Lifestyle behaviors as Effect Modifiers in the Association Between Oral Health and Carotid Artery Calcification: A Cross-Sectional Study.

INTRODUCTION AND AIMS: The relationship between carotid artery calcification (CAC) detected on panoramic radiographs and oral health remains unclear due to potential confounding factors. This study aimed to evaluate this association after adjusting for these confounders and explore potential effect modification by lifestyle behaviours. METHODS: This cross-sectional study assessed the association between CAC on panoramic radiographs and oral health outcomes, including decayed, missing, and filled teeth (DMFT) index, periodontal disease, and apical periodontitis. Directed acyclic graphs were used to determine the minimal sufficient adjustment set, including sociodemographic factors, medical conditions (hypertension, hyperlipidaemia, and diabetes mellitus), and lifestyle habits (alcohol consumption, betel quid chewing, and smoking). A complete dataset was obtained after multiple imputation of missing values. Associations were examined using regression models, and effect modification by lifestyle behaviours was assessed using interaction terms, with stratified analyses performed for significant interactions. RESULTS: The prevalence of CAC (670 patients) was 21.49%. CAC patients had a DMFT index 2.026 units higher, 0.290 more teeth with apical periodontitis, 1.873-fold higher odds of periodontal disease, and 1.554-fold higher odds of concurrent periodontal and apical diseases. After adjustment for confounders, the association between CAC and oral health outcomes disappeared. Age was associated with higher DMFT index (0.279 units), more teeth with apical periodontitis (0.017 units), and higher odds of periodontal and apical disease (3.5%-7.8% per year) (P < .001). Males were associated with periodontal disease. A significant interaction between CAC and alcohol consumption was observed, with CAC significantly associated with periodontal disease among drinkers (odds ratio = 9.051). CONCLUSION: After adjustment for confounders, associations between CAC and oral health outcomes disappeared. Alcohol consumption modified the association between CAC and periodontal disease, with an association observed among drinkers. CLINICAL RELEVANCE: While radiographic detection of CAC facilitates cardiovascular risk identification and referral, alcohol consumption modifies the association between CAC and periodontal disease.