Publication Date




Embargo Period


Degree Type


Degree Name

Doctor of Philosophy (PHD)


Public Health Sciences (Medicine)

Date of Defense


First Committee Member

Daniel J. Feaster

Second Committee Member

Mark Stoutenberg

Third Committee Member

WayWay M. Hlaing

Fourth Committee Member

Neil Schneiderman

Fifth Committee Member

Marc D. Gellman

Sixth Committee Member

Lisa Rosen-Metsch


Cardiovascular disease (CVD) is the leading cause of death for both men and women in the U.S. and is responsible for 1 in 4 deaths annually. While mounting evidence points to an association of periodontal disease (PD) with a significant increase in the risk of CVD, independent of established CVD risk factors, this association has not been studied in Hispanic/Latino populations. Dental care settings offer an untapped health care setting to expand access to screening and early identification of cardiovascular disease (CVD) risk. However, little is known about dentist or patient viewpoints towards CVD screening in the dental office. The objectives of this dissertation were to examine the associations between PD and CVD risk among Hispanics/Latinos, and then to independently assess dentists’ willingness and patient acceptance of screening for CVD in the dental care setting. Three independent cross-sectional studies will evaluate the overall objectives of this dissertation. Study 1 examined the association between PD severity and CVD risk using data collected from the Hispanic Community Health Study / Study of Latinos (HCHS/SOL). The HCHS/SOL is a prospective study that enrolled more than 16,000 self-identified Hispanic/Latino adults from four geographic areas of the U.S. Unique to the HCHS/SOL are measures for PD severity according the most recent Centers for Disease Control and Prevention and the American Association of Periodontology grading guidelines. The HCHS/SOL data set also includes the Framingham (10-year risk) general risk score, a validated measure of CVD risk. The results are the first findings of the association of PD severity and FGRS in a Hispanic/Latino population indicated that the Hispanic/Latino population is a heterogeneous population with a varying, but significant, burden of CVD risk that is associated with PD. Among those exhibiting moderate or severe PD, the study demonstrated a significant sex disparity in 10-year CVD risk. Moreover, the results described heterogeneity in FGRS associated with Hispanic/Latino background that increased across age strata among women and men with moderate or severe PD. Study 2 used data derived from a random sample of 2,876 U.S. dentists, stratified by urbanicity and practice type, from the American Dental Association sampling frame. This study examined the association between dentists’ beliefs, knowledge, practice characteristics, and demographic factors with their willingness to screen for CVD in the dental care setting. The study results indicate that dentists who screened for hypertension, obesity, and who considered CVD screening as part of their role as health professionals were more willing to included CVD screening in their practices This study points to strategies intended to expand future access to early detection of CVD risk. Emphasizing screening for CVD in dental school curricula and providing opportunities for clinical experiences in CVD screening during professional education are among the implications of the study. Study 3 analyzed survey responses of 400 attendees of a university-sponsored dental clinic, who were selected by systematic random sampling. Study 3 examined the correlates of patient acceptance of CVD screening in the dental care setting. This study found that that patients’ belief that oral health was related to overall health and those with a self-rated moderate or high risk of heart disease were also more likely to accept CVD screening by their dentist. Moreover, while dental anxiety did not prevent patients’ use of dental care services, the patients in this study who exhibited high or severe dental anxiety were significantly less likely to accept CVD screening than those with low or moderate dental anxiety. Taken together the studies presented in this dissertation indicate that association demonstrated between PD and CVD risk along with the unique strategies identified to promote dentists’ acceptance of CVD screening for a patient population that will readily accept screening, offer public health opportunities that cannot be ignored. The results speak loudly to dentists, emphasizing that they stand on the threshold of opportunity to reshape the scope of future dental practice in response to severe public health burden of CVD.


Epidemiology; Oral Health; Cardiovascular disease; Periodontal disease; Dentist perspective; Patient perspective