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Oral hygiene, mouthwash usage and cardiovascular mortality during 18.8 years of follow-up

British Dental Journal (2023)Cite this article

Abstract

Aim(s) We tested the following hypotheses: would better oral hygiene self-care (OHS) influence cardiovascular (CVD) mortality? Will using mouthwash in addition to OHS affect CVD mortality? How does mouthwash usage impact the oral microbes?

Design and methods Among 354 dentate subjects from the Kuopio Oral Health and Heart study, the association of OHS with CVD mortality was assessed using Cox regression analyses, adjusting for age, sex, smoking, dyslipidemia, diabetes, hypertension and education. Additionally, whether using mouthwash would affect this relationship was evaluated.

Results In the multivariable-adjusted models, OHS was associated with a 51% reduction in the risk of CVD mortality (hazard ratio [HR] 0.49 [0.28-0.85]; p = 0.01). Even those who had coronary artery disease at baseline showed a marginally significant benefit (0.50 [0.24-1.06]; p = 0.07). However, mouthwash usage did not change OHS effects (HR = 0.49 [0.27-0.87]; p = 0.01), indicating no additional benefits nor detriments. All tested microbes trended to decrease with mouthwash usage in the short term, but none were statistically significant.

Conclusion Good OHS significantly lowered the risk of CVD mortality relative to poor OHS. Mouthwash usage did not show any long-term harm or benefit on CVD mortality beyond the benefits rendered by brushing and flossing.

Key points

  • Good oral hygiene self-care (OHS) that encompasses both brushing and flossing was associated with significantly lower risk of cardiovascular mortality compared with poor OHS during a median follow-up of 18.8 years.

  • The patients who had coronary artery disease at baseline also experienced a marginally significant decrease in the risk of cardiovascular mortality with good OHS (p = 0.07).

  • The additional use of mouthwash with OHS did not influence the risk of cardiovascular mortality.

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Funding

This study was supported by the grant # 0635351N from the American Heart Association awarded to Sok-Ja Janket.

Jukka H. Meurman was supported in part by a grant from the Finnish Medical Society.

Thomas E. Van Dyke was supported NIH/NIDCR grants DE025020 and DE25383.

Author information

Authors and Affiliations

  1. The Forsyth Institute, Centre for Clinical and Translational Research, Cambridge, Massachusetts, USA

    Sok-Ja Janket & Thomas E. Van Dyke

  2. Boston University Externship, Wheeler High School, Providence, Rhode Island, USA

    Caitlyn Lee

  3. Department of Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland

    Markku Surakka

  4. Boston University, H. M. Goldman School of Dental Medicine, USA

    Tejasvini G. Jangam

  5. Department of Neurology, SUNY Downstate Medical Centre, Brooklyn, New York, USA

    Alison E. Baird

  6. Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, University of Helsinki, Helsinki, Finland

    Jukka H. Meurman

Authors
  1. Sok-Ja Janket
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  2. Caitlyn Lee
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  3. Markku Surakka
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  4. Tejasvini G. Jangam
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  7. Jukka H. Meurman
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Contributions

Sok-Ja Janket: designed the study, analysed data, prepared the manuscript and edited and approved the submission to BDJ. Caitlyn Lee: created figures, edited the manuscript, approved the submission to BDJ and performed the actual submission. Markku Surakka: collected the data, edited the manuscript and approved the submission. Tejasvini G. Jangam; created figures, edited the manuscript and approved the submission. Thomas E. Van Dyke: participated in the discussion and edited and approved the submission. Alison E. Baird: contributed to oversight of the data analyses, interpretation of the results and the extensive editing of the manuscript. Jukka H. Meurman designed the study, edited manuscript and approved the submission.

Alison E. Baird and Jukka H. Meurman share senior authorship.

Corresponding author

Correspondence to Sok-Ja Janket.

Ethics declarations

At the time of this study, Caitlyn Lee was a high school student who completed a summer externship at Sok-Ja Janket's laboratory, at Boston University School of Dental Medicine

A portion of this study was submitted as a thesis in partial fulfilment of the requirements for the degree of Master of Science for Tejasvini G. Jangam at the Boston University School of Medicine.

The abstract was presented at the 96th International Association for Dental Research conference in July 2018.

Sok-Ja Janket received a post hoc travel support from SunStar Company to present her results at the International Association for Dental Research conference. This support was made after the data were analysed and manuscript was partially written. Thus, this support could not have affected the results.

The study was approved by the Ethics (institutional review) Board of Kuopio University Hospital and the University of Kuopio in 1995. Written informed consent was obtained from all participants.

No other conflicts of interest are declared.

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Janket, SJ., Lee, C., Surakka, M. et al. Oral hygiene, mouthwash usage and cardiovascular mortality during 18.8 years of follow-up. Br Dent J (2023). https://doi.org/10.1038/s41415-023-5507-4

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