Faculty of Dentistry, University of Toronto, Toronto, ON, Canada.
Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.
JDR Clin Trans Res. 2021 Oct;6(4):390-401. doi: 10.1177/2380084420953121. Epub 2020 Sep 4.
Numerous studies have examined the associations between poor oral health and the incidence of cardiovascular disease (CVD) over the past 25 y. This long history of research has resulted in a broad and heterogenous epidemiological field whose implications are difficult to understand and whose methodological gaps are hard to track.
This systematic mapping review aims to systematically map clinical heterogeneity and methodological gaps in assessing the relationship between poor oral health and CVD outcomes.
Medline, Embase, and Cochrane Library were searched to identify longitudinal studies that examined the relationship between any oral health indicator and CVD outcomes. Each database was searched from its inception date and June 27, 2018. Extracted data assess the clinical heterogeneity (participants' characteristics, exposure and outcome measures, length of follow-up) and methodological gaps (availability of randomized controlled trials, utilization of time-varying exposures, propensity methods, mediation analysis, and competing risks analysis).
Eighty-five studies met the inclusion criteria. Clinical heterogeneity is evident in participants' characteristics (age, clinical status, and occupation) and in the definitions of oral health indicators and CVD outcomes. More important, a significant proportion of studies reported unclear definitions for CVD outcomes. The search strategy did not reveal any randomized controlled trials. Time-varying exposures, propensity methods, mediation analysis, and competing risks analysis are used infrequently in the identified studies.
There is a need for a universally accepted conceptual framework on the association between oral health and CVD to derive more consistent definitions for oral health and CVD outcomes that are aligned with the investigated research questions. There is also a need to use emerging research methods to maximize the impact of research in this area.
Clinical heterogeneity is evident in the definitions of oral health indicators and cardiovascular disease outcomes. Propensity methods, mediation analysis, and competing risks analysis are used infrequently in the identified studies. The identified clinical heterogeneity and methodological gaps interfere with summarizing existing evidence and understanding their practical implications. Advancing the current understanding of the associations between oral health and cardiovascular disease goes hand in hand with minimizing clinical heterogeneity and closing the identified methodological gaps.
在过去的 25 年中，许多研究都探讨了口腔健康不良与心血管疾病 (CVD) 发生率之间的关系。这项长期的研究产生了广泛而多样的流行病学领域，其影响难以理解，方法上的差距也难以追踪。
本系统综述旨在系统地分析评估口腔健康不良与 CVD 结局之间关系的临床异质性和方法学差距。
检索 Medline、Embase 和 Cochrane Library，以确定研究任何口腔健康指标与 CVD 结局之间关系的纵向研究。每个数据库都从其成立日期和 2018 年 6 月 27 日进行了检索。提取的数据评估了临床异质性（参与者的特征、暴露和结局指标、随访时间）和方法学差距（随机对照试验的可用性、时间变化暴露的利用、倾向评分方法、中介分析和竞争风险分析）。
符合纳入标准的 85 项研究。参与者的特征（年龄、临床状况和职业）以及口腔健康指标和 CVD 结局的定义存在明显的临床异质性。更重要的是，相当一部分研究报告 CVD 结局的定义不明确。搜索策略没有发现任何随机对照试验。时间变化暴露、倾向评分方法、中介分析和竞争风险分析在已确定的研究中很少使用。
需要一个普遍接受的口腔健康与 CVD 关联的概念框架，以便为口腔健康和 CVD 结局制定更一致的定义，使其与所研究的研究问题保持一致。还需要使用新兴的研究方法来最大限度地提高该领域研究的影响力。
口腔健康指标和心血管疾病结局的定义存在明显的临床异质性。在已确定的研究中，倾向评分方法、中介分析和竞争风险分析很少使用。所确定的临床异质性和方法学差距干扰了对现有证据的总结和对其实际意义的理解。推进对口腔健康与心血管疾病之间关联的现有认识与最大限度地减少临床异质性和弥合已确定的方法学差距齐头并进。
