title: Oral health and health behavior in patients referred for open-heart surgery.
abstract: OBJECTIVE
  Little is known about the dental health and health behavior of patients referred for open-heart surgery because of severe heart disease. Yet, coronary atherosclerosis has been suggested to be an inflammatory disease in which chronic dental infections may trigger pathogenic mechanisms in the walls of arteries. In epidemiological studies periodontal disease in particular has been linked with coronary heart disease (CHD).
  
  
  METHODS
  We set out to investigate by means of clinical examination, x-ray, and questionnaire the oral health status, health-related behavior, and conceptions of 256 CHD patients referred for open-heart surgery in the Kuopio University Hospital. The patients' heart disease was New York Heart Association grades II-IV. For comparison, 250 age- and sex-matched non-CHD patients were also studied. Differences between groups were analyzed conventionally and with the Total Dental Index (TDI), which uses linear modeling and logistic regression analyses to summarize periodontal factors and other signs of oral infections. We expected to find neglected dental care and worse oral health situation among the CHD patients.
  
  
  RESULTS
  Edentulousness was seen in 35% of the CHD group and in 15% of the non-CHD group (P < .001). The CHD group had significantly lower number of teeth (8.8 +/- 9.1) than the non-CHD group (17 +/- 10.5; P < .001). No dental appointment in the past 10 years was reported in 66% of the CHD patients and 35% of the non-CHD patients. Forty-nine percent of the CHD group and 69% of the non-CHD group had had a dental visit within the past 2 years (P < .001). Daily tooth brushing was reported by 46% of the CHD group and 56% of the non-CHD group (P < .05). Only 2% of the CHD group and 8% of the non-CHD group flossed daily (P < .001). TDI scores were significantly higher in the edentulous than in the dentate study groups (P < .001), but no difference was observed between CHD and non-CHD patients of the same dentate or edentulous status. Mean TDI score was 3.2 +/- 0.8 in edentulous CHD patients and 3.1 +/- 0.4 in edentulous non-CHD patients; the scores in the dentate patients were 2.5 +/- 0.9 in the CHD group and 2.4 +/- 2.0 in the non-CHD group. The TDI score appeared almost significant a predictor of CHD when used as a dependent variable in logistic regression analysis (P = .08).
  
  
  CONCLUSIONS
  Worse oral health status and less satisfactory oral health behavior were observed in the CHD patients than among the cardiologically healthy.
authors.affiliation: Institute of Dentistry, Helsinki University Central Hospital, Department of Oral and Maxillofacial Diseases, Helsinki University Central Hospital, Finland. Jukka.Meurman@Helsinki.Fi
authors.forename: Jukka H
authors.initials: JH
authors.lastname: Meurman
authors.forename: Markku
authors.initials: M
authors.lastname: Qvarnström
authors.forename: Sok-Ja
authors.initials: SJ
authors.lastname: Janket
authors.forename: Pekka
authors.initials: P
authors.lastname: Nuutinen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D006348:Cardiac Surgical Procedures; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003327:Coronary Disease / Q000150:complications*; D003729:Dental Care / Q000523:psychology / Q000706:statistics & numerical data; D003773:Dental Plaque / Q000150:complications* / Q000523:psychology; D003778:Dentures / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010510:Periodontal Diseases / Q000150:complications* / Q000523:psychology; D011795:Surveys and Questionnaires