Periodontal disease among non-diabetic Coronary Heart Disease patients. A case-control study

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Jenisha Patel
Kulkarni Suhas
Dolar Doshi
Pawan Poddar
Adepu Srilatha
Kommuri Sahithi Reddy


Coronary heart disease, periodontal disease, India, epidemiology, oral hygiene


Summary. Background: There is well documented scientific evidence supporting the association between Coronary Heart Disease (CHD) and periodontitis. It is however, uncertain if this association is causal or is mediated by the common inflammatory pathways. Hence, the study assessed and compared the Periodontal Health Status among CHD patients with age and gender matched controls. Methods: A total of 808 medically confirmed CHD patients were compared with 808 age and gender matched controls. Oral examination was conducted using Simplified Oral Hygiene Index (OHI-S) and modified World Health Organization (WHO) Oral Health Assessment form, 1997. Mean scores were compared using Mann- Whitney-U test and Analysis of Variance (ANOVA). Logistic regression analysed the association between the risk factors and CHD. Results: Cases had significantly higher mean sextants with pockets and attachment loss ≥4mm compared to controls (p≤0.05). The cases also had significantly poor oral hygiene mean scores compared to controls (p=0.0001*). There was a lower and insignificant association between age (p=0.99), gender (p=0.84) and CHD. Risk factors education (p=0.001), lesser frequency of dental visit (p=0.001) also showed a lower, yet significant association. Risk of CHD was higher among tobacco (Odds ratio (OR) - 2.26) and alcohol (OR-1.83) users. Presence of poor oral hygiene (OR-5.20), pocket of ≥6 mm (6.70) and attachment loss of ≥9 mm (OR-11.31) also showed higher risk of CHD. Conclusion: The study results support the association between periodontal disease and CHD. To halt the epidemic of CHD, emphasis on screening of wide age range, reinforcement of public health systems and early detection is recommended. (


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Prevention of coronary heart disease. World Health Organ Tech Rep Ser 1982;678:1-53.
Dawber TR, Moore FE, Mann GV. Coronary heart disease in the Framingham study. Am J Public Health Nations Health 1957;47:4-24.
Gupta R, Mohan I, Narula J. Trends in coronary heart disease epidemiology in India. Ann Global Health 2016;82:307-15.
Emingil G, Buduneli E, Alijev A, Akillli A, Atilla G. Association between periodontal disease and acute myocardial infarction. J Periodontol 2000;71:1882-1886.
Kaisare S, Rao J, Dubashi N. Periodontal disease as a risk factor for acute myocardial infarction. A case-control study in Goans highlighting a review of the literature. Br Dent J 2007;203:144-5.
World Health Organization. Global Status report of Non communicable disease 2014. Geneva, Switzerland:World Health Organization:2014.
Registrar General of India. Report on medical certification of cause of death 2014. New Delhi, India: Office of the registrar General. Available at: 2015_c_3191919a.pdf.
Institute of Health Metrics and evaluation. GBD profile:India. http:// 
Prabhakar D, Jeemon P, Roy A. Cardiovascular diseases in India Current epidemiology and future directions. Circulation 2016;133:1605-20.
Gupta R, Guptha S, Sharma KK, Gupta A, Deedwania P. Regional variations in cardiovascular risk factors in India: India heart watch. World J Cardiol 2012;4:112-120.
Gupta R. Epidemiology and regional variations in cardiovascular disease and risk factors in India. J Preventive Cardiology 2011;1:7-15.
Renvert S, Ohlsson O, Pettersson T, Persson GR. Periodontitis: a future risk of acute coronary syndrome? A follow-up study over 3 years. J Periodontol 2010;81:992-1000.
Bazil A, Bissasa NF, Nair R, Siegel BP. Periodontal assessment of patients undergoing angioplasty for the treatment of coronary artery disease. J Periodontol 2002;73:631-636.
Zanella SM, de Souza LV. Suzigan BH, Saba- Chujfi E, Barbisan JN. The Association between Oral Health and Atherosclerotic Coronary Artery Disease in Patients submitted to Coronary Angiography: a Controlled Cross-Sectional Study. Rev Bras Cardiol Invasiva 2012;20:178-83.
Kuramitsu HK, Qi M, Kang IC, Chen W. Role for Periodontal Bacteria in Cardiovascular Diseases. Ann Periodontol 2001;6:41-47.
Fiehn NE, Larson T, Christiansen N, Holmstrup P, Schroeder TV. Identification of periodontal pathogens in atherosclerotic vessels. J Periodontol 2005;76:731-736.
Mackenzie RS, Millard HD. Interrelated effects of diabetes, atherosclerosis and calculus on alveolar bone loss. J Am Dent Assoc 1963;66:191-198.
Malhotra S, Prakash H. Coronary artery disease and periodontitis: a prospective study. JIMSA 2013;26:93-95.
Sikka M, Sequeria PS, Acharya S, Bhat M, Rao A, Nagaraj A. Poor oral health in patients with coronary heart disease: a case-control of Indian adults. N Z Med J 2011;124:53-62.
Parker SM, Modi GN, Jani J. Periodontitis as risk factor for acute myocardial infarction: a case-control study. Heart Views 2013;14:5-11.
Kaisare S, Rao J, Dubashi N. Periodontal disease as a risk factor for acute myocardial infarction. A case-control study in Goans highlighting a review of the literature. Br Dent J 2007;203:144-5.
Yu YH, Chasman DI, Buring JE, Rose L, Ridker PM. Cardiovascular risks associated with incident and prevalent periodontal disease. J Clin Periodontol 2015;42:21-28.
Johansson CS, Ravald N, Pagonis C, Richter A. Periodontitis in patients with coronary artery disease: An 8-year follow-up. J Periodontol 2014;85:417-425.
Hujoel PP, Drangsholt M, Spiekerman C, DeRouen TA. Periodontal disease and coronary heart disease risk. JAMA 2000;284:1406-10.
Greene JC, Vermillion JR. The simplified oral hygiene index. J Am Dent Assoc 1964;68:7-13.
Oral health survey basic methods. World Health Organization, Geneva. 4th ed. Delhi:AITBS Publishers and Distributors;1997.
Greets SO, Legrand V, Charpentier J, Albert A, Rompen EH. Further evidence of the association between periodontal conditions and coronary artery disease. J Periodontol 2004;75:1274-1280.
Janati A, Matlabi H, Allahverdipour H, Gholizadeh M, Abdollahi L. Socioeconomic status and coronary heart disease. Health Promot Perspect 2011;1:105-110.
Mattila K, Vesanen M, Valtonen V, et al. Effect of treating periodontitis on C-reactive protein levels: a pilot study. BMC Infect Dis 2002;2:30.
de Oliveira C, Watt R, Hamer M. Tooth brushing, inflammation and risk of cardiovascular disease: results from Scottish Health Survey. BMJ 2010;340:c2451.
Cueto A, Mesa F, Bravo M, Ocana- Riola R. Periodontitis as risk factor for acute myocardial infarction. A case control study of Spanish adults. J Periodont Res 2005;40:36-42.
Starkhammar Johansson C, Richter A, Lundstrom A, Thorstensson H, Ravald N. Periodontal conditions in patients with coronary heart disease: a case-control study. J Clin Periodontol 2008;35:199-205.
Chambless LE, Heiss G, Folsom AR, Rosamond W, Szklo M, Sharrett AR. Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the atherosclerosis risk in communities (ARIC) study, 1987-1993. Am J Epidemiol 1997;146:483-94.