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

Abstract

The objective of this study was to evaluate the association between number of missing teeth and all cause, cardiovascular, and cancer mortality as well as morbidity and to explore whether socio-economic factors mediate this association. An ongoing prospective cohort study of 1462 Swedish women included a dental survey in 1968/69 with follow-up until 1992/93. The dental examination included a panoramic radiographic survey and a questionnaire. Number of missing teeth at baseline was analysed in a Cox proportional hazards model to estimate time to mortality and morbidity. Number of missing teeth, independently of socio-economic status variables (the husband's occupational category, combined income, and education) was associated with increased all cause mortality and cardiovascular disease mortality respectively (relative risk (RR): 1.36; 95% confidence interval (95% CI): 1.18-1.58) and (RR: 1.46; 95% CI: 1.15-1.85 per 10 missing teeth), but no associations were found for cancer mortality (RR: 1.18; 95% CI: 0.91-1.52). The relation between poor oral health and future cardiovascular disease could not be explained by measures of socio-economic status in this study.

Clinically Classified Periodontitis and Its Association in Patients with Preexisting Coronary Heart Disease

“…Similarly, positive association was recorded in previous reports [8,10], whereas Johansson et al [18] found that CHD patients had significantly higher numbers of periodontal pockets 4-6 mm and higher bleeding on probing (BOP).…”

“…Although many risk factors of CHD have been identified, a significant proportion of this pathological condition cannot be explained by those traditional risk factors [8].…”

“…Significant associations between periodontitis and CHD have been reported in previous case-control and cohort studies [8,10,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30], which are dependent on the severity of periodontal disease (PD) [10,31]. This could be directly due to periodontal pathogens or their products on endothelial cells via transient bacteremia or indirectly due to products on the inflammatory response, central role in pathogenesis of CVD [32].…”

“…The environmental and behavioral risk factors include diet, physical inactivity, stress, cigarette smoking, excessive alcohol consumption, socioeconomic status, chronic infections, use of nonsteroid anti-inflammatory drugs, and possible endothelial cell injury [4][5][6][7]. However, a significant proportion of CHD is not explained by the traditional risk factors [8].…”

Predictors of oral health after spinal cord injury

“…6 Oral hygiene differs among certain races and ethnic groups, 7 with African-Americans reporting higher rates of unmet needs for oral health care. 8 Low socio-economic status is associated with tooth loss 9 and tooth decay. 10 Thus, the typical demographic and socio-economic profile of people who sustained SCI puts the majority at an increased risk for developing oral and dental problems.…”