Oral hygiene, quality of life, and risk of heart failure

Heart failure (HF) is a debilitating form of cardiovascular disease that is increasing worldwide. Poor oral health is an established risk factor for cardiovascular disease, but there are few studies specific to the development of HF. In particular, there are no known studies on oral hygiene and HF in the United States. This study characterizes the association between oral hygiene, oral health-related quality of life (OHRQoL), and risk of HF in adults.

A case-control sample was assembled from adult patients of the Marshfield Clinic Health System in north-central Wisconsin. HF cases were matched on age and sex to HF-free controls. HF case status, along with clinical covariates, were extracted from electronic health records. Surveys were used to collect oral health exposures (toothbrushing, flossing, dental visits, and OHRQoL) and other sociodemographic covariates. Multivariable regression was used to examine associations with HF.

Survey response rates were 67% in HF cases and 74% in HF-free controls, yielding an analytical sample of 410 individuals. OHRQoL was not significantly associated with HF, but both oral hygiene and last dental visit were. Specifically, multivariable models revealed that participants with excellent oral hygiene had significantly lower odds of HF as compared to those with fair/poor oral hygiene [aOR = 0.47 (CI: 0.24, 0.95), p = 0.035]. Similarly, participants with a more recent dental visit that occurred less than two years prior had significantly lower odds of HF as compared to participants with a dental visit that occurred more than two years prior [aOR = 0.43 (CI: 0.25, 0.74), p = 0.002].

Good oral hygiene (i.e., regular toothbrushing/flossing) and a recent dental visit were protective against HF. If poor oral health is established as a causal contributor to HF in future research, it could open up previously unrecognized or underappreciated additional pathways to prevention whereby the risk of HF development could be interrupted by more intense screening/recognition of deteriorating oral health by medical care teams, as well as a more direct focus on cardiovascular disease prevention by dental care teams.