European Journal of Epidemiology

, Volume 20, Issue 3, pp 229–236 | Cite as

Can the relation between tooth loss and chronic disease be explained by socio-economic status? A 24-year follow-up from the Population Study of Women in Gothenburg, Sweden

  • Claudia Cabrera
  • Magnus Hakeberg
  • Margareta Ahlqwist
  • Hans Wedel
  • Cecilia Björkelund
  • Calle Bengtsson
  • Lauren Lissner
Dental Epidemiology

Abstract

The objective of this study was to evaluate the association between number of missing teeth and all cause, cardiovascular, and cancer mortality as well as morbidity and to explore whether socio-economic factors mediate this association. An ongoing prospective cohort study of 1462 Swedish women included a dental survey in 1968/69 with follow-up until 1992/93. The dental examination included a panoramic radiographic survey and a questionnaire. Number of missing teeth at baseline was analysed in a Cox proportional hazards model to estimate time to mortality and morbidity. Number of missing teeth, independently of socio-economic status variables (the husband’s occupational category, combined income, and education) was associated with increased all cause mortality and cardiovascular disease mortality respectively (relative risk (RR): 1.36; 95% confidence interval (95% CI): 1.18–1.58) and (RR: 1.46; 95% CI: 1.15–1.85 per 10 missing teeth), but no associations were found for cancer mortality (RR: 1.18; 95% CI: 0.91–1.52). The relation between poor oral health and future cardiovascular disease could not be explained by measures of socio-economic status in this study.

Keywords

Cancer Cardiovascular disease Diabetes mellitus Socio-economic status Tooth loss Women 

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References

  1. 1.
    Loesche, WJ, Schork, A, Terpenning, MS,  et al. 1998Assessing the relationship between dental disease and coronary heart disease in elderly U.S. veteransJ Am Dent Assoc129301311PubMedGoogle Scholar
  2. 2.
    Paunio, K, Impivaara, O, Tiekso, J 1993Missing teeth and ischaemic heart disease in men aged 45–64 yearsEur Heart J145456PubMedGoogle Scholar
  3. 3.
    Joshipura, K, Hung, HC, Rimm, EB, Willett, WC, Ascherio, A 2003Periodontal disease, tooth loss, and incidence of ischemic strokeStroke344752PubMedCrossRefGoogle Scholar
  4. 4.
    Hung, HC, Willett, W, Merchant, A, Rosner, B, Ascherio, A, Joshipura, K 2003Oral health and peripheral arterial diseaseCirculation10711521157PubMedCrossRefGoogle Scholar
  5. 5.
    Loesche, WJ 2000Periodontal disease: link to cardiovascular diseaseCompend Contin Educ Dent21463482PubMedGoogle Scholar
  6. 6.
    Beck, JD, Offenbacher, S 2001The association between periodontal disease and cardiovascular disease: A state-of-the-science reviewAnn Periodontol6915PubMedCrossRefGoogle Scholar
  7. 7.
    Beck, JD, Offenbacher, S 2002Relationships among clinical measures of periodontol disease and their associations with systemic markersAnn Periodontol77989PubMedCrossRefGoogle Scholar
  8. 8.
    Beck, JD, Offenbacher, S, Williams, R,  et al. 1998Periodontitis: A risk factor for coronary heart disease?Ann Periodontol3127141PubMedGoogle Scholar
  9. 9.
    Joshipura, KJ, Rimm, EB, Douglass, CW,  et al. 1996Poor oral health and coronary heart diseaseJ Dent Res75916311635Google Scholar
  10. 10.
    Wu, T, Trevisan, M, Genco, R,  et al. 2000Examination of the relation between periodontal health status and cardiovascular risk factors: Serum total and high density lipoprotein cholesterol, C-reactive protein, and plasma fibrinogenAm J Epidemiol151273282PubMedGoogle Scholar
  11. 11.
    Lapidus, L, Bengtsson, C 1986Socio-economic factors and physical activity in relation to cardiovascular disease and death: A 12-year follow up of participants in a population study of women in Gothenburg, SwedenBr Heart J55295301PubMedCrossRefGoogle Scholar
  12. 12.
    Cabrera, C, Helgesson, Ö, Wedel, H,  et al. 2001Socioeconomic status and mortality in Swedish women: Opposing trends for cardiovascular disease and cancerEpidemiology12532536PubMedCrossRefGoogle Scholar
  13. 13.
    Bengtsson, C, Blohmé, G, Hallberg, L,  et al. 1973The study of women in Gothenburg 1968–1969 – A population study, general design, purpose, and sampling resultsActa Med Scand193311318PubMedCrossRefGoogle Scholar
  14. 14.
    Bengtsson, C, Ahlqwist, M, Andersson, K 1997The prospective population study of women in Gothenburg Sweden, 1968–69 to 1992–93: A 24-year follow up study with special reference to participation, representativeness, and mortalityScand J Health Care15214219CrossRefGoogle Scholar
  15. 15.
    Ahlqwist, M, Bengtsson, C, Hakeberg, M,  et al. 1999Dental status of women in a 24-year longitudinal and cross-sectional study. Results from a population study of women in GöteborgActa Odontol Scand57162167PubMedCrossRefGoogle Scholar
  16. 16.
    Carlsson G. Socialgruppering. Social mobility and class structure. University of Lund, Sweden: GWK Gleerup. 1958.Google Scholar
  17. 17.
    Halling, A, Bengtsson, C 1984Number of teeth and proximal periodontal bone height in relation to social factorsSwed Dent J818391PubMedGoogle Scholar
  18. 18.
    Parmar, M, Machin, D 1995Survival analysis – A practical approachJohn Wiley and Sons LtdChichesterGoogle Scholar
  19. 19.
    Ahlqwist, M, Bengtsson, C, Gröndhal, H-G,  et al. 1991Social factors and tooth loss in a 12 year follow-up study of women in Gothenburg, SwedenCommunity Dent Oral Epidemiol19141146PubMedCrossRefGoogle Scholar
  20. 20.
    Johansson, I, Tidehag, P, Lundberg, V,  et al. 1994Dental status, diet and cardiovascular risk factors in middle-aged people in northern SwedenCommunity Dent Oral Epidemiol22431436PubMedCrossRefGoogle Scholar
  21. 21.
    Halling, A, Bengtsson, C, Lenner, RA 1988Diet in relation to number of remaining teeth in a population of middle-aged women in Gothenburg, SwedenSwed Dent J123945PubMedGoogle Scholar
  22. 22.
    Hujoel, PP, Drangsholt, M, Spiekerman, C,  et al. 2000Periodontal disease and coronary heart disease riskJ Am Med Assoc28414061410CrossRefGoogle Scholar
  23. 23.
    Howell, TH, Ridker, PM, Ajani, UA,  et al. 2001Periodontal disease and risk of subsequent cardiovascular disease in U.S. male physiciansJ Am Coll Cardiol324454450CrossRefGoogle Scholar
  24. 24.
    Danesh, J 1999Coronary heart disease, Helicobacter pylori, dental disease, Chlamydia pneumoniae, and cytomegalovirus: meta-analyses of prospective studiesAm Heart J138S434S437PubMedCrossRefGoogle Scholar
  25. 25.
    Genco, RJ 2001Periodontal disease and risk of coronary heart diseaseJ Am Med Assoc285103CrossRefGoogle Scholar
  26. 26.
    Kinane, DF, Lowe, GDO 2000How periodontal disease may contribute to cardiovascular diseasePeriodontology23121126CrossRefGoogle Scholar
  27. 27.
    DeStefano, F, Anda, RF, Kahn, HS,  et al. 1993Dental disease and risk of coronary heart disease and mortalityBr Med J306688691Google Scholar
  28. 28.
    Mattila, KJ, Beiminen, MS, Valtonen, VV,  et al. 1989Association between dental health and acute myocardial infarctionBr Med J298779781CrossRefGoogle Scholar
  29. 29.
    Herzberg MC, MacFarlane GD, Liu P, et al. The platelet as an inflammatory cell in periodontal diseases: interactions with Porphyromonas gingivalis. In: Genco RJ, Hamada S, Lehner T, et al. (eds), Molecular pathogenesis of periodontal disease. Washington, DC: American Society for Microbiology, 1994: 247–256.Google Scholar
  30. 30.
    Caplan, DJ, Weintraub, JA 1993The oral health burden in the United States: a summary of recent epidemiological studiesJ Dent Educ5785362PubMedGoogle Scholar
  31. 31.
    Downer, MC 1991The improving dental health of United Kingdom adults and prospects for the futureBr Dent J170154158PubMedGoogle Scholar
  32. 32.
    Hjern, A, Grindefjord, M, Sundberg, H,  et al. 2001Social inequality in oral health and use of dental care in SwedenCommunity Dent Oral Epidemiol2916774PubMedCrossRefGoogle Scholar
  33. 33.
    Åström, AN, Rise, J 2001Socio-economic differences in patterns of health and oral health behaviour in 25-year old NorwegiansClin Oral Investig5122128PubMedCrossRefGoogle Scholar
  34. 34.
    Rundgren, Å, Östeberg, T 1987Dental health and parity in three 70-year old cohortsCommun Dent Oral Epidemiol15134136CrossRefGoogle Scholar
  35. 35.
    Genco, RJ 1994Assessment of risk of periodontal diseaseCompendium18S678S683PubMedGoogle Scholar

Copyright information

© Springer 2005

Authors and Affiliations

  • Claudia Cabrera
    • 1
    • 5
  • Magnus Hakeberg
    • 2
    • 3
  • Margareta Ahlqwist
    • 4
  • Hans Wedel
    • 1
  • Cecilia Björkelund
    • 5
  • Calle Bengtsson
    • 5
  • Lauren Lissner
    • 1
    • 5
  1. 1.Nordic School of Public HealthJönköping UniversitySweden
  2. 2.School of Health SciencesJönköping UniversitySweden
  3. 3.Department of Endodontology/Oral DiagnosisGöteborg UniversitySweden
  4. 4.Department of Oral Diagnostic RadiologyGöteborg UniversitySweden
  5. 5.Department of Primary Health Care, Sahlgrenska AcademyGöteborg UniversityGöteborgSweden

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