Oral health and health behavior in patients referred for open-heart surgery

Treatment planning considerations in the older adult with periodontal disease

Periodontal health in the elderly is influenced by numerous factors, including systemic conditions, patient compliance, age-associated changes, and restorative procedures. The numerous comorbidities seen in the elderly necessitate individualized approaches for treatment planning. In this paper, we review how age, comorbidities, oral hygiene, and restorative dental procedures collectively influence the treatment and management of the periodontium in the elderly. The elderly population is predicted to double in 30 years, which will have an economic impact the dental profession needs to plan for. Preventative and noninvasive treatment, supportive periodontal therapy, and patient-specific maintenance plans are imperative to maintaining oral health in the older population. Multiple coexisting changes, including xerostomia, altered wound healing, altered bone physiology, altered microbiome, and diminished plaque control, can add complexity to periodontal management. Considerations of the patient's general health, the selected periodontal treatment plan, and the selected completed restorative procedures need to be considered. The influence of caries, fixed prosthodontics, partial dentures, shortened dental arch, and implant therapy can have unintended impacts on periodontal health in the elderly. Adverse periodontal outcomes in the elderly can be minimized by carefully assessing the patient's medical history, impact of medications, functional needs, properly finishing and contouring restorations to avoid plaque accumulation, and designing restorations to allow access for hygiene. Partial dentures can be a source of plaque accumulation leading to periodontal disease, caries, and recession around abutment teeth. A shortened dental arch should be considered as a functional and cost-effective alternative to partial dentures. With dental implants, the patient's tissue phenotype, keratinized tissue quantity, risk of peri-implantitis, and patient access for maintaining adequate oral hygiene are all important to consider. Implant risk-assessment tools show promise by providing a systematic approach for early diagnosis to avoid future complications.

Oral Health-Related Quality of Life in Anticoagulated Patients with Warfarin Treatment: A Cross-Sectional Study

To evaluate factors associated with oral health-related quality of life (OHRQoL) in patients under oral anticoagulant therapy with warfarin, a cross-sectional study was conducted. Validated questionnaires assessed self-reported periodontal disease, demographic variables, and OHRQoL using the short version of the Oral Health Impact Profile (OHIP-14) instrument. After calibration (Kappa > 0.60), an examiner evaluated patients' experience with dental caries and the need for dental prostheses. Statistical analysis involved proportions and measures of central tendency. Negative binomial regression models were used to estimate the rate ratios (RR) and the corresponding 95% confidence interval (CI). The sample consisted of 158 individuals, with a mean age of 58.8 years (SD = 12.1), of which 62.7% of the participants were women. The OHIP-14 mean was 10.62 (SD = 10.92). A higher OHIP-14 total score (worse OHRQoL) was associated with ethnic group, age, periodontal disease self-report, dental caries, and oral health self-report. Demographic and clinical factors can negatively influence the perception of anticoagulated patients on OHRQoL.

Periodontal health and detection of periodontal bacteria in patients with acute coronary syndrome

Introduction: Recent studies have found that patients with periodontitis have greater risk of incurring fatal cardiovascular disease than patients without periodontitis. Emerging research has identified inflammation caused by periodontitis as significantly increasing the risk for ACS. Aim: The aim of this study was to investigate a periodontal status in the patients with ACS, and to assess the association of different periodontal parameters with ACS. Material and methods: In the first group, patients both with ACS and periodontitis were enrolled as cases. Patients were examined 3 days after ischemia. The second group consisted of patients who had only periodontitis. The control group consisted of healthy individuals. Periodontal parameters were measured and matched on the basis of demographic characteristics and assessed between the groups. The severity of periodontitis in both cases was analyzed. Results: Analysis of the periodontal parameters showed that median scores were higher in patients in the first and the second group compared to the third control group but significantly higher in group with ACS. Levels of inflammatory markers were highest in the first group, compared to the second group and the control group. Periodontal pathogens were more strongly present in patients with ACS than in the group with periodontitis, indicating that it was a serious illness in these patients. Conclusion: This study supports an association between periodontitis and ACS. Severe periodontitis is present in this patients indicating that periodontitis can further act on the development of ACS.

Oral Health Status, Health Behaviour and Treatment Needs of Patients Undergoing Cardiovascular Surgery

Objective

The aim of the present study was to assess the oral health status and treatment needs of cardiovascular surgery patients. Second, the awareness of cardiovascular surgery patients regarding the association between oral health and heart disease was considered.

Methods

Assessment of oral health status, oral hygiene practices and treatment needs of 106 hospitalized patients in preparation for cardiovascular surgery. Patients were interviewed using a structured questionnaire designed for this study and oral examination was carried out by a dentist.

Results

The oral hygiene practices of the study cohort were not up to the standard. Patients' awareness of infective endocarditis was poor. Approximately 68% patients experienced dental caries as decayed teeth or missing teeth due to caries and filled teeth. The mean plaque index in the study group was 1.25. In this study cohort, the mean probing depth of periodontal pockets was 5.7±1.3, whereas the mean number of teeth with periodontal pockets > 6 mm was 0.5±0.9. A total of 84 (74.2%) of the patients required dental treatment.

Conclusion

The principal finding in this study was that patients with heart disease had poor oral health. This study also highlights the importance of better interaction among all healthcare professionals to integrate oral health as part of comprehensive inpatient healthcare.

Prior oral conditions in patients undergoing heart valve surgery

Background

Patients scheduled for heart valve surgery should be free of any oral infectious disorders that might pose a risk in the postoperative period. Few studies have been made on the dental conditions of such patients prior to surgery. The present study describes the most frequent prior oral diseases in this population group.

Material and Methods

A prospective, observational case-control study was designed involving 60 patients (30 with heart valve disease and 30 controls, with a mean age of 71 years in both groups). A dental exploration was carried out, with calculation of the DMFT (decayed, missing and filled teeth) index and recording of the periodontal parameters (plaque index, gingival bleeding index, periodontal pocket depth, and attachment loss). The oral mucosa was also examined, and panoramic X-rays were used to identify possible intrabony lesions.

Results

Significant differences in bacterial plaque index were observed between the two groups (p<0.05), with higher scores in the patients with valve disease. Probing depth and the presence of moderate pockets were also greater in the patients with valve disease than among the controls (p<0.01). Sixty percent of the patients with valve disease presented periodontitis.

Conclusions

Patients scheduled for heart valve surgery should be examined for possible active periodontitis before the operation. Those individuals found to have periodontal disease should receive adequate periodontal treatment before heart surgery.

Key words:Valve disease, aortic, mitral, heart surgery, periodontitis.

Periodontal and biochemical bone metabolism assessment on a chronic oral anticoagulation population treated with dicoumarins

BACKGROUND

The aim is to evaluate periodontal alteration and biochemical markers associated with bone turnover in chronic oral with dicoumarins anticoagulant treatment patients.

MATERIAL AND METHODS

80 patients treated with oral anticoagulants were divided into 2 cohort: Group A (n=36) 6 month to 1 year with anticoagulant treatment and Group B (n=44) > 2 years with anticoagulant treatment. Clinical evaluation included: Clinical attachment level (CAL), plaque index (PI) and gingival index (GI). Analytically biochemical parameters of bone remodeling (calcium and phosphorus), formation (total acid phosphatase, alkaline phosphatase and osteocalcin) and resorption (tartrate-resistant acid phosphatase and beta-crosslaps) were evaluated.

RESULTS

High values of PI (67-100%) especially in men and in Group B were observed. Men with anticoagulation treatment length showed an increased GI (49.167 vs 78.083) while Group B women showed a decreased GI in comparison with Group A (59.389 vs 42.120). Women presented a greater average CAL than men as well as Group B vs Group A but without statistical significance. All biochemical markers were decreased respect to values of general population. Osteocalcin in GroupB women showed a statistically significant outcome vs GroupA (p=0.004). Acid phosphatase (total and tartrate-resistant) has a slight increase in Group B women versus Group A, and Beta-crosslap showed lower values in Group A men than Group B and slightly lower in Group A women versus Group B, without statistical significance.

CONCLUSIONS

Patients showed a slight to moderate degree of periodontal affectation, especially gingivitis related to bacterial plaque. Periodontal disorders tended to be more severe in Group B. While bone remodeling showed an overall decrease with greater affectation of bone neoformation phenomena, bone destruction tended to recover and normalize in time.

Dental Calculus Links Statistically to Angina Pectoris: 26-Year Observational Study

Objectives

Dental 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.

Methods

In 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.

Results

Of 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).

Conclusion

Our 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.

Caries experience in young children with congenital heart disease in a developing country

Oral care is frequently suboptimal in children from developing countries, especially those suffering from severe systemic diseases. The aim of the present study was to analyze the oral epidemiological profile of 3-to-5-year-old children with congenital heart disease. Dental and medical records of children evaluated at the Dental Service of the National Institute of Cardiology, Rio de Janeiro, Brazil, were reviewed. Caries experience was reported using the dmft index. Negative behavior towards dental management was recorded. The sample consisted of 144 children aged 4.41 ± 0.95 years. The mean dmft value was 5.4 ± 4.9, and 80.5% had at least one caries lesion. Dmft index was greater in the presence of cyanotic cardiac disease and in children with negative behavior. An increase in the "missing" component of the dmft index was also found in children using medicine on a daily basis. A higher caries experience was associated with children whose fathers had only an elementary education. In conclusion, children with congenital heart disease had high levels of caries experience at a young age. Cyanosis, negative behavior, daily use of medicine, one-parent family and the educational level of fathers seem to influence caries experience in children with congenital cardiac disease.

Radiological signs indicating infection of dental origin in elderly Finns

OBJECTIVE

The aim was to assess the prevalence and background factors of signs of infection of dental origin in elderly Finns.

MATERIALS AND METHODS

Every third birth cohort between 60-78 years of age (n = 1733) in a southern and a northern region in Finland were invited. Altogether, 1069 subjects attended radiographic examination. Of those, 660 were dentate and formed the study sample. In the analysis an index as a sum of points (scale per lesion 0-3, range 0-420) indicating the severity of infection from periapical lesions, furcal lesions, vertical bone pockets, horizontal bone loss and severe dental caries was used.

RESULTS

The index ranged individually from 0-91. Horizontal bone loss was found in 94%, vertical bone loss in 19%, periapical lesions in 46%, furcal lesions in 19% and carious lesions in 39% of the subjects. Only 3% of the subjects were free of dental infections, while 2% had mild, 17% moderate and 78% severe risk of dentogenic infection. Statistically significant background factors were region, level of education, number of regular drugs in use, drugs reducing salivation, alcohol consumption, cardiovascular disease, asthma and rheumatoid arthritis.

CONCLUSIONS

Elderly Finns have high a prevalence of signs of infections of dental origin, which is associated with several socio-demographic and health-related factors.

Oral health status of patients with acute coronary syndrome--a case control study

Background

The aim of this investigation was to assess the state of oral health of patients with acute coronary syndrome (ACS) and to compare this with that of a provably healthy control group (H).

Methods

33 patients who were receiving treatment as inpatients following acute myocardial infarction or unstable angina pectoris took part in the study (ACS-group). A healthy control group (H-group) made up of blood donors, was formed following matching for age, gender, and smoking habit with the study patient group.

The dental investigation consisted of the dental status (DMF-T), a plaque-Index (PI), an assessment of gingival inflammation (GI) and periodontal situation (Periodontal Screening Index: PSR®/PSI), and attachment loss (AL). Statistical evaluation: t-test, Mann–Whitney-test and chi- squared test (level of significance p < 0.05).

Results

The mean DMF-T of the ACS-group (18.7 ± 6.8) and the H-group (19.4 ± 5.1) showed no difference (p = 0.7). Although, in the ACS-group the average loss of teeth (M-T: 8.4 ± 5.2) was higher than in the H-group (M-T: 5.8 ± 6.6) the difference was not significant (p = 0.2). Whereas with the PI no difference between the two groups was found (p = 0.9), the ACS-group showed significantly more signs of inflammation (GI) than the H-group (p = 0.045). In the case of PSR®/PSI, there was no difference between the two groups (p = 0.7). With regard to AL, no difference was revealed between ACS- and H-group (p = 0.2).

Conclusion

Although, the state of oral health of the ACS-group differed only insignificantly from that of control, patients with ACS showed more signs of gingival inflammation and a higher loss of teeth.

Association of salivary lysozyme and C-reactive protein with metabolic syndrome

INTRODUCTION

Salivary lysozyme (SLZ) is a proteolytic enzyme secreted by oral leucocytes and contains a domain that has an affinity to advanced glycation end products (AGE). Thus, we hypothesized that SLZ would be associated with metabolic syndrome (metS), a pro-inflammatory state.

METHODS

Utilizing cross-sectional data from 250 coronary artery disease (CAD) and 250 non-CAD patients, the association of SLZ with metS was tested by logistic regression analyses controlling for age, sex, smoking, total cholesterol and C-reactive protein (CRP) levels. The analyses were stratified by CAD status to control for the possible effects of CAD.

RESULTS

MetS was found in 122 persons. The adjusted odds ratio (OR) for metS associated with the highest quartile of SLZ was 1.95 with 95% confidence interval (CI) 1.20-3.12, p-value=0.007, compared with the lower three quartiles combined. Among the 40 subjects with metS but without CAD, the OR was 1.63 (CI: 0.64-4.15, p=0.31), whereas in the CAD group, SLZ was significantly associated with metS [OR=1.96 (1.09-3.52), p=0.02]. In both subgroups, CRP was not significantly associated with metS.

CONCLUSION

SLZ was significantly associated with metS (OR=1.95) independent of CRP level. Future longitudinal research is warranted.

Changing clinical features of odontogenic maxillofacial infections

Odontogenic maxillofacial infections occasionally require hospital care. Our aim was to study whether the number and the clinical features of patients hospitalized due to odontogenic abscesses in a large hospital district in Finland had changed in one decade. A retrospective analysis of two 12-month study cohorts one decade apart from the same population base was conducted. The first cohort comprised 71 patients and the second cohort comprised 101 patients. The incidence of odontogenic infections requiring hospital care increased from 5.3 to 7.2 per 100,000 inhabitants. The need for intensive care increased significantly from 15% to 32%, and the maximal C-reactive protein levels were significantly higher in the latter cohort, 127 mg/L, compared to the first cohort, 104 mg/L. The proportion of previously healthy patients decreased significantly from 83% to 65%. Odontogenic maxillofacial infections have become more prevalent and more severe during the decade in our hospital district. An increasing proportion of patients had underlying diseases.

Oral health, general health, and quality of life in older people

The purpose of this report is to review the interrelationship between poor oral health conditions of older people and general health. The impact of poor oral health on quality of life (QOL) is analyzed, and the implications for public health intervention and oral health care are discussed. Findings from the current research may lead to the following conclusions: The available scientific evidence is particularly strong for a direct relationship between diabetes and periodontal disease; the direct relationship between periodontal disease and cardiovascular disease is less convincing. General and associated oral health conditions have a direct influence on elder people's QOL and lifestyle. The growing number of elderly people challenges health authorities in most countries. The evidence on oral health-general health relationships is particularly important to WHO in its effort to strengthen integrated oral health promotion and disease prevention around the globe.

Prevalence of edentulousness and related factors among elderly Finns

Edentulousness is a multifactor phenomenon. While its overall prevalence is diminishing, it is increasing in older age groups. The aim of this study was to assess the prevalence of edentulousness among the elderly in two municipalities in Finland and to estimate different factors related to it. All persons born in the years 1919, 1922, 1925, 1928, 1931, 1934 and 1937 living in two municipalities (Kirkkonummi in the southern part of Finland and Lakeus in the northern part of Finland) were invited to participate in the study in 1997. The target population consisted of 1733 subjects of whom 1191 were disposed to participate in a clinical examination performed by two dentists. Of the subjects, 624 were from the southern district (Kirkkonummi) and 566 were from the northern district (Lakeus). The participation rates were 62% and 78%, respectively. The subjects answered a questionnaire comprising sociodemographical data, questions on dental and general health and health behaviour. Logistic regression analysis was used to assess the associations between edentulousness and potential associating factors. The overall prevalence of edentulousness was 37%; being 53% in the northern region and 22% in the southern region. Edentulousness was positively associated with high age [odds ratio (OR = 1.09), confidence interval (CI = 1.06-1.12)], female gender (OR = 2.06, CI = 1.43-2.94), northern place of residence (OR = 2.01, CI = 1.45-2.78), low level of education (OR = 7.09, CI = 3.18-15.81), cardiovascular diseases (OR = 1.51, CI = 1.03-2.21) and current smoking versus never smoking (OR = 1.73, CI = 1.17-2.55). Social factors were more prominently associated with edentulousness than factors related to general health.

Periodontal disease as a risk factor for acute myocardial infarction. A case-control study in Goans highlighting a review of the literature

OBJECTIVES

The aim of the present study was to investigate the possible association between periodontal health and acute myocardial infarction (AMI) in a case-control design.

MATERIALS AND METHODS

A total of 500 patients, 250 with AMI and 250 with coronary heart disease (CHD) were included in this study. The patients in the AMI group were admitted in the department of Medicine, Goa Medical College and Hospital, Bambolim-Goa because of AMI. The patients in the CHD group had no documented history of recent acute coronary events. Medical history was taken and data on serum lipid values, decayed teeth, missing teeth, filled teeth, probing depth (PD), simplified oral hygiene index (OHI-S) and bleeding on probing (BOP) were recorded. Sample proportions were compared by Pearson's chi-square test and quantitative variables with Student's t-test. The relation of clinical parameters and conventional risk factors with AMI was assessed with multivariate logistic regression analysis.

RESULTS

All the serum lipids and dental parameters were statistically different between AMI and CHD groups (p <0.05). Logistic regression analysis showed that serum lipids, number of decayed teeth, mean PD, percentage of sites with BOP, and oral hygiene were significantly associated with AMI (p <0.05).

CONCLUSION

The results of this study indicate that periodontal disease may be associated with AMI. We propose that prospective randomised studies are needed to determine whether periodontal disease is a risk factor in the occurrence of AMI.

Salivary constituents and acidogenic microbial counts in coronary artery bypass graft patients from baseline to three-years after operation

Data on saliva in coronary artery bypass graft (CABG) surgery patients are sparse. Understanding salivary parameters, however, may aid clinical decision making. We hypothesized that cardiac surgery might affect patients' salivary flow rates and buffering, salivary proteins, and microbial counts. A 3-year, open follow-up study was conducted examining salivary flow, its chemical composition, and acidogenic microbial counts in 89 CABG surgery patients. The changes in salivary flow and proteins between baseline and 3-year post-CABG surgery were assessed using paired t-test and, with respect to the median of number of drugs used daily, by use of a nonparametric rank sum test. The results showed no long-term change in salivary flow rates and buffering capacity. With the exception of salivary urea, IgA and IgM concentration, and lysozyme output, the differences in salivary proteins between baseline and 3-year post-CABG were not statistically significant. No difference was observed in saliva values between patients taking drugs below or above the median number of drugs. Acidogenic microbial counts remained the same throughout the study. In conclusion, the salivary flow rates and constituents did not practically change in patients who underwent CABG surgery during the 3-year follow-up.

Oral health and morbidity--implications of oral infections on the elderly

Detrimental effects of oral infections on general health have been known for almost 3000 years. Modern studies, however, have cast new light on the pathogenic mechanisms by which oral infections appear to link with morbidity and mortality. In particular, among the elderly, poor dental health seems to associate with all-cause mortality. This review aims to provide an overview of present knowledge of these issues, starting from dental bacteraemia, oral mucosal infections and problems of drug resistance and, briefly, discussing what is known about the link between oral health and some systemic diseases such as atherosclerosis and type-2 diabetes. The main conclusions are that scientific evidence is still weak on these interactions and that the elderly should be better taken into account when planning future studies. Functions of the body differ in the frail and diseased from those of the young. Consequently, novel prevention and treatment strategies should be developed and properly tested for combating oral infections in elderly populations. Specific suggestions for further research are outlined.

Oral health, atherosclerosis, and cardiovascular disease

During the last two decades, there has been an increasing interest in the impact of oral health on atherosclerosis and subsequent cardiovascular disease (CVD). The advent of the inflammation paradigm in coronary pathogenesis stimulated research in chronic infections caused by a variety of micro-organisms-such as Chlamydia pneumoniae, Helicobacter pylori, and cytomegalovirus-as well as dental pathogens, since these chronic infections are thought to be involved in the etiopathogenesis of CVD by releasing cytokines and other pro-inflammatory mediators (e.g., C-reactive protein [CRP], tumor necrosis factor [TNF-alpha]) that may initiate a cascade of biochemical reactions and cause endothelial damage and facilitate cholesterol plaque attachment. Yet, due to the multi-factorial nature of dental infection and CVD, confirming a causal association is difficult, and the published results are conflicting. The main deficit in the majority of these studies has been the inadequate control of numerous confounding factors, leading to an overestimation and the imprecise measurement of the predictor or overadjustment of the confounding variables, resulting in underestimation of the risks. A meta-analysis of prospective and retrospective follow-up studies has shown that periodontal disease may increase the risk of CVD by approximately 20% (95% confidence interval [CI], 1.08-1.32). Similarly, the reported risk ratio between periodontal disease and stroke is even stronger, varying from 2.85 (CI 1.78-4.56) to 1.74 (CI 1.08-2.81). The association between peripheral vascular disease and oral health parameters has been explored in only two studies, and the resultant relative risks among individuals with periodontitis were 1.41 (CI 1.12-1.77) and 2.27 (CI 1.32-3.90), respectively. Overall, it appears that periodontal disease may indeed contribute to the pathogenesis of cardiovascular disease, although the statistical effect size is small.

Asymptotic dental score and prevalent coronary heart disease

BACKGROUND

Oral infections have been postulated to produce cytokines that may contribute to the pathogenesis of coronary heart disease (CHD). We hypothesized that by estimating the combined production of inflammatory mediators attributable to several oral pathologies, we might be able to explain CHD with better precision.

METHODS AND RESULTS

A total of 256 consecutive Finnish cardiac patients from Kuopio University Hospital with angiographically confirmed CHD and 250 age-, gender-, and residence-matched noncardiac patients (controls) were recruited. All dental factors expected to generate inflammatory mediators, including pericoronitis, dental caries, dentate status, root remnants, and gingivitis, were examined, and an asymptotic dental score (ADS) was developed by logistic regression analyses with an appropriate weighting scheme according to the likelihood ratio. We validated the explanatory ability of ADS by comparing it to that of the Total Dental Index and examining whether the ADS was associated with known predictors of CHD. A model that included ADS, C-reactive protein, HDL, and fibrinogen offered an explanatory ability that equaled or exceeded that of the Framingham heart score (C statistic=0.82 versus 0.80). When ADS was removed from this model, the C-statistic decreased to 0.77, which indicates that the ADS was a significant contributor to the explanatory ability of a logistic model.

CONCLUSIONS

ADS may be useful as a prescreening tool to promote proactive cardiac evaluation among individuals without overt symptoms of CHD. However, additional prospective study is needed to validate the use of an oral health score as a predictor of incident CHD.

Dental infections and serum inflammatory markers in patients with and without severe heart disease

OBJECTIVE

The objective of this study was to investigate if patients with severe heart disease (CHD patients) present more signs of dental infections than patients without heart disease (non-CHD patients), if serum inflammatory markers differ between the groups, and if there is a link between these and the oral health parameters.

METHODS

We performed clinical and radiologic dental examinations and collected serum samples of 256 patients with New York Heart Association class II-IV heart disease (CHD patients) and 250 non-CHD controls. Serum samples were analysed using pertinent methods in the clinical laboratory of the hospital, and the differences in serum biomarkers between CHD patients and non-CHD patients were examined using various statistical methods. A modified dental index (MDI) was constructed and used in the analyses.

RESULTS

CHD patients were significantly more likely to be edentulous (34.8% vs. 14.8%) and retain less natural teeth than non-CHD patients (8.6 vs. 17) (P <.001). In CHD patients the remaining teeth and supporting tissues were more often diseased. High MDI scores were significantly associated with CHD status (OR 1.31, CI 1.16-1.48), as was gingivitis (OR 3.37, CI 1.66-6.86), while the presence of deep periodontal pockets was not. Serum C-reactive protein and fibrinogen concentrations and blood erythrocyte sedimentation rates were higher in the CHD group. Also, H. pylori and Chlamydia antibodies were significantly higher in the CHD group.

CONCLUSION

CHD patients presented with poorer oral health status than non-CHD patients. Serum inflammatory markers were significantly higher in the CHD patients compared to the non-CHD group. High MDI scores linked with risk of CHD.

Antibodies to periodontal pathogens are associated with coronary heart disease

OBJECTIVE

We analyzed the association of coronary heart disease (CHD) and serology of periodontitis in a random sample (n=1163) of men (aged 45 to 74 years) by determining serum IgG-antibodies to Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis.

METHODS AND RESULTS

CHD (n=159) was more prevalent among edentulous than dentate subjects (19.8% and 12.1%, P=0.003). In the dentate population, CHD was more common among subjects seropositive for P. gingivalis compared with those seronegative (14.0% and 9.7%, P=0.029). Accordingly, CHD was more prevalent in subjects with a high combined antibody response than those with a low response (17.4% and 11.1%, P=0.026). When adjusted for age and several CHD risk factors, the subjects with a high combined antibody response had an odds ratio of 1.5 (95% CI, 0.95 to 2.50, P=0.077) for prevalent CHD. In a linear regression model, the combined antibody response was directly associated with prevalent CHD (P=0.046) and inversely with serum HDL cholesterol concentration (P=0.050).

CONCLUSIONS

In conclusion, edentulousness and serum antibodies to major periodontal pathogens were associated with CHD. This suggests that periodontal infection or response of the host against the infection may play a role in the pathogenesis of CHD.