Dental caries and risk of newly-onset systemic lupus erythematosus: a nationwide population-based cohort study

Abstract

Objective

This study investigated whether patients with history of dental caries are associated with an increased risk of newly-onset systemic lupus erythematosus (SLE).

Methods

A total of 501,461 carious patients and 258,918 controls without carious teeth were enrolled between 1997 and 2013 from the National Health Insurance Research Database. Subgroup analyses were conducted based on restorative materials including amalgam, composite resins, or both. The cumulative incidence and hazard ratios (HRs) of SLE development were derived after adjusting for age, sex, socioeconomic status, income, insured classification, comorbidities, and frequency of dental visit in a multivariable model.

Results

The risk of SLE was significantly higher in carious patients (HR = 1.98, 95% confidence interval [CI] = 1.65–2.38) compared to controls. Dose-dependent relationship between caries and risk of SLE was identified. The risk of SLE was higher among those who had dental visits ≧11 (HR = 2.53, 95% CI = 1.86–3.43), followed by those with 3–10 dental visits (HR = 1.86, 95% CI = 1.36–2.54), when compared to those with 1–2 visits, and was higher among those who had carious teeth extractions ≧5 (HR = 1.88, 95% CI = 1.19–2.97), followed by those with 1–4 carious teeth extractions (HR = 1.36, 95% CI = 1.17–1.59) than those without extraction. The risk of SLE for dental caries management among different restorative materials, including amalgam, composite resins, or both, was not statistically different.

Conclusions

Patients with dental caries were associated with higher SLE risks. The relationship between dental caries and risk of SLE was dose-dependent, regardless of the material used for the restoration.

Keywords:

• Carious teeth
• cohort study
• dental caries
• restorative materials
• SLE

Transparency

Declaration of funding

This work was supported by grants from Chung Shan Medical University (CSH-2019-C-004).

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Perng, Ma, Huang, Y.M. Hung, and Wei: conceptualization. Huang and Liao: data curation. Perng, Ma, Huang, H.Y. Hung, and Wei: formal analysis. Wei: investigation. Perng, Ma, Huang, Liao, and H.Y. Hung: methodology. Perng, Ma, and Y.M. Hung: writing—original draft. Wei, Perng, Y.M. Hung, Ma, Tsai, and H.Y. Hung: writing—review and editing.

Acknowledgements

None.