Published Online
on February 10, 2003

A more recent version of this article appeared on March 4, 2003

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Submitted on October 8, 2002
Accepted on November 20, 2002

Oral Health and Peripheral Arterial Disease

Hsin-Chia Hung DDS, DrPH, Walter Willett MD, DrPH, Anwar Merchant DMD, DrPH, Bernard A. Rosner PhD, Alberto Ascherio MD, DrPH, and Kaumudi J. Joshipura ScD^*

From the Departments of Epidemiology (H.-C.H., W.W., A.M., A.A., K.J.J.), Nutrition (W.W., A.A.), and Biostatistics (B.A.R.), Harvard School of Public Health; the Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine (H.-C.H., A.M., K.J.J.); and Channing Laboratory, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital (W.W., B.A.R.), Boston, Mass; and the College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (H.-C.H.).

^* To whom correspondence should be addressed. E-mail: Kaumudi_Joshipura{at}hsdm.harvard.edu.

Background--Many studies have reported the association between poor oral health and coronary heart disease or stroke, but few of them evaluated peripheral arterial disease (PAD). Hence, in this study we examined the associations between oral health and PAD.

Methods and Results--In the prospective study of 45 136 eligible male health professionals free of cardiovascular diseases at baseline, we identified 342 cases of PAD during a 12-year follow-up period. We evaluated the association between different measures of oral diseases and the occurrence of PAD. Baseline number of teeth was not related to the risk of PAD, but cumulative incident tooth loss was significantly associated with elevated risk of subsequent occurrence of PAD. The relative risk for history of periodontal disease was 1.41 (95% CI, 1.12 to 1.77) and for any tooth loss during the follow-up period was 1.39 (95% CI, 1.07 to 1.82), controlling for traditional risk factors of cardiovascular disease. Among men with a history of periodontal diseases, the relative risk of tooth loss increased to 1.88 (95% CI, 1.27 to 2.77), whereas no association was found between tooth loss and PAD among those without periodontal diseases (RR, 0.92; 95% CI, 0.61 to 1.38). We further explored the potential induction period of tooth loss and found that tooth loss in the previous 2 to 6 years was most strongly associated with PAD.

Conclusions--We found that incident tooth loss was significantly associated with PAD, especially among men with periodontal diseases. The results support a potential oral infection-inflammation pathway.

Key words: peripheral vascular disease • infection • periodontitis • tooth loss

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