Frequency and duration of tooth brushing is associated with endothelial function
Decreased frequency and duration of tooth brushing is a risk factor for endothelial dysfunction
Literature - Matsui S, Kajikawa M, Maruhashi T, et al. - Int J Cardiol 2017;241:30–34Background
Periodontal disease has been associated with an increased risk of CV and cerebrovascular diseases, since it promotes local and systemic inflammation and atherogenesis [1,2]. It has been shown that the decrease of tooth brushing frequency is independently associated with endothelial dysfunction [3], however, it is unclear whether the duration of tooth brushing on top of the frequency plays a role in this context.
In this study, the relationships of methods of tooth brushing with vascular function was evaluated, in 896 individuals, who were divided in 3 groups based on their tooth brushing behavior:
a) Low frequency and short duration:< twice/day and < 2 min/procedure
b) Low frequency or short duration:< twice/day or < 2 min/procedure
c) Non-low frequency and non-short duration: ≥ twice/day and ≥ 2 min /procedure
Oral health and tooth brushing behaviour were self-reported and captured on a questionnaire. Vascular function was measured by flow-mediated vasodilation (FMD) and nitroglycerine-induced vasodilation in the brachial artery with high-resolution ultrasound [4,5].
Main results
- Significant differences in baseline characteristics were seen between groups, regarding age, gender, SBP, hs-CRP, and prevalence of hypertension, DM, hyperuricemia, and smoking history. The group with the highest frequency and duration of tooth brushing showed significantly lower hs-CRP than the other two groups.
- FMD was significantly lower in the low frequency and short duration group compared with the low frequency or short duration group (3.1% ± 2.7% vs. 4.2% ± 3.1%; P = 0.001), and compared with the non-low frequency and non-short duration group (3.1% ± 2.7% vs. 4.7% ± 3.1%; P < 0.001).
- There was no significant difference in FMD between the low frequency or short duration group and the non-low frequency and non-short duration group.
- Nitroglycerine-induced vasodilation was not significantly different in the low frequency and short duration group compared with the low frequency or short duration group (11.9% ± 6.3% vs. 11.4% ± 6.5%), and compared with the non-low frequency and non-short duration group (11.9% ± 6.3% vs. 12.3% ± 6.2%).
- Using the non-low frequency and non-short duration group as the reference, the low frequency and short duration group was significantly associated with an increased OR of a low FMD tertile after adjustment for age, gender, hypertension, DM, hyperuricemia and smoking history (OR: 2.25; 95% CI: 1.39–3.59; P < 0.001).
- In age-matched groups, the association between lower frequency and duration of tooth brushing with FMD remained significant after adjustment for age, gender, hypertension, DM, hyperuricemia, and smoking history [4.8 ± 3.0% vs. 3.8 ± 2.2% and 3.1 ± 2.7%, P=0.01 and P < 0.001). Again, nitroglyceride-induced vasodilation did not show significant differences between groups.
- The multiple logistic regression analysis revealed that low frequency of tooth brushing, short duration of tooth brushing, age, and hypertension were independently associated with a low tertile of FMD.
- A difference in the prevalence of tooth extraction, a marker of the severity of periodontitis, was seen between groups (64.4% vs. 65.1% vs. 79.6% in non-low frequency and non-short, low frequency or short duration and low frequency and short duration groups, respectively, P=0.01).
Conclusion
Not only high frequency but also long duration of tooth brushing is associated with a better endothelial function. These results imply that adequate tooth brushing may be beneficial for the prevention of CV events, although further studies are needed to determine whether an increased frequency and duration of tooth brushing improves endothelial dysfunction.
References
1. K.J. Mattila, M.S. Nieminen, V.V. Valtonen, et al., Association between dental health and acute myocardial infarction, BMJ 298 (1989) 779–781.
2. F. DeStefano, R.F. Anda, H.S. Kahn, et al. Dental disease and risk of coronary heart disease and mortality, BMJ 306 (1993) 688–691.
3. M. Kajikawa, A. Nakashima, T. Maruhashi, et al. Poor oral health, that is, decreased frequency of tooth brushing, is associated with endothelial dysfunction, Circ. J. 78 (2014) 950–954.
4. D.S. Celermajer, K.E. Sorensen, V.M. Gooch, et al. Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis, Lancet 340 (1992) 1111–1115.
5. D.S. Celermajer, K.E. Sorensen, C. Bull, et al. Endothelium dependent dilation in the systemic arteries of asymptomatic subjects relates to coronary risk factors and their interaction, J. Am. Coll. Cardiol. 24 (1994) 1468–1474.
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