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Wang J, Sun Z, Zhong Y, Ye Y, Chen X, Hu X, Peng Y. Hypertensive patients with periodontitis as predictors of cardiovascular and all-cause mortality: a long-term cohort study. Clin Oral Investig 2024; 28:582. [PMID: 39382756 DOI: 10.1007/s00784-024-05986-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Accepted: 10/01/2024] [Indexed: 10/10/2024]
Abstract
OBJECTIVES The aim of this study is to examine the potential correlation between periodontitis and the risk of cardiovascular mortality and all-cause mortality in individuals diagnosed with hypertension, despite the established association between periodontitis and hypertension. METHODS The study utilized data from the National Health and Nutrition Examination Survey (NHANES) conducted in 1999-2014 involving hypertensive individuals. Following the criteria proposed by Eke et al., periodontitis was classified. Survival estimates were calculated using Kaplan Meier analyses and a Kaplan Meier curve was generated. Weighted multivariate cox regression were employed to assess the association between periodontitis and all-cause mortality, as well as cardiovascular mortality. RESULTS Of the 21,645 individuals, 6,904 individuals were diagnosed with periodontitis. The Kaplan-Meier survival analysis revealed significantly higher rates of all-cause mortality (34.766% vs. 14.739%) and cardiovascular mortality (12.469% vs. 3.736%) in the periodontitis group compared to the non-periodontitis group. Hazard ratios (HRs) for all-cause mortality were 3.19 (95% CI 2.88-3.53) and for cardiovascular mortality were 3.80 (95% CI 3.13-4.61) in individuals with periodontitis compared to those without periodontitis. CONCLUSION Periodontitis is a risk factor for mortality in patient with hypertension, especially if it is moderate to severe. Improving periodontal health could lead to better outcomes for these patients.
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Affiliation(s)
- Junwen Wang
- 1Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
| | - Ziyi Sun
- Department of Intensive Care Unit, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangdong, Shenzhen, 518107, China
| | - Yi Zhong
- Department of Cardiovascular Center, The Seventh Affiliated Hospital, Sun Yat- sen University, Guangdong, Shenzhen, 518107, China
| | - Yuyang Ye
- 1Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
| | - Xuefeng Chen
- 1Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
| | - Xinru Hu
- 1Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
| | - Yong Peng
- 1Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China.
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Kiyomoto K, Matsuo I, Suita K, Ohnuki Y, Ishikawa M, Ito A, Mototani Y, Tsunoda M, Morii A, Nariyama M, Hayakawa Y, Amitani Y, Gomi K, Okumura S. Oral angiotensin-converting enzyme inhibitor captopril protects the heart from Porphyromonas gingivalis LPS-induced cardiac dysfunction in mice. PLoS One 2023; 18:e0292624. [PMID: 37983238 PMCID: PMC10659197 DOI: 10.1371/journal.pone.0292624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 09/25/2023] [Indexed: 11/22/2023] Open
Abstract
Although angiotensin converting enzyme (ACE) inhibitors are considered useful for the treatment of human heart failure, some experimental failing-heart models have shown little beneficial effect of ACE inhibitors in animals with poor oral health, particularly periodontitis. In this study, we examined the effects of the ACE inhibitor captopril (Cap; 0.1 mg/mL in drinking water) on cardiac dysfunction in mice treated with Porphyromonas gingivalis lipopolysaccharide (PG-LPS) at a dose (0.8 mg/kg/day) equivalent to the circulating level in patients with periodontal disease. Mice were divided into four groups: 1) Control, 2) PG-LPS, 3) Cap, and 4) PG-LPS + Cap. After1 week, we evaluated cardiac function by echocardiography. The left ventricular ejection fraction was significantly decreased in PG-LPS-treated mice compared to the control (from 66 ± 1.8 to 59 ± 2.5%), while Cap ameliorated the dysfunction (63 ± 1.1%). The area of cardiac fibrosis was significantly increased (approximately 2.9-fold) and the number of apoptotic myocytes was significantly increased (approximately 5.6-fold) in the heart of PG-LPS-treated group versus the control, and these changes were suppressed by Cap. The impairment of cardiac function in PG-LPS-treated mice was associated with protein kinase C δ phosphorylation (Tyr-311), leading to upregulation of NADPH oxidase 4 and xanthine oxidase, and calmodulin kinase II phosphorylation (Thr-286) with increased phospholamban phosphorylation (Thr-17). These changes were also suppressed by Cap. Our results suggest that the renin-angiotensin system might play an important role in the development of cardiac diseases induced by PG-LPS.
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Affiliation(s)
- Kenichi Kiyomoto
- Department of Physiology, Tsurumi University School of Dental Medicine, Yokohama, Japan
- Department of Periodontology, Tsurumi University School of Dental Medicine, Yokohama, Japan
| | - Ichiro Matsuo
- Department of Periodontology, Tsurumi University School of Dental Medicine, Yokohama, Japan
| | - Kenji Suita
- Department of Physiology, Tsurumi University School of Dental Medicine, Yokohama, Japan
| | - Yoshiki Ohnuki
- Department of Physiology, Tsurumi University School of Dental Medicine, Yokohama, Japan
| | - Misao Ishikawa
- Department of Oral Anatomy, Tsurumi University School of Dental Medicine, Yokohama, Japan
| | - Aiko Ito
- Department of Orthodontology, Tsurumi University School of Dental Medicine, Yokohama, Japan
| | - Yasumasa Mototani
- Department of Physiology, Tsurumi University School of Dental Medicine, Yokohama, Japan
| | - Michinori Tsunoda
- Department of Physiology, Tsurumi University School of Dental Medicine, Yokohama, Japan
- Department of Periodontology, Tsurumi University School of Dental Medicine, Yokohama, Japan
| | - Akinaka Morii
- Department of Physiology, Tsurumi University School of Dental Medicine, Yokohama, Japan
- Department of Periodontology, Tsurumi University School of Dental Medicine, Yokohama, Japan
| | - Megumi Nariyama
- Department of Pediatric Dentistry, Tsurumi University School of Dental Medicine, Yokohama, Japan
| | - Yoshio Hayakawa
- Department of Dental Anesthesiology, Tsurumi University School of Dental Medicine, Yokohama, Japan
| | - Yasuharu Amitani
- Department of Mathematics, Tsurumi University School of Dental Medicine, Yokohama, Japan
| | - Kazuhiro Gomi
- Department of Periodontology, Tsurumi University School of Dental Medicine, Yokohama, Japan
| | - Satoshi Okumura
- Department of Physiology, Tsurumi University School of Dental Medicine, Yokohama, Japan
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Pink C, Holtfreter B, Völzke H, Nauck M, Dörr M, Kocher T. Periodontitis and systemic inflammation as independent and interacting risk factors for mortality: evidence from a prospective cohort study. BMC Med 2023; 21:430. [PMID: 37953258 PMCID: PMC10642059 DOI: 10.1186/s12916-023-03139-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/30/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Recent studies have highlighted the role of low-grade systemic inflammation in linking periodontitis to cardiovascular disease (CVD) outcomes, but many aspects remain unclear. This study examines the independent and reciprocal associations of periodontitis and low-grade systemic inflammation with all-cause and CVD mortality in a large-scale cohort. METHODS A total of 3047 participants from the prospective, population-based Study of Health in Pomerania (SHIP-START) were followed for a period of 13.0 ± 2.4 years. For the association between various inflammation/periodontitis measures and mortality, hazard ratios (HRs) were obtained from covariate-adjusted Cox proportional hazards models. Interactions were analysed in joint models: on the multiplicative scale, HRs were reported and on the additive scale, relative excess risks due to interaction (RERI) were calculated. Subject and variable-specific interval records were used to account for time-varying exposures and covariates. RESULTS During the observation period, 380 (12.5%) individuals died from CVD (n = 125) or other causes (n = 255). All markers of periodontitis and inflammation showed apparent associations with all-cause mortality (HRs per SD-increase: mean PPD: 1.068 (95% confidence interval (CI): 0.988-1.155), mean CAL: 1.205 (95% CI: 1.097-1.323), missing teeth: 1.180 (95% CI: 1.065-1.307), periodontitis score: 1.394 (95% CI: 1.202-1.616), leukocytes: 1.264 (95% CI: 1.163-1.374), fibrinogen: 1.120 (95% CI: 1.030-1.218), CRP: 1.231 (95% CI: 1.109-1.366), inflammation score: 1.358 (95% CI: 1.210-1.523)). For CVD mortality, all PPD related variables showed significant associations. Interaction modelling revealed some variation with respect to mortality type and exposure combinations. On the additive scale, RERIs for periodontitis score and inflammation score implied 18.9% and 27.8% excess mortality risk for all-cause and CVD mortality, respectively. On the multiplicative scale, the HRs for interaction were marginal. CONCLUSIONS Both periodontitis and inflammation were significantly associated with all-cause mortality and CVD mortality. On the additive scale, a substantial excess risk was observed due to the interaction of periodontitis and inflammation, suggesting that the greatest treatment benefit may be achieved in patients with both periodontitis and high systemic inflammation. As periodontal therapy has been reported to also reduce systemic inflammation, the possibility of a reduction in CVD mortality risk by anti-inflammatory treatments, including periodontal interventions, seems worthy of further investigation.
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Affiliation(s)
- Christiane Pink
- Department of Restorative Dentistry, Periodontology, Endodontology and Preventive and Pediatric Dentistry, University Medicine Greifswald, Fleischmannstr. 42, 17475, Greifswald, Germany.
- Department of Orthodontics, University Medicine Greifswald, Greifswald, Germany.
| | - Birte Holtfreter
- Department of Restorative Dentistry, Periodontology, Endodontology and Preventive and Pediatric Dentistry, University Medicine Greifswald, Fleischmannstr. 42, 17475, Greifswald, Germany
| | - Henry Völzke
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
- Institute for Community Medicine, SHIP/Clinical-Epidemiological Research, University Medicine Greifswald, Greifswald, Germany
| | - Matthias Nauck
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Marcus Dörr
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Thomas Kocher
- Department of Restorative Dentistry, Periodontology, Endodontology and Preventive and Pediatric Dentistry, University Medicine Greifswald, Fleischmannstr. 42, 17475, Greifswald, Germany
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4
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Doughan M, Chehab O, de Vasconcellos HD, Zeitoun R, Varadarajan V, Doughan B, Wu CO, Blaha MJ, Bluemke DA, Lima JAC. Periodontal Disease Associated With Interstitial Myocardial Fibrosis: The Multiethnic Study of Atherosclerosis. J Am Heart Assoc 2023; 12:e8146. [PMID: 36718872 PMCID: PMC9973639 DOI: 10.1161/jaha.122.027974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background Periodontitis is a chronic inflammatory disease common among adults. It has been suggested that periodontal disease (PD) may be a contributing risk factor for cardiovascular disease; however, pathways underlying such a relationship require further investigation. Methods and Results A total of 665 men (mean age 68±9 years) and 611 women (mean age 67±9 years) enrolled in the MESA (Multiethnic Study of Atherosclerosis) underwent PD assessment using a 2-item questionnaire at baseline (2000-2002) and had cardiovascular magnetic resonance 10 years later. PD was defined when participants reported either a history of periodontitis or gum disease or lost teeth caused by periodontitis or gum disease. Multivariable linear regression models were constructed to assess the associations of baseline self-reported PD with cardiovascular magnetic resonance-obtained measures of interstitial myocardial fibrosis (IMF), including extracellular volume and native T1 time. Men with a self-reported history of PD had greater extracellular volume percent (ß=0.6%±0.2, P=0.01). This association was independent of age, left ventricular mass, traditional cardiovascular risk factors, and history of myocardial infarction. In a subsequent model, substituting myocardial infarction for coronary artery calcium score, the association of PD with IMF remained significant (ß=0.6%±0.3, P=0.03). In women, a self-reported history of PD was not linked to higher IMF. Importantly, a self-reported history of PD was not found to be associated with myocardial scar independent of sex (odds ratio, 1.01 [95% CI, 0.62-1.65]; P=0.9). Conclusions In a community-based setting, men but not women with a self-reported PD history at baseline were found to be associated with increased measures of IMF. These findings support a plausible link between PD, a proinflammatory condition, and subclinical IMF.
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Affiliation(s)
- Maria Doughan
- Division of Orthodontics, Department of DentistryUniversity of MarylandBaltimoreMD
| | - Omar Chehab
- Division of Cardiology, Department of MedicineJohns Hopkins UniversityBaltimoreMD
| | | | - Ralph Zeitoun
- Division of Cardiology, Department of MedicineJohns Hopkins UniversityBaltimoreMD
| | - Vinithra Varadarajan
- Division of Cardiology, Department of MedicineJohns Hopkins UniversityBaltimoreMD
| | - Bassel Doughan
- Faculty of Dental SurgeryCôte d’Azur UniversityNiceFrance
| | - Colin O. Wu
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of HealthBethesdaMD
| | - Michael J Blaha
- Division of Cardiology, Department of MedicineJohns Hopkins UniversityBaltimoreMD
| | - David A. Bluemke
- Department of RadiologyUniversity of Wisconsin School of Medicine and Public HeathMadisonWI
| | - Joao A. C. Lima
- Division of Cardiology, Department of MedicineJohns Hopkins UniversityBaltimoreMD
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5
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Bond JC, McDonough R, Alshihayb TS, Kaye EK, Garcia RI, Heaton B. Periodontitis is associated with an increased hazard of mortality in a longitudinal cohort study over 50 years. J Clin Periodontol 2023; 50:71-79. [PMID: 36089889 DOI: 10.1111/jcpe.13722] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/22/2022] [Accepted: 09/02/2022] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the association between periodontal disease and all-cause mortality in a longitudinal cohort study over 50 years. MATERIALS AND METHODS Participants (N = 1156) in the Veterans Affairs Dental Longitudinal Study, aged 25-85 years at enrollment in 1968, received comprehensive medical and oral exams approximately every 3 years through 2007. Periodontal status was defined using person-level, mean whole-mouth radiographic alveolar bone loss (ABL) scores using a five-point Schei ruler, each unit representing 20% increments of ABL. Time-varying Cox regression models estimated hazard ratios (HRs) for the association between continuous and categorical ABL and mortality, adjusting for covariates. RESULTS Each one-unit increase in mean ABL score was associated with a 14% increase in the hazard of mortality (adjusted HR = 1.14, 95% confidence interval [CI] 1.02, 1.27). When assessed categorically, HRs for average scores of 2 to <3 and 3 to ≤5 showed increasing associations with hazard of mortality, relative to 0 to <1 (adjusted HR = 1.17, 95% CI 0.94, 1.46; and HR = 1.65, 95% CI 0.94, 2.85, respectively). By contrast, we observed null associations for average scores of 1 to <2 relative to 0 to <1 (adjusted HR = 1.00, 95% CI 0.86, 1.17). CONCLUSIONS Time-varying periodontal status assessed using radiographic ABL was positively associated with all-cause mortality even after confounder adjustment.
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Affiliation(s)
- Julia C Bond
- Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts, USA.,Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Robert McDonough
- Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts, USA
| | - Talal S Alshihayb
- Department of Dental Public Health, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Elizabeth K Kaye
- Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts, USA.,VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Raul I Garcia
- Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts, USA.,VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Brenda Heaton
- Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts, USA.,Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA.,VA Boston Healthcare System, Boston, Massachusetts, USA
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6
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Wu Z, O'Brien KM, Lawrence KG, Han Y, Weinberg CR, Sandler DP, Vogtmann E. Associations of periodontal disease and tooth loss with all-cause and cause-specific mortality in the Sister Study. J Clin Periodontol 2021; 48:1597-1604. [PMID: 34605056 DOI: 10.1111/jcpe.13557] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/07/2021] [Accepted: 09/19/2021] [Indexed: 11/26/2022]
Abstract
AIM Studies have found that periodontal disease and tooth loss are associated with increased mortality; however, associations with cause-specific mortality and all-cause mortality within specific subgroups have not been thoroughly investigated. MATERIALS AND METHODS We examined the association of self-reported periodontal disease and disease/decay-related tooth loss with subsequent all-cause and cause-specific mortality in the Sister Study, a prospective cohort study of 50,884 women aged 35-74 years at baseline, whose sister was diagnosed with breast cancer. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the associations were calculated with adjustment for relevant confounders. RESULTS With a mean follow-up of 10.9 years (range 0.1-14.3), 2058 women died. Participants with periodontal disease had a slightly higher rate of all-cause mortality (HR = 1.08, 95% CI 0.98-1.19), while participants with tooth loss had an increased rate of all-cause mortality (HR = 1.15, 95% CI 1.05-1.26). For cause-specific mortality, women with tooth loss had increased rates of death from circulatory system diseases, respiratory system diseases, and endocrine/metabolic diseases. Results varied in stratified models, but no heterogeneity across strata was found. CONCLUSIONS In this large prospective study, periodontal disease and tooth loss were associated with all-cause and certain specific cause-specific mortality outcomes.
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Affiliation(s)
- Zeni Wu
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Katie M O'Brien
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - Kaitlyn G Lawrence
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - Yongli Han
- Biostatistics Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Clarice R Weinberg
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - Emily Vogtmann
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Bethesda, Maryland, USA
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7
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Gómez-Costa D, San-Roman-Montero J, Rojo R, Gil Á, Gómez de Diego R, López-Sánchez AF. Self-reported prevalence of periodontal disease among the Spanish population and immigrants: 2006, 2011/12 and 2017: a population-based study. BMC Oral Health 2021; 21:215. [PMID: 33910535 PMCID: PMC8082769 DOI: 10.1186/s12903-021-01579-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/15/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Periodontal disease is one of the most common pathologies in the population. Self-reporting has been used as a diagnostic tool in large populations, among other reasons, to detect the needs of potentially vulnerable groups. This study evaluated the prevalence of periodontal disease in people of Spanish nationality and immigrants in Spain. METHODS This population-based, cross-sectional study was carried out using data obtained from National Health Interview Surveys (NHSs) carried out in 2006, 2011/2012 and 2017 in Spain. Subjects aged 16 years and older were included in the NHS-2006 and aged 15 years and older were included in the other NHSs. The following variables were self-reported by the participants: gum bleeding, tooth mobility, tooth extraction and missing teeth. Chi-square homogeneity tests were performed to assess the main associations between the independent variable (nationality) and the dependent variables (bleeding gums, tooth mobility, tooth extraction and missing teeth). Multinomial logistic regression models were constructed to evaluate the influences of the variables age and sex and their interactions on the main associations. RESULTS A total of 115,123 participants were included in the NHS-2006 (n = 37,327, 11.38% immigrants), NHS-2011/12 (n = 38,727, 14.39% immigrants) and NHS-2017 (n = 39,069, 13.71% immigrants). The variables directly related to periodontal disease were gum bleeding and tooth mobility. These were significantly associated with nationality in the NHS-2006 and NHS-2017 cohorts. In the NHS-2011/12 cohort, only tooth mobility was associated with nationality. After adjustments for sex, age, and their interactions, immigrant status was associated with increased odds of bleeding in only the NHS-2006 cohort (RR = 1.65, 95% CI 1.38-1.99, p = 0.000). CONCLUSION Immigrants in Spain have a lower probability of developing signs associated with periodontal disease than the Spanish population. Among the immigrant cohort, females and those in adult age groups had lower prevalence rates than their counterparts.
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Affiliation(s)
- Diego Gómez-Costa
- Doctoral Program in Health Sciences, Faculty of Health Sciences, Rey Juan Carlos University, Avenida de Atenas s/n, Alcorcón, 28922, Madrid, Spain
| | - Jesús San-Roman-Montero
- Department of Medicine Specialties and Public Health, Faculty of Health Sciences, Rey Juan Carlos University, Avenida de Atenas s/n, Alcorcón, 28922, Madrid, Spain
| | - Rosa Rojo
- Faculty of Dentistry, Alfonso X El Sabio University, Villanueva de la Cañada, 28691, Madrid, Spain.
| | - Ángel Gil
- Department of Medicine Specialties and Public Health, Faculty of Health Sciences, Rey Juan Carlos University, Avenida de Atenas s/n, Alcorcón, 28922, Madrid, Spain
| | - Rafael Gómez de Diego
- Department of Nursing and Estomatology, Faculty of Health Sciences, Rey Juan Carlos University, Avenida de Atenas s/n, Alcorcón, 28922, Madrid, Spain
| | - Antonio F López-Sánchez
- Department of Nursing and Estomatology, Faculty of Health Sciences, Rey Juan Carlos University, Avenida de Atenas s/n, Alcorcón, 28922, Madrid, Spain
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8
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Silva NNQ, Albuquerque E Aguiar IH, Gomes MVSW, Neto OBDO, Penteado LADM, de Lima FJC. Is there evidence that periodontal diseases are risk factors for coronary arterial disease?-Scoping review. SPECIAL CARE IN DENTISTRY 2020; 41:66-77. [PMID: 33215733 DOI: 10.1111/scd.12542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/08/2020] [Accepted: 10/30/2020] [Indexed: 11/28/2022]
Abstract
AIM To determine the scientific evidence regarding the condition of periodontal diseases (PDs) as risk factors of coronary artery diseases. MATERIALS AND METHODS A scoping review was performed through the selection of articles from online databases (Medline via PubMed, LILACS, and Cochrane CENTRAL), using a search algorithm and eligibility criteria for data extraction and data synthesis of included papers. Four hundred forty-one studies from online databases and 1364 from reference lists were initially identified, and 34 articles were selected for inclusion. Articles had to be published between 2015 and 2020 and had to associate PDs to coronary arterial diseases. All studies comprised a sample of 446443 participants. Favorable opinions totaled 70.59%, and the cross-sectional observational study design was more frequently found (32.35%). Biochemical outcomes were showed more frequently, such as inflammatory biomarkers (58.82%). Despite a large advantage for favorable opinions, a statistically significant result was not found when extracted data were combined with studies opinions. CONCLUSION The evidence was classified as level II-3, hence, still distant from the best ranks and can therefore be considered as unclear. Moreover, studies with the higher potential to generate evidence showed a high risk of bias.
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Affiliation(s)
| | | | | | - Olavo Barbosa de Oliveira Neto
- Institute of Health and Biological Sciences, Federal University of Alagoas, Maceió, AL, Brazil.,CESMAC University Center, Maceió, AL, Brazil
| | | | - Fernando José Camello de Lima
- Human Anatomy Division, Institute of Health and Biological Sciences, Federal University of Alagoas, Maceió, AL, Brazil
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9
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Saka-Herrán C, Jané-Salas E, González-Navarro B, Estrugo-Devesa A, López-López J. Validity of a self-reported questionnaire for periodontitis in a Spanish population. J Periodontol 2020; 91:1027-1038. [PMID: 31984491 DOI: 10.1002/jper.19-0604] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/28/2019] [Accepted: 12/29/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Clinical examination is the gold-standard approach for surveillance of periodontitis; however, it requires large resources. Several self-reported measures have been developed and tested in diverse scenarios with results suggesting that it may be a useful tool for screening periodontal disease in different populations; yet they have not being tested in Spanish population. We aimed to assess the validity of a self-reported questionnaire for periodontitis in a Spanish population from Barcelona during 2018. METHODS One hundred and twelve participants were enrolled in the study and, in one appointment; a dentist performed the self-reported questionnaire and a full-mouth periodontal examination. Periodontitis was defined as at least mild periodontitis according to three criterion of classification. Receiver-operating characteristics curve analyses were used to test the discriminatory capability, sensitivity and specificity of the self-reported questionnaire and logistic regression models were adjusted to estimate the minimal-set of questions associated with periodontitis. RESULTS The self-reported questionnaire had a useful discriminative capability for detecting individuals with periodontitis (area under the curve [AUC] = 0.85 95% CI 0.78-0.92) and its moderate/severe form (AUC = 0.86 95% CI 0.79-0.04) with sensitivity and specificity of 77% and 74% and 73% and 87%, respectively; representing moderate validity. The combination of four-specific questions had high accuracy (AUC = 0.88 95% CI 0.81-0.94) and validity (sensitivity = 92.2%) and was strongly associated with moderate/severe periodontitis after adjusting by socio-demographic factors. CONCLUSIONS The use of several self-reported questions proved to have a good performance for screening periodontitis in the population under study; specifically, those related with tooth mobility and gum migration. Large community-based studies are needed to test its validity and predictive capability.
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Affiliation(s)
- Constanza Saka-Herrán
- Faculty of Medicine and Health Sciences (Dentistry), University of Barcelona, Barcelona, Spain
| | - Enric Jané-Salas
- Department of Odontostomatology, Faculty of Medicine and Health Sciences (Dentistry), University of Barcelona-Oral Health and Masticatory System Group (Bellvitge Biomedical Research Institute) IDIBELL, University of Barcelona, Barcelona, Spain
| | - Beatriz González-Navarro
- Department of Odontostomatology, Faculty of Medicine and Health Sciences (Dentistry), University of Barcelona-Oral Health and Masticatory System Group (Bellvitge Biomedical Research Institute) IDIBELL, University of Barcelona, Barcelona, Spain
| | - Albert Estrugo-Devesa
- Department of Odontostomatology, Faculty of Medicine and Health Sciences (Dentistry), University of Barcelona-Oral Health and Masticatory System Group (Bellvitge Biomedical Research Institute) IDIBELL, University of Barcelona, Barcelona, Spain
| | - José López-López
- Department of Odontostomatology, Faculty of Medicine and Health Sciences (Dentistry), Odontological Hospital University of Barcelona, University of Barcelona Oral Health and Masticatory System Group (Bellvitge Biomedical Research Institute) IDIBELL, University of Barcelona, Barcelona, Spain
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