Removable dental prosthesis use and low handgrip strength

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Removable dental prosthesis use and low handgrip strength in Korean adults: a nationwide

cross-sectional study

Jae-Hyun Lee, DMD, MSD, PhDa,b, Su Young Lee, DDS, MSD, PhDc,*, Kyungdo Han, MS,

PhDd, Jung-Suk Han, DDS, MSD, PhDa

a Department of Prosthodontics and Dental Research Institute, School of Dentistry, Seoul

National University, Seoul, Korea

b MAS Program of Digital Dental Technologies, University Clinics of Dental Medicine, Faculty

of Medicine, University of Geneva, Geneva, Switzerland

c Department of Prosthodontics, Seoul St. Mary’s Hospital, College of Medicine, The Catholic

University of Korea, Seoul, Korea

d Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea

*Correspondence:

Prof. Su Young Lee, DDS, MSD, PhD

Department of Prosthodontics, Seoul St. Mary’s Hospital, College of Medicine, The Catholic

University of Korea

Banpo-daero 222, Seocho-gu, Seoul 06591, Korea

Tel.: +82 2 2258 6309

Fax: +82 050 7711 1271

Email: [email protected]

This peer-reviewed, accepted manuscript will undergo final editing and production prior to publication in IJP.

© 2021 by Quintessence Publishing Co, Inc. Printing of this document is restricted to personal use only. No part may be reproduced or transmitted in any form without written permission from the publisher.

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Submitted August 12, 2020; accepted April 5, 2021

Abstract

Purpose: To evaluate the association between low handgrip strength and type of dental

prosthesis used in Korean adults in a cross-sectional study of nationally representative big data.

Materials and Methods: This study included 7,681 participants aged ≥ 19 years who were

classified into the following four groups: NP (not using a dental prosthesis); FDP (using

tooth-supported or implant-supported fixed dental prostheses); RPD (using removable partial

dentures); and CD (using removable complete dentures). Low handgrip strength was defined as

the lowest quartile of handgrip strength in each sex. The relationship between handgrip strength

and dental prosthesis use was analyzed with adjustment for potential confounders. Multivariate

logistic regression analyses were performed to examine the association between the use of dental

prostheses and low handgrip strength (α = .05). Results: The handgrip strength level of RPD

users was significantly lower than those not using removable dentures (P < .0001). The

respective adjusted odds ratios (with 95% CI) for low handgrip strength in the NP, FDP, RPD,

and CD groups were 1 (reference), 0.90 (0.77, 1.05), 1.44 (1.13, 1.83), and 1.70 (1.29, 2.23) after

adjustment for confounding factors. Using removable partial and/or complete dentures was

associated with a 1.64-fold higher risk of low handgrip strength compared to not using

removable dental prostheses. Conclusions: The use of removable dentures was associated with

low handgrip strength and may be considered a potential risk indicator for functional decline in

Korean adults. Int J Prosthodont 2021. doi: 10.11607/ijp.7334



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1. Introduction

The demand for health care is increasing in pace with the worldwide increase in life expectancy.1

Oral health is closely related to nutrition and quality of life.2-5 If the natural teeth are lost, the

edentulous areas can be restored using fixed or removable dental prostheses. Even in the absence

of oral disease, such as periodontal disease or dental caries, masticatory ability can vary

depending on the type of dental prosthesis used.6-8 Food preferences may also differ according to

masticatory force and performance, resulting in a nutritional imbalance.2,3,9

Dental prostheses can be broadly classified as fixed or removable.10 Fixed dental

prostheses are generally supported by teeth or implants and allow masticatory performance

similar to that of natural dentition. Removable dental prostheses include both partial and

complete dentures. Masticatory ability when wearing removable partial dentures depends on the

length and distribution of the edentulous area and the status of the underlying residual alveolar

ridge. Removable complete dentures are usually used when all natural teeth are lost and are

known to be the least effective of the various types of dental prostheses for chewing.11-13

Therefore, there are differences in masticatory performance according to the type of dental

prosthesis used,11,12 which may be directly related to nutritional status and affect overall

health.14-16

Handgrip strength is the maximum force that can be exerted by a particular muscle or

muscle group. There is accumulating scientific evidence of a significant association between low

handgrip strength and functional decline, nutritional risk, mortality, and poor quality of life.17-20

The method most commonly used to measure handgrip force is the isometric handgrip strength

test, which measures the force of grasping a handgrip dynamometer with one’s hand.21,22 The



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handgrip strength test is widely used as an indicator of functional decline and sarcopenia because

it is relatively simple to perform, and the result can be evaluated in a short time.21-23

Handgrip strength represents the strength of skeletal muscle and has been reported to

have a positive correlation with oral health status, including masticatory strength.24-30

Furthermore, the masticatory force varies depending on the type of dental prosthesis used;11,12

however, few studies have analyzed the association between the type of dental prosthesis used

and handgrip strength.25 The purpose of this study was to analyze the relationship between the

type of dental prosthesis used and handgrip strength based on nationwide big data. The null

hypothesis was that there would be no significant association between the type of dental

prosthesis used and handgrip strength.

2. Methods

2.1. Study participants and enrolment process

The present study examined data from the Sixth Korean National Health and Nutrition

Examination Survey (KNHANES �) 2014 and 2015. This survey is conducted annually to

compile nationally representative cross-sectional big data for monitoring the health and

nutritional status of the Korean population, and is performed by The Korea Centers for Disease

Control and Prevention (KCDC). The purpose of this survey was to calculate national-level

representative and reliable statistics on the health level, health behavior, and food and nutrition

intake of individuals residing in Korea and use them as basic data for national health policy. The

sampling frame for the KNHANES used the data from the latest Population and Housing Census

available at the time of the sampling design. Based on this, a representative sample of citizens

over the age of 1 year residing in Korea, i.e., the target population, was extracted. The survey

protocol was approved by the Institutional Review Board of the KCDC (approval number,



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2013-12EXP-03-5C) and performed in accordance with the tenets of the Declaration of Helsinki.

Informed consent was obtained from all study participants before the investigation was

conducted. Experienced interviewers and inspectors collected the data from the study

participants during interviews and by examination. This study was conducted in accordance with

the STROBE guidelines.31

The KNHANES 2014 and 2015 included 14,930 participants. In the present study, the

data for 11,921 participants aged ≥19 years were analyzed. Of these, 2521 had no information

available for major variables (such as the handgrip strength test and oral examination) and were

thus excluded, as were 1719 further subjects with other missing values such as data on potential

confounders. Ultimately, data of 7681 participants (3425 men, 4256 women) were included (Fig.

1).

2.2. Classification regarding the use of a dental prosthesis

Specially trained dentists performed the oral examinations in all participants. Dental caries,

periodontal disease, and missing teeth were recorded. Oral conditions were recorded separately

for the maxilla and mandible, according to the use of a dental prosthesis due to tooth loss and

whether they were rehabilitated with a fixed dental prosthesis, removable partial denture, and/or

a removable complete denture. Only study participants with dental prostheses due to tooth loss

were included in this study. A fixed dental prosthesis was defined as a bridge-type prosthesis

having one or more pontics. Single crown restorations of natural teeth were not included in the

fixed dental prosthesis category. An implant-supported fixed dental prosthesis, including a single

implant restoration, was included in the fixed dental prosthesis category because it was used to

restore a missing tooth. Study participants with implant-assisted removable partial dentures or



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removable complete dentures were considered to have removable partial dentures or removable

complete dentures, respectively.

Based on the oral examination findings, the participants were divided into a no-prosthesis

(NP) group (with no fixed or removable dental prosthesis due to tooth loss in either the maxilla or

mandible), a fixed dental prosthesis (FDP) group (with one or more conventional or

implant-supported fixed dental prostheses in the maxilla or mandible, but no removable dental

prosthesis), a removable partial denture (RPD) group (with removable partial dentures in the

maxilla and/or mandible, but not removable complete dentures), and a complete denture (CD)

group (with removable complete dentures in either the maxilla or mandible, or both; Fig. 2).

For further analysis, the participants were divided according to whether or not they used

removable prostheses: (1) “no removable dentures” group (including the NP and FDP groups), (2)

“removable dentures” group (including the RPD and CD groups).

2.3. Assessment of grip strength

Participants were excluded from the grip-strength measurement if they were functionally

constrained in a manner that prevented them from undergoing this assessment or showed

discomfort (such as that caused by wrist surgery, or pain within the last 3 months).

After the investigator explained the grip-strength measurement procedure to the participant, the

procedure was demonstrated directly. The participants were asked to remove any jewelry

attached to their fingers or wrists. Next, a light warm-up exercise, entailing shaking both hands

approximately three times, was performed followed by lightly holding all 10 fingers and

releasing them three times. Staring toward the front in a standing position, the arms were

naturally lowered. Grip strength was measured in that position using a digital grip strength

dynamometer (Model T.K.K.5401; Takei, Tokyo, Japan). Starting with the dominant hand, the



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strength was measured in both hands three times in an alternating manner. The grip time was

limited to less than 3 s. Each participant was asked to continue exhaling while holding the grip

strength dynamometer. A 60-s rest period was allowed after each measurement in each hand. The

results were recorded in 0.1-kg units. The highest grip strength value in the dominant hand was

used in this study. Low handgrip strength was defined as the lowest quartile (0–25%) of handgrip

strength within each sex group based on previous studies.18-20

2.4. General characteristics and potential confounders

Basic information, including subject age and sociodemographic lifestyle parameters, were

examined. Household incomes were categorized into four groups, as were education levels.

Current smokers were documented as “smoking status (yes).” Participants who had consumed

alcohol more than twice a month during the past year were recorded as “alcohol consumption

(yes).” Those who undertook at least 2 h 30 min of moderate physical activity or 1 h 15 min of

high intensity physical activity per week were recorded as “exercise (yes).” Body mass index

(BMI) was calculated after measurement of participant weight, height, and waist circumference by

trained inspectors. Participants with a BMI of ≥ 25 kg/m2 were recorded as “obesity (yes).”32

Blood pressure was measured using a mercury sphygmomanometer (Baumanometer;

Baum, Copiague, NY, USA); participants were recorded as having hypertension if they had a

systolic blood pressure of 140 mmHg or higher, a diastolic blood pressure of 90 mmHg or

higher, and/or were receiving antihypertensive medication. Venous blood was collected from

participants who had fasted for more than 8 h, and those with fasting blood glucose levels of 126

mg/dL or higher, those who had been diagnosed with diabetes, and/or those who were on

hypoglycemic agents or receiving insulin injections were considered to have diabetes.33



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“Removable denture requirement” was determined by specially trained dentists. Partially

or fully edentulous dentition, which needed to be restored but could not be restored with a

natural tooth-supported fixed prosthesis, was classified as “removable partial denture required”

or “removable complete denture required.” The participants were included in the “removable

denture requirement (no)” category if they needed neither removable partial nor complete

dentures. If a removable dental prosthesis was already present in the oral cavity but had to be

remanufactured or replaced, the status was classified as “removable denture requirement (yes).”

The participants were asked whether they felt discomfort while chewing food because of

problems with their oral condition, teeth, dental prosthesis, gums, or other related factors. Those

who reported discomfort were included in the “masticatory discomfort (yes)” category.

2.5. Statistical analysis

The SAS survey procedure was utilized to analyze the data obtained by the complex sample

design of the KNHANES and estimate approximations for the entire Korean population. The

characteristics of the study participants were analyzed using analysis of variance (ANOVA) for

continuous variables and the chi-squared test for categorical variables. Handgrip strength levels

according to whether or not a dental prosthesis was present were analyzed as the mean and

standard error using the independent t-test, ANOVA, and analysis of covariance using an

adjusted general linear model. The means were adjusted for sociodemographic characteristics

and systemic health factors in the models. Model 1 was the crude association, and Model 2 was

adjusted for age. Model 3 was adjusted for age, sociodemographic characteristics, systemic

health factors, and removable denture requirement. The fitness of each model was evaluated

using R-square. Multivariate logistic regression analyses were performed to examine the

association between the use of dental prostheses and low handgrip strength. The level of



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handgrip strength was dichotomized (the lowest quartile versus the others in each sex) to perform

the logistic regression analyses and adjusted for the various confounders in the models. All

statistical analyses were conducted using SAS (version 9.3, SAS Institute, Cary, NC, USA). A

P-value <.05 was considered statistically significant.

3. Results

The general characteristics of the study participants according to the type of dental prosthesis

used are shown in Table 1. All potential confounders considered were significantly associated with

the use of dental prostheses (P<.05). The mean age and proportion of subjects with “masticatory

discomfort (yes)” in each group increased significantly in the following order: NP, FDP, RPD, and

CD (P<.001).

Table 2 shows the measured handgrip strength values according to sex and the use of

dental prostheses. A significant association between the use of a removable prosthesis and

handgrip strength was observed even after the final adjustment in Model 3 (adjusted for age,

household income, education level, smoking status, alcohol consumption, exercise, obesity,

hypertension, diabetes, and removable denture requirement). Participants of either sex in the

RPD and CD groups had a significantly lower handgrip strength than those who did not use any

type of removable prosthesis (P<.0001 for both sexes).

The relationship between low handgrip strength and the use of removable dental

prostheses, as examined using the multivariate logistic regression models, is shown in Table 3.

The lowest quartile cut-off value was 36 kg for men and 22.2 kg for women. In the final adjusted

model 3, a significant association between low handgrip strength and the use of a dental

prosthesis remained. When participants were divided into the same four subgroups, the RPD and

CD groups had a 1.44-fold (95% confidence interval [CI] 1.13, 1.83) and 1.7-fold (95% CI 1.29,



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2.23) higher risk of low handgrip strength, respectively, than the participants without dental

prostheses (P=.0016). When the participants with no removable dentures and those with

removable dentures were compared, the latter had a 1.64-fold (95% CI 1.37, 1.97) increased risk

of low handgrip strength (P<.0001).

4. Discussion

This study is potentially the first to investigate handgrip strength according to the type of dental

prostheses worn utilizing a nationwide dataset. A significant association was observed between

handgrip strength and the use of removable prostheses. Therefore, the null hypothesis was rejected.

The adults with removable dentures showed significantly lower handgrip strength than those not

using removable dentures. Furthermore, the risk of low handgrip strength was significantly higher

in study participants with removable dentures than in those who did not use removable dental

prostheses.

Although the relationship between removable dental prostheses and handgrip strength is

still not well studied, several studies have reported a significant association between oral health

status and handgrip strength.24-30 Some of these studies have demonstrated musculoskeletal

frailty with low handgrip strength in patients with poor masticatory performance.24,27,28,30 Even if

the area of tooth loss is restored with a dental prosthesis, masticatory performance may vary

depending on the type of dental prosthesis used.6-8 It has been reported that individuals who use

removable complete dentures have a masticatory force that is 1/7 to 1/4 lower than those with an

intact dentition.11,12 The relatively limited chewing ability in our study participants with

removable dentures may have been associated with reduced handgrip strength and functional

decline.



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The Asian Working Group for Sarcopenia set diagnostic criteria for sarcopenia based on

handgrip strength at <26 kg for men and <18 kg for women.23 Iwasaki et al. reported a significant

association between dentition status and sarcopenia.25 They found that participants without

occlusal pairs of natural teeth had a 3.37-fold higher risk of sarcopenia than those with 10 or more

occlusal pairs of natural teeth.25 Furthermore, a higher risk of sarcopenia was reported in subjects

who used poorly fitting removable dentures than in those with well-fitted removable dentures.25

These results are consistent with the finding of the present study that functional decline and the use

of dental prostheses are related. Inadequate nutrition could be associated with reduced handgrip

strength in individuals wearing removable dentures.34,35 This is because removable denture users

generally prefer soft foods over hard foods that are difficult to chew.36-38

Conversely, reduced handgrip strength can be a cause of oral health problems. Low

handgrip strength is reportedly associated with muscular dystrophy and dexterity limitations.39,40

Reduced hand function and low handgrip strength may also be associated with poor oral self-care

behaviors, such as daily toothbrushing.41-43 These poor oral health behaviors can lead to

periodontal disease44 and tooth loss.45 Therefore, the possibility of using removable prostheses

would be increased. This, in turn, can lead to nutritional restrictions, leading to a vicious cycle

that could cause functional decline.46

Several previous studies have shown that there is a relationship between the number of

natural teeth and handgrip strength.30,47 However, most missing teeth were rehabilitated with

dental prostheses rather than left edentulous. Compared to removable dentures, fixed dental

prostheses, such as implant-supported crowns, have a similar chewing function to that of natural

teeth. Nevertheless, the sites that had been rehabilitated with fixed dental prostheses were often

included in the number of missing teeth in these previous studies.30,47 In such cases, it may be



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possible to study the degree of natural tooth loss, but it would be difficult to examine how the

chewing function of the oral cavity affects general health. This is because there is a significant

difference in chewing function between fully edentulous subjects who have both arches restored

with removable complete dentures, and fully edentulous subjects with both arches rehabilitated

with complete-arch implant-supported fixed dental prostheses. Considering these issues, in the

present study, the participant data were analyzed according to the type of dental prostheses used

instead of the number of missing teeth.

This study analyzed a large dataset accumulated by a nationwide survey designed to

predict the health and nutritional status of a national population. This allowed analysis of a body

of well-organized data from a large number of study participants. Furthermore, many potential

confounders were adjusted to examine the independent relationship between the use of

removable prostheses and handgrip strength. However, because this study had a cross-sectional

design, it was impossible to assess causality. Additionally, the levels of handgrip strength

between the groups in the final adjusted model shown in Table 2 were relatively close, although

the difference was statistically significant. Further prospective cohort studies are needed to

elucidate the causal relationship between the use of removable dental prostheses and functional

decline.

5. Conclusions

Within the limitations of this cross-sectional study, the use of removable dental prostheses was

shown to be significantly associated with handgrip strength. The risk of having low handgrip

strength for individuals using removable dental prostheses was 1.64-fold higher than that of

those who did not use removable prostheses, even after adjusting for various potential

confounders including age, household income, education level, smoking status, alcohol



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consumption, exercise, obesity, hypertension, diabetes, and removable denture requirement.

Based on the results of the nationwide representative big data analysis in this study, dentists and

physicians may need to consider the potential risk of low muscular strength and functional

decline when examining patients with removable dentures.

FUNDING

This research did not receive any specific grant from funding agencies in the public, commercial,

or not-for-profit sectors.

ACKNOWLEDGMENTS

The authors would like to express their sincere thanks and gratitude to Ms. Da Hye Kim, Mr.

Jin-Hyung Jung, and Prof. Yong-Gyu Park, Department of Biostatistics, College of Medicine,

The Catholic University of Korea, for the review of the statistical analysis.

Conflict of interest statement

The authors declare that there is no conflict of interest.

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Legends to Figures

Figure 1. Flow chart showing the process used to select the study participants.

Overall, 7681 participants were ultimately included. KNHANES, Korean National Health

and Nutrition Examination Survey.



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Figure 2. Chart showing the classification of dental prosthesis groups according to the

results of the oral examination.

CD group: at least one removable complete denture; FDP group: at least one fixed dental

prosthesis, including fixed partial dentures and dental implants, but no removable dental

prosthesis; NP group: no dental prosthesis; RPD group: at least one removable partial

denture but no removable complete dentures.



Table 1. General characteristics of study participants according to the type of dental prosthesis

used.

NP group FDP group

RPD group CD group P-value

n 4437 2328 547 369 Sex (n)

Men 1933 1025 251 216 Women 2504 1303 296 153

Age (years)* 39.3 ± 0.3 53.4 ± 0.4 66.5 ± 0.5 68.6 ± 0.7 <.001 ≥ 70 years 2.2 (0.2) 11.4 (0.7) 41 (2.4) 54 (3.1) <.001

Household income <.001 Lowest quartile 8.9 (0.6) 14.2 (0.9) 37.9 (2.6) 44 (3.2) Lower middle quartile 23.7 (1.1) 23.1 (1.2) 29.9 (2.4) 29.5 (3.1) Upper middle quartile 33.0 (1.2) 30.1 (1.4) 19.4 (2.0) 16.8 (2.5) Highest quartile 34.5 (1.4) 32.7 (1.6) 12.8 (1.8) 9.7 (2.1)

Education level <.001 Elementary or lower 6.7 (0.4) 20.2 (1.0) 50.4 (2.6) 57.6 (3.5) Middle school 6.0 (0.4) 12.9 (0.8) 17.3 (2.0) 16.9 (2.6) High school 41.5 (1.0) 36.5 (1.3) 22.5 (2.1) 19.4 (2.6) College or higher 45.9 (1.1) 30.3 (1.4) 9.8 (1.5) 6.1 (1.7)

Smoking status (yes) 22.3 (0.8) 20.8 (1.0) 17.3 (2.1) 26.3 (2.7) <.05 Alcohol consumption (yes) 51.2 (0.9) 46.6 (1.2) 37.3 (2.3) 36.1 (2.9) <.001 Exercise (yes) 58.3 (0.9) 51.4 (1.3) 41.3 (2.5) 37.8 (2.9) <.001 Obesity (BMI ≥ 25 kg/m2) 30.4 (0.8) 35.1 (1.2) 39.4 (2.3) 37.2 (3.3) <.001 Hypertension (yes) 15.7 (0.7) 33.1 (1.1) 54.7 (2.6) 51.4 (3.3) <.001 Diabetes mellitus (yes) 5.6 (0.4) 11.9 (0.8) 20.8 (2.1) 27.0 (2.7) <.001

Removable denture requirement (no) 95.4 (0.3) 88.7 (0.7) 82.1 (2.0) 85.1 (2.4) <.001

Masticatory discomfort (yes) 12.1 (0.6) 25.1 (1.1) 49 (2.4) 56.3 (3.3) <.001

The data are presented as the weighted percentage (standard error). *Data presented as the mean ± standard error. BMI, body mass index; CD, complete denture; FDP, fixed dental prosthesis, including implant; NP, no dental prosthesis; RPD, removable partial denture



Table 2. Level of handgrip strength (kg) according to sex and the type of dental prosthesis

used

Group Model 1 Model 2 Model 3 Men No removable denturesa 43.1 ± 0.2 42.0 ± 0.2 40.8 ± 0.3

Removable denturesb 36.6 ± 0.4 38.8 ± 0.4 38.8 ± 0.5

P-value <.0001 <.0001 <.0001 R-square 0.05267 0.1226 0.1947 Women No removable denturesa 26.2 ± 0.1 25.8 ± 0.1 25.7 ± 0.3

Removable denturesb 22.3 ± 0.3 23.6 ± 0.3 24.3 ± 0.4

P-value <.0001 <.0001 <.0001 R-square 0.04322 0.08402 0.1331

Men NP 43.5 ± 0.2 41.8 ± 0.2 40.7 ± 0.4

FDP 42.1 ± 0.3 42.3 ± 0.3 41.1 ± 0.4

RPD 37.0 ± 0.5 39.3 ± 0.5 38.9 ± 0.5

CD 36.2 ± 0.6 38.6 ± 0.6 38.7 ± 0.6

P for trend <.0001 <.0001 <.0001 R-square 0.05969 0.1237 0.1952 Women NP 26.4 ± 0.1 25.7 ± 0.1 25.6 ± 0.3

FDP 25.6 ± 0.2 25.9 ± 0.2 25.8 ± 0.3

RPD 22.8 ± 0.3 23.9 ± 0.3 24.6 ± 0.4

CD 21.5 ± 0.5 22.9 ± 0.5 23.8 ± 0.6

P for trend <.0001 <.0001 <.0001 R-square 0.05044 0.08491 0.1338 Data are presented as mean ± standard error. aNP and FDP groups combined. bRPD and CD groups combined. CD, complete denture; FDP, fixed dental prosthesis, including implant; NP, no dental prosthesis; RPD, removable partial denture. Model 1 is the unadjusted association, Model 2 is adjusted for age, and Model 3 is adjusted for age, household income, education level, smoking status, alcohol consumption, exercise, obesity, hypertension, diabetes, and removable denture requirement.



Table 3. Odds ratios for study participants with low handgrip strength according to the type

of dental prosthesis used

Group Model 1 Model 2 Model 3

No removable denturesa 1 (ref.) 1 (ref.) 1 (ref.) Removable denturesb 4.16 (3.5, 4.95) 1.93 (1.61, 2.3) 1.64 (1.37, 1.97) P-value <.0001 <.0001 <.0001 R-squarec 0.0497 0.1085 0.1527

NP 1 (ref.) 1 (ref.) 1 (ref.) FDP 1.46 (1.26, 1.69) 0.88 (0.76, 1.03) 0.9 (0.77, 1.05) RPD 4.22 (3.4, 5.24) 1.66 (1.32, 2.08) 1.44 (1.13, 1.83) CD 5.42 (4.15, 7.08) 2 (1.53, 2.62) 1.7 (1.29, 2.23) P for trend <.0001 <.0001 0.0016 R-squarec 0.0566 0.1092 0.1533 The data are presented as the odds ratio (95% confidence interval). The low handgrip strength was defined as the lowest quartile (cut-off value was 36 kg for men and 22.2 kg for women). aNP and FDP groups combined. bRPD and CD groups combined. cNagelkerke R-square. CD, complete denture; FDP, fixed dental prosthesis, including implant; NP, no dental prosthesis; RPD, removable partial denture. Model 1 is the unadjusted association, Model 2 is adjusted for age, and Model 3 is adjusted for age, household income, education level, smoking status, alcohol consumption, exercise, obesity, hypertension, diabetes, and removable denture requirement.



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Removable dental prosthesis use and low handgrip strength