Number of teeth and cardiovascular mortality

Oral/Systemic Linkages Number of teeth and cardiovascular mortality Background.—Low-grade systemic inflammation has been identified as a possible etiologic factor in cardiovascular disease (CVD). Chronic infection can be a source of low-grade systemic inflammation and is known to produce increased amounts of circulating inflammatory markers, such as C-reactive protein, fibrinogen, and white blood cell count. These markers are known to be linked to an increased risk for CVD. Tooth loss as a result of being middle aged is most commonly associated with periodontal disease. Although a causative connection remains to be discovered, this chronic infection in the supportive tissues of teeth has been known to be associated with CVD. Periodontal disease can produce a low-grade systemic inflammation, which has been already linked to an increased risk for CVD. Various parameters of oral health were investigated for their ability to predict cardiovascular mortality. Methods.—The study included 3300 men and 4374 women ranging in age from 20 to 89 years. All the patients were examined by a periodontal specialist between 1976 and 2002. Among the data obtained were the number of teeth remaining, severity of periodontal disease, number of deepened periodontal pockets, and bleeding on probing, which were evaluated to determine the presence of any relationship with cause of death over a median follow-up period of 12 years (range, 0.2 to 29 years). Results.—The total mortality rate was 0.67 per 100 person-year at risk, with 629 of the total 7674 patients dying during follow-up. The primary cause of death was CVD in 299 subjects. No link was found between severity of periodontal disease and death. However, the number of teeth remaining was predictive in a dose-dependent manner of all-cause mortality, mortality from CVD, and mortality from coronary heart disease (CHD); however, it was not predictive of mortality from stroke. Subjects with <10 teeth remaining had a seven-fold increased risk for CHD mortality as compared with those who had >25 teeth remaining. None of the other parameters was found to be predictive of mortality after adjusting for confounders (Fig 1).

Fig 1.—Cumulative survival plot with the number of teeth as grouping variable, mortality in CVD as censor variable, and follow-up time given in years (log-rank P < 0.0001 for the difference between groups). (Courtesy of Holmlund A, Holm G, Lind L: Number of teeth as a predictor of cardiovascular mortality in a cohort of 7674 subjects followed for 12 years. J Periodontol 81:870-876, 2010.)

Discussion.—Number of teeth remaining was predictive of CVD, CHD, and all-cause mortality in a dosedependent manner in this fairly large prospective study. Therefore, a link between oral health and CVD was confirmed.

Clinical Significance.—Number of teeth remaining is an easy determination for dentists to make. It appears to be a good indicator of oral health and can be used to assess the risk of death from CVD, with the exception of stroke. A general medical examination could be suggested for all individuals with severe tooth loss or periodontal disease to explore this oral health cardiovascular mortality link.

Holmlund A, Holm G, Lind L: Number of teeth as a predictor of cardiovascular mortality in a cohort of 7674 subjects followed for 12 years. J Periodontol 81:870-876, 2010 Reprints available from A Holmlund, Dept of Periodontology, G€avle County Hosp, 801 87 G€avle, Sweden; fax: 046-26-155347; e-mail: [email protected]

Volume 56



Issue 2



2011

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