Healthier oral hygiene by frequent tooth brushing and professional dental cleaning may reduce risk of atrial fibrillation (the most common cardiac arrhythmia) and heart failure (a clinical syndrome accompanied by decreased ability of cardiac contraction or pumping and/or filling with blood), according to a new study by researchers from the Ewha Womans University College of Medicine and the University of Ulsan College of Medicine, Korea.
“Periodontal disease is common in the general population. It is closely related to oral hygiene behavior such as tooth brushing,” said senior author Dr. Tae-Jin Song of the Ewha Womans University College of Medicine and colleagues.
“Indicators of oral hygiene include presence of periodontal disease, number of tooth brushing per day, professional dental cleaning, and number of missing teeth.”
“Poor oral hygiene can provoke transient bacteremia and systemic inflammation, an immune process known to be a mediator of atrial fibrillation and heart failure.”
“We hypothesized that improved oral hygiene care would be associated with decreased risk of atrial fibrillation and heart failure,” they said.
“Thus, the aim of the study was to investigate the association of oral hygiene indicators with risk of atrial fibrillation and heart failure in a nation-wide general population based longitudinal study.”
The study included 161,286 participants (40-79 years old) of the Korean National Health Insurance System who had no missing data for demographics, past history, or laboratory findings. Participants had no history of atrial fibrillation, heart failure, or cardiac valvular diseases.
They underwent a routine medical examination between 2003 and 2004. For oral hygiene indicators, presence of periodontal disease, number of tooth brushings, any reasons of dental visit, professional dental cleaning, and number of missing teeth were investigated.
During a median follow-up of 10.5 years, 4,911 (3.0%) participants developed atrial fibrillation and 7,971 (4.9%) developed heart failure.
Tooth brushing three or more times a day was associated with a 10% lower risk of atrial fibrillation and a 12% lower risk of heart failure during 10.5-year follow up.
The findings were independent of a number of factors including age, sex, socioeconomic status, regular exercise, alcohol consumption, body mass index, and comorbidities such as hypertension.
While the study did not investigate mechanisms, one possibility is that frequent tooth brushing reduces bacteria in the subgingival biofilm (bacteria living in the pocket between the teeth and gums), thereby preventing translocation to the bloodstream.
“The analysis was limited to one country and as an observational study does not prove causation,” Dr. Song said.
“We studied a large group over a long period, which adds strength to our findings.”
The study was published in the European Journal of Preventive Cardiology, a journal of the European Society of Cardiology.
Y. Chang et al. Improved oral hygiene care is associated with decreased risk of occurrence for atrial fibrillation and heart failure: A nationwide population-based cohort study. European Journal of Preventive Cardiology, published online December 1, 2019; doi: 10.1177/2047487319886018