When It Comes to Teeth and Heart Health, Quality, not Quantity, Counts

(l-r) Andrea Lam DMD 14, Dr. Sok-Ja Janket, and Dr. Ronni Schnell
(l-r) Andrea Lam DMD 14, Dr. Sok-Ja Janket, and Dr. Ronni Schnell

Previous studies have shown that having more remaining teeth in the mouth is correlated with a longer life—and fewer, the opposite. In Dr. Sok-Ja Janket’s recent study, published in the high impact, #9 ranked Journal of Dentistry, the researchers asked the question: What effects then, do dental prostheses such as caps or dentures have on health, specifically cardiovascular health? This is among the first studies to suggest a potential causal relationship between oral and cardiac health.

Researchers used baseline data from the Kuopio Oral Health and Heart study, initiated in 1995–1996 and appended mortality data during the span of next 15 years to create a longitudinal study. They investigated the association between oral health and cardiovascular survival.

The aims of Janket’s study were to investigate:

  1. whether the various removable dental prostheses offer different relationship with cardiovascular disease (CVD) mortality;
  2. whether removable dental prostheses are correlated with a variety of inflammatory foci in the oral cavity; and
  3. whether removable dental prostheses accompany candida or streptococcal infections.

The researchers compared the cardiovascular survival among four groups divided according to various combinations of natural, fixed, or removable prosthetic dentitions. “As more remaining teeth were associated with better survival,” Dr. Janket said, “we hypothesized a decreasing CVD survival gradient from natural teeth, to tooth-born, and tissue-born dental prostheses.”

The results were surprising. They found that the group with both natural teeth and partial dentures had a lower risk of CVD mortality than the group with all natural teeth. The group with partial and full dentures had a higher risk of CVD mortality than those who had full dentures only or with very few opposing natural teeth.

“Among clinicians, the prevailing thesis is that removable partial dentures are associated with increasing levels of infection such as gingivitis, candidiasis, or streptococcal infection,” said Dr. Janket. “However, our results suggest that the relationship of partial dentures and oral inflammatory output is not that cut and dry. The group with partial dentures enjoyed better survival than those with all natural teeth; but on the down side, those who had partial dentures and full dentures suffered an increased mortality compared to those with full dentures, depending on the patient’s oral health maintenance.”

In short, they found that it’s not just quantity of teeth, but quality that results in better cardiac survival.

“Having many teeth is only a part of the story,” says Dr. Janket. “One must also keep them well-maintained to receive the full benefits.” This maintenance can include removing potential inflammatory foci, such as pericoronitis or retained root tips, and restoring the broken fillings that may cause mucositis (inflammation of the mucous membranes in the mouth). All of these less-invasive oral maintenance techniques may positively impact cardiovascular survival.

The article was published online June 11, 2013. Additional authors include Dr. Markku Surakka, Kuopio University Hospital, Kuopio, Finland; Ms. Lynda M. Rose, Brigham & Women’s Hospital; Dr. Angus W.G. Walls, Edinburgh Dental Institute; Dr. J.H. Meurman, Helsinki University Central Hospital/University of Helsinki; and Drs. Judith Jones and Ronni Schnell and Andrea Lam DMD 14 from GSDM.

The paper expands on an abstract presented at the International Association for Dental Research Conference (IADR) at Iguacu Falls, Brazil in 2012. This work was supported by an award from the American Heart Association to Dr. Sok-Ja Janket.