Tooth Loss Predicts Myocardial Infarction, Heart Failure, Stroke, and Death

Abstract

We investigated whether oral health, represented by missing teeth, was associated with an increased risk of cardiovascular disease, including myocardial infarction (MI), heart failure (HF), stroke, and all-cause mortality. Subjects who underwent routine dental examinations and health checkups provided by the Korean National Health Insurance from 2007 to 2008 ( n = 4,440,970) were followed up for incident MI, HF, stroke, and death until 2016. During follow-up of 7.56 y, 68,063 (1.5%) subjects died, and 31,868 (0.7%) were admitted for MI, 22,637 (0.5%) for HF, and 30,941 (0.7%) for stroke. Cardiovascular events and mortality increased in proportion to tooth loss. Tooth loss was an independent risk factor for cardiovascular events after multivariable analysis adjusted for cardiovascular risk, behavioral, and income factors. Each missing tooth was associated with an approximately 1% increase in MI (HR, 1.010; 95% CI, 1.007 to 1.014), 1.5% increase in HF (HR, 1.016; 95% CI, 1.013 to 1.019) and stroke (HR, 1.015; 95% CI, 1.012 to 1.018), and 2% increase in mortality (HR, 1.022; 95% CI, 1.020 to 1.023). Having ≥5 missing teeth substantially increased risk for cardiovascular outcomes, and even a small number of missing teeth (1 to 4) was associated with an increased risk for MI, stroke, and death. This association was consistent in subgroup analyses and especially strong among the younger subjects (age <65 y) and those with periodontitis. In this large Korean nationwide cohort study, we found that tooth loss showed a dose-dependent association with incident MI, HF, ischemic stroke, and all-cause death and was a good predictor of cardiovascular outcome. In clinical practice, the number of missing teeth can aid physicians in discriminating patients with a higher cardiovascular risk.

Oral Health, Oral Microbiota, and Incidence of Stroke-Associated Pneumonia—A Prospective Observational Study

“…The numbers of missing teeth found for pneumonia patients clearly outnumbered the numbers reported in the 5th German Oral Health Study in the respective age group (mean 17.8) ( 51 ). Tooth loss represents the end stage of oral diseases such as caries and periodontitis and, thus, is a simple, objective, and easily accessible marker for the accumulated inflammatory burden of oral disease ( 52 , 53 ). A study prospectively investigating a cohort of more than 19,000 Japanese dentists also found that large numbers of lost teeth may indicate increased risk of mortality from pneumonia ( 54 ).…”

Gender Differences in the Levels of Periodontal Destruction, Behavioral Risk Factors and Systemic Oxidative Stress in Ischemic Stroke Patients: A Cohort Pilot Study

“…Patients with fewer teeth may have an increased risk of stroke [ 27 , 35 ]. A consistently strong and dose-dependent association has been found between the number of missing teeth and incident ischemic stroke and mortality in a large population-based cohort of 4,440,970 relatively young subjects (mean age, 41.5 years) after multivariate adjustment for cardiovascular risk factors [ 34 ]. Other studies show no association between missing teeth and stroke [ 113 ].…”

“…In addition, Aarabi et al claimed that chronic oral infections are associated with an imaging surrogate of cerebrovascular ischemia beyond acute ischemic stroke (e.g., silent infarcts and brain white matter hyperintensities) related to small vessel disease [ 33 ]. A dose-dependent association has also been reported between tooth loss as a measure of periodontitis severity and an increased risk for stroke [ 27 , 34 , 35 ]. It is not clear whether the stroke-periodontitis relationship occurs prior to the stroke or develops later, but due to the long-standing characteristic of periodontitis in which the tissue destruction develops during many years (or decades), it is highly probable that severe alveolysis develops before stroke [ 36 ].…”

Effects of occlusal disharmony on susceptibility to atrial fibrillation in mice

“…Poor oral health, particular amongst older people, is manifested in high levels of tooth loss and dental caries, and high prevalence of periodontal disease 56 . Also, extensive tooth loss reduces chewing performance and occlusal force, and has been linked to increase incidence of ischemic stroke, coronary heart disease and poor mental health in clinical studies, in addition to difficulty in eating property 48,56 . However, the mechanisms involved remain poorly understood.…”