Tooth number, World War II, nuns, and the real fountain of youth.

A new appreciation for the direct relationship of mouth health to systemic health is forcing re-evaluation of previous concepts of oral health strategies. Although a person shows adaptation to loss of some permanent teeth, it appears a threshold of 10 functional pairs or 20 teeth have linkage to a number of disabling diseases of aging. The Shortened Dental Arch concept has limitations for sustainability and leaves little functional cushion. Nevertheless, when teeth are lost leaving fewer than 20, systemic disease and mortality risk increase significantly. Several theories try to explain the phenomenon. An unusually credible study, however, changes the metric to fewer teeth, nine or less, before a cognitive decline is noted. Due to a standardized high level of prosthodontic treatment in that study, some of the deleterious health effects of tooth loss appear to be mitigated. The importance of these findings has implications for tooth replacement strategies. Recognizing the huge biologic and psychological cost of tooth loss, a renewed emphasis to maintain natural teeth is indicated. When fewer than 20 teeth are viable, well-made prosthodontics, including maxillary complete denture or a mandibular partial or overdenture, both tooth- and implant-supported, could be remunerative therapies.