Research Spotlight: New Study Continues to Link Gum Disease to Earlier Mortality Rates

Photo of Dr. Heaton
Dr. Brenda Heaton, associate professor of Health Policy & Health Services Research, (pictured here) and colleagues used additional years of data to replicate results from a groundbreaking study from 25 years prior: Periodontal disease can lead to an earlier death. Photo Credit: Dan Bomba, GSDM

Twenty-five years ago, GSDM faculty Drs. Raul Garcia and Elizabeth Kaye broke new ground with a research study that found that men with periodontal disease (“gum disease”) were at a greater risk of dying earlier – “floss or die,” as they phrased it.  

Now, Dr. Brenda Heaton, Associate Professor of Health Policy & Health Services Research, her Epidemiology PhD student Julia Bond and colleagues, have confirmed Garcia and Kaye’s findings with an updated study, published in the Journal of Clinical Periodontology, that draws on an additional 25 years of data and uses more sophisticated analytic methods.  

“Death arrives earlier for those who have periodontal disease,” Dr. Heaton said. “Periodontal disease delivers a chronic inflammatory burden, that the longer you have that inflammatory burden, the higher the risk of death.”  

In the new study, Heaton and Bond drew on data from the VA Dental Longitudinal Study, a cohort of men, first formed in 1968, who receive medical and oral exams approximately every three years. Participants in that study received dental x-rays at each visit from which inflammation-related bone loss around the teeth could be measured. Beginning in the late 1980s, more detailed clinical measures of the current periodontal inflammation, including periodontal pocket depth and clinical attachment loss, were obtained. With periodontal disease, the severity of the condition can change over time, leading to an ever-changing mortality expectancy.  

“The more severe the condition, the higher the risk of death,” Heaton said. 

According to Heaton, the longevity of the study, combined with the frequency with which study participants received exams, allowed them to investigate a variety of systematic biases to determine if other factors could explain the earlier mortality. Heaton said the team came to similar conclusions to the earlier study: Periodontal disease can lead to an earlier death.  

“The long follow-up, over fifty years, allowed us to identify early disease states and update the status of the periodontal disease exposure, which reduces the amount of bias in the time to death that’s related to that exposure condition,” Heaton said.  

Additionally, smoking, a primary risk factor for periodontal disease, poses a potential bias that Heaton and her team were able to examine in more detail, thanks to the additional 25 years of data from which they were drawing. Some participants, who were smokers when they first joined the study, eventually quit smoking. In this new study, Heaton and colleagues were able to be more precise about determining death related to periodontal disease, as opposed to death related to smoking. 

It’s important for people to understand the relationship between oral health and overall health, Heaton said, pointing to another recent study that she and Bond collaborated on, which found a relationship between edentulism – the loss of all one’s teeth – and mortality. Periodontal disease is one of the leading causes of tooth loss, which creates, in Heaton’s words, a “double dose of death.” 

But Heaton also noted that another major cause of tooth loss is clinical treatment decisions: It can be cheaper to extract a tooth than to restore it, for example, so patients and care providers may make a treatment decision based on costs and insurance coverage. In the aggregate, this places a disproportionate burden of tooth loss and periodontal disease on vulnerable populations, particularly individuals from racial and ethnic groups that have historically lacked access to affordable care, according to Heaton. 

“The combination of disease processes that lead to periodontal disease and tooth loss, together with clinical decision making [is] where you get this double dose of death that is disproportionately placed on vulnerable and disadvantaged populations and can contribute to not only oral health disparities but health disparities more generally,” Heaton said.  

With proper access to effective and affordable dental treatment, along with everyday maintenance, the negative consequences associated with periodontal disease are preventable, Heaton said. However, it’s important to be aware of the inequities that exist in accessing that care when thinking about how to prevent the negative outcomes associated with periodontal disease, she added.  

“Basically, nothing good comes from having bad teeth and bad gums,” Heaton said. “It’s floss or die.”


By Rachel Grace Philipson