Table 1.

The summary of selected articles.

No.	Title	Author	Study Design	Subject	Oral Condition	Number of Participants	Study factor/exposure	Outcome	Test Performed	Results	Conclusion
1	Teeth and physical fitness in a community-dwelling 40 to 79-year-old Japanese population (Clinical Intervention in Aging, 29 June 2016)	Akira Inui, Ippei Takahashi, Kaori Sawada, Akimoto Naoki, Toshirou Oyama, Yoshihiro Tamura, et al	Cross sectional. Observational study	Elderly age 40–79 years old	Occlusal condition	n = 522 (198 males and females)	Number of teeth, Occlusal condition (Eichner Index)	Physical Fitness	Timed 10 m walk test, Hand grip strength, SMM of the whole body (kg)	Number of teeth was shown to be an independent risk factor for the timed 10 m walk test in female (P value = 0.007) Number of teeth and SMM in male (P value = 0.031), Eichner index correlated with the Timed 10m walk test	Prevention of teeth loss is important for maintaining muscle strength and its function in people aged 40–79, especially for walking ability. This cross-sectional study on a Japanese community-dwelling population revealed relationships between partial oral conditions and the muscle mass and its function.
2	Influence of dental occlusion on the athetlic performance of young elite rowers: a pilot study (CLINICS, 4 July 2018)	Eric Leroux, Stephanie Leroux, Frederic Maton, Xavier Ravalec, Olivier Sorel	Cross sectional	Members of the ‘‘Pô le France Aviron’’ (age range of 15–17 years)	Dental occlusion	N = 7	Artificial occlusal disturbance	Athletic performance	Body balance (stabilometric test) symmetry of the muscular contraction (posturographic tests) Muscular power (Aerobic test)	None of the three body balance parameters was significantly influenced by the artificial occlusal disturbance. The interposition of the silicone splint resulting in a 4 mm ateral deflection of the mandible increased the proportion of asymmetric muscular contractions from 14.3% to 85.7% of the participants (p = 0.025). The interposition of the silicone splint resulting in a 4 mm lateral deflection of the mandible induced a significant 17.7% reduction in the athletes' muscular power (p = 0.030).	In this pilot study, artificial mandibular laterodeviation induced a significant alteration in the muscular power of the rowers. Such temporomandibular disorders constitute a major public health problem [37]. Based on our findings, dental occlusion examination should be regularly undertaken for young elite rowers. Moreover, for cases in which dental malocclusions are detected, a suitable treatment plan based on prosthetic, surgical and/or orthodontic care can improve athletes' performances.
3	Periodontal Disease as a Risk Indicator for Poor Physical Fitness: A Cross-Sectional Observational Study (J Periodontol, Januariy 2015 Vol 86 No. 1)	Joao Augusto P. Oliveira, Carolina B. Hoppe, Maximiliano S. Gomes, Fabiana S. Grecca, and Alex N. Haas	Cross sectional. Observational Study	Male police officers (aged 20–56 years; mean age: 34.8 years).	Periodontal Health	N = 111	Periodontal Disease	Physical Fitness	Physical Fitness Test (PFT): 1. Push-up exercises 2. Pull-up exercises 3. Sit-up exercises 4. Running exercise	Individuals who reached the highest PFT score had significantly better periodontal conditions compared with those with PFT scores below the maximum. Individuals who did not reach the highest PFT score presented significantly higher mean PD (P = 0.03), mean AL (P = 0.01), BOP (P = 0.04), and number of teeth with AL ‡4 mm (P = 0.04).	Periodontal disease may be considered a risk indicator for poor physical fitness in males. If periodontal health and physical fitness are truly connected, then the prevention and treatment of periodontal diseases, with aims to ensure physical fitness, should be considered at the population level. On an individual level, maintaining periodontal health may be an important strategy for improving physical fitness related to the performance of athletes.
4	Cross sectional association between physical strength, obesity, periodontitis and number of teeth in a general population. (J Clin Periodontol 2016; 43: 401–407)	Michael Eremenko, Christiane Pink, Reiner Biffar, Carsten O. Schmidt, Till Ittermann, Thomas Kocher and Peter Meisel	Cross sectional. Observational Study	Participants of the Study of Health in Pomerania (SHIP-2)	Periodontal Health	N = 2089	Clinical attachment loss, number of teeth, C-reactive protein and glycated haemoglobin	Physical strength	Handgrip strength (GS), anthropometric measures,	In multiple regression adjusted for age, body mass index (BMI) and waist-to-hip ratio (WHR) each mm of diminished periodontal attachment was associated with reduction in GS by 1.47 kg (95% CI -2.29 to -0.65) and 0.38 kg (-0.89 to 0.14) in men and women respectively. Correspondingly, each additional remaining tooth was significantly associated with higher GS.	Periodontitis is associated with GS modified mainly by anthropometric measures related to adiposity and inflammation. Putative mechanisms encompass interactions of factors declining with increasing age.
5	Association between chronic oral inflammatory burden and physial fitness in males: a cross sectional observational study	CB Hoppe, JAP Oliveira, FS Grecca, AN Haas, MS Gomes	cross sectional observational study	male police officer in Military Police of Rio Grande do Sul, Porto Alegre, Brazil	Periodontal health	N = 112	Periodontal disease was assessed by probing depth (PD) and clinical attachment loss (AL). For radiographic analysis, both apical periodontitis (AP) and root canal treatment (RCT) variables were analysed. Endodontic Burden (EB) was calculated merging the total number of teeth with AP and/or RCT per individual. OIB was calculated combining EB and AL.	Physical Fitness	PFT Score (a combination of physical strength and cardiorespiratory fitness)	There was no significant association between AP, RCT and EB with physical fitness. Whereas, PD, AL and OIB were significantly associated with low physical fitness (p < 0.05). Multivariate regression analysis revealed that individuals with OIB = EB ≥ 3 & AL≥4mm had a 81% lower chance of reaching the highest PFT score (OR = 0.19, 95%CI = 0.04–0.87, p = 0.03) compared to individuals with EB < 3 and & no AL≥4mm. Individuals with unfavourable periodontal parameters but with low EB (OIB = EB < 3 & AL≥4mm) showed no significant differences on the chance to reach the highest PFT score compared to participants with favourable periodontal status and low EB (OIB = EB < 3 & no AL≥4mm).	The OIB - higher levels of EB in periodontal patients - was independently associated with poor physical fitness in males.
6	Moderate and severe periodontitis are independent risk factors associated with low cardiorespiratory fitness in sedentary non-smoking men aged between 45 and 65 years	Eberhard J, Stiesch M, Kerling A, Bara C, Eulert C, Hilfiker-Kleiner D, Hilfiker A, Budde E, Bauersachs J, Kück M, Haverich A, Melk A, Tegtbur U.	cross sectional observational study	Non-smoking healthy male aged 45–65 years	Periodontal disease	N = 72	Periodontal disease (probing depth and clinical attachment loss)	Cardiorespiratory fitness	Analysis of oxygen consumption, questionnaire of physical activity, blood pressure, routine blood test (lipid levels, glucose concentration)	Differences between VO2peak levels in subjects with no or mild, moderate or severe periodontitis were statistically significant (p = 0.026). Individuals with low VO2peak values showed high BMI scores, high concentrations of high-sensitive C-reactive protein, low levels of high-density lipoprotein-cholesterol, and used more glucocorticoids compared to individuals with high VO2peak levels. Multivariate regression analysis showed that high age (p = 0.090), high BMI scores (p < 0.001), low levels of physical activity (p = 0.031) and moderate (p = 0.087), respectively, severe periodontitis (p = 0.033) were significantly associated with low VO2peak levels.	moderate and severe periodontitis were independently associated with low levels of CRF in sedentary men aged between 45 and 65 years.
7	Oral Condition and Health Status of Elderly 8020 Archieves in Aichi Prefecture	Masamori H., Katsumi Y., Tsukasa S., Akira O., Tooru T., Shinsuke H., Takeshi S., Toshihide N.	cross sectional observational study	Elderly	Oral condition	N = 217	Total number of teeth, CPITN index, Salivary blood test, masticatory activity	Bone mineral density, Grip strength, balance test, BMI	X-ray absorptiometry, Handgrip strength, balance test	The percentages of CPITN code 0, 1 and 2 were 68% in the 8020 male elderly and 72% in the 8020 female elderly. The positive percentage in the salivary blood test in the 8020 male elderly was lower than that in the non-8020 elderly. Masticatory ability was 1.55g in the 8020 male elderly and 1.53g in the 8020 female elderly. Relative masticatory ability in the 8020 female elderly was 20% higher than that in the non-8020 female elderly. BMD in the 8020 female elderly was significantly higher than that in the non-8020 female elderly. Grip strength in the 8020 elderly was also significantly higher than that in the non-8020 elderly. The duration of balance test in the 8020 male elderly was 2.2 times longer than that in the non-8020 male elderly.	The 8020 elderly showed good oral condition and health status was found to be better in the 8020 elderly than that in the non-8020 elderly
8	Relationship Between Obesity and Physical Fitness and Periodontitis	Yoshihiro S., Yuko E, Takeshi M., George K., Sumio A., Sumie J., Yoshihisa Y	cross sectional observational study	Participants of health promotion program who received dental and medical examination	Periodontal health	N = 1160	Obesity and physical fitness	Periodontal health status	Community Periodontal Index (CPI), BMI	The lowest quintile in BMI and the highest quintile in VO2max were inversely associated with severe periodontitis, ingly, in multivariate logistic regression analyses. Subjects with the combined lowest quintile in BMI and the highest quintile in VO2max had a significantly lower risk of severe periodontitis compared to subjects with other combined quintiles in BMI and in VO2max (odds ratio: 0.17; 95% confidence interval: 0.05 to 0.55).	obesity and physical fitness may have some interactive effect on periodontal health status.
9	Periodontal Infection and Cardiorespiratory Fitness in Younger Adults: Results from Continuous National Health and Nutrition Examination Survey 1999–2004	Ashley Thai., Panos N. Papapanou, David R. Jacobs Jr, Moı¨se Desvarieux, Ryan T. Demmer	cross sectional observational study	participants were enrolled in NHANES 1999–2004 aged 20–49 years old	Periodontal infection	N = 2863	Probing depth, clinical attachment loss	Cardiorespiratory fitness	Maximal oxygen uptake, BMI, treadmill, blood pressure test	After multivariable adjustment, mean eVO2 max levels6SE across quartiles of attachment loss were 39.7260.37, 39.6460.34, 39.5960.36, and 39.8560.39 (P = 0.99). Mean eVO2 max6SE across quartiles of probing depth were 39.5760.32, 39.7860.38, 39.1960.25, and 40.3760.53 (P = 0.28). Similarly, multivariable adjusted mean eVO2 max values were similar between healthy participants vs. those with moderate/severe periodontitis: 39.7060.21 vs. 39.7060.90 (P = 1.00). The odds ratio (OR) for low eVO2 max comparing highest vs. lowest quartile of attachment loss = 0.89 [95% CI 0.64–1.24]. The OR for comparing highest vs. lowest probing depth quartile = 0.77 [95% CI 0.51–1.15].	Clinical measures of periodontal infection were not related to cardiorespiratory fitness in a sample of generally healthy younger adults.
10	Tooth Loss Associated with Physical and Cognitive Decline in Older Adults	G. Tsakos, RG. Watt, PL. Rouxel, C de Oliveira, P. Demakakos	Cross sectional. Observational study	Elderly aged 60 and older	Tooth loss	N = 3166	Number of remaining teeth	Physical and cognitive function	10-word recall test, gait speed assessment	Edentulous participants recalled 0.88 fewer words and were 0.09 m/s slower than dentate participants after adjusting for time and demographics. Only the latter association remained significant after full adjustment, with edentulous participants being 0.02 m/s slower than dentate participants. In age-stratified analyses, baseline edentulousness was associated with both outcomes in fully adjusted models in participants aged 60 to 74 but not in those aged 75 and older. Supplementary analysis indicated significant associations between baseline edentulousness and 4-year change in gait speed and memory in participants aged 60 to 74	Total tooth loss was independently associated with physical and cognitive decline in older adults in England. Tooth loss is a potential early marker of decline in older age.
11	The Effect of Tooth Loss on Body Balance Control Among Community-Dwelling Elderly Persons	M Yoshida, T Kikutani, G Okada, T Kawamura, M Kimura, Y Akagawa	Cross sectional. Observational study	Participants of the 2006 Kyoto Health Seminar	Tooth loss	N = 35 (12 male, 23 female)	Occlusal condition	Physical fitness	Hand grip and leg extensor power reflected muscle strength, body balance test	The test and control groups both included 12 male and 23 female subjects. Body balance ability, measured by time spent standing on one leg with eyes open (P = .013) and functional reach (P = .037), was significantly less in the test group when compared to the control, as shown by analysis done using the Mann-Whitney U test. The stabilometer examination also indicated that sway area (an accurate indicator of postural balance) and body sway (evidence of energy consumption for postural control) while standing with eyes closed were both significantly higher in the test group (P = .035 and .048, respectively; Wilcoxon signed ranks test) than the control.	tooth loss is a risk factor for postural instability. This further suggests that proprioceptive sensation from the periodontal ligament receptor may play a role in body balance control.