Subclinical atherosclerosis in adults can be traced to suboptimal oral health in childhood in some cases, according to a Finnish cohort study.
Kids who’d had periodontal disease or cavities were more likely to exhibit intima-media thickening in the carotid artery as adults in their 30s, per multiple linear regression analyses by a group of researchers led by Pirkko Pussinen, PhD, of the University of Helsinki.
Those who had just one of the four signs of oral infection — bleeding on probing, periodontal probing pocket depth, caries, or dental fillings — carried an increased risk of subclinical atherosclerosis in later life (RR 1.87, 95% CI 1.25-2.79), as did others who exhibited all four signs of oral infection (RR 1.95, 95% CI 1.28-3.00), the investigators reported online in JAMA Network Open.
“An association between childhood oral infections with CVD [cardiovascular disease] risk factors, particularly high blood pressure and BMI, was also evident. However, the oral infections remained an independent risk factor of IMT [intima-media thickness] after adjustment for a lifetime cumulative exposure to risk factors, including 31 separate measurements,” Pussinen’s group reported.
“The results show for the first time, to our knowledge, that childhood oral infections may be a modifiable risk factor for adult cardiovascular disease,” the authors asserted.
Study participants included 755 children who had been followed from 1980 to 2007 as part of the ongoing Cardiovascular Risk in Young Finns Study. Mean age was 8 years at enrollment and 49.1% were boys.
Boys showed particularly strong associations between oral infection in childhood and subclinical atherosclerosis in adulthood, according to Pussinen and colleagues.
However, they acknowledged the small number of participants with IMT measurements and noted the potential for unmeasured confounding in their analyses.
Nevertheless, it may very well be that these kids are maintaining their poor oral health into adulthood, when the link to coronary heart disease is backed by several studies, according to Anwar Merchant, DMD, ScD, of Michael E. DeBakey Veterans Affairs Medical Center in Houston, and Salim Virani, MD, PhD, of William Jennings Bryan Dorn Veterans Affairs Medical Center in Columbia, South Carolina.
The other possibilities are that poor oral health has no causal effect on cardiovascular disease per se, but shares common risk factors such as smoking, poor diet, and physical inactivity, or that the positive association observed between poor oral health in childhood and atherosclerosis in adulthood was because of selection bias secondary to loss of follow-up, the pair suggested in an invited commentary.
“Even if the question of causality remains unanswered … the article by Pussinen, et al. underscores the idea that the distinction between oral health and systemic health is blurred and somewhat artificial,” they said. “Cardiovascular disease and periodontal disease share common risk factors, and controlling those risk factors could result in better overall health.”
“For example, if dentists encouraged their patients to quit smoking and visit their primary care clinician, and primary care clinicians encouraged their patients to maintain good oral health and visit their dentist regularly, the ultimate benefit would be better dental and cardiovascular health,” according to Merchant and Virani.
Study authors were supported by the Academy of Finland; the Social Insurance Institution of Finland; Kuopio, Tampere, and Turku University Hospitals; the Juho Vainio Foundation; the Paavo Nurmi Foundation; the Finnish Foundation for Cardiovascular Research; the Finnish Cultural Foundation; the Sigrid Juselius Foundation; Tampere Tuberculosis Foundation; the Emil Aaltonen Foundation; the Yrjö Jahnsson Foundation; the Signe and Ane Gyllenberg Foundation; the European Endodontic Society; Apollonia the Dental Association of Finland; the Paulo foundation; the Diabetes Research Foundation of the Finnish Diabetes Association; EU Horizon 2020; the European Research Council; and Tampere University Hospital’s Supporting Foundation.
Pussinen and Merchant disclosed no relevant conflicts of interest.
Virani reported research funding from the Department of Veterans Affairs and an honorarium from the American College of Cardiology.