University of Oulu

Liljestrand, JM, Salminen, A, Lahdentausta, L, Paju, S, Mäntylä, P, Buhlin, K, Tjäderhane, L, Sinisalo, J, Pussinen, PJ. Association between dental factors and mortality. International Endodontic Journal, 54, 672– 681, 2021.

Association between dental factors and mortality

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Author: Liljestrand, J. M.1; Salminen, A.1; Lahdentausta, L.1;
Organizations: 1Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki
2Institute of Dentistry, University of Eastern Finland and Kuopio University Hospital, Oral and Maxillofacial Diseases, Kuopio, Finland
3Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
4Research Unit of Oral Health Sciences, and Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 8.8 MB)
Persistent link:
Language: English
Published: John Wiley & Sons, 2021
Publish Date: 2021-12-04


Aim: To study whether oral parameters such as endodontic infections, root canal fillings, number of teeth or wearing removable dentures at baseline are associated with cardiovascular- and all-cause mortality in a follow-up of approximately 8 years.

Methodology: The Finnish Parogene cohort consists of 508 Finnish adults (mean age 63.3 years, SD 9.1) with cardiac symptoms, all of whom had undergone coronary angiography for accurate baseline coronary status. Extensive clinical and radiographic oral examinations were performed, and additional data were acquired from medical records and questionnaires. Root canal fillings and endodontic lesions, as well as their co-occurrence, were determined from panoramic radiographs. The mortality data were assessed via record linkage with the Finnish Causes of Death register (mean follow-up time 7.81 years, SD 1.45 years). A total of n = 471 dentate patients were included in the statistical analyses.

Results: A total of n = 69 deaths were recorded, of which n = 41 were due to cardiovascular diseases (CVDs, ICD-10 I00–I99). The deceased had fewer root canal fillings (mean 1.57; SD 1.64 vs. mean 2.30; SD 2.34, P = 0.03) than the survivors. The number of missing teeth was associated with smoking, occluded coronary arteries and diabetes. Cox regression with Firth’s penalized maximum-likelihood method using age as timescale revealed an inverse association (HR; 95%CI) between mortality and number of teeth (all-cause 0.91; 0.86–0.96, CVD mortality 0.89; 0.83–0.96), use of removable dentures (all-cause 0.24; 0.09–0.62, CVD mortality 0.20; 0.06–0.72), root canal fillings (all-cause 0.82; 0.70–0.94, CVD mortality 0.79; 0.63–0.96) and having root canal fillings in all teeth with apical rarefactions (all-cause 0.27; 0.06–0.79, CVD mortality 0.09; 0.01–0.63), when gender, smoking, occluded coronary arteries, periodontal inflammatory burden index and the number of teeth were adjusted for.

Conclusions: The number of missing teeth appeared to be the strongest predictor of mortality in this study, whereas endodontic infections per se had no independent association. Nevertheless, signs of professional intervention in these problems, such as root canal fillings and removable dentures, appeared to be associated with improved survival, which might partly be explained by the utilization of healthcare services.

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Series: International endodontic journal
ISSN: 0143-2885
ISSN-E: 1365-2591
ISSN-L: 0143-2885
Volume: 54
Issue: 5
Pages: 672 - 681
DOI: 10.1111/iej.13458
Type of Publication: A1 Journal article – refereed
Field of Science: 313 Dentistry
Funding: This study was supported by the Academy of Finland grants no (1266053 to P.J.P.), 1296541 and 1316777 (S.P.), Sigrid Juselius Foundation (P.J.P), European Endodontic Society (P.J.P.), Paulo Foundation (P.J.P.), the Finnish Dental Society Apollonia (P.J.P.), Päivi and Sakari Sohlberg Foundation (P.J.P.), Aarne Koskelo Foundation (P.J.P.), Orion Research Foundation (J.M.L) and Odontologiska Samfundet i Finland r.f. (J.M.L.).
Copyright information: © 2020 International Endodontic Journal. Published by John Wiley & Sons Ltd. This is the peer reviewed version of the following article: Liljestrand, JM, Salminen, A, Lahdentausta, L, Paju, S, Mäntylä, P, Buhlin, K, Tjäderhane, L, Sinisalo, J, Pussinen, PJ. Association between dental factors and mortality. International Endodontic Journal, 54, 672– 681, 2021, which has been published in final form at [Link to final article using the DOI]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.