Toothbrushing, inflammation, and risk of cardiovascular disease: results from Scottish Health Survey.
OBJECTIVE
To examine if self reported toothbrushing behaviour is associated with cardiovascular disease and markers of inflammation (C reactive protein) and coagulation (fibrinogen).


METHODS
National population based survey.


METHODS
Scottish Health Survey, which draws a nationally representative sample of the general population living in households in Scotland.


METHODS
11,869 men and women, mean age 50 (SD 11).


METHODS
Oral hygiene assessed from self reported frequency of toothbrushing. Surveys were linked prospectively to clinical hospital records, and Cox proportional hazards models were used to estimate the risk of cardiovascular disease events or death according to oral hygiene. The association between oral hygiene and inflammatory markers and coagulation was examined in a subsample of participants (n=4830) by using general linear models with adjustments.


RESULTS
There were a total of 555 cardiovascular disease events over an average of 8.1 (SD 3.4) years of follow-up, of which 170 were fatal. In about 74% (411) of cardiovascular disease events the principal diagnosis was coronary heart disease. Participants who reported poor oral hygiene (never/rarely brushed their teeth) had an increased risk of a cardiovascular disease event (hazard ratio 1.7, 95% confidence interval 1.3 to 2.3; P<0.001) in a fully adjusted model. They also had increased concentrations of both C reactive protein (beta 0.04, 0.01 to 0.08) and fibrinogen (0.08, -0.01 to 0.18).


CONCLUSIONS
Poor oral hygiene is associated with higher levels of risk of cardiovascular disease and low grade inflammation, though the causal nature of the association is yet to be determined.
Department of Epidemiology and Public Health, University College London, London WC1E 6BT.
Cesar
C
de Oliveira
Richard
R
Watt
Mark
M
Hamer
D015415:Biomarkers / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology*; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D003729:Dental Care / Q000706:statistics & numerical data; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006306:Health Surveys; D006801:Humans; D007239:Infections / Q000097:blood / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010518:Periodontitis / Q000097:blood / Q000209:etiology*; D015995:Prevalence; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D014099:Toothbrushing / Q000706:statistics & numerical data*
D015415:Biomarkers; D005340:Fibrinogen; D002097:C-Reactive Protein