Dental disease management and good oral care were associated with lower risk of heart failure (HF) in patients with type 2 diabetes, a study found.
The study included 173,927 type 2 diabetes patients ages 40 years and older who underwent Korean National Health Insurance Service health examinations in 2008 and were followed until the end of 2017. Participants responded to a survey about their dental visits and oral hygiene care, and dentists performed an oral examination. Results were published Aug. 7 by the Journal of the American Heart Association.
During a median follow-up of 9.3 years, 1.94% of participants developed HF. An increased number of missing teeth was associated with a higher risk of HF (P<0.001); individuals with more than 15 missing teeth had a hazard ratio (HR) of 1.37 for HF (95% CI, 1.14 to 1.64) compared with those without missing teeth. Decreased risk of HF was observed in individuals who received a professional dental cleaning at least once a year (HR, 0.93; 95% CI, 0.87 to 0.99) and in those who brushed their teeth at least twice a day (HR, 0.90; 95% CI, 0.82 to 0.98) compared with those who didn't. While patients who had both missing teeth and periodontal disease (P=0.004) or dental caries (P=0.007) were at increased HF risk, combined oral hygiene care (dentist and toothbrushing) was associated with further HF risk reduction (P=0.024). Better oral hygiene care was associated with decreased HF risk, even as the number of missing teeth increased (P<0.001).
Dental diseases and oral hygiene care are important determinants of developing heart failure among patients with type 2 diabetes, the study authors said, although they noted that the observational study design makes it difficult to assess causality. They speculated that some pathological mechanisms for the association may involve oral human microbiota. Various bacteria of the oral microbiome produce chemicals that may induce atherosclerosis and increase cholesterol, for example, they noted. “Conversely, oral hygiene care might attenuate chronic inflammation and modify the oral microbiome,” the authors wrote.