The relationship between metabolic conditions and prevalence of periodontal disease in rural Korean elderly

Cardiovascular Health Behavior Prediction Model in Patients With Type 2 Diabetes

BACKGROUND

To prevent cardiovascular disease in adults with type 2 diabetes, it is necessary to identify the factors that affect cardiovascular health behavior.

OBJECTIVE

The aim of this study was to verify the causal relationship between illness perception and diabetes knowledge as cognitive representations, depression as emotional representations, self-efficacy as cognitive coping, and oral health and cardiovascular health behaviors as behavioral coping strategies. A hypothetical model was established based on a literature review and the self-regulation model.

METHODS

In this study, a cross-sectional survey design was used, and the participants were adults 30 years or older who had been given a diagnosis of type 2 diabetes for more than 6 months and were recruited from South Korea. Data from 272 participants were collected through face-to-face interviews or Google surveys in 2021, and analyzed using SPSS 25.0 and AMOS 22.0.

RESULTS

Oral health behavior (β = 0.26, P < .001) and self-efficacy (β = 0.16, P = .048) had a direct effect on cardiovascular health behavior, and illness perception (β = 0.24, P = .018) and depression (β = -0.25, P < .001) had an indirect effect through self-efficacy (β = 0.24, P = .016), with a total explanatory power of 19.1%. Oral health behavior was directly affected by illness perception and self-efficacy, and self-efficacy was directly affected by illness perception, diabetes knowledge, and depression (P < .05).

CONCLUSION

To practice cardiovascular health behaviors in adults with diabetes, self-efficacy for diabetes management should be enhanced. To this end, it is necessary to increase illness perception and knowledge, and reduce depression through cardiovascular disease prevention education for them, and the importance of oral health behaviors should also be emphasized.

Identifying metabolic parameters related to severity and extent of periodontitis in down syndrome patients

BACKGROUND AND OBJECTIVE

Systemic metabolic status and periodontitis can be related in patients with Down syndrome (DS). The objective of this study was to identify metabolic indicators (anthropometric measurements, blood pressure, and serum markers) related to severity and extent of periodontitis in DS patients.

METHODS

A cross-sectional study was conducted with 49 patients with DS. Periodontal evaluation included the periodontal probing depth (PPD), clinical attachment level (CAL), gingival bleeding index (GBI), and visible plaque index (VPI). Periodontitis severity was classified by the stages system. The extent of periodontitis was assessed as the percentage of sites with CAL ≥3 mm, CAL ≥4 mm, PPD ≥4 mm, and PPD ≥5 mm. The metabolic condition of the participants was determined by analyzing anthropometric parameters, blood pressure, and serum markers. Data were analyzed using the Mann-Whitney test, Spearman's correlation coefficient, and multivariate regression analysis.

RESULTS

Periodontitis stage 3/4 was detected in 32.7% of patients, with high values of VPI (54.6 ± 35.8) and GBI (42.4 ± 33.3). The severity of periodontitis was related to higher mean corpuscular hemoglobin (β = .291, p = .028) and mean corpuscular volume values (β = .293, p = .046). Arm circumference measurements were inversely related to CAL ≥3 mm (β = -.408, p = .023), PPD ≥4 mm (β = -.475, p = .006), and PPD ≥5 mm (β = -.443, p = .010).

CONCLUSIONS

The findings suggest that the severity and extent of periodontitis may be related to some metabolic parameters in DS patients.

Association between periodontitis and the metabolic syndrome in the Hamburg City Health Study

BACKGROUND

Previous studies demonstrated an association between severe chronic periodontitis (CP) and the metabolic syndrome (MetS). However, these studies mostly employed the meanwhile outdated NCEP-ATPIII case definition of the MetS. Additionally, CP was rarely diagnosed based on a full-mouth examination. Thus, the aim of the current study was to re-evaluate the potential association between CP and the MetS in the Hamburg City Health Study (HCHS), a large population-based survey of middle-aged and elderly men and women in Germany, in view of more current definitions of the MetS and CP.

METHODS

A cross-sectional study was performed with baseline-data from participants of the Hamburg City Health Study (HCHS). Periodontitis severity grades were determined in a random sample of 6,209 participants of which 5,456 had sufficient data to call absence or presence of the MetS. Variables defining the MetS according to the currently valid harmonized definition were determined and a full-mouth examination was performed, including determination of the clinical attachment loss (AL), bleeding on probing (BOP), and dental plaque (PI) index. CP was classified in three grades of severity (none/mild, moderate, and severe). The Kruskal-Wallis test or the Chi-squared test were used for descriptive statistics and multivariate logistic regression models with and without adjustments for potential confounders (age, sex, smoking, high sensitivity C-reactive protein (hsCRP), energy intake, and physical activity) were used to test for associations.

RESULTS

The prevalence of the MetS (39.0%) increased according to the severity grades of periodontitis (none/mild: 33.6%; moderate: 38.7%, and severe: 46.8%). Multivariate logistic regression analyses demonstrated that severe but not moderate CP was associated with the MetS after adjusting for age and sex (odds ratio [OR]: 1.24; 95% confidence interval [CI]: 1.03-1.48; p = 0.02). However, the association was attenuated after additional adjustment for smoking (OR: 1.19; 95% CI: 0.99-1.43; p = 0.058) and hsCRP, energy intake, and physical activity (OR: 1.11; 95% CI 0.91-1.36; p = 0.294).

CONCLUSIONS

The use of the more current definitions for the MetS and CP confirmed previous observations of an age- and sex-adjusted association between severe CP and the MetS. Smoking, high energy intake and low physical activity were identified as important lifestyle-related confounders. Abdominal obesity, as indicated by elevated waist circumference, came out as the most important component of the MetS in relation to CP. This article is protected by copyright. All rights reserved.

Association Between Periodontitis and Metabolic Syndrome in Females: A Systematic Review and Meta-analysis

Background:

Metabolic syndrome (MetS) and periodontal diseases (PDs) have shown a bidirectional and vice versa relationship. Hence, this study aimed to identify the extent and magnitude between MetS and PDs in females.

Materials and Methods:

A published literature was explored by considering case–control, cross-sectional, and cohort studies that involved patients with measurements of MetS and PD. Ovid MEDLINE, EMBASE, LILACS, and Cochrane Library databases were used for the search. This study examined the relationship between the MetS and PD among females.

Results:

Of the initial 4150 titles screened, a total of 37 reported papers were eligible for quantitative review. A gender-wise analysis of the findings revealed a crude odds ratio (OR) of 1.385 [95% confidence interval (CI): 1.043–1.839, I² = 94.61%, P < 0.001] for the females relative to the average OR of 1.54 (95% CI: 1.39–1.71, I² = 90.95%, P < 0.001). Further subgroup analysis for directionality in females revealed the crude ORs of 1.28 (95% CI: 0.91–1.79, I² = 96.44%, P < 0.001) for the relationship between PD and MetS, whereas an OR of 2.12 (95% CI: 0.78–5.73, I² = 88.31%, P < 0.001) was found between MetS and PDs.

Conclusion:

This study lacks convincing proof of a link between MetS and PDs in females when compared with an overall association between MetS and PDs. Directionality indicated higher odds of linking between MetS and PD than PD and MetS among females. Further longitudinal and treatment trials are needed to confirm the association among females.

The relationship between body mass index and stage/grade of periodontitis: a retrospective study

OBJECTIVES

Possible impact of obesity on stage and grade of periodontitis has never been investigated before. This study aimed to examine the association between body mass index (BMI) and stage/grade of periodontitis per the current classification of periodontal diseases.

MATERIAL AND METHODS

A total of 142 patients (82 males/60 females) were included in this study. "2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions" was taken as basis to characterize the stage/grade of periodontitis. Age, gender, smoking status, and frequency of tooth brushing, and medical data of the patients including hypertension, hyperlipidemia, BMI, and diabetes mellitus were obtained from the patient's hospital records. Obesity was assessed by BMI using the "World Health Organization" criteria. For estimating the association between BMI and periodontitis, logistic regression analysis was utilized.

RESULTS

BMI was statistically associated with clinical attachment loss (CAL), probing pocket depth (PPD), Plaque index (PI), stage and grade of periodontitis, and number of remaining teeth (p < 0.001, p < 0.05, p < 0.05, p < 0.05, p < 0.001, respectively). According to the multiple regression analysis results, those with BMI 25-29.9 were found to be at risk of being stage III-IV 3.977 times (95% CI: 1.831-8.640, p < 0.001) higher than those with BMI < 25, and similarly, those with BMI ≥ 30 were found to be at risk of being stage III-IV 4.062 times (95% CI: 1.315-12.549, p = 0.015) higher than those with BMI < 25. No relationship was found between obesity and grade of periodontitis according to multivariate analysis.

CONCLUSIONS

BMI increases the likelihood of stage III and stage IV periodontitis; however, it does not have an impact on the grade of periodontitis.

CLINICAL RELEVANCE

It seems that obesity is related to the severity of periodontitis.

Oral health outcomes among adults with diabetes served at HRSA-funded health centers

OBJECTIVES

To examine the association of diabetes with tooth loss and oral manifestations among adult health center patients (HCPs).

METHODS

This cross-sectional study utilized the nationally representative 2014 HCPs-Survey. Descriptive and logistic regression analyses limited to adults (n = 5524) were used to compare self-reported responses of tooth loss and oral manifestations (i.e., loose teeth, bleeding gums, mouth sores, and dry mouth) among HCPs with and without diabetes.

RESULTS

Almost a quarter of the HCPs reported having diabetes. Among patients with diabetes, more than half were 45-64 years old, had low-income status, and attended rural health centers. Analyses revealed that diabetes was significantly associated with permanent tooth loss and presence of at least one oral manifestation after controlling for confounders. Among adults with diabetes, probability of "missing at least one tooth." were two times higher compared to not missing any teeth [AOR = 2.10, (95%CI 1.40-3.16); P ≤0.001]. Adults with diabetes had higher odds of having one or more "oral manifestations" compared to adults without diabetes [AOR = 1.60, (95%CI 1.22-2.11); P = 0.001].

CONCLUSION

Diabetes disproportionately affects HCP adults (23%) compared to the general U.S. adult population (10%). In HCPs having diabetes was associated with a higher prevalence of oral manifestations (i.e., loose teeth, bleeding gums) and losing "At least one" of their permanent teeth. These findings suggest that adults with diabetes had higher prevalence of oral manifestations and tooth loss, highlighting the need for innovative interprofessional models for early screening and identification.

Bidirectional association between periodontal disease and diabetes mellitus: a systematic review and meta-analysis of cohort studies

Periodontal disease has been reported to be associated with diabetes mellitus. However, the direction of the association and the influence of bias are not clear. Thus, the aim of this systematic review and meta-analysis was to summarize the existing evidence on the bidirectional prospective association between periodontal disease and diabetes mellitus by accounting for the risk of bias of the original studies. The literature search was conducted on the electronic data sources PubMed and Web of Science up to February 9th, 2021. We included observational studies, which investigated the prospective association between diabetes mellitus and periodontal disease or vice versa. The risk of bias of the primary studies was evaluated by applying the Quality in Prognosis Studies (QUIPS) tool. Random effects models were used to calculate summary relative risk (SRR) with 95% CI. Subgroup analyses were applied to investigate heterogeneity and the robustness of the finding. In total, 15 studies were included . The SRR for incident diabetes mellitus was 1.26 (95% CI 1.12, 1.41; I²: 71%, n = 10; participants = 427,620; identified cases = 114,361), when comparing individuals with periodontitis to individuals without periodontitis. The SRR for incident periodontitis was 1.24 (95% CI 1.13, 1.37; I²: 92%, n = 7; participants = 295,804; identified cases: > 22,500), comparing individuals with diabetes to individuals without diabetes. There were no significant differences between subgroups after stratification for risk of bias. The findings show a positive bidirectional association between periodontal disease and diabetes mellitus, and thus, underline the need for screening of patients with periodontitis regarding diabetes mellitus and vice versa. The main limitation of the study is the high unexplained heterogeneity between the studies including the different assessment methods of the disease diagnosis.

Association between metabolic syndrome and tooth loss: A systematic review and meta-analysis

BACKGROUND

The authors conducted a systematic review and meta-analysis to verify the existence and level of scientific evidence concerning the association between metabolic syndrome (MetS), as the main exposure, and tooth loss (TL), as the outcome.

TYPES OF STUDIES REVIEWED

Through electronic databases and partially through gray literature, the authors identified observational studies in adults. The authors used no date or language restrictions. The authors evaluated the studies' methodological quality by using the Newcastle-Ottawa Scale. The authors conducted a random-effects model meta-analysis. The authors assessed the quality of evidence by using the Grading of Recommendations Assessment, Development and Evaluation criteria.

RESULTS

Twelve studies met the eligibility criteria, and 9 were retained for the meta-analysis. Most were cross-sectional studies with good methodological quality. Participants with MetS had fewer teeth (standardized mean difference, -2.77; 95% confidence interval, -4.56 to -0.98) and an increased likelihood of lacking functional dentition (odds ratio, 2.37; 95% confidence interval, 1.89 to 2.96) than did those without MetS. The overall quality of evidence was very low.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Better-conducted longitudinal studies are necessary to establish a causal relationship between MetS and TL to inform the best strategies to prevent TL in populations with MetS.

Does diabetes increase the risk of periodontitis? A systematic review and meta-regression analysis of longitudinal prospective studies

AIM

Even though the association between diabetes and periodontitis is taken for granted, results on this association are conflicting within the literature. This systematic review assessed whether poorly controlled diabetes was associated with periodontitis onset or progression.

METHODS

Electronic searches were performed in PubMed, Scopus and Embase databases. Hand search was carried out in the reference list of all articles included. Gray literature was investigated with a Google Scholar search. Prospective longitudinal studies on the association between diabetes and periodontitis were considered for this review. Studies should have presented at least two measurements of periodontal conditions over time. Data on study design, crude and adjusted estimates were collected. We used meta-analysis to estimate the pooled effect of hyperglycemia in people with diabetes on periodontitis onset or progression. Meta-regression and subgroup analyses were employed to investigate potential sources of heterogeneity between studies.

RESULTS

Thirteen studies matched the inclusion criteria, comprising 49,262 individuals, including 3197 diagnosed with diabetes. Meta-analyses of adjusted estimates showed that diabetes increased the risk of incidence or progression of periodontitis by 86% (RR 1.86 [95% CI 1.3-2.8]). However, there is scarce information on the association between diabetes and periodontal destruction.

CONCLUSIONS

This study provides evidence that diabetes is associated with increased risk of periodontitis onset and progression in adults. Upcoming prospective longitudinal studies ought to overcome methodological caveats identified in this review.

Periodontal disease and the metabolic syndrome

The metabolic syndrome (MetS) is a spectrum of conditions that increase the risk of cardiovascular disease and diabetes mellitus. The components of MetS include dysglycemia, visceral obesity, atherogenic dyslipidemia (elevated triglycerides and low levels of high-density lipoprotein) and hypertension. An association of periodontal disease and MetS has been suggested. This association is believed to be the result of systemic oxidative stress and an exuberant inflammatory response. When examined individually, the components of the MetS that are most closely related to the risk of periodontitis are dysglycemia and obesity, with lesser contributions by atherogenic dyslipidemia and hypertension. Data suggest that the odds of periodontitis increase with the number of MetS components present in an individual. The direction of the relationship between MetS and periodontal disease cannot currently be determined because the majority of studies are cross-sectional. The association between MetS and periodontitis, however, suggests that improved understanding of this association could promote interprofessional practice. Evidence suggests that periodontal therapy can reduce the levels of inflammatory mediators in serum. If this finding is confirmed, periodontal treatment could become part of therapy for MetS. Oral health providers who identify patients at risk for MetS could refer them to a medical provider, and physicians could refer patients to dentists to ensure that patients with MetS receive a dental evaluation and any necessary treatment. These clinical activities would improve both oral and general health outcomes.

Relationship between Metabolic Syndrome Components and Periodontal Disease in a Japanese General Population: the Suita Study

Aim: A positive association between metabolic syndrome (MetS) and periodontal status has recently been noted. However, no study has evaluated the relationship by sex and in a general urban population using the uniform definition proposed in the 2009 Joint Interim Statement. The aim of this study was to clarify the relationship between MetS and periodontal status using the uniform definition in a general urban Japanese population.

Methods: A total of 1,856 Japanese men and women (mean age: 66.4 years) were studied using data from the Suita study. Periodontal status was evaluated by the Community Periodontal Index (CPI). MetS was defined using the 2009 Joint Interim Statement. The associations of the MetS and its components with periodontal disease were investigated using multiple logistic regression analysis adjusting for age, drinking, and smoking.

Results: Among the components of the MetS, low HDL cholesterol level was significantly associated with periodontal disease in men and women [odds ratios (OR) = 2.39 and 1.53; 95% confidence intervals = 1.36–4.19 and 1.06–2.19]. Furthermore, the risk of periodontal disease showed 1.43-, 1.42-, and 1.89-fold increases in those with 2, 3, and ≥ 4 components, respectively, compared with those having no components (P_trend < 0.001). For the analysis by sex, the risk of periodontal disease was increased 2.27- and 1.76-fold in those with ≥ 4 components in men and women, respectively (both P_trend = 0.001).

Conclusion: These findings suggest that MetS and lower HDL cholesterol are associated with periodontal disease. Subjects with two or more MetS components had a significantly higher prevalence of periodontal disease.

Preventive dental care in older adults with diabetes

BACKGROUND

The association between poor oral health and diabetes is well documented. Preventive oral health care is, therefore, strongly indicated for people with diabetes. The authors conducted a study to determine if there was a difference in preventive dental care use among older adults with diabetes in 2002 and in 2011 and to compare preventive dental care use by older adults with and without diabetes in 2002 and in 2011.

METHODS

The authors used a data sample of participants from the Medicare Current Beneficiary Survey that included older (65 years and older) fee-for-service Medicare beneficiaries. The key outcome was self-reported preventive dental care. In 2002, there were 8,725 participants; in 2011, there were 7,425 participants. The authors conducted χ(2) and logistic regression analyses.

RESULTS

In 2002, 28.8% of participants with diabetes had preventive dental care. In 2011, this percentage increased to 36.0%. Similar results were seen among participants without diabetes (42.9% in 2002 and 45.5% in 2011). The increase in preventive dental care was statistically significant for participants with and without diabetes. The participants with diabetes, as compared with participants without diabetes, remained statistically less likely to have had preventive dental care in adjusted logistic regression analysis with and without considering the interaction between observation year and diabetes (adjusted odds ratios, 0.73 and 0.86, respectively).

CONCLUSIONS

Although the percentage increase in participants with diabetes receiving preventive dental care is welcomed, older adults with diabetes continue to have substantial preventive dental care needs.

PRACTICAL IMPLICATIONS

Additional efforts are needed to encourage people with diabetes to obtain preventive dental care.

Tooth loss and metabolic syndrome in middle-aged Japanese adults

AIM

Metabolic syndrome is associated with periodontal disease and dental caries; however, little attention has been given to the association between metabolic syndrome and tooth loss, which is the endpoint of these two diseases. This study examined this association in middle-aged adults over a 5-year period.

METHODS

A retrospective study was performed in 2107 participants (1718 males and 389 females) aged 35-60 years who underwent annual dental check-ups, to evaluate tooth loss and metabolic components, including obesity, elevated triglycerides, blood pressure, fasting glucose, and reduced high-density lipoprotein. Logistic regression analysis was performed to evaluate the association between metabolic syndrome (≥3 components) at the baseline examination and tooth loss.

RESULTS

Over a 5-year period, 10.8% of the participants lost at least one tooth. Compared to those with no metabolic components, participants with ≥3 components had an increased risk of tooth loss (odds ratio = 1.54; 95% confidence interval: 1.01-2.37), adjusting for age, gender, dental caries experience, attachment loss, oral hygiene status, number of teeth, tooth brushing frequency, smoking, and occupational status.

CONCLUSIONS

Metabolic syndrome was associated with the incidence of tooth loss among middle-aged adults.

Systemic diseases and oral health

The US population is at the beginning of a significant demographic shift; the American geriatric population is burgeoning, and average longevity is projected to increase in the coming years. Elder adults are affected by numerous chronic conditions, such as diabetes, hypertension, osteoarthritis, osteoporosis, cardiovascular diseases, and cerebrovascular diseases. These older adults need special dental care and an improved understanding of the complex interactions of oral disease and systemic chronic diseases that can complicate their treatment. Oral diseases have strong associations with systemic diseases, and poor oral health can worsen the impact of systemic diseases.

Periodontal disease and metabolic syndrome: a qualitative critical review of their association

BACKGROUND

Metabolic syndrome (MetS) is a conglomerate of several physical conditions/diseases that, as a group, increases the risk of mortality resulting from development of T2DM and cardiovascular diseases (CVD). These conditions/diseases include glucose intolerance/insulin resistance, hypertension, obesity, and dyslipidemia. The results from epidemiological studies suggest that there is an association between metabolic syndrome (MetS) and periodontitis, it is therefore important to understand the current status of the association and a possible contribution of periodontitis to MetS.

OBJECTIVE

This review will qualitatively analyze published papers on the association of MetS and periodontitis/periodontal disease to clarify the current status of the association and suggest future directions for studies which may unravel the causal relationship between them.

RESULTS

Of 309 papers related to MetS and periodontitis, 26 are original research papers that investigated the relationship/association between periodontal disease and MetS. Criteria used to assess periodontitis and MetS as well as overall study designs and patient recruitment criteria varied greatly among these studies.

CONCLUSION

All these studies demonstrated a positive association between periodontal disease and MetS. However, due to the heterogeneity of criteria to assess periodontitis and MetS and also paucity of longitudinal studies, it is difficult to determine the relative contribution of periodontitis to MetS. Age and the number of positive components of MetS appear to strengthen the relationship, however, incidence of each disease entity increases with ageing. Thus, mechanistic studies are also necessary to unravel the inter-relationship between periodontitis and MetS. In this regard, a use of animal models will be helpful as they are more uniform in regards to genetic background and have minimum confounding factors. Finally, development of accurate, quantitative assessment of gingival inflammation are necessary in order to determine the influence of periodontal disease on the development of MetS and its components.