Table 1 Evidence on cardiovascular diseases and caries

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 (ApoE^null) 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