The effect of self-reported flossing behavior on cardiovascular disease events and mortality Findings from the 2009-2016 National Health and Nutrition Examination Surveys

BackgroundThere is increasing evidence suggesting that daily oral hygiene self-care measures may alleviate cardiovascular disease (CVD) risk. The authors aimed to determine the influence of self-reported dental flossing behavior on the prevalence of CVD events, CVD-linked mortality, and a CVD risk m...

وصف كامل

محفوظ في:
التفاصيل البيبلوغرافية
المؤلف الرئيسي: Nebu, Philip (author)
مؤلفون آخرون: Tamimi, Faleh (author), Al-Sheebani, Abdulla (author), Almuzafar, Abdulrahman (author), Shi, Zumin (author)
التنسيق: article
منشور في: 2025
الموضوعات:
الوصول للمادة أونلاين:http://dx.doi.org/10.1016/j.adaj.2024.09.017
https://www.sciencedirect.com/science/article/pii/S0002817724005658
http://hdl.handle.net/10576/65935
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author Nebu, Philip
author2 Tamimi, Faleh
Al-Sheebani, Abdulla
Almuzafar, Abdulrahman
Shi, Zumin
author2_role author
author
author
author
author_facet Nebu, Philip
Tamimi, Faleh
Al-Sheebani, Abdulla
Almuzafar, Abdulrahman
Shi, Zumin
author_role author
dc.creator.none.fl_str_mv Nebu, Philip
Tamimi, Faleh
Al-Sheebani, Abdulla
Almuzafar, Abdulrahman
Shi, Zumin
dc.date.none.fl_str_mv 2025-07-02T05:26:04Z
2025-01-31
dc.format.none.fl_str_mv application/pdf
dc.identifier.none.fl_str_mv http://dx.doi.org/10.1016/j.adaj.2024.09.017
Philip, N., Tamimi, F., Al-Sheebani, A., Almuzafar, A., & Shi, Z. (2025). The effect of self-reported flossing behavior on cardiovascular disease events and mortality: Findings from the 2009-2016 National Health and Nutrition Examination Surveys. The Journal of the American Dental Association, 156(1), 17-27.
00028177
https://www.sciencedirect.com/science/article/pii/S0002817724005658
http://hdl.handle.net/10576/65935
17-27
1
156
1943-4723
dc.language.none.fl_str_mv en
dc.publisher.none.fl_str_mv Elsevier
dc.rights.none.fl_str_mv http://creativecommons.org/licenses/by-nc-nd/4.0/
info:eu-repo/semantics/openAccess
dc.subject.none.fl_str_mv Flossing
cardiovascular disease
periodontal disease
oral hygiene
mortality
dc.title.none.fl_str_mv The effect of self-reported flossing behavior on cardiovascular disease events and mortality Findings from the 2009-2016 National Health and Nutrition Examination Surveys
dc.type.none.fl_str_mv Article
info:eu-repo/semantics/publishedVersion
info:eu-repo/semantics/article
description BackgroundThere is increasing evidence suggesting that daily oral hygiene self-care measures may alleviate cardiovascular disease (CVD) risk. The authors aimed to determine the influence of self-reported dental flossing behavior on the prevalence of CVD events, CVD-linked mortality, and a CVD risk marker of inflammation (ie, C-reactive protein [CRP]). MethodsData from 18,801 adult participants of the 2009-2016 National Health and Nutrition Examination Surveys were analyzed with regard to flossing behavior, prevalence of CVD events, mortality cause data, and CRP levels. Information on mortality was obtained from the US mortality registry, updated to 2019. Participants who answered the flossing question were divided into 4 groups according to their frequency of flossing: not flossing (0 d/wk); occasional flossing (1-3 d/wk); frequent flossing (4-6 d/wk); and daily flossing (7 d/wk). Multiple logistic regression and Cox proportional hazard regression were used for analysis. ResultsDaily flossing was associated with lower prevalence of CVD events after adjusting for age, sex, sociodemographic factors, and lifestyle habits (model 2); the odds ratio was 0.71 (95% CI, 0.59 to 0.85) for CVD prevalence in the daily flossing group compared with the not flossing group. The odds ratio for CVD prevalence for each additional day of flossing was 0.95 (95% CI, 0.93 to 0.98; P for linear trend < .001) in model 2, and remained statistically significant after model 2 was further adjusted for metabolic syndrome. Daily flossing compared with not flossing was associated with lower risk of experiencing CVD mortality (hazard ratio, 0.64; 95% CI, 0.49 to 0.84) in model 2. The hazard ratio of CVD mortality for each additional day of flossing was 0.94 (95% CI, 0.90 to 0.98; P for linear trend = .002) in model 2. Participants in the not flossing group had significantly elevated CRP levels, even after multivariable adjustments. ConclusionsPoor flossing behavior is associated with higher prevalence of cardiovascular events, increased risk of experiencing CVD mortality, and elevated CRP levels. Practical ImplicationsImprovement in flossing behavior can have an additional benefit in the prevention of CVD events. Cardiologists need to advise patients to improve their personal oral hygiene practices, in addition to the standard diet and exercise advice.
eu_rights_str_mv openAccess
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identifier_str_mv Philip, N., Tamimi, F., Al-Sheebani, A., Almuzafar, A., & Shi, Z. (2025). The effect of self-reported flossing behavior on cardiovascular disease events and mortality: Findings from the 2009-2016 National Health and Nutrition Examination Surveys. The Journal of the American Dental Association, 156(1), 17-27.
00028177
17-27
1
156
1943-4723
language_invalid_str_mv en
network_acronym_str qu
network_name_str Qatar University repository
oai_identifier_str oai:qspace.qu.edu.qa:10576/65935
publishDate 2025
publisher.none.fl_str_mv Elsevier
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rights_invalid_str_mv http://creativecommons.org/licenses/by-nc-nd/4.0/
spelling The effect of self-reported flossing behavior on cardiovascular disease events and mortality Findings from the 2009-2016 National Health and Nutrition Examination SurveysNebu, PhilipTamimi, FalehAl-Sheebani, AbdullaAlmuzafar, AbdulrahmanShi, ZuminFlossingcardiovascular diseaseperiodontal diseaseoral hygienemortalityBackgroundThere is increasing evidence suggesting that daily oral hygiene self-care measures may alleviate cardiovascular disease (CVD) risk. The authors aimed to determine the influence of self-reported dental flossing behavior on the prevalence of CVD events, CVD-linked mortality, and a CVD risk marker of inflammation (ie, C-reactive protein [CRP]). MethodsData from 18,801 adult participants of the 2009-2016 National Health and Nutrition Examination Surveys were analyzed with regard to flossing behavior, prevalence of CVD events, mortality cause data, and CRP levels. Information on mortality was obtained from the US mortality registry, updated to 2019. Participants who answered the flossing question were divided into 4 groups according to their frequency of flossing: not flossing (0 d/wk); occasional flossing (1-3 d/wk); frequent flossing (4-6 d/wk); and daily flossing (7 d/wk). Multiple logistic regression and Cox proportional hazard regression were used for analysis. ResultsDaily flossing was associated with lower prevalence of CVD events after adjusting for age, sex, sociodemographic factors, and lifestyle habits (model 2); the odds ratio was 0.71 (95% CI, 0.59 to 0.85) for CVD prevalence in the daily flossing group compared with the not flossing group. The odds ratio for CVD prevalence for each additional day of flossing was 0.95 (95% CI, 0.93 to 0.98; P for linear trend < .001) in model 2, and remained statistically significant after model 2 was further adjusted for metabolic syndrome. Daily flossing compared with not flossing was associated with lower risk of experiencing CVD mortality (hazard ratio, 0.64; 95% CI, 0.49 to 0.84) in model 2. The hazard ratio of CVD mortality for each additional day of flossing was 0.94 (95% CI, 0.90 to 0.98; P for linear trend = .002) in model 2. Participants in the not flossing group had significantly elevated CRP levels, even after multivariable adjustments. ConclusionsPoor flossing behavior is associated with higher prevalence of cardiovascular events, increased risk of experiencing CVD mortality, and elevated CRP levels. Practical ImplicationsImprovement in flossing behavior can have an additional benefit in the prevention of CVD events. Cardiologists need to advise patients to improve their personal oral hygiene practices, in addition to the standard diet and exercise advice.Elsevier2025-07-02T05:26:04Z2025-01-31Articleinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://dx.doi.org/10.1016/j.adaj.2024.09.017Philip, N., Tamimi, F., Al-Sheebani, A., Almuzafar, A., & Shi, Z. (2025). The effect of self-reported flossing behavior on cardiovascular disease events and mortality: Findings from the 2009-2016 National Health and Nutrition Examination Surveys. The Journal of the American Dental Association, 156(1), 17-27.00028177https://www.sciencedirect.com/science/article/pii/S0002817724005658http://hdl.handle.net/10576/6593517-2711561943-4723enhttp://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessoai:qspace.qu.edu.qa:10576/659352025-07-02T19:06:09Z
spellingShingle The effect of self-reported flossing behavior on cardiovascular disease events and mortality Findings from the 2009-2016 National Health and Nutrition Examination Surveys
Nebu, Philip
Flossing
cardiovascular disease
periodontal disease
oral hygiene
mortality
status_str publishedVersion
title The effect of self-reported flossing behavior on cardiovascular disease events and mortality Findings from the 2009-2016 National Health and Nutrition Examination Surveys
title_full The effect of self-reported flossing behavior on cardiovascular disease events and mortality Findings from the 2009-2016 National Health and Nutrition Examination Surveys
title_fullStr The effect of self-reported flossing behavior on cardiovascular disease events and mortality Findings from the 2009-2016 National Health and Nutrition Examination Surveys
title_full_unstemmed The effect of self-reported flossing behavior on cardiovascular disease events and mortality Findings from the 2009-2016 National Health and Nutrition Examination Surveys
title_short The effect of self-reported flossing behavior on cardiovascular disease events and mortality Findings from the 2009-2016 National Health and Nutrition Examination Surveys
title_sort The effect of self-reported flossing behavior on cardiovascular disease events and mortality Findings from the 2009-2016 National Health and Nutrition Examination Surveys
topic Flossing
cardiovascular disease
periodontal disease
oral hygiene
mortality
url http://dx.doi.org/10.1016/j.adaj.2024.09.017
https://www.sciencedirect.com/science/article/pii/S0002817724005658
http://hdl.handle.net/10576/65935