Analysis of 4,564 participants in a Chinese cohort reveals that comprehensive oral health measures—including tooth decay, gum disease, and chewing function—correlate with carotid plaque formation and cardiovascular risk scores. The study found striking gender differences, with significant associations concentrated exclusively in women rather than men. Age patterns also emerged: participants under 65 showed broader oral-cardiovascular connections, while those over 65 demonstrated only functional tooth unit associations with arterial plaque. Blood biomarkers including hemoglobin A1c and platelet size ratios partially mediated these relationships. This multidimensional approach represents a significant advance beyond traditional studies that focus narrowly on periodontal disease alone. The gender-specific findings challenge assumptions about universal oral-cardiovascular pathways and suggest hormonal or behavioral factors may influence these connections. The identification of specific blood mediators offers potential targets for intervention and risk assessment. However, this preprint study awaits peer review, and the observational design cannot establish causation. The focus on a Chinese population may limit generalizability to other ethnic groups. These findings could reshape cardiovascular prevention strategies by incorporating comprehensive oral health assessments, particularly for women under 65.