Table 1.
Study characteristics.
| First Author, Year, and Region | Focused Disease | Aim | Design | Sex (M%) |
Population; Mean Age (Years) |
Comorbidity CVD (Yes%) |
Comorbidity DM (Yes%) |
Comorbidity CKD (Yes%) |
Oral Hygiene Practice(s) |
|---|---|---|---|---|---|---|---|---|---|
| Afsar 2013 [80]; Turkey | CKD | To determine regular TB frequency in HD patients and second, to determine factors related to regular toothbrushing in HD patients. | Observational | 54% | 135; 52.4 ± 13.6 | 32% | 33% | N/A | TB frequency |
| Aggarwal 2012 [34]; India | T2DM | To investigate oral health attitudes, knowledge, and behavior with regard to diabetes-related factors among adults with T2DM and their attitudes to sustaining good oral health through proper oral hygiene and regular dental check-ups. | Cohort | 53.2% | 500; not reported |
Not reported | N/A | Not reported | TB frequency Fluoridated Toothpaste use Mouthwash use Interdental cleaning |
| Almas 2003 [35]; Saudi Arabia | T2DM | To assess the effect of oral hygiene instructions on periodontal disease and to assess the glycemic changes in healthy, T2DM male Saudi patients. | Cohort | 100% | 60; 42 ± 13.6 | Not reported | N/A | Not reported | TB frequency |
| Assante 2020 [33]; Brazil | ESKD | To correlate the self-reported oral health, oral hygiene, and dental assistance to clinic intercurrences with hospitalization in adult CKD patients under dialysis. | Cohort | 49% | 77; 54 ± 16.1 | 66.2% | 2.6% | N/A | TB frequency Mouthwash use Interdental cleaning |
| Chang 2020 [37]; South Korea | CVD | To investigate the association of oral hygiene indicators with atrial fibrillation and heart failure risk in a nationwide general population-based longitudinal study. | Cohort | 61.2% | 161,286; 52.2 ± 8.7 | HTN 38.9% DL 15.9% |
9% | 7.8% | TB frequency |
| Chang 2020 [32]; South Korea | DM | To assess the association between oral hygiene indicators and the risk of new-onset diabetes. | Cohort | 57.9% | 188013; 53.3 ± 8.6 | HTN 34.6% DL 16.9% |
0 | 0.2% | TB frequency |
| Chang 2021 [36]; South Korea | CVD | To investigate the relationship between the presence of periodontal disease and indicators regarding oral hygiene with occurrence for stroke in a nationwide population longitudinal cohort. | Cohort | 59.4% | 206,602; 53.5 ± 8.6 | Hypertension 50.1% DL 24.5% | 12.6% | 0.3% | TB frequency |
| Chang 2021 [58]; South Korea | CKD | To clarify the relationship between oral hygiene indicators and CKD in a nationwide general population-based cohort. | Cohort | 60.9% | 158495; 52.3 ± 8.8 | AF 0.4% HF 1.2% HTN 39% DL 24.5 |
8.8% | N/A | TB frequency |
| Cho 2021 [62]; South Korea | CVD | To investigate the association between periodontal health and stroke amount Korean adults. | Cross- sectional |
47.3% | 9497; 55.71 ± 0.17 | Stroke 2.6% HTN 23.9% |
9.4% | Not reported | TB frequency Oral hygiene product use |
| Choi 2019 [63]; South Korea |
T2DM | To investigate the relationship between HbA1c level and self-reported periodontal symptoms among patients with T2DM. | Cross- sectional |
22.4% | 156; not reported | Not reported | N/A | Not reported | TB frequency TB technique |
| Cinar 2013 [79]; Turkey |
T2DM | To assess the links between tooth loss, oral health behavior, T2DM, obesity, and sleep apnea among patients with T2DM. | Prospective intervention study | 38% | 165; not reported | Not reported | N/A | Not reported | TB frequency |
| Cinar 2014 [83]; Turkey |
T2DM | Assess the impact of health coaching on TB self-efficacy and frequency, and effect on diabetics’ management and quality of life in comparison to health education among patients with T2DM. | RCT | Not reported | 178; not reported | Not reported | N/A | Not reported | TB frequency |
| Cinar 2015 [64]; Turkey |
T2DM | To assess the correlation between a preventive oral health behavior (toothbrushing), HDL, and self-assessed quality of life-related risk factors for non-communicable diseases and communicable diseases among patients with T2DM. | Cross-sectional | Not reported | 178; not reported | Not reported | N/A | Not reported | TB frequency |
| deOliveira 2010 [65]; Scotland | CVD | To investigate whether self-reported frequency of TB (as a proxy of periodontal disease) was associated with risk of CVD events in a sample of adults from the Scottish Health Survey. To also examine the association between frequency of TB and inflammatory markers in a subset of participants. | Cross-sectional | 46% | 11869; 50.0 ± 11.0 | HTN: 24% | 2.6% | Not reported | TB frequency |
| deSouza 2014 [38]; Brazil | CKD | To assess the prevalence and impact of oral health parameters, periodontitis, and its treatment on survival in a group of patients undergoing hemodialysis. | Cohort | 64.8% | 122; 50 ± 13 | 23% HTN 75% |
21% | N/A | Dental floss use |
| Frisbee 2010 [66]; United States | CVD | To investigate the associations between self-reported dental hygiene practices and overall dental health, cardiovascular risk factors and systemic inflammation, in adults living in rural communities. | Cross-sectional | 37.5% | 128; 41.5 ± 9.3 | Not reported |
Not reported | Not reported | TB frequency Flossing frequency |
| Fujita 2009 [67]; Japan |
CVD, DM | To investigate the relationship between frequency of daily teeth brushing and prevalence of cardiovascular risk factors. | Cross-sectional | 37% | 54,551; not reported | HTN 41.5% | 7.8% | Not reported | TB frequency |
| Guo 2023 [53]; China |
CVD, DM | To evaluate the association between oral health behavior and various chronic diseases among middle-aged and older Chinese adults. | Cohort | 48% | 18,158; 61.3 ± 10.3 | 50.24% | 40.2% grouped as diseases of the endocrine or nutritional metabolic. |
TB frequency | |
| Han 2021 [72]; South Korea |
CVD, DM | To elucidate the prevalence of oral health complications and the relationship between DM and oral health status in diabetic patients with CVD. | Cross-sectional | 42.9% | 3495; not reported | Stroke 6.6% MI 3% HTN 71.2% DL 56.9% |
24.2% | 0.05% | TB frequency |
| Hiramatsu 2022 [81]; Japan | CKD | To investigate whether dental care in peritoneal dialysis patients might affect the incidence of CVD and infections such as peritonitis. | Retrospective observational | 57.6% | 165; Group A = 63.9 ± 12.0 Group B = 64.2 ± 10.5 |
Not reported | 20% | N/A | TB frequency Dental floss frequency Mouth wash frequency |
| Hirano 2022 [39]; Japan | CKD | To evaluate the relationship between toothbrushing frequency and kidney function. | Cohort | 50% | 76,472; 45.9 ± 12.4 | HTN 7.6% | 2.24% | N/A | TB frequency |
| Huang 2023 [71]; Taiwan | CVD | To explore farmers’ self-care behaviors, including oral hygiene, remaining natural teeth, cardiometabolic risks, hepatitis, risk of stroke, and their determinant factors | Cross-sectional | 54.8 | 183; 66.9 ± 11.7 | Not reported | Not reported | Not reported | Dental floss use |
| Huh 2023 [57]; South Korea |
CVD, T2DM | To evaluate the association of dental diseases and oral hygiene care (alone or in combination) with incident HF among patients with T2DM. | Cohort | 72.4% | No PD: 62.8 ± 11.1 Yes PD: 65.3 ± 10.1 |
5.4% | N/A | 0.84% | TB frequency |
| Hwang 2018 [68]; South Korea | CVD | To examine whether periodontal disease and/or poor oral health behavior predicted 10-year general cardiovascular risk among Korean adults with no CVD history using representative national data. | Cross-sectional | 41.2% | 8370; normal: 46.37 ± 11.92 At risk of CVD: 67.71 ± 10.6 |
HTN 22.4% DL 12.6% |
8.29% | Not reported | TB frequency |
| Hwang 2022 [56]; South Korea | CVD | To investigate the association of periodontitis, missing teeth, and oral hygiene behaviors with the incidence of hypertension | Cohort | 55.1% | 104,349; 51.1 ± 8.2 | Not reported | 4.3% | Not reported | TB frequency |
| Isomura 2023 [54]; Japan | CVD | To investigate whether the timing of TB affects the risk of cardiovascular diseases. | Cohort study | 58.2% | 1583; reported as group medians Group MN: 65 Group night: 66 Group M: 68 Group none: 63 |
N/A | Not reported | Not reported | TB frequency |
| Jain 2015 [77]; India | CVD | To find the prevalence of periodontal disease in stroke patients and compare with age- and gender-matched controls and to compare the oral hygiene practices followed by stroke patients and controls. | Case–control | 59.2% | 216; 59 ± 12 (Stroke) 58 ± 9 (Control) | Stroke group only: AF 3.7% Hypercholesterolemia 9.25% HTN 72% Carotid stenosis 1.85% CAD 17.6% RHD 2.77% |
44.4% (stroke group only) | 0 | TB frequency, device used, technique, timing, toothpaste use |
| Jangam 2017 [51]; United States | CVD | To examine the association between oral hygiene home care habits and cardiovascular mortality. | Cohort (part of a Ph.D. Thesis) | 63.6% | 506; 60 | 50.6% Hypertension 33.4% |
9.8% | Not reported | TB frequency, instrument used, dental floss use, mouthwash use |
| Janket 2023 [76]; Finland | CVD | Primary: To determine if brushing and flossing affect the risk of CVD mortality in multivariable adjusted models. Secondary: To determine if mouthwash usage has independent impact on CVD mortality. To determine if mouthwash usage affects some periodontal pathogens and cariogenic bacteria proportions. |
Case–control | 68% | 359; Seldom/no brushing: 56.3 ± 8.6 Daily brushing only: 58.0 ± 9.6 Daily brushing and flossing: 58.9 ± 8.0 |
CAD 44% HTN 31% |
7.34% | Yes, number not reported | TB frequency Dental floss use Mouthwash use |
| Joshipura 2017 [41]; Puerto Rico | DM | To evaluate longitudinally the hypothesis that regular over-the-counter mouthwash use was associated with increased risk of pre-diabetes/diabetes over a three-year period. | Cohort | 25.8% | 945; 50.6 ± 6.8 | Pre-hypertensive 30.7% HTN 47.2% |
Prediabetic: 56.7% | 0 | Mouthwash use |
| Joshipura 2020 [42]; Puerto Rico | CVD | To evaluate if routine over-the-counter mouthwash use increases hypertension risk. | Cohort | 22% | 540; 49.0 ± 6.5 | 0 | 6.1% | 0 | Mouthwash use |
| Kaur 2023 [84]; India | T2DM | To evaluate the efficacy of subgingival home irrigation using water along with powered toothbrushes in diabetic patients with chronic periodontitis. | RCT | Not reported | 31; Group A 50.13 ± 6.6 Group B 55.07 ± 9.83 | 0 | N/A | 0 | TB instrument used Mouthwash use (Subgingival irrigation) |
| Kim 2022 [52]; South Korea | CVD | To investigate whether oral hygiene indicators were linked to the development of major CVDs in hypertensive patients in a longitudinal study setting. | Cohort | 63.25% | 52,677; 54.99 ± 9.51 | AF 0.90% | 7.21% | 2.88% | TB frequency |
| Kobayashi 2020 [40]; Japan | CVD | Evaluate the association between the frequency of daily toothbrushing and subsequent cardiovascular events. | Cohort | 50.3% | 71,221; 45.6 ± 12.2 | HTN 7.4% DL 4% |
2.1% | Not reported | TB frequency |
| Kuwabara 2016 [69]; Japan | CVD, DM, CKD | To clarify the association between TB and risk factors for CVD: HT, DM, DL, HUA, and CKD | Cross-sectional | 49% | 85,866; 47 ± 11.5 | HTN 15.9% DL 36.3% |
4.3% | CKD 3.4% HUA 13.5% |
TB frequency |
| Kuwabara 2017 [43]; Japan | CVD, DM | To clarify the relationship between TB practices and the risk factors for CVD: DM, DL, HT, and HUA. | Cohort | 48.48% | 13,070; not reported | HTN 19.9% DL 39.2% |
4.4% | HUA 14.6% | TB frequency |
| Long 2023 [59]; China | CVD | To explore the relationship between oral health behavior and the incidence of stroke in Guizhou Province, China. | Cohort | 47.5% | 7970; 44.50 ± 15.15 | HTN 26% | 17.8% | Not reported | TB frequency |
| Luo 2022 [30]; United States | DM | To assess the association between inflammation and oral health and diabetes, as well as the mediating role of oral hygiene practice in this association. | Cohort | Not reported | 2192; 64.5 (Elevated CRP) 62.4 (Non-elevated CRP) |
0 | No exact numbers reported | 0 | Dental floss use |
| Moon 2024 [73]; Korea | CVD | To explore the association between cardiovascular risk and frequency of toothbrushing in the context of traditional risk factors and inflammatory markers. | Cross-sectional | 48.3% | 13761; 51.3 ± 0.2 | HTN 30.6% | 11% | Not reported | TB Frequency |
| Matsui 2022 [55]; Japan | CVD | To determine the association of toothbrushing behavior assessed in detail with the incidence of future cardiovascular events in a general population including patients with CVD. | Prospective observational | 68.9% | 692; 63 ± 16 | HTN 72% DL 60% CAD 19% HF 6.4% Stroke 8.4% Prior CABG 11% |
27% | 16% reported as dialysis | TB frequency and duration |
| Palmer 2015 [45]; Europe arm: (France, Hungary, Italy, Poland, Portugal, and Spain); and South American arm: (Argentina) |
CKD | To investigate whether oral disease using standardized assessments of dental disease and preventative dental health practices are associated with early death in patients undergoing haemodialysis. | Cohort | 57.7% | 4205; 61.6 ± 15.6 | MI: 12.5% Stroke: 10.3% |
32% | N/A | TB frequency and duration Dental floss use Mouthwash use |
| Park 2019 [44]; South Korea |
CVD | To evaluate whether oral hygiene behavior can alleviate cardiovascular risk associated with oral health status using a nationwide population-based cohort. | Cohort | 58% | 247,969; 52 | HTN 19.9% DL 24% |
6% | 0.7% | TB frequency |
| Patel 2021 [78]; India |
CVD | To assess and compare the periodontal health status among CHD patients with age- and gender-matched controls. | Case–control | 63.6% | 1616; 48.30 ± 7.73 | 50% | 0 | Not reported | TB frequency and method |
| Reichert 2015 [46]; Germany | CVD | To investigate whether oral hygiene habits, severe periodontitis, presence of periodontopathogens in the subgingival biofilm, or certain IL-6 genotypes represent independent risk factors for the incidence of new cardiovascular events among inpatients suffering from CHD. | Cohort | 74% | 942; 68.8 (median) | HTN 87.6% | 34.20% | Not reported | Dental floss or interdental brush use TB frequency |
| Saengtipbovorn 2014 [82]; Thailand | T2DM | To assess the effectiveness of a Lifestyle Change plus Dental Care program to improve glycemic and periodontal status in the elderly with T2DM. | Quasi-experimental RCT | 34.35% | 131; Intervention: 63.83 ± 4.51 Control: 64.06 ± 5.53 |
0 | N/A | 0 | TB Interdental cleaning Mouth rinse use |
| Song 2021 [47]; South Korea | DM, CVD | Evaluate periodontitis and poor oral hygiene as independent risk factors for either cerebral or MI in the diabetes population. | Cohort | 64.75% | 17,009; 55.65 ± 9.66 | 0 | N/A | 0 | TB frequency |
| Song 2021 [48]; South Korea | DM (risk factor) | To assess the association between oral hygiene indicators of periodontitis, tooth loss, and TB with longitudinal fasting glucose levels in non-diabetic subjects. | Cohort | 58% | 91,963; 56.16 ± 7.6 | HTN 36.2% | Not reported | 9.1% | TB frequency |
| VanWormer 2013 [74]; United States | DM | To examine the degree oral hygiene habits were associated with CVD and T2DM risk levels among American adults. | Cross-sectional | 43% | 1008; not reported | 0 | 0 | 0 | TB and flossing frequency |
| Vogtmann 2017 [61]; Korea | CVD | To test the association between oral health, oral care, and denture use with overall and cause-specific mortality. | Cohort | 46.4% | 50024; 51.9 ± 8.9 | HTN 30.6% | 11% | Not reported | TB frequency |
| Wang 2022 [31]; China | DM, CVD (risk factor) | To investigate the relationship between oral health and incident hypertension/T2DM. | Cohort | 47.5% | 8139; 44.52 ± 15.16 | HTN 26.1% DL 57.7% |
8.4% | Not discussed | TB frequency |
| Winning 2017 [50]; UK | T2DM | The aim of this study was to investigate periodontitis as a risk factor for incident T2DM in a group of men aged 58–72 years. | Cohort | 100% | 63.7 ± 3.0 | ACVD 9.09% HTN 29.45% |
0 | Not reported | TB frequency |
| Yoshioka 2021 [70]; Japan | T2DM | To clarify the association between oral health behavior and diabetes-related clinical indicators among patients with T2DM. | Cross-sectional | 74.9% | 74; 63.7 ± 12.4 | HTN medications 56.8% |
N/A | Not reported | TB timing |
| Zhang 2023 [75]; United States | DM | To examine the associations between oral health behaviors, specifically flossing and preventive dental care, and periodontitis and glycemic control, among US dentate adults with diabetes. | Cohort | 51.1% | 892; 60.0 ± 0.4 | Not reported | 100% | Not reported | Flossing |
| Zhuang 2021 [49]; China | CVD, T2DM, CKD | To investigate the associations between a self-reported measure of TB behavior [as a proxy of oral hygiene] and the risk of cardiovascular events, as well as examine the association of TB behavior with nonvascular diseases such as DM and CKD. | Cohort | 41% | 487,198; 51.5 ± 10.6 | 0 | 3.2% | Not reported | TB frequency |
| Zhou 2024 [60]; China | CVD | To examine the associations of oral health with all-cause and cause-specific mortality in middle-aged and older Chinese adults. | Cohort | 27.6% | 28006; 62.0 ± 7.1 | Not reported | 14.6% | Not reported | TB frequency |
%: percentage; ACVD: acute cardiovascular disease; CABG: coronary artery bypass graft; CAD: coronary artery disease; CHD; coronary heart disease; CKD: chronic kidney disease; CRP: C-reactive protein; CVD: cardiovascular disease; DL: dyslipidemia; DM: diabetes mellitus; DM: diabetes mellitus; ESKD: end-stage kidney disease; HD: haemodialysis; HDL: high-density lipoprotein; HTN: hypertension; IL-6; cytokine interleukin-6; MI: myocardial infarction; RCT: randomised controlled trial; RHD: rheumatic heart disease; T2DM: type II diabetes mellitus; TB: toothbrushing.