SR, Gao P, et al. Inflammatory cytokines and risk of coronary heart disease: new prospective study and updated meta analysis. Eur Heart J 2014;35(9):578–89.
[16] Lagrand WK, Visser CA, Hermens WT, et al. C-reactive protein as a cardiovascular risk factor: more than an epiphenomenon? Circulation 1999;100(1):96–102.
[17] Hasturk H, Kantarci A. Activation and resolution of periodontal inflammation and its systemic impact. Periodontol 2000 2015;69:255–73.
[18] Pussinen PJ, Havulinna AS, Lehto M, Sundvall J, Salomaa V. Endotoxemia is associated with an increased risk of incident diabetes. Diabetes Care. 2011;34(2):392–7.
[19] Pussinen PJ, Tuomisto K, Jousilahti P, Havulinna AS, Sundvall J, Salomaa V. Endotoxemia, immune response to periodontal pathogens, and systemic inflammation associate with incident cardiovascular disease events. Arterioscler Thromb Vasc Biol. 2007;27(6):1433–9.
[20] Xu X, Zhao Y, Wu B, Pei Y, Gu D. Association between tooth loss and frailty among Chinese older adults: the mediating role of dietary diversity. BMC Geriatrics. 2023;23(1).
[21] D’Aiuto F, Parkar M, Andreou G, Brett PM, Ready D, Tonetti MS.Periodontitis and atherogenesis: causal association or simple coincidence? J Clin Periodontol 2004;31(5):402–11.
[22] Higashi Y, Goto C, Jitsuiki D, et al. Periodontal infection is associated with endothelial dysfunction in healthy subjects and hypertensive patients. Hypertension 2008;51(2):446–53.
[23] Chen DY, Lin CH, Chen YM, Chen HH. Risk of atrial fibrillation or flutter associated with periodontitis: a nationwide, population-based,cohort study. PLoS One 2016;11(10):e0165601.
[24] Mattila KJ, Valle MS, Nieminen MS, et al. Dental infections and coronary atherosclerosis. Atherosclerosis 1993;103(2):205–11.
[25] Buhlin K, M€antyl€a P, Paju S, et al. Periodontitis is associated with angiographically verified coronary artery disease. J Clin Periodontol 2011;38(11):1007–14.
[26] Costa TH, de Figueiredo Neto JA, et al. Association between chronic apical periodontitis and coronary artery disease. J Endod 2014;40(2):164–7.
[27] Ford PJ, Gemmell E, Hamlet SM, et al. Cross-reactivity of GroEL antibodies with human heat shock protein 60 and quantification of pathogens in atherosclerosis. Oral Microbiol Immunol 2005;20(5):296–302.
[28] Saji N, Matsushita K, Takeda A, Sakurai T. Association between periodontal disease and age-related cognitive impairment: a narrative review. BMC Oral Health. 2025 Mar 14;25(1):373.
[29] Dominy SS, Lynch C, Ermini F, et al. Porphyromonas gingivalis in Alzheimer's disease brains: Evidence for disease causation and treatment with small-molecule inhibitors. Sci Adv. 2019 Jan 23;5(1):eaau3333.
[30] Liljestrand JM, Havulinna AS, Paju S, Mannisto S, Salomaa V, Pussinen PJ. Missing teeth predict incident cardiovascular events, diabetes, and death. J Dent Res. 2015;94(8):1055–62.
[31] Demmer RT, Jacobs DRJ, Desvarieux M. Periodontal disease and incident type 2 diabetes: results from the first National Health and nutrition examination survey and its epidemiologic follow-up study. Diabetes Care. 2008;31(7):1373–9.
[32] Song SJ, Han K, Lee S-S, Park J-B. Association between the number of natural teeth and diabetic retinopathy among type 2 diabetes mellitus: the Korea national health and nutrition examination survey. Medicine (Baltimore). 2017;96(47):e8694.
[33] Shin H-S. The number of teeth is inversely associated with metabolic syndrome: a Korean Nationwide population-based study. J Periodontol. 2017;88(9):830–8.
[34] Chen L, Su Y, Ni J, Luo W, Xuan DY, Zhang J. Effects of non-surgical periodontal treatment on clinical response, serum inflammatory parameters, and metabolic control of type 2 diabetes patients with moderate to severe periodontitis. Hua Xi Kou Qiang Yi Xue Za Zhi. 2014 Feb;32(1):66-70.
[35] Hirotomi T, Yoshihara A, Ogawa H, Miyazaki H. Number of teeth and 5‐year mortality in an elderly population. Community Dentistry and Oral Epidemiology. 2015;43(3):226-231.
[36] Matsuyama Y, Aida J, Watt RG, et al. Dental Status and Compression of Life Expectancy with Disability. Journal of Dental Research. 2017;96(9):1006-1013.
[37] 李刚,刘书润,刘博,等.数字化可视牙刷用户刷牙时间的分析与评价.口腔护理用品工业,2023,33(06):17-21.
[38]中国居民口腔健康指南.口腔颌面修复学杂志,2013,14(04):251-256.
