Untreated tooth cavities linked to worse lung health in CF: Study
Oral care identified as a potential target to support respiratory function
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Dental problems, particularly untreated tooth cavities, are associated with poor lung health and reduced respiratory-related quality of life in young people with cystic fibrosis (CF), a study suggests.
Adolescents and young adults with CF who had more extensive untreated cavities had worse lung function and reported a larger impact of respiratory symptoms on daily life, despite generally having preserved lung function.
“Our results suggest that poor oral health could be a modifiable risk factor for worse lung health in CF,” researchers wrote, highlighting oral care as a potential target to support respiratory health.
The study, “Association of dental diseases with pulmonary outcomes in a multicenter cohort of adolescents and young adults with CF,” was published in the Journal of Cystic Fibrosis.
Participants generally had preserved lung function
CF is associated with several risk factors for poor oral health and dental problems, including eating high-calorie foods to maintain weight, changes in saliva characteristics, and higher levels of cavity-causing bacteria in the mouth.
Poor oral health may affect lung health because bacteria from the mouth can enter the airways through a process known as aspiration. However, “the association between dental diseases and respiratory outcomes in CF has not previously been evaluated,” the researchers wrote.
To address that knowledge gap, researchers conducted an observational study in 203 adolescents and young adults with CF followed up at three U.S. centers between 2022 and 2024. Participants had a mean age of 18.7 years, and most were taking a highly effective CFTR modulator (85%).
At the start of the study, participants generally had preserved lung function. Their mean FEV1 z-score was 0.1, corresponding to a mean forced expiratory volume in 1 second (FEV1) of 101.3% of the predicted value considering age and sex norms. FEV1 measures how much air a person can forcefully breathe in 1 second and is commonly used to assess lung function.
Participants also reported relatively good respiratory-related quality of life, with a mean CF Questionnaire-Revised respiratory domain (CFQ-R RD) score of 86.9 (out of 100 maximum), where higher scores indicate fewer respiratory symptoms and less impact on daily activities.
Dental problems were common among participants
However, dental problems were common, with more than one-quarter of participants (28%) having at least one untreated tooth cavity (also called dental caries), including 12.3% with three or more tooth surfaces with untreated cavities. Signs of gum inflammation, or gingivitis, were also frequent, with about two-thirds of participants showing localized or generalized gum inflammation.
Overall, having more extensive untreated dental caries was associated with poorer lung function. Participants with cavities affecting three or more surfaces had lower FEV1 z-scores, by a mean of 0.88 points, than those without untreated cavities.
They also had a mean CFQ-R RD score that was 11.7 points lower, indicating a clinically meaningful decline in respiratory-related quality of life. The researchers noted that a 4-point change in CFQ-R RD is generally considered meaningful to patients.
Gingivitis, in contrast, was not significantly associated with lung function or respiratory-related quality-of-life scores.
Overall, “our results suggest that poor oral health could be a modifiable risk factor for worse lung health in CF, likely mediated through oral dysbiosis,” which means an imbalance in the community of microbes living in the mouth, “and that prevention and treatment of dental caries, for example, with regular toothbrushing with [fluoride] toothpastes, could potentially improve respiratory health in [adolescents and young adults] with CF, even in the post-modulator era,” the researchers wrote.
Future analyses will examine how dental problems change over three years and whether changes in mouth bacteria may help explain the link between oral health and respiratory outcomes.
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