Oral Health Score May Reveal Heart Risks
New Oral Health Score May Predict Heart Disease Risk
Feb. 18, 2004 -- Your smile may speak volumes about your heart.
New research shows that poor scores in five different areas of oral health may
serve as a red flag for heart disease risk.
A small study shows that poor oral health was a stronger
predictor of heart disease than other commonly used risk factors, such as low
HDL "good" cholesterol, high levels of a clotting factor called
fibrinogen, and high triglycerides (a type of fat).
Researchers say if future studies confirm these results, a
dental exam may help identify people at risk for heart attack or stroke who do
not yet have symptoms of heart disease.
5 Oral Diseases Top the List
In the study, which appears in the current issue of
Circulation: Journal of the American Heart Association, researchers used
five types of oral diseases to create a general rating of oral health, called
the asymptomatic dental score (ADS).
"Oral infections are thought to produce inflammation that
might be associated with coronary heart disease, so we examined all oral
pathologies that might generate inflammation," says researcher Sok-Ja
Janket, DMD, MPH, assistant professor at Boston University School of Dental
Medicine, in a news release.
The diseases include:
- Pericoronitis -- an infection around the third molar
- Gingivitis -- gum inflammation
- Root remnants -- when teeth are decayed to the point that only the tip of
the root remains
- Missing teeth
Researchers used a mathematical model to determine the strength
of each disease's association with heart disease in 256 Finnish adults with
heart disease and a group of 250 similar adults without heart disease. They
then weighted each disease's contribution and came up with the ADS.
Of the five diseases, the strongest predictor of heart disease
was pericoronitis, followed by root remnants, gingivitis, cavities, and missing
When researchers compared the ADS with other known indicators
of heart disease risk, they found the oral health score was a stronger
predictor of risk than several well-studied factors, including some types of
inflammatory markers for heart disease and cholesterol levels.
Which Comes First -- Cavities or Heart Disease?
Although this study shows overall oral health is significantly
associated with heart disease, researchers say it doesn't not necessarily mean
that poor oral health causes heart disease. They say more study is needed to
determine whether poor oral health contributes to or is the result of heart
disease. Janket suggests that oral health may not only contribute to heart
disease through the inflammation process but also through poor nutrition.
"People who do not have teeth cannot chew their food well
and therefore do not get as much heart-healthy nutrients or fiber," says
Janket. "Future studies should look at nutrition, oral health, and coronary
Researchers say people without health insurance who have poor
access to preventive care that might reduce their risk of heart disease are
also more likely to have poor oral health.
In an editorial that accompanies the study, Gordon D.O. Lowe,
of the University Department of Medicine, Royal Infirmary in Glasgow, U.K.,
says it's still too early to apply these findings to the general public.
"We should continue to emphasize proven risk factors, such
as age, sex, smoking habits, diabetes, blood pressure, and total
cholesterol/HDL ratio. Further studies are needed to evaluate the additive
predictive value of 'emerging' risk predictors, including dental health
scores," writes Lowe.