Poor oral health associated with coronary heart disease
American Heart Association Journal Report -- 02/17/2004

Source: http://www.americanheart.org/presenter.jhtml?identifier=3019173

DALLAS, Feb. 17 – Having poor scores in five areas of oral health is associated with coronary heart disease, according to a report in today’s rapid access issue of Circulation: Journal of the American Heart Association.

In this small study, a poor oral health diagnosis was a stronger predictor of heart disease than other markers, such as high levels of fibrinogen (a clotting factor), low HDL (“good”) cholesterol or high triglycerides.

Researchers used five oral diseases to create the asymptotic dental score (ADS) for determining cardiac risk. The diseases were pericoronitis, an infection around the third molar; gingivitis, or gum inflammation; missing teeth; root remnants, which means that patients’ teeth were so decayed that only the tip of the root remained; and dental caries, or cavities.

“Oral infections are thought to produce inflammation that might be associated with coronary heart disease, so we examined all oral pathologies that might generate inflammation,” said lead author Sok-Ja Janket, D.M.D., M.P.H., assistant professor at Boston University School of Dental Medicine, and postdoctoral fellow at Harvard University’s school of public health in Boston. “The ADS is a non-invasive risk measure that can be assessed easily at the time of dental check-up.”

They used a mathematical model called the C statistic to check each oral disease’s association with coronary heart disease, select the disease that had the most significant associations, score the strengths of the individual disease’s contributions and weigh them to determine how much of a collective impact they had on coronary heart disease.

Janket and her associates compared the oral health data of 256 Finnish cardiac patients to that of 250 non-cardiac patients with similar demographic characteristics.

Among the five oral diseases, the strongest predictor of coronary disease was pericoronitis, followed by root remnants and gingivitis; then dental caries and missing teeth.

According to Janket, this study suggests oral disease and coronary heart disease are linked, but it does not show whether one causes the other. But, she said dentists who have patients with poor oral health should consider encouraging them to have cardiac examinations, even if they do not have symptoms of heart disease.

Janket hypothesizes that oral health not only contributes to heart disease through the inflammation process, but also because of inadequate nutritional intake. “People who do not have teeth cannot chew their food well and therefore do not get as much heart-healthy nutrients or fiber,” she said. “Future studies should look at nutrition, oral health and coronary heart disease.”

American Heart Association President, Augustus O. Grant, M.D., Ph.D., points out that the association seen in this study, if confirmed, could have many explanations. “Individuals who are un- or under-insured, those of low socio-economic status, or even those who simply have poor general health habits, are also likely to have poor dental health. They are also likely to have less access to preventive care that would protect them from coronary artery disease, so this association may simply reflect the fact that our society needs to do much better in promoting health in all individuals.”

In an accompanying editorial, Professor Gordon D.O. Lowe, of the University Department of Medicine, Royal Infirmary in Glasgow, U.K., cautioned about applying these findings to the general population. “We should continue to emphasize proven risk factors, such as age, sex, smoking habit, diabetes, blood pressure and total cholesterol/HDL ratio. Further studies are needed to evaluate the additive predictive value of ‘emerging’ risk predictors, including dental health scores,” he wrote.

Co-authors of the study are Markku Qvarnstrőom, D.D.S., M.S.; Jukka H. Meurman, D.D.S., M.D.; Alison E. Baird, M.D., Ph.D.; Pekka Nuutinen, M.D., Ph.D.; and Judith A. Jones, D.D.S., M.P.H., D.ScD.

NR02 – 1215 (Circ/Janket)