Evidence summary: the relationship between oral and cardiovascular disease

Dietrich, Thomas; Webb, Ian; Stenhouse, Laura; Pattni, Amit; Ready, Derren; Wanyonyi, Kristina; White, Sandra; Gallagher, Jennifer E.

doi:10.1038/sj.bdj.2017.224

Cited by 123 publications

(95 citation statements)

References 24 publications

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“…In older adults, poor oral health has been associated with numerous diseases, including cardiovascular disease, respiratory disease, and diabetes, as well as incident frailty . Frailty is a clinical state in which there is an increase in an individualʼs vulnerability for developing dependency and/or mortality when exposed to a stressor .…”

mentioning

confidence: 99%

Oral Health, Diet, and Frailty at Baseline of the Canadian Longitudinal Study on Aging

Bassim

Mayhew

Kanters

et al. 2020

J American Geriatrics Society

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OBJECTIVES: Poor diet due to poor oral health was proposed as a potential mediator of the association between poor oral health and frailty. This study explores the cross-sectional associations between poor oral health, poor diet, and frailty in Canadian adults, aged 45 to 85 years, and then tests whether the expected oral health-frailty association is changed by taking into account the pathway through poor diet. DESIGN: Cross-sectional study. SETTING: The baseline wave of the Canadian Longitudinal Study on Aging, a nationally representative population study. PARTICIPANTS: Data from 28 738 community-dwelling participants, aged 45 to 85 years. MEASUREMENTS: We characterized poor oral health (cumulative count of 24 items of oral health problems), poor diet (scale of poor food consumption from 7 healthy foods groups), and frailty (cumulative frailty index of 76 items). Regression-based path analyses were used to investigate associations between poor oral health, poor diet, and frailty, adjusted for age group, sex, income, smoking, living alone, education, physical activity, social support, and dental visit. RESULTS: Poorer oral health was associated with low income, smoking, low physical activity, low social support, and no dental visit. There were associations between poorer oral health and poorer diet (effect size β adjusted = .40; 95% confidence interval [CI] = .20-.61) and between poorer oral health and increased frailty (β adjusted = .85; 95% CI = .68-1.02). The indirect effect through the path of poor diet was approximately 0.01 (95% CI = 0.01-0.02) (ie, explaining 1% of the effect of poor oral health on frailty). CONCLUSIONS: Poor oral health was associated with poor diet and frailty. Each additional oral health problem was associated with an increase of approximately 1 frailty index point, even after full adjustment for poor diet. The indirect effect of poor oral health through poor diet was modest. Though poor oral health was associated with poorer diet quality, a more direct effect of poor oral health on increasing frailty may be indicated. J Am Geriatr Soc 68:959-966, 2020.

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confidence: 99%

Oral Health, Diet, and Frailty at Baseline of the Canadian Longitudinal Study on Aging

Bassim

Mayhew

Kanters

et al. 2020

J American Geriatrics Society

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“…In addition to bacterial components (e.g., lipopolysaccharide or LPS), periodontal disease allows locally‐produced proinflammatory mediators (e.g., interleukin‐(IL‐1) 1β, tumor necrosis factor‐α (TNF‐α), IL‐6, and prostaglandin E2 (PGE2)) to pour into the bloodstream, initiating responses in more distant tissues (Gemmell, Marshall, & Seymour, ; Loos, ; Loos, Craandijk, Hoek, Wertheim‐van Dillen, & van der Velden, ; Moutsopoulos & Madianos, ). The dissemination of bacteria and their biproducts into the bloodstream have the added effect of inducing system‐level infection responses that may instigate or affect the progression of cardiovascular diseases (for reviews of the evidence, see Dietrich, Sharma, Walter, Weston, & Beck, ; Dietrich et al, ), chronic obstructive pulmonary disease (Liu et al, ; Wang et al, ; Zeng et al, ), pneumonia (Awano et al, ; El Attar, Zaghloul, & El Menoufy, ; Scannapieco & Mylotte, ; Sharma & Shamsuddin, ; Terpenning et al, ), and diabetes (Bissett, Stone, Rapley, & Preshaw, ; Borgnakke, Ylöstalo, Taylor, & Genco, ; Lalla et al, ; Nelson et al, ; Taylor, Burt, Becker, Genco, & Shlossman, ). For example, platelet aggregation can be induced by oral bacteria such as P. gingivalis and S. sanguis or by the proinflammatory immune cytokines generated in response to them, affecting the formation of thrombi in the arteries and veins (Herzberg & Meyer, ).…”

Section: Discussionmentioning

confidence: 99%

Calculus and survivorship in medieval London: The association between dental disease and a demographic measure of general health

Yaussy

DeWitte

2019

American J Phys Anthropol

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Objectives: Dental plaque is associated with a variety of systemic diseases and mortality risks in living populations. However, bioarchaeologists have not fully investigated the mortality risks associated with plaque (or its mineralized form, calculus) in the past. This study examines the relationship between survivorship and calculus in a medieval skeletal sample.Materials and methods: Our sample (n = 1,098) from four medieval London cemeteries, c. 1000-1540 CE, includes people who died under attritional (normal) and catastrophic (famine and plague) conditions. The associations between age and the presence of dental calculus on the permanent left first mandibular molar are assessed using binary logistic regression and Kaplan-Meier survival analysis. Results: The regression results indicate a significant negative relationship between age and calculus presence for individuals of all ages who died under normal mortality conditions and for adults who died under both normal and catastrophic conditions. Survival analysis reveals decreased survivorship for people of all ages with calculus under normal mortality conditions. Similarly, during conditions of catastrophic mortality, adult males with calculus suffered reduced survivorship compared to males without it, though there was no difference in survivorship between adult females with and without calculus. Conclusions: These results suggest that, as in modern populations, calculus accumulation in the inhabitants of medieval London reflects a greater risk of premature death. The evaluation of calculus, a potential measure of underlying frailty, in the context of a demographic measure of general health suggests that it might provide insights into health in past populations. K E Y W O R D S binary logistic regression, bioarchaeology, mortality, paleodemography, paleopathology, survival analysis

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“…Evidence shows that oral health complications, such as inflammation and infections that begin in the mouth, can lead to major health complications (e.g., dental abscess) [2]. Furthermore, a growing body of research has identified a potential connection between oral health and other chronic conditions, such as diabetes and cardiovascular diseases [3][4][5]. The National Academy of Medicine (an American nonprofit, non-governmental organization providing expert advice on issues relating to health, medicine, and health policy) has proposed integrating oral health into primary care as a way to expand access to recommended treatments and promote better health overall [6,7].…”

Section: Introductionmentioning

confidence: 99%

Dental Practice Integration into Primary Care: A Microsimulation of Financial Implications for Practices

Choi

Simon

Barrow

et al. 2020

IJERPH

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Given the widespread lack of access to dental care for many vulnerable Americans, there is a growing realization that integrating dental and primary care may provide comprehensive care. We sought to model the financial impact of integrating dental care provision into a primary care practice. A microsimulation model was used to estimate changes in net revenue per practice by simulating patient visits to a primary dental practice within primary care practices, utilizing national survey and un-identified claims data from a nationwide health insurance plan. The impact of potential changes in utilization rates and payer distributions and hiring additional staff was also evaluated. When dental care services were provided in the primary care setting, annual net revenue changes per practice were −$92,053 (95% CI: −93,054, −91,052) in the first year and $104,626 (95% CI: 103,315, 105,316) in subsequent years. Net revenue per annum after the first year of integration remained positive as long as the overall utilization rates decreased by less than 25%. In settings with a high proportion of publicly insured patients, the net revenue change decreased but was still positive. Integrating primary dental and primary care providers would be financially viable, but this viability depends on demands of dental utilization and payer distributions.

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Evidence summary: the relationship between oral and cardiovascular disease

Cited by 123 publications

References 24 publications

Oral Health, Diet, and Frailty at Baseline of the Canadian Longitudinal Study on Aging

Oral Health, Diet, and Frailty at Baseline of the Canadian Longitudinal Study on Aging

Calculus and survivorship in medieval London: The association between dental disease and a demographic measure of general health

Dental Practice Integration into Primary Care: A Microsimulation of Financial Implications for Practices

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