Cardiometabolic diseases share many modifiable risk factors. However, periodontitis, a chronic inflammatory condition of the gums, is a risk factor that is rarely publicized. This systematic review aims to evaluate the impact of oral hygiene practices on the risk, incidence, and/or mortality rate of cardiovascular disease (CVD), type 2 diabetes mellitus (T2DM), and chronic kidney disease (CKD). Searches were conducted using MEDLINE, Embase, Scopus, and CINHAL. Randomized controlled trials (RCTs), quasi-RCTs, and observational studies were included. Eligible studies reported on associations of toothbrushing, interdental cleaning, mouthwash, or toothpaste use, either alone or in combination with CVD, CKD, and/or T2DM outcomes in adults ≥ 18 years. Fifty-five studies were included. Cochrane’s risk of bias tool and the Newcastle–Ottawa Scale were used for quality assessment. Data synthesis is narratively presented. Toothbrushing and interdental cleaning were associated with lower risk of developing T2DM or hypertension HR 0.54 [p < 0.001] and a lower mortality risk in those with CVD HR = 0.25 [p = 0.03]. Mouthwash use reportedly increased the risk of developing hypertension and diabetes by 85% and 55%, respectively. This review highlights how simple oral hygiene practices can reduce cardiometabolic risk. Non-dental clinicians could integrate the findings into chronic disease health promotion.

Objective: To identify and describe the impact of current oral health education programmes provided to patients in cardiology hospital wards and outpatient clinics.Methods: This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Scoping Reviews statement. Searches were conducted using electronic databases: Cochrane, Medline, and Scopus, as well as grey literature searching.Results: Three eligible studies were identified. All included studies reported generalised poor oral health in their participants at baseline, with significant improvement at follow-up. They all reported significant reductions in plaque deposits and gingival bleeding. One study reported significantly less bacteria on participant tongues, as well as fewer days with post-operative atrial fibrillation in the intervention group. Furthermore, in this study, one patient in the intervention group developed pneumonia, whilst four patients in the control group did.Conclusion: Oral health education for patients with cardiovascular disease is limited and many have poor oral health. Educational programmes to improve oral health behaviours in patients with cardiovascular disease can improve both oral and general health outcomes.Implications for public health: Oral disease is a modifiable risk factor for cardiovascular disease. Integrating oral health education into cardiology hospital settings is a simple strategy to improve access to oral health information and improve both oral and cardiovascular outcomes.

Introduction: Diseases of the periodontal tissues including gingivitis and periodontitis can affect up to 90% and 50% of the population respectively. These conditions are multifactorial inflammatory conditions involving a dysbiotic biofilm that, if left untreated, can lead to the destruction of the supporting structures of the teeth and have significant systemic implications, specifically on cardiovascular health. The elevation of inflammatory markers, particularly high-sensitive C-reactive protein (hsCRP), are strongly associated with an increased risk of atherosclerosis, a key risk factor for cardiovascular disease (CVD). HsCRP as well as other inflammatory markers can be detected in blood samples as early as 21 days after ceasing toothbrushing, due to the immune response to stagnant oral biofilm. The most effective way to ensure oral biofilm cannot remain on oral tissues, thus preventing periodontitis and reducing inflammatory CVD risk, is with good oral hygiene. The primary aim of this study is to assess whether individualised oral hygiene instruction (OHI) partnered with a digital oral health education (DOHE) package can improve the oral health of patients living with CVD. Methods and analysis: A total of 165 participants will be recruited from the Westmead and Blacktown Mt Druitt cardiac rehabilitation out-patient clinics into this dual centre, single blind, parallel design, randomised controlled trial. A baseline oral health clinical examination will be completed, followed by a self-report questionnaire before they are randomised in a 1:1:1 ratio into one of 3 arms as follows: individualised OHI partnered with DOHE (Group A), (Group B) DOHE only (Group B), and control/usual care (no oral health education) (Group C). Groups will have their intervention repeated at the 6-week follow-up. After completing the 12-week follow-up, Group B and Group C will receive tailored OHI. Group C will also receive the DOHE package. The primary outcome is the change in approximal plaque index score between baseline and 6-week follow up. Ethics and dissemination: The study has been approved by the Western Sydney Local Health District Human Ethics Committee 2023/ETH00516. Results will be published in peer-reviewed journals and presented at conferences. Trial registration number: ACTRN12623000449639p ANZCTR: https://www.anzctr.org.au/.

Background The impact of ketone supplementation, low carbohydrate diets (LCDs) and ketogenic diets (KDs) on heart failure (HF) outcomes is largely unknown. This systematic review and meta-analysis investigated how these dietary changes impacted cardiac function and HF outcomes. Method A systematic search of MEDLINE, Embase, CINAHL and Web of Science was performed; last search on 19 November 2025. Randomised controlled trials (RCTs) and observational studies in humans receiving ketone supplementation, LCD and KD interventions were included. Studies were eligible if they reported at least one cardiac function/HF measure. Risk of bias was performed using RoB2 and ROBINS-I (Risk Of Bias In Non-randomised Studies of Interventions). Treatment effects were pooled, mean differences and 95% CIs calculated. Subgroup analysis was performed and heterogeneity was assessed. Results 14 studies were included in this systematic review. A meta-analysis was performed on six RCTs. Ketone supplementation increased left ventricular ejection fraction by 3.12% (95% CI 0.95% to 5.30%, p<0.01), with greater improvement in patients with HF with reduced ejection fraction (HFrEF); 4.25% (95% CI 1.99% to 6.51%, p<0.001). In patients with HFrEF, ketone supplementation increased peak systolic annular velocity (0.60% (95% CI 0.17% to 1.02%, p<0.01)) and cardiac output (1.24 L/min (95% CI 0.24 to 2.24, p<0.05)), compared with controls. Due to small cohorts and different treatment durations, assessment of certainty was low to high. Meta-analysis could not be performed on LCD or KD studies, due to low study numbers. Conclusions Ketone supplementation significantly improved cardiac function compared with controls, especially in people with HFrEF. More research is needed to determine how low carbohydrate and ketogenic diets affect HF outcomes. PROSPERO registration number CRD42024615367.

Despite the evidence supporting an association between oral disease and cardiovascular disease (CVD), oral health as a modifiable risk factor for cardiovascular health is rarely addressed. This randomised clinical trial (1:1:1) evaluated whether oral health education improves oral hygiene behaviours and knowledge of individuals attending cardiac rehabilitation. Three interventions were compared: individualised oral hygiene instruction (OHI) combined with a digital oral health education (DOHE) package, DOHE alone, or usual care: no oral health education. The primary outcome was improvement in oral hygiene, assessed by the approximal plaque index (API) at 6 weeks. Secondary outcomes included API reductions at 12 weeks, as well as self-reported changes in oral hygiene behaviours, knowledge, confidence, status, and motivation. A total of 158 participants were randomised (mean age 62 (11) years; 82.3% males). At 6 weeks, 77.1% (27/35) of participants receiving OHI + DOHE showed a reduction in API, compared to 26.8% (11/51) receiving usual care (odds ratio [OR] 9.16, 95% CI: 3.34–27.75). Participants receiving DOHE alone showed similar reductions. High participant acceptability of the digital materials, together with supportive feedback from cardiac nursing staff, underpins the feasibility of this approach. Oral health education delivered during cardiac rehabilitation using digital media alone, or in combination with clinician-delivered face-to-face messaging, shows evidence of initiating behavioural changes and is a scalable model for integrating oral health promotion into existing frameworks (Trial registration: Registered with anzctr.org.au, May 2nd, 2023: ACTRN12623000449639p).

Background: Despite the growing body of evidence supporting an association between oral disease and cardiovascular disease (CVD), oral health as a modifiable risk factor for cardiovascular health is rarely addressed. Objective: To determine whether a novel oral health education program improves oral health related behaviours and knowledge of individuals attending cardiac rehabilitation. Methods: This randomised clinical trial (1:1:1) in Australian public hospitals compared three interventions: Group A) individualised oral hygiene instruction (OHI) combined with a digital oral health education (DOHE) package, Group B) DOHE alone, or Group C) usual care: no oral health education. All participants received OHI+DOHE after final follow-up. The primary outcome was improvement in oral hygiene, assessed by approximal plaque index (API) at 6 weeks. Secondary outcomes included API reductions at 12 weeks, as well as self-reported changes in oral hygiene behaviours, knowledge, confidence, status, and motivation. Results: A total of 158 participants were randomised (mean age 62 ± 11 years; 82% males). At six weeks, 77.1% (27/35) of participants receiving OHI+DOHE showed a reduction in API, compared to 26.8% (11/51) receiving usual care (odds ratio [OR] 9.16, 95% CI: 3.34-27.75). Participants receiving DOHE alone showed similar reductions. Conclusion: Oral health education delivered during cardiac rehabilitation using digital media alone, or in combination with clinician delivered face-to-face messaging improves oral hygiene, behaviours and knowledge among patients with CVD and can be integrated into cardiology care. Trial registration: anzctr.org.au ACTRN12623000449639p