Oral health status, C-reactive protein and mortality--a 10 year follow-up study.
BACKGROUND
Epidemiological studies have reported a strong association between C-reactive protein (CRP) and cardiovascular diseases (CVD). Elevated CRP levels have been observed both in dentate individuals with chronic dental infections like periodontal disease and in those edentulous. The mechanisms behind these observations, especially the reasons for the elevation of CRP in the edentulous, are poorly understood. The comparative data on the importance of these inflammatory conditions in the oral cavity as causes of elevated CRP levels and CVD risk factors are also limited.


OBJECTIVE
To determine if edentulism is associated with increased levels of CRP and investigate the possible mechanism for this association; and to study the influence of periodontal disease and edentulism on 10-year mortality.


METHODS
Of the 364 subjects aged 76, 81, and 86 years in 1990, 196 were dentate and 168 edentulous. By December 1999, 179 had died, almost half (n = 87) of them due to cardiovascular disease.


RESULTS
Significantly more of the edentulous subjects had elevated (> or = 3 mg/L) CRP levels as compared to those with at least 20 teeth (p < 0.01). They also had high salivary microbial counts (p < 0.05), and more mucosal lesions (p < 0.0001) than those with at least 20 teeth. In multivariate analysis, high microbial counts (OR 2.3, CI 1.06-5.05) and mucosal lesions (OR 2.18, CI 1.03-4.61) were significantly associated with elevated CRP levels. The risk for all-cause mortality was non-significantly elevated among the edentulous (RR 1.48, CI 0.95-2.31) and dentate with periodontal disease (RR 1.58, CI 0.96-2.61). CVD mortality was significantly higher among the dentate with periodontal disease (RR 1.97, CI 1.01-3.85) when compared with dentate without periodontal disease.


CONCLUSIONS
Among the edentulous, chronic infections like denture-related mucosal lesions are important determinants of elevated CRP, comparable to periodontal disease in the dentate. Elevated CRP per se and edentulism were not significantly associated with increased mortality. Periodontal disease was, however, still associated with a two-fold CVD mortality in this very old population.
Ajwani
S
S
Institute of Dentistry, University of Helsinki, Finland. shilpi.ajwani@stonebow.otago.ac.nz
Mattila
K J
KJ
Närhi
T O
TO
Tilvis
R S
RS
Ainamo
A
A
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002097:C-Reactive Protein / Q000032:analysis*; D002318:Cardiovascular Diseases / Q000401:mortality; D016009:Chi-Square Distribution; D002908:Chronic Disease; D015897:Comorbidity; D003753:Dental Health Surveys; D003778:Dentures / Q000401:mortality; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D007576:Jaw, Edentulous, Partially / Q000097:blood / Q000401:mortality; D016015:Logistic Models; D008297:Male; D009066:Mouth, Edentulous / Q000097:blood / Q000401:mortality*; D009909:Oral Health; D009910:Oral Hygiene / Q000401:mortality; D010510:Periodontal Diseases / Q000097:blood / Q000401:mortality*; D010518:Periodontitis / Q000453:epidemiology; D017678:Sex Distribution; D016019:Survival Analysis
D002097:C-Reactive Protein