Home Product Information Clinical Studies Store - Purchase a Purebrush and Accessories Testimonials

Results

Demographics and medical history. Data were collected from 320 subjects, 99 percent of whom were male. There were no age or racial differences among the subjects with and without a diagnosis of CHD. Because the relationship between dental status and CHD was the primary parameter under investigation, the results are shown separately for the dentate subjects, the edentulous subjects and all subjects combined. Forty-six percent of the dentate subjects and 53 percent of the edentulous subjects had received a diagnosis of CHD. This stratification of subjects, based on the presence of teeth, was not associated with any difference in age, race or any of the standard risk factors analyzed for CHD (Table 1).


Subjects with and without CHD had similar BMIs, blood pressures and total serum cholesterol levels. The edentulous subjects were more likely to be current smokers than were the dentate subjects. Subjects without CHD were more likely to report that they drank alcoholic beverages on a daily basis. Subjects with CHD received significantly more medications of any type and more xerogenic medications than did subjects without CHD.


Dental findings. The dentate subjects with CHD had significantly fewer teeth than the dentate subjects without CHD (Table 2). Significantly more subjects with CHD had from one to 14 teeth, compared with subjects without CHD (P = .007). Dentate subjects with CHD were significantly more likely to be wearing at least one full denture than were dentate subjects without CHD. Among the edentulous subjects, there was no relationship between wearing full dentures and CHD status. Most subjects complained of dryness at some time during the day, but the complaint was significantly more frequent in the subjects with CHD, especially in the dentate subjects.


We examined the tooth-related parameters in more detail by comparing the oral health variables in subjects with one to 14 teeth with those in subjects having 15 to 28 teeth (Table 3). We report the findings as a percentage of teeth with decay or periodontal morbidity because subjects with one to 14 teeth would have a smaller number of involved teeth than would subjects with 15 to 28 teeth. Thus, by reporting dental decay and periodontal disease as a percentage of teeth with the given problem, we could compare results between subjects with one to 14 teeth and those with 15 to 28 teeth.


Bacterial findings. Because some of the observed oral conditions might affect certain bacterial species on the tooth/mucosal surfaces, we measured the salivary levels of representative oral and medically important species. Salivary levels of yeast were significantly higher in all subjects with CHD than in all subjects without CHD (2.9 log10/milliliter vs. 2.5 log10/mL, P < .05, Wilcoxon test), whereas the levels of Streptococcus sanguis were significantly lower in subjects with CHD than in subjects without CHD (Table 2).


The levels of cariogenic organisms, such as Streptococcus mutans and the lactobacilli species, did not differ between subjects with or without CHD. Streptococcus sobrinus, another cariogenic species, was rarely encountered, but when it was, the levels were elevated in dentate subjects without CHD and in edentulous subjects without CHD.


There were no differences in the salivary levels of certain periodontopathic species such as Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum and Capnocytophaga species, or in levels of medically important species, such as b-hemolytic streptococci, Bacteroides fragilis and aerobic gram-negative bacilli. There was no apparent difference in the mean plaque BANA score or in the percentage of subjects with plaque BANA scores of 2 or greater as a function of number of teeth or CHD status. (A BANA score of 2 or greater means that all four plaque samples tested positive.)


Statistical models. We initially evaluated three logistic regression models, one that included all subjects, but omitted the tooth-related variables (Table 4); one that was restricted to the dentate subjects but included all the variables (Table 4); and one that included only edentulous subjects. The edentulous subject model showed that the higher numbers of medications used were positively associated with CHD, but since this variable along with others were significant in the other models, we omitted the edentulous model. Because some of the parameters asso-ciated with CHD in the bivariate analyses, such as number of medications taken, presence of dentures, complaints of dry mouth and various oral hygiene parameters, could be a function of the dependent living status, a separate variable for dependent living was added to the model.


As Table 4 shows, dependent living status was not significant in the all-subjects and dentate subjects models. CHD was 2.64 times more likely to be found in subjects with one to 14 teeth than in subjects with either zero teeth or 15 to 28 teeth. A higher salivary level of S. sanguis was inversely associated with CHD. A higher number of medications taken and a complaint of xerostomia were significantly associated with CHD. The reported daily consumption of alcoholic beverages had a significant negative association with CHD � that is, an odds ratio, or OR, of less than one.


When the recognized risk factors such as the BMI, age, total serum cholesterol levels, smoking status and diabetic status were added to the model, they were not statistically associated with CHD. They did not affect the significance of the other variables in the model.


As Table 4 shows, CHD was 2.92 times more likely to be found in dentate subjects with one to 14 teeth than in dentate subjects with 15 to 28 teeth. Again, a higher salivary level of S. sanguis had a significant negative association with CHD. The mean BANA score was 2.08 times more likely to be higher in subjects with CHD. None of the measured oral hygiene parameters was significant. The complaint of xerostomia was positively associated with CHD, as was the number of medications taken. The daily consumption of alcoholic beverages was not significantly associated with CHD and was dropped from the model. When the recognized risk factors were included in the dentate subjects model, none was found to be significantly associated with CHD.


The prevalence of CHD in residents in the long-term care facility (dependent living) was 62 percent compared with 42 percent in the dental outpatients (independent living) (Table 5). This raised a concern that there may be factors operating in the nursing home subjects that were not detected in our all-subjects models (Table 4). Accordingly, we repeated the modeling procedure using separate models for the independent living group and the dependent living group. In the independent living, all-subjects model, the greater use of medications and daily consumption of alcoholic beverages were significantly associated with CHD, but the presence of one to 14 teeth, a complaint of xerostomia and salivary levels of S. sanguis were no longer significantly associated with CHD (Table 5).


In the independent living, dentate subjects model, the presence of one to 14 teeth, a complaint of xerostomia, a greater use of medications and a higher BANA test score had significant positive associations with CHD, and the salivary levels of S. sanguis had significant negative associations with CHD. A higher level of gingivitis, as measured by the PBS, was also significantly associated with CHD (Table 5). A higher OR for the PBS paralleled the clinical severity of the condition, as gingivitis that did not involve bleeding had an OR of 2.4, and gingivitis that involved bleeding had an OR of 4.6.


The smaller number of subjects in the dependent living group hampered the modeling procedures, especially in the dentate model, but the presence of one to 14 teeth and salivary levels of S. sanguis were significantly associated with CHD in both the all-subjects and dentate subjects models (Table 5). In the all-subjects model, patients who had a complaint of xerostomia were 2.92 times more likely to have CHD. Two variables became significant for the first time: subjects who quit smoking were 11.9 times more likely to have CHD than subjects who never smoked, and subjects who controlled their diabetic condition with diet were almost five times less likely to have CHD than diabetic subjects who did not control their condition with diet.

Subjects and methods

Discussion

 

Home | Information | Clinical Studies | Press Releases | Store | Testimonials

123 Primrose Road - Burlingame, CA 94010
Sales: 800-439-2497 Lab: 650-579-1352
 Fax: 650-579-1351 Email:
info@purebrush.com