Asymptotic Dental Score and Prevalent Coronary Heart Disease

Abstract

Background-Oral infections have been postulated to produce cytokines that may contribute to the pathogenesis of coronary heart disease (CHD). We hypothesized that by estimating the combined production of inflammatory mediators attributable to several oral pathologies, we might be able to explain CHD with better precision. Methods and Results-A total of 256 consecutive Finnish cardiac patients from Kuopio University Hospital with angiographically confirmed CHD and 250 age-, gender-, and residence-matched noncardiac patients (controls) were recruited. All dental factors expected to generate inflammatory mediators, including pericoronitis, dental caries, dentate status, root remnants, and gingivitis, were examined, and an asymptotic dental score (ADS) was developed by logistic regression analyses with an appropriate weighting scheme according to the likelihood ratio. We validated the explanatory ability of ADS by comparing it to that of the Total Dental Index and examining whether the ADS was associated with known predictors of CHD. A model that included ADS, C-reactive protein, HDL, and fibrinogen offered an explanatory ability that equaled or exceeded that of the Framingham heart score (C statisticϭ0.82 versus 0.80). When ADS was removed from this model, the C-statistic decreased to 0.77, which indicates that the ADS was a significant contributor to the explanatory ability of a logistic model. Conclusions-ADS may be useful as a prescreening tool to promote proactive cardiac evaluation among individuals without overt symptoms of CHD. However, additional prospective study is needed to validate the use of an oral health score as a predictor of incident CHD.

Oral Health, Atherosclerosis, and Cardiovascular Disease

“…We have further improved the TDI formulated by Mattila and co-workers in our case-control study by developing a mathematical scoring system called the Asymptotic Dental Score (ADS; Janket et al, 2004). The ADS is a mathematically proper way to combine several oral health factors, and the likelihood ratios of these factors reflect their relative importance.…”

“…ADS has significantly facilitated the interpretation of several regression models, above and beyond CRP, HDL, and fibrinogen, all proven predictors of CVD. This suggests that oral health has the potential to affect systemic health via more than just the inflammatory process (Janket et al, 2004).…”

Oral infection, hyperglycemia, and endothelial dysfunction

“…Our group has reported that a mathematically summed score from several types of oral mucositis was significantly associated with coronary artery disease. 41 Some researchers postulated that the number of teeth might represent the effects of previous oral infection and additional diet-related proinflammatory process associated with cardiovascular pathogenesis. 42 However, the number of teeth appears to be a proxy for oral infection in cardiopathogenesis, because we found that our asymptotic dental score 41 was inversely correlated to the number of remaining teeth (γ = -0.8; P = .001).…”

Anti‐Tumor Necrosis Factor‐Alpha Therapy and Periodontal Parameters in Patients With Rheumatoid Arthritis

“…Кроме того, при хроническом ПД установлено повышение частоты кардиоваскулярных и цереброваскулярных заболеваний независимо от традици-онных ФР [4, 8,29]. Выявление асимптомной ПП предложе-но использовать для скрининга ССЗ [30].…”