Tooth loss in middle age linked to heart disease

Losing two or more natural teeth in middle age may signal an increased risk for coronary heart disease, a US study suggests. 

“In addition to other established associations between dental health and risk of disease, our findings suggest that middle-aged adults who have lost two or more teeth in recent past could be at increased risk for cardiovascular disease,” Dr Lu Qi of Tulane University in New Orleans said in a statement. “That’s regardless of the number of natural teeth a person has as a middle-aged adult, or whether they have traditional risk factors for cardiovascular disease, such as poor diet or high blood pressure.” 

Qi presented the study findings at the 2018 American Heart Association’s (AHA) Epidemiology and Prevention, Lifestyle and Cardiometabolic Health Scientific Sessions in March. 

“The relation between dental health such as tooth loss and cardiovascular risk remains unclear,” Qi told Reuters Health by e-mail. “Most previous studies only investigated pre-existing tooth loss; and little is known about whether incident [recent] tooth loss during middle adulthood is associated with future cardiovascular disease.” 

The study team analysed data on women and men from the long-term Nurses’ Health Study (NHS) and Health Professionals Follow-Up Study (HPFS). The participants were between 45 and 69 years old at the outset and did not have heart disease. They were asked about the number of natural teeth first in 1986 in the HPFS, and in 1992 in the NHS. On follow-up questionnaires, participants reported whether they had any recent tooth loss. 

Among adults with 25 to 32 natural teeth at the beginning of the study, those who lost two or more teeth during follow-up had a 23 per cent increased risk of coronary heart disease compared with those who did not lose any teeth. This was true after adjusting for diet quality, physical activity, body weight, hypertension and other cardiovascular risk factors. 

Losing just one tooth during the study period was not associated with a notable increased risk of heart disease. 

Regardless of the number of natural teeth at start of the study, the risk of coronary heart disease increased 16 per cent among those losing two or more teeth during the study period compared with those who did not lose any teeth. 

Adults with fewer than 17 natural teeth (vs 25 to 32 natural teeth) at the outset were 25 per cent more likely to develop coronary heart disease. 

“Peridontitis and gingivitis lead to tooth loss and the loss of a tooth is certainly the end-stage of dental disease,” said Dr Russell Luepker, an AHA spokesperson who was not involved in the study. 

The association between periodontal disease and heart disease has been “fairly well studied” and the relationships reported in this study are “modest,” he said in a telephone interview. 

It is also important to consider the role of socioeconomic status, he said. “We all get cavities and if you want to save teeth, you want to have good dental insurance and many people don’t. So it’s good to brush your teeth and it’s good to have dental insurance,” Luepker commented.