title: The impact of dental disease on mortality in patients with asymptomatic carotid atherosclerosis.
abstract: BACKGROUND
  Dental status and oral hygiene are associated with progression of atherosclerosis in patients with carotid stenosis. It remains unclear whether dental disease is a risk factor for mortality in these patients. We evaluated the bearing of dental disease on mortality among patients with asymptomatic carotid atherosclerosis.
  
  
  METHODS
  Three World Health Organization-validated indices in 411 patients with asymptomatic carotid atherosclerosis were evaluated, measuring DMFT (decayed, missing, filled teeth) for dental status, CPITN (community periodontal index for treatment needs) for periodontal status and SLI (Silness-Löe Index) for oral hygiene respectively. Patients were prospectively followed for median 6.2 years (IQR 5.8 to 6.6 years) for all-cause mortality.
  
  
  RESULTS
  During follow-up, 107 (26%) deaths occurred (74 cardiovascular causes). DMFT and SLI, but not CPITN, showed a significant and gradual association with mortality. For continuous variables, the adjusted hazard ratios (HR) for death were 1.06 (95% CI 1.0 to 1.12; p = 0.04) for DMFT, and 1.43 (95% CI, 1.01 to 2.03; p = 0.04) for SLI respectively. Edentulousness was a significant risk factor for death (adjusted HR 1.99, 95% CI, 1.18 to 3.02; p = 0.008).
  
  
  CONCLUSIONS
  Dental status and oral hygiene were associated with mortality in patients with carotid atherosclerosis regardless of conventional cardiovascular risk factors.
authors.affiliation: Department of Internal Medicine II, Division of Angiology, Vienna General Hospital, Medical University, Währinger Gürtel 18-20, 1090 Vienna, Austria. matthias.hoke@meduniwien.ac.at
authors.forename: Matthias
authors.initials: M
authors.lastname: Hoke
authors.forename: Thomas
authors.initials: T
authors.lastname: Schillinger
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Mlekusch
authors.forename: Oswald
authors.initials: O
authors.lastname: Wagner
authors.forename: Erich
authors.initials: E
authors.lastname: Minar
authors.forename: Martin
authors.initials: M
authors.lastname: Schillinger
mesh_terms: D000368:Aged; D058070:Asymptomatic Diseases; D050197:Atherosclerosis / Q000000981:diagnostic imaging / Q000401:mortality*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000401:mortality*; D004245:DMF Index; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009066:Mouth, Edentulous / Q000150:complications*; D009911:Oral Hygiene Index; D010512:Periodontal Index; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016388:Tooth Loss / Q000150:complications*; D014463:Ultrasonography