Oral health in adults: predictors, social gradients and correlation with cardiovascular health in women and men

A number of diseases are increasing in incidence due to reasons such as increased life expectancy, poor diet and lifestyle. Oral cavity diseases such as caries and gum disease (periodontitis) belong to this group together with cardiovascular disease, among other things. A connection between diseases in the oral cavity and cardiovascular disease has been demonstrated in a number of studies and the spread of bacteria and inflammatory factors from the oral cavity have been indicated as possible causes, but we do not know whether the severity of disease in the oral cavity can be seen in connection with the development of heart - vascular disease. We also do not know how lifestyle factors such as obesity, high blood pressure and diabetes earlier in life affect oral health as we get older, nor whether social status or socio-economic conditions in the course of life are important. Information on health, education, social status and lifestyle has been collected from people who have taken part in the Health Surveys in Hordaland (HUSK 1,2,3), and the first survey was in the early 90s. In HUSK-3, their heart health is examined to determine whether they have incipient heart disease. The same participants have contributed to data in HUSK dental health, an oral and dental health survey where bacteria samples from the participants' gum pockets have also been collected in the period from 2020-2022. The participants (a total of 1,306 people) were born in 1950/51 and are permanent residents of the former Hordaland county. Our results show that the participants had on average lost approx. 3 teeth in their lifetime and had an average of 25 teeth at the time of the survey. Caries requiring treatment were found in 18% of the participants. The majority of the participants considered themselves to be satisfied with their dental health, but those who had less than 20 teeth and who reported dry mouth and jaw joint problems with pain were less satisfied. The incidence of periodontitis among our participants was 92%, with the majority of these (74%) having mild/moderate periodontitis and 26% having severe disease. Our analyzes show that values of some inflammatory markers in the bloodstream, which can be linked to chronic inflammatory conditions and which were measured when the participants were in their late 40s, are not associated with tooth loss or periodontitis later in life. We are now examining microbiome data from the participants' gum pockets and relating them to the incidence and risk factors for cardiovascular disease. With age, the arteries become stiffer and this increases if you have high blood pressure or diabetes. We are therefore now investigating whether stiffer arteries in our participants can be linked to the severity of periodontitis. The project is interdisciplinary and involves researchers from several research institutions with the University of Bergen as the main partner. The research project is carried out in collaboration with Vestland County Municipality, the National Association for Public Health and the Association of Teeth and Health.

Non-communicable diseases (NCDs) are rising in prevalence because of aging, unhealthy diet and sedentary lifestyle, and common NCDs are caries and periodontitis (here oral diseases) and cardiovascular disease (CVD). Association between oral diseases and CVD has been observed in epidemiological studies, and suggested mechanisms include transfer of oral pathogen bacteria and pro-inflammatory mediators to other organs triggering immune response and systemic inflammation. Circulating mediators may initiate a response in the liver with production of C-reactive protein, serum amyloid A and increased tryptophan degradation, that contribute to CV inflammation and atherosclerosis. We have demonstrated that higher serum levels of these markers are associated with presence of hypertension and obesity and with higher risk of CVD. However, CVD and oral diseases also share many of the same risk factors, including hypertension, obesity, diabetes and smoking. Since the association of oral disease with CV risk factors mostly has been demonstrated in cross-sectional studies, the direction has not been ascertained. These CVD risk factors lead to changes in the heart and arteries (preclinical CVD); more harmful in women than men. If these conditions can impact development of oral diseases is not been investigated in large studies. Socio-economic inequalities have been reported for oral diseases and are linked to low socio-economic status (SES). It is unknown whether CV health and SES in midlife may impact prevalence of oral diseases later in life. It is also unknown if the oral microbiome differ by periodontitis severity and can be associated with inflammatory biomarkers, CV risk factors and preclinical CVD. The project will be performed in adults approaching the retirement age in Vestland county. We will combine their data from the ongoing Hordaland Oral Health Survey with their data from three surveys in the longitudinal Hordaland Health Study performed in the period 1992-2020.