Periodontitis and atherosclerotic vascular disease

Prevalence of Periodontitis and its Association with Reduced Pulmonary Function: Results from the Korean National Health and Nutrition Examination Survey

Background and Objectives: The current study was performed to evaluate the prevalence of periodontitis and to examine the association between reduced pulmonary function and periodontitis using Sixth Korea National Health and Nutrition Examination Survey (KNHANES) in 2014. Materials and Methods: A cross-sectional evaluation was conducted to estimate the prevalence of periodontitis and to examine the association between periodontitis and reduced pulmonary function while adjusting for sociodemographic characteristics and current smoking status in survey participants between 40 and 79 years old. The presence of periodontitis was evaluated by community periodontal index defined by the World Health Organization, and the assessments of reduced pulmonary function data were made as "normal," "restrictive impairment," or "obstructive impairment." Results: A total of 4004 survey participants representing 25.4 million Koreans were included in the study. Overall, 41.1% of the study population were determined to have periodontitis, and 22.1% had reduced pulmonary function; 7.9% and 14.2% had restrictive- and obstructive- pulmonary impairments, respectively. Age, male gender, and current smoking status were positive predictors for periodontitis. Insurance coverage by workplace and higher education were protective factors against periodontitis. The association between periodontitis and restrictive impairment (adjusted odds ratio (OR) = 1.059, 95% CI 0.729-1.540) or obstructive impairment (adjusted OR = 1.140, 95% CI 0.849-1.530) was not significant. Conclusions: For Koreans, 40-79 years old, age, smoking status, gender, education, and insurance coverage were significant predictors of periodontitis. The prevalence of periodontitis was not significantly associated with reduced pulmonary function. To better understand the relationship between periodontitis and reduced pulmonary function, well-designed and larger scale epidemiologic studies are needed.

Association Between Asthma and Periodontitis: Results From the Korean National Health and Nutrition Examination Survey

BACKGROUND

The aim of this study is to examine the association between asthma and periodontitis in a representative sample of Korean adults from the Sixth Korean National Health and Nutrition Examination Survey (KNHANES) in 2014.

METHODS

This study conducts a cross-sectional evaluation using 2014 KNHANES data to describe the association between current asthma condition and chronic periodontitis while adjusting for sociodemographic characteristics and lifestyle factors. Presence of periodontitis is evaluated by community periodontal index defined by the World Health Organization, and current asthma condition is defined as "currently suffering from asthma condition."

RESULTS

The study population comprises a total of 5,976 patients aged 19 years and older, representing 40.7 million Koreans. A multivariable logistic regression analysis with weighted observations reveals patients with current asthma condition are ≈5 times more likely to be associated with periodontitis (adjusted odds ratio [OR]: 5.36; 95% confidence interval [95% CI]: 1.27 to 22.68). In addition, 83% of patients who regularly receive scheduled antiasthmatic medications are less likely to have a diagnosis of periodontitis than individuals who do not receive medication regularly (adjusted OR: 0.17; 95% CI: 0.05 to 0.57). However, the association is not significant if treatment with antiasthmatic medication is delivered on an "as-needed" basis (adjusted OR:1.80; 95% CI: 0.87 to 3.74).

CONCLUSIONS

Findings from the current study show a positive association between periodontitis and current asthma condition. In addition, patients taking scheduled antiasthmatic medications are less likely to be diagnosed with periodontitis. Due to limitations of study design and available data from the national survey, well-designed follow-up studies are needed to confirm these findings.

Systemic effects of periodontitis: lessons learned from research on atherosclerotic vascular disease and adverse pregnancy outcomes

Studies conducted over the past 25 years have focussed on the role of periodontitis, an inflammatory condition of microbial aetiology that destroys the tooth-supporting tissues, as a systemic inflammatory stressor that can act as an independent risk factor of atherosclerotic vascular disease (AVSD) and adverse pregnancy outcomes (APOs). It has been suggested that periodontitis-associated bacteraemias and systemic dissemination of inflammatory mediators produced in the periodontal tissues may result in systemic inflammation and endothelial dysfunction, and that bacteria of oral origin may translocate into the feto-placental unit. Epidemiological studies largely support an association between periodontitis and ASVD/APOs, independently of known confounders; indeed, periodontitis has been shown to confer statistically significantly elevated risk for clinical events associated with ASVD and APOs in multivariable adjustments. On the other hand, intervention studies demonstrate that although periodontal therapy reduces systemic inflammation and improves endothelial function, it has no positive effect on the incidence of APOs. Studies of the effects of periodontal interventions on ASVD-related clinical events are lacking. This review summarises key findings from mechanistic, association and intervention studies and attempts to reconcile the seemingly contradictory evidence that originates from different lines of investigation.

The influence of prevalent cohort bias in the association between periodontal disease progression and incident coronary heart disease

PURPOSE

In longitudinal studies, the onset of the index condition (e.g. exposure) does not always coincide with the start of a study's observation period, leading to the possibility of bias in estimation that derives from studying prevalent exposure rather than new exposure. We investigate the possible role of this bias in the relationship between periodontitis progression and coronary heart disease (CHD) among a cohort of men participating in the Veterans Administration Dental Longitudinal Study.

METHODS

At baseline, there were 298 men with existing (i.e., prevalent) periodontitis. During follow-up, routine dental inspection identified 163 new (i.e., incident) cases of periodontitis. Change in mean alveolar bone loss score (MBLS) served as the measure of disease progression. Tabular analyses were performed to obtain crude, stratified, and adjusted measures of the association for periodontitis cases overall and separately for prevalent and incident cases. Potential bias was evaluated by comparing estimates across these subcohorts.

RESULTS

Among all periodontitis cases, increasing MBLS was associated with increasing risk of CHD event. Subdividing periodontal cases into new and prevalent cases revealed that the relationship was most pronounced among incident periodontitis cases (incident rate ratio for MBLS change >0.5 = 5.4), compared with prevalent cases (incident rate ratio for MBLS change >0.5 = 2.5).

CONCLUSIONS

Studying prevalent cases of periodontitis underestimates the association between incidence periodontitis and CHD.

Adverse oral health and cognitive decline: the health, aging and body composition study

OBJECTIVES

To investigate the relationship between periodontal disease and cognitive decline.

DESIGN

Analysis of a prospective cohort study.

SETTING

The Health, Aging and Body Composition (Health ABC) Study.

PARTICIPANTS

One thousand fifty-three participants who were administered the Modified Mini-Mental State Examination (3MS) at Year 1 (baseline) and Year 3 and had participated in a comprehensive periodontal examination at Year 2.

MEASUREMENTS

The prospective association between a range of oral health parameters and cognitive function was examined. Decline in 3MS score from Year 3 to 5 was investigated in 947 (89.9%) participants. Covariates included age, sex, education, race, cardiovascular disease and risk, and depressive symptoms.

RESULTS

Most indicators of adverse oral health at Year 2 were associated with cognitive impairment based on averaged 3MS scores less than 80 for Years 1 and 3, but education and race substantially confounded these associations. Higher gingival index, a measure of gingival inflammation, at Year 2 remained independently associated with this definition of cognitive impairment and, in fully adjusted analyses, was also an independent predictor of a more-than-5-point cognitive decline from Year 3 to 5.

CONCLUSION

Periodontitis may be a risk factor for cognitive decline. Gingivitis is reversible, and periodontitis to some degree is preventable and controllable when manifest. Therefore, further research is needed to clarify potential underlying mechanisms and oral health interventions that might ameliorate cognitive decline.