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Li Y, Wang J, Cai Y, Chen H. Association of Serum Vitamin D With Periodontal Disease. Int Dent J 2023; 73:777-783. [PMID: 37419778 PMCID: PMC10509416 DOI: 10.1016/j.identj.2023.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/07/2023] [Accepted: 06/10/2023] [Indexed: 07/09/2023] Open
Abstract
OBJECTIVE There are conflicting reports on the relationship between vitamin D and periodontal disease. Our research is intended to further analyse the association between serum 25(OH)D3, a vitamin D precursor and periodontal disease based on a large national survey sample in Japan. METHODS We downloaded the 2009-2018 National Health and Nutrition Examination Survey (NHANES) cycle, which included a total of 23,324 samples. Logistic regression of factors influencing perioral disease including periodntal disease, and subgroup logistic regression were performed to analyse the relationship between serum vitamin D and perioral disease, using WTMEC2YR as weights for regression analysis. Then machine learning model-based prediction of perioral disease onset was performed, and the machine learning algorithms used included boost tree, artificial neural network, AdaBoost, and random forest. RESULTS We evaluated the vitamin D, age, sex, race, education, marriage, body mass index, ratio of family income to poverty (PIR), smoking, alcohol consumption, diabetes, and hypertension as variables in the included samples. Vitamin D was negatively associated with perioral disease; compared with Q1, the odds ratios and 95% CI were 0.8 (0.67-0.96) for Q2, 0.84 (0.71-1.00) for Q3, and 0.74 (0.6-0.92) for Q4 (P for trend <.05), respectively. The results of the subgroup analysis showed that the effect of 25(OH)D3 on periodontal disease was more pronounced in women younger than 60 years. Based on the accuracy and receiver operating characteristic curve, we concluded that a boost tree was a relatively good model to predict periodontal disease. CONCLUSIONS Vitamin D might be a protective factor for periodontal disease, and boost tree analysis we emplyed was a relatively good model to predict perioral disease.
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Affiliation(s)
- Ying Li
- Department of Health Management Center, Hangzhou Fuyang Hospital of Orthopedics of Traditional Chinese Medicine, Hangzhou, China.
| | - Jinjuan Wang
- Department of Stomatology, The Third People's Hospital of Hangzhou, Hangzhou, China
| | - Yunxian Cai
- Department of Health Management Center, Hangzhou Fuyang Hospital of Orthopedics of Traditional Chinese Medicine, Hangzhou, China
| | - Haokun Chen
- Department of Stomatology, Ningbo No.2 Hospital, Ningbo, China
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2
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Meghil MM, Cutler CW. Influence of Vitamin D on Periodontal Inflammation: A Review. Pathogens 2023; 12:1180. [PMID: 37764988 PMCID: PMC10537363 DOI: 10.3390/pathogens12091180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/09/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
The active form of vitamin D is the hormonally active 1,25(OH)2D3 (Vit D) vitamin, which plays an important role in bone biology and host immunity. The vitamin D receptor (VDR) is a nuclear ligand-dependent transcription factor expressed by many cells. Ligation of VDR by VitD regulates a wide plethora of genes and physiologic functions through the formation of the complex Vit D-VDR signaling cascade. The influence of Vit D-VDR signaling in host immune response to microbial infection has been of interest to many researchers. This is particularly important in oral health and diseases, as oral mucosa is exposed to a complex microbiota, with certain species capable of causing disruption to immune homeostasis. In this review, we focus on the immune modulatory roles of Vit D in the bone degenerative oral disease, periodontitis.
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Affiliation(s)
- Mohamed M. Meghil
- Department of Periodontics, The Dental College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Christopher W. Cutler
- Department of Periodontics, The Dental College of Georgia, Augusta University, Augusta, GA 30912, USA
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Lu EMC. The role of vitamin D in periodontal health and disease. J Periodontal Res 2023; 58:213-224. [PMID: 36537578 DOI: 10.1111/jre.13083] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/20/2022] [Accepted: 11/27/2022] [Indexed: 12/24/2022]
Abstract
Vitamin D plays an essential role in calcium and bone metabolism, immune regulation and possesses profound anti-inflammatory effects. Evidence suggests that low serum vitamin D is associated with increased severity of periodontitis, a chronic inflammatory condition characterised by destruction of the supporting tissues surrounding the tooth, which has several shared risk factors with other chronic non-communicable diseases. The biological functions of vitamin D are mediated by its strong anti-microbial, anti-inflammatory, and host modulatory properties. Experimental periodontitis models involving targeted deletion of 1α-hydroxylase, the enzyme responsible for the conversion of inactive substrate to active 1,25(OH)2 D3 (calcitriol), showed augmented alveolar bone loss and gingival inflammation. Vitamin D receptor (VDR) gene polymorphisms have also been associated with increased severity of periodontitis. Thus, the involvement of vitamin D in the pathogenesis of periodontitis is biological plausible. Clinical studies have consistently demonstrated an inverse relationship between serum 25OHD3 and periodontal disease inflammation. However, due to the paucity of well-designed longitudinal studies, there is less support for the impact of vitamin D status on periodontal disease progression and tooth loss. The evidence emphasises the importance of maintaining vitamin D sufficiency in supporting periodontal health. This review aims to first examine the biological mechanisms by which vitamin D might influence the pathogenesis of periodontal disease and second, discuss the clinical evidence which implicate the role of vitamin D in periodontal disease.
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Affiliation(s)
- Emily Ming-Chieh Lu
- Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, Guy's Hospital, London, UK
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Yakşi E, Horasan N. Vitamin D levels and oral health in stroke patients during inpatient rehabilitation. J Oral Rehabil 2023; 50:293-299. [PMID: 36648365 DOI: 10.1111/joor.13415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 12/30/2022] [Accepted: 01/09/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUND Stroke is a severe that restricts the individual's functions, effects the oral health. OBJECTIVES The aim of this study was to investigate the relationship between oral health and vitamin D levels in stroke patients in rehabilitation units. METHODS Participants with stroke, and age- and sex-matched healthy controls were recruited for the study. Oral Health Impact Scale-14 (OHIP-14), Decayed, Missing, Filled Teeth (DMFT) Index, Community Periodontal Index of Treatment Needs (CPITN), Gingival Index (GI) and Plaque Index (PI) were assessed for all participants. Barthel Index (BI), Brunnstrom Recovery Scale (BRS) and Modified Ashworth Scale (MAS) assessed for the stroke patients. Vitamin D levels of each participant were recorded. RESULTS The stroke patients' DMFT index and OHIP-14 values were higher than those of the healthy controls (p < .05). However, no significant differences were observed in terms of CPTIN, PI, or GI scores (p > .05). No statistically significant difference was determined in the DMFT index, OHIP-14 scores, Community Periodontal Index of Treatment Needs (CPITN), PI (Plaque Index) and GI (Gingival Index) scores according to vitamin D levels among the stroke patients (p > .05). Stroke patients' functional scores (BRS, MAS and BI), vitamin D levels and oral health status (OHIP-14, DMFT, CPITN, PI and GI) were subjected to correlation analysis. This revealed significant negative correlation between BRS (arm, hand and leg), and BI and OHIP-14 scores (p < .05). CONCLUSION Although the DMFT index and oral health-related quality of life were adversely affected in stroke patients, no relationship was found between vitamin D and oral health status.
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Affiliation(s)
- Elif Yakşi
- Department of Physical Medicine and Rehabilitation, Bolu Abant Izzet Baysal University Faculty of Medicine, Bolu, Turkey
| | - Nevin Horasan
- Nilüfer Oral and Dental Health Hospital, Bursa, Turkey
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5
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Costa SA, Nascimento GG, Colins PMG, Alves CMC, Thomaz EBAF, Carvalho Souza SDF, da Silva AAM, Ribeiro CCC. Investigating oral and systemic pathways between unhealthy and healthy dietary patterns to periodontitis in adolescents: A population-based study. J Clin Periodontol 2022; 49:580-590. [PMID: 35415936 DOI: 10.1111/jcpe.13625] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/10/2022] [Accepted: 04/02/2022] [Indexed: 01/11/2023]
Abstract
AIM To investigate pathways between unhealthy and healthy dietary patterns and periodontitis in adolescents (18-19 years of age). MATERIALS AND METHODS This population-based study (n = 2515) modelled direct and mediated pathways (via biofilm and obesity) from patterns of healthy diet (fruits, fibre, vegetables, and dairy) and unhealthy diet (sugars, snacks, and salty/fast foods) with initial periodontitis (bleeding on probing [BoP], probing depth [PD] ≥ 4 mm, clinical attachment loss [CAL] ≥ 4 mm), moderate periodontitis (BoP, PD ≥ 5 mm, and CAL ≥ 5 mm), and European Federation of Periodontology and the American Academy of Periodontology (EFP-AAP) periodontitis definitions, adjusting for sex, socio-economic status, smoking, and alcohol, through structural equation modelling (α = 5%). RESULTS Higher values of healthy diet were associated with lower values of initial periodontitis (standardized coefficient [SC] = -0.160; p < .001), moderate periodontitis (SC = -0.202; p < .001), and EFP-AAP periodontitis (p < .05). A higher value of unhealthy diet was associated with higher values of initial periodontitis (SC = 0.134; p = .005) and moderate periodontitis (SC = 0.180; p < .001). Biofilm mediated the association between higher values of unhealthy diet and all periodontal outcomes (p < .05). CONCLUSIONS Our findings suggest that both healthy and unhealthy dietary patterns may contribute to reduced or increased extent and severity of periodontitis by local and systemic mechanisms, preceding the effect of other established causes such as smoking and obesity, in younger population.
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Affiliation(s)
| | - Gustavo G Nascimento
- Section for Periodontology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
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Yu B, Wang CY. Osteoporosis and periodontal diseases - An update on their association and mechanistic links. Periodontol 2000 2022; 89:99-113. [PMID: 35244945 DOI: 10.1111/prd.12422] [Citation(s) in RCA: 84] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Periodontitis and osteoporosis are prevalent inflammation-associated skeletal disorders that pose significant public health challenges to our aging population. Both periodontitis and osteoporosis are bone disorders closely associated with inflammation and aging. There has been consistent intrigue on whether a systemic skeletal disease such as osteoporosis will amplify the alveolar bone loss in periodontitis. A survey of the literature published in the past 25 years indicates that systemic low bone mineral density (BMD) is associated with alveolar bone loss, while recent evidence also suggests a correlation between clinical attachment loss and other parameters of periodontitis. Inflammation and its influence on bone remodeling play critical roles in the pathogenesis of both osteoporosis and periodontitis and could serve as the central mechanistic link between these disorders. Enhanced cytokine production and elevated inflammatory response exacerbate osteoclastic bone resorption while inhibiting osteoblastic bone formation, resulting in a net bone loss. With aging, accumulation of oxidative stress and cellular senescence drive the progression of osteoporosis and exacerbation of periodontitis. Vitamin D deficiency and smoking are shared risk factors and may mediate the connection between osteoporosis and periodontitis, through increasing oxidative stress and impairing host response to inflammation. With the connection between systemic and localized bone loss in mind, routine dental exams and intraoral radiographs may serve as a low-cost screening tool for low systemic BMD and increased fracture risk. Conversely, patients with fracture risk beyond the intervention threshold are at greater risk for developing severe periodontitis and undergo tooth loss. Various Food and Drug Administration-approved therapies for osteoporosis have shown promising results for treating periodontitis. Understanding the molecular mechanisms underlying their connection sheds light on potential therapeutic strategies that may facilitate co-management of systemic and localized bone loss.
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Affiliation(s)
- Bo Yu
- Division of Regenerative and Constitutive Sciences, School of Dentistry, University of California at Los Angeles, Los Angeles, California, USA
| | - Cun-Yu Wang
- Division of Oral Biology and Medicine, School of Dentistry, University of California at Los Angeles, Los Angeles, California, USA.,Department of Bioengineering, Henry Samueli School of Engineering and Applied Science, Broad Stem Cell Research Center and Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, California, USA
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Baumeister SE, Reckelkamm SL, Baurecht H, Nolde M, Kocher T, Holtfreter B, Ehmke B, Hannemann A. A Mendelian randomization study on the effect of 25-hydroxyvitamin D levels on periodontitis. J Periodontol 2021; 93:1243-1249. [PMID: 34939682 DOI: 10.1002/jper.21-0463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/28/2021] [Accepted: 12/09/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND 25-hydroxy vitamin D (25OHD) levels have been proposed to protect against periodontitis based on in vitro and observational studies but evidence from long-term randomized controlled trials (RCTs) is lacking. This study tested whether genetically proxied 25OHD is associated with periodontitis using Mendelian randomization (MR). METHOD Genetic variants strongly associated with 25OHD in a genome-wide association study (GWAS) of 417,580 participants of European ancestry were used as instrumental variables, and linked to GWAS summary data of 17,353 periodontitis cases and 28,210 controls. In addition to the main analysis using an inverse variance weighted (IVW) model, we applied additional robust methods to control for pleiotropy. We also undertook sensitivity analyses excluding single nucleotide polymorphisms (SNPs) used as instruments with potential pleiotropic effects and used a second 25OHD GWAS for replication. We identified 288 SNPs to be genome-wide significant for 25OHD, explaining 7.0% of the variance of 25OHD levels and providing ≥90% power to detect an odds ratio (OR) of ≤ 0.97. RESULTS MR analysis suggested that a 1 standard deviation increase in natural log-transformed 25OHD was not associated with periodontitis risk (IVW OR = 1.04; 95% confidence interval (CI): 0.97-1.12; P-value = 0.297). The robust models, replication, and sensitivity analyses were coherent with the primary analysis. CONCLUSIONS Collectively, our findings suggest that 25OHD levels are unlikely to have a substantial effect on the risk of periodontitis, but large long-term RCTs are needed to derive definitive evidence on the causal role of 25OHD in periodontitis. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Stefan Lars Reckelkamm
- Institute of Health Services Research in Dentistry, University of Münster, Münster, Germany
| | - Hansjörg Baurecht
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Germany
| | - Michael Nolde
- Institute of Health Services Research in Dentistry, University of Münster, Münster, Germany.,Chair of Epidemiology, University of Augsburg, Germany.,Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, LMU Munich, Munich, Germany
| | - Thomas Kocher
- Unit of Periodontology, Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - Birte Holtfreter
- Unit of Periodontology, Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - Benjamin Ehmke
- Clinic for Periodontology and Conservative Dentistry, University of Münster, Münster, Germany
| | - Anke Hannemann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, D-17489, Germany
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8
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Costa SA, Ribeiro CCC, de Oliveira KR, Alves CMC, Thomaz EBAF, Casarin RCV, Souza SDFC. Low bone mineral density is associated with severe periodontitis at the end of the second decade of life: A population-based study. J Clin Periodontol 2021; 48:1322-1332. [PMID: 34288024 DOI: 10.1111/jcpe.13525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 11/29/2022]
Abstract
AIM To evaluate the association between low bone mineral density (BMD) and severe periodontitis at the end of the second decade of life. MATERIALS AND METHODS This population-based study analysed 2032 youngers (18-19 years old) of the RPS cohort. BMD of lumbar spine (BMD-LS) and of the whole body (BMD-WB) were assessed by dual x-ray emission densitometry. Low BMD-LS (Z-score ≤ -2) and low BMD-WB (Z-score ≤ -1.5) were correlated with severe periodontitis. The extent of periodontal disease was also evaluated as the following outcomes: proportions of teeth affected by clinical attachment loss ≥5 mm and probing depth ≥5 mm. Multivariate models by sex, education, family income, risk of alcohol dependence, smoking, plaque, bleeding index, and body mass index were estimated through logistic regression (binary outcomes) and Poisson regression (continuous outcomes). RESULTS The prevalence of severe periodontitis was 10.97%. Low BMD-LS (odds ratio [OR] = 2.08, confidence interval [CI] = 1.12-3.85, p = .01) and low BMD-WB (OR = 1.34, CI = 1.001-1.81, p = .04) were associated with severe periodontitis in the final multivariate models. Low BMD-LS and BMD-WB were also associated with a greater extent of periodontitis (p < .05). CONCLUSIONS Low BMD was found to be associated with the severity and extent of periodontitis in adolescents. Adolescents at peak bone mass age presenting low BMD are more likely to be affected by severe periodontitis.
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Plasma 25-Hydroxyvitamin D Concentrations and Serum and Salivary C-Reactive Protein in the Osteoporosis and Periodontal Disease Study. Nutrients 2021; 13:nu13041148. [PMID: 33807159 PMCID: PMC8067277 DOI: 10.3390/nu13041148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 11/16/2022] Open
Abstract
Vitamin D has been hypothesized to play an important role in preventing the development and progression of periodontal disease, but the underlying immune modulatory mechanisms remain understudied. We examined the cross-sectional association between biomarkers of vitamin D status and C-reactive protein (CRP) among postmenopausal women aged 53–81 years. Linear regression was used to examine the association between plasma 25-hydroxyvitamin D (25[OH]D) concentrations, a biomarker of vitamin D status, and both salivary and serum CRP concentrations in 567 women from the Buffalo Osteoporosis and Periodontal Disease (OsteoPerio) Study (1997–2000). CRP concentrations were measured with multiplex arrays and transformed for normality using the natural log. Concentrations above and below the limit of detection were included in analysis as right- and left-censored observations. An inverse association was observed between 25(OH)D and salivary CRP in a model adjusted for age, smoking status, frequency of tooth brushing and flossing, and hormone therapy use (−7.56% difference in salivary CRP concentrations per 10 nmol/L increase in 25(OH)D, 95% CI: −12.78 to −2.03). Further adjustment for percent body fat attenuated this association (−2.48%, 95% CI: −7.88 to 3.24). No significant associations were found between 25(OH)D and serum CRP. Plasma vitamin D concentrations were not associated with salivary or serum CRP concentrations in this cohort of postmenopausal women.
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Kim H, Shin MH, Yoon SJ, Kweon SS, Lee YH, Choi CK, Kim O, Kim YJ, Chung H, Kim OS. Low serum 25-hydroxyvitamin D levels, tooth loss, and the prevalence of severe periodontitis in Koreans aged 50 years and older. J Periodontal Implant Sci 2020; 50:368-378. [PMID: 33350177 PMCID: PMC7758301 DOI: 10.5051/jpis.2002540127] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/29/2020] [Accepted: 08/17/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Vitamin D deficiency may cause bone loss and increased inflammation, which are well-known symptoms of periodontal disease. This study investigated whether serum 25-hydroxyvitamin D (25(OH)D) levels are associated with periodontal disease status and tooth loss. METHODS Cross-sectional data from 5,405 individuals aged ≥50 years (2,253 males and 3,152 females) were obtained from the 2008-2010 Dong-gu study, a prospective cohort study of risk factors for chronic diseases. Periodontal examinations were conducted to evaluate the number of remaining teeth, the periodontal probing depth (PPD), the clinical attachment level (CAL), and bleeding on probing. The percentages of sites with PPD ≥4 mm and CAL ≥4 mm were recorded for each participant. The severity of periodontitis was classified using the Centers for Disease Control and Prevention and the American Academy of Periodontology case definitions. Serum 25(OH)D levels were classified as reflecting severe deficiency, deficiency, insufficiency, or sufficiency. Multivariate linear regression analysis was performed to assess the associations of serum 25(OH)D levels with periodontal parameters and the number of remaining teeth after adjusting for confounders including age, smoking status, alcohol consumption status, month of blood collection, and physical activity. Multivariate logistic regression was used to evaluate the association between serum vitamin D levels and severe periodontitis. An overall statistical analysis and a stratified analysis by sex were performed. RESULTS Overall, the rates of severe deficiency, deficiency, insufficiency, and sufficiency were 6.5%, 67.9%, 22.4%, and 3.2%, respectively. After adjustment for confounders, vitamin D levels were directly associated with the number of remaining teeth, an association that was significant in males, but not in females. Sufficient serum 25(OH)D was associated with a low frequency of severe periodontitis. CONCLUSIONS This population-based cross-sectional study indicates that low serum 25(OH)D is significantly associated with tooth loss and severe periodontitis in Koreans aged 50 years and older.
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Affiliation(s)
- Hyunju Kim
- Department of Periodontology, Dental Science Research Institute, Chonnam National University School of Dentistry, Gwangju, Korea
| | - Min Ho Shin
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, Korea.
| | - Suk Ja Yoon
- Department of Oral and Maxillofacial Radiology, Dental Science Research Institute, Chonnam National University School of Dentistry, Gwangju, Korea
| | - Sun Seog Kweon
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, Korea
- Jeonnam Regional Cancer Center, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Young Hoon Lee
- Department of Preventive Medicine, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
| | - Chang Kyun Choi
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - OkJoon Kim
- Department of Oral Pathology, Dental Science Research Institute, Chonnam National University School of Dentistry, Gwangju, Korea
| | - Young Joon Kim
- Department of Periodontology, Dental Science Research Institute, Chonnam National University School of Dentistry, Gwangju, Korea
| | - HyunJu Chung
- Department of Periodontology, Dental Science Research Institute, Chonnam National University School of Dentistry, Gwangju, Korea
| | - Ok Su Kim
- Department of Periodontology, Dental Science Research Institute, Chonnam National University School of Dentistry, Gwangju, Korea.
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Gil-Montoya JA, Garrido-Martínez M, Barrios-Rodríguez R, Ramos-García P, Lenouvel D, Montes-Castillo C, Martínez-Ramírez MJ. Association between low bone mineral density and periodontitis in generally healthy perimenopausal women. J Periodontol 2020; 92:95-103. [PMID: 32716051 DOI: 10.1002/jper.20-0029] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/05/2020] [Accepted: 04/08/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The association between low bone mineral density (BMD) and periodontitis in perimenopausal women is controversial. The purpose of this study was to determine whether osteoporosis or osteopenia is associated with periodontal disease in a population of adult women. METHODS A sample of over-45-year-old women with or without low BMD underwent lumbar spine and hip bone densitometry and a complete periodontal examination. The extent/severity or absence of periodontal disease was noted using two different case definitions. Data were gathered on socio-economic status, medication history, systemic co-morbidities, alcohol or tobacco use as well as serum levels of calcium and vitamin D. RESULTS One hundred seventy three women aged between 45 and 72 years old were recruited with a mean age of 57.8 years. One hundred and three had decreased BMD (61 with osteoporosis and 42 with osteopenia) and 70 were healthy. Moderate or severe periodontitis was present in 52.6% of the women. Multivariate analysis showed a clear association between low BMD and periodontitis, but only in women above 58 years old and independent of tobacco consumption or oral hygiene. CONCLUSION In this sample of generally healthy perimenopausal women, low BMD was associated with clinical attachment level (CAL). Women over 58 years old with decreased BMD presented with a higher mean percentage of sites with CAL ≥ 4 mm as well as CAL ≥ 6 mm when compared to controls, independent of active smoking status or poor oral hygiene.
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Affiliation(s)
- José Antonio Gil-Montoya
- Biosanitary Institute of Granada (ibs.GRANADA), University Hospitals of Granada-University of Granada, Granada, Spain
| | | | - Rocío Barrios-Rodríguez
- Biosanitary Institute of Granada (ibs.GRANADA), University Hospitals of Granada-University of Granada, Granada, Spain
| | - Pablo Ramos-García
- Biosanitary Institute of Granada (ibs.GRANADA), University Hospitals of Granada-University of Granada, Granada, Spain
| | - Daniel Lenouvel
- Biosanitary Institute of Granada (ibs.GRANADA), University Hospitals of Granada-University of Granada, Granada, Spain
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12
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Blufstein A, Behm C, Kubin B, Gahn J, Moritz A, Rausch-Fan X, Andrukhov O. Transcriptional activity of vitamin D receptor in human periodontal ligament cells is diminished under inflammatory conditions. J Periodontol 2020; 92:137-148. [PMID: 32474936 PMCID: PMC7891446 DOI: 10.1002/jper.19-0541] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/22/2019] [Accepted: 04/26/2020] [Indexed: 12/27/2022]
Abstract
Background Although vitamin D3 deficiency is considered as a risk factor for periodontitis, supplementation during periodontal treatment has not been shown to be beneficial to date. Human periodontal ligament cells (hPDLCs) are regulated by vitamin D3 and play a fundamental role in periodontal tissue homeostasis and inflammatory response in periodontitis. The aim of this study is to investigate possible alterations of the vitamin D3 activity in hPDLCs under inflammatory conditions. Methods Cells isolated from six different donors were treated with either 1,25(OH)2D3 (0 to 10 nM) or 25(OH)D3 (0 to 100 nM) in the presence and absence of ultrapure or standard Porphyromonas gingivalis lipopolysaccharide (PgLPS), Pam3CSK4, or interferon‐γ for 48 hours. Additionally, nuclear factor (NF)‐κB inhibition was performed with BAY 11‐7082. The bioactivity of vitamin D in hPDLCs was assessed based on the gene expression levels of vitamin D receptor (VDR)‐regulated genes osteocalcin and osteopontin. Additionally, VDR and CYP27B1 expression levels were measured. Results The vitamin D3‐induced increase of osteocalcin and osteopontin expression was significantly decreased in the presence of standard PgLPS and Pam3CSK4, which was not observed by ultrapure PgLPS. Interferon‐y had diverse effects on the response of hPDLCs to vitamin D3 metabolites. NF‐kB inhibition abolished the effects of standard PgLPS and Pam3CSK4. Standard PgLPS and Pam3CSK4 increased VDR expression in the presence of vitamin D3. CYP27B1 expression was not affected by vitamin D3 and inflammatory conditions. Conclusions This study indicates that the transcriptional activity of VDR is diminished under inflammatory conditions, which might mitigate the effectiveness of vitamin D3 supplementation during periodontal treatment.
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Affiliation(s)
- Alice Blufstein
- Department of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Christian Behm
- Department of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Barbara Kubin
- Department of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Johannes Gahn
- Department of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Andreas Moritz
- Department of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Xiaohui Rausch-Fan
- Department of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Oleh Andrukhov
- Department of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
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13
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Millen AE, Pavlesen S. Could Vitamin D influence risk for Periodontal Disease - to "D" or not to "D"? CURRENT ORAL HEALTH REPORTS 2020; 7:98-111. [PMID: 33457183 PMCID: PMC7810034 DOI: 10.1007/s40496-020-00253-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to discuss the literature on associations between vitamin D and periodontal disease, including its strengths and weaknesses. Future direction for continued work in this area is provided. RECENT FINDINGS Research in cross-sectional cohorts, surveys, and case-control studies provide support for a role of vitamin D in periodontal disease, especially using clinical indicators such as bleeding on probing and clinical attachment loss. However, these studies have a number of limitations. They cannot establish temporality of these associations. Most case-control studies have been limited in sample size and have inconsistent findings. A number of cross-sectional studies are restricted to select populations (e.g., persons with HIV, diabetes, rheumatoid arthritis) limiting extrapolation of findings to the general aging population.Fewer prospective studies have been conducted, and only three have examined associations using a biomarker for vitamin D that reflects exposure from all its sources (sunlight, diet and supplements). One study is limited by using self-reported measures of disease outcomes, and only two used measures of alveolar crestal height. However, of the prospective studies published, there is a suggestion that vitamin D might prevent against tooth loss. Only two randomized controlled trials have examined these associations, and they support the effects of vitamin D supplementation on prevention of tooth loss and gingival bleeding. SUMMARY We strongly suggest that new research should focus on prospective study designs with followup of participants longer than a decade and long-term clinical trials. Such studies should incorporate measures of alveolar bone loss and tooth loss with indication for reason for tooth loss. Such clinical trials should be designed to examine both the influence of vitamin D supplementation alone as well as with other nutrients (e.g., calcium) or therapeutic medications (e.g., bisphosphonates). Currently, there is no strong evidence to suggest that vitamin D protects against development of periodontal disease.
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Affiliation(s)
- Amy E Millen
- Farber Hall 270F, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY. 14214
| | - Sonja Pavlesen
- Buffalo General Medical Center 6D501, 100 High St., Department of Orthopedic Surgery, Jacobs School of Medicine and Biomedical Science, University at Buffalo, State University of New York, Buffalo, NY. 14203
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14
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Wactawski-Wende J, LaMonte MJ, Hovey K, Banack H. The Buffalo OsteoPerio Studies: Summary of our findings and the unique contributions of Robert J. Genco, DDS, PhD. CURRENT ORAL HEALTH REPORTS 2020; 7:29-36. [PMID: 35591981 PMCID: PMC9116690 DOI: 10.1007/s40496-020-00257-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Robert ("Bob") Genco was a member of the research team that established the Buffalo Osteoporosis and Periodontal Disease (OsteoPerio) study. Here we detail the scientific discoveries emanating from this enduring collaboration. STUDY COHORTS OsteoPerio is ancillary to the Women's Health Initiative Observational Study (WHI-OS). WHI-OS is a longitudinal study of 93,000 postmenopausal women aged 50-79 enrolled at 40 U.S. centers (enrolled 1993-1998). OsteoPerio enrolled 1342 women 3 years later (1997-2001) from the Buffalo WHI-OS participants to study the association of osteoporosis and periodontal disease. OsteoPerio has 5-year (N=1026) and 17-year (N=518) follow-up examinations. PARTICIPANTS In addition to information on health status from the WHI-OS, OsteoPerio further included comprehensive oral examinations assessing probing pocket depth, clinical attachment loss, gingival bleeding, alveolar crestal height, and DMFT. Systemic bone density (measured by DXA), blood, saliva and plaque also were collected at all three visits. SUMMARY Findings from these studies are summarized here.
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Affiliation(s)
- Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo
| | - Michael J. LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo
| | - Kathy Hovey
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo
| | - Hailey Banack
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo
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15
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Cagetti MG, Wolf TG, Tennert C, Camoni N, Lingström P, Campus G. The Role of Vitamins in Oral Health. A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030938. [PMID: 32028631 PMCID: PMC7037089 DOI: 10.3390/ijerph17030938] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/24/2020] [Accepted: 01/29/2020] [Indexed: 12/31/2022]
Abstract
The association between vitamins and oral health have recently been discussed, yielding increased attention from medical and dental perspectives. The present review aimed to systematically evaluate and appraise the most recently scientific papers investigating the role of vitamins in the prevention and treatment of the main oral diseases as hard dental pathological processes and gum/periodontal disease. Randomized controlled trials, cross-sectional studies, cohort studies, comparative studies, validation studies and evaluation studies, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, reporting associations between vitamins and oral diseases or the use of vitamins to prevent or treat oral diseases in patients of any age were included. PubMed, Embase and Scopus were searched to November 2019 using an ad hoc prepared search string. All the papers meeting the inclusion criteria were subjected to a quality assessment. The search identified 1597 papers; 741 were selected after removing duplicates. A total of 334 articles were excluded after title and abstract evaluation; 407 were assessed and 73 papers were full-text assessed; other 14 papers were discharged after full text evaluation, leaving finally 58 papers included. In general, there is weak evidence supporting the association between vitamins and both gingival/periodontal disease and hard dental pathological processes.
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Affiliation(s)
- Maria Grazia Cagetti
- Department of Biomedical, Surgical and Dental Science, University of Milan, IT-20142 Milan, Italy; (M.G.C.); (N.C.)
| | - Thomas Gerhard Wolf
- Department of Restorative, Preventive and Paediatric Dentistry, University of Bern, CH-3010 Bern, Switzerland; (C.T.); (G.C.)
- Correspondence: ; Tel.: +41-(0)31-664098
| | - Christian Tennert
- Department of Restorative, Preventive and Paediatric Dentistry, University of Bern, CH-3010 Bern, Switzerland; (C.T.); (G.C.)
| | - Nicole Camoni
- Department of Biomedical, Surgical and Dental Science, University of Milan, IT-20142 Milan, Italy; (M.G.C.); (N.C.)
| | - Peter Lingström
- Department of Cariology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, SE-41390 Gothenburg, Sweden;
| | - Guglielmo Campus
- Department of Restorative, Preventive and Paediatric Dentistry, University of Bern, CH-3010 Bern, Switzerland; (C.T.); (G.C.)
- Department of Surgery, Microsurgery and Medicine Sciences, School of Dentistry, University of Sassari, IT-07100 Sassari, Italy
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16
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Meghil MM, Hutchens L, Raed A, Multani NA, Rajendran M, Zhu H, Looney S, Elashiry M, Arce RM, Peacock ME, Dong Y, Cutler CW. The influence of vitamin D supplementation on local and systemic inflammatory markers in periodontitis patients: A pilot study. Oral Dis 2019; 25:1403-1413. [PMID: 30912231 DOI: 10.1111/odi.13097] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 02/27/2019] [Accepted: 03/18/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Vitamin D deficiency/insufficiency is a worldwide public health issue that has been linked to numerous inflammatory disorders, including periodontitis. There is increasing support for a role for adequate vitamin D levels in overall health. Populations with darker skin color have a higher prevalence of vitamin D deficiency/insufficiency and periodontitis. The purpose of this small pilot study was to investigate the influence of 12 weeks of 25(OH)D vitamin D supplementation (VDS) on mediators of systemic inflammation in dark-skinned, periodontitis patients. MATERIALS AND METHODS A total of 23 patients with moderate to severe periodontitis were randomly assigned to the vitamin D group or placebo group and received intensive single visit scaling and root planning to elicit a systemic inflammatory response. RESULTS Vitamin D supplementation increased serum 25(OH)D levels approximately 2-fold over baseline levels; moreover, VDS group had reduced peripheral blood CD3 and CD3+CD8+ cytotoxic T lymphocyte (CTLs) counts and reduced pro-inflammatory salivary cytokines. In contrast, VDS group had higher levels of the autophagy-related proteins and other proteins crucial for anti-microbial autophagy in whole blood PBMCs. CONCLUSION In conclusion, VDS has multiple benefits for reducing systemic inflammation and promoting induction of autophagy-related proteins related to anti-microbial functions.
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Affiliation(s)
- Mohamed M Meghil
- Department of Periodontics, The Dental College of Georgia at Augusta University, Augusta, Georgia.,Department of Oral Biology, The Dental College of Georgia at Augusta University, Augusta, Georgia
| | - Lance Hutchens
- Department of Periodontics, The Dental College of Georgia at Augusta University, Augusta, Georgia
| | - Anas Raed
- Georgia Prevention Institute, Augusta University, Augusta, Georgia
| | - Neha A Multani
- Department of General Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, New York
| | - Mythilypriya Rajendran
- Department of Periodontics, The Dental College of Georgia at Augusta University, Augusta, Georgia
| | - Haidong Zhu
- Georgia Prevention Institute, Augusta University, Augusta, Georgia
| | - Stephen Looney
- Department of Biostatistics and Epidemiology, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Mahmoud Elashiry
- Department of Periodontics, The Dental College of Georgia at Augusta University, Augusta, Georgia.,Department of Oral Biology, The Dental College of Georgia at Augusta University, Augusta, Georgia
| | - Roger M Arce
- Department of Periodontics, The Dental College of Georgia at Augusta University, Augusta, Georgia
| | - Mark E Peacock
- Department of Periodontics, The Dental College of Georgia at Augusta University, Augusta, Georgia
| | - Yanbin Dong
- Georgia Prevention Institute, Augusta University, Augusta, Georgia
| | - Christopher W Cutler
- Department of Periodontics, The Dental College of Georgia at Augusta University, Augusta, Georgia
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17
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Dommisch H, Kuzmanova D, Jönsson D, Grant M, Chapple I. Effect of micronutrient malnutrition on periodontal disease and periodontal therapy. Periodontol 2000 2019; 78:129-153. [PMID: 30198127 DOI: 10.1111/prd.12233] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Periodontitis is a complex chronic inflammatory noncommunicable disease, initiated by the development of a dysbiotic microbial plaque biofilm below the gingival margin. Whilst the pathogenic biofilm is a "necessary cause" of periodontitis, it is insufficient on its own to cause the disease, and a destructive immune-inflammatory response is a key to the translation of risk to destructive events. Other exposures or "component causes" include individual genetic predisposition, lifestyle (including smoking and nutrition), and environmental factors. Dietary nutrients are essential for life as they provide crucial energy sources in the form of macronutrients, as well as important cofactors in the form of micronutrients, which regulate the functionality of enzymes during the regulation of anabolic and catabolic processes in human cells. Moreover, micronutrients can regulate gene transcription factors, such as the proinflammatory nuclear factor kappa B and the anti-inflammatory nuclear factor (erythroid-derived 2)-like 2. This review focuses on the role of vitamins (vitamin A, carotenoids, the vitamin B complex, vitamins C, D, and E, and coenzyme Q10) and minerals (calcium, magnesium, iron, zinc, potassium, copper, manganese, and selenium) in human physiology and the impact of their deficiencies upon periodontal health and disease.
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Affiliation(s)
- Henrik Dommisch
- Department of Periodontology and Synoptic Dentistry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Denica Kuzmanova
- Department of Periodontology and Synoptic Dentistry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Daniel Jönsson
- Department of Periodontology, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Melissa Grant
- Periodontal Research Group, School of Dentistry, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Iain Chapple
- Periodontal Research Group, School of Dentistry, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK.,Birminham Community Health Foundation Trust, Birmingham, UK
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18
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Banack HR, Genco RJ, LaMonte MJ, Millen AE, Buck MJ, Sun Y, Andrews CA, Hovey KM, Tsompana M, McSkimming DI, Zhao J, Wactawski-Wende J. Cohort profile: the Buffalo OsteoPerio microbiome prospective cohort study. BMJ Open 2018; 8:e024263. [PMID: 30518590 PMCID: PMC6286477 DOI: 10.1136/bmjopen-2018-024263] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/29/2018] [Accepted: 10/15/2018] [Indexed: 12/15/2022] Open
Abstract
PURPOSE The Buffalo Osteoporosis and Periodontal Disease (OsteoPerio) study is a prospective cohort study focused on the relationship between the microbiome and oral and systemic health outcomes in postmenopausal women. The cohort was established to examine how the oral microbiome is affected by (and how it affects) periodontal disease presence, severity and progression and to characterise the relationship between the microbiome, lifestyle habits and systemic disease outcomes. PARTICIPANTS Participants (n=1342) were postmenopausal women who were participating in the Women's Health Initiative observational study at the Buffalo, New York clinical centre. There were 1026 participants at the 5-year follow-up visit and 518 at the 15-year visit. FINDINGS TO DATE Data collected include questionnaires, anthropometric measures, serum blood and saliva samples. At each clinic visit, participants completed a comprehensive oral examination to measure oral health and the oral microbiome. Preliminary findings have contributed to our understanding of risk factors for periodontal disease and the relationship between the oral microbiome and periodontal disease. FUTURE PLANS The novel microbiome data collected on a large sample of participants at three time points will be used to answer a variety of research questions focused on temporal changes in the microbiome and the relationship between the oral microbiome and oral and systemic disease outcomes. Little is currently known about the relationship between the oral microbiome and health outcomes in older adults; data from the OsteoPerio cohort will fill this gap. Microbiome samples are currently being analysed using next-generation sequencing technology with an anticipated completion date of late 2018.
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Affiliation(s)
- Hailey R Banack
- Department of Epidemiology and Environmental Health, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Robert J Genco
- Departments of Oral Biology, and Microbiology and Immunology, and Center for Microbiome Research, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Michael J LaMonte
- Department of Epidemiology and Environmental Health, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Amy E Millen
- Department of Epidemiology and Environmental Health, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Michael J Buck
- Departments of Biochemistry and Bioinformatics, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Yijun Sun
- Department of Computer Science and Engineering, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Christopher A Andrews
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Kathleen M Hovey
- Department of Epidemiology and Environmental Health, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Maria Tsompana
- Center of Excellence in Bioinformatics and Life Sciences, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Daniel I McSkimming
- Genome, Environment and Microbiome Community of Excellence, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Jiwei Zhao
- Department of Biostatistics, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, University at Buffalo, The State University of New York, Buffalo, New York, USA
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19
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Khammissa RAG, Ballyram R, Jadwat Y, Fourie J, Lemmer J, Feller L. Vitamin D Deficiency as It Relates to Oral Immunity and Chronic Periodontitis. Int J Dent 2018; 2018:7315797. [PMID: 30364037 PMCID: PMC6188726 DOI: 10.1155/2018/7315797] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 08/12/2018] [Indexed: 11/17/2022] Open
Abstract
The biologically active form of vitamin D, 1,25 dihydroxyvitamin D (1,25(OH)2D) and its receptor, the vitamin D receptor (VDR), play roles in maintaining oral immunity and the integrity of the periodontium. Results of observational cross-sectional clinical studies investigating the association between vitamin D serum level and the incidence and severity of chronic periodontitis indicate that, perhaps owing to the immunomodulatory, anti-inflammatory, and antibacterial properties of 1,25(OH)2 D/VDR signalling, a sufficient serum level of vitamin D is necessary for the maintenance of periodontal health. In cases of established chronic periodontitis, vitamin D supplementation is associated with reduction in the severity of periodontitis. As cross-sectional studies provide only weak evidence for any causal association and therefore are of questionable value, either longitudinal cohort studies, case controlled studies, or randomized control trials are needed to determine whether or not deficiency of vitamin D is a risk factor for chronic periodontitis, and whether or not vitamin D supplementation adjunctive to standard periodontal treatment is in any way beneficial. In this article, we discuss the relationship between vitamin D, oral immunity and periodontal disease and review the rationale for using vitamin D supplementation to help maintain periodontal health and as an adjunct to standard periodontal treatment.
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Affiliation(s)
- R. A. G. Khammissa
- Department of Periodontology and Oral Medicine, Sefako Makgatho Health Sciences University, Medunsa 0204, South Africa
| | - R. Ballyram
- Department of Periodontology and Oral Medicine, Sefako Makgatho Health Sciences University, Medunsa 0204, South Africa
| | - Y. Jadwat
- Department of Periodontology and Oral Medicine, Sefako Makgatho Health Sciences University, Medunsa 0204, South Africa
| | - J. Fourie
- Department of Periodontology and Oral Medicine, Sefako Makgatho Health Sciences University, Medunsa 0204, South Africa
| | - J. Lemmer
- Department of Periodontology and Oral Medicine, Sefako Makgatho Health Sciences University, Medunsa 0204, South Africa
| | - L. Feller
- Department of Periodontology and Oral Medicine, Sefako Makgatho Health Sciences University, Medunsa 0204, South Africa
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20
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Gong A, Chen J, Wu J, Li J, Wang L, Goltzman D, Miao D. 1,25-dihydroxyvitamin D deficiency accelerates alveolar bone loss independent of aging and extracellular calcium and phosphorus. J Periodontol 2018; 89:983-994. [DOI: 10.1002/jper.17-0542] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 01/27/2018] [Accepted: 02/03/2018] [Indexed: 01/08/2023]
Affiliation(s)
- Aixiu Gong
- Department of Stomatology; Children's Hospital of Nanjing Medical University; Nanjing PR China
| | - Jie Chen
- State Key Laboratory of Reproductive Medicine; Center for Bone and Stem Cells; Department of Anatomy; Histology and Embryology, Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University; Nanjing PR China
| | - Jun Wu
- State Key Laboratory of Reproductive Medicine; Center for Bone and Stem Cells; Department of Anatomy; Histology and Embryology, Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University; Nanjing PR China
| | - Jing Li
- Department of Stomatology; Children's Hospital of Nanjing Medical University; Nanjing PR China
| | - Lin Wang
- Jiangsu Key Laboratory of Oral Diseases; Department of Orthodontics; School of Stomatology; Nanjing Medical University; Nanjing PR China
| | - David Goltzman
- Calcium Research Laboratory; McGill University Health Centre and Department of Medicine; McGill University; Montreal Canada
| | - Dengshun Miao
- State Key Laboratory of Reproductive Medicine; Center for Bone and Stem Cells; Department of Anatomy; Histology and Embryology, Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University; Nanjing PR China
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21
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Dragonas P, Kaste LM, Nunn M, Gajendrareddy PK, Weber KM, Cohen M, Adeyemi OM, French AL, Sroussi HY. Vitamin D deficiency and periodontal clinical attachment loss in HIV-seropositive women: A secondary analysis conducted in the Women's Interagency HIV Study (WIHS). Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 125:567-573. [PMID: 29550079 PMCID: PMC6002805 DOI: 10.1016/j.oooo.2018.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 01/31/2018] [Accepted: 02/10/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of this study was to test a hypothesized positive association between low vitamin D (VitD) serum levels and the severity of periodontal disease in women with HIV infection. STUDY DESIGN This was a cross-sectional secondary analysis of data from an oral substudy conducted within the Chicago site of the Women's Interagency HIV Study. Serum VitD levels and clinical attachment loss (CAL) measurements were available for 74 women with HIV infection. VitD levels were treated as both continuous and categorical variables in bivariate and multivariate analyses. Mean clinical attachment loss (mCAL) was determined for each subject by obtaining the averages of measurements taken at 4 sites in each measured tooth. RESULTS Average age of study participants (n = 74) was 39.6 years (standard deviation 7.2), and the majority were African Americans (70.3%) with VitD deficiency (58.1%). VitD deficiency was positively associated with higher mCAL (P = .012). After adjustment for race, age, smoking, and HIV viral load, an association was found between VitD deficiency and mCAL (Beta 0.438; P = .036). CONCLUSIONS We identified a previously unreported association between VitD deficiency and mCAL in women with HIV infection. Larger and more inclusive, multisite, longitudinal studies are warranted to investigate whether these findings can be generalized to all individuals with HIV infection in the current treatment era and to determine causality.
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Affiliation(s)
- Panagiotis Dragonas
- Department of Periodontology, College of Dentistry, University of Illinois at Chicago, Chicago, IL, USA
| | - Linda M Kaste
- Department of Pediatric Dentistry, College of Dentistry, University of Illinois at Chicago, Chicago, IL, USA
| | - Martha Nunn
- Department of Periodontics, School of Dentistry, Creighton University, Omaha, NE, USA
| | - Praveen K Gajendrareddy
- Department of Periodontology, College of Dentistry, University of Illinois at Chicago, Chicago, IL, USA
| | - Kathleen M Weber
- The Core Center, Cook County Health and Hospitals System, Chicago, IL, USA
| | - Mardge Cohen
- The Core Center, Cook County Health and Hospital System, Rush University Medical College, Chicago, IL, USA
| | - Oluwatoyin M Adeyemi
- The Core Center, Cook County Health and Hospital System, Rush University Medical College, Chicago, IL, USA
| | - Audrey L French
- The Core Center, Cook County Health and Hospital System, Rush University Medical College, Chicago, IL, USA
| | - Herve Y Sroussi
- Division of Oral Medicine & Dentistry, Brigham and Women's Hospital, Boston, MA, USA.
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22
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Pinto JPNS, Goergen J, Muniz FWMG, Haas AN. Vitamin D levels and risk for periodontal disease: A systematic review. J Periodontal Res 2018; 53:298-305. [PMID: 29492977 DOI: 10.1111/jre.12531] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the existing evidence supporting or refuting the following questions: (i) Do patients with lower vitamin D levels have higher risk for periodontal disease? (ii) Are periodontal treatment outcomes improved by the adjuvant supplementation of vitamin D or by elevated serum vitamin D levels? MATERIAL AND METHODS MEDLINE, SCOPUS, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched up to September 2017. Studies were included if they had measured serum vitamin D levels or vitamin D intake and any periodontal parameter. RESULTS Overall, 27 studies were included (13 cross-sectional studies, 6 case-control studies, 5 cohort studies, 2 randomized clinical trials and 1 case series study). Sixty-five percent of the cross-sectional studies reported significant associations between low vitamin D levels and poor periodontal parameters. None of the observational longitudinal studies found that periodontal disease progression could be attributed to lower vitamin D levels. No interventional studies that evaluated the use of vitamin D supplementation as a solely adjuvant to periodontal treatment was found. No meta-analysis was performed due to high variability across studies. CONCLUSION The data to support or refute the association between vitamin D levels and periodontal disease are inconclusive at the moment. More rigorously designed longitudinal studies with standardized definitions of periodontal disease and vitamin D are necessary.
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Affiliation(s)
- J P N S Pinto
- Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - J Goergen
- Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - F W M G Muniz
- Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - A N Haas
- Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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23
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Teles R, Moss K, Preisser JS, Genco R, Giannobile WV, Corby P, Garcia N, Jared H, Torresyap G, Salazar E, Moya J, Howard C, Schifferle R, Falkner KL, Gillespie J, Dixon D, Cugini M. Patterns of periodontal disease progression based on linear mixed models of clinical attachment loss. J Clin Periodontol 2017; 45:15-25. [PMID: 28985450 DOI: 10.1111/jcpe.12827] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2017] [Indexed: 11/30/2022]
Abstract
AIM The goal of the present longitudinal cohort study was to examine patterns of periodontal disease progression at progressing sites and subjects defined based on linear mixed models (LMM) of clinical attachment loss (CAL). MATERIALS AND METHODS A total of 113 periodontally healthy and 302 periodontitis subjects had their CAL calculated bimonthly for 12 months. LMMs were fitted for each site and the predicted CAL levels used to categorize their progression state. Participants were grouped based on the number of progressing sites into unchanged, transitional and active subjects. Patterns of periodontal disease progression were explored using descriptive statistics. RESULTS Progression occurred primarily at molars (50% of progressing sites) and inter-proximal sites (72%), affected a higher proportion of deep than shallow sites (2.7% versus 0.7%), and pocketing was the main mode of progression (49%). We found a low level of agreement (47%) between the LMM and traditional approaches to determine progression such as change in CAL ≥3 mm. Fourteen per cent of subjects were classified as active and among those 93% had periodontitis. The annual mean rate of progression for the active subjects was 0.35 mm/year. CONCLUSION Progressing sites and subjects defined based on LMMs presented patterns of disease progression similar to those previously reported in the literature.
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Affiliation(s)
- Ricardo Teles
- Department of Periodontics, Penn Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Applied Oral Sciences, Forsyth Institute, Cambridge, MA, USA
| | - Kevin Moss
- Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - John S Preisser
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Robert Genco
- Department of Oral Biology, School of Dental Medicine, State University of New York at Buffalo, Buffalo, NY, USA
| | - William V Giannobile
- Department of Periodontics and Oral Medicine, Michigan Center for Oral Health Research, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Patricia Corby
- New York University College of Dentistry, Bluestone Center for Clinical Research, New York, NY, USA
| | - Nathalia Garcia
- Section of Periodontics, Department of Applied Dental Medicine, Southern Illinois University School of Dental Medicine, Alton, IL, USA
| | - Heather Jared
- Rho Inc., Contract Research Organization, Chapel Hill, NC, USA
| | - Gay Torresyap
- Department of Applied Oral Sciences, Forsyth Institute, Cambridge, MA, USA
| | - Elida Salazar
- Department of Applied Oral Sciences, Forsyth Institute, Cambridge, MA, USA
| | - Julie Moya
- New York University College of Dentistry, Bluestone Center for Clinical Research, New York, NY, USA
| | - Cynthia Howard
- New York University College of Dentistry, Bluestone Center for Clinical Research, New York, NY, USA
| | - Robert Schifferle
- Department of Oral Biology, School of Dental Medicine, State University of New York at Buffalo, Buffalo, NY, USA
| | - Karen L Falkner
- Department of Oral Biology, School of Dental Medicine, State University of New York at Buffalo, Buffalo, NY, USA
| | - Jane Gillespie
- Section of Periodontics, Department of Applied Dental Medicine, Southern Illinois University School of Dental Medicine, Alton, IL, USA
| | - Debra Dixon
- Section of Periodontics, Department of Applied Dental Medicine, Southern Illinois University School of Dental Medicine, Alton, IL, USA
| | - MaryAnn Cugini
- Department of Applied Oral Sciences, Forsyth Institute, Cambridge, MA, USA
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Abstract
Osteoporosis and periodontitis are both diseases characterized by bone resorption. Osteoporosis features systemic degenerative bone loss that leads to loss of skeletal cancellous microstructure and subsequent fracture, whereas periodontitis involves local inflammatory bone loss, following an infectious breach of the alveolar cortical bone, and it may result in tooth loss. Most cross-sectional studies have confirmed the association of osteoporosis and periodontitis primarily on radiographic measurements and to a lesser degree on clinical parameters. Multiple shared risk factors include age, genetics, hormonal change, smoking, as well as calcium and vitamin D deficiency. Both diseases could also be risk factors for each other and have a mutual impact that requires concomitant management. Suggested mechanisms underlying the linkage are disruption of the homeostasis concerning bone remodeling, hormonal balance, and inflammation resolution. A mutual interventional approach is emerging with complex treatment interactions. Prevention and management of both diseases require interdisciplinary approaches and warrants future well-controlled longitudinal and interventional studies for evidence-based clinical guidelines.
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Affiliation(s)
- Chin-Wei Jeff Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, 1101 N. University, Ann Arbor, MI, 48109-1078, USA.
| | - Laurie K McCauley
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, 1101 N. University, Ann Arbor, MI, 48109-1078, USA
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Pavlesen S, Mai X, Wactawski-Wende J, LaMonte MJ, Hovey KM, Genco RJ, Millen AE. Vitamin D Status and Tooth Loss in Postmenopausal Females: The Buffalo Osteoporosis and Periodontal Disease (OsteoPerio) Study. J Periodontol 2016; 87:852-63. [PMID: 27086615 PMCID: PMC4966999 DOI: 10.1902/jop.2016.150733] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Vitamin D is hypothesized to reduce risk for tooth loss via its influence on bone health, inflammation, and the immune response. The association between plasma 25-hydroxyvitamin D [25(OH)D] concentrations and prevalence and 5-year incidence of tooth loss in a cohort of postmenopausal females was examined. METHODS Participants underwent oral examinations at study baseline (1997 to 2000) and follow-up (2002 to 2005) to determine the number of missing teeth and 5-year incidence of tooth loss, respectively. At both visits, females self-reported reasons for each missing tooth. At baseline, 152 females reported no history of tooth loss, and 628 were categorized as reporting a history of tooth loss as a result of periodontal disease (n = 70) or caries (n = 558) (total n = 780). At follow-up, 96, 376, 48, and 328 females were categorized into the aforementioned categories related to tooth loss (total n = 472). Logistic regression was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for tooth loss by category of baseline 25(OH)D (nmol/L) concentrations. Models were adjusted for age, income, smoking status, frequency of dental visits, waist circumference, and recreational physical activity. P value for trend was estimated using continuous concentrations of 25(OH)D. RESULTS Among females with 25(OH)D ≥50 (adequate vitamin D status) compared to <50 nmol/L (deficient/inadequate), the adjusted ORs were 1.24 (95% CI = 0.82 to 1.87), P-trend = <0.05 for the history (prevalence) of tooth loss resulting from periodontal disease or caries and 1.07 (95% CI = 0.62 to 1.85), P-trend = 0.11 for the incidence of tooth loss resulting from periodontal disease or caries. No statistically significant association was observed between 25(OH)D and the history or incidence of tooth loss caused by periodontal disease. An increased odds of the history of tooth loss attributable to caries was observed with increasing concentrations of 25(OH)D (P-trend = <0.05) but was not confirmed in prospective analyses. CONCLUSION In this cohort of postmenopausal females, the data do not support an association between vitamin D status and tooth loss.
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Affiliation(s)
- Sonja Pavlesen
- Department of Epidemiology and Environmental Health, Buffalo, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY
- Department of Orthopedics, School of Medicine and Biomedical Science, University at Buffalo, The State University of New York, Buffalo, NY
| | - Xiaodan Mai
- Department of Epidemiology and Environmental Health, Buffalo, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, Buffalo, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY
| | - Michael J. LaMonte
- Department of Epidemiology and Environmental Health, Buffalo, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY
| | - Kathy M. Hovey
- Department of Epidemiology and Environmental Health, Buffalo, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY
| | - Robert J. Genco
- Department of Oral Biology, School of Dental Medicine and Department of Microbiology and Immunology, School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY
| | - Amy E. Millen
- Department of Epidemiology and Environmental Health, Buffalo, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY
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Eagle I, Benavides E, Eber R, Kolenic G, Jung Y, Van Poznak C, Taichman LS. Periodontal health in breast cancer patients on aromatase inhibitors versus postmenopausal controls: a longitudinal analysis. J Clin Periodontol 2016; 43:659-67. [PMID: 27062507 DOI: 10.1111/jcpe.12562] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2016] [Indexed: 10/22/2022]
Abstract
AIM This study was conducted to determine periodontal changes in postmenopausal breast cancer (BCa) survivors using aromatase inhibitors (AI) as compared to postmenopausal women without BCa. METHODS An 18-month prospective examination of periodontal health in postmenopausal women (29 receiving AI therapy; 29 women without BCa) was conducted at University of Michigan. Comprehensive periodontal examinations including alveolar bone height (ABH) were conducted at baseline, 6, 12, and 18 months. Bisphosphonate, vitamin D, and calcium supplementation were collected via chart review. Linear mixed models were utilized to investigate the relationship between AI and periodontal measures. RESULTS Aromatase inhibitor users had significantly deeper probing depths, more dental plaque and clinical attachment loss as compared to controls at the 6, 12, and 18 month study visits (p < 0.05). ABH loss was seen over time within the AI group. The linear mixed model showed a significant effect of time as well as an interaction between aromatase inhibitor use and calcium supplement status. AI users taking calcium experienced less ABH loss over the study than AI users not taking calcium (p = 0.005). CONCLUSION Aromatase inhibitor therapy has a negative impact on the periodontal health of postmenopausal BCa patients. Calcium supplementation appears to mitigate ABH loss in women on AI.
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Affiliation(s)
- Iwonka Eagle
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Erika Benavides
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Robert Eber
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Giselle Kolenic
- Division of Obstetrics and Gynecology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Younghun Jung
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Catherine Van Poznak
- Hematology and Oncology Division, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - L Susan Taichman
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
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27
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Freudenheim JL, Millen AE, Wactawski-Wende J. Periodontal Disease and Breast Cancer-Response. Cancer Epidemiol Biomarkers Prev 2016; 25:862. [PMID: 27197140 PMCID: PMC4876638 DOI: 10.1158/1055-9965.epi-16-0069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/10/2016] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jo L Freudenheim
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York.
| | - Amy E Millen
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
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Affiliation(s)
- Amy E Millen
- Associate Professor, University at Buffalo, Department of Epidemiology and Environmental Health, Farber Hall, Room 270, 3435 Main Street (South Campus), Buffalo, NY 14214-8001, USA, Tel.: +1 716 829 5377; fax: +1 716 829 2979.
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