Association between asthma and periodontitis in the US adult population: A population-based observational epidemiological study

Association between asthma and periodontitis: A case-control analysis of risk factors, related medications, and allergic responses

AIMS

This study aimed to investigate the association between asthma, related allergies and medication use, and the presence and severity of periodontitis among individuals at the University of Michigan School of Dentistry.

METHODS

Employing a case-control design, the study analyzed data from 892 patients, half with asthma and half without asthma. Data collection included demographics, asthma history, medication use, allergies, and periodontal examination outcomes, including probing pocket depth (PPD), mobility, furcation involvement, and radiographic bone loss (RBL). Logistic regression models assessed the relationship between asthma and periodontitis, adjusting for confounders.

RESULTS

Asthmatic patients exhibited significantly lower odds of periodontitis (OR = 0.10, p < .001) and were less likely to present with advanced stages (OR = 0.23, p < .001) and grades of the disease (OR = 0.31, p < .001) compared to non-asthmatic patients. The study also found a higher proportion of females in the asthmatic group (67% vs. 51.8%, p < .001). Smoking was identified as a significant factor associated with periodontitis in patients with asthma, with former smokers at more than double the odds (OR = 2.28, p = .035) and current smokers at a slightly lower yet significant odds (OR = 1.87, p = .050). Additionally, asthmatic patients on adrenergic inhalers had an increased likelihood of developing periodontitis (OR = 1.76, p = .045). Allergies to codeine and latex were associated with higher odds of periodontitis, with ORs of 3.41 and 6.09, respectively.

CONCLUSIONS

Asthma was found to be associated with lower odds of periodontitis. However, this association appears to be modified by smoking habits and the use of certain asthma medications, which are related to an increased likelihood of periodontitis among asthmatic patients.

Associations of dietary antioxidant intake with periodontal health among US adults: An exploratory mediation analysis via mitochondrial function

AIM

To assess the relationship between dietary antioxidant intake and periodontal health in US adults and the potential role of mitochondrial function.

MATERIALS AND METHODS

We performed a cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES) 2011-2014. Dietary antioxidant intake was evaluated using three diet-related indices: dietary oxidative balance score (DOBS), dietary total antioxidant capacity (DTAC) of antioxidant vitamins and composite dietary antioxidant index (CDAI). Periodontal parameters included attachment loss (AL) and probing pocket depth (PPD). Mitochondrial dysfunction was assessed using the methylmalonic acid (MMA) level. Weighted multivariable linear regression analyses were employed to investigate the association between dietary antioxidant intake and periodontal status. Additionally, exploratory mediation analyses were conducted to determine the mediating effect of MMA on the association.

RESULTS

Totally, 5520 participants were included in our study. Participants with higher DOBS and DTAC scores had lower mean AL/PPD and MMA values. CDAI was negatively associated with mean AL and PPD. Furthermore, MMA mediated 9.4% and 4.9% of the associations between DOBS and mean AL and mean PPD, respectively. MMA also accounted for 7.2% and 3.3% of the association between DTAC and mean AL and PPD, respectively.

CONCLUSIONS

The findings support that dietary antioxidant intake helps in improving periodontal health, possibly and partially by enhancing mitochondrial function.

Causal association between asthma and periodontitis: A two-sample Mendelian randomization analysis

BACKGROUND

A unified view of whether asthma and periodontitis interact and the direction of action is not found in previous studies. Therefore, in this article, we will elucidate bidirectional causality by two-sample Mendelian randomization (MR).

METHODS

We obtained summary-level data for asthma and periodontitis from the massive GWAS databases of several publicly available. Meanwhile, it will ensure no confounders like smoking using the Phenoscanner website to have a search over each SNP. The F statistic value of each SNP is calculated as more significant than 10. This MR analysis mainly used five MR methods: MR-Egger, weighted median, inverse variance weighted (IVW), simple mode, and weighted mode. As a result, we performed heterogeneity and horizontal pleiotropy tests.

RESULTS

We have found supporting evidence to verify the hypothesis that asthma may be a protective factor for periodontitis (IVW OR = 0.34; 95% CI = [0.132,0.87]; p = 0.025). The consistent impact direction is shown when additional asthma GWAS dataset are used (MR-Egger OR = 0.118; 95%CI = [0.016,0.883]; p = 0.04). There is no evidence of a causal effect of periodontitis at the risk of asthma in the reverse analysis (p > 0.05).

CONCLUSIONS

Our analysis found that people with asthma may have a lower risk of periodontitis than those without. This MR analysis could have significant implications for the clinical process and future research.

Association between Asthma and Periodontitis

The current study aimed to investigate the association between asthma and periodontitis in the Korean adult population. Data from the Korean Genome and Epidemiology Study Health Examinees between 2004 and 2016 were considered. Of the 173,209 participants, 2521 asthmatic and 132,806 control participants were selected. The participants were categorized according to their current status of asthma, as 'well-controlled', 'being treated', and 'not being treated'. The prevalence of periodontitis was found to be significantly higher in the participants with asthma (13.1%) than in the controls (7.3%). In the fully adjusted model, the patients with asthma had a higher odds ratio (OR = 1.79, 95% confidence interval [CI] = 1.59-2.02, p < 0.001) for periodontitis than those without asthma. The results were consistent across all the age and sex subgroups. The adjusted ORs for periodontitis were 2.15 (95% CI = 1.68-2.76, p < 0.001) in the 'well-controlled' asthma group, 1.44 (95% CI = 1.16-1.78, p < 0.001) in the 'being treated' asthma group, and 1.86 (95% CI = 1.55-2.22, p < 0.001) in the 'not being treated' asthma group compared to the control group. Overall, we found asthma to be associated with periodontitis in Korean adults, and the participants with well-controlled asthma had the highest ORs for periodontitis.

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 chronic kidney disease by functional atherosclerosis status among older Japanese individuals: A cross-sectional study

AIM

This study aimed to clarify the influence of functional atherosclerosis on the association between periodontitis and chronic kidney disease (CKD).

MATERIALS AND METHODS

A cross-sectional study of 998 older Japanese individuals aged 60-99 years who participated in an oral health check-up was conducted. Early and advanced periodontitis were defined as periodontal pocket depth of 4.0-5.9 mm and ≥6.0 mm, respectively. Functional atherosclerosis was defined as cardio-ankle vascular index ≥9.0.

RESULTS

Of the 998 study participants, 238 (23.8%) had CKD. No significant associations between periodontitis and CKD were observed in participants without functional atherosclerosis. After adjusting for known cardiovascular risk factors, the odds ratio (OR) (95% confidence interval [CI]) was 1.31 (0.81-2.11) for early periodontitis and 0.74 (0.41-1.34) for advanced periodontitis. Significant positive associations were observed for participants with functional atherosclerosis; the adjusted ORs (95% CIs) were 1.76 (1.04-3.01) for early periodontitis and 1.95 (1.05-3.63) for advanced periodontitis.

CONCLUSIONS

A significant positive association between periodontitis and CKD was established for older participants with functional atherosclerosis. No significant associations were observed for those without functional atherosclerosis. These results can help clarify the influence of periodontitis on systemic circulation.

Prevalence of Asthma, Allergic Rhinitis, and Atopic Dermatitis and Their Association With Oral Health in Saudi Arabia

Background  The word "atopy" is frequently used to describe immunoglobulin E (IgE)-mediated diseases. The prevalence of atopic dermatitis, allergic rhinitis, and asthma is increasing and disconcerting in Saudi Arabia. This study aims to investigate the association between allergic rhinitis, atopic dermatitis, asthma, and oral health among adults in the Makkah region of Saudi Arabia. Methods A cross-sectional study of 726 adults using an electronic questionnaire was adopted. The study was carried out from January to December 2022. The questionnaire included demographic data, patients' diseases in response to inclusion and exclusion criteria, oral health status and symptoms, and dental health-related behaviors. Results Most participants were aged from 18 to <40 years (79.1%). More than half of the participants were females (53.6%); 39.7% of participants had poor oral health. Poor health was significantly higher among obese subjects as well as those with lower levels of physical activity, higher perceived levels of stress, those who received a sealant, and those who brushed their teeth for ≤ one time per day. The results showed that the individual symptoms of oral health did not associate significantly with being diagnosed with allergic rhinitis or asthma in the past 12 months. However, atopic dermatitis was independently associated with a chipped or broken tooth (OR = 1.52) and pain in the tongue or inside the cheeks (OR = 3.57). Conclusion Poor oral health was significantly associated with atopic dermatitis in Saudi adults. Some systemic diseases are considered chronic diseases, and they are multifactorial; thus, we cannot claim that periodontal pathogens are the definite cause of systemic infections. More studies are necessary to find a definitive association.

Unravelling the link between periodontitis and abdominal aortic calcification in the US adult population: a cross-sectional study based on the NHANES 2013-2014

OBJECTIVE

We aimed to explore the association between periodontitis and abdominal aortic calcification (AAC) among a nationally representative sample of US adults.

DESIGN

Cross- sectional study.

SETTING

The National Health and Nutrition Examination Survey (2013-2014).

PARTICIPANTS

A total of 2149 participants aged 40 years or older who have complete information for periodontitis and AAC assessment test were included in this study.

PRIMARY AND SECONDARY OUTCOME MEASURES

AAC scores can be accurately identified on lateral spine images obtained by dual-energy X-ray absorptiometry, and both the AAC-24 and AAC-8 semiquantitative scoring tools were used for AAC evaluation. Linear regression analysis was used to investigate the relationship between periodontitis and the AAC-8 and AAC-24 scores. Multivariate logistic regression models and reported ORs were used to examine the relationship between periodontitis and AAC.

RESULTS

The prevalence of severe periodontitis combined with severe AAC was 8.49%-8.54%. According to the AAC-8 and AAC-24 score classifications, patients with severe periodontitis had higher odds of severe AAC (AAC-8 score ≥3: (OR: 2.53; 95% CI 1.04 to 6.17) and AAC-24 score >6: (OR: 3.60; 95% CI 1.48 to 8.78)). A positive association between mild-moderate periodontitis and severe AAC was found only when the AAC-24 score was applied (OR: 2.25; 95% CI 1.24 to 4.06). In the subgroup analyses, the likelihood ratio test showed no multiplicative interaction (all p value for interaction >0.05).

CONCLUSIONS

The findings showed that periodontitis is associated with an increased risk of severe AAC in the US population aged 40 years and older; this requires further large-scale prospective studies for confirmation.

Serum antibodies to periodontal pathogens are related to allergic symptoms

BACKGROUND

The association between periodontitis and allergic symptoms has been investigated. However, the difference in immune signatures between them remains poorly understood. This cross-sectional study assessed the relationship between serum immunoglobulin G (IgG) antibodies to periodontal pathogens and allergic symptoms in a nationwide population cohort.

METHODS

Two phases of the Third National Health and Nutrition Examination Survey (NHANES III) were used as discovery dataset (n = 3700) and validation dataset (n = 4453), respectively. Based on the antibodies against 19 periodontal pathogens, we performed an unsupervised hierarchical clustering to categorize the population into three clusters. In the discovery dataset, cluster 1 (n = 2847) had the highest level of IgG antibodies, followed by clusters 2 (n = 588) and 3 (n = 265). Data on allergic symptoms (asthma, hay fever, and wheezing) were obtained using a self-reported questionnaire. Survey-weighted multivariable logistic regression evaluated the association between these clusters and allergic symptoms.

RESULTS

In the discovery dataset, the participants with lower levels of antibodies to periodontal pathogens exhibited a higher risk of asthma (odds ratio [OR]_{cluster 3 vs. cluster 1} = 1.820, 95% confidence interval [CI]: 1.153-2.873) and wheezing (OR_{cluster 3 vs. cluster 1} = 1.550, 95% CI: 1.095-2.194) compared to those with higher periodontal antibodies, but the non-significant association with hay fever. Consistent results were found in the validation dataset.

CONCLUSIONS

Serum IgG titers to periodontal pathogens were inversely associated with the risk of asthma and wheezing, suggesting the potentially protective role against allergic conditions.

The association of healthy eating index with periodontitis in National Health and Nutrition Examination Study 2011–2012

Aim

Periodontitis is a chronic inflammatory disorder caused by periodontopathic bacteria that causes inflammation of the supporting tissues around teeth. Previous studies have found that daily dietary nutritional intake can influence the development of periodontal disease. However, research on the Healthy Eating Index’s involvement in periodontitis is limited. The purpose of this study was to look at the link between the Healthy Eating Index and periodontitis.

Methods and design

We examined data from the National Health and Nutrition Examination Study (NHANES), a nationally representative survey that was performed in 2-year cycles from 2011 to 2012. As part of our investigation, we used multivariate logistic regression models to investigate the independent relationship between the Healthy Eating Index and periodontitis. We used odds ratios (OR) with 95% confidence intervals to assess the significance of the connection (95% CI).

Results

Individuals with a lower total healthy eating index were more likely to have periodontitis. A higher healthy diet index was associated with a lower prevalence of periodontitis (OR = 0.69; 95%CI: 0.49–0.97), according to adjusted multivariate regression models. The restricted cubic spline (RCS) analysis revealed that the non-linear relationship between HEI-2015 and periodontitis was statistically significant and that high HEI-2015 reduced periodontitis prevalence.

Conclusion

The study’s findings revealed that dietary structure was linked to the prevalence of periodontitis. Patients with a higher Healthy Eating Index were less likely to have periodontitis. There is a need for future prospective longitudinal studies to confirm causality.