Cardiovascular risks of periodontitis and oral hygiene indicators in patients with diabetes mellitus

Tae Jin Song, Jimin Jeon, Jinkwon Kim

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18 Scopus citations


Aim: Periodontitis is a common chronic inflammatory disease prevalent in diabetes. The aim of this study was to evaluate periodontitis and poor oral hygiene as independent risk factors for either cerebral or myocardial infarction in the diabetes population. Methods: This retrospective cohort study included 17,009 patients with diabetes who had participated in a nationwide health-screening programme, including oral health examination, during 2002–2003 in South Korea. Presence of periodontitis, tooth loss and carious teeth were assessed by professional dentists, and the number of tooth brushings per day was evaluated through self-reported questionnaires. The primary study outcome was the development of cerebral or myocardial infarction, based on International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) codes, up to 31 December 2015. Results: The study enrolled 17,009 patients with diabetes. Over the mean 11.64 years of follow-up, 1341 patients presented with either cerebral or myocardial infarction. On multivariable Cox proportional hazards regression analysis, presence of periodontitis was an independent risk factor for either cerebral or myocardial infarction [adjusted hazard ratio (HR): 1.17, 95% confidence interval (CI): 1.02–1.34; P = 0.030]. An increased number of carious teeth (≥5) was also associated with risk of cerebral or myocardial infarction (adjusted HR: 1.67, 95% CI: 1.20–2.32; P = 0.002), whereas frequent tooth brushing (≥2 times/day) was negatively associated with risk of cerebral or myocardial infarction (adjusted HR: 0.79, 95% CI: 0.70–0.90; P < 0.001) compared with tooth brushing ≤1 time/day. Conclusion: Early identification and intervention of periodontal disease may be effective in reducing cardiovascular complications in the diabetes population, and improved oral hygiene would probably be associated with lower cardiovascular risk in diabetes.

Original languageEnglish
Article number101252
JournalDiabetes and Metabolism
Issue number6
StatePublished - Nov 2021

Bibliographical note

Funding Information:
This work was supported by the Basic Science Research Program through the National Research Foundation (NRF) of Korea funded by the Ministry of Education ( NRF-2020R1I1A1A01060447 to J.K., 2018R1D1A1B07040959 to T.-J.S.), and by a faculty research grant from Yonsei University College of Medicine for 2020 ( 6-2020-0065 ).

Publisher Copyright:
© 2021


  • Cerebral infarction
  • Diabetes mellitus
  • Myocardial infarction
  • Periodontitis
  • Tooth brushing


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