Researchers Investigate the Association between Childhood Oral Health and Adult Cardiovascular Disease Risk

Cardiovascular diseases significantly contribute to the global burden of disease, with atherosclerotic cardiovascular diseases (ASCVD) considered the most common causes of premature death. ASCVD is caused by plaque buildup in arteries and includes conditions such as ischemic heart disease, myocardial infarction, and ischemic stroke.^1,2 It is plausible that prevention strategies that include addressing risk factors during childhood and early adulthood may reduce the risk of developing ASCVD in middle age. To do so, we must identify both common and novel risk factors for early intervention and develop prevention strategies.¹

The effects of oral health on nutrition, behavior, and physical health later in life are well documented.¹ Oral diseases such as gingivitis, periodontitis, and dental caries are among the most prevalent diseases worldwide, across all demographics.^1,3 In the United States, dental caries is the most common chronic disease in children.³ In fact, the Centers for Disease Control and Prevention (CDC) reported in 2020 that an estimated 46% of children aged 2 to 19 have untreated or restored dental caries.^1,4 Although childhood periodontitis is rare (0.2%–0.5%), its precursor, gingivitis, is one of the most common inflammatory conditions in humans. Even so, oral health care in children is often delayed or overlooked.¹

Oral health is increasingly recognized as being associated with systemic health. Two key pathways have been proposed to explain this association: chronic systemic low-grade inflammation and oral bacterial dissemination from the oral cavity to the rest of the body through translocation. Previous studies have reported an association between periodontal disease and cardiovascular disease in adults. Yet studies on the long-term effects of oral disease in children on cardiovascular health are limited.¹

To address this gap, a longitudinal epidemiological study investigated the association between childhood oral health and the risk of developing ASCVD. The authors hypothesize that childhood dental caries and gingivitis are associated with the incidence of adult-onset ASCVD, specifically ischemic heart disease, myocardial infarction, and/or ischemic stroke.¹

The Study

This nationwide study used the Danish registry data from 1995 to 2018 to evaluate the association between childhood oral health and adult-onset ASCVD. Participants born between 1963 and 1972 were followed from January 1, 1995, or from age 30, whichever came last, until their first ASCVD diagnosis, death, emigration, or the end of follow-up at the study’s conclusion.¹

The primary outcome was the first registered event of ischemic heart disease, myocardial infarction, or ischemic stroke. Researchers categorized disease levels, measured via dmft/DMFT scores and the Silness and Löe gingival index, into groups based on peak recorded childhood disease severity. They also mapped disease trajectories by comparing highest dental caries scores (DCS) and gingival index scores (GI) before and after age 12 to classify participants’ oral health over time.¹

The Results

Childhood oral disease severity was positively associated with adult-onset ASCVD incidence in both sexes. Compared with low DCS, males with high DCS had a 32% higher risk of ASCVD, while high GI scores were associated with a 21% higher risk. Females showed even higher relative risk increases, with high DCS associated with a 45% increase and high GI scores with a 31% increase.¹

Evaluating childhood oral health trajectories showed that persistent or worsening disease elevated long-term cardiovascular risk compared to a baseline of stable, low disease. Males with a worsening, moderate-to-severe caries trajectory experienced a 26% higher ASCVD incidence, while females in the same trajectory had a 45% higher incidence in adulthood. Stable, moderate-to-severe caries trajectories similarly increased risk by 21% in males and 41% in females.¹

Gingivitis trajectories followed a similar pattern, suggesting higher risk associated with worsening disease trajectories. Worsening moderate-to-severe trajectories conferred up to a 13% higher risk than a stable trajectory with low-level disease in males. In females, moderate-to-severe disease was associated with a 27% higher incidence of ASCVD in adulthood, while a stable trajectory at the same disease level was associated with a 25% higher risk. Low-disease trajectories, whether improving or worsening, showed no statistically significant differences in ASCVD incidence compared to stable low-disease baselines.¹

Limitations

Several limitations should be considered when interpreting the study’s findings. First, reliance on Danish registry data prevented direct adjustment for key lifestyle factors such as smoking, dietary habits, and physical activity, behaviors known to correlate with both poor oral health and ASCVD. Second, the study could not account for adult oral health status. However, childhood dental habits, dietary habits, and oral hygiene patterns typically persist into adulthood. Further, evidence shows that poor oral health is associated with increased risk of ASCVD in adulthood. This suggests potential health benefits of improving childhood oral health.¹

Additional methodological limitations involve exposure measurement and cohort age. Using the dmft/DMFT index may introduce imprecision, as it conflates active caries with restored caries or inactive lesions. Finally, because the cohort was relatively young at follow-up (ending around age 50), the overall number of cardiovascular events was limited, potentially biasing the sample toward early-onset ASCVD phenotypes and inflating hazard ratios.¹

Despite these limitations, the study has some strengths that support the validity of its conclusions. Using nationwide registries provided a large sample size, decades of follow-up, and highly accurate ASCVD diagnosis data from the Danish National Patient Register, where missing acute care records are minimal. Furthermore, detailed historical childhood oral health metrics from the National Child Odontology Registry accurately reflect dental caries prevalence, though gingivitis prevalence may be underestimated. Nonetheless, this offers a rare longitudinal perspective on early-life disease burden in a Danish population. However, the overall generalizability of the results worldwide may vary.¹

Conclusion

This study found that higher levels of childhood dental caries and gingivitis, alongside worsening or persistently moderate-to-severe disease trajectories, are associated with an increased incidence of adult-onset ASCVD. Given that dental care remains the greatest unmet healthcare need among children in the United States, even the modest hazard ratios observed here translate into substantial population-level impacts on overall ASCVD burden.¹

While this observational design cannot establish direct causality or rule out unmeasured lifestyle factors or other confounders, the results suggest childhood oral health may be a modifiable early-life risk factor for cardiovascular prevention. Further studies are needed that adjust for lifestyle factors and adult oral health. The authors suggest that mitigating future ASCVD burden will likely require greater multidisciplinary collaboration between dental and cardiovascular healthcare providers, alongside sustained public policy investment in pediatric oral healthcare programs to promote oral and cardiovascular health.¹

Before you leave, check out the Today’s RDH self-study CE courses. All courses are peer-reviewed and non-sponsored to focus solely on high-quality education. Click here now.

Listen to the Today’s RDH Dental Hygiene Podcast Below:

References

1. Nygaard, N., D’Aiuto, F., Eriksen, A.K., et al. Childhood Oral Health is Associated with the Incidence of Atherosclerotic Cardiovascular Disease in Adulthood. Int J Cardiol. 2026; 448: 134151. https://www.internationaljournalofcardiology.com/article/S0167-5273(25)01194-5/fulltext
2. Atherosclerotic Cardiovascular Disease. (n.d.). American Heart Association. https://www.heart.org/en/professional/quality-improvement/ascvd
3. Data and Statistics: Children. (2022, November). National Institute of Dental and Cranial Research. https://www.nidcr.nih.gov/research/data-statistics/children
4. Oral and Dental Health. (2026, June 12). Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/fastats/dental.htm