Relationship between atherosclerosis and occlusal support of natural teeth with mediating effect of atheroprotective nutrients: From the SONIC study.

Shinichiro Tada ,Yoshinobu Maeda,Hiromi Rakugi,Ayumi Shintani,Takuma Ishihara,Chisato Inomata,Shinya Murakami,Ryutaro Takahashi,Chikako Nakama,Yasuyuki Gondo,Yukie Masui,Ryousuke Oguro,Yasumichi Arai,Masahiro Kitamura,Kazunori Ikebe,Ken Sugimoto,Mai Kabayama,Tatsuo Kawai,Kei Kamide,Kōichi Yamamoto ,Ken Ich Matsuda ,Hitoshi Takeshita

doi:10.1371/journal.pone.0182563

Abstract

Whereas most of studies investigating relationship between oral health and atherosclerosis have focused on periodontitis, very few of them were examined about occlusal status of natural teeth which possibly influence dietary habit. The primary aim of this cross-sectional study was to investigate the association between the occlusal support of posterior teeth and the prevalence of atherosclerosis in community-dwelling septuagenarians. Also, the second aim was to test the hypothesis that the intake of key nutrients for atherosclerosis prevention would have a mediating effect on the relationship between the occlusal status and atherosclerosis. The study population included 468 community-dwelling dentate persons aged 69–71 years recruited from the local residential registration in Japan. Participants were divided into three groups, according to the number of occlusal support zones (OSZ) in the posterior area: Complete (four OSZ), Moderate (three or two OSZ), and Collapsed (one or no OSZ). Dietary intakes were assessed using a brief-type self-administered diet history questionnaire. Atherosclerosis was defined as carotid intima-media thickness ≧1.10 mm by using carotid ultrasonography test. The logistic or linear regression model was used in multivariate analysis to assess relationship between occlusal status and atherosclerosis, and the mediating effect of key nutrients within the relationship. Multivariable analysis showed a significant association between occlusal status and atherosclerosis (odds ratio for Collapsed group to Complete group: 1.87; 95% CI: 1.45–2.41), independent of periodontal status (odds ratio: 2.01, 95%CI: 1.46–2.78). Fish and shellfish, vitamin B6 and n-3PUFAs were significantly related to both of occlusal status and atherosclerosis, and also was indicated a mediating effect on the association between occlusal status and atherosclerosis. This study implied that, within the limitation of the cross-sectional study design, the reduced posterior occlusion was related to the increased prevalence of atherosclerosis via the decline of key dietary intakes among Japanese community-dwelling dentate individuals.

Highlights

In older adults, oral health has a high impact on diet and nutrition, which can affect systemic health
In assessing the association between the prevalence of atherosclerosis and each variable in the group A (n = 468), the outcome assessed in this study was set as the prevalence of atherosclerosis, and two predictors were defined as occlusal status and periodontal status
Relationship between atherosclerosis and occlusal support mediated with atheroprotective nutrients had healthy periodontal status, 40% (n = 185) had moderate periodontal disease, and 44% (n = 206) had severe periodontal disease

Summary

Introduction

Oral health has a high impact on diet and nutrition, which can affect systemic health. A decline in masticatory function resulting from loss of natural occlusion in the posterior region is reported to make chewing difficult for older adults and to lead to avoidance of hard-to-chew foods such as vegetables, fruits, fish and shellfish [1,2,3,4,5]. Since the beginning of the 21st century, the relationship between atherosclerosis, which contributes to cardiovascular and cerebrovascular accidents, and periodontal disease has been the subject of growing research [13]. Recent literature reviews report a potential link between atherosclerosis and oral health through the inflammatory effects of periodontal disease [14,15]

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Discussion

Conclusion