Systemic Factors Associated with Caries Outcomes: Toward a Medically Integrated Risk Model Using Electronic Health Record Data.

OBJECTIVES: To identify systemic conditions, medication exposures, and clinical factors associated with caries outcomes and to inform the development of a medically integrated caries risk framework. METHODS: This retrospective study included approximately 7,000 patients treated at a university-based dental clinic with integrated medical-dental electronic health record data. Independent variables included chronic medical conditions, medication use, and social determinants of health. Outcomes included CAMBRA risk score, CAMBRA risk level, decayed-missing-filled teeth (DMFT), decayed-missing-filled surfaces (DMFS), and incident caries. Associations were evaluated using chi-squared tests, t-tests, multivariable linear regression models, age-adjusted analyses, interaction models, and sensitivity analyses using variable frequency thresholds. RESULTS: Several systemic conditions, including hypertension, diabetes, gastroesophageal reflux disease, HIV, hypothyroidism, and obesity, were significantly associated with caries outcomes (p < 0.05). Medication classes, including antihypertensives, antihistamines, psychotherapeutics, and anti-inflammatory agents, were also associated, although less consistently after adjustment for age. Age was a significant factor across all outcomes (p < 0.001), and many variables remained statistically significant in DMFT and DMFS models. Interaction analyses demonstrated age-dependent effects for multiple conditions, including hypertension and HIV-related variables. Hypertension showed consistent associations across models, and HIV-specific analyses identified relationships between immune markers (CD4, CD8, CD4:CD8 ratio) and caries outcomes. Sensitivity analyses demonstrated similar results across thresholds. CONCLUSIONS: Systemic conditions and medication use are associated with caries outcomes, with age influencing these relationships. These findings identify key variables that may inform the development of a medically integrated framework for caries risk assessment beyond traditional behavioral models. CLINICAL SIGNIFICANCE: These findings emphasize the clinical impact of medications and comorbidities on dental caries risk and progression. Xerostomia-inducing drugs and chronic conditions such as diabetes alter salivary function and microbial balance, increasing susceptibility. Incorporating medical history into caries risk assessment enables targeted prevention, optimized management, and improved outcomes in medically complex patients.