Abstract
ObjectivesDental infections, such as periodontitis, associate with atherosclerosis and its complications. We studied a cohort followed-up since 1985 for incidence of angina pectoris with the hypothesis that calculus accumulation, proxy for poor oral hygiene, links to this symptom.MethodsIn our Swedish prospective cohort study of 1676 randomly selected subjects followed-up for 26 years. In 1985 all subjects underwent clinical oral examination and answered a questionnaire assessing background variables such as socio-economic status and pack-years of smoking. By using data from the Center of Epidemiology, Swedish National Board of Health and Welfare, Sweden we analyzed the association of oral health parameters with the prevalence of in-hospital verified angina pectoris classified according to the WHO International Classification of Diseases, using descriptive statistics and logistic regression analysis.ResultsOf the 1676 subjects, 51 (28 women/23 men) had been diagnosed with angina pectoris at a mean age of 59.8 ± 2.9 years. No difference was observed in age and gender between patients with angina pectoris and subjects without. Neither was there any difference in education level and smoking habits (in pack years), Gingival index and Plaque index between the groups. Angina pectoris patients had significantly more often their first maxillary molar tooth extracted (d. 16) than the other subjects (p = 0.02). Patients also showed significantly higher dental calculus index values than the subjects without angina pectoris (p = 0.01). Multiple regression analysis showed odds ratio 2.21 (95% confidence interval 1.17–4.17) in the association between high calculus index and angina pectoris (p = 0.015).ConclusionOur study hypothesis was confirmed by showing for the first time that high dental calculus score indeed associated with the incidence of angina pectoris in this cohort study.
Highlights
The link between chronic oral infections and atherosclerosis and its complications, such as heart infarction and stroke, has been explored in numerous studies.[1,2,3] Periodontal diseases, in particular, have been intensively investigated in this perspective.[4]
No difference was observed in age and gender between patients with angina pectoris and subjects without
Multiple regression analysis showed odds ratio 2.21 (95% confidence interval 1.17–4.17) in the association between high calculus index and angina pectoris (p = 0.015)
Summary
The link between chronic oral infections and atherosclerosis and its complications, such as heart infarction and stroke, has been explored in numerous studies.[1,2,3] Periodontal diseases, in particular, have been intensively investigated in this perspective.[4]. The biofilm may absorb calcium or phosphate ions from saliva and gingival crevicular fluid resulting in dental calculus [6]. Dental calculus is primarily composed of calcium phosphate mineral salts covered by non-mineralized bacterial biofilm. The first evidence of calcification in the biofilm is seen after only a few days, mature calculus requires months or even years to develop.[7,8] Lactate dehydrogenase and alkaline and acid phosphatase activities have been detected in dental plaque suggesting an enhanced calcification by the plaque enzymes.[9] Viable aerobic and anaerobic bacteria have been detected in supragingival calculus while subgingival calculus provides an excellent environment for further microbial adhesion and growth.[10] Periopathogens such as Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Treponema denticola have been found within the deep recesses of the structural channels and lacunae of both supra- and subgingival calculus.[11,12] Bacteria are not essential for calculus formation, but they facilitate its development. The average microscopic count of bacteria in non-mineralized dental plaque has been calculated to be up to 2.1 ×108/mg wet weight.[13, 14] Oral microbiota contains hundreds of species. [15,16]
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