Potential associations between chronic respiratory disease and periodontal disease: analysis of National Health and Nutrition Examination Survey III

Periodontal disease prevalence and oral hygiene status of adults with cystic fibrosis: A case-control study

AIM

To investigate the prevalence of gingivitis and periodontitis, and the oral hygiene status of adults with cystic fibrosis (CF) in the Republic of Ireland.

MATERIALS AND METHODS

A case-control study in the form of a clinical examination of 92 adults with a diagnosis of CF was carried out in the adult CF unit in Cork University Hospital. A 40-item questionnaire was used to capture socio-demographic variables and medical and dental information. Two calibrated examiners carried out a periodontal assessment on participants, using the WHO-recommended CPI-modified index, and oral hygiene status was measured using the Greene-Vermillion index. The results were compared with a population-based control group of similar socio-demographic profile.

RESULTS

Oral hygiene levels (plaque and calculus) were significantly worse in people with CF, with a median plaque index of 0.83 (interquartile range [IQR] 0.333-1.542) in the CF group compared with 0.5 (IQR 0.167-0.667) in the non-CF group. Calculus index in the CF group was 0.33 (IQR 0.17-0.83) compared with 0.33 (IQR 0.125-0.33) in the non-CF group. However, periodontal disease levels were significantly lower in the CF group. Gingivitis (bleeding on probing ≥ 10% sites) was seen in 67.4% of the CF group, compared with 83.7% of the non-CF group, OR 0.365 (95% confidence interval [CI] 0.181-0.736), relative risk (RR) 0.779 (95% CI 0.655-0.928). Mild periodontitis (periodontal probing depth [PPD] < 5 mm) was seen in 15.2% of the CF group, compared with 31.5% of the non-CF group, OR 0.390 (CI 0.190-0.800), RR 0.483 (95% CI 0.273-0.852). Severe periodontitis (PPD ≥ 6 mm) was seen in 0% of the CF group, compared with 9.8% of the non-CF group. There was a tendency, albeit non-significant, towards reduced periodontitis in PWCF who regularly took antibiotics, particularly azithromycin.

CONCLUSIONS

In this study, adults with CF had poor oral hygiene practices, with high levels of plaque and calculus. Despite this finding, adults with CF had lower levels of clinical gingivitis and periodontitis than seen in a non-CF control group. Further study is required to examine the causes of this phenomenon.

Association between periodontal diseases and chronic obstructive pulmonary disease: Evidence from sequential cross-sectional and prospective cohort studies based on UK Biobank

AIM

To investigate the association between periodontal diseases, airflow limitation and incident chronic obstructive pulmonary disease (COPD) in a large-scale prospective UK Biobank cohort.

MATERIALS AND METHODS

Our approach comprised a cross-sectional study and a prospective cohort. Periodontal diseases were determined based on the participants' self-reported dental symptoms, including painful gums, bleeding gums and loose teeth. Logistic regression and Cox proportional hazards models were used to evaluate the association of periodontal diseases with airflow limitation and incident COPD in the cross-sectional study and the prospective cohort, respectively.

RESULTS

The cross-sectional study involved 495,610 participants. Multivariable analysis found that periodontal diseases were significantly associated with airflow limitation (odds ratio = 1.036, 95% confidence interval [CI]: 1.015-1.059). The cohort study included 379,266 participants with a median follow-up period of 12.68 years. An elevated risk of incident COPD was associated with the presence of periodontal diseases (hazard ratio: 1.248, 95% CI: 1.174-1.326). The effect was consistent among subgroups, including baseline age (≤65 or >65 years), sex, smoking status and diabetes mellitus.

CONCLUSIONS

Periodontal diseases are associated with airflow limitation and elevated COPD incidence. Maintaining good periodontal health in patients with chronic bronchitis and emphysema may help prevent the onset of COPD.

Unmasking the Silent Threat: Periodontal Health's Impact on COPD Severity and Hospitalization

OBJECTIVE

This study investigated the relationship between chronic obstructive pulmonary disease (COPD) and periodontitis, focusing on how periodontal health impacts COPD airflow limitation, exacerbations, and hospitalization.

BACKGROUND

Periodontitis, a multifactorial inflammatory disease, is characterized by destruction of tooth-supporting structures, while COPD is a global pulmonary disorder with high mortality.

METHODS

A total of 199 COPD patients aged over 40 years underwent lung function tests (spirometry), 6 min walk test, and St George's Respiratory Questionnaire-COPD (SGRQ-C) to assess lung health. Periodontal indices such as probing depth (PD), clinical attachment loss (CAL), and plaque index (PI) were assessed.

RESULTS

We found a significant negative correlation between periodontal disease severity and lung function (lower FEV1, FVC, and FEV1/FVC ratio) after adjusting for smoking. Likewise, periodontal parameters (PPD, PI, and CAL) exhibited negative correlations with lung function. These periodontal indices were independently associated with airflow limitation severity, exacerbations frequency, and prior-year hospitalization. Linear regression indicated that each unit increase in PPD, PI, and CAL corresponded to estimated increases in GOLD airflow limitation grading (0.288, 0.718, and 0.193, respectively) and number of exacerbations (0.115, 0.041, and 0.109, respectively). In logistic regression, PPD, PI, and CAL adjusted odds ratios (ORs) were estimated to increase by 1.29 (95%CI: 1.03-1.62), 3.04 (95%CI: 1.28-7.2), and 1.26 (95%CI: 1.06-1.49), respectively, for hospitalization in previous year.

CONCLUSION

Periodontitis is associated with COPD airflow limitation, exacerbation, and hospitalization, with PI being the most clinically relevant periodontal factor. Dentists and physicians should monitor and increase awareness among COPD patients to maintain oral hygiene for prevention of periodontal diseases and mitigate its effect on COPD progression.

Association between periodontal disease and chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) and periodontal disease are chronic inflammatory conditions that significantly affect an individual's overall health and well-being. Generally, the prevalence of periodontitis is higher in patients with COPD than those without COPD, which may partly be attributed to common risk factors in COPD, such as smoking, respiratory infections, and inflammation. In particular, periodontitis may exacerbate the progression of COPD and further deteriorate the respiratory system by promoting inflammatory responses and bacterial infections. Immunocytes, including neutrophils, and microorganisms such as Fusobacterium nucleatum originating from oral biofilms are believed to be crucial factors influencing to COPD. Furthermore, the potential benefits of treating periodontal disease in COPD outcomes have been investigated. Although the relationship between COPD and periodontal disease has been preliminarily studied, there is currently a lack of large-scale clinical studies to validate this association. In addition to clinical examinations, investigating biomarkers and microbiology may contribute to explore the underlying mechanisms involved in the management of these conditions. This review aims to contribute to a better understanding of the clinical and basic research aspects of COPD and periodontitis, allowing for potential therapeutic approaches and interdisciplinary management strategies.

Public Awareness on Perio-systemic Interplay: A Cross-Sectional Survey in South India

BACKGROUND

The oral cavity has been referred to as "the gateway to overall health." It is also said to be the meeting point of medicine and dentistry.

AIMS

Our study sought to determine the extent to which the public was aware of the connection between oral/periodontal conditions and general health.

SETTINGS AND DESIGN

The observational cross-sectional study's questionnaire was sectioned into oral health awareness, systemic influence on oral health, and personal oral health assessment.

MATERIALS AND METHODS

A total of 994 responses were recorded and a Chi-square test was performed to uncover the relationships using SPSS version 22.0. According to responses, 70% of the population on average comprehended the responses to the majority of the oral health awareness-related questions.

RESULTS

It has been noticed that only 30% of the general public was aware of the prevalent health issues like diabetes, hypertension, and malnutrition's impact on dental health. However, more than 60% had confidence in their oral health and gave a rating of at least 5.

CONCLUSION

The study indicates that a good number of the population was prioritizing their oral health. However, there exists a definitive need to improve oral health awareness thereby ameliorating the overall health of an individual.

Impact of breastfeeding and other early-life factors on the development of the oral microbiome

The oral cavity is home to the second most diverse microbiome in the human body. This community contributes to both oral and systemic health. Acquisition and development of the oral microbiome is a dynamic process that occurs over early life; however, data regarding longitudinal assembly of the infant oral microbiome is scarce. While numerous factors have been associated with the composition of the infant oral microbiome, early feeding practices (breastfeeding and the introduction of solids) appear to be the strongest determinants of the infant oral microbiome. In the present review, we draw together data on the maternal, infant, and environmental factors linked to the composition of the infant oral microbiome, with a focus on early nutrition. Given evidence that breastfeeding powerfully shapes the infant oral microbiome, the review explores potential mechanisms through which human milk components, including microbes, metabolites, oligosaccharides, and antimicrobial proteins, may interact with and shape the infant oral microbiome. Infancy is a unique period for the oral microbiome. By enhancing our understanding of oral microbiome assembly in early life, we may better support both oral and systemic health throughout the lifespan.

Research on the Association Between Periodontitis and COPD

Periodontitis is a common chronic bacteria-initiated inflammatory disease that is closely associated with various systemic diseases, including chronic obstructive pulmonary disease (COPD). Periodontitis and COPD share similar risk factors, pathology and microorganisms. Epidemiological and clinical research have shown positive correlation between the two diseases. Individuals with severe periodontitis had a higher risk of developing COPD. Moreover, the relative risk of COPD in severe periodontitis was much higher compared to people without periodontal disease and patients with mild to moderate periodontitis. COPD patients with periodontitis had a higher frequency of COPD exacerbation and periodontal treatment demonstrated some control of COPD. However, the nature of periodontitis affecting COPD still needs further exploration. Periodontitis caused microbial and immune imbalances of the lung through several aspects: (I) under periodontitis status, periodontal pathogens directly caused the lung inflammatory reaction after inhalation and colonization on the lung, (II) periodontitis status promoted the oral colonization of pneumonia-associated pathogens, (III) periodontitis status affected the respiratory epithelium structure and (IV) periodontitis status caused imbalances in neutrophils, macrophages and inflammatory cytokines. In this review, we conclude the association between periodontitis and COPD through several aspects and further discuss the potential mechanism by which periodontitis affects COPD.

Periodontal health status among chronic obstructive pulmonary disease with age- and gender-matched controls

Background

Periodontal disease and chronic obstructive pulmonary disease (COPD) share a pathogenic mechanism that involves activating and using inflammatory cytokines and neutrophils, which generate pathological changes in various tissues with a chronic degenerative outcome.

Aim

the aim of this study was to assess and compare the periodontal health status among COPD patients with age- and gender-matched controls.

Materials and Methods

All the patients aged >30 years who were diagnosed with COPD by the physician were included as cases, while people who are apparently healthy and age and gender matched with cases were included as controls. Data on demographic details, socioeconomic status (Kuppuswamy scale), deleterious oral habits, and oral hygiene practices were obtained. The Simplified Oral Hygiene Index (OHI-S) and the WHO basic oral health survey proforma (1997) were used to obtain the data on oral hygiene and periodontal status respectively.

Results

Most cases had moderate COPD severity (58.25%). The overall mean OHI-S, CPI, and LOA were higher among cases (3.92 ± 0.95, 3.68 ± 0.60, and 2.33 ± 1.10, respectively) in comparison to controls. Further, among cases, the mean oral hygiene and periodontitis increased with increased severity of COPD. Although among both cases and controls, gender, tobacco use, and alcohol consumption influenced their periodontal status, significant odds of higher risk were seen only among cases. Further, subjects with COPD had higher odds of having poor oral hygiene, deeper pocket depths, and LOA.

Conclusion

A strong association between COPD and periodontitis was observed. The oral hygiene and periodontal disease worsened with the severity of COPD.

Association Between Oral Health and Airflow Limitation: Analysis Using a Nationwide Survey in Korea

BACKGROUND

Although poor oral health is a common comorbidity in individuals with airflow limitation (AFL), few studies have comprehensively evaluated this association. Furthermore, the association between oral health and the severity of AFL has not been well elucidated.

METHODS

Using a population-based nationwide survey, we classified individuals according to the presence or absence of AFL defined as pre-bronchodilator forced expiratory volume in 1 second/forced vital capacity < 0.7. Using multivariable logistic regression analyses, we evaluated the association between AFL severity and the number of remaining teeth; the presence of periodontitis; the Decayed, Missing, and Filled Teeth (DMFT) index; and denture wearing.

RESULTS

Among the 31,839 participants, 14% had AFL. Compared with the control group, the AFL group had a higher proportion of periodontitis (88.8% vs. 79.4%), complete denture (6.2% vs. 1.6%), and high DMFT index (37.3% vs. 27.8%) (P < 0.001 for all). In multivariable analyses, denture status: removable partial denture (adjusted odds ratio [aOR], 1.12; 95% confidence interval [95% CI], 1.04-1.20) and complete denture (aOR, 1.52; 95% CI, 1.01-2.05), high DMFT index (aOR, 1.13; 95% CI, 1.02-1.24), and fewer permanent teeth (0-19; aOR, 1.32; 95% CI, 1.12-1.52) were significantly associated with AFL. Furthermore, those with severe to very severe AFL had a significantly higher proportion of complete denture (aOR, 2.41; 95% CI, 1.11-3.71) and fewer remaining teeth (0-19; aOR, 2.29; 95% CI, 1.57-3.01).

CONCLUSION

Denture wearing, high DMFT index, and fewer permanent teeth are significantly associated with AFL. Furthermore, a reduced number of permanent teeth (0-19) was significantly related to the severity of AFL. Therefore, physicians should pay attention to oral health in managing patients with AFL, such as chronic obstructive pulmonary disease.

Oral health profile and periodontal diseases awareness and knowledge among the jordanian population: a cross-sectional study

OBJECTIVE

To explore the oral health profile and periodontal diseases awareness and knowledge among the Jordanian population. In addition, we aimed to identify predictors of good knowledge of periodontal diseases.

METHOD

This was an online cross-sectional survey study that was conducted in Jordan between January and May 2022. A total of 13 item from the world health organisation (WHO) oral health questionnaire for adults were used to examine the oral health profile of our study participants. In addition, a previously developed questionnaire by Abdulbaqi et al. were adapted and used to examine participants' knowledge about periodontal diseases. Binary logistic regression analysis was used to identify predictors of better knowledge of periodontal diseases.

RESULTS

This study involved 1,099 participants in total. More than half of them (61.1%) claimed that throughout the previous 12 months, they had experienced pain or discomfort in their mouths or teeth. Nearly half of the participants said their teeth and gums were in good or very good condition. 70.7% said they brush their teeth once or more per day. The vast majority of them (93.0%) claimed to brush their teeth using toothpaste that contained 61.9% fluoride. The most frequent cited cause for dental visits was pain or difficulty with teeth, gums, or mouth (36.3%), according to almost one-third of study participants who said they had visited a dentist during the previous six months. The most commonly reported problems that occurs frequently due to the state of the participants' teeth or mouth were avoiding smiling because of teeth, feeling embarrassed due to appearance of teeth, and having difficulty in biting foods with 11.0%, 10.2%, and 9.0%, respectively. Tea with sugar (16.5%) was the most frequently reported beverage as being consumed frequently on a daily basis. The most popular tobacco product to be smoked often on a daily basis was cigarettes (21.6%). For periodontitis knowledge questions, the percentage of accurate responses ranged from 32.3 to 55.8%. The majority of participants (55.8%) were able to recognize that poor oral hygiene is one of the most frequent causes of malodor, whereas the least number of participants (32.3%) were able to recognize that improper teeth brushing is a frequent cause of gingival recession.

CONCLUSION

The average degree of periodontitis knowledge among Jordanians was moderate. Along with it, there were modest oral hygiene practices. In order to prevent further oral complications that have a detrimental influence on patients' quality of life, educational campaigns are required to increase public awareness of knowledge and practices in terms of proper oral hygiene and periodontitis.

Subgingival microbial diversity and respiratory decline: A cross-sectional study

AIM

To investigate whether there is an association between subgingival microbial diversity and reduced respiratory function.

MATERIALS AND METHODS

A group of dentate 58-72-year-old men in Northern Ireland had a comprehensive periodontal examination including subgingival plaque sampling. DNA was extracted from plaque samples and the V1-V3 regions of the 16S rRNA gene were analysed by high-throughput sequencing and a microbial diversity index (MDI) was derived. Spirometry measurements were made using a wedge bellows spirometer. The primary outcome variable of interest was the percentage of predicted forced expiratory volume in 1 s (% predicted FEV1 ). Analysis included multiple linear regression with adjustment for various confounders.

RESULTS

Five-hundred and seven men were included in the analysis. The mean age was 63.6 years (SD = 3.1). Of these, 304 (60.0%) men had no or mild periodontitis, 105 (20.7%) had moderate periodontitis and 98 (19.3%) had severe periodontitis. Multiple linear regression analysis showed that a one unit increase in MDI was associated with a 0.71% loss (95% confidence interval: 0.06%-1.35%; p = .03) in % predicted FEV1 after adjustment for all confounders.

CONCLUSIONS

In this group of dentate men from Northern Ireland, subgingival microbial diversity was associated with reduced respiratory function.

Association between chronic obstructive pulmonary disease and periodontal disease: a systematic review and meta-analysis

Objectives

Studies have suggested contradictory results on the relationship between chronic obstructive pulmonary disease (COPD) and periodontal disease (PD). The aim of this study was to determine whether PD increased the risk of COPD and COPD-related clinical events.

Design

A systematic review and meta-analysis.

Data sources

PubMed, Ovid EMBASE and Ovid CENTRAL were searched from inception to 22 February 2023.

Eligibility criteria for studies

We included trials and observational studies evaluating association of PD with the risk of COPD or COPD-related events (exacerbation and mortality), with statistical adjustment for smoking.

Data extraction and synthesis

Two investigators independently extracted data from selected studies using a standardised Excel file. Quality of studies was evaluated using the Newcastle-Ottawa Scale. OR with 95% CI was pooled in a random-effect model with inverse variance method.

Results

22 observational studies with 51 704 participants were included. Pooled analysis of 18 studies suggested that PD was weakly associated with the risk of COPD (OR: 1.20, 95% CI 1.09 to 1.32). However, in stratified and subgroup analyses, with strict adjustment for smoking, PD no longer related to the risk of COPD (adjusting for smoking intensity: OR: 1.14, 95% CI 0.86 to 1.51; smokers only: OR: 1.46, 95% CI 0.92 to 2.31; never smokers only: OR: 0.93, 95% CI 0.72 to 1.21). Moreover, PD did not increase the risk of COPD-related exacerbation or mortality (OR: 1.18, 95% CI 0.71 to 1.97) in the pooled result of four studies.

Conclusions

This study demonstrates PD confers no risk for COPD and COPD-related events when strictly adjusted by smoking. Large-scale prospective cohort studies with control of potential confounding factors are warranted to validate the present findings.

Could oral hygiene prevent cases of at-home-acquired Legionnaires' disease? - Results of a comprehensive case-control study on infection sources, risk, and protective behaviors

Introduction

The "LeTriWa study" on community-acquired cases of Legionnaires' disease (LD) found that most cases likely acquired their infection at home (AHALD). However, which sources confer the infection is largely unknown. We therefore analyzed the data set from the LeTriWa study to find out if individual sources were associated with AHALD and if specific behavioral habits may increase or lower the risk for AHALD.

Methods

During the study we had used two comparison groups: (i) controls matched for age group and hospital ("controls"), (ii) household members of cases with AHALD ("AHALD-HHM"). We inquired about exposure to water sources, such as showering or wearing dentures, as well as behavioral factors and habits related to oral hygiene. We took standardized household bathroom water and biofilm samples of both cases with AHALD and controls, and in addition from households of cases with AHALD only samples from suspect residential (non-)drinking water sources. We first conducted bivariate analyses for infection sources and behaviors, followed by multivariable analyses.

Results

There were 124 cases with AHALD, 217 controls and 59 AHALD-HHM. In bivariate analyses using controls for comparison, wearing dentures was the only variable significantly positively associated (odds ratio (OR) = 1.7, 95% confidence interval (CI) = 1.1-2.7, p-value = 0.02). Behavioral factors such as showering, letting water run before use and not being alcohol abstinent were significantly negatively associated, smoking was significantly positively associated. In a multivariable analysis, we identified good oral hygiene as a preventive factor for both denture wearers (OR = 0.33, 95% CI = 0.13-0.83, p-value = 0.02) and non-denture wearers (OR = 0.32, 95% CI = 0.10-1.04, p-value = 0.06). Analyses of comparisons with AHALD-HHM showed similar effects but lacked statistical power. We identified Legionella in 16 residential (non-)drinking water sources, one of which was a PCR-positive scratch sample of dentures.

Discussion

Wearing (inadequately cleaned) dentures or poor oral hygiene might confer an increased risk for AHALD, and oral hygiene may prevent AHALD. The hypothesis that Legionella in oral biofilm or dental plaque may be the cause of cases with AHALD should be examined further. If confirmed this may open new and simple avenues for the prevention of LD.

The association between respiratory diseases and periodontitis: A systematic review and meta-analysis

AIM

To evaluate (1) whether periodontitis has an influence on the prevalence/incidence of respiratory diseases (chronic obstructive pulmonary disease [COPD], asthma, community-acquired pneumonia [CAP], obstructive sleep apnoea [OSA] and COVID-19), and (2) what is the impact of periodontal therapy on the onset or progression of respiratory diseases.

MATERIALS AND METHODS

An electronic search was performed on Pubmed, Cochrane Library and Scopus databases up to October 2021, to identify studies answering the PECOS and PICOS questions.

RESULTS

Seventy-five articles were selected. Meta-analyses identified statistically significant associations of periodontitis with COPD (nstudies  = 12, odds ratio [OR] = 1.28, 95% confidence interval [CI] [1.16; 1.42], p < .001), and OSA (ns  = 6, OR = 1.65, 95% CI [1.21; 2.25], p = .001), but not for asthma (ns  = 9, OR = 1.53, 95% CI [0.82; 2.86], p = .181). For acute conditions, two studies were found for CAP, while for COVID-19, significant associations were found for the need of assisted ventilation (ns  = 2, OR = 6.24, 95% CI [2.78; 13.99], p < .001) and COVID-related mortality (ns  = 3, OR = 2.26, 95% CI [1.36, 3.77], p = .002). Only four intervention studies were found, showing positive effects of periodontal treatment on COPD, asthma and CAP.

CONCLUSIONS

A positive association between periodontitis and COPD, OSA and COVID-19 complications has been found, while there is a lack of intervention studies.

The association of denture wearing with reduced lung function and increased airflow limitation in 58-72 year old men

OBJECTIVE

To investigate the association between denture wearing and airflow limitation in men in Northern Ireland enrolled in the Prospective Epidemiological Study of Myocardial Infarction (PRIME) study.

METHODS

A case-control design was used to study partially dentate men. Cases were men aged 58-72 years who were confirmed as denture wearers. Controls were never denture wearers who were matched by age (± 1 month) and smoking habit to the cases. The men had a periodontal assessment and completed a questionnaire detailing their medical history, dental history and behaviours, social circumstances, demographic background and tobacco use. Physical examination and spirometry measurements of forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were also undertaken. Spirometry data for edentulous men who wore complete dentures were compared with that recorded for the partially dentate men studied.

RESULTS

There were 353 cases who were partially dentate and were confirmed denture wearers. They were matched for age and smoking habit to never denture wearer controls. The cases had an FEV1 that was on average 140 ml lower than the controls, p = 0.0013 and a 4% reduction in percent predicted FEV1, p = 0.0022. Application of the GOLD criteria indicated that 61 (17.3%) of the cases had moderate to severe airflow limitation compared with 33 (9.3%) of controls, p = 0.0051. Fully adjusted multivariable analysis showed that partially dentate men who were denture wearers were significantly more likely (p = 0.01) to have moderate to severe airflow reduction with an adjusted odds ratio (OR) of 2.37 (95% confidence intervals 1.23-4.55). In the 153 edentulous men studied moderate to severe airflow limitation was recorded in 44 (28.4%), which was significantly higher than in the partially dentate denture wearers (p = 0.017), and the men who had never worn a denture (p<0.0001).

CONCLUSION

Denture wearing was associated with an increased risk of moderate to severe airflow limitation in the cohort of middle-aged Western European men studied.

Associations between Periodontitis and COPD: An Artificial Intelligence-Based Analysis of NHANES III

A number of cross-sectional epidemiological studies suggest that poor oral health is associated with respiratory diseases. However, the number of cases within the studies was limited, and the studies had different measurement conditions. By analyzing data from the National Health and Nutrition Examination Survey III (NHANES III), this study aimed to investigate possible associations between chronic obstructive pulmonary disease (COPD) and periodontitis in the general population. COPD was diagnosed in cases where FEV (1)/FVC ratio was below 70% (non-COPD versus COPD; binary classification task). We used unsupervised learning utilizing k-means clustering to identify clusters in the data. COPD classes were predicted with logistic regression, a random forest classifier, a stochastic gradient descent (SGD) classifier, k-nearest neighbors, a decision tree classifier, Gaussian naive Bayes (GaussianNB), support vector machines (SVM), a custom-made convolutional neural network (CNN), a multilayer perceptron artificial neural network (MLP), and a radial basis function neural network (RBNN) in Python. We calculated the accuracy of the prediction and the area under the curve (AUC). The most important predictors were determined using feature importance analysis. Results: Overall, 15,868 participants and 19 feature variables were included. Based on k-means clustering, the data were separated into two clusters that identified two risk characteristic groups of patients. The algorithms reached AUCs between 0.608 (DTC) and 0.953% (CNN) for the classification of COPD classes. Feature importance analysis of deep learning algorithms indicated that age and mean attachment loss were the most important features in predicting COPD. Conclusions: Data analysis of a large population showed that machine learning and deep learning algorithms could predict COPD cases based on demographics and oral health feature variables. This study indicates that periodontitis might be an important predictor of COPD. Further prospective studies examining the association between periodontitis and COPD are warranted to validate the present results.

Oral Lesions Associated with COVID-19 and the Participation of the Buccal Cavity as a Key Player for Establishment of Immunity against SARS-CoV-2

BACKGROUND

Some oral lesions have been described in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); the possibility has been raised that the buccal lesions observed in patients with the coronavirus disease 2019 (COVID-19) are due to this virus and the patient's systemic condition. The aim of this review was to integrate the knowledge related to the oral lesions associated with COVID-19 and the participation of the buccal cavity in the establishment of immunity against SARS-CoV-2.

METHODS

A literature search on the manifestations of buccal lesions from the beginning of the pandemic until October 2021 was carried out by using the PubMed database. A total of 157 scientific articles were selected from the library, which included case reports and reports of lesions appearing in patients with COVID-19.

RESULTS

Oral lesions included erosions, ulcers, vesicles, pustules, plaques, depapillated tongue, and pigmentations, among others. The oral cavity is a conducive environment for the interaction of SARS-CoV-2 with the mucosal immune system and target cells; direct effects of the virus in this cavity worsen the antiviral inflammatory response of underlying oral disorders, immunodeficiencies, and autoimmunity primarily.

CONCLUSIONS

The oral cavity is an accessible and privileged environment for the interaction of SARS-CoV-2 with the mucosal immune system and target cells; the direct effects of the virus in this cavity worsen the antiviral inflammatory response of underlying oral disorders, in particular those related to immunodeficiencies and autoimmunity.

Association of periodontal therapy, with inflammatory biomarkers and complications in COVID-19 patients: a case control study

BACKGROUND

In previous studies, COVID-19 complications were reported to be associated with periodontitis. Accordingly, this study was designed to test the hypothesis that a history of periodontal therapy could be associated with lower risk of COVID-19 complications.

METHODS

A case-control study was performed using the medical health records of COVID-19 patients in the State of Qatar between March 2020 and February 2021 and dental records between January 2017 and December 2021. Cases were defined as COVID-19 patients who suffered complications (death, ICU admissions and/or mechanical ventilation); controls were COVID-19 patients who recovered without major complications. Associations between a history of periodontal therapy and COVID-19 complications were analysed using logistic regression models adjusted for demographic and medical factors. Blood parameters were compared using Kruskal-Wallis test.

RESULTS

In total, 1,325 patients were included. Adjusted odds ratio (AOR) analysis revealed that non-treated periodontitis was associated with significant risk of need for mechanical ventilation (AOR = 3.91, 95% CI 1.21-12.57, p = 0.022) compared to periodontally healthy patients, while treated periodontitis was not (AOR = 1.28, 95% CI 0.25-6.58, p = 0.768). Blood analyses revealed that periodontitis patients with a history of periodontal therapy had significantly lower levels of D-dimer and Ferritin than non-treated periodontitis patients.

CONCLUSION

Among COVID-19 patients with periodontal bone loss, only those that have not received periodontal therapy had higher risk of need for assisted ventilation. COVID-19 patients with a history of periodontal therapy were associated with significantly lower D-dimer levels than those without recent records of periodontal therapy.

CLINICAL RELEVANCE

The fact that patients with treated periodontitis were less likely to suffer COVID-19 complications than non-treated ones further strengthen the hypothesis linking periodontitis to COVID-19 complications and suggests that managing periodontitis could help reduce the risk for COVID-19 complications, although future research is needed to verify this.

Oral Microbiome: Getting to Know and Befriend Neighbors, a Biological Approach

The oral microbiome, forming a biofilm that covers the oral structures, contains a high number of microorganisms. Biofilm formation starts from the salivary pellicle that allows bacterial adhesion–colonization–proliferation, co-aggregation and biofilm maturation in a complex microbial community. There is a constant bidirectional crosstalk between human host and its oral microbiome. The paper presents the fundamentals regarding the oral microbiome and its relationship to modulator factors, oral and systemic health. The modern studies of oral microorganisms and relationships with the host benefits are based on genomics, transcriptomics, proteomics and metabolomics. Pharmaceuticals such as antimicrobials, prebiotics, probiotics, surface active or abrasive agents and plant-derived ingredients may influence the oral microbiome. Many studies found associations between oral dysbiosis and systemic disorders, including autoimmune diseases, cardiovascular, diabetes, cancers and neurodegenerative disorders. We outline the general and individual factors influencing the host–microbial balance and the possibility to use the analysis of the oral microbiome in prevention, diagnosis and treatment in personalized medicine. Future therapies should take in account the restoration of the normal symbiotic relation with the oral microbiome.

Periodontitis and coronavirus disease 2019

The coronavirus disease 2019 caused by severe acute respiratory syndrome coronavirus 2 is usually a mild condition; however, in some cases it can result in severe sickness and even death. Thus, understanding the reasons behind these grave outcomes is of great importance. Coronavirus disease 2019 and periodontitis share some intriguing characteristics. They can both lead to systemic inflammation and alterations of coagulation pathways, and both share confounding factors, such as diabetes, hypertension, and obesity. Accordingly, a possible association between these conditions has been hypothesized in the literature. The objective of this review was to evaluate the scientific evidence linking these diseases and the possible underlying mechanisms. Evidence has shown that coronavirus disease 2019 presents oral manifestations and can even affect periodontal tissues. Moreover, some studies have shown a possible association between coronavirus disease 2019 severity and the presence of periodontitis. Current evidence suggests that this association could be explained through the direct role of periodontal bacteria in aggravating lung infections, as well as through the indirect effect of periodontitis in inducing systemic inflammation and priming of the immune system to an exacerbated reaction to severe acute respiratory syndrome coronavirus 2 infection. Future research is needed to confirm these observations and explore the possible role that periodontal care might play in the coronavirus disease 2019 pandemic.

Pulmonary disease and periodontal health: a meta-analysis

OBJECTIVE

Research has shown a positive relationship between pulmonary and periodontal disease. However, the relationship remains unclear. The aim of this meta-analysis was to evaluate the associations between pulmonary disease and periodontal health.

MATERIALS AND METHODS

MEDLINE, PubMed, EMBASE, Web of Science, Science Citation Index, Wanfang, and CNKI were searched for all the relevant studies of relationship between pulmonary disease and periodontal health. Weighted mean difference (WMD)/odds ratio (OR) with 95% confidence interval (CI) was used to assess the strength of the association.

RESULTS

Thirty-seven studies were included in this meta-analysis. Pooled analysis showed a significant association between pulmonary and periodontal disease (adjusted OR, 1.93; 95%CI: 1.60-2.33; P < 0.05), and pooled adjusted OR was 1.64, 3.03, and 2.21 in COPD, asthma, and pneumonia, respectively. The pooled analysis also showed that patients with pulmonary disease suffered from worse periodontal health as most periodontal indexes in those patients were poorer.

CONCLUSIONS

There is a strong association between pulmonary disease and periodontal health. Clinical trials analyzing the causality and pathological basis of the association of these two diseases are needed.

Association of periodontitis with microvascular complications of diabetes mellitus: A nationwide cohort study

BACKGROUND

Periodontitis is a common chronic inflammatory disease and one of oral complications in diabetes. Diabetes-related microvascular complications and periodontitis are also closely related to systemic inflammation. We hypothesized that periodontitis and oral hygiene markers might increase the risk of microvascular complications in diabetes mellitus.

METHODS

We enrolled 11,353 diabetes participants without prior microvascular complications who received complete oral health checkups in the National Health Insurance Service-National Health Screening Cohort in 2003-2004. The primary outcome was the first development of diabetes-related microvascular complications, including nephropathy, neuropathy, and retinopathy.

RESULTS

The age of all participants was 55.27 ± 9.46 years, and 7833 (68.99%) participants were male. Periodontitis was noted in 8.37%. During the 7.03 ± 4.30 year of the mean follow-up period, 7227 patients experienced diabetes-related microvascular complications (2645 with nephropathy, 2513 with neuropathy, 2069 with retinopathy). Multivariable Cox regression analyses revealed that periodontitis was an independent risk factor for diabetes-related microvascular complications (adjusted hazard ratio (HR):1.13; 95% confidence interval (CI):1.04-1.23; p = 0.004). In the secondary analysis for individual microvascular complications, periodontitis was an independent risk factor for retinopathy (adjusted HR: 1.21; 95% CI: 1.04-1.40; p = 0.013).

CONCLUSIONS

The presence of periodontitis was associated with an increased risk of microvascular complications in diabetes patients.

Relationship between the oral cavity and respiratory diseases: Aspiration of oral bacteria possibly contributes to the progression of lower airway inflammation

The global population is aging, and elderly people have a higher incidence of lower airway diseases owing to decline in swallowing function, airway ciliary motility, and overall immunity associated with aging. Furthermore, lower airway diseases in the elderly tend to have a high mortality rate. Their prevention is important for extending healthy life expectancy and improving the quality of life of each individual.

In recent years, the relationship between “chronic periodontitis and oral bacteria, especially the periodontopathic ones” and “respiratory diseases” (e.g., pneumonia, chronic obstructive pulmonary disease, and influenza) has become clear. In addition, the association of several periodontal pathogens with the onset and aggravation of coronavirus disease 2019 (COVID-19) is also being reported.

In support of these findings, oral health management has shown to reduce deaths from pneumonia and prevent influenza in nursing homes and inpatient wards. This has led to clinical and multidisciplinary cooperation between physicians and dentists, among others. However, to date, the mechanisms by which “chronic periodontitis and oral bacteria” contribute to lower airway diseases have not been well understood. Clarifying these mechanisms will lead to a theoretical basis for answering the question, “Why is oral health management effective in preventing lower airway diseases?”

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.

Morphometric and volumetric evaluation of maxillary sinus in patients with chronic obstructive pulmonary disease using cone-beam CT

OBJECTIVES

The purpose of present study is to assess the maxillary sinuses patients with COPD morphometrically and volumetrically using cone-beam computed tomography (CBCT) images and compared these findings according to in age and gender of control groups.

METHODS

CBCT images of 80 individuals that exist from 40 patients with COPD and 40 healthy individuals (6 females, 34 males) in the tomography archive were retrospectively analyzed. The volume and surface area of maxillary sinuses in COPD and control group were measured by semi-automatic segmentation method and obtained findings were statistically examinated according to age, gender.

RESULTS

The study was observed that there was no statistically significant difference between the right maxillary sinus area and the groups, but left maxillary sinus and total sinus area of COPD group were observed to be significantly lower than the control group (p < 0.05). Maxillary sinus volume was found to be statistically significantly lower in patients with COPD than in healthy controls (p < 0.05).

CONCLUSIONS

CBCT is a practical and effective imaging method for the evaluation of maxillary sinuses. It is thought that inflammatory diseases that cause sinonasal changes such as COPD may affect maxillary sinus sizes.

Airflow limitation and tongue microbiota in community-dwelling elderly individuals

Numerous oral indigenous microorganisms are constantly introduced into the stomach via the laryngopharynx, and a portion of these microorganisms irregularly reaches the lower airways and lungs. This study investigated the association between airflow limitation and the status of tongue microbiota, which is a primary source of ingested oral bacterial populations.

The study population consisted of 484 community-dwelling adults aged 70–80 years inhabiting Hisayama town, Japan, who underwent a regular health examination including dental examination and spirometry test in 2016. The bacterial density and composition of their tongue microbiota were determined using a previously used 16S rRNA gene to understand their relationship with oral health conditions. The present cross-sectional study compared the tongue microbiota status between elderly individuals with airflow limitation and those with normal airflow.

The total bacterial density of the tongue microbiota of individuals with airflow limitation was significantly higher than that of individuals with normal airflow. Logistic regression analysis demonstrated that a high-biomass tongue microbiota was significantly associated with airflow limitation after adjustment for smoking intensity and other covariates (adjusted OR 1.61, 95% CI 1.01–2.60). Of the predominant commensals, higher amounts of Prevotella melaninogenica and Actinomyces odontolyticus were associated with a higher prevalence of airflow limitation.

These results indicate that increased bacterial burden in the tongue microbiota is associated with a higher prevalence of airflow limitation.

Bacterial enrichment in the tongue microbiota is associated with airflow limitation characterising COPD in community-dwelling elderly adultshttps://bit.ly/36qMf6G

Streptococcus pneumoniae prevalence in nasopharynx, oropharynx and gingival sulcus in Brazilian adults:A preliminary study

AIM

This study aimed to evaluate the prevalence of S. pneumoniae colonization in three different sites in healthy adults: nasopharynx, oropharynx and gingival sulcus.

METHODS

Two-hundred and sixty five adults, aged 20-60 years, who attended dental clinics in one public university (n = 106) and one military institution (n = 159) were enrolled in this study. Pneumococcal detection was performed by direct culture (DC) and PCR for lytA gene after a broth enrichment step. Capsular types were determined by sequential multiplex PCR.

RESULTS

We identified 18 (6.8%) pneumococcal carriers among 265 adults by PCR, but only one (0.4%) pneumococcal strain was isolated by DC method. Oropharynx (17; 6.4%) was the main source of S. pneumoniae. Colonization of gingival sulcus and nasopharynx was found in 4 (1.5%) and 2 (0.8%) adults, respectively. Nine distinct capsular types were detected from 9 adults and co-colonization with 2 serotypes was confirmed in 4 (1.5%) subjects. Factors associated with carriage were being females, low level of schooling, non-military and regular medication. We observed a low (6.8%) pneumococcal carriage prevalence, but oropharyngeal samples yielded more sensitive results, especially by the PCR-based detection methodology.

CONCLUSION

Gingival sulcus was found to be a possible reservoir for S. pneumoniae independently of the oropharynx or nasopharynx colonization.

Can povidone iodine gargle/mouthrinse inactivate SARS-CoV-2 and decrease the risk of nosocomial and community transmission during the COVID-19 pandemic? An evidence-based update

The Coronavirus disease in 2019 (COVID-19), also referred to as the novel ‘CoV19 (nCov19)’ is caused by a new coronavirus strain similar to Severe Acute Respiratory Syndrome (SARS-CoV-2). SARS-CoV-2 spreads via respiratory droplets, saliva, or direct contact. Therefore it is important to control the viral load in the saliva and respiratory secretions. One of the most simple and cost-effective measures that can be adopted by the public and healthcare professionals to prevent cross-contamination and community transmission, is the implementation of effective oral and throat hygiene. Recent evidence has confirmed that 0.5% povidone iodine (PVP-I) mouthrinse/gargle for 30 s can reduce SARS-CoV-2 virus infectivity to below detectable levels. PVP-I can even interrupt SARS-CoV-2 attachment to oral and nasopharyngeal tissues and lower the viral particles in the saliva and respiratory droplets. Thus, the use of PVP-I mouthrinse as a prophylactic measure has been advocated across the globe to reduce disease transmission. Although the efficacy of PVP-I against SARS-CoV-2 is proven, no review articles have yet discussed the evidence and mechanisms of PVP-I against the SARS-CoV-2. Thus, this paper highlights the rationale, safety, recommendations, and dosage of PVP-I gargle/mouthrinse as an effective method to decrease the viral loads during the pressing times of COVID-19.

Severe COVID-19 Lung Infection in Older People and Periodontitis

Periodontal bacteria dissemination into the lower respiratory tract may create favorable conditions for severe COVID-19 lung infection. Once lung tissues are colonized, cells that survive persistent bacterial infection can undergo permanent damage and accelerated cellular senescence. Consequently, several morphological and functional features of senescent lung cells facilitate SARS-CoV-2 replication. The higher risk for severe SARS-CoV-2 infection, the virus that causes COVID-19, and death in older patients has generated the question whether basic aging mechanisms could be implicated in such susceptibility. Mounting evidence indicates that cellular senescence, a manifestation of aging at the cellular level, contributes to the development of age-related lung pathologies and facilitates respiratory infections. Apparently, a relationship between life-threatening COVID-19 lung infection and pre-existing periodontal disease seems improbable. However, periodontal pathogens can be inoculated during endotracheal intubation and/or aspirated into the lower respiratory tract. This review focuses on how the dissemination of periodontal bacteria into the lungs could aggravate age-related senescent cell accumulation and facilitate more efficient SARS-CoV-2 cell attachment and replication. We also consider how periodontal bacteria-induced premature senescence could influence the course of COVID-19 lung infection. Finally, we highlight the role of saliva as a reservoir for both pathogenic bacteria and SARS-CoV-2. Therefore, the identification of active severe periodontitis can be an opportune and valid clinical parameter for risk stratification of old patients with COVID-19.

The Impact of Periodontal Disease on Hospital Admission and Mortality During COVID-19 Pandemic

Introduction: COVID-19 has had a huge impact on society and healthcare and it has been suggested that people with periodontal disease are at risk of having worse outcomes from the disease. The aim of this study was to quantify the impact of periodontal disease on hospital admission and mortality during the COVID-19 pandemic.

Materials and Methods: The study extracted UK Biobank participants who had taken a COVID-19 test between March and June 2020 (n = 13,253), of which 1,616 were COVID-19 positive (12%) and 11,637 were COVID-19 negative (88%). Self-reported oral health indicators of painful or bleeding gums and loose teeth were used as surrogates for periodontal disease, participants who did not report any of the aforementioned indicators were used as controls. Multivariable logistic regressions were used to obtain crude and adjusted odds ratios of COVID-19 infection, subsequent hospital admission and mortality adjusted for demographics, BMI, biomarkers, lifestyle and co-morbidities.

Results: Painful gums, bleeding gums and loose teeth were reported in 2.7, 11.2 and 3.3% of participants with COVID-19 infection, respectively. Risk of COVID-19 infection in participants with painful or bleeding gums and loose teeth compared to controls was not increased (odds ratio [OR]: 1.10, 95% CI: 0.72–1.69; OR: 1.15, 95% CI: 0.84–1.59). COVID-19 positive participants with painful or bleeding gums had a higher risk of mortality (OR: 1.71, 95% CI: 1.05–2.72) but not hospital admission (OR: 0.90, 95% CI: 0.59–1.37). Participants with loose teeth did not show higher risk of hospital admission or mortality compared to the control group (OR = 1.55, 95% CI: 0.87–2.77; OR: 1.85; 95% CI: 0.92–2.72).

Conclusion: There was insufficient evidence to link periodontal disease with an increased risk of COVID-19 infection. However, amongst the COVID-19 positive, there was significantly higher mortality for participants with periodontal disease. Utilization of linked dental and hospital patient records would improve the understanding of the impact of periodontal disease on COVID-19 related outcomes.

Oral Pathogen Porphyromonas gingivalis Can Escape Phagocytosis of Mammalian Macrophages

Macrophages are phagocytic cells that play a key role in host immune response and clearance of microbial pathogens. Porphyromonas gingivalis is an oral pathogen associated with the development of periodontitis. Escape from macrophage phagocytosis was tested by infecting THP-1-derived human macrophages and RAW 264.7 mouse macrophages with strains of P. gingivalis W83 and 33277 as well as Streptococcus gordonii DL1 and Escherichia coli OP50 at MOI = 100. CFU counts for all intracellular bacteria were determined. Then, infected macrophages were cultured in media without antibiotics to allow for escape and escaping bacteria were quantified by CFU counting. P. gingivalis W83 displayed over 60% of the bacterial escape from the total amount of intracellular CFUs, significantly higher compared to all other bacteria strains. In addition, bacterial escape and re-entry were also tested and P. gingivalis W83, once again, showed the highest numbers of CFUs able to exit and re-enter macrophages. Lastly, the function of the PG0717 gene of P. gingivalis W83 was tested on escape but found not related to this activity. Altogether, our results suggest that P. gingivalis W83 is able to significantly avoid macrophage phagocytosis. We propose this ability is likely linked to the chronic nature of periodontitis.

Periodontal Status and Microbiologic Pathogens in Patients with Chronic Obstructive Pulmonary Disease and Periodontitis: A Case-Control Study

Purpose

To evaluate clinical periodontal status and microbiologic pathogens in patients with chronic obstructive pulmonary disease (COPD) and periodontitis.

Patients and Methods

We conducted a case–control study of 60 periodontitis patients with COPD (case group) and 60 periodontitis patients with normal pulmonary function (control group). Their periodontal status and respiratory function were clinically examined. Real-time polymerase chain reaction assays were used to measure five dental pathogens and four respiratory pathogens in subgingival dental plaque. Spearman’s rank correlation coefficients (r²) were calculated to assess correlations of pathogens. Principal component analysis (PCA) was employed to assess the similarity of bacterial diversity between the two groups. Logistic regression was performed to examine the associations of periodontal variables and pathogens with COPD risk.

Results

COPD patients had fewer remaining teeth, higher plaque index (PLI), and more severe site percentages of clinical attachment level (CAL) than the controls. Although COPD patients tended to have relatively higher ranked means of Porphyromonas gingivalis, Tannerella forsythensis, Treponema denticola, and Haemophilus influenza than control participants, the differences were not significant. Some periodontal pathogens and respiratory pathogens were positively correlated with each other (r² =0.29 to 0.47, all P < 0.05). The PCA graph showed that the distributions of pathogens were more dispersed but less discriminated in the COPD group than those in the control group. PLI (P = 0.045) and CAL ≥ 5mm site percentages (P = 0.01) were significantly associated with an increased risk of COPD, while pathogens were not associated with COPD.

Conclusion

Our results from this study do not indicate periodontal pathogens as potential predictors of COPD risk, despite significantly poor periodontal status associated with COPD.

The clinical and inflammatory relationships between periodontitis and chronic obstructive pulmonary disease

AIM

To investigate associations between periodontitis and chronic obstructive pulmonary disease (COPD) with and without alpha-1 antitrypsin deficiency (AATD), including neutrophil functions implicated in tissue damage.

METHODS

The presence and severity of periodontitis (using two international criteria) and lung disease were assessed in 156 COPD patients with and without AATD accounting for common confounding factors. Saliva and systemic inflammatory markers were measured by ELISA together with neutrophil migration.

RESULTS

COPD and AATD patients exhibited higher prevalence of periodontitis (COPD 95%; AATD 88%) than reported in unselected community-dwelling populations even when risk factors (age, smoking history, socio-economic status and dental habits) were considered. Periodontitis severity associated with lung disease severity (AATD, periodontitis versus no periodontitis; FEV1 = 56% versus 99% predicted; TLCO = 59% versus 81% predicted, p < .0001 for both). Neutrophil migratory accuracy declined in stage II-IV periodontitis patients with COPD or AATD compared to COPD or AATD with no or stage I periodontitis. Improved dental habits appeared to be associated with a reduction in exacerbation frequency in COPD.

CONCLUSION

The results support shared pathophysiology between periodontitis and COPD, especially when associated with AATD. This may reflect an amplification of neutrophilic inflammation and altered neutrophil functions, already described in periodontitis, COPD and AATD.

The impact of periodontitis in the course of chronic obstructive pulmonary disease: Pulmonary and systemic effects

AIMS

The aim of this study was to verify the impact of periodontitis in the course of chronic obstructive pulmonary disease (COPD) in C57Bl/6J mice.

MAIN METHODS

The animals were randomly divided into four groups (n = 8): Basal, Periodontitis (P), COPD and COPD+P. COPD was induced by orotracheal instillation of 30 μl of cigarette extract 3 times/week for 7 weeks. Periodontitis was induced by ligation technique for 22 days. Euthanasia was performed on 51st day. The analyzes were total/differential cells and cytokines recovered from bronchoalveolar lavage (BAL), total/differential blood cell count, platelets, total marrow cell count, airway collagen deposition, alveolar enlargement analyzed by mean linear intercept (Lm), mucus and bone crest reabsorption. One-way ANOVA followed by the Student-Newman-Keuls was used.

KEY FINDINGS

The association COPD+P decreased macrophages (p = 0,0351), TNF-α (p = 0,0071) and INF-γ (p = 0,0004) in BAL, when compared to the COPD group maintaining emphysema levels by alveolar enlargement (p < .05) reorganization of collagen fibers (p = .001) and also mean linear intercept (lm) (p = .001) and mucus (p = .0001). The periodontitis group caused TNF-α increase (p = 0, 0001) in BAL.

SIGNIFICANCE

Periodontitis, per se, does not alter any of the parameters analyzed, except for increased TNF-α in BAL. However, its association with COPD caused macrophages TNF-α and INF-γ alterations, when compared to the COPD group maintaining emphysema levels by alveolar enlargement and reorganization of collagen fibers. It seems that periodontitis is influencing the course of Th1 profile cell, and cytokines and pulmonary alterations. Further studies are needed to clarify the regulatory process underlying these two diseases.

Periodontitis and airflow limitation in older Swedish individuals

AIM

To investigate whether there was an association between periodontitis and airflow limitation in older Swedish individuals.

MATERIALS AND METHODS

Study individuals were randomly selected from the Swedish civil registration database representing the ageing population in Karlskrona, Sweden. Clinical and radiographic examinations were performed, alongside which participants completed questionnaires gathering information on their medical history, social circumstances, demographic background and tobacco use. A physical examination assessed anthropometric measures. Standard spirometry was performed to identify subjects with airflow limitation. Periodontitis was defined based on radiographic periodontal bone loss. Analysis included multiple logistic regression with adjustment for various confounders.

RESULTS

A total of 826 Caucasian dentate subjects were included in the analysis. The median age of participants was 73.2 (IQR 66-81) years, and 443 (54.6%) subjects were female. Eighty-six (10.4%) individuals presented with airflow limitation. The proportion of participants presenting with periodontitis in the airflow limitation group was 65.1% compared to 41.5% with normal respiratory function (p < .001). Multiple logistic regression analysis showed that periodontitis was independently associated with airflow limitation with an odds ratio of 2.31 (95% CI 1.27-4.22) p < .01.

CONCLUSION

In this group of older dentate individuals, periodontitis was significantly associated with airflow limitation independent of other known risk factors.

Periodontitis increases the risk of respiratory disease mortality in older patients

Evidence for an association between periodontitis and respiratory disease in the older patients is limited. Additionally, little information exists regarding the role of potential effect modifiers. The aim of this study is to examine whether periodontitis increases the risk of respiratory disease mortality in older patients. Between January 2010 and December 2014, 1385 patients aged 75 years and above who underwent radiographic examination in the largest dental hospital in Shanghai, China were included in this retrospective cohort study. The dental examination was made with the panoramic radiographs. Demographic information and comorbid health conditions were collected from local health authorities. Participant follow up was continued until either the occurrence of mortality, or the end of the study on December 31, 2018. Cox proportional hazards regression and competing risk hazard models were performed to examine the association between periodontitis and respiratory disease mortality. We found that periodontitis was associated with total respiratory disease mortality. Compared with healthy participants, the hazards ratio and 95% confidence interval for total respiratory disease mortality in patients with severe periodontitis was 2.72(1.04,7.11) after adjusting for relevant confounding variables. With increasing severity of periodontitis, risks for chronic obstructive pulmonary disease (COPD) mortality also increased significantly (P = .038). Smokers and participants with body mass index (BMI) < 25 kg/m² were at increased risk. Loss of teeth was not associated with either total respiratory disease or COPD mortality. Although the present study cannot ascertain causal association, it provides substantial evidence that poor periodontal health is associated with respiratory disease in the older patients, particularly in smokers and patients with BMI < 25 kg/m².

Association of periodontal status with lung function in patients with and without chronic obstructive pulmonary disease visiting a medical hospital in Pune: A comparative study

BACKGROUND

The relationship between oral health and systemic conditions has been increasingly debated over recent decades with one such discussion existing about oral hygiene and periodontitis with chronic obstructive pulmonary disease (COPD). Hence, a study was conducted to assess and compare the oral hygiene status and periodontal status of age and gender-matched participants with and without COPD and to correlate oral hygiene status and periodontal status with lung function status among them.

MATERIALS AND METHODS

This hospital-based study included a study population of 117 participants (39 patients of COPD and 78 participants without COPD) 35-75 years of age with at least 20 natural teeth. Participant's demographic details and history of smoking were recorded. Lung function was recorded using a spirometer. Periodontal health was assessed by measuring Probing Pocket Depth (PPD), Clinical Attachment Loss (CAL), and Oral Hygiene Index (OHI) by a trained and calibrated examiner.

RESULTS

Higher mean of PPD, CAL, and OHI is being reported in the present study with 4.07 versus 3.50, 0.58 versus 0.24, and 5.24 versus 3.60, respectively, among patients with and without COPD which was statistically significant. The risk of having COPD was 0.4 times more in participants having poor oral hygiene and 0.07 times more in patients smoking. Smoking and oral hygiene, as independent variables, have a significant influence on COPD which is a dependent variable. A weak correlation was found of poor oral hygiene and loss of attachment among participants with COPD.

CONCLUSION

Periodontitis and respiratory disease share a common risk factor, i.e., smoking. Smoking has a definite relation with periodontitis and COPD. Oral hygiene is significantly associated with increased risk for COPD when age and gender effects have been matched and when adjusted for smoking. However, no association was found of PPD with COPD.

A review of the influence of periodontal treatment in systemic diseases

The effects and consequences of periodontal diseases might not be confined to the oral cavity. A great body of evidence has arisen supporting the claim demonstrating an association with several systemic conditions and diseases. With different levels of evidence, an association between periodontal disease and cardiovascular disease, diabetes, psoriasis, rheumatoid arthritis, pregnancy outcomes and respiratory diseases has been established. However, the true nature of this association, if it is causal, still remains elusive. For a better understanding of the complex relationships linking different conditions, interventional studies now begin to focus on the possible outcomes of periodontal treatment in relation to the events, symptoms and biomarkers of several systemic disorders, assessing if periodontal treatment has any impact on them, hopefully reducing their severity or prevalence. Therefore, we proceeded to review the recent literature on the subject, attempting to present a brief explanation of the systemic condition or disease, what proposed mechanisms might give biological plausibility to its association with periodontal disease, and finally and more importantly, what data are currently available pertaining to the effects periodontal treatment may have. Raising awareness and discussing the possible benefits of periodontal treatment on overall systemic health is important, in order to change the perception that periodontal diseases are only limited to the oral cavity, and ultimately providing better and comprehensive care to patients.

Asthma, chronic obstructive pulmonary disease, tooth loss, and edentulism among adults in the United States: 2016 Behavioral Risk Factor Surveillance System survey

BACKGROUND

Adults with chronic respiratory conditions, specifically asthma or chronic obstructive pulmonary disease (COPD), may be at risk of experiencing poor oral health due to systemic inflammation, challenges in routine oral health care, and adverse effects of medications used to treat these conditions. The authors examined the association of asthma, COPD, and coexisting asthma and COPD (asthma-COPD overlap syndrome [ACOS]) with tooth loss among US adults.

METHODS

The authors conducted a cross-sectional study using 2016 Behavioral Risk Factor Surveillance System data (N = 387,217). The authors categorized the participants with missing permanent teeth into 4 groups: asthma only (n = 38,817), COPD only (n = 19,819), ACOS (n = 13,494), no asthma, no COPD (n = 315,087). The authors used adjusted multinomial logistic regressions to examine the associations between asthma and COPD categories and tooth loss.

RESULTS

According to the authors, 5.3% of study participants reported they were edentulous; 10.7% reported 6 or fewer missing teeth. Participants with asthma only, COPD only, and ACOS had higher odds of reporting tooth loss (6 or more teeth) than those in the no asthma, no COPD group; adjusted odds ratios were 1.12 (95% confidence interval, 1.00 to 1.26) to 2.04 (95% confidence interval, 1.85 to 2.26). A lower percentage of participants with COPD and ACOS visited dentists in the past year than those with no asthma and no COPD. Interactive associations suggested participants with asthma or COPD with dental visits were less likely to report edentulism than those with neither asthma nor COPD and no dental visits.

CONCLUSIONS

Participants with asthma or COPD had higher odds of tooth loss compared with those with neither asthma nor COPD.

PRACTICAL IMPLICATIONS

People with asthma or COPD should maintain routine dental visits to reduce the risk of experiencing tooth loss.

Red complex periodontal pathogens are risk factors for liver cirrhosis

Periodontal disease has been associated with liver disease; however, the identities of the periodontal disease-causing bacteria in patients with viral liver disease remain unknown. The aim of the present study was to determine the counts of the 3 periodontal pathogens that form the red complex in chronic periodontitis (Porphyromonas gingivalis, Tannerella forsythia and Treponema denticola) and 3 other bacteria (Aggregatibacter actinomycetemcomitans, Prevotella intermedia and Fusobacterium necrophorum) in patients with liver disease. A total of 47 patients with liver disease were divided into two groups based on the counts of the red complex bacteria: group A (high counts of red complex bacteria) and group B (low counts of red complex bacteria). The counts of the 6 types of bacteria in saliva and the prevalence of P. gingivalis-specific fimA genotype were determined. In addition, salivary occult blood tests and serological assays were performed. Univariate and multivariate logistic regression analyses were used to analyze the risk factors between the two groups of patients. Hepatitis C virus-related liver disease was the most frequent (41/47; 87.2%) occurrence followed by liver cirrhosis (LC; 12/47; 25.5%) and oral lichen planus (32/47; 68.1%). The significant risk factors between the two groups were LC, albumin (Alb) level, ratios of each bacteria and prevalence of the fimA II genotype. The 3 factors identified in the multivariate analysis to be associated with the red complex bacteria count were low Alb level (<3.7 g/dl), LC and fimA II genotype, with adjusted odds ratios of 6.93, 4.72 and 4.08, respectively (P<0.05). These data indicated that patients with LC were at increased risk of presenting with the red complex bacteria leading to periodontal disease progression. Therefore, these patients may need to take additional care of their oral health compared with patients without LC, which may prove beneficial for the maintenance of their general health.

Prevalence of Candida albicans in primary endodontic infections associated with a higher frequency of apical periodontitis in type two diabetes mellitus patients

To identify the prevalence of C. albicans in primary endodontic infections of type two diabetes mellitus (T2DM) patients and compare their clinical and radiographical characteristics with a non-diabetic control group, establishing the possible relationship between primary endodontic infection, T2DM, and C. albicans, since diabetes mellitus (DM), influences the development, course, and response to the treatment of apical periodontitis, but the presence of Candida albicans (C. albicans) has not been considered before. A total of 120 patients were selected and divided into two groups: 60 T2DM diagnosed patients and 60 non-diabetic controls. A clinical examination and radiographic analysis were performed to establish a periapical index score (PAI). Root canal samples were taken. Deoxyribonucleic acid (DNA) was extracted, and specific primers were used to identify C. albicans by polymerase chain reaction (PCR). A twofold increase in the prevalence of C. albicans in T2DM patients was observed in contrast to control patients (p = 0.0251). Sixty-five percent of T2DM patients with positive C. albicans scored a ≥ 3 PAI, while only 27% of the patients without C. albicans had a ≥ 3 PAI score (p = 0.0065). Long-term DM patients presented C. albicans more frequently (p < 0.0001). In this study, long-term T2DM patients carried C. albicans in their root canals more frequently when having a primary endodontic infection. Furthermore, this C. albicans presence seems to be related to a higher frequency of apical periodontitis.

The association between Parkinson's disease and temporomandibular disorder

The prevalence of temporomandibular disorder (TMD) among elderly people with Parkinson’s disease (PD) is relatively high, but a population-based study of the relationship between PD and TMD is still lacking. This study, therefore, sought to investigate the association between TMD and PD by using data for one million randomly sampled beneficiaries of Taiwan’s National Health Insurance program, including 6,185 PD patients who were matched through propensity score matching with 18,555 non-PD patients. Both the PD and non-PD cohorts were followed until death, any diagnosis of TMD, or December 31, 2013, whichever occurred first. Each diagnosis of TMD was made by a qualified physician according to the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), using the diagnosis codes 524.60, 524.62, 524.63, and 524.69 while excluding tooth abscess, wisdom tooth eruption, herpes zoster and postherpetic neuralgia, mastoiditis, otitis externa, otitis media, parotitis, sialadenitis, and trigeminal neuralgia. We used Cox proportional hazard regression models to calculate the relative risk of TMD and found a 2.11-fold (95% CI: 1.35–3.30) increased risk of TMD overall in the PD group compared with the non-PD group. Stratified by follow-up period, there was a 4.25-fold (95% CI: 1.51–11.93) increased risk in the PD group in the first year after the initial PD diagnosis and a 3.88-fold (95% CI: 1.33–11.28) increased risk in the second year. Over the long-term (>5 years), PD was significantly associated with an increased risk of TMD. These findings suggest that it is important to closely monitor the temporomandibular joint health of PD patients.

Periodontitis Is Associated with Chronic Obstructive Pulmonary Disease

Although they are known to share pathophysiological processes, the relationship between periodontitis and chronic obstructive pulmonary disease (COPD) is not fully understood. The aim of the present study was to test the hypothesis that periodontitis is associated with a greater risk of development of COPD, when smoking is taken into account. The analysis in a 5-y follow-up population-based cohort study was based on 900 community-dwelling Japanese adults (age: 68.8 ± 6.3 [mean ± SD], 46.0% male) without COPD aged 60 or older with at least 1 tooth. Participants were classified into 3 categories according to baseline periodontitis severity (no/mild, moderate, and severe). COPD was spirometrically determined by a fixed ratio of <0.7 for forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) and by FEV1/FVC below the lower limit of normal. Poisson regression was used to calculate the relative risk (RR) of developing COPD according to the severity of periodontitis. The population attributable fraction (PAF) was also calculated. During follow-up, 22 (2.4%) subjects developed COPD. Compared with no/mild periodontitis subjects, a significantly increased risk of COPD occurred among severe periodontitis subjects (RR = 3.55; 95% confidence interval [CI], 1.18 to 10.67), but no significant differences were observed between the no/mild and moderate categories (RR = 1.48; 95% CI, 0.56 to 3.90). After adjustment for potential confounders, including smoking intensity, the relationship between severe periodontitis and risk of COPD remained significant (RR = 3.51; 95% CI, 1.15 to 10.74). Likewise, there was a positive association of periodontitis severity with risk of COPD ( P for trend = 0.043). The PAF for COPD due to periodontitis was 22.6%. These data highlight the potential importance of periodontitis as a risk factor for COPD.

Diversity and functional analysis of salivary microflora of Indian Antarctic expeditionaries

Introduction: The human oral microbiota continues to change phenotype by many factors (environment, diet, genetics, stress, etc.), throughout life with a major impact on human physiology, psychology, metabolism and immune system. Amongst one such factor with unique and extreme environmental conditions is Antarctica. The sea voyage to Antarctica has many risks than at station for expedition members. In this study, we investigated the influence of Antarctic sea voyage and stay at the Indian Antarctic station Maitri, on the health of Indian expedition members by using a metagenomic approach to explore oral biodiversity. Methods: Saliva samples were collected from 12 expedition members, at 3 different time points viz. before the start of the ship voyage, after the completion of the voyage and at the end of the stay at Antarctica. Samples were analyzed for whole genome and 16S rRNA sequencing. Result: The oral microbial diversity of the expedition members was significantly changed, during the days of sailing and after the stay at Antarctica. The oral microbiota comprised mainly of the phyla Firmicutes (46%, 29% & 36%); Proteobacteria (40%, 48%, & 44%), Bacteroidetes (10%, 22%, &14%), Fusobacterium and Actinobacteria (5%-1%) and Unclassified (17%, 25% & 23%), at three time points, respectively. Further, the differential analysis of microbes across all the phyla revealed 89, 157 and 157 OTUs genera. The altered microbiota indicated changes in amino acid, lipid and carbohydrate metabolism. Conclusion: Study suggests that understanding the compositional and functional differences in the oral microbiota of Antarctic expedition members, can lay the foundation to relate these differences to their health status. It will further demonstrate the need for providing improved management during ship voyage and stay in Antarctica.

Methodological Quality Assessment of Meta-analyses and Systematic Reviews of the Relationship Between Periodontal and Systemic Diseases

OBJECTIVES

The aims of this article are to identify all the published systematic reviews (SRs) and meta-analyses (MAs) that studied the relationship between periodontal and systemic diseases and to assess their quality using 2 scales (the Overview Quality Assessment Questionnaire [OQAQ] and A Measurement Tool to Assess Systematic Reviews [AMSTAR] checklist).

METHODS

For SRs and MAs to be included, they should have investigated one of the following systemic diseases: pulmonary conditions, cardiac conditions, endocrine conditions, cancer, blood disorders, psychological conditions, anxiety, depression, mood disorders, and several other diseases. Two investigators screened MEDLINE via PubMed, Embase, Scopus, Web of Science, and the Cochrane Database of Systematic Reviews. The tools used to evaluate quality were the AMSTAR scale and OQAQ. The protocol was prospectively registered in PROSPERO (CRD42018102208).

RESULTS

The search strategy found 691 unique articles, 42 of which met the eligibility criteria and were included in this review. Diabetes mellitus was the most investigated disease (14 out of 42 studies), followed by obesity (11 studies) and cardiovascular diseases (5 studies). A total of 40 reviews reported on the characteristics of included studies, and, as per the AMSTAR scale, 39 reviews had an a priori design. The number of reviews that fulfilled the status of publication criterion was the lowest (7 reviews only), followed by the number used in the assessment of publication bias (11 reviews). The number of high-quality reviews was higher with the OQAQ than with the AMSTAR checklist (33 vs 25 studies), but the AMSTAR showed a higher number of medium-quality reviews than the OQAQ (14 vs 6 studies). Both showed the same number of low-quality reviews.

CONCLUSIONS

High-quality SRs and MAs are crucial to understanding the relationship between systemic and periodontal diseases. Medical practitioners must be able to inform patients about oral health and specific periodontal health concerns.

Transcriptome analysis of Porphyromonas gingivalis and Acinetobacter baumannii in polymicrobial communities

Acinetobacter baumannii is a nosocomial, opportunistic pathogen that causes several serious conditions including meningitis, septicemia, endocarditis, and pneumonia. It can be found in the oral biofilm, which may be a reservoir for pneumonia and chronic obstructive pulmonary disease. Subgingival colonization by A. baumannii is associated with chronic and aggressive periodontitis as well as refractory periodontal disease. Porphyromonas gingivalis, a keystone periodontal pathogen localized to subgingival plaque, is also implicated in several chronic conditions including aspiration pneumonia. Although both bacteria are found together in subgingival plaque and can cause multiple polymicrobial infections, nothing is known about the interactions between these two important human pathogens. In this study, we used RNA sequencing to understand the transcriptional response of both species as they adapt to heterotypic communities. Among the differentially regulated genes were those encoding a number of important virulence factors for both species including adhesion, biofilm formation, and protein secretion. Additionally, the presence of A. baumannii increased the abundance of P. gingivalis in model dual-species communities. Collectively these results suggest that both P. gingivalis and A. baumannii adapt to each other and have synergistic potential for increased pathogenicity. In identifying the mechanisms that promote pathogenicity and refractory disease, novel approaches to mitigate polymicrobial synergistic interactions may be developed to treat or prevent associated diseases.

Chronic obstructive pulmonary disease subpopulations and phenotyping

The diagnosis and treatment of chronic obstructive pulmonary disease (COPD) has been based largely on a one-size-fits-all approach. Diagnosis of COPD is based on meeting the physiologic criteria of fixed obstruction in forced expiratory flows and treatment focus on symptomatic relief, with limited effect on overall prognosis. However, patients with COPD have distinct features that determine very different evolutions of the disease. In this review we highlight distinct subgroups of COPD characterized by unique pathophysiologic derangements, response to treatment, and disease progression. It is likely that identification of subgroups of COPD will lead to discovery of much needed disease-modifying therapeutic approaches. We argue that a precision approach that integrates multiple dimensions (clinical, physiologic, imaging, and endotyping) is needed to move the field forward in the treatment of this disease.