Infectious dental diseases in patients with coronary artery disease: an orthopantomographic case-control study.

PURPOSE To investigate a potential association between coronary artery disease (CAD) and a variety of radiographically detectable infectious dental diseases, a hospital-based prospective case-control study was conducted in Kuwait. MATERIALS AND METHODS Eighty-eight consecutive patients with a first attack of unstable angina pectoris or acute myocardial infarction were enrolled as cases and were matched on the basis of age, sex and nationality with control patients who were known not to have CAD. The severity and extent of periodontal bone loss and other radiographic signs of infection in both cases and controls were analyzed with orthopantomograms. RESULTS More cases than controls had teeth needing extraction (p = 0.043), periapical lesions (p = 0.028), molars with furcation lesions (p < 0.001), teeth with marginal bone loss > or = 6 mm (p = 0.001) and teeth with angular (vertical) bone loss (p < 0.001). Analysis of the total dental index showed that the median scores were higher for cases than controls for both radiographically diagnosed periodontitis (p < 0.001) and periapical lesions (p = 0.008). CONCLUSIONS In summary, there was a significant association between radiographically diagnosed periodontal diseases and CAD. These results should not be regarded as indicating a causal relationship, especially given that the diagnosis of periodontitis was based only on a radiographic examination. The true impact of oral infections on CAD should be examined in a large prospective clinical and interventional study.