Key Takeaways
- A 2026 Israeli study found that 56.3% of Holocaust survivors in its sample had two full dentures, compared with 45.7% of other older Jewish Israelis.
- The researchers treated two full dentures as a proxy for complete tooth loss, but that measure does not directly confirm the absence of every natural tooth in every participant.
- The analysis continued to link Holocaust exposure with two full dentures after the researchers accounted for age, smoking, dental attendance, religiosity, and caregiver support.
- The study cannot show that Holocaust experiences caused tooth loss because it analyzed one cross-sectional snapshot rather than changes across a lifetime.
- Data collection took place in 2005 and 2006, nearly two decades before publication, so the percentages do not describe the current survivor population.
- Earlier research supports a broader life-course explanation in which childhood adversity, socioeconomic disadvantage, smoking, and barriers to dental care can accumulate and affect tooth retention in later life.
- The findings support accessible, trauma-informed dental care for survivors and other older adults who have lived through severe deprivation.
Introduction
An Israeli study found that Holocaust survivors were more likely to have two full dentures than other older Jewish Israelis. The findings highlight the importance of accessible, trauma-informed dental care.
Tooth loss often tells a story that began long before the final extraction. Decades of dental disease, smoking, limited access to care, financial hardship, treatment decisions, and social conditions can shape how many natural teeth a person retains in later life.
A new Israeli study asks whether that cumulative story looks different for people who survived the Holocaust. Tobias and colleagues analyzed older survey data and found that Holocaust survivors more often had two full dentures than other older Jewish Israelis. The difference was substantial: 56.3% versus 45.7% (Tobias et al., 2026).
The finding deserves attention, but it also requires careful language. The researchers did not follow participants from childhood to old age, and they did not document when or why each tooth disappeared. They measured denture status during a survey that researchers conducted in 2005 and 2006. They then used the presence of two full dentures as a proxy for complete tooth loss.
This distinction matters. The study identifies an association that fits a wider body of research on life-course disadvantage and oral health. It does not prove that Holocaust exposure directly caused later tooth loss. Its most useful contribution lies in showing how historical trauma, aging, health behavior, social conditions, and dental care may converge across an entire lifetime.
What Did the Israeli Study Examine?
The researchers used data from a national health and nutrition survey of Israelis aged 65 years and older. The survey took place between July 2005 and December 2006. For this analysis, the authors included 1,459 Jewish participants who consented to an oral examination. The group included 396 Holocaust survivors and 1,063 Jewish participants without personal exposure to Nazi persecution (Tobias et al., 2026).
The survivor category included people who had lived under Nazi occupation, experienced persecution in a country influenced by the Nazi regime, or fled a Nazi-controlled area before the end of the war. This definition brought together people with widely different experiences, including hiding, forced labor, displacement, and direct confinement.
Trained interviewers conducted structured interviews in participants’ homes. Licensed dentists also completed standardized oral examinations. The survey collected information about natural teeth, dentures, smoking, dental visits, functional status, medical history, and demographic characteristics.
For the main statistical analysis, the researchers used two full dentures as the outcome. In practical terms, this meant a complete upper denture and a complete lower denture. They treated that combination as a proxy for complete tooth loss with prosthetic replacement.
What Did the Researchers Find?
Among Holocaust survivors, 56.3% had two full dentures. Among the comparison group, 45.7% had two full dentures. The difference reached statistical significance (Tobias et al., 2026).
The survivor group was approximately two years older on average, and age strongly predicted denture status. The authors therefore used multivariable regression to examine several factors together. Holocaust exposure remained a statistically significant predictor alongside age, current or past smoking, a recent dental visit, religiosity, and reliance on a caregiver.
Smoking showed an important association. Current and former smokers had approximately 1.7 times the odds of having two full dentures compared with people who had never smoked. Participants who needed caregiver assistance also had higher odds. These findings make clinical sense because tobacco exposure increases the risk of periodontal destruction and tooth loss, while declining function can make daily oral hygiene and access to dental services more difficult.
The association with recent dental attendance requires a different interpretation. Participants who had visited a dentist within the previous year had higher odds of two full dentures. Dental visits did not cause tooth loss. People with complete dentures often need appointments for sore tissues, poor fit, fractures, relining, and replacement. Denture status probably created the need for care.
Why Two Full Dentures Do Not Equal a Direct Tooth Count
The proposed headline that survivors were more likely to have lost all their teeth captures the likely clinical meaning, but it states the conclusion more firmly than the main measure allows.
A person who wears complete upper and lower dentures will usually have no natural teeth in either arch. Still, the study’s regression outcome was denture use, not a tooth-by-tooth record that independently confirmed zero natural teeth for every participant in that category. The paper describes oral examinations and edentulism status, but it specifically defines two full dentures as a proxy in the main analysis (Tobias et al., 2026).
The proxy can also miss people. An older adult may have no natural teeth but lack one or both dentures because of cost, poor access, limited mobility, discomfort, or an inability to tolerate the prosthesis. That person would not enter the two-full-denture group even though the person had experienced complete tooth loss.
Conversely, historical terminology, recording practices, or retained roots could complicate the assumption that every complete denture wearer had absolutely no remaining tooth structure. These possibilities do not erase the observed difference. They simply support a more accurate statement: survivors in this sample were more likely to have two full dentures, a marker that strongly suggests severe lifetime tooth loss.
What Might Explain the Difference?
No single mechanism can explain a lifetime oral health outcome. Several pathways may have contributed, and the study could not separate them.
Severe deprivation and interrupted care
Many survivors endured starvation, nutritional deficiencies, overcrowding, poor sanitation, displacement, and the collapse of ordinary healthcare. During war and persecution, preventive dentistry becomes inaccessible and treatable disease may progress. Early damage can also begin a cycle of pain, emergency treatment, and extraction rather than preservation.
Yet the new study did not measure childhood dental disease, wartime dental treatment, or the timing of extractions. It therefore cannot determine how much those experiences contributed to denture use decades later.
Cumulative socioeconomic disadvantage
Tooth loss reflects more than biology. Income, education, insurance, transportation, availability of clinicians, and the affordability of restorative treatment influence whether a patient receives prevention, a filling, periodontal therapy, root canal treatment, or extraction.
A 2026 systematic review of 68 studies found that socioeconomic disadvantage among older adults consistently correlated with fewer natural teeth, more edentulism, lack of a functional dentition, irregular dental attendance, and poorer oral-health-related quality of life (Syed et al., 2026). An earlier meta-analysis reached a similar conclusion and identified age, education, and socioeconomic status as major correlates of edentulism in older populations (Roberto et al., 2019).
This evidence supports a cumulative-disadvantage interpretation. It does not establish that the same pathways fully account for the difference between the two Israeli groups.
Smoking and other health behaviors
The survivor group included a higher percentage of former smokers than the comparison group. Smoking can accelerate periodontal attachment loss, compromise healing, and increase the probability of tooth loss. The regression analysis adjusted for smoking, but a simple current, former, or never category cannot capture lifetime dose, duration, or the timing of cessation.
Diet, oral hygiene, sugar exposure, and patterns of dental attendance may also matter. The survey did not reconstruct these behaviors across each participant’s life. Residual confounding therefore remains likely.
Trauma and long-term health
Severe trauma may influence health through chronic stress, mental illness, disrupted self-care, social disadvantage, and physiological pathways. Earlier research has linked childhood adversity with poorer dental outcomes in later life. In a study of more than 25,000 older Japanese adults, Matsuyama and colleagues found that reported childhood abuse correlated with fewer remaining teeth even after adjustment for socioeconomic factors. The association was modest, and the researchers relied on retrospective self-reports, but the result supports a life-course connection between early adversity and later oral health (Matsuyama et al., 2016).
Research using the English Longitudinal Study of Ageing also found direct and indirect pathways from childhood socioeconomic position to total tooth loss later in life. Education, adult socioeconomic position, and health behaviors explained part of that relationship (Letelier et al., 2022).
These studies provide context, not proof of a mechanism in Holocaust survivors. Childhood abuse, socioeconomic hardship, and genocidal persecution are not interchangeable exposures. Researchers should not use evidence from one type of adversity to quantify the effect of another.
How Does the Study Compare With Earlier Research?
The new study aligns with a broad and consistent finding: people who experience disadvantage across the life course tend to retain fewer natural teeth in older age. It also agrees with research that treats edentulism as a social and healthcare outcome rather than an unavoidable consequence of aging.
At the same time, the study offers less certainty than a prospective cohort would provide. The authors identified survivor status and current denture use at one survey point. They could not establish whether the oral health gap began during the war, emerged after migration, widened through unequal access to care, or developed through a combination of factors.
The comparison group also deserves scrutiny. Jewish Israelis without Holocaust exposure did not necessarily share the same countries of origin, childhood nutrition, migration histories, cultural practices, or opportunities for dental care. Differences between the groups may therefore reflect factors that the regression model did not capture.
This is where the study both contributes and falls short. It documents a clinically meaningful disparity in an understudied population. It does not isolate the historical, behavioral, biological, or healthcare pathways that produced that disparity.
What Are the Study’s Most Important Limitations?
The design cannot establish causation
The cross-sectional design gives researchers a snapshot. It cannot show the sequence from exposure to disease or rule out alternative explanations. The study supports the wording “associated with,” not “caused by.”
The data are old
Researchers collected the information in 2005 and 2006. The study therefore describes participants at that time, not Holocaust survivors living in Israel today. Dental technology, access to implants, public benefits, preventive care, and the age and health profile of survivors have changed since then.
The long delay does not make the dataset useless. It may preserve information from a larger survivor population at a younger age than researchers could recruit today. However, readers should not interpret 56.3% as a current prevalence estimate.
Two full dentures served as a proxy
The analysis did not base its main outcome on a direct zero-tooth count for every participant. Two full dentures strongly indicate severe tooth loss, but the measure can misclassify people and can exclude edentulous adults who lack dentures.
The response rate was low
Only about three in ten sampled individuals completed the survey. People who participated may have differed from those who declined or could not participate. Frail, institutionalized, cognitively impaired, or highly traumatized adults may appear less often in the final sample. This selection could raise or lower the observed difference.
The survivor category was heterogeneous
The study grouped together people with different ages during the war, countries of origin, durations and types of persecution, nutritional histories, and migration experiences. A single yes-or-no exposure variable cannot represent that complexity.
The model could not capture a lifetime of dental decisions
The survey lacked detailed information about lifelong income, insurance, sugar consumption, oral hygiene, periodontal treatment, previous dental disease, and reasons for extraction. It also could not account fully for older treatment philosophies that favored extraction and dentures over tooth preservation.
What Does This Mean for Dental Care?
The study should not lead clinicians to assume that a survivor’s present oral condition resulted directly from Holocaust exposure. It should encourage clinicians to recognize that severe historical adversity may sit behind current disease, disability, anxiety, and patterns of care.
In my clinical view, the most useful response is neither to reduce a patient to a trauma history nor to ignore that history. Dentists can ask permission before discussing sensitive experiences, explain each step of treatment, preserve the patient’s sense of control, and accommodate a caregiver when the patient wants support. These practices form part of respectful, trauma-informed care.
Clinicians should also assess whether dentures remain functional. Poorly fitting prostheses can cause pain, ulcers, difficulty chewing, and avoidance of nutritious foods. Some patients may benefit from relining, repair, replacement, treatment of dry mouth, hygiene assistance, or evaluation for implant support. Age alone should not determine the treatment plan. General health, anatomy, dexterity, goals, finances, and the ability to maintain the result all matter.
For health systems, the study reinforces a broader point. Tooth loss accumulates over time, but policy can still reduce its effects. Affordable preventive and restorative care, transportation, home-based services, caregiver education, and prosthetic maintenance can improve comfort and function even when clinicians cannot reverse past loss.
What Research Should Come Next?
Researchers now need studies that separate denture status from clinically confirmed tooth count and describe the timing and reasons for extractions. Detailed exposure histories could examine age during persecution, duration and type of deprivation, migration, postwar socioeconomic conditions, smoking dose, and access to dental care.
A contemporary assessment could clarify the present treatment needs of the remaining survivor population. Qualitative interviews could also reveal experiences that numerical survey data miss, including dental fear, trust, affordability, satisfaction with dentures, and barriers to seeking care.
Researchers should approach this work with unusual ethical care. The purpose should not be to reduce an incomparable historical atrocity to a risk factor. The purpose should be to understand unmet needs and improve care while respecting survivors’ histories and autonomy.
Final Thoughts
The Israeli study found a clear association between Holocaust survivor status and having two full dentures among older Jewish adults who participated in the 2005–2006 survey. The finding remained significant after adjustment for several measured factors, but the design cannot establish why the difference existed.
The broader evidence makes a life-course explanation plausible. Severe adversity, socioeconomic disadvantage, smoking, disrupted healthcare, and treatment access can accumulate over decades and influence whether people retain their natural teeth. Still, plausibility is not proof, and the study cannot assign a specific share of tooth loss to wartime deprivation or trauma.
The most defensible conclusion is also the most humane one. This study identifies an oral health disparity that deserves attention. It supports better geriatric and trauma-informed dental services, while reminding readers that denture use records the endpoint of many possible paths rather than a single cause.
Frequently Asked Questions
Did the Study Prove That Holocaust Experiences Caused Tooth Loss?
No. The study found an association between Holocaust survivor status and two full dentures. Its cross-sectional design could not determine when tooth loss occurred or prove that Holocaust experiences caused it (Tobias et al., 2026).
Were All Holocaust Survivors in the Study Toothless?
No. The study reported that 56.3% of survivors had two full dentures. Many survivors did not. The researchers also used two full dentures as a proxy for complete tooth loss rather than directly confirming zero natural teeth through the main outcome measure for every participant.
Why Does Complete Tooth Loss Matter?
Complete tooth loss can affect chewing, food choice, speech, comfort, appearance, and quality of life. Dentures can restore important function, but they require maintenance and do not fully reproduce natural dentition (Gerritsen et al., 2010).
Does Aging Inevitably Lead to Dentures?
No. Age increases cumulative exposure to dental disease and past treatment, but complete tooth loss is not an inevitable biological consequence of aging. Prevention, tobacco avoidance, periodontal care, restorative treatment, and access to regular dental services can help people retain teeth.
What Should Families or Caregivers Do?
They can watch for denture pain, mouth sores, difficulty eating, loose prostheses, dry mouth, and changes in weight or food choice. They should help arrange a dental assessment when problems arise and support daily cleaning without overriding the older adult’s preferences or autonomy.
References
Gerritsen, A. E., Allen, P. F., Witter, D. J., Bronkhorst, E. M., & Creugers, N. H. J. (2010). Tooth loss and oral health-related quality of life: A systematic review and meta-analysis. Health and Quality of Life Outcomes, 8, 126. https://doi.org/10.1186/1477-7525-8-126
Letelier, A., Jivraj, S., Heilmann, A., Watt, R. G., & Tsakos, G. (2022). Life course socioeconomic position and general and oral health in later life: Assessing the role of social causation and health selection pathways. SSM – Population Health, 17, 101026. https://doi.org/10.1016/j.ssmph.2022.101026
Matsuyama, Y., Fujiwara, T., Aida, J., Watt, R. G., Kondo, N., Yamamoto, T., Kondo, K., & Osaka, K. (2016). Experience of childhood abuse and later number of remaining teeth in older Japanese: A life-course study from Japan Gerontological Evaluation Study project. Community Dentistry and Oral Epidemiology, 44(6), 531–539. https://doi.org/10.1111/cdoe.12246
Roberto, L. L., Crespo, T. S., Monteiro-Junior, R. S., Martins, A. M. E. B. L., De Paula, A. M. B., Ferreira, E. F., & Haikal, D. S. (2019). Sociodemographic determinants of edentulism in the elderly population: A systematic review and meta-analysis. Gerodontology, 36(4), 325–337. https://doi.org/10.1111/ger.12430
Syed, S. S., Pojmonpiti, S., Janssens, B., Srinivasan, M., Müller, F., & Tsakos, G. (2026). Association of socioeconomic factors with oral health in older adults: A systematic review and meta-analysis. Gerodontology, 43(3), 456–474. https://doi.org/10.1111/ger.70079
Tobias, G., Mann, J., Zini, A., & Sgan-Cohen, H. D. (2026). Oral health outcomes following early-life exposure to war-related hardship: A cross-sectional study. Clinical Oral Investigations, 30, 127. https://doi.org/10.1007/s00784-026-06821-y
Conflict of Interest
The author declares no conflict of interest relevant to this article.
Funding
The author received no external funding for this article.
