Radiographic Assessment of Dental Health in Middle-aged Men Following Sudden Cardiac Death

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Radiographic Assessment of Dental Health in Middle-aged Men Following Sudden Cardiac Death
2006
V. Karhunen1,2,*, H. Forss3, S. Goebeler1, H. Huhtala6, E. Ilveskoski1, O. Kajander1, J. Mikkelsson1, A. Penttilâ4, M. Perola5, H. Ranta4, J.H. Meurman2, and P.J. Karhunen1,7
Journal of Dental Research

© 2006 International and American Associations for Dental Research

1 Medical School, University of Tampere and Research Unit of Clinical Chemistry, Tampere University Hospital, Finland;
2 Institute of Dentistry, University of Helsinki, and Department of Oral and Maxillofacial Diseases, Helsinki University Central Hospital, Helsinki, Finland;
3 Oral and Maxillofacial Department, Tampere University Hospital, Finland;
4 Department of Forensic Medicine, University of Helsinki, Finland;
5 Department of Molecular Medicine, National Public Health Institute, Helsinki, Finland;
6 Department of Biometrics, Institute of Health, University of Tampere, Finland; and
7 Department of Clinical Pathology and Forensic Medicine, University of Kuopio, Finland

* corresponding author, Pâivionkatu 21, FIN-74100 Iisalmi, Europe; vesa.karhunen@fimnet.fi

ABSTRACT

Poor oral health has been suggested to be a risk factor for myocardial infarction. To study if dental pathology might predispose to pre-hospital sudden cardiac death, and using a sum index of panoramic tomography findings, we compared the oral health of middle-aged (33Ò69 yrs) male victims (Helsinki Sudden Death Study) of sudden cardiac death (n = 117) with that of controls, who died of non-cardiac diseases (n = 63) or suffered unnatural sudden death (n = 120). The mean number of teeth was 15.2, and 17.4% of the men were edentulous. Frequent age-associated findings in dentate victims were fillings (79.9%), horizontal bone loss (72.1%), periapical lesions (45.6%), residual roots (38.2%), and vertical pockets (30.9%). In multivariate analysis with coronary heart disease risk factors and number of teeth as covariates, poor oral health was associated (p = 0.053) with the risk of sudden cardiac death along with age, smoking, and body mass index. This association was especially strong (p = 0.009) among victims < 50 yrs.


KEY WORDS: dental Ô panoramic tomography Ô sudden cardiac death Ô myocardial infarction Ô coronary heart disease Ô middle-aged Ô male Ô autopsy

INTRODUCTION

Previous studies have suggested an association among dental infections, clinical myocardial infarction, and coronary heart disease. However, the results have been contradictoryÛboth positive and negative findings have been reported (Mattila et al., 1989; DeStefano et al., 1993; Paunio et al., 1993; Joshipura et al., 1996; Morrison et al., 1999; Hujoel et al., 2000; Tuominen et al., 2003). According to a recent meta-analysis, individuals with periodontal disease are at a higher risk of future coronary events, the risk being greater in those 65 yrs (Janket et al., 2003).

Today, most (> 50%) cardiovascular deaths are sudden, and take place out-of-hospital. Among men aged < 50Ò55 yrs, as many as 90% of deaths due to coronary heart disease belong in this category (Huikuri et al., 2001; Mikkelsson et al., 2001). The risk factors of pre-hospital sudden cardiac death are mainly unresolved, because sudden death is often the first manifestation of coronary heart disease, and most victims have not been examined by a physician prior to death. Knowledge about risk factors is difficult to obtain after death, and laboratory values or dental records are rarely available. This background explains why the possible association between pre-hospital sudden cardiac death and dental infections has not been studied.

The dental data used in the earlier epidemiological studies on the association between dental infections and cardiovascular disease were obtained from questionnaires (Joshipura et al., 1996; Howell et al., 2001) or clinical examinations (DeStefano et al., 1993; Paunio et al., 1993; Beck et al., 1996; Hujoel et al., 2000; Wu et al., 2000; Tuominen et al., 2003). Panoramic tomography supported by clinical examination has seldom been applied (Mattila et al., 1989, 2000), although it gives a more comprehensive view of oral health. Post mortem panoramic tomography has previously been used for the assessment of marginal bone loss in a small series of cadavers (Soikkonen et al., 1990).

In this paper, we report on our use of panoramic tomography to study the dental health of middle-aged males who died suddenly out-of-hospital, to test the hypothesis that poor oral health may be a risk factor for sudden cardiac death.

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