It is suggested that what claimed his life, along with his bad teeth that weakened his stamina and heart failure from beriberi, were the conflicts in diagnosis between doctors (traditional Chinese medicine doctors, such as Takashina, diagnosed him with beriberi but western medical doctors, such as those from the bakufu, insisted he had rheumatism).
その虫歯が家茂の体力を弱め、脚気衝心、さらには医師間の診断内容の相違（高階ら漢方の典医は脚気との診断を下したが、西洋医の幕府奥医師たちはこれをリウマチだとして譲らなかった）も加わり、家茂の命を奪ったのではないか、と指摘している。