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Original article

Vol. 141 No. 2930 (2011)

The impact of dental disease on mortality in patients with asymptomatic carotid atherosclerosis

  • M Hoke
  • T Schillinger
  • W Mlekusch
  • O Wagner
  • E Minar
  • M Schillinger
DOI
https://doi.org/10.4414/smw.2011.13236
Cite this as:
Swiss Med Wkly. 2011;141:w13236
Published
18.07.2011

Summary

BACKGROUND: Dental status and oral hygiene are associated with progression of atherosclerosis in patients with carotid stenosis. It remains unclear whether dental disease is a risk factor for mortality in these patients.We evaluated the bearing of dental disease on mortality among patients with asymptomatic carotid atherosclerosis.

METHODS: Three World Health Organization-validatedindices in 411 patients with asymptomatic carotid atherosclerosis were evaluated, measuring DMFT (decayed, missing, filled teeth) for dental status, CPITN (community periodontal index for treatmentneeds) for periodontal statusand SLI (Silness-LöeIndex) for oral hygiene respectively. Patients were prospectively followed for median 6.2 years (IQR 5.8 to 6.6 years) for all-cause mortality.

RESULTS: During follow-up, 107 (26%) deaths occurred (74 cardiovascular causes). DMFT and SLI, but not CPITN, showed a significant and gradual association with mortality. For continuous variables, the adjusted hazard ratios (HR) for death were 1.06 (95% CI 1.0 to 1.12; p = 0.04) for DMFT, and 1.43 (95% CI, 1.01 to 2.03; p = 0.04) for SLI respectively. Edentulousness was a significant risk factor for death (adjusted HR 1.99, 95%CI, 1.18 to 3.02; p = 0.008).

CONCLUSION: Dental status and oral hygiene were associated with mortality in patients with carotid atherosclerosis regardless of conventional cardiovascular risk factors.

References

  1. Haynes WG, Stanford C. Periodontal disease and atherosclerosis – from dental to arterial plaque. Arterioscler Thromb Vasc Biol. 2003;23(8):1309–11.
  2. Tonetti MS. Periodontitis and risk for atherosclerosis: an update on intervention trials. J Clin Periodontol. 2009;36(Suppl 10):15–9.
  3. Schillinger T, Kluger W, Exner M, Mlekusch W, Sabeti S, Amighi J, et al. Dental and periodontal status and risk for progression of carotid atherosclerosis: the inflammation and carotid artery risk for atherosclerosis study dental substudy. Stroke. 2006;37(9):2271–6.
  4. Libby P, Ridker PM, Hansson GK; Leducq Transatlantic Network on Atherothrombosis. Inflammation in atherosclerosis: from pathophysiology to practice. J Am Coll Cardiol. 2009;54(23):2129-38.
  5. Niessner A, Graf S, Nikfardjam M, Lehr S, Maurer G, Wojta J, et al. The adaptive immune system and long-term outcome in patients with stable coronary disease. Predictive value of routine laboratory measurements. Thromb Haemost. 2005;93(2):257–60.
  6. Hujoel PP, Drangsholt M, Spiekerman C, DeRouen TA. Periodontal disease and coronary heart disease risk. JAMA. 2000; 284(11):1406–10.
  7. Mattila KJ, Valle MS, Nieminen MS, Valtonen VV, Hietaniemi KL. Dental infections and coronary atherosclerosis. Atherosclerosis. 1993;103(2):205–11.
  8. DeStefano F, Anda RF, Kahn HS, Williamson DF, Russell CM. Dental disease and risk of coronary heart disease and mortality. Br Med J. 1993;306(6879):688–91.
  9. Schillinger M, Exner M, Mlekusch W, Sabeti S, Amighi J, Nikowitsch R, et al. Inflammation and Carotid Artery Risk for Atherosclerosis Study (ICARAS). Circulation. 2005;111(17):2203–9.
  10. WHO Oral Health Country/Area Profile Programme [WWW document]. URL http://www.whocollab.od.mah.se [accessed on 20 September 2010].
  11. Sabeti S, Schillinger M, Mlekusch W, Willfort A, Haumer M, Nachtmann T, et al. Quantification of internal carotid artery stenosis with duplex US: comparative analysis of different flow velocity criteria. Radiology. 2004;232(2):431–9.
  12. Borrell LN, Beck JD, Heiss G. Socioeconomic disadvantage and periodontal disease: the Dental Atherosclerosis Risk in Communities study. Am J Public Health. 2006;96(2):332–9.
  13. Deans KA, Bezlyak V, Ford I, Batty GD, Burns H, Cavanagh J, et al. Differences in atherosclerosis according to area level socioeconomic deprivation: cross sectional, population based study. BMJ. 2009;339:b4170.
  14. Cabrera C, Hakeberg M, Ahlqwist M, Wedel H, Björkelund C, Bengtsson C, et al. Can the relation between tooth loss and chronic disease be explained by socio-economic status? A 24-year follow-up from the population study of women in Gothenburg, Sweden. Eur J Epidemiol. 2005;20(3):229–36.
  15. Desvarieux M, Demmer RT, Rundek T, Boden-Albala B, Jacobs DR Jr, Sacco RL, et al. Periodontal microbiota and carotid intima-media thickness: the Oral Infections and Vascular Disease Epidemiology Study (INVEST). Circulation. 2005;111(5):576–82.
  16. Desvarieux M, Demmer RT, Rundek T, Boden-Albala B, Jacobs DR Jr, Papapanou PN, et al. Relationship between periodontal disease, tooth loss, and carotid artery plaque: the Oral Infections and Vascular Disease Epidemiology Study (INVEST). Stroke. 2003;34(9):2120–5.
  17. Niessner A, Sato K, Chaikof EL, Colmegna I, Goronzy JJ, Weyand CM. Pathogen-sensing plasmacytoid dendritic cells stimulate cytotoxic T-cell function in the atherosclerotic plaque through interferon-alpha. Circulation. 2006;114(23):2482–9.
  18. Mattila KJ, Valle MS, Nieminen MS, Valtonen VV, Hietaniemi KL. Dental infections and coronary atherosclerosis. Atherosclerosis 1993;103(2):205–11.
  19. Arbes SJ, Slade GD, Beck J. Association between extent of periodontal attachment loss and self-reported history of heart attack: an analysis of NHANES III data. J Dent Res. 1999;78(12):1777–82.
  20. Garcia RI, Krall EA, Vokonas PS. Periodontal disease and mortality from all causes in the VA Dental Longitudinal Study. Ann Periodontol. 1998;3(1):339–49.
  21. Morrison HI, Ellison LF, Taylor GW. Periodontal disease and risk of fatal coronary heart and cerebrovascular diseases. J Cardiovasc Risk. 1999;6(1):7–11
  22. Joshipura KJ, Rimm EB, Douglass CW, Trichopoulos D, Ascherio A, Willett WC. Poor oral health and coronary heart disease. J Dent Res. 1996;75(9):1631–6.
  23. Ansai T, Takata Y, Soh I, Awano S, Yoshida A, Sonoki K, et al. Relationship between tooth loss and mortality in 80-year-old Japanese community-dwelling subjects. BMC Public Health. 2010;10:386.
  24. Schuler AA, Holst D. Oral status indicators DMFT and FS-T: reflections on index selection. Eur J Oral Sci. 2001;109(3):155–9.
  25. Mars RG, Magnusson I. Evaluation of reliability and reproducibility of dental indices. J Clin Periodontol. 1993;20(1):54–8.
  26. Holmgren CJ. CPITN – interpretation and limitations. In Dent J. 1994;44(5 Suppl 1):533–46.