Oral health behavior associated with cardiometabolic outcomes: A nationally representative cross-sectional study in Portugal

Abstract

Background: Oral diseases are associated with the development of cardiometabolic diseases. This study aimed to evaluate the relationship between oral health behaviors (tooth brushing and oral health appointments) with cardiometabolic diseases. Methods: Data from the First National Health Examination Survey were used. Participants aged 25-74 years and diagnosis of acute myocardial infarction (n = 4442), stroke (n = 4441), hypertension (n = 4450) and diabetes (n = 4327) were analyzed. A fifth subsample (n = 2555) included participants aged 40-69 for calculating cardiovascular risk. Poor oral health behavior was defined as brushing once a day or less and having the last oral health appointment at 12 months or more. Poisson regression models assessed the relationship between poor oral health behavior and these cardiometabolic outcomes. Results: Among 4.450 participants, 20.5 % had poor oral health behavior. A statistically significant association was found between poor oral health behavior with diabetes (PR: 1.44 [95 % CI: 1.10-1.98], and high/very high cardiovascular risk (PR: 1.42 [95 % CI: 1.25-1.62]). In the sensitivity analysis the association with diabetes and high/very high cardiovascular risk persisted when considering only brushing behavior but not when considering only oral health appointments at 12 months or more. Conclusions: Individuals with poor oral health behavior had a higher prevalence of diabetes and high/very high cardiovascular risk. Sensitivity analysis suggested that regular tooth brushing may be the main behavior for preventing diabetes and cardiovascular risk. The results suggest that regular tooth brushing may act in prevention for diabetes and cardiovascular risk.Highlights: - Oral health is associated with cardiovascular outcomes; - Poor oral health increased the prevalence of diabetes and cardiovascular risk; - Regular tooth brushing may help prevent diabetes and cardiovascular risk.INSEF development was part of the project “Improvement of epide miological health information to support public health decision and management in Portugal. Towards reduced inequalities, improved health, and bilateral cooperation”, benefiting a €1,500,000 Grant from Iceland, Liechtenstein and Norway through the EEA Grants. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors