Inhaled corticosteroid-related tooth problems in asthmatics

Prevalence and Factors Influencing Post-Operative Complications following Tooth Extraction: A Narrative Review

Background

Complications from dental extractions may result in multiple post-operative visits and adversely affect the patient's life. Preventing complications may decrease post-operative morbidity for the individual as well as lower societal costs, such as lost time from work and healthcare costs.

Objectives

This narrative review aims to assess the prevalence and factors influencing post-operative complications following tooth extraction, helping clinicians minimise the risk. Data Sources. Cross-sectional studies. Study Eligibility and Participants. Patients undergoing dental extractions. Our exclusion criteria included in vitro studies, animal studies, terminally ill patients, and tooth loss not due to dental extraction. Literature was collected from "PubMed" and "Web of Science" through search criteria based on the "PICO" framework. Twenty articles were used to formulate a prevalence table, and 156 articles were included for the factors influencing complications. Study Appraisal and Synthesis Methods. This narrative review was reported using the SANRA (a scale for the quality assessment of narrative review articles) checklist. Due to the scope of our narrative review and its associated objectives, the quality of cross-sectional studies (AXIS) will be conducted from the studies outlining the prevalence.

Results

Alveolar osteitis appears to be the most prevalent post-operative complication following tooth extraction. Predisposing factors can be significant in their ability to alter the risk of postoperative complications, and clinicians should provide patient-centred care to mitigate this risk. Limitations. Due to the breadth of context, a systematic review was not feasible, as it may have introduced heterogeneity.

Conclusion

This narrative review has highlighted an array of factors which can influence the prevalence of post-operative complications. Future research would benefit from individually reporting post-operative complications, reducing the heterogeneity in definitions of the complications, and including greater detail on the predisposing factors studied.

The Link between Periodontal Disease and Asthma: How Do These Two Diseases Affect Each Other?

A growing body of evidence suggests that the effects of poor oral hygiene extend beyond the oral cavity and are associated with a variety of systemic diseases, including asthma. Asthma, which results in symptoms of cough, wheezing, and dyspnoea, and is characterized by airflow limitation with variability and (partial or complete) reversibility, is amongst the most prevalent respiratory diseases with approximately 262 million patients worldwide, and its prevalence and disease burden is on the increase. While asthma can occur at a young age, it can also develop later in life and affects a variety of age groups. Both of these diseases have a chronic course, and various researchers have suggested a link between the two. In this article, we aim to provide a literature review focusing on the association between the two diseases. The results demonstrate that medications (primarily, inhaler medicine), hypoxia induced by asthma, and the breathing behaviour of patients potentially trigger periodontal disease. In contrast, oral periodontopathogenic microorganisms and the inflammatory mediators produced by them may be involved in the onset and/or exacerbation of asthma. Common contributing factors, such as smoking, gastro-oesophageal reflux, and type-2 inflammation, should also be considered when evaluating the relationship between the two diseases.

Association between periodontitis and periodontal indices in newly diagnosed bronchial asthma

Background. Periodontitis is an inflammatory disease of the tooth-supporting structures. Current data suggest that periodontal disease may be a risk factor for asthma. The present study aimed to assess the prevalence of periodontitis and its relationship with the severity of asthma in asthmatic patients. Methods. This study was conducted on 70 newly diagnosed asthmatic patients as the case group and 70 healthy subjects as the control group, aged 20‒50. The asthma was diagnosed by a pulmonologist according to Global Initiative for Asthma (GINA) guideline. All the participants underwent peri-odontal examinations, which included measuring the pocket depth (PD), attachment loss (AL), gingi-val index (GI), and plaque index (PI) in one tooth from each sextant, including the incisor/canine and left and right premolar/molar regions for both the maxillary and mandibular dental arches. Results. Periodontal disease was significantly more prevalent in newly diagnosed asthma patients. Patients with asthma had significantly higher PI, GI, PD, and AL scores (P<0.001). Furthermore, dry mouth in asthmatic patients with cough and mucosal changes in asthmatic patients with wheeze were significantly more common than in non-asthmatic patients (P<0.05). The median AL in wheezing patients and the median AL and PD in participants who had asthma attacks within the previous month were significantly higher than in other patients. Furthermore, there was a significant negative correlation between AL with Forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) and PD with FEV1 and FVC. Conclusion. Our results showed that periodontal diseases were more prevalent in newly diagnosed asthmatic patients, and asthma was more severe in periodontitis patients.

Association between asthma and severe tooth loss in the adult population of the United States

OBJECTIVE

This study aimed to investigate the association between asthma and severe tooth loss in the U.S. (United States) adult population.

METHODS

Data were analyzed from the national health and nutritional examination survey (NHANES), 2009-2014. Study-participants were classified into current, former, and never asthmatics based on their asthma status. Former-asthmatics were excluded. The case definition of severe tooth loss (outcome variable) was having 9 or fewer remaining permanent teeth. Characteristics of our study-sample were identified based on the descriptive statistical analyses. Logistic regression analyses were performed to examine the association between asthma and severe tooth. Multivariable models were constructed to control for the known common clinical, demographic, and lifestyle factors. Each analysis accounted for the examination sample weights and the complex clustered design of the continuous NHANES.

RESULTS

Total study-participants were 14,184 representing ≈185.77 million U.S. adults. Prevalence of asthma was 8.99% in our study-sample, and 8.78% had severe tooth loss. Current-asthmatic adults had 34% higher odds of severe tooth loss as compared to their reference group of never-asthmatics adults in the U.S. after controlling for age, race or ethnicity, gender, diabetes, smoking, body mass index, education, and family income-to-poverty ratio.

CONCLUSION

In the United States, as compared to never-asthmatic adults, current-asthmatic adults were more likely to have severe tooth-loss. Oral health promotion is therefore recommended through medical-dental integration to ensure overall health for asthmatic adults.

Oral health in asthmatic patients: a review : Asthma and its therapy may impact on oral health

Different drugs used to treat asthma, such as beta 2 agonists and inhaled steroids, may promote a higher risk of caries, dental erosion, periodontal disease and oral candidiasis. This article reviews the evidences of mechanisms involved in oral diseases in patients affected by asthma. The main mechanism involved is the reduction of salivary flow. Other mechanisms include: acid pH in oral cavity induced by inhaled drugs (particularly dry powder inhaled), lifestyle (bad oral hygiene and higher consumption of sweet and acidic drinks), gastroesophageal reflux, and the impairment of local immunity. In conclusion asthma is involved in the genesis of oral pathologies both directly and indirectly due to the effect of the drugs used to treat them. Other cofactors such as poor oral hygiene increase the risk of developing oral diseases in these patients. Preventive oral measures, therefore, should be part of a global care for patients suffering from asthma.

Association between age at asthma diagnosis and tooth loss

OBJECTIVES

This study aimed to investigate the association between age at asthma diagnosis and tooth loss due to caries using data obtained from the Korean National Health and Nutrition Examination Survey.

MATERIALS AND METHODS

A complex sample multivariable linear regression was used, and the results were analysed. Age at diagnosis and the number of teeth lost were set as independent and dependent variables, respectively. Among the total 65,973 subjects, 10,056 aged <12 years and 11,714 with missing values in dependent and independent variables were excluded. Asthmatic subjects were divided into the following age groups based on the age at diagnosis: 0-6 years, 7-12 years, 13-18 years, 19-28 years, and 29-64 years. In each analysis, the calibration was performed by adding covariates to each model.

RESULTS

Compared with the no asthma group (β = 0), the values of β in asthmatic subjects belonging to the age groups 0-6 years (β = 0.794, 0.521, 0.560) and 7-12 years (β = 0.527, 0.407, 0.437) were high in all models.

CONCLUSIONS

Our findings revealed significant increase in tooth loss due to caries after early asthma diagnosis at 0-6 years (β = 0.560, p < .001) and 7-12 years (β = 0.437, p < .001). Clinicians need to shift their perception of dental risks in young asthmatic patients and provide active oral health care to them.

Prevalence of loss of all teeth (edentulism) and associated factors in older adults in China, Ghana, India, Mexico, Russia and South Africa

Little information exists about the loss of all one’s teeth (edentulism) among older adults in low- and middle-income countries. This study examines the prevalence of edentulism and associated factors among older adults in a cross-sectional study across six such countries. Data from the World Health Organization (WHO’s) Study on global AGEing and adult health (SAGE) Wave 1 was used for this study with adults aged 50-plus from China (N = 13,367), Ghana (N = 4724), India (N = 7150), Mexico (N = 2315), Russian Federation (N = 3938) and South Africa (N = 3840). Multivariate regression was used to assess predictors of edentulism. The overall prevalence of edentulism was 11.7% in the six countries, with India, Mexico, and Russia has higher prevalence rates (16.3%–21.7%) than China, Ghana, and South Africa (3.0%–9.0%). In multivariate logistic analysis sociodemographic factors (older age, lower education), chronic conditions (arthritis, asthma), health risk behaviour (former daily tobacco use, inadequate fruits and vegetable consumption) and other health related variables (functional disability and low social cohesion) were associated with edentulism. The national estimates and identified factors associated with edentulism among older adults across the six countries helps to identify areas for further exploration and targets for intervention.

Fast beneficial systemic anti-inflammatory effects of inhaled budesonide and formoterol on circulating lymphocytes in asthma

BACKGROUND AND OBJECTIVE

Inhaled glucocorticoids and long acting β2 -agonists reduce airway inflammation. It is unclear if this effect is based on the local action of the drugs or is due to a systemic effect on circulating peripheral blood lymphocytes. We assessed whether inhaled budesonide and/or formoterol modify the activity of circulating peripheral blood lymphocytes.

METHODS

Placebo controlled crossover design, including healthy (n = 10) or mild asthmatic males (n = 8). Blood was collected in the morning at 08:00 before drug inhalation, and drugs (placebo, budesonide 400 μg, formoterol 12 μg) were inhaled alone or in combination at 08:30. Four more blood samples were collected after inhalation at 09:00, 09:30, 12:30 and at 09:30 am on the following day. The activity of the glucocorticoid receptor, NFκB and IκB was determined in isolated lymphocytes. Lymphocytes were stimulated with lipopolysaccharide (LPS 10 μg/mL) for 24 h and interleukin (IL)-1β, IL-6, IL-8, tumor necrosis factor (TNF)-α, eotaxin level were determined. Lymphocyte proliferation was induced by phytohaemagglutinin (PHA 10 μg/mL) over 24 h.

RESULTS

When combined, the drugs synergistically activated the glucocorticoid receptor within 30 min but did not modify NFκB or IκB activity. Inhaled budesonide significantly reduced LPS-induced IL-1β, IL-6, IL-8 and TNF-α secretion, while inhaled formoterol had no such effect; however when combined, the inhibitory effect of budesonide was significantly increased by formoterol. PHA-induced proliferation was reduced by both drugs alone and in combination.

CONCLUSIONS

Combined budesonide and formoterol may reduce airway inflammation and immune reactivity of circulating lymphocytes through its local and systemic effects.

Glucocorticoids reduce alveolar and trabecular bone in mice

Glucocorticoid (GC) treatment is the main cause of secondary osteoporosis. There are some controversies about the relationships between alveolar bone loss and bone loss at the appendicular and axial skeleton.

OBJECTIVE

To assess, in parallel, the effects of GCs on alveolar bone and on the tibia in a mice model.

METHODS

Five-month-old male Swiss-Webster mice were randomized into two groups. Pellets releasing 5 mg/kg/day of prednisolone or control pellets were subcutaneously implanted for 28 days. After euthanasia, the right tibia and the right hemimandible of each mouse were analyzed by histomorphometry and microcomputed tomography. Alveolar bone consists of a thin slab between the incisor and the molar roots connected with the alveolar processes. A 2D-frontal section was done through the pulp chamber of the first molar and was used to measure the thickness of the alveolar bone slab. A 2D-sagittal section was done through the pulp chamber of the three molars and was used to measure bone volume in the alveolar processes.

RESULTS

At day 28, thickness and bone volume of alveolar bone were significantly decreased in the GC group (P<0.05). At the tibia, GCs decreased bone formation with a reduced mineral apposition rate and bone formation rate and a significant decrease in BV/TV and Tb.Th (P<0.05).

CONCLUSION

Although the amount of alveolar bone is very low in the mouse, this study shows that GCs can induce an alveolar bone loss in long-term treated animals.

Asthma and oral health: a review

Asthma is a chronic inflammatory condition that causes the airways to constrict and produce excess mucus, making breathing difficult. It is characterized by the obstruction of airflow which is variable over a short period of time. This condition is reversible, either spontaneously or can be controlled with the help of drugs. Asthma medication comprises bronchodilators, corticosteroids and anticholinergic drugs. Most of these drugs are inhaled using various forms of inhalers or nebulizers. The effect of these drugs on oral health is the subject of debate among dental practitioners. Patients taking asthma medication may be at risk of dental caries, dental erosion, periodontal diseases and oral candidiasis. Hence, patients with bronchial asthma on medication should receive special prophylactic attention. This article reviews the correlation between asthma and oral health, and suggests various measures to counter possible oral health problems related to asthma.