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Background/Aim Atrial fibrillation (AF) is a major health problem and causes heart failure and stroke. Pathophysiological mechanisms indicate a link with oral health including periodontitis (PD), but supporting data are scarce. The aim was to investigate the link between features of oral health and the prevalence of AF. Methods This cross-sectional analysis of the Hamburg City Health Study included 5,634 participants with complete data on their PD and AF status. AF was assessed via self-reported questionnaire or medically diagnosed by standard 12-lead resting ECG. The oral health examination included full-mouth measurements of the dental plaque index (PI), the clinical attachment loss (CAL) at 6 sites per tooth, the bleeding on probing (BOP) and the decayed, missing and filled teeth (DMFT) index. Descriptive analyses for all variables stratified by the status of PD were performed. To test for an association between prevalent PD and prevalent AF, multivariable logistic regression models were used. Mediation analysis was used to test if interleukin-6 (IL-6) and/or C-reactive protein (CRP) mediated the association between PD and AF. Results Atrial fibrillation (prevalence: 5.6%) and the severity of PD (prevalence: moderate: 57.7%, severe: 18.9%) increased with age in men and women. Prevalent severe PD, CAL ≥3 mm, PI, and BOP were all associated with prevalent AF in unadjusted regression analysis. However, no association except for PI (odds ratio (OR): 1.22, 95% confidence interval (CI): 1.1–1.35, p<0.001) could be observed after adjusting for age, sex, high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), body mass index, diabetes, smoking, and educational level. Participants brushing their teeth at least twice daily had a lower AF prevalence compared with those brushing only once daily. Hs-CRP, IL-6, and the odds of AF increased as a function of PD severity grades in unadjusted analysis. However, neither the DMFT index nor IL-6 or CRP was associated with AF after adjusting for age and sex. Mediation analyses could not provide support for the hypothesis that IL-6 or CRP acted as mediator of the association between prevalent PD and prevalent AF. Conclusion The study shows an association between prevalent AF and increased dental plaque levels indicated by a higher PI. In contrast, an association of prevalent PD with prevalent AF after adjustments for several confounders could not be demonstrated. Further studies are necessary to investigate the mechanisms underlying poor oral hygiene and AF as well as the influence of improved oral hygiene on AF onset.

Most clinical studies in dentistry are conducted in university‐based settings. However, whether findings can be generalised to private dental practices is not clear. Aims of this study were to determine patients’ criteria for choosing a dentist, and to assess whether criteria differ between patients in university dental clinic and private dental practices. In this cross‐sectional study, a convenience sample of 300 subjects involving dental patients of a university dental clinic and private dental practices, and subjects from general population (each n = 100) were included. Criteria for choosing a dentist were assessed with a 31‐item questionnaire, covering socio‐demographic characteristics, qualifications, psychosocial skills, practice structure, practice offers and accessibility, with a 6‐point ordinal rating scale ranging from "very crucial”‐(5) to “not crucial at all"‐(0). A total of 189 subjects (63%) provided completed questionnaires for analyses. Dentists’ psychosocial skills (mean 4.4) were rated as most important when choosing a dentist, whereas socio‐demographic characteristics were of almost no significance (mean 1.0). Significant differences between settings were observed only for practice offers and accessibility with highest ratings in university setting. However, after controlling for potential confounders, ratings differed only slightly and not statistically significantly. In conclusion, dentists’ psychosocial skills appear to be most important criteria for choosing a dentist. Setting‐related differences in criteria seem to be likely but obviously result from differences in socio‐demographic characteristics.

BackgroundPrevious epidemiological studies regarding the association between chronic periodontitis (CP) and carotid intima‐media thickness (cIMT) and subclinical atherosclerosis have been inconclusive.ObjectiveThe aim of this study was to determine whether CP is associated with subclinical atherosclerosis in a large population‐based cohort study conducted in northern Germany (the Hamburg City Health study).MethodsBaseline data from 5781 participants of the Hamburg City Health Study with complete oral health and carotid ultrasound data (50.7% female, mean age: 62.1 ± 8.4 years) were evaluated. A standardized duplex sonography of the carotid artery was performed with measurement of carotid intima‐media thickness (cIMT) and atherosclerotic plaques. Oral health was assessed by recording the decayed, missing, and filled teeth (DMFT) index, clinical attachment loss (CAL), bleeding on probing (BOP), and the dental plaque index (PI). Correlations were tested for statistical significance by means of descriptive statistics and multivariate regression analyses.ResultsModerate and severe CP were associated with the prevalence of cIMT ≥ 1 mm (none or mild CP: 5.1%, moderate CP: 6.1%, severe CP: 10%) and mean cIMT (none or mild CP: 0.72 mm, moderate CP: 0.75 mm, severe CP: 0.78 mm) in bivariate analyses (p < .001). Additionally, severe and moderate CP were associated with higher prevalence of carotid atherosclerotic plaques (plaque = yes: none or mild CP: 23.9%, moderate CP: 29%, severe CP: 40.2%,). After adjustment for age, sex, smoking, diabetes, hypertension, educational level, hypercholesterolemia, and hsCRP, severe CP still correlated significantly with cIMT and the prevalence of cIMT ≥1 mm and/or presence of carotid atherosclerotic plaques.ConclusionIn this study, severe CP was associated with increased cIMT and higher prevalence of carotid plaques independent of common risk factors.