Caries experience in patients with coronary heart disease: a systematic review

Coronary artery disease (CHD) remains a leading cause of morbidity and mortality worldwide, sharing several behavioral and metabolic risk factors with dental caries. While extensive research has explored links between periodontal disease and cardiovascular health, the association between dental caries experience and coronary artery disease is less understood. This systematic review aimed to synthesize existing evidence regarding dental caries burden, measured by decayed, missing, and filled teeth (DMFT), among individuals with coronary artery disease.

A systematic literature search was performed in April 2025 across PubMed, Scopus, Web of Science, the Cochrane Library, and Google Scholar. Studies published from 1966 to 2025 were eligible if they assessed adult patients with CHD, ischemic heart disease (IHD), myocardial infarction (MI), or related conditions and reported dental caries experience using the DMFT index. Observational studies, including cross-sectional, case-control, or cohort designs, were included. Duplicate records were removed using specialized software. Two independent reviewers screened titles, abstracts, and full texts, resolving discrepancies by discussion. Data extraction included study characteristics, caries indices, and key findings. Risk of bias was assessed using the Newcastle-Ottawa Scale. Due to heterogeneity, results were synthesized narratively.

From 2339 records identified, 1677 unique studies were screened, leading to 38 full-text articles reviewed for eligibility. Ultimately, 4 studies met inclusion criteria, representing populations from Iran, Sweden, Poland, and India, with sample sizes ranging from 100 to nearly 4000 participants. All studies employed either cross-sectional or case-control designs. Findings generally indicated higher mean values of DMFT among individuals with coronary artery disease, particularly for missing teeth. Some studies showed significantly greater untreated decay and tooth loss in patients with coronary artery disease compared to controls, while restorative care levels were often similar between groups. The small number of studies and their observational nature limit definitive conclusions.

This systematic review suggests that patients with coronary artery disease may experience a higher burden of dental caries, primarily through increased missing and decayed teeth. These findings underscore the potential shared risk environment and highlight the importance of integrating oral health within cardiovascular prevention frameworks. Further longitudinal studies are needed to clarify the temporal relationship and explore whether managing caries can contribute to cardiovascular risk reduction.