Journal of Indian Association of Public Health Dentistry

ORIGINAL ARTICLE
Year
: 2022  |  Volume : 20  |  Issue : 2  |  Page : 125--130

Effect of physical activity on oral health: A systematic review


Anuhya Reddy Medapati, Srinivas Pachava 
 Department of Public Health Dentistry, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India

Correspondence Address:
Anuhya Reddy Medapati
Department of Public Health Dentistry, Sibar Institute of Dental Sciences, Takkellapadu, Guntur District, Andhra Pradesh
India

Abstract

Background: Although there is remarkable evidence in the literature that there is an association between physical activity and general health, the possible influence of physical activity on oral health outcomes has not been well documented. The aim of this study is to assess the effects of physical activity on oral health. Methodology: An aggregate of 112 studies has been retrieved from PubMed, Cochrane Library, and Turning Research Into Practice databases from 2001 to 2020, of which 14 observational studies have been integrated into this systematic review. Results: Among the included studies, four studies have reported an association between periodontal disease and regular physical activity. Four studies reported an association between oral health behavior and physical activity. Two studies found an association between physical activity and dental caries. Conclusion: The findings from the present systematic review revealed an association between oral health, oral health behaviors, and individuals practicing physical activity. It was observed that there were reduced inflammatory biomarkers in physically active individuals, which in turn was related to improved periodontal health. As this review only looked at studies that were based on observations, more studies were suggested to see if there was a possible cause-and-effect relationship between each condition.



How to cite this article:
Medapati AR, Pachava S. Effect of physical activity on oral health: A systematic review.J Indian Assoc Public Health Dent 2022;20:125-130


How to cite this URL:
Medapati AR, Pachava S. Effect of physical activity on oral health: A systematic review. J Indian Assoc Public Health Dent [serial online] 2022 [cited 2022 Jul 3 ];20:125-130
Available from: https://www.jiaphd.org/text.asp?2022/20/2/125/346880


Full Text



 Introduction



Scientific evidence has accumulated over the last half-century, demonstrating that being physically inactive has major negative health implications across a lifetime and is a key component of a complete strategy for chronic disease prevention and health promotion.[1] It is an established fact that physical activity has a direct relationship with general health.

Physical activity and exercise are essential factors included in human motricity. Exercise is a systematic and organized activity with the principal goal of improving bodily capabilities, as determined by rigorous training methodological factors such as amount, duration, frequency, and exercise type. Physical activity is defined as any physical action involving skeletal muscles that require more energy expenditure than at rest. Physical activity can take many forms, including everyday activities such as occupation, sports, and active transportation.[2]

Physical activity on a regular basis improves various physical capacities in the general aspects of human health. Physical exercise has been attributed to changes in inflammatory indicators in the body, including reduced levels of C-reactive protein (CRP). On the other hand, upregulation of this protein, on the other hand, has been associated with numerous systemic and oral illnesses, especially periodontal disease.[3] However, this relationship has been less often explored, with particular emphasis on oral health.

Does physical inactivity have something to do with poor oral health status? Can this possible association, should there be any, be explained outside of the behavioral purview that physically inactive individuals assume an increased risk of having poor oral behaviors? Has there been any biological mechanism proposed? Are there any epidemiological studies that attempt to address this question with methodological integrity?

To find possible explanations for these research questions, the present systematic review was carried out with the aim to assess the effects of physical activity on oral health.

 Methodology



A systematic review was performed in compliance with the PRISMA guidelines [Figure 1]. The population interest comparison outcome (PICO) framework has been adapted to implement the quest approach. The PICO question applied through this research was Does regular physical activity influence oral health? The search was carried out by two reviewers that focused on articles which compared people who practice regular physical activity and sedentary lifestyles with oral health as an outcome.{Figure 1}

Search strategy and selection criteria

A search of the databases PubMed, Cochrane library, and Turning Research Into Practice between January 2001 and May 2020 yielded relevant articles related to the topic that compared people who practice regular physical activity and sedentary lifestyles with oral health as an outcome, with the keywords “physical activity, physical fitness, oral health, periodontal disease,” and an advanced search were carried out using the Boolean operator “AND.” Following the identification of 223 studies and the deletion of duplicates, a total of 112 articles were retrieved. After applying the inclusion and exclusion criteria, 14 studies were included. The resulting studies were subjected to quality assessment criteria using the appropriate design-based quality checklist, (STrengthening the Reporting of OBservational studies in Epidemiology [STROBE]).

Inclusion criteria

Studies published only in English related to physical activity and oral healthStudies published within a timeframe of 20 years (2001–2020)Studies which focused on oral health (periodontal health and dental caries) and oral health behavior as an outcome were included in the study.

Exclusion criteria

Review articles, abstracts, and editorials were excluded from the study.

 Results



A total of 318,293 study participants were evaluated in the selected studies. Suratri et al.[4] contributed the maximum number of participants (n = 173,828), whereas Eberhard et al.[5] contributed a minimum number of participants (n = 72). The age range of the participants was between 6 and 77 years. A study done by Samnieng et al.[6] mentioned the mean age of the subjects (68.8 ± 5.9 years). Of the included studies, one is case control, one is a cohort, and 12 are cross-sectional studies [Table 1]. The level of physical activity was measured through the International Physical Activity Questionnaire.{Table 1}

 Discussion



The evidence for the present systematic review regarding physical activity and oral health was obtained through observational studies (n = 14). The studies that resulted were subjected to quality assessment criteria using the STROBE design-based quality checklist.

Due to confounding, observational evidence is typically weaker than randomized controlled trials (RCTs). However, in certain instances, this might be the best accessible proof. Progressively, systematic reviews of medical care interventions incorporate observational studies when evidence from RCT's is viewed as deficient; preliminary studies might be considered infeasible or deceptive, do not report long-haul or more uncommon genuine results, or do not reflect use in authentic settings regarding populations included, correlations made, or how the interventions are applied. Five fundamental inclinations can influence mediation research: choice, execution, discovery, attrition, and particular results announcing bias. Consideration of these predispositions in collecting significant observational investigations will assist in deciding the appropriateness of these examinations for incorporation into a near-viability audit.[18],[19] The present review identified the subsequent domains relating to physical activity and oral health.

Analyzing data from the Third National Health and Nutrition Examination (NHANES III) Survey, Al-Zahrani et al. observed that indulging in the required level of physical activity was significantly related to decreased periodontal disease prevalence (odds ratio [OR] = 0.58, 95% confidence interval [CI], 0.35–0.96). Smoking, on the other hand, was discovered to alter this relationship. The association was robust and significant among newer smokers (OR = 0.46, 95% CI: 0.23–0.93) and past smokers (OR = 0.26, 95% CI: 0.09–0.72) but not among current smokers (OR = 1.10, 95% CI: 0.48–2.53).[8],[9] Merchant et al.[7] observed a similar inverse, linear relationship between prolonged physical exercise and periodontal disease in the absence of conventional risk factors in an extremely prospective study. A physically active lifestyle may have benefits for periodontal health. Physical exercise may protect against periodontal disease by improving insulin sensitivity and therefore reducing the onset of type II diabetes, a known risk factor for periodontal disease. Exercise-induced muscle contraction was found to have a synergistic impact with insulin in accelerating glucose absorption into cells.[7]

Physical activity and oral health behavior

Teenagers who were physically active had better oral hygiene habits than their sedentary peers. Obesity and irregular breakfast consumption were the most robust indicators of poor oral health practices among teenagers, regardless of gender. According to a study done by Virtanen et al., physically active adolescents are better at maintaining their oral health than physically inactive adolescents.[17] They concluded that physically active adolescents had better oral hygiene practices than inactive adolescents. Furthermore, tooth brushing was related to eating behaviors, obesity, and socioeconomic status. Another cross-sectional study conducted by Samnieng et al. concluded that good health practices were related to good oral health habits. Furthermore, general health practices were related with the clinical oral health status such as the teeth present decayed teeth, periodontal disease, oral malodor, and salivary rate.6]

Physical activity and inflammatory response in periodontal disease

Sanders et al. conducted a study to determine the relationship between physical activity and inflammatory mediators such as interleukin-1b (IL-1b), CRP, and periodontal disease, as well as if any such link differs between periodontal disease patients and noncases. Individuals who had been involved in extremely daily physical activity of 30 min or more had reduced levels of the proinflammatory biomarkers IL-1b and serum globulin in gingival crevicular fluid than those who were less active.[10] This applies to every individual, regardless of whether they have periodontal disease or not.

Physical activity and dental caries

A study done by Suratri et al. revealed a significant relation between physical exercise, behaviors/habits, and dental caries status. This study also revealed a substantial connection between hygienic practices and dental caries status. When compared to unhygienic behavior, individuals with hygienic behavior had a reduced incidence of caries.[4] Another study conducted by Rodrigues et al. showed an affiliation between sex, age, and some physical activity with the decayed missed and filled index (DMF). In the majority of individuals with deciduous teeth, it is proven that there is a robust correlation between the low intensity of physical activity with the higher numbers of DMF that being aforementioned it means that there are worst oral health and hygiene in those cases.[15]

Some of the research drew on subsamples from national surveys conducted in the United States.[8],[9],[16] As a result, several studies failed to disclose information concerning clinical periodontal markers (CAL, bleeding on probing, and so forth) needed for periodontal diagnostics. Most of the issues ascertained within the studies were associated with the shortage of adequate sampling strategies,[7],[8],[9] inclusion and exclusion criteria such as participants with smoking habits or general diseases,[6],[7],[8],[9] and small sample size.[10]

 Conclusion



Findings from the present systematic review reveal an association between oral health, oral health behaviors, and individuals practicing physical activity. It was observed that there are reduced inflammatory biomarkers in physically active individuals which in turn is related to improved periodontal health. As this review includes solely observational studies, more studies were suggested to judge an attainable cause-and-effect relationship between each condition.

Periodontal disease and regular physical activity have been linked in four studies. Four studies reported an association between oral health behavior and physical activity. Two studies found an association between physical activity and dental caries. Findings from the present systematic review revealed an association between oral health, oral health behaviors, and individuals practicing physical activity. It was observed that there are reduced inflammatory biomarkers in physically active individuals which in turn is related to improved periodontal health. As this review includes solely observational studies, more studies were suggested to judge an attainable cause-and-effect relationship between each condition.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Haskell WL, Blair SN, Hill JO. Physical activity: Health outcomes and importance for public health policy. Prev Med 2009;49:280-2.
2American College of Sports Medicine; Chodzko-Zajko WJ, Proctor DN, Fiatarone Singh MA, Minson CT, Nigg CR, et al. American College of Sports Medicine position stand. Exercise and physical activity for older adults. Med Sci Sports Exerc 2009;41:1510-30.
3Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: Guidance for prescribing exercise. Med Sci Sports Exerc 2011;43:1334-59.
4Suratri MA, Tjahja I, Setiawaty V. Correlation between dental health maintenance behavior with Dental Caries Status (DMF-T). Bali Med J 2018;7:56-60.
5Eberhard J, Stiesch M, Kerling A, Bara C, Eulert C, Hilfiker-Kleiner D, et al. Moderate and severe periodontitis are independent risk factors associated with low cardiorespiratory fitness in sedentary non-smoking men aged between 45 and 65 years. J Clin Periodontol 2014;41:31-7.
6Samnieng P, Ueno M, Zaitsu T, Shinada K, Wright FA, Kawaguchi Y. The relationship between seven health practices and oral health status in community-dwelling elderly Thai. Gerodontology 2013;30:254-61.
7Merchant AT, Pitiphat W, Rimm EB, Joshipura K. Increased physical activity decreases periodontitis risk in men. Eur J Epidemiol 2003;18:891-8.
8Al-Zahrani MS, Borawski EA, Bissada NF. Increased physical activity reduces prevalence of periodontitis. J Dent 2005;33:703-10.
9Al-Zahrani MS, Borawski EA, Bissada NF. Periodontitis and three health-enhancing behaviors: Maintaining normal weight, engaging in recommended level of exercise, and consuming a high-quality diet. J Periodontol 2005;76:1362-6.
10Sanders AE, Slade GD, Fitzsimmons TR, Bartold PM. Physical activity, inflammatory biomarkers in gingival crevicular fluid and periodontitis. J Clin Periodontol 2009;36:388-95.
11Shimazaki Y, Egami Y, Matsubara T, Koike G, Akifusa S, Jingu S, et al. Relationship between obesity and physical fitness and periodontitis. J Periodontol 2010;81:1124-31.
12Bawadi HA, Khader YS, Haroun TF, Al-Omari M, Tayyem RF. The association between periodontal disease, physical activity and healthy diet among adults in Jordan. J Periodontal Res 2011;46:74-81.
13Maykanathan D, Kaur S. Socio-demographics, oral health behavior, and physical activity: Factors in caries experience among 19-59 years old adults in a Malaysian population. Makara J Health Res 2015;19:3.
14Singla N, Acharya S, Prabhakar RV, Chakravarthy K, Singhal D, Singla R. The impact of lifestyles on the periodontal health of adults in Udupi district: A cross sectional study. J Indian Soc Periodontol 2016;20:330-5.
15Rodrigues O, Adam S, Freitas M, Martins AC, Granja AR, Nogueira P, et al. Relationship between oral health and physical activity in a young population aged 6-18 years from Seixal's public schools, Portugal (2011-2014). J Int Oral Health 2017;9:228-34.
16Anderson AP, Park YM, Shrestha D, Zhang J, Liu J, Merchant AT. Cross-sectional association of physical activity and periodontal antibodies. J Periodontol 2018;89:1400-6.
17Virtanen JI, Muikku T, Similä T, Cinar AB, Pohjola V. Physical activity, BMI and oral health behaviour among adolescents: Finnish School Health Promotion Study. Eur J Public Health 2019;29:296-302.
18Norris S, Atkins D, Bruening W, Fox S, Johnson E, Kane R, et al. Selecting observational studies for comparing medical interventions. In: Methods Guide for Comparative Effectiveness Reviews. Rockville (MD): Agency for Healthcare Research and Quality; 2011. p. 1-16.
19Mueller M, D'Addario M, Egger M, Cevallos M, Dekkers O, Mugglin C, et al. Methods to systematically review and meta-analyse observational studies: A systematic scoping review of recommendations. BMC Med Res Methodol 2018;18:44.