Does Oral Hygiene Trigger Carotid Artery Intima-Media Thickness?


  • Ihsan Sami Uyar
  • Veysel Sahin
  • Mehmet Besir Akpinar
  • Feyzi Abacilar
  • Faik Fevzi Okur
  • Ugur Ozdemir
  • Mehmet Ates
  • Elif Filiz Yasa



Background and Purpose: The aim of this study was to evaluate whether poor oral hygiene is associated with the intima-media thickness of the carotid arteries, which is one of the predictors of future progression of subclinical atherosclerosis.

Methods: We selected 108 patients during periodontal examinations according to their oral hygiene. The patients had no history of atherosclerotic disease. The results of carotid artery B-mode ultrasonography examinations were analyzed at baseline and after a mean of 7.8 months. Patients were scored on the DMFT index for the number of decayed (D), missing (M), and filled (F) teeth (T). We also used the Silness-Loe plaque index (SLI) to evaluate oral hygiene and dental plaque. The patients were divided into 2 groups according to DMFT and SLI criteria. Group I had a DMFT index of 0 to 3 and an SLI score of 0 or 1; group II had a DMFT index of 4 to 28 and an SLI score of 2 or 3.

Results: Dental status and oral hygiene were significantly associated with carotid artery intima-media thickness. Patients with increasing DMFT and SLI indices were correlated with intima-media thickness of the carotid artery.

Conclusions: Chronic poor oral hygiene and tooth loss are related to subclinical atherosclerotic changes in the carotid arteries and might be indicative of future progression of atherosclerosis.


Bartels S, Franco AR, Rundek T, et al. 2012. Carotid intima-media thickness and plaque from risk assessment and clinical use to genetic discoveries. Perspect Med 1:139-45.nBeck JD, Eke P, Heiss G, et al. 2005. Periodontal disease and coronary heart disease: a reappraisal of the exposure. Circulation 112:19-24.nBeck JD, Pankow J, Tyroler HA, et al. 1999. Dental infections and atherosclerosis. Am Heart J 138:528-33.nBlum A, Kryuger K, Eizenberg MM, et al. 2007. Periodontal care may improve endothelial function. Eur J Intern Med 18:295-8.nCotti E, Dessi C, Piras A, Mercuro G. 2011. Can a chronic dental infection be considered a cause of cardiovascular disease? A review of the literature. Int J Cardiol 148:4-10.nDesvarieux M, Demmer RT, Rundek T, et al. 2003. Relationship between periodontal disease, tooth loss, and carotid artery plaque: the Oral Infections and Vascular Disease Epidemiology Study (INVEST). Stroke 34:2120-5.nDesvarieux M, Demmer RT, Rundek T, et al. 2005. Periodontal microbiota and carotid intima-media thickness: the Oral Infections and Vascular Disease Epidemiology Study (INVEST). Circulation 111:576-82.nDesvarieux M, Schwahn C, Völzke H, et al. 2004. Gender differences in the relationship between periodontal disease, tooth loss, and atherosclerosis. Stroke 35:2029-35.nEbersole JL, Machen RL, Steffen MJ, Willmann DE. 1997. Systemic acute phase reactants, C reactive protein and haptoglobin, in adult periodontitis. Clin Exp Immunol 107:347-52.nElter JR, Hinderliter AL, Offenbacher S, et al. 2006. The effects of periodontal therapy on vascular endothelial function: a pilot trial. Am Heart J 151:47.nHoke M, Schillinger T, Mlekusch W, Wagner O, Minar E, Schillinger M. 2011. The impact of dental disease on mortality in patients with asymptomatic carotid atherosclerosis. Swiss Med Wkly 141:w13236.nKiechl S, Egger G, Mayr M, et al. 2001. Chronic infections and the risk of carotid atherosclerosis: prospective analysis from a large population study. Circulation 103:1064-70.nLorenz MW, Markus HS, Bots ML, Rosvall M, Sitzer M. 2007. Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation 115:459-67.nNiessner A, Sato K, Chaikof EL, Colmegna I, Goronzy JJ, Weyand CM. 2006. Pathogen-sensing plasmacytoid dendritic cells stimulate cytotoxic T-cell function in the atherosclerotic plaque through interferon-alpha. Circulation 114:2482-9.nPessoa L, Galvão V, Santos L. 2011. Periodontal disease as a risk factor for cardiovascular disease: suggestion of a further link in systemic lupus erythematosus. Med Hypotheses 77:286-9.nSabeti S, Exner M, Mlekusch W, et al. 2005. Prognostic impact of fibrinogen in carotid atherosclerosis: unspecific indicator of inflammation or independent predictor of disease progression. Stroke 36:1400-4.nSanz M, D'Aiuto F, Deanfield J, Fernandez-Avile F. 2010. European workshop in periodontal health and cardiovascular disease scientific evidence on the association between periodontal and cardiovascular diseases: a review of the literature. Eur Heart J 12(suppl):B3-12.nSaremi A, Nelson RG, Tulloch-Reid M, et al. 2005. Periodontal disease and mortality in type 2 diabetes. Diabetes Care 28:27-32.nSchillinger M, Exner M, Mlekusch W, et al. 2005. Inflammation and Carotid Artery Risk for Atherosclerosis Study (ICARAS). Circulation 111:2203-9.nSchillinger T, Kluger W, Exner M, et al. 2006. Dental and periodontal status and risk for progression of carotid atherosclerosis: the Inflammation and Carotid Artery Risk for Atherosclerosis Study dental substudy. Stroke 37:2271-6.nSoutherland JH, Moss K, Taylor GW, et al. 2012. Poor oral hygiene and diabetes associations with measures of atherosclerosis and CHD. Atherosclerosis 22:196-201.nTonetti MS, D'Aiuto F, Nibali L, et al. 2007. Treatment of poor oral hygiene and endothelial function. N Engl J Med 356:911-20.n



How to Cite

Uyar, I. S., Sahin, V., Akpinar, M. B., Abacilar, F., Okur, F. F., Ozdemir, U., Ates, M., & Yasa, E. F. (2013). Does Oral Hygiene Trigger Carotid Artery Intima-Media Thickness?. The Heart Surgery Forum, 16(4), E232-E236.