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Poor oral hygiene linked to increased CVD risk

BMJ 2010; 340: c2451

People who brush their teeth less than once a day are at increased risk for cardiovascular disease compared with those who brush their teeth twice daily, report researchers.

They say their study confirms and further strengthens the suggested association between oral hygiene and heart disease, also showing that inflammatory markers are associated with poor oral health behaviour.

Richard Watt (University College London, UK) and colleagues analyzed data for over 11,000 adults included in the cross-sectional Scottish Health Survey. They combined data from the 1995, 1998, and 2003 surveys in adults aged 35 years and older who did not have pre-existing cardiovascular disease.

To assess oral health behaviour, participants were asked how often they visited the dentist (at least once every 6 months, every 1–2 years, or rarely/never) and how often they brushed their teeth (twice a day, once a day, or less than once a day).

Other health behaviours such as smoking and physical activity, and demographics, diabetes, hypertension, body mass index, family history of cardiovascular disease, and plasma lipid and inflammatory marker levels were also evaluated.

Watt and team report in the British Medical Journal that oral health behaviour was generally good, with 62% of participants reporting regular (at least every 6 months) visits to the dentist and 71% reporting that they brushed their teeth twice a day.

Over an average of 8.1 years of follow-up, there were 555 cardiovascular disease events (170 fatal); 308 occurred among the 8481 people who brushed their teeth twice daily, 188 among the 2850 who brushed their teeth once a day, and 59 among the 538 who reported toothbrushing less that once daily.

In multivariate analysis adjusting for age, gender, socioeconomic group, health behaviours, visits to dentist, family history, and diagnosed diabetes and hypertension, people who brushed their teeth less than once a day were 1.7 times more likely to suffer a cardiovascular event than those who brushed their teeth twice a day.

Further analysis showed significant associations between oral hygiene and markers of low grade systemic inflammation, with brushing teeth less than once a day associated with significantly higher levels of both C-reactive protein and fibrinogen compared with toothbrushing twice daily.

The authors conclude: "Future experimental studies will be needed to confirm whether the observed association between oral health behaviour and cardiovascular disease is in fact causal or merely a risk marker.

"Nevertheless, use of a simple one time measure of self reported toothbrushing could be a useful and cost effective marker of future health risk in large scale population studies."

Read the abstract

MedWire ( is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2010