Impact of inhalation therapy on the incidence of carious lesions in patients with asthma and COPD

A comparative evaluation of the effects of respiratory diseases on dental caries

PURPOSE

The aim of this study is to evaluate the susceptibility of patients suffering from asthma and chronic obstructive pulmonary disease (COPD) to dental caries by analyzing the physical, chemical, and microbiological characteristics of saliva, which are influenced by the medications they use.

METHODS

A cohort of 104 individuals, spanning from 18 to 70 years of age, underwent a meticulous categorization based on their unique medical profiles and prescribed medication routines. Subsequently, a comprehensive evaluation was conducted to elucidate potential risk factors associated with dental caries. Alongside the assessment of decayed, missing, and filled teeth (DMFT index), decayed, missing, and filled surfaces (DMFS index), and Green and Vermillion Oral Hygiene Index-Simplified (G&V OHI-S) values, measurements were performed to gauge salivary flow rate, buffering capacity, and the presence of S. mutans, L. casei, S. aureus, and C. albicans. The acquired data were then inputted into the Cariogram software, enabling the derivation of personalized caries risk profiles for each individual.

RESULTS

The diseased group exhibited significantly elevated levels of DMFT, DMFS, and G&V OHI-S values in comparison to the control group (p < 0.01). Moreover, the caries risk levels derived from the Cariogram were found to be significantly higher in patients diagnosed with asthma and COPD (p < 0.01). Notably, no substantial distinction was observed between these two experimental groups. Furthermore, it was discerned that COPD patients utilizing two or three distinct medications did not display any discernible variation in terms of their susceptibility to dental caries (p > 0.05).

CONCLUSION

Asthma and COPD patients exhibit an increased susceptibility to dental caries as a result of their medication regimens. Hence, it is highly advisable for these individuals to demonstrate heightened vigilance in terms of oral hygiene practices and seek regular dental check-ups for continuous monitoring and preventive care.

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.

Putative Bidirectionality of Chronic Obstructive Pulmonary Disease and Periodontal Disease: A Review of the Literature

The prevalence of chronic obstructive pulmonary disease (COPD) is increasing worldwide and is currently the third leading cause of death globally. The long-term inhalation of toxic substances, mainly cigarette smoke, deteriorates pulmonary function over time, resulting in the development of COPD in adulthood. Periodontal disease is an inflammatory condition that affects most adults and is caused by the bacteria within dental plaque. These bacteria dissolve the gums around the teeth and the bone that supports them, ultimately leading to tooth loss. Periodontal disease and COPD share common risk factors, such as aging and smoking. Other similarities include local chronic inflammation and links with the onset and progression of systemic diseases such as ischemic heart disease and diabetes mellitus. Understanding whether interventions for periodontal disease improve the disease trajectory of COPD (and vice versa) is important, given our rapidly aging society. This review focuses on the putative relationship between COPD and periodontal disease while exploring current evidence and future research directions.

The Association Between Long-Term Corticosteroids Use and Dental Caries: A Systematic Review

Corticosteroids (CSs) are a group of medications prescribed regularly to treat a wide range of inflammatory and immune-related conditions with great benefit. The impact of long-term use of CSs on the oral cavity has been reported before, including increased risk of periodontal disease and dental caries. Thus, the aim of this study is to evaluate the prevalence of dental caries in patients using CSs. A literature review was completed using PubMed and Cochrane search engines. The search was based on questions related to adults and children (P); corticosteroids (I); no corticosteroids (C); and dental caries (O) (PICO questions) using the keywords "steroids" and "caries" with all relevant variations and MeSH terms. Decay missing filling tooth/decay missing filling surface (DMFT/DMFS) scores were selected as parameters to assess the effects of CSs on caries prevalence. Data was extracted and analyzed for comparisons. The search yielded 1,206 articles from January 2001 to January 2023, of which 21 papers were eligible for analysis. Overall, 14 studies reported an increase in caries with CSs use. However, seven studies failed to report an association of caries prevalence with CSs use. Current evidence supports the correlation between increased risk of caries with chronic CSs use, specifically for inhaler formulation. Future studies with randomized controlled clinical studies are warranted to confirm these findings.

Drugs Prescribed for Asthma and Their Adverse Effects on Dental Health

Asthma is a chronic, heterogeneous respiratory pathology characterized by reversible airway inflammation. Therapeutics focus on symptom reduction and control, aimed at preserving normal pulmonary function and inducing bronchodilatation. The objective of this review is to describe the adverse effects produced by anti-asthmatic drugs on dental health, according to the reported scientific evidence. A bibliographic review was carried out on databases, such as Web of science, Scopus, and ScienceDirect. Most anti-asthmatic medications are administered using inhalers or nebulizers, making it impossible to avoid contact of the drug with hard dental tissues and oral mucosa, and thus promoting a greater risk of oral alterations, mainly due to decreases in the salivary flow and pH. Such changes can cause diseases, such as dental caries, dental erosion, tooth loss, periodontal disease, bone resorption, as well as fungal infections, such as oral candidiasis.

Effects of Fermented Lingonberry Juice Mouthwash on Salivary Parameters—A One-Year Prospective Human Intervention Study

A one-year prospective human intervention study was performed to examine the effects of fermented lingonberry juice (FLJ), used as a mouthwash for six months, on salivary parameters. A total of 25 adult participants used 10 mL of FLJ as mouthwash 30 s daily for 6 months in addition to their normal oral homecare routines. Standard oral examinations and gathering of samples were performed at the beginning of the study and after six months and one year. Resting and stimulated saliva secretion rates, resting saliva pH, and stimulated saliva buffering capacity were determined. A questionnaire of participants’ subjective sensations of mouth dryness was also recorded at each timepoint. Fermented lingonberry juice mouthwash had positive effect to all five salivary parameters and were, according to the omnibus test, statistically significant during the study period. Analysis of the subjective dry mouth sensation questionnaires revealed that symptoms of xerostomia decreased due to the use of FLJ. This study revealed that the once-a-day use of FLJ mouthwash had a beneficial, increasing effect on salivary flow rates, buffering capacity, and salivary pH. FLJ thus can be safely used as an adjunctive and beneficial therapy in oral homecare, protecting teeth and oral mucosa, including periodontium, and also relieving dry mouth symptoms.

Oral Candidal Load and Oral Health Status in Chronic Obstructive Pulmonary Disease (COPD) Patients: A Case-Cohort Study

Objective

The objective of this study was to determine the candidal load of the patients with Chronic Obstructive Pulmonary Disease (COPD) and evaluate the oral health status of subjects with COPD. Material and Methods. N = 112 COPD subjects and N = 100 control subjects were included in the study. The selection of COPD cases was confirmed based on the set criteria from the American College of Physicians. The oral health status was assessed as per WHO criteria to determine the score of decayed, missing, and filled teeth (DMFT), significant caries index (SiC), community periodontal index and treatment needs (CPITN), and oral hygiene index-simplified (OHI-S). Gram staining was performed to identify Candida using the whole saliva. Quantitative evaluation of the candidal load was carried out using Sabouraud Dextrose Agar (SDA). Chrome agar was used to differentiate between the commensal carriages. A statistical analysis paired t-test and 95% confidence interval (CI) for proportions was carried out using STATA software.

Results

Candidal growth was found in 21.42% (n = 24) of COPD cases and 1.1% (n = 11) of control cases (p < 0.05) (95% CI 0.45, 0.59). The DMFT score was 8.26 in COPD subjects and 4.6 in controls, the SiC score was 16.42 in COPD subjects and 10.25 in controls, and the CPITN score for both COPD and control cases was score 2.

Conclusion

In conclusion, there was a higher candidal load among subjects suffering from COPD. Theophylline medication can be a risk factor for increased candidal load in COPD patients.

The dental management of the asthmatic patients

Asthma is the most common chronic respiratory condition characterized by airway inflammation and obstruction. Our increased knowledge and understanding of the etiology and pathogenesis of this condition has widely assisted us in delivering effective therapies. Physicians strive to provide the best treatment modality to achieve symptom-control and minimize the adverse effects of medication use. Nonetheless, patients continue to endure oral complications from the use of asthma medications. As dentists, it is prudent to address these oral complications and promote the oral health of these patients by way of early preventive and therapeutic dental intervention. This must be accomplished by adhering to certain precautionary measures for the sake of avoiding intraoperative problems while optimizing oral care. In this article, we discuss the diagnosis, oral findings, dental care, and emergency management of the asthmatic patients.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

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

Periodontal Status, Its Treatment Needs, and Its Relationship with Airflow Limitation and Quality of Life in COPD Patients

Objective

Chronic obstructive pulmonary disease (COPD) is one of the most prevalent respiratory diseases in the world. There is an impressive relationship between periodontal status and airflow limitation in patients with COPD. Therefore, in this study, we aimed to investigate the periodontal status, its treatment needs, and its relationship with the severity of airway obstruction and quality of life in patients with COPD.

Materials and Methods

In this case-control study, 36 healthy men (control group) and 35 men afflicted with COPD (case group) were investigated. On the basis of spirometry results and Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria, patients with COPD were further divided into 4 groups. The participants' quality of life was evaluated using COPD Assessment Test (CAT) questionnaire. Thereafter, both groups of participants were referred to a dentistry clinic so that the related specialist could investigate their periodontal health status. The relationship between the periodontal indices and the variables under study including GOLD stage, CAT score, Forced Expiratory Volume in first second and Forced Vital Capacity (FEV1/FVC) ratio, Forced Expiratory Volume in first second (FEV1), and the exacerbation rate were statistically analyzed using independent t-test, one-way analysis of variance, Tukey's test, and Pearson correlation coefficient.

Results

The results revealed that probing pocket depth (PDD), bleeding on probing (BOP), and loss of attachment (LOA) are negatively correlated with FEV1% (r=-0.53, p=0.001), (r=-0.62, p=0.001), and (r=-0.72, p=0.001) as well as FEV1/FVC ratio (r=-0.45, p=0.007), (r=-0.47, p=0.004), and (r=-0.61, p=0.001), respectively. The results showed that PDD, BOP, and LOA are positively correlated with CAT score (r=0.51, p=0.002), (r=0.47, p=0.004), and (r=0.71, p=0.001), respectively.

Conclusion

Periodontal problems are positively associated with COPD severity as determined by GOLD criteria and negatively associated with quality of life of patients with COPD.

Association between asthma and dental caries in US (United States) adult population

Objective: To investigate the associations of asthma with dental-caries-experience (DFT: decayed and filled teeth) and untreated-dental-caries (DT: decayed teeth) in the US adult population.Methods: Data from the National Health and Nutritional Examination Survey, 2009-2014 were analyzed. Study-participants were classified into current, former and never asthmatics based on their asthma-status. Former-asthmatics were excluded. Both the outcomes, dental-caries-experience and untreated-dental-caries were dichotomized as being either present or absent, and were also categorized into tertiles based on their distributions in our study-sample. Logistic regression analyses were performed to determine the associations of asthma with dichotomized outcomes. The generalized logit model was applied for multilevel categorical outcomes. Multivariable models were developed to control for common demographic, clinical, and lifestyle factors.Results: Total study-participants were 13,135, representing 175.26 million US adults. In the adjusted models, current-asthmatics, when compared to the reference group of never-asthmatics, were more likely to have dental-caries-experience (odds ratio [OR], 1.37; 95% confidence interval [CI], 1.13-1.66) and untreated-dental-caries (OR, 1.38; 95% CI, 1.10-1.73) in ≥1 tooth. Asthma was associated with all three categories of dental-caries-experience in our study-sample. We observed a positive gradient in the OR with an increasing extent of untreated-dental-caries. Relative to never-asthmatics, asthma doubled the odds of having untreated dental caries in the subgroup of current-smokers.Conclusion: Current-asthmatic adults had higher odds of dental-caries-experience and untreated-dental-caries as compared to never-asthmatic adults in the US. Based on the observations from this study, interprofessional collaboration should be recommended to institute caries control and health promotion in current-asthmatic adult population.

Evaluation of Salivary Parameters and Oral Health Status Among Asthmatic and Nonasthmatic Adult Patients Visiting a Tertiary Care Hospital

Introduction: Asthma is a chronic inflammatory disorder of the airways characterized by attacks of bronchoconstriction causing shortness of breath, coughing, and rapid breathing. Patients undergoing inhalation therapy are subjected to a higher risk of dental caries due to the reduced saliva secretion, decreased pH value, increased number of cariogenic bacteria caused by inappropriate oral hygiene, and the use of inhaling medicaments with dry powder.

Methods: The descriptive study was carried out among 200 patients aged (18-45 years) visiting Yenepoya Hospital, Mangalore during the period from May 2018 to October 2018 to evaluate salivary parameters and oral health status in asthmatic and nonasthmatic patients. Data were collected using WHO criteria (2013) and samples of unstimulated saliva were collected for evaluation of salivary flow rate, pH, buffering capacity, and calcium. Statistical analysis was done using SPSS version 21.0 software with the level of significance set at p < 0.05.

 Results: A decreased mean score of salivary flow rate, pH, and buffering capacity were found in asthmatic patients compared to nonasthmatic patients (p < 0.001). A higher mean decayed, missing, and filled teeth (DMFT) score and an increased dental erosion score were found in asthmatics compared to nonasthmatics (p < 0.05). Asthmatics had higher gingival bleeding score than nonasthmatics.

Conclusion: In order to prevent disease progression in the hard dental tissue and oral cavity of asthmatic patients, it is necessary to apply adequate preventive measures and motivate their continuous application in this caries-risk population.

Allergic rhinitis, rather than asthma, might be associated with dental caries, periodontitis, and other oral diseases in adults

BACKGROUND

The association between asthma (AS), allergic rhinitis (AR) and oral diseases remains inconclusive in adults. AS and AR often coexist. However, studies that investigate AS, AR together and their association with oral diseases are scarce.

METHODS

Data from 22,898 men and 28,541 women, aged 21 to 25 years, were collected from a national database in Taiwan. Five common oral diseases: dental caries, periodontitis, pulpitis, gingivitis, and stomatitis/aphthae were studied. Differences in the incidence of the five oral diseases in AR vs. non-AR, and AS vs. non-AS groups were compared. The incidence of the five oral diseases in men/ women, urban/country citizen, and high/low income groups was studied. The frequencies of clinical visits and impact of topical steroid use between the groups were also studied. The confounding factors included sex, socioeconomic status, urbanization, dentofacial anomalies, disease of salivary flow, diabetes mellitus, and esophageal reflux.

RESULTS

The incidence and the frequencies of clinical visits for all five oral diseases were higher in those with AR than in the non-AR group after adjusting for confounding factors and AS. Similar observation was made for the AS group, without adjusting for AR. However, if AR was included for adjustment, no relationship was found between AS and oral diseases. In the AR group, those with higher incomes, and country residents had a high risk of developing oral disease. Intranasal steroids, rather than inhaled steroids, were also associated with oral diseases.

CONCLUSION

AR, rather than AS, may be associated with oral diseases in young adults.

[Characteristics of non-pharmacological interventions in the elderly with COPD. Smoking cessation, pulmonary rehabilitation, nutritional management and patient education]

Chronic obstructive pulmonary disease (COPD) is a respiratory disorder responsible for a high mortality and disability. People older than 65 years are more commonly affected than younger people and tend to present with more symptoms and a greater level of disability. Non-pharmacological interventions play an important role in the management of all patients with COPD and this is particularly true in the elderly. Given the improvement in quality of life and risk of hospitalization, smoking cessation should be promoted to patients of all ages. Increased physical activity is associated with reduced respiratory symptoms. Tests such as the "Short Physical Performance Battery" can be useful in frailer older people with COPD, while walking tests such as the 6-minute walk test are used as an assessment before pulmonary rehabilitation. Increased physical activity should be combined with nutritional management. Screening for undernutrition by questionnaire, body mass index and albumin quantification is recommended in the elderly. In case of undernutrition, oral supplementation seems to reduce the risk of re-admission. All these measures must be included in an education program adapted to the elderly comorbidities (hearing loss, isolation…).