Research Spotlight: New Study Continues to Link Gum Disease to Earlier Mortality Rates


Photos of Dr. Heaton
Dr. Brenda Heaton (pictured), associate professor of health policy and health services research, and colleagues used additional years of data to replicate the findings of a seminal study from 25 years ago: periodontal disease may cause premature die. Photo credit: Dan Bomba, GSDM

Twenty-five years ago, a new breakthrough occurred in a study by GSDM faculty members Drs. Raul Garcia and Elizabeth Kaye, which found that patients with periodontal disease (“gum disease” ) were at greater risk of dying earlier – in their words, “flossing or dying.

Now, new research from Brenda Heaton, Ph.D., associate professor of health policy and health services research, her epidemiology doctoral student Julia Bond, and colleagues confirms Garcia and Kay's findings. Published in the Journal of Clinical Periodontologywhich draws on an additional 25 years of data and uses more sophisticated analysis methods.

“For those with periodontal disease, death comes early,” Dr. Heaton said. “Periodontal disease carries a chronic inflammatory burden, and the longer the inflammatory burden, the higher the risk of mortality.”

For the new study, Heaton and Bond drew on data from the VA Dental Longitudinal Study, a group of men first established in 1968 who received medical and oral exams about every three years. Participants in the study received dental X-rays at each visit, which measured inflammation-related bone loss around the teeth. Beginning in the late 1980s, more detailed clinical measurements of current periodontal inflammation, including pocket depth and clinical attachment loss, became available. With periodontal disease, the severity of the condition changes over time, resulting in changing expected mortality rates.

“The more severe the disease, the higher the risk of death,” Heaton said.

Heaton said the longer duration of the study, coupled with the frequency with which study participants were tested, allowed them to investigate various systematic biases to determine whether other factors could explain early mortality. Heaton said the team came to a similar conclusion to earlier studies: periodontal disease may lead to premature death.

“More than fifty years of long-term follow-up allows us to identify early disease states and update periodontal disease exposure status, thereby reducing bias in time to death associated with exposure conditions,” Heaton said.

In addition, smoking is a major risk factor for periodontal disease, which introduces potential bias, and Heaton and her team were able to examine in more detail with an additional 25 years of data. Some participants who started smoking when they entered the study eventually quit. In the new study, Heaton and colleagues were able to more accurately identify deaths related to periodontal disease rather than smoking.

Heaton said it's important for people to understand the relationship between oral health and overall health, noting Another recent study she and Bond collaborated on, which found a relationship between edentulism (loss of all teeth) and mortality. Periodontal disease is one of the leading causes of tooth loss, causing, in Heaton's words, “a double death.

But Heaton also noted that another major cause of tooth loss is clinical treatment decisions: For example, it is cheaper to extract a tooth than to restore it, so patients and caregivers may make treatment decisions based on cost and insurance coverage. Overall, Heaton said, this places a disproportionate burden of tooth loss and periodontal disease on vulnerable populations, particularly individuals from racial and ethnic groups that have historically lacked affordable care.

“The integration of disease processes leading to periodontal disease and tooth loss into clinical decision-making [is] Heaton said this double death occurs disproportionately among disadvantaged groups and contributes not only to oral health disparities but to broader health disparities.

Heaton said the negative consequences associated with periodontal disease can be prevented through proper access to effective and affordable dental treatment and routine maintenance.However, it is important to be aware of the inequalities that exist access She adds that this is something to be concerned about when considering how to prevent the negative outcomes associated with periodontal disease.

“Basically, bad teeth and bad gums don't do any good,” Heaton said. “Floss or die.”

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Research Spotlight: New research continues to link gum disease to early mortality

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1 year ago

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