Abstract
This study explores the association between Coronary Artery Calcium (CAC) scores and dental pathology such as missing teeth, the (peri-apical) health status and restoration grade of the teeth, and the grade of alveolar bone loss seen on a dental panoramic radiograph (Orthopantomograph-OPG). In this retrospective cross-sectional study, data was collected from three hospitals spread in the Netherlands. Patients were included when a CAC score and an OPG were available, both recorded within a maximum period of 365 days from 2009-2017. The CAC score was measured on a CT scan, using the Agatston method. To assess dental pathology, the number of missing teeth, the number of dental implants, alveolar bone loss, caries, endodontic treatments, peri-apical radiolucencies, bone loss at implants, impacted teeth and dental cysts, were determined on the OPG. All observers were calibrated. The electronic health records provided information about: gender, age, smoking, Diabetes Mellitus, hypercholesterolemia, hypertension and Body Mass Index (BMI). 212 patients were included. We found a statistically significant association between the number of missing teeth and the CAC score. When modeling age, sex, and other well-known risk factors for cardiovascular disease, the significant correlation was no longer present after multivariate correction. Furthermore, the results showed a trend for more teeth with peri-apical lesions and a higher percentage of mean alveolar bone loss in the group with the highest CAC scores. This study showed that being edentulous or missing teeth is correlated to higher CAC scores however failed to be an independent predictor of atherosclerotic cardiovascular diseases. The number of (missing) teeth is an easily accessible marker and could be used as a marker for atherosclerotic cardiovascular disease (ACVD) risk by almost any healthcare worker. The current study needs to be considered as an explorative pilot study and could contribute to the design of further (prospective) studies on the relationship between dental pathology and coronary artery calcification by adding clinical information and extra cardiovascular biomarkers.
Highlights
Atherosclerotic cardiovascular diseases (ACVD) are one of the leading causes of death and morbidity in the Western world [1]
We found a statistically significant association between the number of missing teeth and the CAC score
The results showed a trend for more teeth with peri-apical lesions and a higher percentage of mean alveolar bone loss in the group with the highest CAC scores
Summary
Atherosclerotic cardiovascular diseases (ACVD) are one of the leading causes of death and morbidity in the Western world [1]. The underlying pathology, atherosclerosis, is a progressive disease characterized by the accumulation of lipids and fibrous elements in the arteries. Over the past two decades, inflammation has emerged as an integrative factor for coronary atherosclerosis. Inflammation can be evident in all stages of this disease, from initiation through progression and, the thrombotic complications of coronary atherosclerosis [2]. Remarkable epidemiological and pathological associations between oral health and cardiovascular diseases have been reported. The first study that found evidence for the association between dental pathology and coronary heart disease was in 1989 by Mattila et al [3]. Since a multitude of cross-sectional and longitudinal studies have implicated periodontitis as a risk for ACVD in addition to the well-known risk factors including smoking, hypercholesterolemia and diabetes [4]
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