Poor oral health in childhood may be associated with an increased risk of atherosclerotic cardiovascular disease in adulthood, according to findings from a nationwide Danish cohort study. The analysis linked registry data from more than 568,000 individuals and followed the participants for cardiovascular outcomes over more than 2 decades.
In the study, investigators examined the association between childhood dental caries and gingivitis and the later development of atherosclerotic cardiovascular disease (ASCVD), defined as ischemic heart disease, myocardial infarction, or ischemic stroke. '[W]hile adult oral health has been consistently linked to cardiovascular disease, the long-term impact of childhood oral health remains underexplored,” wrote lead study author Nikoline Nygaard, of the Department of Odontology in the Faculty of Health and Medical Sciences at the University of Copenhagen in Denmark, and colleagues.
The investigators included 568,778 individuals born in Denmark between 1963 and 1972. Childhood oral health data were obtained from the National Child Odontology Registry between 1972 and 1987, and cardiovascular outcomes were identified using the Danish National Patient Register from 1995 through 2018. The participants were followed from January 1995, or from age 30 years, until ASCVD diagnosis, death, emigration, or the end of follow-up.
During the study period, 10,049 male participants and 5,705 female participants developed ASCVD. Among the male participants, myocardial infarction accounted for the largest proportion of events (41.8%), while ischemic stroke was the most common ASCVD outcome among female participants (54.3%). Most of the participants had moderate levels of dental caries and gingivitis during childhood.
The ivestigators found that higher levels of dental caries in childhood were associated with a higher incidence of ASCVD in adulthood. For instance, male participants with severe dental caries had a 32% higher incidence of ASCVD compared with those with low caries levels, while female participants had a 45% higher incidence. High gingivitis scores were also associated with increased ASCVD incidence.
Analyses of disease trajectories across childhood showed similar patterns. Worsening or persistently moderate to severe dental caries and gingivitis across childhood were associated with higher ASCVD incidence compared with stable low levels of disease.
“In this study, we found that higher levels of dental caries and gingivitis in childhood were associated with an increased incidence of ASCVD in adulthood compared to low levels of disease,” the study authors stated.
The investigators noted that oral diseases may influence systemic health through mechanisms such as systemic low-grade inflammation or bacterial dissemination from the oral cavity. They indicated that “oral health and disease are increasingly being linked to systemic health through two major pathways: by contributing to systemic low-grade inflammation and bacterial dissemination.”
The investigators acknowledged several limitations, including the inability to adjust for lifestyle factors such as smoking or diet and the lack of data on oral health in adulthood. The relatively young age of the cohort also limited the number of cardiovascular events and may reflect early-onset disease.
“Within the limitations of this study, poor childhood oral health, particularly persistent or worsening dental caries and gingivitis, is associated with an increased risk of ASCVD in adulthood,” the study authors concluded.