CVD, Mortality Risk in Older Women Predicted by Tooth Loss and Periodontitis

Periodontitis was associated with an increased mortality risk while edentulism was linked with an increased cardiovascular disease risk.

A recent study by researchers from multiple US universities linked periodontitis with elevated mortality rates, and edentulism with increased mortality and cardiovascular disease (CVD) risk.1  

Periodontitis and tooth loss affect an estimated 64% and 33% of Americans age 60 and older, respectively, to a moderate to severe degree.2,3 Although both conditions have been associated with an increased risk of atherosclerotic CVD and mortality, studies involving women and older adults have been scarce or have produced inconsistent results.4-7

Noting that “understanding the relationship of periodontitis and tooth loss with CVD risk and mortality is relevant to health and population aging,” the study researchers investigated these associations in 57,001 postmenopausal women participating in the Women’s Health Initiative Observational Study across 40 sites in the United States.

The mean age of the patients was 68 (>85% 60 and older), and they did not have known CVD when they were initially evaluated for periodontitis and edentulism at year 5 of the study.

Periodontitis status was self-reported with a yes-or-no answer to the question “Has a dentist or dental hygienist ever told you that you had periodontal or gum disease?” Participants were also asked if they had visited the dentist’s office for a cleaning or checkup within the past 3 years and whether they had lost their permanent teeth.

During a mean follow-up period of 6.7 years, 3589 CVD events and 3816 deaths occurred in the study participants, and the following results were observed:

  • While multivariable analysis showed no relationship between periodontitis and CVD events, there was a connection between periodontitis and increased mortality (hazard ratio [HR]: 1.12, 95% CI, 1.05-1.21).
  • After adjustment for smoking and age, edentulism was linked with increased CVD risk (HR: 1.42; 95% CI, 1.27-1.59) and mortality (HR: 1.47; 95% CI, 1.32-1.63).
  • The CVD-edentulism connection was especially pronounced in women who had ≥1 annual dental visit (HR: 1.57) compared with women who had <1 visit (HR: 1.03; P =.004).

Inflammation and infection, both established contributors to atherosclerosis, are key aspects of periodontal disease progression.

“The mouth could be serving as a reservoir for bacteria and inflammation that make their way into the overall circulation and to atherosclerotic plaque within coronary or brain arteries,” lead investigator Michael J. LaMonte, PhD, MPH, a research associate professor in the department of epidemiology and environmental health at University at Buffalo in New York, told Cardiology Advisor.

“This would conceivably contribute to onset or progression of atherosclerotic disease, which presumably increases an individual’s likelihood of eventually having a clinical CVD event,” he explained. In addition, there could be an indirect effect in that periodontitis and tooth loss are associated with other CVD risk factors including smoking and diabetes. 

Further research in this area should examine the effects of periodontitis treatment on CVD risk and mortality.


Related Articles



  1. LaMonte MJ, Genco RJ, Hovey KM, et al. History of periodontitis diagnosis and edentulism as predictors of cardiovascular disease, stroke, and mortality in postmenopausal women. J Am Heart Assoc. 2017;29:6(4). doi:10.1161/JAHA.116.004518
  2. Beltran-Aguilar ED, Barker LK, Canto MT, et al. Surveillance for dental caries, dental sealants, tooth retention, edentulism, and enamel fluorosis–United States, 1988-1994 and 1999-2002. MMWR Surveill Summ. 2005;54(3):1-43.
  3. Eke PI, Dye BA, Wei L, Thornton-Evans GO, Genco RJ; CDC Periodontal Disease Surveillance workgroup. Prevalence of periodontitis in adults in the United States: 2009 and 2010. J Dent Res. 2012;91(10):914-920. doi:10.1177/0022034512457373
  4. Tonetti MS, Van Dyke TE; working group 1 of the joint EFPAAP Workshop. Periodontitis and atherosclerotic cardiovascular disease: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. J Periodontol. 2013;84(4 Suppl):S24-S29. doi:10.1902/jop.2013.1340019
  5. DeStefano F, Anda RF, Kahn HS, Williamson DF, Russell CM. Dental disease and risk of coronary heart disease and mortality. Br Med J. 1993;306(6879):688-691.
  6. Garcia RI, Krall EA, Vokonas PS. Periodontal disease and mortality from all causes in the VA Dental Longitudinal Study. Ann Periodontol. 1998;3(1):339-349. doi:10.1902/annals.1998.3.1.339
  7. Hirotomi T, Yoshihara A, Ogawa H, Miyazaki H. Number of teeth and 5-year mortality in an elderly population. Community Dent Oral Epidemiol. 2015;43:226-231.