University of Oulu

Paju, S, Pietiäinen, M, Liljestrand, JM, Lahdentausta, L, Salminen, A, Kopra, E, Mäntylä, P, Buhlin, K, Hörkkö, S, Sinisalo, J, Pussinen, PJ. Carotid artery calcification in panoramic radiographs associates with oral infections and mortality. International Endodontic Journal, 54, 15– 25, 2021, https://doi.org/10.1111/iej.13394

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

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Author: Paju, S.1; Pietiäinen, M.1; Liljestrand, J.M.1;
Organizations: 1Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki
2Oral and Maxillofacial Diseases, Institute of Dentistry, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
3Division of Periodontology, Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
4Research Unit of Biomedicine, Medical Microbiology and Immunology, Faculty of Medicine, University of Oulu, Oulu
5Medical Research Center and Nordlab Oulu, University Hospital and University of Oulu, Oulu
6Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland
Format: article
Version: accepted version
Access: embargoed
Persistent link: http://urn.fi/urn:nbn:fi-fe202102023523
Language: English
Published: John Wiley & Sons, 2021
Publish Date: 2021-08-31
Description:

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.

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Series: International endodontic journal
ISSN: 0143-2885
ISSN-E: 1365-2591
ISSN-L: 0143-2885
Volume: 54
Issue: 1
Pages: 15 - 25
DOI: 10.1111/iej.13394
OADOI: https://oadoi.org/10.1111/iej.13394
Type of Publication: A1 Journal article – refereed
Field of Science: 313 Dentistry
3121 General medicine, internal medicine and other clinical medicine
Subjects:
Funding: The study was financially supported by the Academy of Finland, the Sigrid Juselius foundation, the European Society of Endodontology, the Paulo foundation, the Finnish Dental Society Apollonia, the Aarne Koskelo foundation, the Yrjö Jahnsson foundation and the Päivi and Sakari Sohlberg foundation.
Copyright information: © 2020 International Endodontic Journal. Published by John Wiley & Sons Ltd. This is the peer reviewed version of the following article: Paju, S, Pietiäinen, M, Liljestrand, JM, Lahdentausta, L, Salminen, A, Kopra, E, Mäntylä, P, Buhlin, K, Hörkkö, S, Sinisalo, J, Pussinen, PJ. Carotid artery calcification in panoramic radiographs associates with oral infections and mortality. International Endodontic Journal, 54, 15– 25, 2021, which has been published in final form at https://doi.org/10.1111/iej.13394. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.