Interplay Between Oral Health and Cardiovascular Risk Factors in Tooth Loss: Evidence from a Cross-Sectional Analysis

Background: Tooth loss is a cumulative oral-health outcome associated with reduced quality of life and several behavioral and systemic factors. Fewer studies have examined oral hygiene and multiple cardiovascular risk factors simultaneously in relation to the number of missing teeth within the same ambulatory clinical population. Our study examined the cross-sectional associations of oral hygiene status and major cardiovascular risk factors with the number of missing natural teeth in an ambulatory adult population. Methods: In this cross-sectional study, 1031 ambulatory adults underwent clinical assessment of missing natural teeth and oral hygiene status, categorized as good, fair, or poor. Hypertension, obesity, dyslipidemia, current smoking, and diabetes mellitus were recorded. Multivariable negative binomial regression adjusted simultaneously for oral hygiene status, age, sex, and the measured cardiovascular risk factors was the primary analysis, with multivariable linear regression used as a supportive analysis. Results: The mean number of missing teeth increased across oral hygiene categories. In the adjusted negative binomial model, fair oral hygiene (IRR 1.179, 95% CI 1.114–1.248) and poor oral hygiene (IRR 1.490, 95% CI 1.406–1.579) were associated with a higher expected number of missing teeth compared with good oral hygiene. Increasing age (IRR 1.031 per year, 95% CI 1.029–1.033), current smoking (IRR 1.147, 95% CI 1.099–1.198), and diabetes mellitus (IRR 1.118, 95% CI 1.056–1.182) were also associated with a higher expected number of missing teeth. Sex, hypertension, obesity, and dyslipidemia were not statistically significant in the fully adjusted model. Conclusions: Poorer oral hygiene, older age, current smoking, and diabetes mellitus were associated with a greater number of missing teeth after adjustment for the other measured covariates. Because current oral hygiene and cumulative tooth loss were assessed at the same visit, temporal and causal relationships cannot be established. Furthermore, multimorbidity and polypharmacy were not systematically assessed, and their potential contribution to the observed associations could not be evaluated.