Lower risk for cardiovascular mortality for patients with root filled teeth in a Finnish population.

AIM: To investigate the relationship of radiographic evidence of root filled teeth to cardiovascular outcomes. METHODOLOGY: Baseline data for 506 subjects including 256 angiographically verified heart disease patients and 250 matched cardiologically healthy controls participating in the Kuopio Oral Health and Heart study were collected in 1995-1996. Cardiovascular disease (CVD) mortalities were accrued until 31 May 2015 and appended to the baseline data. Mortality status data were obtained from the Finnish National Death Register where all mortality cases and the causes of death are compiled for all Finnish citizens. Of the 506 participants, 473 subjects who had no missing values in the predictor, outcome or confounding factors were included in the analyses to assess the relationship of radiographic evidence of root filled teeth with prevalent coronary artery disease (CAD) cross sectionally and also with CVD mortality longitudinally. Multivariable logistic regression was used for the cross-sectional part and proportional hazard regression analyses for the longitudinal part of the study were used adjusting for age, sex, smoking, edentulism, diabetes, hypertension, total/HDL cholesterol ratio and income. Additionally, whether this association was independent of periodontitis, and a systemic marker of inflammation, serum C-reactive protein (CRP) was examined. RESULTS: Having ≥1 root filled teeth was associated with 84% lower odds of prevalent CAD with Odds Ratio (OR) = 0.16, 95% confidence interval (CI) 0.09-0.28, P < 0.0001. The OR for edentulism was 1.32 (CI: 0.73-2.38), P = 0.36, suggesting a nonsignificant increase in risk. Prospectively, having at least one root filled teeth was associated with a 49% lower risk of CVD mortality (hazard ratio [HR] = 0.51, CI = 0.27-0.97, P = 0.04) whilst edentulism was associated with nonsignificantly increased risk for CVD mortality: HR = 1.25 (CI: 0.65-2.42), P = 0.36. Adjustment for periodontitis or serum CRP levels changed the OR or HR slightly but the associations remained significant. CONCLUSIONS: Having ≥1 root filled teeth was associated with significantly lower odds for prevalent CAD cross sectionally and lower risk of cardiovascular mortality prospectively. These reduced associations with CVD were independent of periodontitis or serum CRP levels.

Oral Infections, Metabolic Inflammation, Genetics, and Cardiometabolic Diseases.

Although several epidemiologic studies reported plausible and potentially causal associations between oral infections and cardiometabolic diseases (CMDs), controversy still lingers. This might be due to unrecognized confounding from metabolic inflammation and genetics, both of which alter the immune responses of the host. Low-grade inflammation termed metainflammation is the hallmark of obesity, insulin resistance, type 2 diabetes, and CMDs. According to the common soil theory, the continuum of obesity to CMDs is the same pathology at different time points, and early metainflammations, such as hyperglycemia and obesity, display many adverse cardiometabolic characteristics. Consequently, adipose tissue is now considered a dynamic endocrine organ that expresses many proinflammatory cytokines such as TNF-α, IL-6, plasminogen activator inhibitor 1, and IL-1ß. In metainflammation, IL-1ß and reactive oxygen species are generated, and IL-1ß is a pivotal molecule in the pathogenesis of CMDs. Note that the same cytokines expressed in metainflammation are also reported in oral infections. In metabolic inflammation and oral infections, the innate immune system is activated through pattern recognition receptors-which include transmembrane receptors such as toll-like receptors (TLRs), cytosolic receptors such as nucleotide-binding oligomerization domain-like receptors, and multiprotein complexes called inflammasome. In general, TLR-2s are presumed to recognize lipoteichoic acid of Gram-positive microbes-and TLR-4s, lipopolysaccharide of Gram-negative microbes-while nucleotide-binding oligomerization domain-like receptors detect both Gram-positive and Gram-negative peptidoglycans on the bacterial cell walls. However, a high-fat diet activates TLR-2s, and obesity activates TLR-4s and induces spontaneous increases in serum lipopolysaccharide levels (metabolic endotoxemia). Moreover, genetics controls lipid-related transcriptome and the differentiation of monocyte and macrophages. Additionally, genetics influences CMDs, and this creates a confounding relationship among oral infections, metainflammation, and genetics. Therefore, future studies must elucidate whether oral infections can increase the risk of CMDs independent of the aforementioned confounding factors.

Removable dental prostheses and cardiovascular survival: a 15-year follow-up study.

OBJECTIVES: In previous studies, increasing number of teeth predicted better survival and the acute needs for dental treatment predicted mortality. We sought to investigate whether restored dentitions by various removable dental prostheses impact cardiovascular (CVD) longevity. METHODS: Kuopio Oral Health and Heart study was initiated as a cross-sectional investigation with 256 subjects with diagnosed coronary artery disease [CAD] and 250 age- and sex-matched controls without CAD in 1995-1996. The mean age of both groups was 61, 30% were females. We appended mortality follow-up records to the baseline data and formulated this 15-year follow-up study. We examined the relationship between various types of dental prostheses and cardiovascular mortality by proportional hazard regression analyses. We also explored their correlation to oral and systemic inflammatory markers such as asymptotic dental score and C-reactive protein. RESULTS: In a model adjusted for age, sex and smoking, groups having only natural teeth (NT), removable partial denture(s) [PD] and NT, a PD and a full denture [FD], and FD/FD or FD/NT demonstrated the following hazard ratios for mortality (95% confidence interval). NT both arches: 1.00 [reference]; PD and NT: 0.75 [0.22-2.56]; PD and FD: 1.99 [1.05-3.81]; and FD opposed by FD or NT: 1.71 [0.93-3.13], respectively [p for trend=0.05]. Although statistically not significant, those with PD and NT with mean a number of teeth [Nteeth] of 15.4 had better survival compared with those who had all NT [Nteeth=22.5]; while those who had FD and PD [Nteeth=6.5] had shorter longevity than those with FD/FD or FD/NT [Nteeth=3.5]. CONCLUSIONS: Although not all subgroups of dental prostheses reached significant relationship with CVD mortality, our study suggests that not only the number [quantity] of remaining teeth but their maintenance [quality] removing potential inflammatory foci, such as pericoronitis or retained root tips, may positively impact on cardiovascular survival.

Are sugar-free confections really beneficial for dental health?

BACKGROUND: Various sugar substitutes have been introduced and are widely used in confections and beverages to avoid tooth decay from sugar and other fermentable carbohydrates. One group of sugar substitutes are sugar alcohols or polyols. They have been specifically used in foods for diabetic patients because polyols are not readily absorbed in the intestine and blood stream, preventing post-prandial elevation of glucose level. Additionally they may lower caloric intake. METHODS: We searched PubMed, Cochrane Controlled Trials Registry, Cochrane Oral Health Review, Centre for Reviews and Dissemination in the UK, National Library for Public Health and a Centre for Evidence Based Dentistry website up to the end of October 2010, using the search terms 'sugar alcohol' or 'sugar-free' or 'polyols' and combined with a search with terms 'dental caries' or 'dental erosion'. RESULTS: Xylitol, a polyol, has been approved by the US Food and Drug Administration for its non-cariogenic properties that actually reduce the risk of dental decay and recently, the European Union also officially approved a health claim about xylitol as a 'tooth friendly' component in chewing gums. Although the presence of acidic flavourings and preservatives in sugar-free products has received less attention, these additives may have adverse dental health effects, such as dental erosion. Furthermore, the term sugar-free may generate false security because people may automatically believe that sugar-free products are safe on teeth. CONCLUSION: We concluded that polyol-based sugar-free products may decrease dental caries incidence but they may bring another dental health risk, dental erosion, if they contain acidic flavouring. There is a need for properly conducted clinical studies in this area.

Oral health care patterns and the history of miscarriage.

OBJECTIVE: Oral infections can trigger the production of pro-inflammatory mediators that may be risk factors for miscarriage. We investigated whether oral health care patterns that may promote or alleviate oral inflammation were associated with the history of miscarriage in 328 all-Caucasian women. MATERIALS AND METHODS: Of 328 women in this cross-sectional cohort, 74 had history of miscarriage (HMC). Medical, dental and sociodemographic data were collected through clinical examinations, medical record searches and structured questionnaires. RESULTS: The multivariate regression analyses indicated that urgency-based dental treatment demonstrated a significant association [odds ratio (OR) = 2.54; 95% confidence interval (CI): 1.21-5.37; P = 0.01] and preventive dental treatment demonstrated a marginally significant inverse association (OR = 0.53; CI: 0.26-1.06; P = 0.07) with HMC. Self-rated poor oral health had a non-significant positive association with HMC (OR 1.60; CI: 0.88-2.90). CONCLUSION: Our results provide sufficient evidence for hypothesis generation to test whether other precise measures of oral inflammation are associated with adverse birth outcomes.

Salivary matrix metalloproteinase-8 in patients with and without coronary heart disease may indicate an increased susceptibility to periodontal disease.

BACKGROUND AND OBJECTIVE: Tissue destruction caused by periodontitis may increase the number of cytokines implicated in the pathogenesis of cardiovascular diseases. We measured the concentration of the leukocyte-derived proteolytic enzyme, salivary neutrophil collagenase-2 [matrix metalloproteinase-8 (MMP-8)], as a marker of periodontal disease and assessed its relationship to coronary heart disease (CHD). Our aim was to study whether salivary MMP-8 levels were different among patients with and without CHD. The hypothesis was that patients with heart disease might present higher salivary MMP-8 levels than cardiologically healthy controls. MATERIAL AND METHODS: Saliva samples were taken from 256 patients with CHD and from 250 matched controls with known oral and general health status. The MMP-8 levels in saliva were analyzed by immunofluorometric assay, salivary albumin was assessed by enzyme-linked immunosorbent assay (ELISA) and total protein was determined using the colorimetric method. We further investigated the molecular forms and isoform distribution of salivary MMP-8 by western immunoblotting. The MMP-8 results were adjusted for the number of teeth and salivary protein concentrations. RESULTS: The adjusted logarithmic MMP-8 values were 0.145 +/- 0.245 microg/l in patients with CHD and 0.088 +/- 0.115 microg/l in controls (p < 0.01). The respective MMP-8 : total protein and MMP-8 : albumin ratios were also significantly higher in CHD patients than in non-CHD subjects. CONCLUSION: Elevated salivary MMP-8 levels seemed to associate with CHD, suggesting more tissue breakdown as a result of periodontitis among the patients with heart disease.

Does periodontal treatment improve glycemic control in diabetic patients? A meta-analysis of intervention studies.

Previous analyses regarding effects of periodontal treatment on glycemic control included studies where causal association might not be assumed, or the results were reported non-quantitatively. We initiated this meta-analysis of 10 intervention studies to quantify the effects of periodontal treatment on HbA1c level among diabetic patients, to explore possible causes for the discrepant reports, and to make recommendations for future studies. Data sources were MEDLINE (January, 1980, to January, 2005), the EBMR, Cochrane Register, and bibliographies of the published articles. Three investigators extracted data regarding intervention, outcomes, and effect size. A total of 456 patients was included in this analysis, with periodontal treatment as predictor and the actual change in hemoglobin A1c level as the outcome. The weighted average decrease in actual HbA1c level was 0.38% for all studies, 0.66% when restricted to type 2 diabetic patients, and 0.71% if antibiotics were given to them. However, none was statistically significant.