Toothbrushing, inflammation, and risk of cardiovascular disease: results from Scottish Health Survey

OBJECTIVE: To examine if self reported toothbrushing behaviour is associated with cardiovascular disease and markers of inflammation (C reactive protein) and coagulation (fibrinogen). DESIGN: National population based survey. SETTING: Scottish Health Survey, which draws a nationally representative sample of the general population living in households in Scotland. PARTICIPANTS: 11,869 men and women, mean age 50 (SD 11). MAIN OUTCOME MEASURES: Oral hygiene assessed from self reported frequency of toothbrushing. Surveys were linked prospectively to clinical hospital records, and Cox proportional hazards models were used to estimate the risk of cardiovascular disease events or death according to oral hygiene. The association between oral hygiene and inflammatory markers and coagulation was examined in a subsample of participants (n=4830) by using general linear models with adjustments. RESULTS: There were a total of 555 cardiovascular disease events over an average of 8.1 (SD 3.4) years of follow-up, of which 170 were fatal. In about 74% (411) of cardiovascular disease events the principal diagnosis was coronary heart disease. Participants who reported poor oral hygiene (never/rarely brushed their teeth) had an increased risk of a cardiovascular disease event (hazard ratio 1.7, 95% confidence interval 1.3 to 2.3; P<0.001) in a fully adjusted model. They also had increased concentrations of both C reactive protein (beta 0.04, 0.01 to 0.08) and fibrinogen (0.08, -0.01 to 0.18). CONCLUSIONS: Poor oral hygiene is associated with higher levels of risk of cardiovascular disease and low grade inflammation, though the causal nature of the association is yet to be determined.