Association between atherosclerosis and tooth loss in adult patients: systematic review and meta-analysis

To evaluate the association between atherosclerosis and tooth loss in adults.

This systematic review and meta-analysis addressed the PECO question: Is there an association between atherosclerosis (E) and tooth loss (O) in adults (P)? Observational studies conducted in individuals over 18 years old with atherosclerosis were considered. The literature search employed controlled and uncontrolled vocabulary in PubMed (MEDLINE), Scopus, Web of Science, and LILACS databases. Two reviewers independently assessed titles, abstracts, and full texts, followed by the extraction of relevant data. The information was narratively synthesized, and the methodological quality was assessed using the Joanna Briggs Institute (JBI) checklists. The researchers used the R v.4.5.1 software program for meta-analysis. The results were presented in forest plots, using mean differences and odds ratios with their respective 95% confidence intervals (95%CI) (PROSPERO CRD42025630179).

The search identified 390 records, from which, after removing duplicates and applying the inclusion criteria, 13 studies were selected for qualitative analysis and 12 for quantitative analysis. On average, individuals with atherosclerosis experienced significantly greater tooth loss, with 3.08 teeth lost (95%CI: 1.53;4.64), compared to those without the disease. However, the researchers observed no statistically significant association between atherosclerosis and the presence of severe tooth loss (OR 1.27 95%CI: 0.45;3.56). The methodological quality assessment revealed a low risk of bias.

Tooth loss was associated with atherosclerosis, potentially due to shared inflammatory, metabolic, and vascular mechanisms. Due to heterogeneity, confounding factors, and the low certainty of the evidence, the results should be interpreted cautiously. However, the findings underscore the importance of integrating oral health into cardiovascular risk assessments and support the systemic relevance of managing oral diseases in adults.

The evidence confirmed an association between missing teeth and atherosclerosis. However, because of the included studies, this association cannot be interpreted as a clinical predictor or as a consequence of atherosclerosis. In this context, future research should examine the potential of tooth loss as an indicator that clusters with atherosclerotic burden and other related systemic factors.