Association between dental factors and mortality

Abstract

Aim To study whether oral parameters such as endodontic infections, root canal fillings, number of teeth or wearing removable dentures at baseline are associated with cardiovascular-and all-cause mortality in a follow-up of approximately 8 years. Methodology The Finnish Parogene cohort consists of 508 Finnish adults (mean age 63.3 years, SD 9.1) with cardiac symptoms, all of whom had undergone coronary angiography for accurate baseline coronary status. Extensive clinical and radiographic oral examinations were performed, and additional data were acquired from medical records and questionnaires. Root canal fillings and endodontic lesions, as well as their co-occurrence, were determined from panoramic radiographs. The mortality data were assessed via record linkage with the Finnish Causes of Death register (mean follow-up time 7.81 years, SD 1.45 years). A total of n = 471 dentate patients were included in the statistical analyses. Results A total of n = 69 deaths were recorded, of which n = 41 were due to cardiovascular diseases (CVDs, ICD-10 I00-I99). The deceased had fewer root canal fillings (mean 1.57; SD 1.64 vs. mean 2.30; SD 2.34, P = 0.03) than the survivors. The number of missing teeth was associated with smoking, occluded coronary arteries and diabetes. Cox regression with Firth's penalized maximum-likelihood method using age as timescale revealed an inverse association (HR; 95%CI) between mortality and number of teeth (allcause 0.91; 0.86-0.96, CVD mortality 0.89; 0.83-0.96), use of removable dentures (all-cause 0.24; 0.09-0.62, CVD mortality 0.20; 0.06-0.72), root canal fillings (all-cause 0.82; 0.70-0.94, CVD mortality 0.79; 0.63-0.96) and having root canal fillings in all teeth with apical rarefactions (all-cause 0.27; 0.06-0.79, CVD mortality 0.09; 0.01-0.63), when gender, smoking, occluded coronary arteries, periodontal inflammatory burden index and the number of teeth were adjusted for. Conclusions The number of missing teeth appeared to be the strongest predictor of mortality in this study, whereas endodontic infections per se had no independent association. Nevertheless, signs of professional intervention in these problems, such as root canal fillings and removable dentures, appeared to be associated with improved survival, which might partly be explained by the utilization of healthcare services.

Response to Letter to Editor regarding article, ‘Association between dental factors and mortality’

“…The authors of the letter make a valid point that these might affect gingival bleeding. However, our main analyses were adjusted for the periodontal inflammatory burden index (Lindy et al 2008), which is based on the number of deepened periodontal pockets, not bleeding on probing. Also, no statistically significant differences (Student's t-test) were observed in the bleeding on probing values when comparing users to nonusers for any of the three abovementioned medications.…”

“…We are grateful for the opportunity to reply to the concerns raised by Dr. Wu and colleagues in their letter regarding our recent publication titled ‘Association between dental factors and mortality’ (Liljestrand et al . 2020). The responses to the four remarks are listed below in the corresponding order as they appeared in the letter.…”

Number of teeth is associated with all-cause and disease-specific mortality

“…Periodontal diseases, one of the major causes of tooth loss [5,6], was found to be significantly associated with cardiovascular diseases [7], diabetes and the related healthcare expenditure [8,9]. Recent reports have demonstrated that dental factors, such as the accumulation of oral health symptoms, or having severe tooth loss could serve as a significant predictor for mortality [10][11][12][13]. Elderly with less than functional dentition, weak chewing ability, or having difficulty in eating or swallowing later developed physical frailty (a geriatric syndrome manifested by fatigue, diminished strength, and reduced physical functioning leading to dependency or death [14]) and other adverse health outcome including mortality [11,15].…”

“…We aimed to investigate whether having fewer NoT imposes a higher risk in mortality. We tested such hypotheses using three groups of [20][21][22][23][24][25][26][27][28][10][11][12][13][14][15][16][17][18][19][0][1][2][3][4][5][6][7][8][9], edentulism and without functional dentition (NoT < 19).…”

Letter to Editor regarding article, ‘Association between dental factors and mortality’

“…We read with great interest the study by Liljestrand et al . (2020) evaluating the association between oral parameters at baseline with cardiovascular mortality and all‐cause mortality in a follow‐up of approximately 8 years, which demonstrated that number of missing teeth appeared to be the strongest predictor of mortality, and signs of professional intervention such as root canal fillings and removable dentures appeared to be associated with improved survival. After reading this article carefully, we would like to make the following suggestions:…”