Leelapatana Pattranee, Limpuangthip Nareudee
Cardiac Center, Division of Cardiovascular Medicine, Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Department of Prosthodontics, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.
Heliyon. 2022 Mar 23;8(3):e09161. doi: 10.1016/j.heliyon.2022.e09161. eCollection 2022 Mar.
Poor oral health increases systemic inflammation, which has complex pathophysiologic links with atrial fibrillation (AF). The aim of this comprehensive systematic review was to investigate the association between oral health and AF in terms of new-onset AF and AF recurrence.
After PROSPERO protocol was registered, PubMed, Scopus, and Cochrane Database of Systematic Reviews were standardly searched from database inception to February 2021. The included studies were assessed for quality and risk of bias using the modified Newcastle-Ottawa scale. The indicators of poorer oral health were the presence of periodontitis, lower frequency of dental scaling, lower frequency of toothbrushing, and lower number of missing teeth.
We initially identified 424 studies; however, only 5 studies met the inclusion criteria. The included studies comprised 3 nationwide population-based retrospective cohort studies, 1 large prospective cohort study, and 1 case-control study that reported the association between oral health and AF. These studies demonstrated that poor oral health was associated with new-onset AF, and may promote AF recurrence and progression. Moreover, AF patients with poorer oral health may have a higher risk of arrhythmias and major adverse cardiovascular events during long-term follow-up.
Improved oral health potentially reduces new-onset AF. Periodontitis prevention, regular dental visits for professional dental scaling, and frequent tooth brushing, are oral health care interventions that contribute to AF protection. Therefore, promoting oral health should be integrated as a part of AF primary prevention.
口腔健康状况不佳会加剧全身炎症，而全身炎症与心房颤动（AF）存在复杂的病理生理联系。本全面系统评价的目的是研究口腔健康与新发房颤及房颤复发之间的关联。
在PROSPERO方案注册后，对PubMed、Scopus和Cochrane系统评价数据库从建库至2021年2月进行了标准检索。使用改良的纽卡斯尔-渥太华量表对纳入研究的质量和偏倚风险进行评估。口腔健康较差的指标包括牙周炎的存在、洗牙频率较低、刷牙频率较低以及缺牙数量较少。
我们最初识别出424项研究；然而，只有5项研究符合纳入标准。纳入的研究包括3项基于全国人群的回顾性队列研究、1项大型前瞻性队列研究和1项病例对照研究，这些研究报告了口腔健康与房颤之间的关联。这些研究表明，口腔健康状况不佳与新发房颤相关，可能会促进房颤复发和进展。此外，口腔健康较差的房颤患者在长期随访中可能发生心律失常和主要不良心血管事件的风险更高。
改善口腔健康可能会降低新发房颤的发生。预防牙周炎、定期进行专业洗牙以及频繁刷牙，都是有助于预防房颤的口腔保健干预措施。因此，促进口腔健康应纳入房颤一级预防的一部分。
