Gum Disease, Tooth Loss Predict Increased Mortality in Older Women: WHI Analysis

Marcia Frellick

April 04, 2017

BUFFALO, NY — A large study of postmenopausal women suggests periodontitis and tooth loss predict a significantly increased risk of death, but not necessarily an increase in risk for cardiovascular disease[1].

Lead author Dr Michael J LaMonte (University at Buffalo, NY) told heartwire from Medscape that their findings, if confirmed by prospective trials, could have substantial implications for public health in that they may support intensive oral screening in midlife, especially for women.

In particular, oral health could potentially become as important for screening as cholesterol and high blood pressure for prolonging life, he says.

Earlier research has suggested a connection between tooth loss, as a surrogate for gum disease, and an increased mortality risk in a broad population. But studying women in particular was important, LaMonte said, because menopause negatively affects oral health, and because by 2035, people aged 65 and older will make up a large age group, and "among that group, women will outnumber men two to one."

Information was gathered from 57,001 women 50 to 79 years old who were part of the Women's Health Initiative (WHI) Observational Study at 40 centers across the US from 1993 through 1998.

Half were either overweight or obese. Most were non-Hispanic white and had at least some college.

This latest WHI analysis was published online March 29, 2017 in the Journal of the American Heart Association.

The size of the cohort and duration of the study—conducted over 6.7 years—helped to overcome some of the problems smaller studies have had, LaMonte said. Over the follow-up period of the study, there were 3589 incident CVD events and 3816 total deaths.

"This is the largest group of women who are known to be postmenopausal and 55 years of age and older," he said, "and whom we know with good documentation were without heart disease at the beginning of our study."

In this study of community-dwelling older women, mean age 68, loss of all permanent teeth predicted a 17% increase in mortality (hazard ratio [HR] 1.17, 95% CI 1.02–1.33).

LaMonte said his research team hypothesizes that tooth loss probably reflects more than just oral hygiene, and it could be influenced by health factors such as diet, smoking, or other conditions that have accumulated over a lifetime.

"We see it as a proxy measure for poorer overall health than in those who keep their teeth," he said.

His group expected to find that a history of periodontitis was related to having a heart attack or stroke, as well as increased mortality, according to LaMonte. However, gum disease was not linked with CV events, although it was associated with 12% higher total mortality (HR 1.12, 95% CI 1.05–1.21).

That finding is consistent with other studies that have measured gum disease by asking a question, LaMonte said. In the current study women were asked: "Has a dentist or dental hygienist ever told you that you had periodontal or gum disease?"

Although the WHI cohort is large and there was lengthy follow-up, the authors point out, having the women report on their own history of gum disease and tooth-loss status is admittedly a limitation of analysis.

Other studies that have measured gum disease objectively in an exam have been more likely to find positive association between gum disease and CVD, LaMonte said. "It could be that that measure of oral health is just really difficult to assess with a question."

Both conditions are prevalent among older people—64% of US adults over 60 have moderate to severe gum disease and 33% have tooth loss, according to the report.

LaMonte explained that they looked at four scenarios: tooth loss and gum disease; gum disease without tooth loss; tooth loss without gum disease; and neither tooth loss nor gum disease.

"When we looked at women who had both, their risk of dying was higher than any of the other groups," he said. "That gave us some notion that we were in the right ballpark," he said.

The Women's Health Initiative is funded by the National Heart, Lung, and Blood Institute. The authors report no relevant financial relationships.

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