Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Department of Medicine, University of Turku, Turku, Finland.
JAMA Netw Open. 2019 Apr 5;2(4):e192523. doi: 10.1001/jamanetworkopen.2019.2523.
Severe forms of common chronic oral infections or inflammations are associated with increased cardiovascular risk in adults. To date, the role of childhood oral infections in cardiovascular risk is not known because no long-term studies have been conducted.
To investigate whether signs of oral infections in childhood are associated with cardiovascular risk factors and subclinical atherosclerosis in adulthood.
DESIGN, SETTING, AND PARTICIPANTS: The cohort study (n = 755) was derived from the Cardiovascular Risk in Young Finns Study, an ongoing prospective cohort study in Finland initiated in 1980. Participants underwent clinical oral examinations during childhood, when they were aged 6, 9, or 12 years and a clinical cardiovascular follow-up in adulthood in 2001 at age 27, 30, or 33 years and/or in 2007 at age 33, 36, or 39 years. Cardiovascular risk factors were measured at baseline and during the follow-up until the end of 2007. Final statistical analyses were completed on February 19, 2019.
Four signs of oral infections (bleeding on probing, periodontal probing pocket depth, caries, and dental fillings) were documented. Cumulative lifetime exposure to 6 cardiovascular risk factors was calculated from dichotomized variables obtained by using the area-under-the-curve method. Subclinical atherosclerosis (ie, carotid artery intima-media thickness [IMT]) was quantified in 2001 (n = 468) and 2007 (n = 489).
This study included 755 participants, of whom 371 (49.1%) were male; the mean (SD) age at baseline examination was 8.07 (2.00) years. In this cohort, 33 children (4.5%) had no sign of oral infections, whereas 41 (5.6%) had 1 sign, 127 (17.4%) had 2 signs, 278 (38.3%) had 3 signs, and 248 (34.1%) had 4 signs. The cumulative exposure to risk factors increased with the increasing number of oral infections both in childhood and adulthood. In multiple linear regression models, childhood oral infections, including signs of either periodontal disease (R2 = 0.018; P = .01), caries (R2 = 0.022; P = .008), or both (R2 = 0.024; P = .004), were associated with adulthood IMT. The presence of any sign of oral infection in childhood was associated with increased IMT (third tertile vs tertiles 1 and 2) with a relative risk of 1.87 (95% CI, 1.25-2.79), whereas the presence of all 4 signs produced a relative risk of 1.95 (95% CI, 1.28-3.00). The associations were more obvious in boys: if periodontal disease were present, the corresponding estimate was 1.69 (95% CI, 1.21-2.36); if caries, 1.46 (95% CI, 1.04-2.05); and if all 4 signs of oral infections, 2.25 (95% CI, 1.30-3.89). The associations were independent of cardiovascular risk factors.
Oral infections in childhood appear to be associated with the subclinical carotid atherosclerosis seen in adulthood.
重要性：严重的常见慢性口腔感染或炎症与成年人的心血管风险增加有关。迄今为止，由于没有进行长期研究，儿童期口腔感染对心血管风险的作用尚不清楚。
目的：研究儿童期口腔感染迹象是否与成年人心血管危险因素和亚临床动脉粥样硬化有关。
设计、环境和参与者：本队列研究（n=755）源自芬兰正在进行的前瞻性队列研究——“年轻芬兰人心血管风险研究”。参与者在儿童期 6、9 或 12 岁时接受了临床口腔检查，在 2001 年成年时进行了临床心血管随访，年龄分别为 27、30 或 33 岁和/或在 2007 年年龄为 33、36 或 39 岁。在基线和随访期间测量了心血管危险因素，直至 2007 年底。最终的统计分析于 2019 年 2 月 19 日完成。
主要结果和测量：记录了 4 种口腔感染迹象（探诊出血、牙周探诊袋深度、龋齿和牙填充物）。使用基于曲线下面积的方法获得的二分类变量计算了 6 种心血管危险因素的终生累积暴露量。使用颈动脉内-中膜厚度（IMT）来量化亚临床动脉粥样硬化（即），于 2001 年（n=468）和 2007 年（n=489）进行了测量。
结果：本研究纳入了 755 名参与者，其中 371 名（49.1%）为男性；基线检查时的平均（SD）年龄为 8.07（2.00）岁。在该队列中，有 33 名儿童（4.5%）没有口腔感染迹象，41 名（5.6%）有 1 种迹象，127 名（17.4%）有 2 种迹象，278 名（38.3%）有 3 种迹象，248 名（34.1%）有 4 种迹象。在儿童期和成年期，风险因素的累积暴露量随着口腔感染数量的增加而增加。在多元线性回归模型中，包括牙周病（R2=0.018；P=0.01）、龋齿（R2=0.022；P=0.008）或两者（R2=0.024；P=0.004）的儿童期口腔感染与成年期 IMT 有关。儿童期存在任何口腔感染迹象与 IMT 增加有关（第三三分位数与第一和第二三分位数相比），相对风险为 1.87（95%CI，1.25-2.79），而存在所有 4 种口腔感染迹象的相对风险为 1.95（95%CI，1.28-3.00）。在男孩中，这些关联更为明显：如果存在牙周病，相应的估计值为 1.69（95%CI，1.21-2.36）；如果存在龋齿，为 1.46（95%CI，1.04-2.05）；如果存在所有 4 种口腔感染迹象，则为 2.25（95%CI，1.30-3.89）。这些关联独立于心血管危险因素。
结论：儿童期的口腔感染似乎与成年期可见的亚临床颈动脉粥样硬化有关。
