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Berg RL, Glurich I, Panny A, Scannapieco FA, Miecznikowski J, VanWormer J, Acharya A. Modeling longitudinal oral health status and pneumonia risk: secondary data analyses of an integrated dental-medical cohort. BMC Oral Health 2023; 23:950. [PMID: 38041050 PMCID: PMC10690969 DOI: 10.1186/s12903-023-03629-0] [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: 05/24/2023] [Accepted: 11/06/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Mounting evidence indicates potential associations between poor oral health status (OHS) and increased pneumonia risk. Relative pneumonia risk was assessed in the context of longitudinally documented OHS. METHODS Electronic medical/dental patient data captured from 2007 through 2019 were retrieved from the integrated health records of Marshfield Clinic Health Systems. Participant eligibility initiated with an assessment of OHS, stratified into the best, moderate, or worst OHS groups, with the additional criterion of 'no pneumonia diagnosis in the past 90 days'. Pneumonia incidence was longitudinally monitored for up to 1 year from each qualifying dental visit. Models were assessed, with and without adjustment for prior pneumonia incidence, adjusted for smoking and subjected to confounding mitigation attributable to known pneumonia risk factors by applying propensity score analysis. Time-to-event analysis and proportional hazard modeling were applied to investigate relative pneumonia risk over time among the OHS groups. RESULTS Modeling identified associations between any incident pneumonia subtype and 'number of missing teeth' (p < 0.001) and 'clinically assessed periodontal status' (p < 0.01), which remained significant following adjustment for prior pneumonia incidence and smoking. The hazard ratio (HR) for 'any incident pneumonia' in the best OHS group for 'number of missing teeth' was 0.65, 95% confidence interval (CI) [0.54 - 0.79] (unadjusted) and 0.744, 95% CI [0.61 - 0.91] (adjusted). The HR for 'any incident pneumonia' in the best 'clinically assessed periodontal status' group was 0.72, 95% CI [0.58 - 0.90] (unadjusted) and 0.78, 95% CI [0.62 - 0.97] (adjusted). CONCLUSION/CLINICAL RELEVANCE Poor OHS increased pneumonia risk. Proactive attention of medical providers to patient OHS and health literacy surrounding oral-systemic disease association is vital, especially in high-risk populations.
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Affiliation(s)
- Richard L Berg
- Office of Research Computing and Analytics, Marshfield Clinic Research Institute, Marshfield, WI, USA
| | - Ingrid Glurich
- Cancer Care and Research Center, Marshfield Clinic Research Institute, Marshfield, WI, USA.
| | - Aloksagar Panny
- Clinical Informatics, Methodist Health System, Dallas, TX, USA
| | - Frank A Scannapieco
- Department of Oral Biology, School of Dental Medicine, University at Buffalo, Foster Hall, Buffalo, NY, USA
| | - Jeffrey Miecznikowski
- Department of Biostatistics School of Public Health and Health Professions, University at Buffalo, Kimball Tower, Buffalo, NY, USA
| | - Jeffrey VanWormer
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, Marshfield, WI, USA
| | - Amit Acharya
- Advocate Aurora Health, 3075 Highland Parkway, Suite 600, Downers Grove, IL, 60515, USA.
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Sen S, Curtis J, Hicklin D, Nichols C, Glover S, Merchant AT, Hardin JW, Logue M, Meyer J, Mason E, Huang DY, Susin C, Moss K, Beck J. Periodontal Disease Treatment After Stroke or Transient Ischemic Attack: The PREMIERS Study, a Randomized Clinical Trial. Stroke 2023; 54:2214-2222. [PMID: 37548008 PMCID: PMC10668075 DOI: 10.1161/strokeaha.122.042047] [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: 11/18/2022] [Accepted: 06/22/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Patients with stroke/transient ischemic attack and periodontal disease (PD) are at increased risk for cardiovascular events. PD treatments that can improve stroke risk factors were tested if they might assist patients with cerebrovascular disease. METHODS In this multicenter phase II trial, patients with stroke/transient ischemic attack and moderately severe PD were randomly assigned to intensive or standard PD treatment arms. The primary outcome measure was a composite of death, myocardial infarction, and recurrent stroke, as well as adverse events. Secondary outcome included changes in stroke risk factors. RESULTS A total of 1209 patients with stroke/transient ischemic attack were screened, of whom 481 met the PD eligibility criteria; 280 patients were randomized to intensive arm (n=140) and standard arm (n=140). In 12-month period, primary outcome occurred in 11 (8%) in the intensive arm and 17 (12%) in the standard arm. The intensive arm was nonsuperior to the standard arm (hazard ratio, 0.65 [95% CI, 0.30-1.38]) with similar rates of adverse events (sepsis 2.1% versus 0.7%; dental bleeding 1.4% versus 0%; and infective endocarditis 0.7% versus 0%). Secondary-outcome improvements were noted in both arms with diastolic blood pressure and high-density lipoprotein cholesterol (P<0.05). CONCLUSIONS In patients with recent stroke/transient ischemic attack and PD, intensive PD treatment was not superior to standard PD treatment in prevention of stroke/myocardial infarction/death. Fewer events were noted in the intensive arm and the 2 arms were comparable in the safety outcomes. Secondary-outcome measures showed a trend toward improvement, with significant changes noted in diastolic blood pressure and high-density lipoprotein in both the treatment arms.
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Affiliation(s)
- Souvik Sen
- Department of Neurology, Prisma Health and University of South Carolina, School of Medicine, Columbia, SC
| | - James Curtis
- Department of Dentistry, Prisma Health Medical Group, Columbia, SC
| | - David Hicklin
- Department of Dentistry, Prisma Health Medical Group, Columbia, SC
| | - Cynthia Nichols
- Department of Dentistry, Prisma Health Medical Group, Columbia, SC
| | - Saundra Glover
- Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Anwar T. Merchant
- Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - James W. Hardin
- Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Makenzie Logue
- Department of Dentistry, Prisma Health Medical Group, Columbia, SC
| | - Jaclyn Meyer
- Department of Neurology, Prisma Health and University of South Carolina, School of Medicine, Columbia, SC
| | - Emma Mason
- Department of Neurology, Prisma Health and University of South Carolina, School of Medicine, Columbia, SC
| | - David Y. Huang
- Department of Neurology, University of North Carolina, Chapel Hill, NC
| | - Cristiano Susin
- Division of Comprehensive Oral Health/Periodontology, University of North Carolina, Chapel Hill, NC
| | - Kevin Moss
- Division of Comprehensive Oral Health/Periodontology, University of North Carolina, Chapel Hill, NC
| | - James Beck
- Division of Comprehensive Oral Health/Periodontology, University of North Carolina, Chapel Hill, NC
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Geisinger ML, Geurs NC, Novy B, Otomo-Corgel J, Cobb CM, Jacobsen PL, Takesh T, Wilder-Smith P. A randomized double-blind clinical trial evaluating comparative plaque and gingival health associated with commercially available stannous fluoride-containing dentifrices as compared to a sodium fluoride control dentifrice. J Periodontol 2023; 94:1112-1121. [PMID: 37016272 PMCID: PMC10524004 DOI: 10.1002/jper.22-0675] [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: 11/18/2022] [Revised: 03/15/2023] [Accepted: 03/18/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND Gingivitis is a non-specific inflammatory lesion in response to the accumulation of oral biofilm and is a necessary precursor to periodontitis. Enhanced oral hygiene practices, including utilization of a dentifrice that could significantly improve plaque accumulation and gingival inflammation, is desirable to prevent and treat gingivitis and potentially prevent progression to periodontitis. This clinical study aimed to investigate the effect of a new stannous fluoride-containing dentifrice with 2.6% ethylenediamine tetra acetic acid (EDTA) as an anti-tartar agent to reduce plaque index and gingival index over a 3-month study period compared to other commercially-available fluoride-containing dentifrices. METHODS This double-blind, randomized controlled clinical study evaluated plaque, gingival inflammation, and sulcular bleeding in patients using one of five commercially available fluoride-containing dentifrices The dentifrices tested contained: 0.454% stannous fluoride and 2.6% EDTA (D1), 0.24% sodium fluoride (C), and 0.454% stannous fluoride (D2-D4). One hundred fifty subjects participated over a 3-month period. Co-primary endpoints were improvements in plaque index (PI) and modified gingival index (mGI) from baseline values. No professional cleaning was performed during the study period. RESULTS All subjects in the study demonstrated statistically significant improvements in all measures of oral hygiene over the 3-month study period. Subjects using dentifrice 1 (D1) showed statistically significantly greater reductions in PI, mGI, and modified sulcular bleeding index (mSBI) compared with all other commercially-available dentifrices tested (p < 0.00001). CONCLUSIONS A new dentifrice with 0.454% stannous fluoride and 2.6% EDTA demonstrated significant improvements in clinical parameters associated with gingivitis compared to other sodium and stannous fluoride containing dentifrices.
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Affiliation(s)
- Maria L. Geisinger
- University of Alabama at Birmingham School of Dentistry, Department of Periodontology
| | - Nicolaas C. Geurs
- University of Alabama at Birmingham School of Dentistry, Department of Periodontology
| | - Brian Novy
- Harvard University, School of Dental Medicine
| | - Joan Otomo-Corgel
- University of California at Los Angeles, School of Dentistry, Department of Periodontology
| | - Charles M. Cobb
- University of Missouri-Kansas City, Department of Periodontology
| | | | - Thair Takesh
- University of California at Irvine, Beckman Laser Institute and Medical Center, Department of Dentistry
| | - Petra Wilder-Smith
- Department of Ecology and Evolutionary Biology, University of California Irvine, Irvine, California, USA
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Sen S, Meyer J, Mascari R, Trivedi T, Suri F, Wasserman B, Rosamond W, Moss K, Beck J, Gottesman RF. Association of Dental Infections with Intracranial Atherosclerotic Stenosis. Cerebrovasc Dis 2023; 53:28-37. [PMID: 37121226 DOI: 10.1159/000530829] [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: 11/27/2022] [Accepted: 04/24/2023] [Indexed: 05/02/2023] Open
Abstract
INTRODUCTION Periodontal disease (PD) and dental caries are oral infections leading to tooth loss that are associated with atherosclerosis and cerebrovascular disease. We assessed the hypothesis that PD and caries are associated with asymptomatic intracranial atherosclerosis (ICAS) in the Atherosclerosis Risk in Communities (ARIC) study. METHODS Full-mouth clinical periodontal measurements (7 indices) collected at 6 sites per tooth from 6,155 subjects from the Dental Atherosclerosis Risk in Communities Study (DARIC) without prior stroke were used to differentiate seven PD stages (Periodontal Profile Class [PPC]-I to -VII) and dental caries on coronal dental surface (DS) and dental root surface (DRS). A stratified subset underwent 3D time-of-flight MR angiogram and 3D high isotropic-resolution black blood MRI. ICAS was graded according to the criteria established by the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial. We evaluated the relationship between PD stage and dental caries with asymptomatic ICAS, graded as no ICAS, <50% ICAS, and ≥50% ICAS. RESULTS Among dentate subjects who underwent vascular imaging, 801 (70%) had no ICAS, 232 (20%) had <50% ICAS, and 112 (10%) had ≥50% ICAS. Compared to participants without gum disease (PPC-I), participants with mild-moderate tooth loss (PPC-VI), severe tooth loss (PPC-VII), and severe PD (PPC-IV) had higher odds of having <50% ICAS. Participants with extensive gingivitis (PPC-V) had significantly higher odds of having ≥50% ICAS. This association remained significant after adjusting for confounding variables: age, gender, race, hypertension, diabetes, dyslipidemia, 3-level education, and smoking status. There was no association between dental caries (DS and DRS) and ICAS <50% and ≥50%. CONCLUSION We report significant associations between mild-moderate tooth loss, severe tooth loss, and severe PD with <50% ICAS as well as an association between extensive gingivitis and ≥50% ICAS. We did not find an association between dental caries and ICAS.
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Affiliation(s)
- Souvik Sen
- Department of Neurology, University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Jaclyn Meyer
- Department of Neurology, University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Rachel Mascari
- Department of Neurology, University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Tushar Trivedi
- Department of Neurology, University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Fareed Suri
- Department of Neurology, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Bruce Wasserman
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Wayne Rosamond
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kevin Moss
- Division of Oral and Craniofacial Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - James Beck
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Division of Comprehensive Oral Health/Periodontology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rebecca F Gottesman
- Stroke Branch, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Maryland, USA
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Zhou B, Lu J, Beck JD, Moss KL, Prizment AE, Demmer RT, Rodriguez KAP, Joshu CE, Michaud DS, Platz EA. Periodontal and Other Oral Bacteria and Risk of Lung Cancer in the Atherosclerosis Risk in Communities (ARIC) Study. Cancer Epidemiol Biomarkers Prev 2023; 32:505-515. [PMID: 35999656 PMCID: PMC9947191 DOI: 10.1158/1055-9965.epi-22-0601] [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: 05/23/2022] [Revised: 07/21/2022] [Accepted: 08/12/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Evidence suggests that periodontal disease is associated with increased lung cancer risk, but whether periodontal pathogens are explanatory is unknown. We prospectively studied associations of prediagnostic circulating antibodies with oral bacteria and of periodontal bacteria in subgingival plaque with lung cancer. METHODS We included 4,263 cancer-free participants in the Atherosclerosis Risk in Communities study with previously measured serum IgG antibodies to 18 oral bacteria. In 1,287 participants for whom subgingival plaque was collected, counts for 8 periodontal bacteria were previously measured. Incident lung cancers (N = 118) were ascertained through 2015 (median follow-up = 17.5 years). We used Cox regression to estimate multivariable-adjusted associations, including for sums of antibodies to orange (C. rectus, F. nucleatum, P. intermedia, P. micra, and P. nigrescens) and red (P. gingivalis, T. forsythensis, and T. denticola) complex bacteria. RESULTS Orange complex bacteria antibodies were positively associated with lung cancer [per IQR hazard ratios (HR) = 1.15; 95% confidence intervals (CI), 1.02-1.29], which was stronger in men (HR = 1.27, 95% CI 1.08-1.49), and explained by P. intermedia and P. nigrescens (HR = 1.15; 95% CI, 1.04-1.26). Suggestive positive associations with lung cancer (N = 40) were observed for F. nucleatum, A. actinomycetemcomitans, and P. gingivalis counts. Significant positive associations were found for the count to antibody ratio for P. intermedia and P. gingivalis. CONCLUSIONS We identified positive associations with lung cancer for oral bacteria, especially orange complex that are moderately pathogenic for periodontal disease. IMPACT This prospective study supports the need for more research on periodontal bacteria in lung cancer etiology. If associations are supported, this may inform novel lung cancer prevention strategies.
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Affiliation(s)
- Baijun Zhou
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jiayun Lu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - James D. Beck
- Division of Comprehensive Oral Health/ Periodontology, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC
| | - Kevin L. Moss
- Division of Comprehensive Oral Health/ Periodontology, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC
| | - Anna E. Prizment
- Division of Hematology, Oncology and Transplantation, University of Minnesota Medical School, and the University of Minnesota Masonic Cancer Center, Minneapolis, MN
| | - Ryan T. Demmer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Kori A. Porosnicu Rodriguez
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Corinne E. Joshu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Dominique S. Michaud
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA
| | - Elizabeth A. Platz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
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Corredor Z, Suarez-Molina A, Fong C, Cifuentes-C L, Guauque-Olarte S. Presence of periodontal pathogenic bacteria in blood of patients with coronary artery disease. Sci Rep 2022; 12:1241. [PMID: 35075206 PMCID: PMC8786953 DOI: 10.1038/s41598-022-05337-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/04/2022] [Indexed: 02/06/2023] Open
Abstract
It has been hypothesised that oral bacteria can migrate, through the blood, from the mouth to the arterial plaques, thus exacerbating atherosclerosis. This study compared bacteria present in the peripheral blood of individuals with and without coronary artery disease (CAD). RNA sequences obtained from blood were downloaded from GEO (GSE58150). Eight patients with coronary artery calcification (CAC) scoring > 500 and eight healthy individuals were analysed. After conducting quality control, the sequences were aligned to the hg38 reference genome using Hisat2. Bacterial taxa were analysed by inputting the unmapped sequences into Kraken. Ecological indices were calculated using Vegan. The package DESeq2 was used to compare the counts of bacteria per standard rank between groups. A total of 51 species were found only in patients with CAD and 41 were exclusively present in healthy individuals. The counts of one phylum, one class, three orders, two families and one genus were significantly different between the analysed groups (p < 0.00032, FDR < 10%), including the orders Cardiobacteriales, Corynebacteriales and Fusobacteriales. Twenty-three bacterial species belonging to the subgingival plaque bacterial complexes were also identified in the blood of individuals from both the groups; Fusobacterium nucleatum was significantly less frequent in patients with CAD (p = 0.0012, FDR = 4.8%). Furthermore, the frequency of another 11 bacteria differed significantly among patients with CAD than that among healthy individuals (p < 0.0030, FDR < 10%). These bacteria have not been previously reported in patients with atherosclerosis and periodontitis. The presence of members of the subgingival plaque bacterial complexes in the blood of patients with CAC supports the hypothesis that the periodontopathogens can be disseminated through the blood flow to other body parts where they may enhance inflammatory processes that can lead to the development or exacerbation of atherosclerosis.
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Affiliation(s)
- Zuray Corredor
- Faculty of Dentistry, Universidad Cooperativa de Colombia Campus Pasto, Pasto, Colombia
| | | | - Cristian Fong
- Faculty of Medicine, Universidad Cooperativa de Colombia Campus Santa Marta, Santa Marta, Colombia
| | - Laura Cifuentes-C
- Faculty of Dentistry, Universidad Cooperativa de Colombia Campus Pasto, Pasto, Colombia
| | - Sandra Guauque-Olarte
- GIOM Group, Faculty of Dentistry, Universidad Cooperativa de Colombia Campus Envigado, Cra. 47 No. 37 sur 18, Envigado, Antioquia, Colombia.
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Gómez PAM, Mendizábal MFR, Poma RDC, Cifuentes TVR, Quispe FMM, Torres DJM, Amaranto REB, Medina CAM, Contreras LAP. Antibacterial and Antiadhesion Effects of Psidium guajava Fractions on a Multispecies Biofilm Associated with Periodontitis. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2022. [DOI: 10.1590/pboci.2022.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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