Lower risk for cardiovascular mortality for patients with root filled teeth in a Finnish population.
OBJECTIVE
To investigate the relationship of radiographic evidence of root filled teeth to cardiovascular outcomes.


METHODS
Baseline data for 506 subjects including 256 angiographically verified heart disease patients and 250 matched cardiologically healthy controls participating in the Kuopio Oral Health and Heart study were collected in 1995-1996. Cardiovascular disease (CVD) mortalities were accrued until 31 May 2015 and appended to the baseline data. Mortality status data were obtained from the Finnish National Death Register where all mortality cases and the causes of death are compiled for all Finnish citizens. Of the 506 participants, 473 subjects who had no missing values in the predictor, outcome or confounding factors were included in the analyses to assess the relationship of radiographic evidence of root filled teeth with prevalent coronary artery disease (CAD) cross sectionally and also with CVD mortality longitudinally. Multivariable logistic regression was used for the cross-sectional part and proportional hazard regression analyses for the longitudinal part of the study were used adjusting for age, sex, smoking, edentulism, diabetes, hypertension, total/HDL cholesterol ratio and income. Additionally, whether this association was independent of periodontitis, and a systemic marker of inflammation, serum C-reactive protein (CRP) was examined.


RESULTS
Having ≥1 root filled teeth was associated with 84% lower odds of prevalent CAD with Odds Ratio (OR) = 0.16, 95% confidence interval (CI) 0.09-0.28, P < 0.0001. The OR for edentulism was 1.32 (CI: 0.73-2.38), P = 0.36, suggesting a nonsignificant increase in risk. Prospectively, having at least one root filled teeth was associated with a 49% lower risk of CVD mortality (hazard ratio [HR] = 0.51, CI = 0.27-0.97, P = 0.04) whilst edentulism was associated with nonsignificantly increased risk for CVD mortality: HR = 1.25 (CI: 0.65-2.42), P = 0.36. Adjustment for periodontitis or serum CRP levels changed the OR or HR slightly but the associations remained significant.


CONCLUSIONS
Having ≥1 root filled teeth was associated with significantly lower odds for prevalent CAD cross sectionally and lower risk of cardiovascular mortality prospectively. These reduced associations with CVD were independent of periodontitis or serum CRP levels.
Department of Oral and Maxillofacial Diseases, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
J H
JH
Meurman
Department of Periodontology, Center for Clinical Research, General Dentistry, H. M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA.
S-J
http://orcid.org/0000-0003-0078-3992
SJ
Janket
Otorhinolaryngology/Maxillofacial Surgery, Kuopio University Hospital, Kuopio, Finland.
M
M
Surakka
Preventive Cardiology, Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
E A
EA
Jackson
Department of Public Health, University of Massachusetts, Lowell, MA, USA.
L K
LK
Ackerson
Department of Periodontology, Center for Clinical Research, General Dentistry, H. M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA.
H R
HR
Fakhri
Endodontics, H. M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA.
S
S
Chogle
Edinburgh Dental Institute, University of Edinburgh, Scotland, UK.
A
A
Walls
D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis; D002318:Cardiovascular Diseases / Q000401:mortality*; D003324:Coronary Artery Disease / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003793:Dental Restoration, Permanent; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011861:Radiography, Dental; D012307:Risk Factors; D012389:Root Canal Obturation; D014092:Tooth Root / Q000000981:diagnostic imaging
D002097:C-Reactive Protein
C-reactive protein; cardiovascular mortality; coronary artery disease; endodontic treatment; pulpitis