Background Oral health conditions such as tooth loss, periodontal (gum) disease and dryness of mouth are very common health problems in older people, with significant impacts on nutrition, quality of life and well-being of ageing populations. Oral health, particularly periodontal disease, has been linked to systemic inflammation, such as high C-reactive protein (CRP) and interleukin-6 (IL-6). However, very few studies of older people have investigated the associations between oral health and inflammation. We examined whether a range of oral health markers are associated with inflammatory markers in two population-based studies of older people in the UK and USA.
Methods Cross-sectional analyses were conducted in the British Regional Heart Study (BRHS) comprising men aged 71–92 (n=2147) from 24 British towns, and the US Health, Aging and Body Composition (HABC) Study comprising men and women aged 71–80 (n=3075). Assessments included oral health (periodontal disease, tooth count, dry mouth) and inflammatory markers such as CRP, IL-6, leptin, tissue plasminogen activator (tPA), von Willebrand Factor (vWF), fibrin D-dimer, high sensitivity Troponin T (hsTnT), N-Terminal prohormone of brain natriuretic peptide (NTproBNP), and proinsulin.
Results In the BRHS, having no natural teeth was associated with being in the top tertiles of CRP, and fibrin D-dimer (odds ratio (OR)=1.35, 95%CI: 1.01–1.80; OR=1.38, 95%CI: 1.03–1.85, respectively) after adjustment for age, social class, smoking, history of cardiovascular disease and diabetes, and BMI. Tooth loss (<21 teeth) was associated with being in the top tertiles of CRP, hsTnT, fibrin D-dimer, and NTproBNP (fully adjusted OR=1.31, 95%CI: 1.02–1.68; OR=1.32, 95%CI: 1.01–1.74; OR=1.37, 95%CI: 1.05–1.77, OR=1.40, 95% CI: 1.01–1.94, respectively). Periodontal disease was associated with being in the top tertile of hsTnT. In the HABC Study, having no teeth and partial tooth loss were associated with being in the top tertile of CRP (OR=1.57, 95%CI: 1.10–2.25; OR=1.40, 95%CI: 1.13–1.75, respectively) after adjustment for age, gender, race, education, smoking, history of cardiovascular disease and diabetes, and BMI. Moreover, having ≥3 oral health problems was associated with being in the top tertiles of CRP and IL-6 after full adjustment.
Conclusion Poor oral health in older people was associated with increased levels of various inflammatory markers including CRP, fibrin D-dimer, hsTnT and NTproBNP. These findings suggest that poor oral health in older age is linked not only to general systemic inflammation but also inflammation associated with metabolic disturbances. These associations could offer insights into mechanistic pathways by which poor oral health could influence age-related conditions.
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