A study published online March 29, 2017 in the Journal of the American Heart Association found that tooth loss and gum disease in older women was associated with higher rates of cardiovascular disease and death.
It was reported March 29, 2017 by CNN.
What's the most important thing I should know about this study related to my health?
Women who had complete tooth loss as an adult (edentulism) had a higher risk of heart and vascular disease as well as a higher risk of dying compared to women who had not lost all of their teeth, even when accounting for traditional cardiovascular risk factors – such as age, smoking and diabetes. So the bottom line is: the better the health of your teeth and gums, the better your overall health and cardiovascular health will tend to be, and the lower your risk of dying.
What was this study seeking to determine? Has this been done before?
This study wanted to better understand the link between tooth loss and inflammation of the tissue around the teeth known as periodontitis with cardiovascular disease risk and overall death rate. This has been looked at in prior studies, but they were less likely to include older adults and less likely to include women. The Women's Health Initiative Observational Study population used in this study provided an ideal patient population to better understand this association. This population included 57, 001 women who were 55 years of age or older. So this study is the largest of its kind with a focus specifically on post-menopausal women.
Who were the subjects and how were they categorized?
The subjects were taken from a group of participants from the 57,001 postmenopausal women who were enrolled in the Women's Health Initiative Observational Study and who were without cardiovascular disease at the time when the five-year follow-up questionnaire was completed. They were categorized as having "self-reported" periodontitis described as non or mild, moderate or severe, or reaching edentulous (complete loss of adult teeth).
What were the results?
Among those studied, 26% had periodontitis and 5.9% had lost all of their adult teeth but had a lower prevalence of periodontitis. Overall, higher risk of total cardiovascular disease as well as total mortality was higher in women without teeth, and this group tended to visit the dentist more frequently. Total mortality was also higher for both groups with periodontitis as well as the group without teeth. Those with periodontal disease had a 12% higher risk of death from any cause and the study participants who had lost all of their teeth had a 17% higher risk of death from any cause.
Did the researchers offer an explanation for the results?
The self-reported nature of the study in terms of periodontitis may be less robust than studies that would be based on an objective clinical exam. The complete loss of teeth may be a more objective reflection of overall oral health than the self-reported periodontitis. Frequency of dental visits may better reflect the severity of the condition as well.
What conclusions, if any, can be made about cause and effect?
There are several theories that explore the link between poor dental health and increased risk of cardiovascular disease and death. Inflammation and bacteria that get into the bloodstream can trigger inflammation in other parts of the body besides the mouth. This inflammation can affect the lining of blood vessels in the circulatory system and lead to hardening of the arteries and heart attacks. There may also be something about the low estrogen hormone state after menopause that may promote periodontitis as well as heart and vascular disease. However, the design of the study was not intended to establish a cause and effect relationship.
What, if anything, should people and health care professionals do differently in the face of these findings? What are the challenges to addressing this issue?
Health care providers need to stress the importance of good dental care, with routine cleanings and exams, and consider poor oral health as a risk factor for cardiac disease that the patient can control. As with other things, patient compliance with the recommendation of their health care professions and the resources available to promote good health are always challenges to doing the right things to live a long and healthy life.
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