• 2/17/2004
  • Laurie Barclay, MD
  • Medscape Medical News 2004

Information sources/original article in the medical publication Circulation. Published Feb. 16, 2004

Asymptotic dental scores (ADS) reflecting poor oral health are linked to coronary heart disease (CHD), according to the results of a study published in the March 9 issue of Circulation, and published online Feb. 16. “Oral infections are thought to produce inflammation that might be associated with CHD, so we examined all oral pathologies that might generate inflammation,” lead author Sok-Ja Janket, DMD, MPH, from Boston University School of Dental Medicine in Massachusetts, says in a news release. “The ADS is a noninvasive risk indicator that can be measured easily at the time of dental check-up.”Using a logistic regression model, the investigators determined the weight that each of five oral diseases should be assigned to create the ADS as a predictor of cardiac risk. The strongest predictor of CHD was pericoronitis, followed by root remnants and gingivitis; then dental caries and missing teeth. Comparing oral health records from 256 Finnish patients with CHD to those of 250 matched controls without CHD revealed that individuals with high ADS, low levels of high-density lipoprotein (HDL) cholesterol and high levels of fibrinogen had an 82% probability of having CHD. A model that included ADS, C-reactive protein, and HDL cholesterol and fibrinogen levels was at least as good a predictor of cardiac risk as was the Framingham heart score High ADS alone was associated with a 70% probability of having CHD, low HDL cholesterol level with 63%, HDL to total cholesterol ratio with 62%, high fibrinogen level with 60%, and high triglyceride level with a 60% probability of having CHD. “If you see that a patient has five poor oral health pathologies, then chances are that 70% of the time he or she would have CHD,” Dr. Janket says. “People who do not have teeth cannot chew their food well and therefore do not get as much heart-healthy nutrients or fiber. Future studies should look at nutrition, oral health, and [CHD].”Study limitations include potential selection bias because the controls were selected from hospital patients. Although these findings suggest an association between oral pathology and CHD, they do not indicate a cause-effect relationship. However, Dr. Janket recommends that dentists encourage their patients with poor oral health to have cardiac examinations even if they are asymptomatic.”Individuals who are un- or underinsured, those of low socioeconomic status, or even those who simply have poor general health habits, have poor dental health,” says American Heart Association president Augustus O. Grant. “They are also likely to have less access to preventive care that would protect them from coronary artery disease, so this association may simply reflect the fact that our society needs to do much better in promoting health in all individuals.” In an accompanying editorial, Gordon D.O. Lowe, from the Royal Infirmary in Glasgow, U.K., suggests that these findings may not be generalizable to the general population. “We should continue to emphasize proven risk factors, such as age, sex, smoking habit, diabetes, blood pressure and total cholesterol/HDL ratio,” he writes. “Further studies are needed to evaluate the additive predictive value of ’emerging’ risk predictors, including dental health scores.”