The Association of Tooth Scaling and Decreased Cardiovascular Disease: A Nationwide Population-based Study

Study Questions:

What is the association between tooth scaling and the risk of cardiovascular events, using a nationwide, population-based study and a prospective cohort design?


The analyses were conducted using information from a random sample of 1 million persons enrolled in the nationally representative Taiwan National Health Insurance Research Database. Exposed individuals consisted of all subjects who were ages 50 years and who received at least one tooth scaling in 2000. The comparison group of nonexposed persons consisted of persons who did not undergo tooth scaling and were matched to exposed individuals using propensity score matching by the time of enrollment, age, gender, history of coronary artery disease, diabetes, hypertension, and hyperlipidemia.


During an average follow-up period of 7 years, 10,887 subjects who had ever received tooth scaling (exposed group) and 10,989 age-, gender-, and comorbidity-matched subjects who had not received tooth scaling (nonexposed group) were enrolled. The exposed group had a lower incidence of acute myocardial infarction (1.6% vs. 2.2%, p < 0.001), stroke (8.9% vs. 10%, p = 0.03), and total cardiovascular events (10% vs. 11.6%, p < 0.001) when compared with the nonexposed group. After multivariate analysis, tooth scaling was an independent factor associated with less risk of developing future myocardial infarction (hazard ratio [HR], 0.69; 95% confidence interval [CI], 0.57-0.85), stroke (HR, 0.85; 95% CI, 0.78-0.93), and total cardiovascular events (HR, 0.84; 95% CI, 0.77-0.91). Furthermore, when compared with the nonexposed group, increasing frequency of tooth scaling correlated with a higher risk reduction of acute myocardial infarction, stroke, and total cardiovascular events (p for trend < 0.001).


The authors concluded that tooth scaling is associated with a decreased risk for future cardiovascular events.


A relationship between oral hygiene and periodontal disease and cardiovascular events has been demonstrated in some, but not all longitudinal studies. The pathogenesis of coronary disease and periodontal disease share many features, as described by Richard Ross, a dentist and pioneer in the understanding of atherosclerosis. The theoretical relationships include increase in the systemic inflammatory process as is seen in other infections that are associated with coronary events (e.g., influenza, pneumonia, chronic obstructive pulmonary disease, connective tissue diseases), and a direct effect of anaerobic flora. While there are many other potential confounding variables such as nutrition and smoking that were not included in this study, the evidence of a direct relationship is compelling and deserves further studies to test the hypothesis. Until such data are available, it would be prudent cardiovascular risk reduction to encourage good dental hygiene, along with other measures such as seasonal flu vaccines.

Clinical Topics: Atherosclerotic Disease (CAD/PAD)

Keywords: Connective Tissue Diseases, Coronary Artery Disease, Dentists, Myocardial Infarction, Atherosclerosis, Follow-Up Studies, Periodontal Diseases, Risk Factors, Incidence, Oral Hygiene, Cardiology, Cardiovascular Diseases, Taiwan, Lung Diseases

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