The association of periodontal disease parameters with systemic medical conditions and tobacco use

Periodontal disease in patients with thyroid diseases: A systematic review with meta-analysis

PURPOSE

The imbalance of thyroid hormones affects the metabolic activity of various tissues, including periodontium. Also, autoimmune diseases present an increased tendency to suffer from periodontal disease. Therefore, our systematic review was designed to answer the question "Is there a relationship between thyroid diseases and periodontal disease?".

MATERIALS AND METHODS

Following the inclusion and exclusion criteria, 10 studies were included in this systematic review using the databases PubMed, Scopus and Web of Science (according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines).

RESULTS

Based on the meta-analysis, patients with thyroid diseases (especially with hypothyroidism) demonstrated significantly worse periodontal status than systemically healthy controls. Moreover, according to the cross-sectional studies, 5.74 ​% of periodontitis patients reported the concomitance of thyroid diseases.

CONCLUSIONS

In summary, the included studies suggest a potential relationship between thyroid diseases and periodontal disease. However, further research is necessary to reliably assess the oral health in patients with hypothyroidism and hyperthyroidism.

Could the periodontal therapy improve the cardiologic patient health? A narrative review

BACKGROUND

Cardiovascular diseases (CVD) is the major cause of mortality globally, with increasing evidence suggesting a link between periodontitis, and CVD. This study aims to explore the association between periodontitis and CVD, and the impact of periodontal therapy on cardiovascular health.

METHODS

This review synthesized findings from preclinical and clinical studies, without publication year restrictions, examining periodontitis and CVD through various lenses. Scientific databases were inspected with keywords related to periodontitis and CVD.

RESULTS

The review identifies a substantial association between periodontitis and an increased risk of several CVD, supported by both epidemiological and interventional studies. Results suggest the complexity of the relationship, influenced by factors like the severity of periodontitis and the presence of other systemic conditions. Clinical data indicates that periodontal therapy, particularly non-surgical periodontal therapy, may reduce systemic inflammatory markers and thus may play a role in the primary and secondary prevention of CVD events, highlighting the potential of periodontal therapy to not only maintain oral health but also to modulate cardiovascular risk factors.

CONCLUSIONS

Current evidence supports a significant association between periodontitis and increased cardiovascular risk, promoting integrated healthcare approaches that consider oral health as a key-component of cardiovascular care and wellbeing.

Evaluating the Impact of Tobacco Cessation Counseling on Oral Health-Related Quality of Life and Identifying Barriers to Quitting Among Tobacco Smokers

Introduction Tobacco addiction is widely recognized as the most significant menace to both systemic and oral diseases, resulting in around eight million fatalities worldwide annually. The current investigation was conducted to assess the influence of tobacco cessation counseling on the quality of life linked to oral health and to identify obstacles to quitting among those who use tobacco. Methods This observational, follow-up study was carried out among patients referred to the tobacco cessation unit for the cessation of their smoking tobacco habit. Data on the participants was collected in two phases. Oral health-related quality of life (OHRQoL) was assessed at baseline and again three months after quitting smoking habits in the second phase. The assessment of barriers to quitting was done by asking a few questions of all participants. A student t-test and a chi-square test were applied with a p-value <0.05 considering significance. Results The study comprised a total of 322 patients, ranging in age from 18 to 62, with a mean age of 32.58 ± 12.901 years. After three months of quitting tobacco, a comparison of the mean scores of the Oral Health Impact Profile (OHIP) domains revealed a significant reduction in the mean score across all domains. The reduction was statistically significant, with a p-value of 0.001. Upon investigating the association between obstacles to quitting tobacco and socioeconomic position, it was discovered that the expense of quitting aids or tobacco programs, as well as the likelihood of weight gain, were strongly linked to the socioeconomic status of the individuals involved in the study. Conclusion Based on the results, the present study concluded that oral health-related quality of life significantly improved after quitting.

Association between Periodontitis Extent, Severity, and Progression Rate with Systemic Diseases and Smoking: A Retrospective Study

BACKGROUND

The aim of this study was to analyze the relationship between extent, severity (stage), and rate of progression (grade) of periodontitis with systemic diseases as well as smoking using a large database.

METHODS

Patients' records identified in the BigMouth Dental Data Repository with a periodontal diagnosis based on the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions were evaluated. Patients were further categorized based on extent, severity, and rate of progression. Data were extracted from patients' electronic health records including demographic characteristics, dental procedural codes, and self-reported medical conditions, as well as the number of missing teeth.

RESULTS

A total of 2069 complete records were ultimately included in the analysis. Males were more likely to have generalized periodontitis and stage III or IV periodontitis. Older individuals were more likely diagnosed with grade B and stage III or IV periodontitis. Individuals with generalized disease, grade C, and stage IV demonstrated a significantly higher number of missing teeth. Higher numbers of tooth loss reported during supportive periodontal treatment were noted in generalized disease and stage IV periodontitis. Multiple sclerosis and smoking were significantly associated with grade C periodontitis.

CONCLUSIONS

Within the limitations of this retrospective study that utilized the BigMouth dental data repository, smokers were significantly associated with rapid progression of periodontitis (grade C). Gender, age, number of missing teeth, and number of tooth loss during supportive periodontal treatment were associated with disease characteristics.

Poor Oral Health in the Etiology and Prevention of Aspiration Pneumonia

Aspiration pneumonia (AP), inflammation of the lung parenchyma initiated by aspirated microorganisms into the lower airways from proximal sites, including the oral cavity, is prevalent in, and problematic for, the elderly, especially those in institutions, and for those with several important risk factors. Many factors influence the pathogenesis of AP, including dysphagia, poor oral hygiene, diminished host defense, and underlying medical conditions. This article reviews the epidemiology, microbiology, pathogenesis, and prevention of AP, focusing on the role of poor oral health as a risk factor for, and on dental care for the prevention and management of, this important infection.

What is the future of Periodontal Medicine?

In the last five decades, considerable progress has been made towards understanding the etiology and pathogenesis of periodontal diseases and their interactions with the host. The impact of an individual periodontal condition on systemic homeostasis became more evident because of this knowledge and prompted advances in studies that associate periodontitis with systemic diseases and conditions. The term Periodontal Medicine describes how periodontal infection/inflammation can affect extraoral health. This review presents the current scientific evidence on the most investigated associations between periodontitis and systemic diseases and conditions, such as cardiovascular diseases, diabetes, preterm birth and low birth weight, and pneumonia. Additionally, other associations between periodontitis and chronic inflammatory bowel disease, colorectal cancer, and Alzheimer's disease that were recently published and are still poorly studied were described. Thus, the aim of this review was to answer the following question: What is the future of Periodontal Medicine? Epidemiological evidence and the evidence of biological plausibility between periodontitis and general health reinforce the rationale that the study of Periodontal Medicine should continue to advance, along with improvements in the epidemiological method, highlighting the statistical power of the studies, the method for data analysis, the case definition of periodontitis, and the type of periodontal therapy to be applied in intervention studies.

Association between Periodontal Disease and Systemic Inflammatory Conditions Using Electronic Health Records: A Pilot Study

AIMS

To investigate the association between periodontal disease and systemic inflammatory conditions and examine the link between medical conditions and the extent of missing teeth in a large population.

METHODS

In this retrospective study, a total of 4890 randomly selected patients who had attended the University of Minnesota dental clinics were analyzed. Severity of periodontal disease was determined based on the percentage of bone loss, evaluated through the examination of a full-mouth intraoral series of radiographs. The number of missing teeth was calculated from the examined radiographs, while ten systemic inflammatory conditions were extracted from patients' self-reported medical histories.

RESULTS

Moderate bone loss was observed in 730 (14.9%) and severe in 323 (6.6%) patients of the total population, while the mean number of missing teeth was 3.54 ± 3.93. The prevalence of systemic conditions and tobacco use were gender-dependent (p < 0.05). Regression analysis showed that hypertension, arthritis, asthma, diabetes and HIV were associated significantly with the severity of bone loss, while diabetes and lupus with the extent of missing teeth.

CONCLUSIONS

The findings reported in our study add to this body of knowledge, strengthening the association between periodontal disease with systemic inflammatory conditions.

Poor Oral Health in the Etiology and Prevention of Aspiration Pneumonia

Aspiration pneumonia (AP), inflammation of the lung parenchyma initiated by aspirated microorganisms into the lower airways from proximal sites, including the oral cavity, is prevalent in, and problematic for, the elderly, especially those in institutions, and for those with several important risk factors. Many factors influence the pathogenesis of AP, including dysphagia, poor oral hygiene, diminished host defense, and underlying medical conditions. This article reviews the epidemiology, microbiology, pathogenesis, and prevention of AP, focusing on the role of poor oral health as a risk factor for, and on dental care for the prevention and management of, this important infection.

Periodontal Disease in Diabetes Mellitus: A Case-Control Study in Smokers and Non-Smokers

INTRODUCTION

It is well established that periodontal disease (PD) and diabetes mellitus (DM) can have a detrimental effect on each other's disease course, and that cigarette smoking exacerbates both conditions. However, literature on the periodontal status of smokers with DM is scarce, and the studies conducted to date did not use healthy controls or non-smokers with DM as controls. Consequently, the individual effects of smoking and DM on PD are difficult to untangle and estimate.

METHODS

A total of 128 participants were recruited to this study and their data analyzed. They were assigned to four groups: smoking patients with DM (SDM); non-smoking patients with DM (NSDM); smokers without DM (control group, SC) and (4) non-smokers without DM (control group, NSC). Each group consisted of 32 age-matched participants. The periodontal status of the participants was assessed by full oral examination. To express periodontal status, we used the four-stage classification introduced by Fernandes and colleagues (J Periodontol. 80(7):1062-1068, 2009). The control of DM was estimated by measuring hemoglobin A1c (HbA1c) levels in the peripheral blood.

RESULTS

A significant difference in the severity of PD was found between the SC and NSC groups (p = 0.027) and between the NSC and SDM groups (p = 0.000), while the difference between the NSDM and SDM groups approached significance (p = 0.052). No person in the smoker groups could be classified as having a healthy periodontal status. The four-stage classification followed a normal distribution in the healthy, non-smoking controls (NSC). Smoking caused a shift toward medium-severe PD, while a marked shift toward the most severe stage was observed when both smoking and DM were present (SDM). There was no significant association between the type of DM and periodontal status, nor between diabetes control and the severity of PD. Persons in the SDM group had significantly fewer teeth than those in the NSC group (mean ± standard deviation: 16.0 ± 7.9 vs. 20.7 ± 5.6; p = 0.02).

CONCLUSION

Smoking damages the periodontium of even healthy individuals, but the damage is multiplied in a smoker who has DM, even though the effect of DM alone on periodontium health is relatively mild. Our results suggest a synergy between DM and smoking in terms of damage to the periodontal tissues, but the limited sample size of this study does not allow any hard conclusion to be drawn.

Relationship between hypothyroidism and periodontitis: A scoping review

AIM

The objective of this study was to assess the existing literature to determine if a relationship exists between hypothyroidism and periodontitis.

METHODS

We used a modified approach to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses by searching five databases in addition to the gray literature. Keywords in the title and abstract fields, as well as subject headings for both periodontal disease and hypothyroidism, were used to search the existing literature for publications relevant to evaluation of the thyroid-periodontitis relationship.

RESULTS

The authors screened 847 unique publications which, after applying inclusion and exclusion criteria, yielded 29 publications, which were further analyzed for relevance and applicability. Most of the included papers were cross-sectional studies and retrospective chart reviews. Following critical analysis, four publications, including one abstract, were used to further assess the hypothyroid-periodontitis relationship.

CONCLUSIONS

There are very few high-quality studies describing the potential association between hypothyroidism and periodontitis. In general, and among the included papers with the fewest confounding factors, a positive relationship between hypothyroidism and periodontitis was found. Further well-controlled, prospective clinical and immunologic studies will be required to confirm that relationship.

Validity of self-reported periodontal measures, demographic characteristics, and systemic medical conditions

BACKGROUND

The objective of the present study was to assess self-reported periodontal screening questions, demographic characteristics, systemic medical conditions, and tobacco use for predicting periodontal disease among individuals seeking dental therapy in a university dental clinic.

METHODS

In this retrospective study, a total of 4,890 randomly selected dental charts were evaluated from among patients who had attended the University of Minnesota School of Dentistry clinics for treatment. Radiographic bone loss measurements were used to assess the severity of periodontal disease. Demographic characteristics as well as medical history of the patients were also recorded. Five self-reported periodontal screening questions were included, with answers limited to Yes/No. Generalized logit models were used to assess the association between bone loss and the predictors.

RESULTS

The sample's mean age was 54.1 years and included 52.6% males and 14.9% smokers, with a mean of 3.5 missing teeth. Self-reported tooth mobility, history of "gum treatment," and the importance of retaining teeth as well as age, tobacco use, and cancer were statistically significant predictors (P < 0.05) of a radiographic diagnosis of moderate and severe periodontal disease. With respect to severe periodontal disease, significant associations (P < 0.05) were also found with "bleeding while brushing," gender, diabetes, anxiety, and arthritis.

CONCLUSIONS

Self-reported periodontal screening questions as well as demographic characteristics, smoking, and systemic medical conditions were significant predictors of periodontal disease, and they could be used as valid, economic, and practical measures.

The Association of Periodontitis and Peripheral Arterial Occlusive Disease-A Systematic Review

Background: Observational studies support an association between periodontitis (PD) and atherosclerotic vascular disease, but little is known specifically about peripheral arterial occlusive disease (PAOD).

OBJECTIVES

To systematically review the evidence for an association between PD and PAOD.

DATA SOURCES

Medline via PubMed.

REVIEW METHODS

We searched the Pubmed database for original studies, case reports, case series, meta-analyses and systematic reviews that assessed whether there is an association between PD (all degrees of severity) and PAOD (all degrees of severity). The reporting of this systematic review was in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement following the Population, Intervention, Control, and Outcome (PICO) format.

RESULTS

17 out of 755 detected studies were included in the qualitative synthesis. Nine studies demonstrated associations between PD and PAOD, and two studies reported associations between tooth loss and PAOD. Six studies addressed the pathomechanism regarding PD as a possible trigger for PAOD. No study that dismissed an association could be detected. Odds ratios or hazard ratios ranged from 1.3 to 3.9 in four large cohort studies after adjusting for established cardiovascular risk factors.

CONCLUSIONS

The presented evidence supports a link between PD and PAOD. Further studies which address the temporality of PD and PAOD and randomized controlled intervention trials examining the causal impact of PD on PAOD are needed. Although our results cannot confirm a causal role of PD in the development of PAOD, it is likely that PD is associated with PAOD and plays a contributing role.

Oral inflammation and infection, and chronic medical diseases: implications for the elderly

Oral diseases, such as caries and periodontitis, not only have local effects on the dentition and on tooth-supporting tissues but also may impact a number of systemic conditions. Emerging evidence suggests that poor oral health influences the initiation and/or progression of diseases such as atherosclerosis (with sequelae including myocardial infarction and stoke), diabetes mellitus and neurodegenerative diseases (such as Alzheimer's disease, rheumatoid arthritis and others). Aspiration of oropharyngeal (including periodontal) bacteria causes pneumonia, especially in hospitalized patients and the elderly, and may influence the course of chronic obstructive pulmonary disease. This article addresses several pertinent aspects related to the medical implications of periodontal disease in the elderly. There is moderate evidence that improved oral hygiene may help prevent aspiration pneumonia in high-risk patients. For other medical conditions, because of the absence of well-designed randomized clinical trials in elderly patients, no specific guidance can be provided regarding oral hygiene or periodontal interventions that enhance the medical management of older adults.

Oral health disparities in older adults: oral bacteria, inflammation, and aspiration pneumonia

Poor oral hygiene has been suggested to be a risk factor for aspiration pneumonia in the institutionalized and disabled elderly. Control of oral biofilm formation in these populations reduces the numbers of potential respiratory pathogens in the oral secretions, which in turn reduces the risk for pneumonia. Together with other preventive measures, improved oral hygiene helps to control lower respiratory infections in frail elderly hospital and nursing home patients.

Association between indices of clinically-defined periodontitis and self-reported history of systemic medical conditions

AIM

The aim of the current research was to investigate whether possible associations exist between indices of clinically-defined periodontitis and several systemic medical conditions in outpatients referred to a special hospital clinic.

METHODS

The study sample consisted of 3360 outpatients aged 45-65 years. Data were collected by means of an oral clinical examination and a self-administered questionnaire. Statistical analysis of the questionnaire items was done with Fisher's exact test and the logistic regression model to assess possible associations between systemic medical conditions as independent variables, and the relative frequency of periodontal pockets ≥5 mm and clinical attachment loss (CAL) of ≥6 mm as dependent variables.

RESULTS

The depth of periodontal pockets was significantly associated with male sex, the presence of vascular disease, hypertension, stroke, heart attack, diabetes mellitus, other endocrine diseases, thyroid disease, respiratory allergies, and rheumatoid arthritis. CAL was significantly associated with the mentioned conditions, and also infective endocarditis and chronic obstructive pulmonary disease, but not other endocrine and thyroid disease.

CONCLUSIONS

The findings confirm the results from previous investigations in which a number of systemic medical conditions were significantly associated with probing pocket depth and/or CAL.

A prospective study of periodontal disease and risk of gastric and duodenal ulcer in male health professionals

OBJECTIVES

Periodontal disease has been associated with higher circulating levels of inflammatory markers and conditions associated with chronic inflammation, including vascular disease, diabetes mellitus, and cancer. Limited data exist on the relationship between periodontal disease and gastric and duodenal ulcer.

METHODS

We conducted a prospective cohort study of 49,120 men in the Health Professionals Follow-up Study, aged 40-75 years at enrollment in 1986. Biennially, we assessed periodontal disease, tooth loss, and other risk factors for gastric and duodenal ulcer. We validated diagnoses of gastric and duodenal ulcer through medical record review. We used Cox proportional hazards modeling, adjusting for potential confounders, to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

We documented 138 cases of gastric ulcer and 124 cases of duodenal ulcer with available information on Helicobacter pylori status over 24 years of follow-up. After adjustment for risk factors, including smoking and regular use of aspirin and non-steroidal anti-inflammatory drugs, men with periodontal disease with bone loss had a multivariate HR of ulcer of 1.62 (95% CI, 1.24-2.12). Periodontal disease appeared to be associated with a similar risk of developing ulcers that were H. pylori negative (HR 1.75; 95% CI, 1.26-2.43) than H. pylori positive (HR 1.40; 95% CI, 0.87-2.24), as well as ulcers in the stomach (HR 1.75; 95% CI, 1.21-2.53) than ulcers in the duodenum (HR 1.47; 95% CI, 0.98-2.19).

CONCLUSIONS

Periodontal disease is associated with an increased risk of incident gastric and duodenal ulcer. This relationship may be mediated by alterations in the oral and gastrointestinal microbiome and/or systemic inflammatory factors.

The influence of cigarette smoking on gingival bleeding and serum concentrations of haptoglobin and alpha 1-antitrypsin

The objectives of this study were to evaluate the influence of cigarette smoking on gingival bleeding and serum concentrations of cotinine, haptoglobin, and alpha 1-antitrypsin in Malaysian smokers. A total of 197 male smokers and nonsmokers were recruited for this study. Plaque index, bleeding on probing (BOP), and levels of serum cotinine, haptoglobin, and alpha 1-antitrypsin were evaluated. The data were analyzed using SPSS version 20.0, with the significance level set at α ≤ 0.05. Linear regression analyses were performed. The mean cigarette consumption per day was 13.39 ± 5.75 cigarettes; the mean duration was 16.03 ± 8.78 years. Relatively low BOP values (26.05 ± 1.48) and moderate plaque indexes (51.35 ± 11.27) were found. The levels of serum cotinine (106.9 ± 30.71 ng/dL), haptoglobin (76.04 ± 52.48 mg/dL), and alpha 1-antitrypsin (141.90 ± 18.40 mg/dL) were significantly higher in smokers compared to non-smokers. Multiple logistic regression models for all variables and smokers demonstrated observed differences between BOP, the number of cigarettes per day, and duration of smoking, while serum cotinine, haptoglobin and alpha-1 antitrypsin levels showed no significant differences. Duration of smoking (years) and the cotinine level in serum showed a significant correlation with plaque index. The present analysis demonstrated that the duration of smoking in years, but not the number of cigarettes smoked per day, was associated with reduced gingival bleeding in smokers.

Dentists' attitudes, behaviors, and barriers related to tobacco-use cessation in the dental setting

OBJECTIVE

This study assessed attitudes, behaviors, and barriers among general dentists in California, Pennsylvania, and West Virginia, related to patient tobacco cessation counseling.

METHODS

From 2004 to 2008, a baseline survey was mailed to 271 study dentists randomly selected from a master Delta Dental Insurance Company provider list in each state who had agreed to participate in a tobacco cessation randomized clinical trial. Four backward logistic regression models assessed correlates of the five As related to tobacco cessation: Asking about tobacco use, Advising users to quit, Assessing readiness to quit, Assisting with quitting, and Arranging follow-up.

RESULTS

Most respondents (n=265) were male, had practiced dentistry for over 15 years, asked about tobacco use (74%), and advised tobacco users to quit (78%). Only 19% assessed readiness to quit; 39% assisted with quitting; 4% arranged follow-up; and 42% had formal training in tobacco cessation. Believing that tobacco cessation counseling was an important professional responsibility, practicing <15 years, and asking about tobacco use significantly related to advising users to quit. Providing cessation advice and feeling effective intervening related to assessing readiness to quit. Advising users to quit, assessing readiness to quit, feeling effective intervening, and having had formal tobacco cessation training related to assisting with quitting. Barriers to cessation counseling were perceived patient resistance (66%), lack of insurance reimbursement (56%), not knowing where to refer (49%), and lack of time (32%).

CONCLUSION

Study dentists reported not fully performing the five As. Advising, assessing, having formal training, and feeling effective increased the likelihood of cessation counseling.

Association between periodontal disease and peptic ulcers among Japanese workers: MY health up study

OBJECTIVE

This study aimed to investigate the association between periodontal disease and peptic ulcers in a working population.

METHODS

Self-administered questionnaires were distributed to all employees of a large insurance company in Japan. The questionnaire asked about their health status and lifestyle habits. Peptic ulcer was defined as either stomach ulcer, duodenal ulcer, or both. For the evaluation of periodontal disease, three indices were used: (a) loss of five or more teeth, (b) having been told of having periodontitis, and (c) periodontal risk score.

RESULTS

Of the eligible 28 765 subjects analyzed, peptic ulcer was present in 397 (1.4%). The results of bivariate analyses showed that a significantly higher proportion of subjects with peptic ulcer reported that they lost five or more teeth (35.3 vs. 17.4%, p&lt;0.001) or that they were told they had periodontitis (33.5 vs. 20.7%, p&lt;0.001). Moreover, the periodontal risk score was higher for those with peptic ulcer than those without (mean 0.83 vs. 0.59, p&lt;0.001). In multivariate logistic regression analyses, statistical associations were found between the presence of peptic ulcer and loss of five or more teeth (odds ratio (OR): 1.41, 95% confidence interval (CI): 1.13-1.76, p&lt;0.01), having been told of having periodontitis (OR: 1.28, 95% CI: 1.03-1.59, p&lt;0.05), and a 1-point increase in the periodontal risk score (OR: 1.17, 95% CI: 1.04-1.30, p&lt;0.01), respectively.

CONCLUSION

Modest but statistically significant associations were found between the self-reported measures of periodontal disease and peptic ulcers.

Periodontal status in smokers and nonsmokers: a clinical, microbiological, and histopathological study

A case-control study was done to assess the influence of smoking on clinical, microbiological, and histopathological parameters. Methods. Two hundred dentate male patients (100 smokers and 100 nonsmokers) ranging between 25 and 50 years were enrolled in the study. Periodontal parameters were recorded. Plaque samples were collected for microbial analysis for BANA test. Gingival biopsies were obtained from selected site for assessing histopathological changes. Results. Both groups showed almost similar plaque levels (P=0.258), but smokers had reduced gingival (0.62 ± 0.31) and bleeding indices (28.53 ± 17.52) and an increased calculus index (1.62 ± 0.36). Smokers had an increased probing depth of 4-7 mm (P=0.009) and overall increased CAL. No difference in microbiota was found between the two groups. Histopathologically smokers showed a decreased blood vessel density (8.84 ± 0.96) and inflammatory cells (52.00 ± 9.79). Conclusions. It is quite possible that many of the pathogenic mechanisms involved in tissue degradation in periodontitis in smokers could be quite different from those in nonsmokers.

A role for non-antimicrobial actions of tetracyclines in combating oxidative stress in periodontal and metabolic diseases: a literature review

This review addresses the role of adjunctive tetracycline therapy in the management of periodontal diseases and its efficacy in reducing inflammatory burden, oxidative stress and its sequelae in patients with coexisting features of metabolic syndrome. Removal of the dimethylamine group at C4 of the tetracycline molecule reduces its antibiotic properties, enhancing its non-antimicrobial actions; this strategy has aided the development of several chemically modified tetracyclines such as minocycline and doxycycline, by altering different regions of the molecule for focused action on biological targets. Tetracyclines are effective in reducing inflammation by inhibiting matrix metalloproteinases, preventing excessive angiogenesis, inhibiting apoptosis and stimulating bone formation. There are important applications for tetracyclines in the management of diabetic, dyslipidaemic periodontal patients who smoke. The diverse mechanisms of action of tetracyclines in overcoming oxidative stress and enhancing matrix synthesis are discussed in this review.

The relationship of medical and dental factors to perceived general and dental health

OBJECTIVE

To determine the relative importance of dental and medical features in relation to perceived oral and general health in a sample of 31-year-old individuals.

SUBJECTS AND METHODS

The present study used information collected from the longitudinal Cardiff Survey, which commenced in 1981. The initial sample consisted of 1018 11-year-old Caucasian schoolchildren. Three hundred and thirty-seven individuals attended the latest examination in 2001 (aged 31 years). For every individual who attended in 2001, the following information was collected: perceived general and oral health recorded on a five-point Likert scale; self-reported medical history; SF-36v(2) questionnaire; assessment of dental features; and the Index of Complexity, Outcome and Need (ICON).

RESULTS

Ninety-four and 82% of individuals reported good-excellent general and oral health, respectively. Females reported a higher level of physical health than males as measured using the SF-36v( 2). Four medical conditions were associated with perceived poor general health: mental [odds ratios (OR); 95% confidence limits (95% CI): 4.5; 1.1-18.4], gastrointestinal (OR 3.4; 95% CI 1.2-9.5) and genitourinary disorders (OR 7; 95% CI 1.6-30.2), and conditions that did not readily fit into a defined category or system (OR 12.8; 95% CI 3.9-42.3). The highest prevalence of dental factors was gingivitis followed by gingival recession and plaque. Photographically assessed dental factors associated with self-reported poor/fair oral health were fillings (OR 0.45; 95% CI 0.2-0.9), root caries/abrasion (OR 0.37; 95% CI 0.1-0.9) and gingivitis (OR 0.31; 95% CI 0.1-0.9). There was a statistically significant association between oral and general health. Of those individuals reporting fair-poor oral health (18%), the proportion also reporting fair-poor general health was 63.6%. Unexpectedly, per-unit increase in ICON score was also significantly associated with fair-poor general health (OR 0.97) with clinically relevant increases of 7 ICON units producing an OR of 0.82.

CONCLUSION

The relative importance of the various dental and medical conditions has been identified. Further studies are required to explore the importance of ICON in perceived medical health and importance of the various conditions on oral and general health over different age groups.

Severity of periodontal disease and number of remaining teeth are related to the prevalence of myocardial infarction and hypertension in a study based on 4,254 subjects

BACKGROUND

During the past 15 years, mounting evidence for the association between periodontal and cardiovascular disease has been presented in epidemiological studies. The aim of this study was to investigate how the severity of periodontal disease and number of remaining teeth relates to myocardial infarction (MI) and hypertension (HT).

METHODS

Self-reported history of HT and MI was collected in 3,352 patients referred to the Department of Periodontology, Gävle County Hospital, and in 902 subjects randomly selected from the general population. Severity of periodontitis was estimated by a combination of the amount of bone loss around each tooth investigated from a full-mouth x-ray, the presence or absence of bleeding on probing (BOP), and involvement of furcations.

RESULTS

The severity of periodontitis was significantly associated with HT (prevalence 16%; P<0.0005), even after adjustment for age, gender, number of teeth, and smoking in the total sample, and with MI (prevalence 1.7%, P<0.03) after above-mentioned adjustments, but in middle-aged (40 to 60 years) subjects only. The number of diseased periodontal pockets was related to HT only (P<0.0001), and this relationship remained after the above-mentioned adjustments. The number of teeth was associated with MI (P<0.03) even after correction for age, gender, and smoking but was not related to hypertension.

CONCLUSIONS

The severity of periodontal disease was related to HT independent of age but to the prevalence of MI in middle-aged subjects only. The number of diseased pockets was significantly related to HT only. On the other hand, the number of teeth was associated with the prevalence of MI independent of age but not to HT. These data support the view that oral health is related to cardiovascular disease in a dose-dependent manner.

Gingivitis, dental caries and tooth loss: risk factors for cardiovascular diseases or indicators of elevated health risks

OBJECTIVES

The results of earlier studies connecting dental diseases to cardiovascular diseases are inconsistent. Our aim in this cross-sectional study was to investigate whether there are associations of dental diseases and diagnosed angina pectoris among the 1966 Northern Finland Birth Cohort.

MATERIALS AND METHODS

A postal questionnaire was sent to all cohort members in 1997-1998. The number of replies totalled 8690. Angina pectoris was determined by asking whether the respondent had been diagnosed with angina pectoris. Gingivitis, dental caries and tooth loss were determined on the basis of self-reported gingival bleeding, presence of dental caries and six or more missing teeth.

RESULTS

We found overall associations of gingivitis (odds ratio (OR) 1.52, confidence interval (CI) 1.04-2.22), dental caries (OR 1.50, CI 1.04-2.18) and tooth loss (OR 1.53, CI 0.69-3.42) with the presence of angina pectoris. The associations were modified by gender and socioeconomic status. In addition, gingivitis, dental caries and tooth loss were also associated with several cardiovascular risk factors.

CONCLUSION

There were associations of self-reported gingivitis, dental caries and tooth loss with angina pectoris. However, the associations between dental diseases and cardiovascular risk factors suggest that the associations may be because of confounding.

The effect of smoking on periodontal treatment response: a review of clinical evidence

BACKGROUND

Smoking has been identified as a significant risk factor for periodontal diseases and is regarded as being responsible for incomplete or delayed healing in patients following treatment.

AIM AND METHOD

The aim of this conventional review was to review, collate and tabulate the relative effectiveness of treatments of chronic periodontitis in smokers, non-smokers and ex-smokers.

OBSERVATIONS

The majority of clinical trials show significantly greater reductions in probing depths and bleeding on probing, and significantly greater gain of clinical attachment following non-surgical and surgical treatments in non-smokers compared with smokers. This benefit is also seen at class I and II furcation sites and in patients prescribed systemic or local antimicrobial treatments.

CONCLUSIONS

Data from epidemiological, cross-sectional and case-control studies strongly suggest that quitting smoking is beneficial to patients following periodontal treatments. The periodontal status of ex-smokers following treatment suggests that quitting the habit is beneficial although there are only limited data from long-term longitudinal clinical trials to demonstrate unequivocally the periodontal benefit of quitting smoking.

Tooth loss in treated periodontitis patients responsible for their supportive care arrangements

AIM

To identify risk indicators associated with tooth loss and periodontitis in treated patients responsible for arranging supportive periodontal care (SPC).

MATERIALS AND METHODS

Ninety-seven Chinese subjects (34-77 years) who showed favourable responses to periodontal therapy provided in a teaching hospital 5-12 years previously were recalled. They were advised to seek regular SPC on discharge. Background information, general health status, smoking, oral hygiene habits, follow-up dental care, tooth loss, and periodontal parameters were investigated. Multiple regression analysis was performed.

RESULTS

Two hundred and fifty-six teeth had been lost, 195 because of self-reported periodontal reasons. Up to 26.8% sites were with pockets > or =6 mm. Positive correlations were found between total/periodontal tooth loss and (i) smoking pack-years, (ii) time spent on oral hygiene, (iii) years since therapy's conclusion, (iv) age, and negative correlations with (v) inter-dental brush use, and (vi) education levels. Tooth loss by arch was correlated with wearing of removable partial denture in that arch. Percentage sites with pockets > or =6 mm were significantly negatively correlated with percentage sites without bleeding on probing.

CONCLUSIONS

Smokers, more elderly patients, removable partial denture wearers, and patients with lower education levels or not using inter-dental brushes ought to be targeted for clinic-based SPC.

Risk Indicators for Tooth Loss Due to Periodontal Disease

BACKGROUND

Several risk indicators for periodontal disease severity have been identified. The association of these factors with tooth loss for periodontal reasons was investigated in this cross-sectional comparative study.

METHODS

All extractions performed in 21 general dental practice clinics (25% of such clinics in Kuwait) over a 30-day period were recorded. Documented information included patient age and gender, medical history findings, dental maintenance history, toothbrushing frequency, types and numbers of extracted teeth, and the reason for the extraction. Reasons were divided into periodontal disease versus other reasons in univariate and binary logistic regression analyses.

RESULTS

A total of 1,775 patients had 3,694 teeth extracted. More teeth per patient were lost due to periodontal disease than for other reasons (2.8 +/- 0.2 versus 1.8 +/- 0.1; P <0.001). Factors significantly associated with tooth loss due to periodontal reasons in logistic regression analysis were age >35 years (odds ratio [OR] 3.45; 95% confidence interval [CI] 2.79 to 4.26), male gender (OR 1.42; 95% CI 1.17 to 1.73), never having periodontal maintenance (OR 1.48; 95% CI 1.23 to 1.78), never using a toothbrush (OR 1.81; 95% CI 1.49 to 2.20), current or past smoking (OR 1.56; 95% CI 1.28 to 1.91), anterior tooth type (OR 3.23; 95% CI 2.57 to 4.05), and the presence of either of the following medical conditions: diabetes mellitus (OR 2.64; 95% CI 2.19 to 3.18), hypertension (OR 1.73; 95% CI 1.41 to 2.13), or rheumatoid arthritis (OR 4.19; 95% CI 2.17 to 8.11).

CONCLUSION

Tooth loss due to periodontal disease is associated with the risk indicators of age, male gender, smoking, lack of professional maintenance, inadequate oral hygiene, diabetes mellitus, hypertension, rheumatoid arthritis, and anterior tooth type.

Tobacco attitudes, practices, and behaviors: A survey of dentists participating in managed care

Tobacco cessation knowledge, attitudes, and behaviors of dentists participating in a large national managed care dental plan were assessed using a mailed survey. The survey was administered to dentists recruited to participate in an evaluation of a CD-ROM and supportive electronic detailing to promote increased tobacco cessation activities. General dentists who met specific technological criteria, had an active E-mail account, and at least 200 adult patients were eligible to participate in this study. A total of 184 dentists, located in 29 states, agreed to participate. The survey instrument included questions that addressed (a) Ask, Advise, Assess, Assist, and Arrange behaviors, (b) self-efficacy including knowledge, confidence, and success regarding tobacco cessation, (c) success of various tobacco cessation strategies, (d) barriers to tobacco cessation, and (e) demographics including year of graduation, gender, and race/ethnicity. Self-reported baseline tobacco intervention-related behaviors were low, with 28% of dentists reporting that they asked their patients about tobacco or recorded tobacco use in their patients' charts at least 41% of the time. For Advise behavior, approximately half of the dentists advised tobacco-using patients to quit at least 41% of the time. Although self-reported lack of knowledge was high, 71% of respondents indicated that their lack of knowledge was either not a barrier or a slight barrier to incorporating tobacco cessation into their practices. The survey revealed that dentists do not routinely incorporate tobacco cessation into their practices. Newer information-transfer technologies may serve as vehicles for increased smoking cessation activities by dentists.