Oral Health in Adults: Predictors, Social Gradients and Correlation With Cardiovascular Health in Women and Men

Title:

Oral health in adults: predictors, social gradients and correlation with cardiovascular health in women and men. Date: 24.02.2023

1. Excellence 1.1 State of the art, knowledge needs and project objectives Non-communicable diseases (NCD) are rising in prevalence globally because of aging, refined diets and sedentary lifestyle. Two of the most common NCDs in humans, caries and periodontitis (here named oral diseases), contribute substantially to years lived with disability in age-standardized prevalence rates worldwide. Cardiovascular (CV) disease (CVD) is the leading cause of death and years lived with disability globally. Co-presence of CVD and oral diseases is therefore common, and an association between oral diseases and CVD has been observed in epidemiological studies.

Mechanisms linking oral diseases to CVD include transfer of oral pathogen bacteria and pro-inflammatory mediators to other organs triggering immune response and systemic and vascular inflammation. Circulating inflammatory cytokines may initiate an acute-phase response in the liver with production of C-reactive protein and serum amyloid A and increased tryptophan degradation, that contribute to CV inflammation and atherosclerosis. We have demonstrated that higher serum levels of these inflammatory markers are associated with presence of hypertension and obesity in midlife in the Hordaland Health Study, and with higher risk of subsequent CVD independent of clinical risk factors. However, CVD and oral diseases also share many of the same risk factors, including hypertension, obesity, diabetes, and smoking. Since the association of oral disease with CV risk factors so far mostly has been demonstrated in cross-sectional studies, the direction of these associations has not been ascertained. These CVD risk factors lead to chronic CV inflammation which promotes atherosclerosis as well as structural and functional changes in the heart and arteries (preclinical CVD) and are all more harmful in women than men. Whether these conditions can impact development of oral diseases is not fully explored.

Socio-economic inequalities have been reported for many oral diseases. In a study in subjects older than 65 yrs from Northern Norway, severe periodontitis was more prevalent in men, smokers and subjects with low socio-economic status (SES). Thus, sex and SES may modify the association between oral diseases and CVD. It is presently unknown whether CV health in midlife, measured by CV risk factor burden, circulating inflammatory markers and SES, may impact presence and severity of oral disease in women and men later in life. It is also unknown if the structural and functional oral microbiome differ by periodontitis severity and can be associated with inflammatory biomarkers, CV risk factors and presence or absence of preclinical CVD. Finally, the association between oral diseases and preclinical CVD has to date not been explored in large studies.