Childhood Oral Infections Associated with Subclinical Atherosclerosis

A recent study has found an association of childhood oral infections with cardiovascular risk factors and subclinical atherosclerosis in adulthood.

In a 27-year follow-up, investigators found that signs of oral infections in childhood were associated with both cumulative exposure to cardiovascular risk factors during the follow-up and subclinical atherosclerosis in adulthood.

Investigators obtained 755 study participants from the ongoing Cardiovascular Risk in Young Finns Study. The entire population underwent a baseline evaluation and oral examination in 1980 at age 6, 9, or 12 years old and a clinical cardiovascular follow-up in adulthood in 2001 at age 27, 30, or 33 years and/or in 2007 at 33, 36, or 39 years old. Authors noted that the final statistical analyses were completed on Feb. 19, 2019.

In 2001 and 2007, intima-media thickness (IMT) was measured on the posterior wall of the left carotid artery — at least 4 measurements were taken approximately equal to 10 mm proximal to the bifurcation to obtain the mean carotid artery IMT.

Bleeding was detected in 511 (67.7%) participants, caries in 656 (86.9%), and fillings in 621 (82.3%). A total of 33 (4.5%) children had no sign of oral infections, 41(5.6%) had 1 sign, 127 (17.4%) had 2 signs, 278 (38.3%) had 3 signs, and 248 (34.1%) had 4 signs.

Through multiple linear regression models, authors found that childhood oral infections, including signs of either periodontal disease, caries, or both, were associated with adulthood IMT. The presence of signs of oral infection in childhood was associated with increased IMT with a relative risk of 1.87 (95% CI, 1.25-2.79), while the presence of all 4 signs produced a relative risk of 1.95 (95% CI, 1.28-3.00).

Authors noted that the association were more obvious in boys, if periodontal disease were present, the corresponding estimate was 1.69 (95% CI, 1.21-2.36); if caries, 1.46 (95% CI, 1.04- 2.05); and if all 4 signs of oral infections, 2.25 (95% CI, 1.30-3.89). Additionally, the authors wrote that the associations were independent of cardiovascular risk factors.

The authors ultimately concluded that oral infections in childhood were associated with the development of subclinical carotid atherosclerosis later in life. Male participants with all 4 signs of oral infections in childhood had a 125% increase risk for high IMT values 27 years later.

Authors noted several limitations within their study, including the small number of participants with IMT measurements and a slight difference in the number of girls (384) and boys (371) examined. They were unable to perform oral examination in 2007, which would have been of interest in relation to childhood factors of adulthood oral health status. Plaque or saliva samples were not collected during the examination and, because of this, microbiological profiling was not possible.

In an invited commentary, Anwar T. Merchant, DMD, ScD, MPH, professor at Arnold School of Public Health, and Salim S. Virani, MD, PhD, professor of cardiology at the Baylor College of Medicine, wrote that a greater understanding of the association between oral and systemic health can be of great benefit to patients.

“Even if the question of causality remains unanswered, with issues pertaining to the performance of a conventional randomized clinical trial in this context, the article by Pussinen et al. underscores the idea that the distinction between oral health and systemic health is blurred and somewhat artificial,” they wrote. “Cardiovascular disease and periodontal disease share common risk factors, and controlling those risk factors could result in better overall health.”

This study, titled “Association of Childhood Oral Infections With Cardiovascular Risk Factors and Subclinical Atherosclerosis in Adulthood,” is published in the Journal of the American Medical Association.