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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. |
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Subjects and methods |
Discussion
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