Association between periodontitis and health behavior in women over 40 years of age - comparison based on the cardiovascular disease

40세 이상 여성의 치주염과 건강행동의 관련성 - 심혈관질환 여부에 따른 비교

  • Jung, Jae-Yeon (Department of Dental Hygiene, Hanyang Women's University) ;
  • Han, Su-Jin (Department of Dental Hygiene, Gachon University)
  • Received : 2021.08.23
  • Accepted : 2021.11.29
  • Published : 2021.12.30


Objectives: The purpose of this study was to examine the association between periodontitis and health behavior in women aged ≥40 years. In addition, related factors were compared according to the presence or absence of cardiovascular disease. Methods: Data from the 7th Korean National Health and Nutrition Examination Survey (2016-2018) were used. The study included 3,801 women aged 40-79 years, who participated in a questionnaire health survey related to hypertension, stroke, myocardial infarction, and angina pectoris, as well as completed blood tests, anthropometry, and oral examination. Statistical analyses were performed using complex sample general linear, complex sample crosstabs, and complex sample logistic regression analyses. Results: In all subjects, smoking and drinking, use of interdental care products, and dental checkups were confirmed to be significantly related to periodontitis. In the group with cardiovascular disease, the use of interdental care products, experience in dental checkups, and toothbrushing more than three times a day were confirmed as significant factors for lowering the prevalence of periodontitis. In the group without cardiovascular disease, smoking and drinking, use of interdental care products, and experience in dental checkups were confirmed as the significant factors. Conclusions: To improve the periodontal health of women over 40 years of age with cardiovascular disease, a health education program including self-care methods for proper dental plaque management and regular dental checkups are critical. Additionally, awareness of the risks of smoking and drinking would be helpful even for women without cardiovascular diseases.



This thesis was supported by a research grant from Hanyang Women's University in 2021 (2021-1-014).


  1. Kang BW, Ku IY, Kim NH, Kim DY, Kim YK, Kim JS, et al. Geriatric dental hygiene care. Seoul: Koonja; 2012: 7,43-4.
  2. Kang BW, Kim KS, Kim YK, Kim YH, Moon SE, Seong MG, et al. Preventive dentistry. 2nd ed. Seoul: Komoonsa; 2019: 27,81-8,144-5.
  3. Cheon HW, Yu MS, Choi MH. The association of oral diseases and chronic diseases in Korean adult population. J Korean Soc Dent Hyg 2012;12(2):235-49.
  4. Lee YK, Kim MA. The association between cardiovascular disease and periodontal disease on convergence study in adults over age 40. J Korea Converg Soc 2019;10(4):65-71.
  5. Kang HJ. The convergence relationship between health behavior and cardiovascular disease and periodontitis. J Korea Converg Soc 2019;10(11):233-9.
  6. Nam YO, Kim IJ. Association between two major oral diseases and cardiovascular diseases. J Korean Soc Dent Hyg 2018;18(5):653-64.
  7. Mensah GA, Roth GA, Fuster V. The global burden of cardiovascular diseases and risk factors: 2020 and beyond. J Am Coll Cardiol 2019;74(20):2529-32.
  8. World Health Organization. Cardiovascular diseases (CVDs) [Internet]. World Health Organization. [cited 2021 Jan 16]. Available from:
  9. Korean Statistical Information Service. Changes in mortality rates by major causes of death. In. Daejeon: Statistics Korea; 2021[Internet]. Statistics Korea. [cited 2021 Jun 01]. Available from:
  10. Kim YJ, Kwak C. Prevalence and associated risk factors for cardiovascular disease: findings from the 2005, 2007 Korea national health and nutrition examination survey. Korean J Health Promot 2011;11(3):169-76.
  11. Schatzle M, Loe H, Burgin W, Anerud A, Boysen H, Lang NP. Clinical course of chronic periodontitis: I. Role of gingivitis. J Clin Periodontol 2003;30(10):887-901.
  12. Oh MS, Jeong MH. Sex differences in cardiovascular disease risk factors among Korean adults. Korean J Med 2020;95(4):266-75.
  13. Hong MH. Relationship between oral health behavior, chronic disease and periodontal disease in middle and older adults according to gender. Journal of the Korea Academia - Industrial Cooperation Society 2018;19(11):403-10.
  14. Brown TT, Dela Cruz E, Brown SS. The effect of dental care on cardiovascular disease outcomes: an application of instrumental variables in the presence of heterogeneity and self - selection. Health Econ 2011;20(10):1241-56.
  15. Kim KA, Hwang SY. Impact of physical activity, central obesity and depression on the quality of life according to the presence of cardiovascular risk among menopausal middle - aged women: secondary data analysis. Korean J Adult Nurs 2017;29(4):382-92.
  16. Naderi S, Merchant AT. The association between periodontitis and cardiovascular disease: an update. Curr Atheroscler Rep 2020;22(10):52.
  17. Ellis JS, Averley PA, Preshaw PM, Steele JG, Seymour RA, Thomason JM. Change in cardiovascular risk status after dental clearance. Br Dent J 2007;202(9):543-4.
  18. The National Cholesterol Education Program (NCEP) Expert Panel. Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III) final report. Circulation 2002;106(25):3143-421.
  19. Korea Centers for Disease Control and Prevention. The seventh Korea National Health and Nutrition Examination Survey (KNHANES VII) [Internet]. Korea Centers for Disease Control and Prevention. [cited 2021 Jan 26]. Available from:
  20. Korea Centers for Disease Control and Prevention. The seventh Korea National Health and Nutrition Examination Survey raw data use guidelines. Cheongju: Korea Centers for Disease Control and Prevention; 2020: 93-200.
  21. World Health Organization. Global recommendations on physical activity for health. Geneva: World Health Organization; 2010: 24-33.
  22. Seo MH, Lee WY, Kim SS, Kang JH, Kang JH, Kim KK, et al. 2018 Korean society for the study of obesity guideline for the management of obesity in Korea. J Obes Metab Syndr 2019;28(1):40-5.
  23. Reichert S, Schlitt A, Beschow V, Lutze A, Lischewski S, Seifert T, et al. Use of floss / interdental brushes is associated with lower risk for new cardiovascular events among patients with coronary heart disease. J Periodontal Res 2015;50(2):180-8.
  24. Han SJ. Association between periodontitis, obesity, and health behavior according to sex and age groups in Korean adults. J Korean Soc Dent Hyg 2020;20(4):421-33.
  25. Kim YH, Lee JH. Menopause experience and the relationship beyween metabolic syndrome components and periodontitis. J Korean Acad Oral Health 2019;43(2):56-62.
  26. Bascones-Martinez A, Gonzalez-Febles J, Sanz-Esporrin J. Diabetes and periodontal disease. Review of the literature. Am J Dent 2014;27(2):63-7.
  27. Lee SH, Roh SC. Vitamin D level in blood of menopausal women over 50 and the relation with the proportion requiring dental scaling. J Dent Hyg Sci 2013;13(4):393-402.
  28. Cha ES, Son KY, Yun JM, Chung WJ, Cho BL, Jin BH. Associations between atherosclerosis and periodontitis, physical health and dental care: a pilot study. J Korean Acad Oral Health 2017;41(4):274-81.
  29. Korea centers for disease control and prevention. Korea health statistics 2018: Korea National Health and Nutrition Examination Survey (KNHANES VII-3). Cheongju: Ministry of Health and Welfare; 2019: 32-4.
  30. Leite FRM, Nascimento GG, Baake S, Pedersen LD, Scheutz F, Lopez R. Impact of smoking cessation on periodontitis: a systematic review and meta - analysis of prospective longitudinal observational and interventional studies. Nicotine Tob Res 2019;21(12):1600-8.
  31. Jeong W, Choi DW, Kim YK, Lee HJ, Lee SA, Park EC, et al. Associations of electronic and conventional cigarette use with periodontal disease in South Korean adults. J Periodontol 2020;91(1):55-64.
  32. Wakabayashi I. Smoking and lipid - related indices in patients with diabetes mellitus. Diabet Med 2014;31(7):868-78.
  33. Lee SK, Hwang SY. Effects of oral health awareness and oral health behavior on preventive behavior of cardiocerebrovascular disease in cardiocerebrovascular disease risk group. Journal of the Korea Academia - Industrial Cooperation Society 2018;19(8):303-11.
  34. Zhao D, Guallar E, Ouyang P, Subramanya V, Vaidya D, Ndumele CE, et al. Endogenous sex hormones and incident cardiovascular disease in post - menopausal women. J Am Coll Cardiol 2018;71(22):2555-66.
  35. Kingman A, Albandar JM. Methodological aspects of epidemiological studies of periodontal diseases. Periodontology 2000 2002;29:11-30.