Hypertension and Its Associations with Dental Status: Data from the Dental, Oral, Medical Epidemiological (DOME) Nationwide Records-Based Study

Abstract

Conflicting results have been published regarding the associations between dental status and hypertension. This study aims to explore whether or not hypertension is associated with dental status among young to middle-aged adults. To that end, data from the Dental, Oral, Medical Epidemiological (DOME) study were analyzed. The DOME is a cross-sectional records-based study that combines comprehensive socio-demographic, medical, and dental databases of a nationally representative sample of military personnel. Included were 132,529 subjects aged 18–50 years who attended the military dental clinics for one year. The prevalence of hypertension in the study population was 2.5% (3363/132,529). Following multivariate analysis, the associations between hypertension and dental parameters were lost and hypertension retained a positive association with obesity (Odds ratio (OR) = 4.2 (3.7–4.9)), diabetes mellitus (OR = 4.0 (2.9–5.7)), birth country of Western Europe vs. Israeli birth country (OR = 1.9 (1.6–2.2)), male sex (OR = 1.9 (1.6–2.2)), cardiovascular disease (OR = 1.9 (1.6–2.3)), presence of fatty liver (OR = 1.8 (1.5–2.3)), the birth country Asia vs. Israeli birth country (OR = 1.6 (1.1–2.3)), smoking (OR = 1.2 (1.05–1.4)), and older age (OR = 1.05 (1.04–1.06)). Further analysis among an age-, smoking- and sex matched sub-population (N = 13,452) also revealed that the dental parameters lost their statistically significant association with hypertension following multivariate analysis, and hypertension retained a positive association with diabetes (OR = 4.08 (2.6–6.1)), obesity (OR = 2.7 (2.4–3.2)), birth country of Western Europe vs. Israel (OR = 1.9 (1.6–2.3)), cardiovascular disease (OR = 1.8 (1.5–2.2)), fatty liver (OR = 1.7 (1.3–2.3)), high school education vs. academic (OR = 1.5 (1.3–1.8)), and low socio-economic status (SES) vs. high (OR = 1.4 (1.03–1.8)). We analyzed the associations between C-reactive protein (CRP) and dental parameters and combined the statistically significant variables to create a dental inflammation score (DIS). This crated a final model with the appropriate weights written as follows: DIS = (periodontal disease × 14) + (the number of teeth that required crowns × 11) + (missing teeth × 75). The mean DIS was 10.106 ± 25.184, and it exhibited a weak positive association with hypertension in the univariate analysis (OR = 1.011 (1.010–1.012)). Receiver operating characteristic (ROC) analysis of the DIS against hypertension produced a failed area under the curve (AUC) result (0.57 (0.56–0.58)). Moreover, the DIS also lost its statistical significance association with hypertension following multivariate analysis. We conclude that hypertension had no statistically significant nor clinically significant association with dental status. The study established a profile of the “patient vulnerable to hypertension”, which retained well-known risk factors for hypertension such as older age, male sex, smoking, diabetes, obesity, and fatty liver but not dental parameters.

“Dental Cluster” Versus “Metabolic Cluster”: Analyzing the Associations of Planned and Delivered Dental Procedures with Metabolic Syndrome, Utilizing Data from the Dental, Oral, Medical Epidemiological (DOME) Cross-Sectional Record-Based Nationwide Study

“…Moreover, findings from the Atherosclerosis Risk in Communities (ARIC) study did not support an independent association between endodontic treatment and the development of coronary heart disease, ischemic stroke, heart failure, or venous thromboembolism [22]. In our previous publications exploring the associations of MetS with periodontitis [11] and with caries [12,20], we have shown that the associations between dental pathologies and MetS components were only found in the univariate analyses, and they vanished following the multivariate analysis.…”

“…The current research is part of the Dental, Oral, Medical Epidemiological (DOME) crosssectional record-based nationwide study [12,20,32,33]. The protocol and study methods of the DOME study have been detailed previously [33].…”

“…The DOME structured repository brings together comprehensive socio-demographic, health-related habits, dental, and medical data of a nationally representative sample of military personnel from the Israel Defense Forces (IDF). In Israel, military service is mandatory for all eligible citizens, and, therefore, the military population in Israel is large and creates a well-grounded data source for epidemiologic research among young and middle-aged adults [12,20,[32][33][34]. It is noteworthy that medically complex individuals also enlist and perform non-combat tasks, and those considered unfit for physical or mental reasons can apply for voluntary tasks [12,33].…”

“…In other studies, instead of using pathologies as dental outcomes, the dental-MetS associations were analyzed using dental/periodontal indices as outcomes, including the Decayed, Missing, and Filled teeth (DMFT) index [6,7,13,14], the Community Periodontal Index (CPI) [15,16], clinical attachment loss (CAL) [16,17], plaque index (PI), gingival index (GI), pocket depth (PD) [18], and tooth mobility [19]. Previously, we explored the associations of hypertension diagnosis with dental treatment needs and actual dental treatments [20]. Other studies have also used the number of teeth in need of dental restorations, root canal treatments, and extractions as a proxy for oral health [21].…”

“…Considering the need to assess the impact of several concomitant dental pathologies, the "dental cluster" components in the present study included assessment of dental treatment needs as well as actual dental treatments of the following: (1) fillings, (2) endodontic treatments, (3) post fabrications, (4) crowns, (5) extractions, (6) scaling and root planning, ( 7) and dental implants. The use of these variables as a proxy for oral health was described previously [20,21]. We hypothesized that MetS will be positively associated with higher dental treatment needs (representing presence of pathologies requiring treatments) rather than with dental treatments performed de facto.…”