Bidirectional Association between Tooth Loss and Hypertension: A Systematic Review and Meta-analysis

Abstract

Background: To investigate the bidirectional association between tooth loss and hypertensionMethods: PubMed, EMBASE, OVID were searched through May, 2020. Longitudinal and cross-sectional studies reporting the association between tooth loss and hypertension were included. We quantitatively analyzed the basic framework and study characteristics, and then pooled estimate effects with 95% confidence intervals (CIs) of outcomes of each included studies using random-effects meta-analysis.Results: This systematic review included sixteen studies involving about 188,000 participants. Quantitatively summarized results suggested, compared to individuals who have lost fewer than ten teeth, there was no significantly difference in the incidence of hypertension among participants who lost more than ten teeth (OR: 1.09, 95%CI: 0.93,1.28). Besides, there is no significant difference of incident hypertension between individuals who ever lost teeth and never lost teeth (OR:1.03, 95% CI: 0.85,1.25). There was a significant association between hypertension and incidence of tooth loss (OR: 1.33, 95% CI: 1.04,1.70). Subgroup analysis by study design, age, gender ratio and religion showed statistically significant association between hypertension and incidence of tooth loss in specific subgroups.Conclusions: This meta-analysis identified hypertension as a significantly risk factor of tooth loss while tooth loss was not an efficient predictor for incident hypertension. Considering the limited number of available researches and drawback of cross-sectional studies, more high-quality prospective studies of large sample sizes are needed to understand details of this bidirectional association. Since both tooth loss and hypertension are worldwide problems, our study provides new and comprehensive evidence for the prevention in oral complication of hypertensive patients.

Counterfactual approach on the effect of metabolic syndrome on tooth loss: A population‐based study

“…Despite stronger causal inference can usually be drawn from a well-conducted randomized control trial or cohort studies, it also can be made from cross-sectional or other observational studies if the causal diagram is accurate, bias is minimized, potential confounding pathways excluded or blocked, statistical analyses performed correctly, and assumptions of MSM are met, as is our study. 36 The results of MSM reinforced the hypothesis of causality between MetS and tooth loss, which has already been observed in cohort studies. 4,5 However, these studies differed from ours.…”

“…Beyond the possibility of collinearity, as both caries and periodontitis are reasons for tooth loss, previous studies have conditioned their regression models on the mediator. 36 Besides, the total effect of MetS on tooth loss seems to have not yet been estimated. Using a careful literature analysis and directed acyclic graphs, we get a more holistic view of the complex inter-relationships between variables and selected potential confounders to minimize methodological issues related to over adjustment.…”

“…Moreover, chronic systemic inflammation impairs the individual's immune response and, therefore, increases the risk of periodontitis onset and progression, 8,29 which may result in tooth loss 6 30–32 dysglycemia, 33 reduced HDL cholesterol 34 and hypertension 35 are also associated with tooth loss through the same aforementioned mechanisms. Then, the combination of these metabolic abnormalities in MetS can reinforce its effect on tooth loss.…”