Carotid artery calcification in panoramic radiographs tied to oral infections and mortality: Study

The authors, S. Paju and colleagues from the Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland conducted the present study to assess the prevalence of carotid artery calcification (CAC) in relation to apical and marginal periodontitis, subgingival dysbiotic bacterial species and serum and saliva immune responses against them. In addition, the researchers also aimed was to analyse the association of CAC with angiographically verified coronary artery disease (CAD) and mortality.

In the present random Parogene cohort, the patients had an indication for coronary angiography. Apical and marginal periodontitis were diagnosed during clinical and radiographic oral examinations, and CAC on panoramic radiographs (n = 492).

Presence and severity of CAD were registered from angiography. Subgingival dysbiotic bacterial species were quantitated using checkerboard DNA‐DNA‐hybridization, and serum and saliva antibody levels were determined by immunoassays.

The cohort was followed‐up for 10 years or until death (median 9.9, range 0.21–10.4) via linkage to the national death register. The statistical models were adjusted for age, gender, smoking, hypertension, diabetes and dyslipidemia.

The results showed that-

a. A total of 102 (20.7%) patients had detectable CAC, which was moderate in 81 (16.4%) and severe in 21 (4.3%).

b. CAC was associated (OR, 95% CI) with severe apical periodontitis (2.25, 1.15–4.41), root canal fillings (1.15, 1.04–1.26), alveolar bone loss (2.66, 1.21–5.84), severe periodontal inflammation (2.23, 1.11–4.47), high level of gram‐negative subgingival species (2.73, 1.34–5.50), saliva IgG against dysbiotic species (1.05, 1.01–1.10/unit) and severe (2.58, 1.36–4.90) and chronic (2.13, 1.15–3.93) CAD.

c. A total of 105 (20.7%) patients died during the follow‐up and 53 (10.4%) deaths were because of cardiovascular diseases (CVD).

d. Severe CAC predicted worse survival with HRs (95% CI) of 3.08 (1.58–6.06) for all‐cause and 3.43 (1.42–8.25) for CVD death.

Hence, the authors concluded that "CAC on panoramic tomography was associated with (i) apical and marginal periodontitis and dysbiotic bacterial species giving rise to an immunological response, and with (ii) severe, chronic CAD and increased mortality."

The results further emphasize the role of oral infections in coronary artery disease and the importance of referring a patient with CAC for a cardiovascular evaluation, they further added.