Ji Zuhong, Mei Jianwen, Li Youjian, Wang Zijie, Guo Zhirui, Miao Lin
Medical Centre for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Department of Oncology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China.
BMC Public Health. 2025 Apr 21;25(1):1462. doi: 10.1186/s12889-025-22747-8.
Oral diseases affect approximately 3.5 billion people worldwide, disproportionately burdening populations in developing countries. Chronic diarrhea and constipation, as common intestinal disorders, may interact bidirectionally with oral health, though their population-level associations remain unexamined.
We analyzed data from the National Health and Nutrition Examination Surveys (NHANES) 2005-2008, selecting participants based on inclusion criteria. Chronic diarrhea and constipation were defined based on the bowel health questionnaire. Oral health indicators (teeth condition and oral pain frequency) were derived from the oral health questionnaire. Covariates selected by Lasso regression were analyzed through adjusted logistic regression to examine associations between bowel habits and oral health. Restricted cubic splines (RCS), subgroup stratification, and sensitivity analyses were also used.
A total of 7512 participants aged ≥ 20 with complete information were included. Multivariable logistic regression revealed a significant association between chronic constipation and poor teeth condition (OR:1.45, 95% CI: 1.05-2.01, P = 0.029). A U-shaped dose-response relationship was observed between stool frequency and poor teeth condition (nonlinear P-value = 0.002) using RCS analysis, with both abnormally low and high bowel frequencies correlating with increased oral health risks. No significant association was identified between oral pain frequency and abnormal bowel habits after full covariate adjustment. Stratified analyses indicated that daily dietary fiber intake ≥ 25 g was associated with reduced risks of poor teeth condition (chronic diarrhea OR: 0.40, 95% CI: 0.12-0.98; chronic constipation OR: 0.44, 95% CI: 0.13-1.09), whereas higher income (PIR > 3.5) correlated with elevated risks (chronic diarrhea OR: 2.38, 95% CI: 1.35-3.98; chronic constipation OR: 2.18, 95% CI: 1.22-3.70). Sensitivity analyses supported the stability of associations between abnormal bowel habits and poor teeth condition.
Both chronic constipation and diarrhea were associated with higher risk of poor teeth condition. In the general population and subgroup analyses, individuals with stool frequency around 8-10 times per week demonstrated the lowest risk of poor teeth condition. Stratified analysis indicates that dietary fiber intake and PIR might modify the observed relationship between abnormal bowel habits and teeth condition.
口腔疾病影响着全球约35亿人，给发展中国家的人群带来了不成比例的负担。慢性腹泻和便秘作为常见的肠道疾病，可能与口腔健康存在双向相互作用，尽管它们在人群层面的关联尚未得到研究。
我们分析了2005 - 2008年美国国家健康与营养检查调查（NHANES）的数据，根据纳入标准选择参与者。慢性腹泻和便秘根据肠道健康问卷进行定义。口腔健康指标（牙齿状况和口腔疼痛频率）来自口腔健康问卷。通过Lasso回归选择的协变量经调整逻辑回归分析，以检验排便习惯与口腔健康之间的关联。还使用了受限立方样条（RCS）、亚组分层和敏感性分析。
总共纳入了7512名年龄≥20岁且信息完整的参与者。多变量逻辑回归显示慢性便秘与牙齿状况不佳之间存在显著关联（比值比：1.45，95%置信区间：1.05 - 2.01，P = 0.029）。使用RCS分析观察到排便频率与牙齿状况不佳之间呈U形剂量反应关系（非线性P值 = 0.002），排便频率异常低和高均与口腔健康风险增加相关。在进行全面协变量调整后，未发现口腔疼痛频率与异常排便习惯之间存在显著关联。分层分析表明，每日膳食纤维摄入量≥25克与牙齿状况不佳风险降低相关（慢性腹泻比值比：0.40，95%置信区间：0.12 - 0.98；慢性便秘比值比：0.44，95%置信区间：0.13 - 1.09），而较高收入（贫困收入比>3.5）与风险升高相关（慢性腹泻比值比：2.38，95%置信区间：1.35 - 3.98；慢性便秘比值比：2.18，95%置信区间：1.22 - 3.70）。敏感性分析支持了异常排便习惯与牙齿状况不佳之间关联的稳定性。
慢性便秘和腹泻均与牙齿状况不佳的较高风险相关。在总体人群和亚组分析中，每周排便频率约为8 - 10次的个体牙齿状况不佳的风险最低。分层分析表明，膳食纤维摄入量和贫困收入比可能会改变观察到的异常排便习惯与牙齿状况之间的关系。
