title: Loss of alveolar bone due to periodontal disease exhibits a threshold on the association with coronary heart disease.
abstract: BACKGROUND
  A number of epidemiologic studies were published that looked at the association between coronary heart disease (CHD) and periodontal disease. However, debate exists about whether this association is a true relationship or simply an example of an uncontrolled confounder. This retrospective cohort study examines the relationship between periodontal disease and CHD.
  
  
  METHODS
  Digital panoramic radiographs were used to assess alveolar bone loss (ABL) using a Schei ruler. Participants consisted of Veterans Administration (VA) patients who were eligible for dental benefits and had a digital panoramic radiograph taken at the VA Medical Center, Denver, Colorado. Information on CHD and other important clinical variables were obtained from electronic medical records.
  
  
  RESULTS
  The examination of the relationship between ABL and CHD revealed a significant non-linear relationship with a threshold at ≈ 20% bone loss with a doubling of the probability ratios of CHD compared to those at 7.5% bone loss.
  
  
  CONCLUSIONS
  To our knowledge, this is the first study to demonstrate a non-linear relationship between ABL and CHD. A significant positive association between ABL and CHD was found at even low levels of bone loss between 10% and 20%.
authors.affiliation: Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA. amy.alman@ucdenver.edu
authors.forename: Amy C
authors.initials: AC
authors.lastname: Alman
authors.forename: Lonnie R
authors.initials: LR
authors.lastname: Johnson
authors.forename: David C
authors.initials: DC
authors.lastname: Calverley
authors.forename: Gary K
authors.initials: GK
authors.lastname: Grunwald
authors.forename: Dennis C
authors.initials: DC
authors.lastname: Lezotte
authors.forename: Jeri E F
authors.initials: JE
authors.lastname: Harwood
authors.forename: John E
authors.initials: JE
authors.lastname: Hokanson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016301:Alveolar Bone Loss / Q000150:complications*; D015992:Body Mass Index; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000150:complications; D003327:Coronary Disease / Q000150:complications*; D048909:Diabetes Complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications; D006973:Hypertension / Q000150:complications; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000473:pathology; D017711:Nonlinear Dynamics; D010510:Periodontal Diseases / Q000150:complications; D011336:Probability; D019252:Radiography, Dental, Digital; D011862:Radiography, Panoramic; D012189:Retrospective Studies; D018570:Risk Assessment; D012907:Smoking; D016388:Tooth Loss / Q000150:complications