Department of Oral and Maxillofacial Surgery, Amsterdam UMC, Academic Centre of Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands.
Department of Oral and Maxillofacial Surgery, Isala Hospital Zwolle, Zwolle, The Netherlands.
PLoS One. 2020 Dec 16;15(12):e0243232. doi: 10.1371/journal.pone.0243232. eCollection 2020.
This study explores the association between Coronary Artery Calcium (CAC) scores and dental pathology such as missing teeth, the (peri-apical) health status and restoration grade of the teeth, and the grade of alveolar bone loss seen on a dental panoramic radiograph (Orthopantomograph-OPG).
In this retrospective cross-sectional study, data was collected from three hospitals spread in the Netherlands. Patients were included when a CAC score and an OPG were available, both recorded within a maximum period of 365 days from 2009-2017. The CAC score was measured on a CT scan, using the Agatston method. To assess dental pathology, the number of missing teeth, the number of dental implants, alveolar bone loss, caries, endodontic treatments, peri-apical radiolucencies, bone loss at implants, impacted teeth and dental cysts, were determined on the OPG. All observers were calibrated. The electronic health records provided information about: gender, age, smoking, Diabetes Mellitus, hypercholesterolemia, hypertension and Body Mass Index (BMI).
212 patients were included. We found a statistically significant association between the number of missing teeth and the CAC score. When modeling age, sex, and other well-known risk factors for cardiovascular disease, the significant correlation was no longer present after multivariate correction. Furthermore, the results showed a trend for more teeth with peri-apical lesions and a higher percentage of mean alveolar bone loss in the group with the highest CAC scores.
This study showed that being edentulous or missing teeth is correlated to higher CAC scores however failed to be an independent predictor of atherosclerotic cardiovascular diseases. The number of (missing) teeth is an easily accessible marker and could be used as a marker for atherosclerotic cardiovascular disease (ACVD) risk by almost any healthcare worker. The current study needs to be considered as an explorative pilot study and could contribute to the design of further (prospective) studies on the relationship between dental pathology and coronary artery calcification by adding clinical information and extra cardiovascular biomarkers.
本研究旨在探讨冠状动脉钙化（CAC）评分与牙齿缺失、牙齿（根尖周）健康状况和修复等级、以及牙全景片（OrthoPantomograph-OPG）上牙槽骨丧失程度等牙科病理学之间的关联。
在这项回顾性横断面研究中，数据来自荷兰三家医院。纳入的患者需同时具备 CAC 评分和 OPG，且两者均在 2009-2017 年期间内的 365 天内记录。CAC 评分通过 CT 扫描，采用 Agatston 法测量。为评估牙科病理学，在 OPG 上确定缺失牙齿的数量、种植牙的数量、牙槽骨丧失、龋齿、根管治疗、根尖周放射透影、种植体周围骨丧失、阻生牙和牙囊肿的数量。所有观察者均进行了校准。电子健康记录提供了以下信息：性别、年龄、吸烟、糖尿病、高胆固醇血症、高血压和体重指数（BMI）。
共纳入 212 例患者。我们发现缺失牙齿的数量与 CAC 评分之间存在统计学显著关联。在对年龄、性别和心血管疾病的其他已知危险因素进行模型化后，多元校正后这种显著相关性不再存在。此外，结果显示，在 CAC 评分最高的组中，根尖周病变的牙齿数量更多，平均牙槽骨丧失百分比更高。
本研究表明，无牙或缺失牙齿与 CAC 评分升高相关，但不是动脉粥样硬化性心血管疾病的独立预测因子。牙齿缺失的数量是一个易于获取的标志物，几乎任何医疗保健工作者都可以使用它作为动脉粥样硬化性心血管疾病（ACVD）风险的标志物。本研究目前被视为探索性初步研究，通过添加临床信息和额外的心血管生物标志物，可以为进一步研究牙齿病理学与冠状动脉钙化之间的关系提供参考，设计出更多的（前瞻性）研究。
