Is poor oral health a risk marker for incident cardiovascular disease hospitalisation and all-cause mortality? Findings from 172 630 participants from the prospective 45 and Up Study

Abstract

ObjectiveTo investigate the relationship between oral health and incident hospitalisation for ischaemic heart disease (IHD), heart failure (HF), ischaemic stroke and peripheral vascular disease (PVD) and all-cause mortality.DesignProspective population-based study of Australian men and women aged 45 years or older, who were recruited to the 45 and Up Study between January 2006 and April 2009; baseline questionnaire data were linked to hospitalisations and deaths up to December 2011. Study exposures include tooth loss and self-rated health of teeth and gums at baseline.SettingNew South Wales, Australia.ParticipantsIndividuals aged 45–75 years, excluding those with a history of cancer/cardiovascular disease (CVD) at baseline; n=172 630.Primary outcomesIncident hospitalisation for IHD, HF, ischaemic stroke and PVD and all-cause mortality.ResultsDuring a median follow-up of 3.9 years, 3239 incident hospitalisations for IHD, 212 for HF, 283 for ischaemic stroke and 359 for PVD, and 1908 deaths, were observed. Cox proportional hazards models examined the relationship between oral health indicators and incident hospitalisation for CVD and all-cause mortality, adjusting for potential confounding factors. All-cause mortality and incident CVD hospitalisation risk increased significantly with increasing tooth loss for all outcomes except ischaemic stroke (ptrend<0.05). In those reporting no teeth versus ≥20 teeth left, risks were increased for HF (HR, 95% CI 1.97, 1.27 to 3.07), PVD (2.53, 1.81 to 3.52) and all-cause mortality (1.60, 1.37 to 1.87). The risk of IHD, PVD and all-cause mortality (but not HF or ischaemic stroke) increased significantly with worsening self-rated health of teeth and gums (ptrend<0.05). In those reporting poor versus very good health of teeth and gums, risks were increased for IHD (1.19, 1.03 to 1.38), PVD (1.66, 1.13 to 2.43) and all-cause mortality (1.76, 1.50 to 2.08).ConclusionsTooth loss and, to a lesser extent, self-rated health of teeth and gums, are markers for increased risk of IHD, PVD and all-cause mortality. Tooth loss is also a marker for increased risk of HF.

Tooth loss is a complex measure of oral disease: Determinants and methodological considerations

“…Several studies have reported that having fewer teeth at baseline or losing teeth during study follow-up increases the risk of a range of adverse health outcomes. [1][2][3][4][5][6][7] While there is growing interest in tooth loss as an epidemiological measure of dental status, valid inference from these studies requires an understanding of what is represented by tooth loss.…”

Development of guidelines for improving oral health in individuals with Parkinson’s disease

“…4,5,[23][24][25][26] The results of this pilot project support the usefulness and applicability of oral health guidelines for this population. Because oral health is important for systemic health, [8][9][10][11][12] interventions that support oral health may have a positive impact on overall health in this population.…”

“…Furthermore, individuals with PD are more likely to have difficulty retaining dentures, have an increased likelihood of cracked teeth and often suffer from orofacial pain, burning mouth syndrome and taste impairment . Poor OH is a risk factor for systemic diseases, including cardiovascular disease, diabetes and respiratory infections . Poor OH can also lead to poor nutrition, including decreased calorie intake and nutrient intake and a decreased quality of life …”

“…7Poor OH is a risk factor for systemic diseases, including cardiovascular disease, diabetes and respiratory infections. [8][9][10][11][12] Poor OH can also lead to poor nutrition, including decreased calorie intake and nutrient intake and a decreased quality of life. 13 Several governmental agencies have called for an increased focus on OH.…”

Oral Healthcare and Cardiovascular Disease

“…This, in turn, can exacerbate systemic inflammation, leading to atheroma formation and ultimate rupture. 34 Two recent large studies in the United States and Europe also showed that new cases of periodontal disease, not just those preexisting, increase the risk of future cardiovascular events. 18 Several clinical studies suggest that the prevalence of CVD seems to be highest among those individuals in whom periodontitis coexists with elevated C-reactive protein and proinflammatory cytokine levels.…”