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Childhood cavities, periodontal disease increase intima-media thickness later in life
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Patients who had oral infections in childhood had an increased risk for subclinical carotid atherosclerosis in adulthood, according to a study published in JAMA Network Open.
“The results show for the first time, to our knowledge, that childhood oral infections may be a modifiable risk factor for adult cardiovascular disease,” Pirkko J. Pussinen, PhD, university researcher in the department of oral and maxillofacial diseases at University of Helsinki, and colleagues wrote.
Cardiovascular Risk in Young Finns Study
Researchers analyzed data from 755 patients (49% men; mean age at baseline, 8 years) from the Cardiovascular Risk in Young Finns Study who underwent a baseline evaluation with a dental examination in 1980 at age 6, 9 or 12 years. These patients also underwent a clinical CV follow-up in 2001 at age 27, 30 or 33 years and/or in 2007 at age 33, 36 or 39 years.
The oral examination included a questionnaire on brushing frequency and an assessment of dental infections, number of teeth and periodontal diseases. CV risk factors were measured throughout the study such as BMI, BP, triglycerides, total cholesterol, LDL, HDL and carotid artery intima-media thickness.
At baseline, 4.5% of children had no sign of oral infections, 5.6% had one sign, 17.4% had two signs, 38.3% had three signs and 34.1% had four signs of oral infections.
The mean number of CV risk factors increased as the number of signs of oral infections increased in adulthood, as shown in patients with no signs (mean, 4.9), one sign (mean, 4.91), two signs (mean, 5.6), three signs (mean, 5.98) and four signs (mean, 6.1; P for trend = .04). This was prominent in childhood in those with no signs (mean, 5.31), one sign (mean, 6.34), two signs (mean, 6.71), three signs (mean, 6.91) and four signs (mean, 7.2; P = .008).
Childhood oral infections were associated with adulthood intima-media thickness and included signs of cavities (R2 = 0.022), periodontal disease (R2 = 0.018) or both (R2 = 0.004).
Any sign of oral infection in children was linked to increased intima-media thickness when the third tertile was compared with the first and second tertiles (RR = 1.87; 95% CI, 1.25-2.79). The presence of four signs of oral infection resulted in a RR of 1.95 (95% CI, 1.28-3).
The risk for intima-media thickness was more prominent in boys with cavities (RR = 1.46; 95% CI, 1.04-2.05), periodontal disease (RR = 1.69; 95% CI, 1.21-2.36) and all four signs of oral infection (RR = 2.25; 95% CI, 1.3-3.89).
The association between signs of oral infection and intima-media thickness was independent of CV risk factors.
“The results of the present study show that the cumulative exposure to both childhood and adulthood risk factors increased with the increasing number of oral infections,” Pussinen and colleagues wrote.
Common risk factors
“Even if the question of causality remains unanswered, with issues pertaining to the performance of a conventional randomized clinical trial in this context, the article by Pussinen et al underscores the idea that the distinction between oral health and systemic health is blurred and somewhat artificial,” Anwar T. Merchant, DMD, ScD, professor, director of curriculum development and division head in the department of epidemiology and biostatistics at the Arnold School of Public Health at University of South Carolina in Columbia, and Salim S. Virani, MD, PhD, associate professor in the section of cardiovascular research and director of the cardiovascular disease fellowship training program at Baylor College of Medicine in Houston, wrote in a related editorial. “Cardiovascular disease and periodontal disease share common risk factors, and controlling those risk factors could result in better overall health.” – by Darlene Dobkowski
Disclosures: Pussinen and Merchant report no relevant financial disclosures. Virani reports he received funding from the Department of Veterans Affairs Health Services Research and Development and the Houston Veterans Affairs Health Services Research and Development and has received honorarium from the American College of Cardiology. Please see the study for all other authors’ relevant financial disclosures.
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