Key messages:
- Poor oral health in childhood is associated with increased risk of adulthood ischemic heart disease, myocardial infarction, and ischemic stroke.
- Persistent or worsening dental caries and gingivitis in childhood are associated with higher atherosclerotic cardiovascular disease risk in adulthood.
- These findings highlight the potential of early oral health interventions to reduce long-term cardiovascular risk.
Introduction
Cardiovascular diseases are significant contributors to the global burden of disease. Atherosclerotic cardiovascular diseases (ASCVD), including ischemic heart disease, myocardial infarction, and ischemic stroke, are among the leading causes of premature death. Implementing prevention strategies that address risk factors early in life, particularly during childhood and young adulthood, could help decrease ASCVD risk in middle age. Identifying common and novel risk factors for cardiometabolic diseases for early intervention in children could help prevent ASCVD.
Oral inflammatory conditions such as periodontitis, gingivitis, and dental caries are some of the most prevalent diseases worldwide, including among children. The relationship between oral health and systemic health is increasingly recognized through two main pathways: 1) contributing to systemic low-grade inflammation and 2) oral bacterial dissemination to the body. Numerous studies have demonstrated the association between oral disease, particularly periodontal disease in adults and an increased risk of various cardiovascular outcomes. However, few studies have explored the long-term effects of oral disease in children on cardiovascular health. Thus, further investigation into the connection between childhood oral health and cardiovascular disease in adulthood is essential.
Objective
This study investigated the association between dental caries and gingivitis in childhood and the incidence of atherosclerotic cardiovascular disease (ASCVD) in adulthood.
Methods
This nationwide Danish cohort study utilized oral health data from the National Child Odontology Registry (1972–1987) and ASCVD outcomes from the National Patient Register (1995–2018) from 568,778 participants born between 1963 and 1972. Dental caries and gingivitis were categorized by severity and trajectory across childhood. Regression models were used to estimate hazard ratios and 95% confidence intervals for incident ischemic heart disease, myocardial infarction, and ischemic stroke.
Results
Severe childhood dental caries was associated with increased ASCVD incidence in both males and females. High gingivitis scores also predicted elevated ASCVD risk. Disease trajectories with moderate to severe level oral disease and oral health deterioration were significantly associated with higher ASCVD incidence.
Conclusion
The results of this study indicate an association between dental caries and gingivitis in childhood and the incidence of ASCVD in adulthood, as measured by ischemic heart disease, myocardial infarction, and ischemic stroke. However, the data do not establish causality. Further studies that consider lifestyle factors and oral health in adulthood are necessary. Nevertheless, these findings suggest that the influence of childhood oral health on the risk of ASCVD in adulthood is worth further exploration. This area of study could enhance understanding of the complex factors that contribute to ASCVD development and may lead to new methods for early detection and prevention. To fully realize this potential, closer collaboration between cardiovascular and oral health professionals is essential. Additionally, the findings emphasize the need for government investment in cross-disciplinary initiatives and childhood oral health programs to promote both oral and cardiovascular health throughout the lifespan.
