Childhood cavities and gum disease raise adult heart disease risk

By Dr. Liji Thomas, MDReviewed by Lauren HardakerMar 4 2026

A national study suggests that cavities and gum disease in childhood may echo decades later in the arteries, reinforcing the idea that protecting young smiles could also help safeguard lifelong heart health.

Study: Childhood oral health is associated with the incidence of atherosclerotic cardiovascular disease in adulthood. Image credit: PeopleImages/Shutterstock.com

Oral disease in adults is linked to cardiovascular disease (CVD), but little is known about the association of CVD with childhood oral health. A recent paper in the International Journal of Cardiology examined this question. In a large nationwide Danish cohort study, researchers found that childhood oral health was associated with adult atherosclerotic cardiovascular disease (ASCVD).

Preventing heart disease may start in childhood

ASCVD accounts for a large chunk of premature mortality due to CVD, and includes ischemic heart disease (IHD), myocardial infarction (MI), and ischemic stroke (IS). Preventive strategies should be rooted in childhood and young adult years, making it important to identify risk factors.

Oral disease in children affects later behavior, nutritional status, and physical growth and development. Oral inflammation occurs with periodontitis and gingivitis, and dental caries, and is widespread in children and adults.

Oral disease contributes to the translocation of oral bacteria to the rest of the body and to low-grade systemic inflammation. Such inflammation is hypothesized to drive atherosclerotic plaque formation and other adverse health outcomes. It may be due to bacteremia and arterial biofilm formation, or oral inflammation. However, little research has explored this association with childhood oral disease.

Linking childhood dental records to ASCVD diagnoses

This Danish study used national registry data, including over 568,000 people aged at least 30 years. They were classified based on the presence and severity of dental caries and gingivitis throughout their childhood. The data came from the National Child Odontology Registry.

Cox regression analyses were used to identify associations between these conditions and ASCVD in adult life. The categories were further stratified by sex to account for the protective effect of estrogen against CVD in females; education, a proxy for socioeconomic and lifestyle factors linked to ASCVD risk; and type 2 diabetes, also linked to CVD.

Persistent childhood dental disease predicts higher ASCVD risk

The study showed that children with poor oral health were more likely to develop CVD in adult life. The risk was highest among children with persistently poor or declining oral health, however, this observational study does not establish causality.

Moderate dental caries and gingivitis affected up to 68 % of participants, but no statistical interaction was found between caries and gingivitis scores.

The most common form of ASCVD in males was MI, comprising 42 % of the total diagnoses, compared to IS, which made up 54 % of the total in females. Males with severe dental caries as children had a 32 % higher risk of ASCVD. For females, the risk was 45 % higher. Severe gingivitis was also associated with a 21 % and 31 % higher risk of ASCVD in males and females, respectively.

Worsening Childhood Dental Caries Raises ASCVD Risk

With moderate to severe dental caries, boys with worsening disease had a 26 % higher incidence of ASCVD as adults. For girls, the risk was 45 % higher. With stable disease, the risk was 21 % higher in males and 41 % higher in females, compared to a stable low-caries history.

Even when oral health improved over time, adult ASCVD risk remained elevated, 19 % higher in males and 31 % higher in females. Overall, worsening or persistently high levels of childhood oral disease were associated with the greatest relative risks.

Gingivitis Trajectories and Adult ASCVD Risk

Moderate to severe gingivitis showed similar trends but with a more muted pattern. Improving disease trajectories in males was associated with a modestly increased risk of ASCVD in adult life, at 8 %. Worsening or stable disease was associated with a 13 % increased risk. In females, worsening and stable disease were associated with a 27 % and 25 % increase in ASCVD risk, respectively.

Inflammation Pathways Linking Oral Disease and ASCVD

This finding is somewhat unexpected, as periodontal inflammation typically arises from gingivitis rather than dental caries and has been proposed as a pathway linking oral disease to cardiovascular disease. The authors suggest that this pattern may reflect the frequent coexistence of gingivitis with severe dental caries, as well as the indirect role inflammation may play in the development of ASCVD.

Findings from this study also agree with an earlier study showing a correlation between poor oral health in childhood and thicker arterial walls with higher blood pressure in adult life.

Sex-Specific Risks of Childhood Oral Disease

Another study reported that females with a history of childhood oral disease were more likely to have type 2 diabetes, compared to males. Similar sex-specific disparities have been reported for CVD risk following exposure to smoking and poor diet, possibly because these factors have differential effects on physiology in men compared to women.

On the other hand, interaction analyses in the current study did not show any effect of sex on oral disease. Differences in hazard ratios may reflect sex-specific baseline ASCVD hazards rather than a true interaction between sex and childhood oral disease. Further research is necessary to uncover the mechanisms underlying the observed differences.

Socioeconomic Disparities in Oral Health and ASCVD

Underprivileged children have poor access to dental healthcare, putting them at higher risk for oral disease. This study suggests that this could mean this segment of society starts out at a higher risk for adult ASCVD, potentially perpetuating the disparity. However, the study was conducted in Denmark, where access to healthcare differs from many other countries, and the findings may not be directly generalizable to all populations. This could pose a large public health burden, given the high prevalence of ASCVD.

Strengths and limitations

The study does not provide data on smoking and diet, both of which affect oral health and ASCVD risk. Residual confounding is likely, despite adjustment for educational status, which correlates with better lifestyle and oral health. There was no data on adult oral health, despite this being a known risk factor for ASCVD. However, the researchers believe that childhood oral hygiene and dental care habits tend to carry over into adulthood.

In addition, the sample had a relatively young mean age, possibly biasing estimates toward early-onset ASCVD and potentially inflating relative risk estimates.

However, the study’s strengths include the nationwide cohort, long follow-up, and accurate ASCVD and dental caries diagnosis data. These support the conclusions and lend them generalizability in the Danish context.

Childhood oral health may influence lifelong heart risk

The study findings indicate a higher risk of ASCVD in adult life following childhood oral disease of moderate-to-severe intensity, whether stable or worsening. While the relative risks were modest, the high prevalence of childhood oral disease means the population-level implications could still be meaningful.

Investing in childhood oral health may have downstream benefits far beyond the oral cavity, providing further impetus for governments and other stakeholders to invest more in childhood oral health.

Future studies should validate these findings, as they may indicate a modifiable risk factor for ASCVD.

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