Oral Health Score May Reveal Heart Risks

Jennifer Warner

Feb. 18, 2004 -- Your smile may speak volumes about your heart. New research shows that poor scores in five different areas of oral health may serve as a red flag for heart disease risk.

A small study shows that poor oral health was a stronger predictor of heart disease than other commonly used risk factors, such as low HDL "good" cholesterol, high levels of a clotting factor called fibrinogen, and high triglycerides (a type of fat).

Researchers say if future studies confirm these results, a dental exam may help identify people at risk for heart attack or stroke who do not yet have symptoms of heart disease.

5 Oral Diseases Top the List

In the study, which appears in the current issue of Circulation: Journal of the American Heart Association, researchers used five types of oral diseases to create a general rating of oral health, called the asymptomatic dental score (ADS).

"Oral infections are thought to produce inflammation that might be associated with coronary heart disease, so we examined all oral pathologies that might generate inflammation," says researcher Sok-Ja Janket, DMD, MPH, assistant professor at Boston University School of Dental Medicine, in a news release.

The diseases include:

Pericoronitis -- an infection around the third molar
Gingivitis -- gum inflammation
Root remnants -- when teeth are decayed to the point that only the tip of the root remains
Missing teeth
Cavities

Researchers used a mathematical model to determine the strength of each disease's association with heart disease in 256 Finnish adults with heart disease and a group of 250 similar adults without heart disease. They then weighted each disease's contribution and came up with the ADS.

Of the five diseases, the strongest predictor of heart disease was pericoronitis, followed by root remnants, gingivitis, cavities, and missing teeth.

When researchers compared the ADS with other known indicators of heart disease risk, they found the oral health score was a stronger predictor of risk than several well-studied factors, including some types of inflammatory markers for heart disease and cholesterol levels.

Which Comes First -- Cavities or Heart Disease?

Although this study shows overall oral health is significantly associated with heart disease, researchers say it doesn't not necessarily mean that poor oral health causes heart disease. They say more study is needed to determine whether poor oral heath contributes to or is the result of heart disease. Janket suggests that oral health may not only contribute to heart disease through the inflammation process but also through poor nutrition.

"People who do not have teeth cannot chew their food well and therefore do not get as much heart-healthy nutrients or fiber," says Janket. "Future studies should look at nutrition, oral health, and coronary heart disease."

Researchers say people without health insurance who have poor access to preventive care that might reduce their risk of heart disease are also more likely to have poor oral health.

In an editorial that accompanies the study, Gordon D.O. Lowe, of the University Department of Medicine, Royal Infirmary in Glasgow, U.K., says it's still too early to apply these findings to the general public.

"We should continue to emphasize proven risk factors, such as age, sex, smoking habits, diabetes, blood pressure, and total cholesterol/HDL ratio. Further studies are needed to evaluate the additive predictive value of 'emerging' risk predictors, including dental health scores," writes Lowe.

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