Are periodontitis patients at risk for atrial fibrillation?

2016 11 01 12 44 24 673 Heart Beat 400

Are patients with periodontitis more likely to be at risk for atrial fibrillation (AF) or atrial flutter (AFL)? In the first population-based study to look at a possible link between periodontitis and atrial fibrillation, researchers from Taiwan report results that may have implications for your patients.

They reviewed the records of almost 800,000 patients in an effort to understand the link between periodontal disease (PD) and the risk from atrial fibrillation.

"Although inflammation has been found to be associated with the development, recurrence, persistence, or severity of PD, no prior longitudinal human studies have reported an association between PD, a chronic inflammatory disease, and AF/AFL," wrote the study authors, led by Der-Yuan Chen, MD, PhD (PLOS One, October 31, 2016).

Dr. Chen is the director of the department of medical education at Taichung Veterans General Hospital in Taichung City, Taiwan.

Irregular heartbeat

Atrial fibrillation is the most common cardiac arrhythmia in the world and occurs when a person's heart has an irregular heartbeat, perhaps too fast or too slow. Heart failure and thromboembolic diseases are possible consequences. Studies have indicated that inflammation has an influential role in how AF begins and continues in a patient.

“This population-based cohort study is the first to suggest an association between PD exposure and the development of AF or AFL.”
— Der-Yuan Chen, MD, PhD, and colleagues

Periodontitis, the authors wrote, is a bacterial-initiated inflammatory disorder with oral and systemic consequences, including systemic inflammation.

The researchers undertook a review of almost 800,000 patients from the years 1999 to 2010 from Taiwan's National Health Insurance Research Database. They enrolled more than 393,000 patients in the periodontal disease group and the same number in the non-PD group. They adjusted for a number of factors, including age, sex, baseline comorbidities, annual number of ambulatory visits, and frequency of dental scaling.

The researchers found that the patients in the periodontal disease group had a 31% greater risk of atrial fibrillation or atrial flutter compared with the non-PD group (see table below).

Incidence rates of AF and AFL by periodontitis status
PD status Total Event (%) Total
person years
Incidence rate
(/105 years)
No PD 393,745 6,180 (1.57) 3,405,292 181
PD 393,745 8,138 (2.07) 4,075,682 200
Data adapted from "Risk of Atrial Fibrillation or Flutter Associated with Periodontitis: A Nationwide, Population-Based, Cohort Study."

The authors also reported that those patients who had at least one dental scaling appointment during the year had a lower risk of AF and AFL compared with those patients who had no such appointments.

Other risk factors

Terrence Griffin, DMD, the president of the American Academy of Periodontology (AAP), said in an email to that this study added to the expanding amount of research that supported the link between periodontal disease and other systemic conditions.

“The researchers note the shared marker of inflammation between periodontal disease and atrial fibrillation," Dr. Griffin wrote."The periodontal community continues to investigate the implication that inflammation -- whether it originates in the gum tissue or exists systemically -- has on the overall health and wellness of individuals."

He noted this study found an increased incidence of periodontal disease exposure and the risk of atrial fibrillation among study participants who had diabetes, hypertension, and heart conditions -- all ailments that have shown an association to periodontal disease in existing research.

"The latest findings about the link between atrial fibrillation and periodontal disease are worth continued study. As such research continues, the AAP encourages patients to develop an informed team of care professionals, including a physician and periodontist, to monitor, assess, and treat any changes in the condition of their physical and oral health, “ Dr. Griffin wrote.

The study had some important limitations, including a lack of patient information about obesity, alcohol consumption, and tobacco use, the authors noted. They reported that all of these factors may be potential risk factors for atrial fibrillation and atrial flutter. Also, the study included no data on the severity of a patient's periodontal disease, which stopped the researchers from exploring the "dose-response relationship" between PD and AF/AFL risk.

"This population-based cohort study is the first to suggest an association between PD exposure and the development of AF or AFL," the authors concluded.

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