Toothbrushing, inflammation, and risk of cardiovascular disease: results from Scottish Health Survey

We read with interest the paper by Cesar de Oliveira, Richard Watt
and Mark Hamer entitled ‘Toothbrushing, inflammation, and risk of
cardiovascular disease: results from Scottish Health Survey’ which was
published recently in the BMJ (1). This study found an association between
poor oral hygiene and increased risk of cardiovascular disease. Along the
same lines, we would like to draw our colleagues' attention to previous
studies which have found an association between poor oral hygiene and
inflammatory arthritis. This is also known to be associated with increased
cardiovascular risk.

Patients with juvenile idiopathic arthritis have significantly more
dental decay (2) while patients with rheumatoid arthritis (RA) have
significantly more alveolar bone loss and periodontal disease compared to
healthy controls (3). This is likely to be multi-factorial. Various
studies have shown significant relationships between periodontal disease
and RA and this may be a reflection of a common underlying altered
inflammatory response in these patients (4). As well as exacerbating RA,
periodontal disease may be involved in the aetiology of the disease. RA
patients with concomitant periodontal disease certainly benefit from
having their dental condition optimised since studies have found a
decrease in RA disease activity when compared to patients not receiving
periodontal treatment (5).

Inflammatory arthritis is associated with a high incidence of
cardiovascular disease and the incidence of it in RA is similar to that
found in patients with diabetes mellitus. It is possible that the findings
of increased periodontal disease may explain some of the higher risk of
cardiovascular disease observed in inflammatory arthritis.

We would like to stress the importance of oral hygiene and suggest
that more should be done to raise awareness both among patients and the
general public as to its potentially adverse effects on general health.

References:

(1) de Oliveira C, Watt R, Hamer M. Toothbrushing, inflammation, and
risk of cardiovascular disease: results from Scottish Health Survey. BMJ
2010;340:c2451

(2) Welbury RR, Thomason JM, Fitzgerald JL, Steen IN, Marshall NJ,
Foster HE. Increased prevalence of dental caries and poor oral hygiene in
juvenile idiopathic arthritis. Rheumatology 2003;42:1445-51

(3) Pischon N, Pischon T, Kroger J, Gulmez E, Kleber BM, Bernimoulin
JP, et al. Association among rheumatoid arthritis, oral hygiene, and
periodontitis. J Periodontol 2008;79:979-86.

(4) Mercado FB, Marshall RI, Klestov AC, Bartold PM. Relationship
between rheumatoid arthritis and periodontitis. J Periodontol 2001;72:779
-87.

(5) Ortiz P, Bissada NF, Palomo L, Han YW, Al-Zahrani MS,
Panneerselvam A, et al. Periodontal Therapy Reduces the Severity of Active
Rheumatoid Arthritis in Patients Treated With or Without Tumor Necrosis
Factor Inhibitors. J Periodontol 2009;80:535-40.

Competing interests:
None declared