Higher risk of cardiovascular mortality in young edentulous patients treated with dental implants

Background: 
Previous research has reported an association between tooth loss and patient mortality, while, the causal relationship has not been elucidated. 
Rationale: 
The purpose of this study was to examine the cause of death in edentulous patients in relation to a reference population in different age groups.
Patient and methods:
Altogether, 3885 consecutively treated implant patients were provided with implants in the edentulous jaw between 1986 and 2014. Of this group, 2098 patients were deceased during the follow-up period.  Data on the causes of death for these patients were compared to data from the entire Swedish population using the national cause of death register, which is part of the Swedish Health and Welfare Statistical Database. Analyses were performed based on the gender of the patient and age at implant surgery.  Standardized mortality ratios (SMR) were calculated as the observed number of death relative to the expected number. These were tested for statistical significance using SAS/STAT®software.
Results:
Cancers are the most common cause of death in the entire Swedish population in the age range 45-59 years. In contrast, cardiovascular mortality was the most common cause of death in the present study group of 1308 edentulous patients, who were younger than 60 years at the time of implant surgery. In total 386 patients died during the inclusion period and 76 of them were below an age of 60 years when reported as deceased. 
Over the entire inclusion period (1986-2014) there was no statistically significant difference in the causes of death between the study group and the normal reference population, expect for CVD-ralated mortality.  Edentulous patients under 60 years of age who had been treated with implant surgery between 1986-2014 showed significantly increased mortality due to cardiovascular disease (CVD) compared to the reference population of the same age (p<0.05.). 
Conclusion:
Younger patients (<60 years) who are treated today with implants in the edentulous jaw have an increased risk for early mortality related to cardiovascular diseases. 
Impact:
The observation of higher risk for CVD-related mortality in younger edentulous patients nowadays suggests a need for increased awareness of health problems in these patients. However, the causal relationship requires further study. 

Keywords: age, CVD, dental implant; mortality; causes of death; edentulous