Loss of alveolar bone due to periodontal disease exhibits a threshold on the association with coronary heart disease

Background: A number of epidemiologic studies were published that looked at the association between coronary heart disease (CHD) and periodontal disease. However, debate exists about whether this association is a true relationship or simply an example of an uncontrolled confounder. This retrospective cohort study examines the relationship between periodontal disease and CHD. Methods: Digital panoramic radiographs were used to assess alveolar bone loss (ABL) using a Schei ruler. Participants consisted of Veterans Administration (VA) patients who were eligible for dental benefits and had a digital panoramic radiograph taken at the VA Medical Center, Denver, Colorado. Information on CHD and other important clinical variables were obtained from electronic medical records. Results: The examination of the relationship between ABL and CHD revealed a significant non-linear relationship with a threshold at ̃20% bone loss with a doubling of the probability ratios of CHD compared to those at 7.5% bone loss. Conclusions: To our knowledge, this is the first study to demonstrate a non-linear relationship between ABL and CHD. A significant positive association between ABL and CHD was found at even low levels of bone loss between 10% and 20%. J Periodontol 2011;82:1304-1313.