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Published: 03 February 2023 Oral hygiene, mouthwash usage and cardiovascular mortality during 18.8 years of follow-up

Sok-Ja Janket, Caitlyn Lee, …Jukka H. Meurman Show authors British Dental Journal (2023)Cite this article

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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.