People with fewer teeth prone to die of heart disease: study

People with fewer teeth prone to die of heart disease: study

AFP) – Apr 12, 2010

STOCKHOLM — People with dented smiles run a far greater risk of dying of heart disease than those who still have all their pearly whites, a Swedish researcher said Monday.

"Cardiovascular disease and in particular coronary heart disease is closely related to the number of teeth" that a person has left, Anders Holmlund told AFP, explaining the results of a Swedish study to be published in the Journal of Periodontology.

"A person with fewer than 10 of their own teeth has a seven times higher risk for death by coronary heart disease than a person of the same age and of the same sex with more than 25 teeth left," Holmlund said.

Although many studies published in the past 15 years have showed a link between oral health and cardiovascular disease, Holmlund's study shows a direct relationship between cardiovascular disease and the number of teeth in a person's mouth.

The study, conducted with colleagues Gunnar Holm and Lars Lind, surveyed 7,674 women and men, most suffering from periodontal disease, for an average of 12 years, and examined the cause of death of the 629 people who died during the period.

For 299 of the subjects, the cause of death was cardiovascular disease.

The theory connecting teeth numbers and heart disease, Holmlund explained, maintains that "infections in the mouth and around the teeth can spill over to the systemic circulation system and cause a low graded chronic inflammation," which is known to be a risk factor for heart attacks and other cardiovascular episodes.

The number of natural teeth a person had left "could reflect how much chronic inflammation one has been exposed to in a lifetime," he added.

The study had been limited by the fact that it had not been possible to adjust the results for socio-economic factors and to fully adjust them according to other cardiovascular risk factors, he acknowledged.

Heart disease is the number one killer worldwide, claiming upward of 17 million lives every year according to the World Health Organisation.

Research links diabetes and oral inflammatory diseases

Research links diabetes and oral inflammatory diseases.


A large majority of patients with diabetes, the fastest-growing disease in the world, also suffer from oral inflammatory diseases, according to a Canadian study that predicts that the interaction of the two diseases will have a growing impact on both dental and overall healthcare.

"More and more, dental and other healthcare professionals will be required to collaborate to create teams dedicated to the management of people with diabetes at both the community and patient levels, given the interactions between oral inflammation and the comorbidities associated with diabetes," wrote lead study author Anthony Iacopino, D.M.D., Ph.D. (Canadian Journal of Diabetes, September 2009, pp. 146-147).

The authors noted that 75% of diabetics also have gingivitis and periodontitis.

"Yet it also goes without saying that by providing dental care to improve both 'oral' and 'systemic' health, healthcare professionals must remember that 'health is health' and 'disease is disease,' regardless of anatomical location," the authors pointed out.

Don Friedlander, D.D.S., an Ottawa, Ontario, dentist and president of the Canadian Dental Association (CDA), notes that oral health is a component of overall health.

"What we're beginning to understand more and more are the linkages with good general health," he told the Vancouver Sun. "Correlations and associations have been found between poor oral health and many systemic diseases such as cardiovascular disease, diabetes, respiratory problems, and preterm births."

Robert MacGregor, D.D.S., a Nova Scotia dentist and vice president of the CDA, says that in addition to the connection between oral and heart health, "recent research shows that people with oral bacteria and periodontal disease seem more prone to respiratory illness and having babies with low birth weights. And it has long been known that uncontrolled diabetes can lead to aggressive periodontal disease and vice versa," according to the Sun story.

Many chronic inflammatory diseases and conditions have been shown to share common physiological and biochemical bases (especially periodontitis and diabetes), including related underlying pathophysiological mechanisms and risk factors, according to the study authors. "Indeed, the risk factors for cardiovascular disease (a major complication of diabetes) and periodontitis are virtually identical," they wrote.

The researchers noted that diabetes predisposes patients to oral infection, and once the infection is established, it exacerbates diabetes-related hyperglycemia and may even predispose otherwise healthy individuals to develop diabetes.

Patients with diabetes have elevated serum levels of low-density lipoprotein cholesterol and triglycerides (even when blood glucose levels are well-controlled), and these can alter immune cell function via the upregulation of proinflammatory cytokines and downregulation of growth factors, Dr. Iacopino wrote.

This predisposes diabetics to chronic inflammation, progressive tissue breakdown, and diminished tissue repair -- a process that is critically important for periodontal tissues, which are under continual assault by substances emanating from oral biofilms. Hence, periodontitis is more severe and rapidly progressive in people with diabetes compared to people without diabetes, the researchers concluded.

Additionally, periodontitis induces general increases in systemic inflammation and even insulin resistance, along with the potential to destroy pancreatic beta cells. Perhaps this explains why periodontitis has a deleterious effect on diabetes-induced hyperlipidemia, immune cell function, tissue repair, and glucose metabolism, the study authors found.

Studies have shown that when periodontitis is treated, diabetes disease parameters improve.

"All healthcare professionals must recognize that there is no 'trap door' at the mouth," the authors warned. "Oral health is one constituent of general health, existing within the health-disease continuum and requiring attention by all healthcare professionals. Indeed, there is no better model for the concept of interprofessional care than the diabetes-periodontitis axis."

People with fewer teeth found to die sooner.

The fewer teeth a person has, the sooner they are likely to die, researchers at the University Hospital of Uppsala report.
The researchers followed 7,674 patients for a median of 12 years and found that those with fewer teeth were most likely to die, particularly when the death was from cardiovascular disease or coronary heart disease.
The study will be published in the Journal of Periodontology and is available online as the dissertation of Anders Holmlund.
The correlation between death and teeth correlated very highly (p < 0.0001), Holmlund wrote. In fact, those with fewer than 10 teeth were seven times more likely to die during the study than those with more than 25 teeth.
The researchers found correlations among various markers of periodontal disease, such as bleeding on probing and the number of deepened pockets, and hypertension and myocardial infarction, although these were inconsistent.
They also turned up a relationship between antibodies for the periodontal bacterium Porphyromonas gingivalis and myocardial infarction, suggesting a role for this type of infection in both periodontal disease and cardiovascular disease.