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Little knowledge and contradictory results exist on the association of oral diseases with systemic diseases and with health predictors such as dental care utilization and health insurance. This research project aimed to examine 1) the association between Coronary heart disease (CHD) and periodontal disease using meta-analysis, 2) to examine the association between dental care utilization, health insurance coverage and periodontal disease with the prevalence of CVD, 3) the association between dental caries, periodontal disease and blood glucose level. For meta-analysis, literature searches were conducted using the PubMed computerized database (1966-2019), Cochrane Controlled Trials Register (1970-2019), EMBASE (1980-2019), and CINAHL (1982-2019). A systematic review of the literature identified fifteen prospective cohort studies and seven case control studies that meet the inclusion criteria. Maximum likelihood random effects analysis was used to compute the combining relative risk (RR) and odd ratio (OR). Data on periodontal disease, dental caries, dental care utilization, health insurance coverage, cardiovascular disease and blood glucose level were obtained from the National Health and Nutrition Examination Survey (2011–2014) for dentate community-dwelling persons 30 years of age and over. The outcome was cardiovascular disease (heart attack, hypertension, CHD, congestive heart failure and stroke) and glucose level (HbA1c and OGTT). The main independent variable was dental care utilization, insurance, periodontal disease and dental caries. Covariates included in the analysis were race/ethnicity, age, sex, income, education levels, body mass index, diabetes status, smoking status and alcohol drinking status. To obtain unbiased point estimates and correct variance estimation, proper sampling weights and statistical survey procedures were used. A-meta-analysis of the fifteen prospective cohort studies indicated that patients with periodontal disease are at 1.19 times increased the risk of having CHD compared to periodontally healthy patients (RR: 1.19, 95% CI (1.12 – 1.26)). The result of the seven case control studies, showed a significant association between periodontitis and CHD with odds ratio 2.37 (95% CI 1.72-3.28). In addition, lower dental care utilization and insurance were significantly increased the odd of developing CVD respectively; (OR 1.65, 95%CI 1.01–2.69, OR 1.52, 95% 1.09–2.11). Looking into the association between oral diseases and blood glucose level. Dental caries was significantly associated with increased the odd of high OGTT and HbA1c values respectively (OR 2.47, 95% 1.56-3.90, OR 1.37, 95% 1.14-1.64). However, periodontal disease was significantly associated with high HbA1c values only (OR 2.77, 95% 2.40-3.20). In conclusion, our analysis supports the association between periodontal disease and CHD. Additionally, using a large national representative sample, our analysis showed that health insurance and dental care utilization were significantly associated with the prevalence of CVD. Also, having either periodontal disease or dental caries increased the odds of poor glycemic control among US population. |
