Lack of dental care linked to higher heart and dementia risk

Being unable to afford dental care may increase a person's risk of developing cardiovascular disease or dementia, according to a new study led by researchers at Boston University School of Public Health (BUSPH).

Published in The Journals of Gerontology, Series A, the study found that older people who forego necessary dental procedures because of financial barriers may be more likely to experience heart failure, a heart attack, a stroke, or dementia.

Poor oral health has been previously linked to cardiovascular and neurological conditions, but the prior research was mostly limited to specific oral health issues, such as periodontitis or tooth loss. Being unable to pay for dental care is a modifiable problem that, if addressed, could potentially lower people's chances of developing more serious or fatal health conditions.

"Cost is one of the main barriers to dental care," says study lead author Ms. Mabeline Velez, an instructor of health policy and health services research at BUSPH and a PhD candidate at Boston University's Henry M. Goldman School of Dental Medicine. "As a result, people often delay critical care or they accept the coverage available, which may be more drastic measures-such as getting a tooth pulled than is clinically indicated. Tooth loss, especially early in life, can cause a whole set of health problems later in life including increased mortality. Finding ways to make dental care more accessible and affordable for everyone is a preventative measure that we can take to improve health outcomes down the line."

For the study, Velez and colleagues from BUSPH and the University of California, San Francisco utilized survey data among participants ages 55 and older in the All of Us study, an initiative that the National Institutes of Health launched in 2017 to develop a diverse database on a variety of health conditions. Analyzing electronic health records and survey responses, the team examined the associations of unmet dental care needs due to cost with new diagnoses of heart failure, heart attacks, strokes, and all-cause dementia. A total of 88,496 people were analyzed for incident heart attacks, 86,593 people for heart failure, 88,410 people for strokes, and 92,272 people for dementia.

They found that people who skipped dental checkups and procedures because they could not afford them had higher incidence of all of the above conditions. On a population level, eliminating the financial barriers that prevented people from receiving dental care could prevent 2-4 percent of each outcome among older adults. With the exception of strokes, the associations were reduced after the researchers accounted for socioeconomic, behavioral, and clinical factors. 

The researchers note that this weakened relationship signals that further data is needed to understand and address the underlying or systemic drivers of chronic diseases.

"Multiple studies have evaluated pieces of this puzzle, but this is the first time we can point to financial barriers to care as being linked with the incidence of cardiovascular disease and dementia: two leading causes of disability and death among older adults," says study senior author Dr. Kendra Sims, assistant professor of epidemiology at BUSPH. "This study serves as an indicator that if we alleviate upstream factors such as financial constraints, we can prevent chronic disease."

Fewer than 30 percent of US adults 65 and older have dental insurance and nearly 8 percent say they are unable to afford necessary dental care. Medicare and Medicaid do provide dental coverage, but that coverage is limited and often excludes preventive services. Medicaid dental coverage also varies widely by state, and in some instances, only covers emergency care. 

Policies that facilitate access to preventive dental care could widely reduce poor oral health outcomes, with benefits that extend to cardiovascular and cognitive outcomes, the researchers say. For example, states that extended dental care under the Affordable Care Act reported an increase in dental visits, fewer missing teeth, and better overall oral functioning. 

These dental visits also present an opportunity to conduct other health screenings.

"People who can access and afford routine dental care typically visit the dentist twice a year," Dr. Sims says. "What if insurance could cover screening for cardiovascular risk factors like diabetes or hypertension when a patient is in the chair?" 

For her dissertation, Ms. Velez is exploring how periodontitis, a condition where plaque built up on the gums causes inflammation and infection, can eventually lead to cardiovascular issues. 

"Periodontitis is very common, but it is a treatable disease," she says. "I hope this new insight will encourage doctors to integrate dental care into general practice."