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Table 1 Evidence on cardiovascular diseases and caries

From: Associations between dental caries and systemic diseases: a scoping review

Study Objectives and study design Study type Number of participants Location of study Outcomes and conclusions
Human studies on cardiovascular diseases and caries
 Coronary artery disease (CAD)
  Fadel et al.
[29]
Evaluate caries (using Cariogram) and periodontal disease risk in patients with CAD Case-control 127 (54 cases, 73 controls) Saudi Arabia Outcomes: For lifestyle factors, patients with CAD consumed significantly less sugar, used less fluoride toothpaste and had worse periodontal health (p < 0.005). Non-significant differences were noted between groups for caries [mean decayed, missing, and filled surfaces (DMFS)] but both groups had relatively higher caries risk (assessed by Cariogram); gingival recession was correlated positively with onset of CAD
Conclusion: Long-term studies are needed to validate the use of Cariogram in patients with CAD
 Congenital heart disease
  Siahi-Benlarbi et al
 [30]
Investigate oral and intestinal Candida colonization and dental caries status [decayed, missing, and filled teeth (DMFT/dmft)] in immunocompromised pediatric cohort (2–16 yrs) by comparing patients with heart transplants (n = 31) and congenital heart disease (n = 24) to controls (n = 23) Case-control 78 (55 cases, 23 controls) Germany Outcomes: DMFT/dmft (p < 0.001) and intestinal candida colonization (p = 0.027) was significantly lower in transplant patients compared to other groups; significant correlation (p < 0.001) was noted between incidence of Candida and dental caries; significant difference p < 0.001) was noted in between groups for positive serum concentration of Candida-mannan antigen with no Candida-anti-mannan antibodies in the heart transplant group
Conclusion: There is a correlation between oral Candida colonization and dental caries
 Peripheral arterial disease
  Soto-Barreras et al
 [31]
Compare caries (DMFT), periodontal (probing depth, attachment loss), microbiological (subgingival flora) and biochemical [C-reactive protein (CRP)] markers between patients with and without peripheral arterial disease (measured by ankle-brachial index) Case-control 60 (30 cases and controls) Mexico Outcomes: Prevalence of periodontitis (p = 0.03) and missing component (p = 0.04) of DMFT were significantly higher in the peripheral arterial disease group; levels of CRP were significantly higher in the peripheral arterial disease group (p = 0.04); P. gingivalis was non-significantly higher in peripheral arterial disease group and S. mutans did not show statistical difference between groups; after controlling for risk factors and confounders, periodontitis was positively associated with peripheral arterial disease
Conclusion: There was positive relationship between periodontitis and peripheral arterial disease [Odds Ratio (OR = 8.18)]
 Hypertension
  Ostalska-Nowicka et al. [32] Evaluate association between dental caries and hypertension in children and adolescents aged 6–18 years of age. Blood pressure, dental caries (dmft/DMFT), sIgA and various serum biochemical parameters were recorded. These parameters were compared with normotensive control group Case-control 109 (65 cases, 44 controls) Poland Outcomes: Significantly higher uric acid concentration was noted in hypertensive group when compared to normotensive controls (p = 0.047). Salivary cortisol and α-amylase levels were significantly higher in hypertensive group (p = 0.002 and p = 0.004 respectively). Multivariate analysis showed dental caries was associated with hypertension (p < 0.0001)
Conclusion: Dental caries in children and adolescents may be considered as a contributory factor to hypertension when other causes have been ruled out
Animal study on cardiovascular diseases and caries
 Coronary artery disease
  Kesavalu et al
[33]
Animal study to investigate the effect of S. mutans, OMZ175 in atherogenesis using an apolipoprotein E deficient (ApoEnull) mouse model by comparing groups with and without balloon angioplasty injury and appropriate controls Outcomes: Histomorphometric analysis of aortic sections in angioplasty with S. mutans group showed significant increase (p < 0.05) in plaque area and intimal/medial thickness when compared to controls; immunohistochemical studies showed significantly increased (p < 0.05) macrophage invasion in the adventitia and upregulation of Toll-like receptor (TLR) 4 in angioplasty with S. mutans group when compared to controls
Conclusion: S. mutans accelerated atherosclerotic plaque growth, macrophage invasion and TLR4 expression after aortic injury