Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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5-Year Impact Factor – 2.135
Index Copernicus  – 168.52
MEiN – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
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Advances in Clinical and Experimental Medicine

2016, vol. 25, nr 5, September-October, p. 861–870

doi: 10.17219/acem/58866

Publication type: original article

Language: English

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The Association Between Dental Status and Risk of Acute Myocardial Infarction Among Poles: Case-control Study

Bartłomiej Górski1,B,D, Ewa Nargiełło2,B,D, Ewa Grabowska1,C, Grzegorz Opolski2,A,E, Renata Górska1,A,E,F

1 Department of Periodontology and Oral Mucous Membrane Diseases, Medical University of Warsaw, Poland

2 First Department of Cardiology, Medical University of Warsaw, Poland


Background. Results of scientific research on the effects of periodontitis on the incidence of myocardial infarction (MI) are ambiguous.
Objectives. The aim of this study was to investigate the association of the severity and extent of periodontitis with acute MI in Poles.
Material and Methods. This case-control study included 134 cases hospitalized with acute MI under the age of 70 years and 155 controls drawn from the general population with no MI history. Sociodemographic, cardiologic and periodontal variables were assessed. Three periodontal indicators were evaluated: (1) the severity of periodontitis classified in accordance with Page and Eke definition, (2) the extent of periodontitis determined on the basis of the percentage of sites with CAL ≥ 3 mm (Arbes Index) and (3) tooth loss (> 10 teeth). In a logistic regression model, the association of periodontal parameters with MI occurrence was evaluated after adjusting for well-known cardiovascular risk factors.
Results. The extent of periodontitis was significantly associated with the risk of acute MI even after adjusting for age, sex, tobacco smoking, hypertension, diabetes, BMI, education and income (odds ratio [OR] = 2.4; 95% confidence interval [CI] = 1.1 to 5.2; p = 0.0203). However, the severity of periodontitis was associated with MI after adjusting for age and sex (OR = 2.0; 95% CI = 1.2–3.5; p = 0.0109), but not after adjusting for the other above-mentioned risk factors. The association between the number of lost teeth and acute MI was significant after adjusting for age, sex, tobacco smoking, arterial hypertension and diabetes mellitus (OR = 2.1; 95% CI = 1.2–5.9; p = 0.0151).
Conclusion. This study proves the positive association between periodontitis and acute MI in Poles. This association seems to be stronger with regard to the extent rather than to the severity of periodontitis.

Key words

periodontitis, acute myocardial infarction, risk factor

References (31)

  1. Wojtyniak B, Goryński P, Moskalewicz B: The health situation of Poles and it determinants. National Institute of Public Health – National Institute of Hygiene, Warszawa 2012, ISBN 83-89379-63-9, 59–74.
  2. Schenkein HA, Loos BG: Inflammatory mechanisms linking periodontal diseases to cardiovascular diseases. J Periodontol 2013, 84, Suppl 4, 51–69.
  3. Tonetti MS, Van Dyke TE: Periodontitis and atherosclerotic cardiovascular disease: Consensus report of the joint EFP/AAP workshop on periodontitis and systemic diseases. J Periodontol 2013, 84 Suppl 4, 24–29.
  4. Bahekar AA, Singh S, Saha S, Molnar J, Arora R: The prevalence and incidence of coronary heart disease is significantly increased in periodontitis: A meta-analysis. Am Heart J 2007, 154, 830–837.
  5. Humphrey LL, Fu R, Buckley DI, Freeman M, Helfand M: Periodontal disease and coronary heart disease incidence: A systematic review and meta-analysis. J Gen Intern Med 2008, 23, 2079–2086.
  6. Lockhart PB, Bolger AF, Papapapanou PN, Osinbowale O, Trevisan M, Levison ME, Tauber KA, Newburegr JW, Gornik HL, Gewitz MH, Wilson WR, Smith SC, Baddour LM: Periodontal disease and atherosclerotic vascular disease: Does the evidence support an independent association? A scientific statement from the American Heart Association. Circulation 2012, 125, 2520–2544.
  7. Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, Albus C, Benlian P, Boysen G, Cifkova R, Deaton C, Ebrahim S, Fisher M, Germano G, Hobbs R, Hoes A, Karadeniz S, Mezzani A, Prescott E, Ryden L, Scherer M, Syvänne M, Scholte op Reimer WJ, Vrints C, Wood D, Zamorano JL, Zannad F: European guidelines on cardiovascular disease prevention in clinical practice (v. 2012). The fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Risk Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J 2012, 33, 1635–1701.
  8. Górska R, Pietruska M, Dembowska E, Wysokińska-Miszczuk J, Włosowicz M, Konopka T: Prevalence of periodontal diseases in 35–44 year-olds in the large urban agglomeration. Dent Med Probl 2012, 49, 19–27.
  9. Eke PI, Dye BA, Wei L, Slade GD, Thornton-Evans GO, Borgnakke WS, Taylor GW, Page RC, Beck JD, Genco RJ: Update on prevalence of periodontitis in the United States: NHANES 2009 to 2012. J Periodontol 2015, 86, 611–622.
  10. Arbes SJ, Slade GD, Beck JD: Association between extent of periodontal attachment loss and self-reported history of heart attack: An analysis of NHANES III data. J Dent Res 1999, 78, 1777–1782.
  11. López R, Oyarzún M, Naranjo C, Cumsille F, Ortiz M, Baelum V: Coronary heart disease and periodontitis – a case control study in Chilean adults. J Clin Periodontol 2002, 29, 468–473.
  12. Cueto A, Mesa F, Bravo M, Ocaňa-Riola R: Periodontitis as risk factor for acute myocardial infarction. A case control study of Spanish adults. J Periodont Res 2005, 40, 36–42.
  13. Andriankaja OM, Genco RJ, Dorn J, Dmochowski J, Hovey K, Falkner KL, Trevisan M: Periodontal disease and risk of myocardial infarction: The role of gender and smoking. Eur J Epidemiol 2007, 22, 699–705.
  14. Dietrich T, Jimenez M, Krall Kaye EA, Vokonas PS, Garcia RI: Age-dependent associations between chronic periodontitis/edentulism and risk of coronary heart disease. Circulation 2008, 117, 1668–1674.
  15. Marfil-Álvarez R, Mesa F, Arrebola-Moreno A, Ramirez-Hernández JA, Magán-Fernández A, O’Valle F, Galindo-Moreno P, Catena A: Acute myocardial infarct size is related to periodontitis extent and severity. J Dent Res 2014, 93, 993–998.
  16. Parkar SM, Modi GN, Jani J: Periodontitis as risk factor for acute myocardial infarction: A case control study. Heart Views 2013, 14, 5–11.
  17. Noguchi S, Toyokawa S, Miyoshi Y, Suyama Y, Inoue K, Kobayashi Y: Five-year follow-up study of the association between periodontal disease and myocardial infarction among Japanese male workers: MY Health Up Study. J Public Health (Oxf) 2015, 37, 605–611.
  18. Howell TH, Ridker PM, Ajani UA, Hennekens CH, Christen WG: Periodontal disease and risk of subsequent cardiovascular disease in U.S. male physicians. J Am Coll Cardiol 2001, 37, 445–501.
  19. Buhlin K, Gustafsson A, Håkansson J, Klinge B: Oral health and cardiovascular disease in Sweden. Results of a national questionnaires study. J Clin Periodontol 2002, 29, 254–259.
  20. Johansson SC, Ravald N, Pagonis C, Richter A: Periodontitis in patients with coronary artery disease: An 8-year follow-up. J Periodontol 2014, 85, 417–425.
  21. Slots J: Periodontology: Past, present, perspectives. Periodontology 2000 2013, 62, 7–19.
  22. Holmlund A, Holm G, Lind L: Severity of periodontal disease and number of remaining teeth are related to the prevalence of myocardial infarction and hypertension in a study based on 4,254 subjects. J Periodontol 2006, 77, 1173–1178.
  23. Lund Häheim L, Olsen I, Nafstad P, Schwarze P, Rønningen KS: Antibody levels to single bacteria or in combination against myocardial infarction. J Clin Periodontol 2008, 35, 473–478.
  24. Paspuleti MK, Nagireddy RR, Dinahalli R, Anumala D, Kishore Kumar A, Chavan V: Microbiological tests to identify a link between periodontitis and acute myocardial infarction – an original research. Iran J Microbiol 2013, 5, 391–395.
  25. De Boer SP, Cheng JM, Rangé H, Garcia-Garcia HM, Heo JH, Akkerhuis KM, Meilhac O, Cosler G, Pussinen PJ, van Geuns RJ, Serruys PW, Boersma E, Kardys I: Antibodies to periodontal pathogens are associated with coronary plaque remodeling but not with vulnerability or burden. Atherosclerosis 2014, 237, 84–91.
  26. Spivakovsky S: Myocardial infarction and tooth extraction associated. Evid Based Dent 2012, 13, 110. DOI: 10.1038/ sj.ebd.6400894.
  27. Liljestrand JM, Havulinna AS, Paju S, Männistö S, Salomaa V, Pussinen PJ: Missing teeth predict incident cardiovascular events, diabetes, and death. J Dent Res 2015, May, 19. pii: 0022034515586352. [Epub ahead of print].
  28. Asai K, Yamori M, Yamazaki T, Yamaguchi A, Takahashi K, Sekine A, Kosugi S, Matsuda F, Nakayama T, Bessho K: Tooth loss and atherosclerosis: The Nagahama study. J Dent Res 2015, 94, Suppl 3, 52–58.
  29. Seirafi AH, Ebrahimi R, Golkari A, Khosropanah H, Soolari A: Tooth loss assessment during periodontal maintenance in erratic vs. complete compliance in a periodontal private practice in Shiraz, Iran: A 10-year retrospective study. J Int Acad Periodontol 2014, 16, 43–49.
  30. Syrjäla AMH, Ylöslo P, Hartikainen S, Sulkava R, Knuuttila ML: Number of teeth and myocardial infarction and stroke among elderly never smokers. J Negat Results Biomed 2009, 8, 6. DOI: 10.1186/1477-5751-8-6.
  31. Wożakowska-Kapłon B, Włosowicz M, Gorczyca-Michta I, Górska R: Oral health status and the occurrence and clinical course of myocardial infarction in hospital phase: A case-control study. Cardiol J 2013, 20, 370–377.