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Assessing the Relationship Between Dental Disease and Coronary
Heart Disease in Elderly U.S. Veterans
- Walter J. Loesche, D.M.D., Ph.D.
- Anthony Schork, Ph.D.
- Margaret S. Terpenning, M.D.
- Yin-Miao Chen, M.S.
- B. Liza Dominguez, D.D.S., M.S.
- Natalie Grossman, R.D.H., M.A.
Abstract
| Several recent studies have shown a link
between dental disease and coronary heart disease. The authors
studied 320 U.S. veterans in a convenience sample to assess
the relationship between oral health and systemic diseases
among older people. They present cross-sectional data
confirming that a statistically significant association exists
between a diagnosis of coronary heart disease and certain oral
health parameters, such as the number of missing teeth, plaque
benzoyl-DL-arginine-naphthylamide test scores, salivary levels
of Streptococcus sanguis and complaints of xerostomia. The
oral parameters in these subjects were independent of and more
strongly associated with coronary heart disease than were
recognized risk factors, such as serum cholesterol levels,
body mass index, diabetes and smoking status. However, because
of the convenience sample studied, these findings cannot be
generalized to other populations. |
In 1989, Mattila and colleagues1 reported that
poor dental health could be associated with both an acute
myocardial infarction and a cerebral vascular accident.2 The investigators
developed two measurements of dental disease, one based
on radiographs of the teeth and jaws, called the pantomographic
index, and the second, based on clinical examination findings,
which they termed the Total Dental Index, or TDI.
In a subsequent seven-year prospective study, the TDI,
the number of previous myocardial infarctions and, to a
lesser extent, diabetes and the pantomographic index were
associated with a risk of developing a new and often fatal
myocardial infarction.3 Traditional
risk factors such as hypertension, smoking, total cholesterol
levels, high-density lipoprotein cholesterol levels, triglycerides
levels, socioeconomic status, sex and age were not significant
predictors of a coronary event when included in a model
that contained the dental variables.
Other studies have generally confirmed this link between
dental disease and coronary heart disease, or CHD. A prospective,
cohort-designed study, involving data from 9,760 American
men who were examined three times between 1971 and 1987,
found a significant relationship between either periodontitis
or edentulism and CHD, even after adjusting for 13 known
risk factors.4 A study of
1,384 Finnish men, aged 45 to 64 years, showed that the
number of missing teeth, along with hypertension, geographical
area and educational level were independent explanatory
factors for the presence of ischemic heart disease.5
In a longitudinal aging study of U.S. veterans, Beck and
colleagues6 found a significant
association between periodontal disease, as measured by
the extent of alveolar bone loss, and CHD and stroke after
adjusting for various cardiovascular risk factors. In a
case-control study of hospitalized patients, people with
acute cerebrovascular ischemia had a higher TDI than did
age- and sex-matched controls.7
These associations indicate that there may be some type
of linkage between dental disease and cardiovascular disease.
Because dental caries and periodontal disease are chronic
infections that are often asymptomatic, they could be the
source of the increased levels of C-reactive protein that
have been suggested as a predictor of myocardial infarction
and stroke.8
Since 1990, we have been recording information for a large
number of oral health variables in a group of elderly veterans
to study the relationship between oral health and systemic
diseases among older people.9 We present
cross-sectional data confirming that a statistically significant
association exists between a diagnosis of CHD and certain
oral health parameters, such as the level of gingival bleeding;
number of missing teeth; benzoyl-DL-arginine-naphthylamide,
or BANA, test scores; and complaints of xerostomia.
Subjects and methods
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