Carotid artery calcification in panoramic radiographs associates with oral infections and mortality

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Paju , S , Pietiäinen , M , Liljestrand , J , Lahdentausta , L , Salminen , A , Kallio , E , Mäntylä , P , Buhlin , K , Hörkkö , S , Sinisalo , J & Pussinen , P 2021 , ' Carotid artery calcification in panoramic radiographs associates with oral infections and mortality ' , International Endodontic Journal , vol. 54 , no. 1 , pp. 15-25 . https://doi.org/10.1111/iej.13394

Title: Carotid artery calcification in panoramic radiographs associates with oral infections and mortality
Author: Paju, Susanna; Pietiäinen, Milla; Liljestrand, John; Lahdentausta, Laura; Salminen, Aino; Kallio, Elisa; Mäntylä, Päivi; Buhlin, Kåre; Hörkkö, Sohvi; Sinisalo, Juha; Pussinen, Pirkko
Contributor: University of Helsinki, HUS Head and Neck Center
University of Helsinki, Department of Oral and Maxillofacial Diseases
University of Helsinki, HUS Head and Neck Center
University of Helsinki, Department of Oral and Maxillofacial Diseases
University of Helsinki, Department of Oral and Maxillofacial Diseases
University of Helsinki, Department of Oral and Maxillofacial Diseases
University of Helsinki, Department of Oral and Maxillofacial Diseases
University of Helsinki, HUS Heart and Lung Center
University of Helsinki, HUS Head and Neck Center
Date: 2021-01
Language: eng
Number of pages: 11
Belongs to series: International Endodontic Journal
ISSN: 0143-2885
URI: http://hdl.handle.net/10138/333781
Abstract: Aim To study the prevalence of carotid artery calcification (CAC) in relation to apical and marginal periodontitis, subgingival dysbiotic bacterial species and serum and saliva immune responses against them. In addition, the aim was to analyse the association of CAC with angiographically verified coronary artery disease (CAD) and mortality. Methodology In the present random Parogene cohort, the patients had an indication for coronary angiography. Apical and marginal periodontitis were diagnosed during clinical and radiographic oral examinations, and CAC on panoramic radiographs (n = 492). Presence and severity of CAD were registered from angiography. Subgingival dysbiotic bacterial species were quantitated using checkerboard DNA-DNA-hybridization, and serum and saliva antibody levels were determined by immunoassays. The cohort was followed-up for 10 years or until death (median 9.9, range 0.21-10.4) via linkage to the national death register. The statistical models were adjusted for age, gender, smoking, hypertension, diabetes and dyslipidemia. Results A total of 102 (20.7%) patients had detectable CAC, which was moderate in 81 (16.4%) and severe in 21 (4.3%). CAC was associated (OR, 95% CI) with severe apical periodontitis (2.25, 1.15-4.41), root canal fillings (1.15, 1.04-1.26), alveolar bone loss (2.66, 1.21-5.84), severe periodontal inflammation (2.23, 1.11-4.47), high level of gram-negative subgingival species (2.73, 1.34-5.50), saliva IgG against dysbiotic species (1.05, 1.01-1.10/unit) and severe (2.58, 1.36-4.90) and chronic (2.13, 1.15-3.93) CAD. A total of 105 (20.7%) patients died during the follow-up and 53 (10.4%) deaths were because of cardiovascular diseases (CVD). Severe CAC predicted worse survival with HRs (95% CI) of 3.08 (1.58-6.06) for all-cause and 3.43 (1.42-8.25) for CVD death. Conclusions CAC on panoramic tomography was associated with (i) apical and marginal periodontitis and dysbiotic bacterial species giving rise to an immunological response, and with (ii) severe, chronic CAD and increased mortality. The results further emphasize the role of oral infections in CAD and the importance of referring a patient with CAC for a cardiovascular evaluation.
Subject: ATHEROMAS
BURDEN
CARDIOVASCULAR RISK
CHRONIC APICAL PERIODONTITIS
DOPPLER SONOGRAPHY
LESIONS
MICROBIOTA
PREVALENCE
STROKE
VASCULAR-DISEASE
antibodies
cardiovascular diseases
oral microbiota
panoramic tomography
saliva
subgingival plaque
313 Dentistry
3121 General medicine, internal medicine and other clinical medicine
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