Periodontal disease, tooth loss, and incidence of ischemic stroke

Periodontal disease and incident dementia: The Atherosclerosis Risk in Communities Study (ARIC)

OBJECTIVE

To test the hypothesis that periodontal disease would be associated with increased risk for dementia and mild cognitive impairment (MCI) by assessing dementia/MCI outcomes after a baseline periodontal examination.

METHODS

Participants enrolled in the Atherosclerosis Risk in Communities study with a clinical periodontal examination (or edentulous participants) at visit 4 (1996-1998; mean ± SD age 63 ± 6 years, 55% female, 21% black) and adjudicated dementia outcomes through 2016 were included (n = 8,275). A subgroup of 4,559 participants had adjudicated dementia and MCI assessments at visit 5 (2011-2013). Participants received a full-mouth periodontal examination and were classified into periodontal profile classes (PPCs) based on the severity and extent of gingival inflammation and attachment loss. MCI and dementia were determined via neurocognitive testing, neurological examination and history, informant interviews, and brain MRI in a subset. Cox proportional hazards models regressed incident dementia on PPCs. Relative risk regression models were used for the composite of MCI/dementia.

RESULTS

The cumulative incidence and incidence density of dementia during follow-up (average 18.4 years) were 19% (n = 1,569) and 11.8 cases per 1,000 person-years. Multivariable adjusted hazard ratios for incident dementia among participants with severe PPC or edentulism (vs periodontal healthy) were 1.22 (95% confidence interval [CI] 1.01-1.47) and 1.21 (95% CI 0.99-1.48), respectively. For the combined dementia/MCI outcome, adjusted risk ratios among participants with mild/intermediate PPC, severe PPC, or edentulism (vs periodontal healthy) were 1.22 (95% CI 1.00-1.48), 1.15 (95% CI 0.88-1.51), and 1.90 (95% CI 1.40-2.58). Results were stronger among younger (≤62 years) participants (p for interaction = 0.02).

CONCLUSION

Periodontal disease was modestly associated with incident MCI and dementia in a community-based cohort of black and white participants.

An investigation of tooth loss factors in elderly patients using panoramic radiographs

OBJECTIVES

The aim of this study was to observe the dental condition in a group of elderly patients over a period of 10 years in order to clarify important risk factors.

MATERIALS AND METHODS

Participants were elderly patients (in their eighties) who took panoramic radiographs between 2015 and 2016, and for whom panoramic radiographs taken around 10 year earlier were also available. The number of remaining and lost teeth, the Eichner Index, the presence or absence of molar occlusion, the respective condition of dental pulp, dental crowns, alveolar bone resorption, as well as periapical lesions were investigated through the analysis of panoramic radiographs. Additionally, other important variables were collected from patients' medical records. From the obtained panoramic radiograph sets, the patients' dental condition was investigated, and a systematic comparison was conducted.

RESULTS

The analysis of the panoramic radiographs showed that the number of remaining teeth decreased from an average of 20.8-15.5, and the percentage of patients with 20 or more teeth decreased from 69.2 to 26.9%. A factor analysis investigating tooth loss risk suggested that tooth loss was associated with the bridge, P2 or greater resorption of the alveolar bone, and apical lesions, and gender (with males having a higher risk compared to females).

CONCLUSIONS

Teeth showing P2 or greater alveolar bone resorption, bridge, and apical lesions on panoramic radiographs are most likely to be lost in an elderly patient's near future. Consequently, this group should be encouraged to visit their dental clinics regularly and receive comprehensive instruction on individual self-care methods.

Association of Tooth Loss with New-Onset Parkinson's Disease: A Nationwide Population-Based Cohort Study

Introduction

Tooth loss is associated with poor oral hygiene. During insufficient oral sanitation, focal infection and inflammation can occur and these reactions may induce systemic inflammation. Systemic inflammatory reaction may be related to the degeneration of dopamine neurons in the substantia nigra. We hypothesized that tooth loss is related to increased risk of new-onset Parkinson's disease.

Methods

Between 2003 and 2006, we included 153,165 participants from the national health insurance system-health screening cohort in Korea. The incidence of new-onset Parkinson's disease was defined as International Classification of Diseases-10 code “G20,” accompanying the prescription records for any anti-Parkinson's disease medication.

Results

Approximately 19.9% of the included participants had periodontal disease. After a median duration of 10.4 years, 1,227 (0.8%) cases of new-onset Parkinson's disease were noted. The number of tooth loss was positively related to an increased risk of new-onset Parkinson's disease. Contrastingly, the frequency of tooth brushings and dental clinic visits for any causes as well as competent dental care were negatively related to the development of new-onset Parkinson's disease. In multivariable analysis, the number of tooth loss (≥15) was positively related to new-onset Parkinson's disease development (hazard ratio: 1.38, 95% confidence interval (1.03–1.85), p=0.029, p for trend = 0.043) after adjusting variables.

Conclusion

Our study demonstrated that the number of tooth loss was positively correlated with a higher risk of new-onset Parkinson's disease development in a longitudinal study setting. Increased number of tooth loss may be an important risk indicator of new-onset Parkinson's disease.

Gender Differences in the Levels of Periodontal Destruction, Behavioral Risk Factors and Systemic Oxidative Stress in Ischemic Stroke Patients: A Cohort Pilot Study

Background: Due to the higher frequency of ischemic stroke in men compared to women, we aimed to determine if gender differences exist regarding periodontal status and several plasma biomarkers in patients with a recent large artery atherosclerosis ischemic stroke (IS). Material and methods: Patients with their first IS within less than six weeks who were able to undergo periodontal examinations were evaluated. Demographic data, periodontal status, oxidative stress parameters/plasma antioxidant capacity, and C-reactive protein in patients who suffered a recent large artery atherosclerosis ischemic stroke were reccorded. Results: 93 patients were included in the study. More men were smokers (12/57 vs. 3/36) and consumed alcohol (17/57 vs. 3/36), and more women had higher glycemic values (p = 0.023), total cholesterol (p < 0.001), LDL (low-density lipoprotein)-cholesterol (p = 0.010), and HDL (high-density lipoprotein)-cholesterol (p = 0.005) levels. Significantly more men than women had moderate plus severe periodontal disease (p = 0.018), significantly higher levels of nitric oxide (p = 0.034), and significantly lower levels of total antioxidant capacity (p = 0.028). Conclusions: In this pilot study, men seem to be more prone to oxidative stress and to develop more severe forms of periodontitis among patients with stroke, but the results need validation on a larger sample.

Defining the oral microbiome by whole-genome sequencing and resistome analysis: the complexity of the healthy picture

Background

The microbiome of the oral cavity is the second-largest and diverse microbiota after the gut, harboring over 700 species of bacteria and including also fungi, viruses, and protozoa. With its diverse niches, the oral cavity is a very complex environment, where different microbes preferentially colonize different habitats. Recent data indicate that the oral microbiome has essential functions in maintaining oral and systemic health, and the emergence of 16S rRNA gene next-generation sequencing (NGS) has greatly contributed to revealing the complexity of its bacterial component. However, a detailed site-specific map of oral microorganisms (including also eukaryotes and viruses) and their relative abundance is still missing. Here, we aimed to obtain a comprehensive view of the healthy oral microbiome (HOM), including its drug-resistance features.

Results

The oral microbiome of twenty healthy subjects was analyzed by whole-genome sequencing (WGS) and real-time quantitative PCR microarray. Sampled oral micro-habitat included tongue dorsum, hard palate, buccal mucosa, keratinized gingiva, supragingival and subgingival plaque, and saliva with or without rinsing. Each sampled oral niche evidenced a different microbial community, including bacteria, fungi, and viruses. Alpha-diversity evidenced significant differences among the different sampled sites (p < 0.0001) but not among the enrolled subjects (p = 0.876), strengthening the notion of a recognizable HOM. Of note, oral rinse microbiome was more representative of the whole site-specific microbiomes, compared with that of saliva. Interestingly, HOM resistome included highly prevalent genes conferring resistance to macrolide, lincosamides, streptogramin, and tetracycline.

Conclusions

The data obtained in 20 subjects by WGS and microarray analysis provide for the first time a comprehensive view of HOM and its resistome, contributing to a deeper understanding of the composition of oral microbiome in the healthy subject, and providing an important reference for future studies, allowing to identify microbial signatures related to functional and metabolic alterations associated with diseases, potentially useful for targeted therapies and precision medicine.

The relationship between cigarette smoking and the tongue microbiome in an East Asian population

Background: The oral microbiome, which consists of various habitats, has been shown to be influenced by smoking. However, differences in the tongue microbiomes of current and former smokers, as well as their resultant functional consequences, have rarely been investigated in East Asian populations. Methods: We used 16S rRNA amplicon sequencing of tongue-coating samples obtained from East Asian subjects who were current, former, or never smokers to identify differences in their tongue microbiomes and related metagenomic functions. Two sets of participants from 2016 to 2017 (n = 657 and n = 187, respectively) were analyzed separately. Results: We found significant differences between the overall microbiome compositions of current versus never smokers (p = 0.0015), but not between former versus never smokers (p = 0.43) based on the weighted UniFrac distance. Twenty-nine of 43 investigated genera showed significantly different expression levels in current versus never smokers. Neisseria and Capnocytophaga were less abundant, and Streptococcus and Megasphaera were more abundant in current smokers. Moreover, the abundances of metagenomic pathways, including those related to nitrate reduction and the tricarboxylic acid cycle, were significantly different between current and never smokers. Conclusions: The tongue microbiomes and related metagenomic pathways of current smokers differ from those of never smokers among East Asians.

Gastric and duodenal ulcers, periodontal disease, and risk of bladder cancer in the Health Professionals Follow-up Study

PURPOSE

Studies suggest that peptic ulcer and periodontal disease are positively associated with bladder cancer risk. These two factors are likely to share common biologic mechanisms such as inflammation and dysbiosis. We examined the joint association of peptic ulcer (gastric/duodenal) and periodontal disease on bladder cancer risk.

METHODS

We conducted a prospective analysis among 45,185 men (563 invasive bladder cancer cases) in the Health Professionals Follow-Up Study (follow-up 1986-2016). History of ulcer and periodontal disease was self-reported at baseline and updated during the follow-up. Cox proportional hazards models estimated hazard ratio (HR) and 95% confidence interval (CI) for the joint associations of ulcers (gastric, duodenal) and periodontal disease, adjusting for age and other potential confounders. We tested for interaction using the Wald test for product terms.

RESULTS

Compared with men having no history of ulcer and periodontal disease, men with a history of peptic ulcer only (HR 1.22, 95% CI 0.90-1.66) and men with a history of periodontal disease only (HR 1.19, 95% CI 0.98-1.46) were associated with higher risk of invasive bladder cancer. The highest bladder cancer risk was observed in men with a history of both peptic ulcer and periodontal disease (HR 1.52, 95% CI 1.05-2.20). Similar results were found when we stratified by ulcer types. The interactions between ulcer and periodontal disease were not statistically significant for all ulcer types (p-interaction ≥ 0.59).

CONCLUSION

We did not find sufficient evidence for interaction between gastric/duodenal ulcers and periodontal disease on bladder cancer risk.

Oral health and cardiovascular disease risk factors and mortality of cerebral haemorrhage, cerebral infarction and unspecified stroke in elderly men: A prospective cohort study

Background: Stroke mortality comprises different specific diagnoses as cerebral infarction, different haemorrhagic conditions and unspecified stroke. This study seeks to explore the prediction of oral health indicators versus known cardiovascular disease risk factors for stroke mortality. Methods: Altogether, 12,764 men aged 58 to 77 years were invited to the health screening Oslo II in the year 2000. It included general medical measurements and questionnaire information. Mortality data were supplied by Statistics Norway for the 6530 attending men. Cox proportional hazards regression analyses were used to establish prediction models for mortality. Results: Oral health by number of tooth extractions >10 was found to be an independent predictor for cerebral infarction hazard ratio = 2.92, 95% confidence interval (1.24-6.89). This was independent of HDL-Cholesterol (inversely) hazard ratio = 0.21, 95% confidence interval (0.06-0.76), frequent alcohol consumption (drinking 4-7 times per week) hazard ratio = 3.58, 95% confidence interval (1.40-9.13) and diabetes hazard ratio = 4.28, 95% confidence interval (1.68-10.89). Predictors for cerebral haemorrhage were age, hs-C-reactive protein and body mass index (inversely). Age and total cholesterol (inversely) were predictors for unspecified stroke. Conclusions: Oral health measured by number of tooth extractions >10 was an independent predictor for cerebral infarction in addition to age, HDL-C, hs-C-reactive protein and diabetes. The pattern of risk factors varied between the specific stroke diagnoses.

Dental Care Utilization and Service Needs Among American Indian/Alaska Native/Native Hawaiian Elders: 2008 to 2017

Objective: This study describes trends in self-reported dental care utilization and services needed among American Indian/Alaska Native/Native Hawaiian (AI/AN/NH) elders 2008 to 2017, including demographic and socioeconomic variability. Method: Researchers utilized data from the Survey of Elders administered by the National Resource Center on Native American Aging, representing all regions of the United States and 262 tribes. Data were analyzed comparing means over time and between/within groups. Results: Between April 2008 and March 2017, there was a statistically significant (p < .001) increase in the proportion of older adults who visited a dentist and an increase in need for treatment. A smaller proportion of older adults reported need for treatment among those who were privately insured, high income, had no tobacco use, were employed, and had visited a dental professional in the last year. Discussion: These findings highlight current dental needs among tribal elders while also identifying elders at greater risk of poor oral health.

Countering the poor oral health of people with intellectual and developmental disability: a scoping literature review

Background

People with intellectual and developmental disability (IDD) have poor oral health and need support to maintain optimal oral health outcomes. Little is known about how, when and where to intervene for this population. Thus the aim of this review was to summarise the existing evidence surrounding improving oral health outcomes for people with IDD.

Methods

A scoping literature review was conducted focusing on ‘oral health’ and ‘intellectual disability’. Systematic searches of five electronic databases were conducted in line with the study aims and two authors independently examined all records for relevance, with consensus achieved by a third author.

Results

A small number of approaches and interventions were identified to support people with IDD to independently maintain optimal oral hygiene. Identified studies highlighted that caregivers play a vital role in the provision of oral health support, emphasising the effectiveness of educational interventions for caregivers. However, there was uncertainty regarding the efficacy of specific tooth brushing interventions for people with IDD. In cases of more severe IDD and/or dental-related behavioural problems, dental treatment under general anaesthesia was often both a necessary and effective method of oral health care provision. The findings also identified outreach and exclusive oral health services as successful strategies for increasing the limited access of people with IDD to oral care services.

Conclusions

A uniform approach to supporting oral health for people with IDD is unlikely to succeed. A system-based approach is needed to address the diverse needs of the population of people with IDD, their caregivers and service context. Further high quality evidence is required to confirm these findings.

Periodontitis As A Risk Factor For Stroke: A Systematic Review And Meta-Analysis

This systematic review and meta-analysis investigate the association between periodontitis and stroke. This review followed the methods established by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Searches were conducted in five databases and two sources of grey literature. After the selection of the articles, a risk of bias evaluation was performed. Three meta-analyzes were performed: Assessing the overall association between stroke and periodontitis in case–control studies; Ischemic stroke and periodontitis in case–control studies; The association between stroke and periodontitis in cohort studies. Heterogeneity was assessed using the I² index and the odds ratio was also calculated (p < 0.05). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was applied to evaluate the level of evidence. 2193 potentially relevant studies were identified, with 10 studies included in qualitative and quantitative analysis. All the articles were considered with low risk of bias and a low level of certainty. The results demonstrated a positive association between both disorders and increased risk for stroke among cohort studies (RR 1.88 [1.55, 2.29], p<0.00001, I²=0%) and for ischemic stroke events in case–control studies (RR 2.72 [2.00, 3.71], p<0.00001, I²= 4%). Periodontitis may represent a risk factor for stroke, especially in ischemic events. However, new studies with a robust design are necessary for a reliable conclusion.

Effect of tooth loss and nutritional status on outcomes after ischemic stroke

OBJECTIVES

Tooth loss, closely associated with malnutrition, increases the risk for cardiovascular disease. The aim of this study was to examine the link between tooth loss, nutritional status, and stroke outcomes.

METHODS

We retrospectively analyzed 195 consecutive patients with acute ischemic stroke who were evaluated for tooth loss. Tooth loss was classified as mild or severe. Nutritional status was evaluated using the Controlling Nutritional Status (CONUT) score. A poor neurologic outcome was defined as a score of 3 to 6 on the modified Rankin Scale at 3 mo post-stroke onset; a score of 0 to 2 was defined as a good outcome.

RESULTS

A significant correlation was observed between tooth loss and the CONUT score at admission (ρ = 0.156; P = 0.034). Patients with poor outcomes had higher CONUT scores (P < 0.001) and a greater frequency of severe tooth loss (P = 0.025). On multivariate analysis, severe tooth loss (odds ratio [OR], 3.93; 95% confidence interval [CI], 1.31-11.8) and the CONUT score (OR, 1.33; 95% CI, 1.02-1.74) were independently associated with poor stroke outcomes.

CONCLUSIONS

Nutritional status was associated with tooth loss among patients with acute ischemic stroke. Severe tooth loss and a higher CONUT score were independently associated with poor stroke outcomes.

Contribution of systemic inflammation and nutritional status to the relationship between tooth loss and mortality in a community-dwelling older Japanese population: a mediation analysis of data from the Tsurugaya project

OBJECTIVES

To assess whether systemic inflammation and nutritional status contribute to a relationship between tooth loss and mortality in community-dwelling older Japanese individuals using mediation analyses.

MATERIALS AND METHODS

This longitudinal study targeted community-dwelling older Japanese individuals (N = 891). The exposure variable was the number of teeth (edentulous, 1-9, 10-19, ≥ 20), while the outcome was all-cause mortality from 2003 to 2016. Nutritional status and systemic inflammation were evaluated as mediators and based on serum albumin and high-sensitivity C-reactive protein levels, respectively. Covariates included age, sex, smoking, alcohol consumption, medical history, educational level, depressive symptoms, cognitive impairment, and physical function. The Cox proportional hazards model was applied to calculate hazard ratios (HRs) for the association between tooth loss and mortality and the contributions of systemic inflammation and nutritional status to this association.

RESULTS

Edentulous participants (HR, 1.84; 95 % confidence interval [CI], 1.30-2.59) and those with 1-9 teeth (HR, 1.75; 95% CI, 1.28-2.40) groups exhibited a significantly higher risk of mortality than did those with ≥ 20 teeth. Mediation analyses showed that nutritional status contributed to the association between tooth loss and mortality in participants with 1-9 teeth, whereas systemic inflammation played no role in this association.

CONCLUSIONS

Nutritional status may contribute to the association between tooth loss and mortality in community-dwelling older Japanese individuals with fewer remaining teeth.

CLINICAL RELEVANCE

The data from this prospective cohort study help in elucidating parts of the biological mechanism underlying tooth loss and all-cause mortality in older individuals.

Prevalence and determinants of dental visits among older adults: findings of a nationally representative longitudinal study

BACKGROUND

The first aim was to present descriptive data on the frequency of dental visits among older adults in Germany. The second aim was to identify the determinants of the number of dental visits using a longitudinal approach.

METHODS

Longitudinal data were derived from the German Ageing Survey, which is a nationally representative sample of community-dwelling individuals ≥40 years in Germany. The frequency of dental visits in the past 12 months was recorded in the years 2002, 2008 and 2011. In order to control for time-constant unobserved heterogeneity, Poisson fixed effects regressions were used.

RESULTS

While the mean number of dental visits was 2.3 (SD: 2.0) in 2002, it was 2.0 (SD: 1.7) in 2008 and 2.1 (SD: 1.7) in 2011. The frequency of dental visits declined with age (total sample and women), transitions from normal weight to overweight (total sample), changes from divorced/widowed/single/married, living separated from spouse to 'married, living together with spouse' in women and with a decrease in the number of physical illnesses (total sample and men).

CONCLUSIONS

The frequency of dental visits declines with age in older adults. While some of the determinants of frequency are non-modifiable (e.g., ageing and worsening of general health), others are modifiable (e.g., change in weight category).

The socioeconomic impact of Korean dental health insurance policy on the elderly: a nationwide cohort study in South Korea

Purpose

The purpose of this retrospective study was to investigate the relationships of types of dental insurance coverage in Korea with sociodemographic characteristics and the prevalence of systemic and oral diseases, as well as to evaluate the socioeconomic impact of Korean dental insurance policies.

Methods

Sample cohort data from 2006 to 2015 were obtained from the National Health Insurance Service. Patients were divided into 2 groups. The exposed group comprised patients who received insurance benefits for complete dentures, removable partial dentures, and implant care, while the control group comprised patients who did not receive these benefits. The type of insurance coverage and the prevalence of systemic and oral diseases were compared between the 2 groups.

Results

Patients who received benefits in the form of complete dentures, removable partial dentures, and implants had similar sociodemographic characteristics in terms of sex, age, income quintile, and type of insurance coverage to the control group. The prevalence of hypertension, anemia, renal disease, rheumatoid arthritis, osteoporosis, asthma, and cerebral infarction was higher in the exposed group than in the control group (P<0.05). The prevalence of periodontal diseases and dental caries was also higher in the exposed group.

Conclusions

Korean dental health insurance policy has been beneficial for the medical expenses of low-income and elderly people suffering from a cost burden due to systemic diseases. However, since there is a tendency to avoid invasive interventions in older patients due to the high risk of systemic diseases, insurance coverage of dentures may be more helpful from a socioeconomic perspective than coverage of dental implant treatments.

Distal Consequences of Oral Inflammation

Periodontitis is an incredibly prevalent chronic inflammatory disease, which results in the destruction of tooth supporting structures. However, in addition to causing tooth and alveolar bone loss, this oral inflammatory disease has been shown to contribute to disease states and inflammatory pathology at sites distant from the oral cavity. Epidemiological and experimental studies have linked periodontitis to the development and/or exacerbation of a plethora of other chronic diseases ranging from rheumatoid arthritis to Alzheimer's disease. Such studies highlight how the inflammatory status of the oral cavity can have a profound impact on systemic health. In this review we discuss the disease states impacted by periodontitis and explore potential mechanisms whereby oral inflammation could promote loss of homeostasis at distant sites.

Ligature-induced periodontitis induces systemic inflammation but does not alter acute outcome after stroke in mice

Background

Stroke is a major cause of disability and mortality. Poorer outcome after stroke is associated with concomitant inflammatory and infectious disease. Periodontitis is a chronic inflammatory disease of the dental supporting structures and is a prominent risk factor for many systemic disorders, including cardiovascular disease and stroke. While epidemiological studies suggest that periodontitis increases the likelihood of stroke, its impact on stroke severity is poorly understood. Here, we sought to determine the contribution of periodontitis to acute stroke pathology.

Methods

We characterized a murine ligature model of periodontitis for inflammatory responses that could potentially impact stroke outcome. We applied this model and then subjected mice to either transient or permanent middle cerebral artery occlusion. We also enhanced the periodontitis model with repeated intravenous administration of a periodontal-specific lipopolysaccharide to better mimic the clinical condition.

Results

Ligature-induced periodontitis caused bone loss, bacterial growth, and increased local inflammatory cell trafficking. Systemically, periodontitis increased circulating levels of pro-inflammatory cytokines, and primed bone marrow monocytes to produce elevated tumour necrosis factor-alpha (TNFα). Despite these changes, periodontitis alone or in tandem with repeated lipopolysaccharide challenge did not alter infarct volume, blood–brain barrier breakdown, or systemic inflammation after experimental stroke.

Conclusions

Our data show that despite elevated systemic inflammation in periodontitis, oral inflammatory disease does not impact acute stroke pathology in terms of severity, determined primarily by infarct volume. This indicates that, at least in this experimental paradigm, periodontitis alone does not alter acute outcome after cerebral ischemia.

Association between subjective well-being and presence of primary care dentists in community-dwelling elderly people: A cross-sectional study

OBJECTIVE

The aim was to investigate the relationships between subjective well-being and the existence of primary care dentists in community-dwelling elderly people.

BACKGROUND

Some studies have reported subjective well-being focusing on oral health, but no studies have examined the relationship between subjective well-being and primary care dentists.

METHODS

This cross-sectional study used data from community-dwelling elderly people aged ≥70 years (n = 624). The Philadelphia Geriatric Center Morale Scale (PGCMS; range = 0 [low morale]-17) was used to assess subjective well-being. Additional information regarding age group, sex, medical consulting situation (ambulatory care/home care), primary care dentists, family structure, economic status, health status was collected via questionnaire.

RESULTS

The average PGCMS score in ambulatory care patients (ACP) group who have primary care dentists was highest among community-dwelling elderly people. In a logistic regression model, a low PGCMS score (0-11) was independently correlated to 80-89 age group (OR = 1.70; 95% CI, 1.13-2.54; P = 0.008), ≥90 age group (OR = 3.86; 95% CI, 1.83-8.18; P < 0.001), unsatisfied for economic status (OR = 2.68; 95% CI, 1.59-4.53; P < 0.001), unsatisfied for health status (OR = 3.94; 95% CI, 2.60-5.98; P < 0.001) and having no primary care dentists (OR = 1.81; 95% CI, 1.09-3.01; P = 0.021) in ACP group.

CONCLUSIONS

The subjective well-being of ACP who have primary care dentists was higher than in other people. Primary dentists contributed to the subjective well-being of elderly people.

Longitudinal association between periodontitis and development of diabetes

BACKGROUND

Clinical trials have shown very modest short-term improvements in glycemic control among participants with diabetes after periodontitis treatment. Few longitudinal studies suggest that periodontitis may be related to prediabetes/diabetes risk.

METHODS

We evaluated 1206 diabetes free participants in the San Juan Overweight Adults Longitudinal Study (SOALS) and 941 with complete 3-year follow-up data were included. The National Health and Nutrition Examination Survey (NHANES) methods were used to assess periodontitis. Diabetes and prediabetes were classified using American Diabetes Association cutoffs for fasting and 2-hour post-load glucose and HbA1c. We used Poisson regression adjusting for baseline age, gender, smoking, education, family history of diabetes, physical activity, waist circumference, and alcohol intake.

RESULTS

Over the 3-year follow-up, 69 (7.3%) of the 941 individuals developed type 2 diabetes, and 142 (34.9%) of the 407 with normal glycemia at baseline developed prediabetes. In multivariable models, greater mean pocket depth and mean attachment loss at baseline were associated with lower risk of developing prediabetes/diabetes over the follow-up (IRR = 0.81; 95% CI: 0.67-0.99, and IRR = 0.86; 95% CI: 0.74-0.99, respectively). Increase in periodontal attachment loss from baseline to follow-up was associated with higher prediabetes/diabetes risk (multivariate IRR = 1.25; 95% CI: 1.09-1.42), and increase in pocket depth was associated with >20% fasting glucose increase (multivariate IRR = 1.43; 95% CI: 1.14-1.79). The inverse associations persisted after additionally adjusting for baseline income, sugar-sweetened beverages, number of teeth, oral hygiene, glycemia, or previous periodontal therapy.

CONCLUSIONS

There is no association between periodontitis and risk of prediabetes/diabetes in this longitudinal study.

Relationship between status of dentition and incident functional disability in an elderly Japanese population: prospective cohort study of the Tsurugaya project

PURPOSE

The purpose of this study was to examine whether the status of dentition is associated with incident functional disability in elderly people.

METHODS

This prospective cohort study targeted community-dwelling Japanese adults of age ≥70 years (n=838). Participants were classified into the following four groups in accordance with Miyachi's Triangular Classification, which represents the status of dentition on the basis of numbers of remaining teeth and occlusal supports: Zone A, ≥10 occlusal supports; Zone B, 5-9 occlusal supports; Zone D, ≤4 occlusal supports and ≥11 remaining teeth and Zone C, ≤10 remaining teeth. Incident functional disability was defined by the first certification of long-term care insurance in Japan. Data regarding age, sex, body mass index, medical history, smoking, alcohol consumption, education, depressive symptoms, cognitive impairment, social support, history of fall, and subjective masticatory ability were collected.

RESULTS

During follow-up for 5185 person-years, 305 participants experienced functional disability. Considering the follow-up data of  ≥3 years from baseline, participants in Zones C (hazard ratio [HR], 1.98; 95 % confidence interval [CI], 1.26-3.11) and D (HR, 2.50; 95 %CI, 1.54-4.05) were found to be more likely to develop functional disability than those in Zone A (p for trend=0.002).

CONCLUSIONS

Status of dentition was associated with incident functional disability in an elderly Japanese population. The findings of this study suggest that maintenance of remaining teeth and retention of occlusal supports contribute to the prevention of functional disability.

The relationship between tooth loss, body mass index, and hypertension in postmenopausal female

Objective

This study aimed to investigate the relationship between tooth loss and the level of blood pressure with the hypothesis that tooth loss is associated with the increase of hypertension in postmenopausal women.

Materials and Methods

Sixty postmenopausal female patients aged 51-68 years were included in the study to assess the relationship between tooth loss and the level of blood pressure. The information including sociodemographics, last menstruation period, hypertension history, and the duration of having tooth loss was recorded. Blood pressure was measured using sphygmomanometer and the number of tooth loss was determined.

Results

The results showed a more significant tooth loss in hypertension (median: 23 + 4; interquartile range [IQR]: 6) compared to the normotension postmenopausal women (median: 18 + 6; IQR: 12; P < 0.05). Furthermore, obese patients had more tooth loss (median: 23 + 5; IQR: 8) than the overweight patients (median: 19 + 8; IQR: 8).

Conclusion

Tooth loss is associated with the increase of hypertension in postmenopausal women which may have a role in the development of vascular diseases.

Tooth loss is associated with accelerated cognitive decline and volumetric brain differences: a population-based study

Tooth loss has been related to cognitive impairment; however, its relation to structural brain differences in humans is unknown. Dementia-free participants (n = 2715) of age ≥60 years were followed up for up to 9 years. A subsample (n = 394) underwent magnetic resonance imaging at baseline. Information on tooth loss was collected at baseline, and cognitive function was assessed using the Mini-Mental State Examination at baseline and at follow-ups. Data were analyzed using linear mixed effects models and linear regression models. At baseline, 404 (14.9%) participants had partial tooth loss, and 206 (7.6%) had complete tooth loss. Tooth loss was significantly associated with a steeper cognitive decline (β: -0.18, 95% confidence interval [CI]: -0.24 to -0.11) and remained significant after adjusting for or stratifying by potential confounders. In cross-sectional analyses, persons with complete or partial tooth loss had significantly lower total brain volume (β: -28.89, 95% CI: -49.33 to -8.45) and gray matter volume (β: -22.60, 95% CI: -38.26 to -6.94). Thus, tooth loss may be a risk factor for accelerated cognitive aging.

Nut Consumption and Survival in Patients With Stage III Colon Cancer: Results From CALGB 89803 (Alliance)

Purpose

Observational studies have reported increased colon cancer recurrence and mortality in patients with states of hyperinsulinemia, including type 2 diabetes, obesity, sedentary lifestyle, and high glycemic load diet. Nut intake has been associated with a lower risk of type 2 diabetes, metabolic syndrome, and insulin resistance. However, the effect of nut intake on colon cancer recurrence and survival is not known.

Patients and Methods

We conducted a prospective, observational study of 826 eligible patients with stage III colon cancer who reported dietary intake on food frequency questionnaires while enrolled onto a randomized adjuvant chemotherapy trial. Using Cox proportional hazards regression, we assessed associations of nut intake with cancer recurrence and mortality.

Results

After a median follow-up of 6.5 years, compared with patients who abstained from nuts, individuals who consumed two or more servings of nuts per week experienced an adjusted hazard ratio (HR) for disease-free survival of 0.58 (95% CI, 0.37 to 0.92; P_trend = .03) and an HR for overall survival of 0.43 (95% CI, 0.25 to 0.74; P_trend = .01). In subgroup analysis, the apparent benefit was confined to tree nut intake (HR for disease-free survival, 0.54; 95% CI, 0.34 to 0.85; P_trend = .04; and HR for overall survival, 0.47; 95% CI, 0.27 to 0.82; P_trend = .04). The association of total nut intake with improved outcomes was maintained across other known or suspected risk factors for cancer recurrence and mortality.

Conclusion

Diets with a higher consumption of nuts may be associated with a significantly reduced incidence of cancer recurrence and death in patients with stage III colon cancer.

Role of oral and gut microbiome in nitric oxide-mediated colon motility

Periodontal disease (PD), a severe form of gum disease, is among the most prevalent chronic infection in humans and is associated with complex microbial synergistic dysbiosis in the subgingival cavity. The immune system of the body interacts with the microbes as the plaque extends and propagates below the gingival sulcus. Once bacteria reach the gingival sulcus, it can enter the blood stream and affect various areas of the human body. The polymicrobial nature of periodontal disease, if left untreated, promotes chronic inflammation, not only within the oral cavity, but also throughout the human body. Alterations seen in the concentrations of healthy gut microbiota may lead to systemic alterations, such as gut motility disorders, high blood pressure, and atherosclerosis. Although gut microbiome has been shown to play a vital role in intestinal motility functions, the role of oral bacteria in this setting remains to be investigated. It is unclear whether oral microbial DNA is present in the large intestine and, if so, whether it alters the gut microbiome. In addition, polybacterial infection induced PD reduced nitric oxide (NO) synthesis and antioxidant enzymes in rodent colon. In this review, we will discuss the interactions between oral and gut microbiome, specifics of how the oral microbiome may modulate the activities of the gut microbiome, and possible ramifications of these alterations.

Oral microbiome and health

The oral microbiome is diverse in its composition due to continuous contact of oral cavity with the external environment. Temperatures, diet, pH, feeding habits are important factors that contribute in the establishment of oral microbiome. Both culture dependent and culture independent approaches have been employed in the analysis of oral microbiome. Gene-based methods like PCR amplification techniques, random amplicon cloning, PCR-RELP, T-RELP, DGGE and DNA microarray analysis have been applied to increase oral microbiome related knowledge. Studies revealed that microbes from the phyla Firmicutes, Proteobacteria, Bacteroidetes, Actinobacteria, Fusobacteria, Neisseria, TM7 predominately inhabits the oral cavity. Culture-independent molecular techniques revealed the presence of genera Megasphaera, Parvimonas and Desulfobulbus in periodontal disease. Bacteria, fungi and protozoa colonize themselves on various surfaces in oral cavity. Microbial biofilms are formed on the buccal mucosa, dorsum of the tongue, tooth surfaces and gingival sulcus. Various studies demonstrate relationship between unbalanced microflora and development of diseases like tooth caries, periodontal diseases, type 2 diabetes, circulatory system related diseases etc. Transcriptome-based remodelling of microbial metabolism in health and disease associated states has been well reported. Human diets and habitat can trigger virus activation and influence phage members of oral microbiome. As it is said, "Mouth, is the gateway to the total body wellness, thus oral microbiome influences overall health of an individual".

Oral Health and Brain Injury: Causal or Casual Relation?

Background

To systematically review the current literature investigating the association between oral health and acquired brain injury.

Methods

A structured search strategy was applied to PubMed, Embase, Web of Science, and CENTRAL electronic databases until March 2017 by 2 independent reviewers. The preferred reporting items for systematic review and meta-analysis guidelines were used for systematic review.

Results

Even though the objective was to assess the association between oral health and acquired brain injury, eligible studies focused solely on different forms of stroke and stroke subtypes. Stroke prediction was associated with various factors such as number of teeth, periodontal conditions (even after controlling for confounding factors), clinical attachment loss, antibody levels to Aggregatibacter actinomycetemcomitans and Prevotella intermedia. The literature showed no consensus on the possible association between gingivitis and stroke. Patients with stroke generally had poorer oral hygiene practices and oral health. Dental prophylaxis and professional intervention reduced the incidence of stroke.

Conclusions

Overall, oral health and stroke were related. Periodontitis and tooth loss were independently associated with stroke. However, prevention and timely intervention may reduce the risk of stroke. Stroke was the main cerebral lesion studied in the literature, with almost no publications on other brain lesions.

Exploring the Association between Alzheimer's Disease, Oral Health, Microbial Endocrinology and Nutrition

Longitudinal monitoring of patients suggests a causal link between chronic periodontitis and the development of Alzheimer’s disease (AD). However, the explanation of how periodontitis can lead to dementia remains unclear. A working hypothesis links extrinsic inflammation as a secondary cause of AD. This hypothesis suggests a compromised oral hygiene leads to a dysbiotic oral microbiome whereby Porphyromonas gingivalis, a keystone periodontal pathogen, with its companion species, orchestrates immune subversion in the host. Brushing and chewing on teeth supported by already injured soft tissues leads to bacteremias. As a result, a persistent systemic inflammatory response develops to periodontal pathogens. The pathogens, and the host’s inflammatory response, subsequently lead to the initiation and progression of multiple metabolic and inflammatory co-morbidities, including AD. Insufficient levels of essential micronutrients can lead to microbial dysbiosis through the growth of periodontal pathogens such as demonstrated for P. gingivalis under low hemin bioavailability. An individual’s diet also defines the consortium of microbial communities that take up residency in the oral and gastrointestinal (GI) tract microbiomes. Their imbalance can lead to behavioral changes. For example, probiotics enriched in Lactobacillus genus of bacteria, when ingested, exert some anti-inflammatory influence through common host/bacterial neurochemicals, both locally, and through sensory signaling back to the brain. Early life dietary behaviors may cause an imbalance in the host/microbial endocrinology through a dietary intake incompatible with a healthy GI tract microbiome later in life. This imbalance in host/microbial endocrinology may have a lasting impact on mental health. This observation opens up an opportunity to explore the mechanisms, which may underlie the previously detected relationship between diet, oral/GI microbial communities, to anxiety, cognition and sleep patterns. This review suggests healthy diet based interventions that together with improved life style/behavioral changes may reduce and/or delay the incidence of AD.

Influence of Oral and Gut Microbiota in the Health of Menopausal Women

Sex differences in gut microbiota are acknowledged, and evidence suggests that gut microbiota may have a role in higher incidence and/or severity of autoimmune diseases in females. Additionally, it has been suggested that oral, vaginal, and gut microbiota composition can be regulated by estrogen levels. The association of vaginal microbiota with vulvovaginal atrophy at menopause is well described in the literature. However, the relevance of oral and gut microbiota modulation in the immune system during estrogen deficiency and its effect on inflammatory diseases is not well explored. Estrogen deficiency is a condition that occurs in menopausal women, and it can last approximately 30 years of a woman’s life. The purpose of this mini- review is to highlight the importance of alterations in the oral and gut microbiota during estrogen deficiency and their effect on oral and inflammatory diseases that are associated with menopause. Considering that hormone replacement therapy is not always recommended or sufficient to prevent or treat menopause-related disease, we will also discuss the use of probiotics and prebiotics as an option for the prevention or treatment of these diseases.

Heritability of the Number of Teeth in Middle-Aged and Older Danish Twins

Tooth loss is a common health concern in older adults. We aimed to estimate the relative contributions of genetic and environmental factors to the variation in the number of teeth in middle-aged and older populations using a population-based cohort of Danish twins. The study included 5,269 Danish middle-aged or older twins who provided data on the number of teeth at baseline by structured interviews. The data were analyzed using univariate liability threshold modeling, stratified by sex and age, to estimate familial risk of tooth loss as well as estimates of heritability. In the whole cohorts, 23% of participants were edentate and 53% had retained 20 or more teeth. A statistical model including additive genetic factors and environmental factors partly shared by co-twins and partly unique to each individual twin gave the best statistical fit for the number of teeth in both age categories as well as in men and women. Overall, additive genetic factors explained 36% (95% confidence interval [CI]: 23% to 49%), common environmental factors 20% (95% CI: 9% to 31%), and unique environmental factors 44% (95% CI: 40% to 48%) of the total variation of the number of teeth. This study indicates that a substantial part of the variation in tooth loss is explained by genetic as well as environmental factors shared by co-twins. Our results implied that family background importantly affects tooth loss in both the middle-aged and the older populations. Family history is thus an important factor to take into account in dental health care.

Assessment of the association between dentate status and self-rated general health

OBJECTIVE

Aiming at preparing the basis for evidence-based dental public health policy making in Slovenia, the objective of the study was to assess the strength of association between oral health status measured by the number of missing teeth and self-rated health (SRH).

METHODS

The study was designed as a pooled individual-level data study from four national cross-sectional studies carried out in the period 2001-2012, based on CINDI Health Monitor methodology. Altogether, 34,412 participants were included. A logistic regression model with poor SRH as observed outcome and the number of teeth as explanatory factor (adjusted for selected biologic, socio-economic and health factors) was proposed.

RESULTS

In the sample, women represented 55.7% and men 44.3%, median age was 45 years. Persons with more missing teeth more likely rated their health as poor. The association was persistent even when different confounding variables were included in the model. In the group with 1-5 missing teeth, in comparison to the group with none missing teeth, OR was 1.23 (p=0.049), whereas for the group with 6-10 missing teeth, OR was 1.32 (p=0.019); for the group with >10 missing teeth, but not all, OR was 1.77 (p<0.001), and for the group with all missing teeth, OR was 2.19 (p<0.001).

CONCLUSIONS

Study results showed clear association of SRH with dentate status, which confirms the oral-general health connection. This indicates the need for the development of proper dental public health policies for better oral health, and presents a new view on the importance of preserving teeth.

The association between diabetes mellitus, sugar-sweetened beverages, and tooth loss in adults: Evidence from 18 states

BACKGROUND

Sugar-sweetened beverages (SSBs) are dietary sources of sugar that are factors in caries development and tooth loss. Dietary sugar also is linked to diabetes mellitus (DM). There is limited research related to SSBs and tooth loss in people with DM. The authors investigated the association between SSBs and tooth loss as it related to the presence or absence of DM.

METHODS

The authors used a cross-sectional design with data reported by adults (18 years and older) who responded to the 2012 Behavior Risk Factor Surveillance System questionnaire, which was used in 18 states (N = 95,897; 14,043 who had DM and 81,854 who did not have DM). The authors conducted χ² and logistic regression analyses to determine associations related to DM status.

RESULTS

Overall, 12.3% of the survey respondents had DM, 15.5% had 6 or more teeth extracted, and 22.6% reported that they consumed 1 or more SSB daily. In the adjusted analyses, among adults who had DM, those who consumed at least 2 SSBs daily were more likely to have had 6 or more teeth extracted than those who reported that they did not consume SSBs (adjusted odds ratio, 2.35; 95% confidence interval, 1.37 to 4.01; P = .0018). Among adults who did not have DM, those who consumed more than 1 but fewer than 2 SSBs per day were more likely to have had at least 6 teeth extracted (adjusted odds ratio, 1.46; 95% confidence interval, 1.21 to 1.77; P < .0001).

CONCLUSIONS

The authors found that, among adults with DM, consuming 2 or more SSBs per day was associated with having had 6 or more teeth extracted.

PRACTICAL IMPLICATIONS

Dietary sugar is a concern for oral and systemic health; however, a strong, independent relationship between the number of teeth extracted and a single source of dietary sugar is not adequate to explain the complexity of tooth loss. Clinicians should use broadly worded dietary messages when discussing caries assessment with patients.

Poor Response to Periodontal Treatment May Predict Future Cardiovascular Disease

Periodontal disease has been associated with cardiovascular disease (CVD), but whether the response to the treatment of periodontal disease affects this association has not been investigated in any large prospective study. Periodontal data obtained at baseline and 1 y after treatment were available in 5,297 individuals with remaining teeth who were treated at a specialized clinic for periodontal disease. Poor response to treatment was defined as having >10% sites with probing pocket depth >4 mm deep and bleeding on probing at ≥20% of the sites 1 y after active treatment. Fatal/nonfatal incidence rate of CVD (composite end point of myocardial infarction, stroke, and heart failure) was obtained from the Swedish cause-of-death and hospital discharge registers. Poisson regression analysis was performed to analyze future risk of CVD. During a median follow-up of 16.8 y (89,719 person-years at risk), those individuals who did not respond well to treatment (13.8% of the sample) had an increased incidence of CVD ( n = 870) when compared with responders (23.6 vs. 15.3%, P < 0.001). When adjusting for calendar time, age, sex, educational level, smoking, and baseline values for bleeding on probing, probing pocket depth >4 mm, and number of teeth, the incidence rate ratio for CVD among poor responders was 1.28 (95% CI, 1.07 to 1.53; P = 0.007) as opposed to good responders. The incidence rate ratio among poor responders increased to 1.39 (95% CI, 1.13 to 1.73; P = 0.002) for those with the most remaining teeth. Individuals who did not respond well to periodontal treatment had an increased risk for future CVD, indicating that successful periodontal treatment might influence progression of subclinical CVD.

History of Periodontitis Diagnosis and Edentulism as Predictors of Cardiovascular Disease, Stroke, and Mortality in Postmenopausal Women

BACKGROUND

Few studies have reported associations between periodontitis and cardiovascular disease (CVD) risk in older women, which is the objective of the present investigation.

METHODS AND RESULTS

Participants were 57 001 postmenopausal women ages 55 to 89 years (mean 68 years; >85% 60 and older) who were enrolled (1993-1998) in the Women's Health Initiative Observational Study, and were without known CVD when history of periodontitis and edentulism was assessed by questionnaire at study Year-5 (1998-2003). There were 3589 incident CVD events and 3816 total deaths during a mean follow-up of 6.7 years. In multivariable analysis, periodontitis was not associated with CVD events, but was associated with higher total mortality (hazard ratio (HR)=1.12, 95% CI: 1.05-1.21). Edentulism was associated with higher age- and smoking-adjusted risks of CVD (HR=1.42, 95% CI: 1.27-1.59) and mortality (HR=1.47, 95% CI: 1.32-1.63). Further adjustment eliminated the association with CVD, but mortality remained significantly increased (HR=1.17, 95% CI: 1.02-1.33). Stratification on age, race-ethnicity, smoking, and diabetes mellitus yielded comparable results; however, edentulism was more strongly associated with CVD in women reporting ≥1 dental visit (HR=1.57) compared with <1 visit (HR 1.03, interaction P=0.004) annually.

CONCLUSIONS

In community-dwelling older women, edentulism was associated with increased risks of CVD and total mortality, and presence of periodontitis, which is more prevalent than edentulism, was associated with 17% higher mortality rate. These findings suggest that improving periodontal condition of the general population could reduce overall mortality.

Periodontal Treatment and the Risks of Cardiovascular Disease in Patients with Type 2 Diabetes: A Retrospective Cohort Study

Objective Periodontal disease may predispose individuals to cardiovascular disease (CVD). Diabetes mellitus, especially in patients with severe periodontitis, increases the risk of CVD mortality. However, the outcomes of periodontal therapy vary among the different treatment modalities. We aim to investigate whether periodontal treatment could influence the occurrence of CVD in patients with type 2 diabetes and periodontal problems. Methods A retrospective cohort study was conducted based on a dataset released by Taiwan National Health Insurance (NHI). The dataset was composed of randomly sampled, newly diagnosed diabetic patients who received insurance benefits from 1999 to 2001; patients who were younger than 18 years of age or who already had CVD before 1999 were excluded. The NHI code was used to identify the treatments, including subgingival curettage and flap operations. The patients' demographic variables were matched using a 1:4 propensity score. All of the subjects were followed up until the onset of CVD, or December 31, 2011. A Cox proportional hazards regression analysis was performed to evaluate the effects of periodontal treatment on the rates of myocardial infarction, heart failure and stroke. Results Three thousand thirty-nine and 12,156 diabetic subjects were classified into the advanced periodontal treatment group and the non-advanced periodontal treatment group, respectively. The Cox proportional hazards analysis revealed that although the overall incidence of CVD was not significantly improved (Hazard ratio, HR 0.95; 95% CI 0.90-1.01), advanced periodontal treatment reduced the rates of myocardial infarction (HR 0.92; 95% CI 0.85-0.99) and heart failure (HR 0.60; 95% CI 0.45-0.80). There was no significance difference in the incidence of stroke (HR 0.95; 95% CI 0.85-1.06). Conclusion Advanced periodontal therapy lowers the rate of CVD, especially myocardial infarction and heart failure. Dental management has a beneficial effect on the health of patients with type 2 diabetes.

Association Between Tooth Loss, Receipt of Dental Care, and Functional Disability in an Elderly Japanese Population: The Tsurugaya Project

OBJECTIVES

To examine whether number of remaining teeth and regular dental care affect incident functional disability in elderly Japanese adults.

DESIGN

Prospective cohort study.

SETTING

Tsurugaya district, Sendai, Japan.

PARTICIPANTS

Community-dwelling individuals aged 70 and older (N = 834).

MEASUREMENTS

The outcome measurement was incident functional disability, defined as first certification of long-term care insurance in Japan, which is determined on the basis of a strictly established uniform nationwide standard. During a median follow-up of 7.9 years (interquartile range 4.8-7.9 years), information on long-term care insurance was obtained from the Sendai Municipal Authority. Oral health was assessed according to number of remaining teeth and presence or absence of regular dental care. Data were also collected on age, sex, body mass index, medical history, smoking, alcohol consumption, duration of education, depressive symptoms, cognitive impairment, physical functioning, and social support.

RESULTS

Participants with 10 to 19 teeth (adjusted hazard ratio (aHR) = 1.42, 95% confidence interval (CI) = 1.03-1.94), one to nine teeth (aHR = 1.46, 95% CI = 1.04-2.03), and no teeth (aHR = 1.49, 95% CI = 1.03-2.14) were more likely to develop functional disability than those with 20 or more teeth. There was no significant difference in risk of functional disability between participants with 20 or more teeth and those with zero to 19 teeth who were receiving regular dental care, whereas those with zero to 19 teeth without regular dental care had a significantly greater risk of functional disability than those with 20 or more teeth (HR = 1.46, 95% CI = 1.11-1.92).

CONCLUSION

Tooth loss was associated with greater risk of functional disability in community-dwelling elderly Japanese. Regular dental care might moderate the risk of functional disability in elderly individuals with missing teeth.

Edentulism and associated factors among community-dwelling middle-aged and elderly adults in China

OBJECTIVE

To investigate the prevalence of self-reported edentulism and its associated risk factors among community-dwelling adults aged 45 years and older in China.

MATERIALS AND METHODS

Data from the national baseline survey (2011-2012) of the China Health and Retirement Longitudinal Study (CHARLS) were used for this study (N = 17 167). Bivariate and multivariate logistic regressions were conducted to assess the predictors of edentulism. Models 1 and 2 were based on the whole sample. Models 3 and 4 were based on the subsample (N = 9933) from whom anthropometric and blood biomarker data were available.

RESULTS

The prevalence of edentulism was 8.64% among Chinese adults aged 45 and above. As shown by Model 1, older age was a robust predictor for edentulism (odds ratio [OR] = 3.81 for people aged 55-64; OR = 11.22 for people aged 65-74; OR = 24.05 for people aged 75 and above). Other factors positively associated with edentulism included being female (OR = 1.25), rural residence (OR = 1.30), asthma (OR = 1.48), depression (OR = 1.20), reduced physical function (OR = 1.37) and current smoking status (OR = 1.36). People with higher educational levels (OR = 0.75 for people who can read and write; OR = 0.64 for people who obtained a junior high school education or above) and better-off economic status (OR = 0.80) were less likely to be edentate. The association between edentulism and age, educational level, economic status and physical function remained significant in Model 3, and in addition, being underweight appeared as another strong predictor (OR = 1.93).

CONCLUSIONS

The estimated prevalence of edentulism and the identified associated factors will provide epidemiologic evidence for future research and interventions in the target population in China.

A practical guide to the oral microbiome and its relation to health and disease

The oral microbiome is incredibly complex with the average adult harboring about 50-100 billion bacteria in the oral cavity, which represent about 200 predominant bacterial species. Collectively, there are approximately 700 predominant taxa of which less than one-third still have not yet been grown in vitro. Compared to other body sites, the oral microbiome is unique and readily accessible. There is extensive literature available describing the oral microbiome and discussing the roles that bacteria may play in oral health and disease. However, the purpose of this review is not to rehash these detailed studies but rather to educate the reader with understanding the essence of the oral microbiome, namely that there are abundant bacteria in numbers and types, that there are molecular methods to rapidly determine bacterial associations, that there is site specificity for colonization of the host, that there are specific associations with oral health and disease, that oral bacteria may serve as biomarkers for non-oral diseases, and that oral microbial profiles may have potential use to assess disease risk.

Association between periodontitis and ischemic stroke: a systematic review and meta-analysis

Several observational studies have suggested an association between periodontitis and cerebral ischemia. This meta-analysis aimed to investigate whether this link exists, and if so, the degree to which it is significant. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guideline for systematic review was used. The search strategy included using electronic databases and hand searching works published up to March 2015. MEDLINE via PubMed, EMBASE, Proceedings Web of Science and Current Contents Connect were searched by two independent reviewers. Case-control, cross-sectional or cohort studies including patients with measures of periodontitis and ischemic stroke were eligible to be included in the analysis. Quality assessments of selected studies were performed. From a total of 414 titles and abstracts, 57 potentially relevant full text papers were identified. After inclusion criteria were applied, 8 studies were included in the present systematic review (5 case-control and 3 cohort studies). Although it was not the intention, cross-sectional studies were excluded due to eligibility criteria were not accomplished. Therefore, meta-analyses were conducted with data retrieved from the 8 studies included. These meta-analyses showed statistically significant association between periodontitis and ischemic stroke in both cohort pooled relative risks at 2.52 (1.77-3.58), and case-control studies pooled relative risks at 3.04 (1.10-8.43). In conclusion, the present meta-analysis demonstrated an association between periodontitis and ischemic stroke. However, well-designed prospective studies should be carried out to provide robust evidence of the link between both diseases. In regards to ischemic stroke subtypes, further case-control studies should be carried out to investigate whether there is any association between the different subtypes of cerebral infarcts and periodontitis.

Association of serum immunoglobulin-G to Porphyromonas gingivalis with acute cerebral infarction in the Chinese population

Background/Purpose:

There is evidence supporting an association between ischemic stroke and periodontitis in western countries. Differing genetic backgrounds and lifestyles among populations may affect this association. The aim of our study was to determine whether antibody titers to Porphyromonas gingivalis are associated with acute cerebral infarction in the Chinese population.

Materials and Methods:

This case-control study was conducted on 88 acute cerebral infarction patients and 40 healthy control subjects. Serum immunoglobulin-G (IgG) antibody to P. gingivalis was analyzed by enzyme-linked immune sorbent assay. Serum lipids were determined with the automatic biochemical analyzer. Fibrinogen was measured using automated coagulation analyzer. High-sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6) were quantified using commercial ELISA kits. The intima-media thickness of the common carotid arteries (IMT-CCA) was measured by ultrasonography.

Results:

The results showed that P. gingivalis IgG antibody levels were significantly higher in acute cerebral infarction cases than in healthy controls (mean ± standard deviation, 11.06 ± 1.49 vs. 9.15 ± 1.70, P < 0.001). There were significant correlations of P. gingivalis IgG titer with total cholesterol (r = 0.34, P = 0.001), low-density lipoprotein (r = 0.39, P < 0.001), apolipoprotein-B (r = 0.30, P = 0.004), hs-CRP (r = 0.35, P = 0.001), IL-6 (r = 0.27, P = 0.011), and IMT-CCA (left: r = 0.306, P = 0.004; right: r = 0.241, P = 0.024).

Conclusion:

Antibody titers to P. gingivalis are associated with acute cerebral infarction in the Chinese population.

Evaluation of the relationship between periodontal risk and carotid artery calcifications on panoramic radiographs

Objective:

To evaluate if there is a relationship between findings of carotid artery calcification (CAC) and periodontal risk in nonsmoker subjects by using panoramic radiographs (DPR).

Materials and Methods:

A total of 1146 DPRs were investigated. Gender, age, severity of bone loss, tooth loss, periodontal risk, and findings of carotid calcification were recorded. The periodontal risk was evaluated and classified according to the degree of alveolar bone loss.

Results:

CAC was diagnosed in %13.6 (n: 156) of DPRs. Of 1146 patients, 338 (29.5%) had low, 668 (60%) had moderate, and 120 (10.5%) had high periodontal risk. A statistically significant relation was observed between carotid calcification and periodontal risk.

Conclusion:

Positive findings of carotid calcification may be related with periodontal problems. Clinicians must be careful about diagnosing CACs on DPRs during routine examinations. In the case of positive findings of CAC and periodontitis together, the patient may be consulted to a specialist for further investigation.

Association between tooth loss and medical costs related to stroke in healthy older adults aged over 75 years in Japan

AIM

Growing evidence suggests that tooth loss is associated with increased risk of stroke. In the current study, we investigated cumulative medical costs related to stroke using data from the Advanced Elderly Medical Service System. We hypothesized that tooth loss was associated with an increase in medical costs related to stroke among older Japanese adults.

METHODS

A total of 273 Japanese adults aged 80 years were enrolled in the current study. Baseline medical and dental examinations were carried out in June 2008. Medical care use and costs were monitored by linkage with National Health Insurance claim files from baseline to the end of February 2011. Medical costs related to stroke per month were calculated and examined for any association with the baseline number of remaining teeth using a linear regression model with robust standard errors.

RESULTS

A total of 19 individuals were admitted to hospital for stroke during the follow-up period. A significant negative association was found between the number of teeth and medical costs related to stroke per month. The regression coefficients of the number of teeth in relation to medical costs related to stroke was -248 (95% CI -438 to -58, P = 0.011) in the crude model and -226 (95% CI -413 to -38, P = 0.018) after adjusting for other confounders.

CONCLUSION

Within the limitations of the present study, the reported findings suggest an independent relationship of tooth loss with increase in medical cost related to stroke among older Japanese adults. Further studies are necessary to substantiate these findings. Geriatr Gerontol Int 2017; 17: 202-210.

Comorbid depression/anxiety and teeth removed: Behavioral Risk Factor Surveillance System 2010

OBJECTIVE

The purpose of this study was to examine the association between participants (i) who reported having had clinical diagnoses of depression and anxiety with 6+ teeth removed and (ii) who reported having had clinical diagnoses of depression and anxiety with edentulism.

METHODS

The Behavioral Risk Factor Surveillance System (BRFSS) Survey 2010 was used for the study. Analyses involved using SAS 9.3® to determine variable frequencies, Rao-Scott chi-square bivariate analyses, and Proc Surveylogistic for the logistic regressions on complex survey designs. Participants eligibility included being 18 years or older and having complete data on depression, anxiety, and number of teeth removed.

RESULTS

There were 76 292 eligible participants; 13.4% reported an anxiety diagnosis, 16.7% reported a depression diagnosis, and 8.6% reported comorbid depression and anxiety. The adjusted logistic regression models were significant for anxiety and depression alone and in combination for 6+ teeth removed (AOR: anxiety 1.23; 95% CI: 1.10, 1.38; P = 0.0773; AOR: depression 1.23; 95% CI: 1.10, 1.37; P = 0.0275; P < 0.0001; and AOR: comorbid depression and anxiety 1.30; 95% CI: 1.14, 1.49; P = 0.0001). However, the adjusted models with edentulism as the outcome failed to reach significance.

CONCLUSIONS

Comorbid depression and anxiety are associated independently with 6+ teeth removed compared with 0-5 teeth removed in a national study conducted in United States. Comorbid depression and anxiety were not shown to be associated with edentulism as compared with any teeth present.

Multiple tooth loss is associated with vascular cognitive impairment in subjects with acute ischemic stroke

BACKGROUND AND OBJECTIVE

Emerging evidence shows that tooth loss is associated with cognitive impairment and dementia. Vascular cognitive impairment (VCI) is a common consequence of ischemic stroke. This study investigated the association of tooth loss with VCI in patients with acute stroke.

MATERIAL AND METHODS

A total of 161 subjects with acute ischemic stroke were recruited. Within 1 wk after admission, fasting blood tests were undertaken and the number of teeth present was recorded. VCI was evaluated with the Montreal Cognitive Assessment (MoCA).

RESULTS

The patients with loss of ≥ 8 teeth exhibited significantly lower MoCA values as compared to those with loss of ≤ 7 teeth (13.2 ± 6.6 vs. 17.3 ± 6.0, p < 0.001). Multivariate logistic regression analysis showed that loss of ≥ 8 teeth (OR = 3.1, 95% CI: 1.2-7.9, p = 0.02) and stroke history (OR = 3.8, 95% CI: 1.1-14.1, p = 0.04) were significantly associated with VCI (MoCA score ≤ 20.0).

CONCLUSION

Within the limitations of this study, the current findings provide the first evidence that multiple tooth loss is independently associated with VCI in patients with acute ischemic stroke.