Abstract
BackgroundTooth loss is associated with increased cardiovascular disease (CVD) mortality risk. This association may however be due to residual confounding. We aimed to assess whether tooth loss is associated with specific CVD mortality endpoints in a national population sample adjusting for potential confounders.Methods and ResultsWe used a prospective cohort design and data from the Scottish Health Survey. We combined data from surveys in 1995, 1998, 2003 and linked this to mortality records. Dental status was classified through self-reports as natural teeth only, natural teeth and dentures, and no natural teeth (edentate). Cox proportional hazards models were used to estimate risk of CVD mortality by dental status adjusting for potential confounders. The sample consisted of 12871 participants. They were followed for 8.0 (SD: 3.3) years. During 103173 person-years, there were 1480 cases of all-cause mortality, 498 of CVD, and 515 of cancer. After adjusting for demographic, socio-economic, behavioural and health status, edentate subjects had significantly higher risk of all-cause (HR, 1.30; 95% CI, 1.12,1.50) and CVD mortality (HR, 1.49; 95% CI, 1.16,1.92) compared to subjects with natural teeth only. Dental status was not significantly associated with cancer mortality in fully adjusted analysis. Further analysis for CVD mortality showed that in the fully adjusted model, edentate subjects had 2.97 (95% CI, 1.46, 6.05) times higher risk for stroke-related mortality.ConclusionsIn a national population sample of Scottish adults, being edentate was an independent predictor of total CVD mortality, although this was mainly driven by fatal stroke events.
Highlights
Oral diseases, in particular dental caries and periodontal diseases are highly prevalent chronic conditions which have a significant impact on quality of life and require costly lifelong treatment [1], [2]
In a national population sample of Scottish adults, being edentate was an independent predictor of total cardiovascular disease (CVD) mortality, this was mainly driven by fatal stroke events
Poorer dental status was associated with older individuals, women, lower socioeconomic group, not being married, smoking, physical inactivity, less alcohol intake, obesity, poor self-rated health, diabetes, hypertension and high C-reactive protein (CRP) (p,0.001 in all cases)
Summary
In particular dental caries and periodontal diseases are highly prevalent chronic conditions which have a significant impact on quality of life and require costly lifelong treatment [1], [2]. In the last 20 years researchers have explored the potential association between oral diseases, and morbidity and mortality. Most of the research has investigated the association between periodontal disease and an increased risk of cardiovascular disease (CVD) and CVD mortality [4], [5], [6]. The proposed biological pathway linking periodontal diseases and CVD is thought to be through a low grade inflammatory response caused by oral bacterial infections [7], [8]. Tooth loss is associated with increased cardiovascular disease (CVD) mortality risk. This association may be due to residual confounding. We aimed to assess whether tooth loss is associated with specific CVD mortality endpoints in a national population sample adjusting for potential confounders
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