Association Between Pulsatile Components of Blood Pressure and Severe Tooth Loss in Rural Ecuador: The Three Villages Study

Abstract

Background: Arterial hypertension has been associated with severe tooth loss, but differential associations with individual components of blood pressure (BP) have scarcely been investigated. We assessed the independent associations between pulsatile/steady components of BP and severe tooth loss in community-dwelling adults residing in 3 rural Ecuadorian villages. Methods: Individuals aged ≥40 years living in Atahualpa, El Tambo, and Prosperidad were identified during door-to-door surveys. Data collection focused on the number of remaining teeth and measurements of pulsatile/steady components of BP. Multivariate models were fitted to assess independent associations between pulsatile/steady BP components and severe tooth loss, after adjusting for relevant covariates. Results: A total of 1543 individuals were included. Oral exams identified 426 (28%) individuals with severe tooth loss. BP levels ≥140/90 mm Hg were determined in 481 (31%) individuals. The mean pulse pressure (PP) level was 55.3 ± 19 mm Hg. For systolic BP (SBP), the mean level was 133.1 ± 23.5 mm Hg, and for diastolic BP (DBP) it was 77.8 ± 11.5 mm Hg. Univariate models showed significant associations between severe tooth loss and SBP and PP, but not with DBP. However, the significance was taken away in fully adjusted generalized linear models. Age remained as an independent significant covariate in models using SBP and PP. Causal mediation analyses disclosed that percentages of the effect of severe tooth loss mediated by age were 99.5% for SBP and 98.9% for PP. Conclusion: This study shows that age captures most of the effect of the association between pulsatile components of BP and severe tooth loss.

Blood Pressure and Tooth Loss: A Large Cross-Sectional Study with Age Mediation Analysis

“…There is already evidence that demonstrates a relationship between hypertension and tooth loss. Hitherto, the vast majority did not employ accurate methods to measure tooth loss, for instance, self-reported measures [ 9 , 11 , 12 , 28 ]. Thus, in our study, to be as precise as possible, we resorted to clinical confirmation combined with a thorough analysis via panoramic X-ray taken at our dental hospital.…”

“…Panoramic radiographs were made via digital Orthophos XG 5 DS/Ceph (Sirona Dental System, New York, NY, USA) at the Radiology Department of EMDC. Participants were categorized for tooth loss severity based on how many teeth they had lost: 10 or more—severe; lower than 10—nonsevere [ 11 , 12 , 28 ].…”

“…In addition, uncontrolled hypertension may also precipitate stroke events and cognitive impairment, and it contributes to increased mortality rate [ 6 ]. Recently, high BP was associated with oral conditions, mainly tooth loss, caries and periodontal disease [ 7 , 8 , 9 , 10 , 11 , 12 ].…”

“…Several lines of evidence have addressed the association between tooth loss and high BP [ 4 , 8 , 9 , 12 ]. In a French cohort of people under 65 years old, hypertension was associated with higher levels of missing teeth, gum bleeding, masticatory dysfunction and dental plaque [ 19 ].…”

On the Association Between Social Determinants of Health and Disability in Stroke-Free Older Adults Living in Rural Settings. The Three Villages Study

“…Taking the opportunity of an already established clinical cohort of community-dwelling older adults living in 3 neighboring rural villages located in coastal Ecuador. 15 , 16 the present study assessed the association between SDH and disability in stroke-free older adults living in these villages.…”