Periodontal Disease as a Risk Indicator for Poor Physical Fitness: A Cross-Sectional Observational Study

Twenty-first century knowledge mapping on oral diseases and physical activity/exercise, trends, gaps, and future perspectives: a bibliometric review

Maintenance and improvement of an individual's overall well-being require a multidisciplinary approach that encompasses everything from oral health care to regular physical exercise. The notion that poor oral health can influence general health and athletic performance has sparked an interest in this relationship. This study offers an overview of relevant research and a knowledge map,and discusses publication metrics and key topics concerning the relationship between physical activity or exercise and oral diseases. We searched the Web of Science database for articles published in the 21st century that addressed the relationship between physical activity and oral diseases. Under the stipulated inclusion criteria, a rigorous selection process yielded 276 from 3,883 retrieved articles. The articles were classified by what was assessed as follows: occurrence of oral diseases in athletes or sports enthusiasts (n = 174); impact of physical activity or exercise on the oral cavity (n = 59); effects of oral changes on sports performance and physical fitness (n = 31); and the connection between oral health status, physical activity or exercise, and systemic conditions (n = 12). Orofacial trauma has received the most attention among all investigated oral diseases. However, there is a need for greater attention of dysfunctional habits that can contribute to premature tooth wear, as well as oral inflammatory diseases that can have systemic implications. This mapping can encourage the development of new primary research.

Determining the relationship between oral health and physical function in elderly people

BACKGROUND

Poor oral conditions in the elderly may have numerous effects on general health, including physical fitness and performance.

OBJECTIVES

This study aimed to determine the relationship between oral health and physical function in elderly people.

METHODS

Physical function and oral health parameters were compared using parametric comparison tests and Pearson correlation analyses. In addition, principal components analysis, hierarchical clustering and multidimensional scaling analysis clustered the patients' physical and oral health scores. The relationship between the groups was also determined using decision tree analysis.

RESULTS

A total of 112 elderly patients participated in the study. Grip strength (GS) was higher in patients with high chewing ability, and Timed Up and Go (TUG) scores were lower in the high oral health group (p < .05). GS was correlated with Decay, Missing, and Filled Teeth Index (DMFT) and the number of remaining and functional teeth (p < .05). According to principal component analysis, it was seen that there were three components (oral, functional and quality of life (QoL) parameters), and the features that were related to each other were gathered together. TUG and GS showed the highest relative importance among physical function criteria in the classification based on chewing ability. They were GS and physical activity for oral health-related QoL.

CONCLUSION

In the elderly, higher physical function parameters, especially GS may be an indicator of a better oral health and oral health-related QoL. Preventive physical rehabilitation practices, in addition to oral treatments, may be effective in improving oral health in the elderly.

Oral health and physical performance in Asian military males: The cardiorespiratory fitness and health in armed forces

Background/purpose

It is unclear about whether the oral health has impact on physical performance. Therefore, this study aimed to examine the association between oral health and physical performance in 300 military adults in Taiwan.

Materials and methods

Oral health was assessed by the presence of periodontitis and dental caries. The status of cardiorespiratory and muscular endurance capacity was respectively assessed by tertiles of time for a 3000-m run and 2-min push-up numbers. Multivariable logistic and linear regression analyses with adjustments for age, smoking, alcohol drinking, blood pressure, anthropometric variables, lipid profile, fasting glucose and physical activity were used to determine the association.

Results

Participants with periodontitis were more likely to have worse 3000-m running performance classified in the lowest tertile [odds ratio (OR) and 95% confidence interval: 1.94 (1.03, 3.66)]. Participants with any dental caries were more likely to have worse push-ups performance classified in the lowest tertile [OR: 2.50 (1.27, 4.92)]. In linear regression analyses, dental caries numbers were inversely correlated with 2-min push-ups numbers [β = -1.04 (-2.07, -0.01)].

Conclusion

This study suggests that oral health is crucial to maintain physical fitness, and dental caries and periodontitis may affect differently on aerobic and muscular endurance capacities.

Sports Diet and Oral Health in Athletes: A Comprehensive Review

Food and fluid supply is fundamental for optimal athletic performance but can also be a risk factor for caries, dental erosion, and periodontal diseases, which in turn can impair athletic performance. Many studies have reported a high prevalence of oral diseases in elite athletes, notably dental caries 20-84%, dental erosion 42-59%, gingivitis 58-77%, and periodontal disease 15-41%, caused by frequent consumption of sugars/carbohydrates, polyunsaturated fats, or deficient protein intake. There are three possible major reasons for poor oral health in athletes which are addressed in this review: oxidative stress, sports diet, and oral hygiene. This update particularly summarizes potential sports nutritional effects on athletes' dental health. Overall, sports diet appropriately applied to deliver benefits for performance associated with oral hygiene requirements is necessary to ensure athletes' health. The overall aim is to help athletes, dentists, and nutritionists understand the tangled connections between sports diet, oral health, and oral healthcare to develop mitigation strategies to reduce the risk of dental diseases due to nutrition.

The underlying relationship between exercise and the prevalence of periodontitis: a systematic review and meta-analysis

BACKGROUND

Although exercise has been proposed as an effective intervention for various lifestyle-related diseases and pathological scenarios, few researches assessed the impact of taking exercise on the prevalence of periodontitis.

PURPOSE

This study aimed to perform a comprehensive literature review and meta-analysis from both observational and intervention studies to explore the relationship between exercise and periodontitis and to provide references for future intervention programs aimed at preventing periodontitis.

METHOD

A systematic literature search was conducted in PubMed/MEDLINE, Web of Science, Cochrane Library, and Scopus for peer-reviewed studies published in English From January 1993 to January 2023 according to the PRISMA guidelines. Articles were selected if subjects were human and studies evaluating the association between exercise and periodontitis.

RESULTS

4098 references were retrieved. After screening the results, 30 studies were selected. Of these, 20 studies indicated an inverse association between exercise and periodontitis, while the remaining 10 did not reach conclusive findings. The meta-analysis demonstrated a risk ratio of 0.84 (95%CI: 0.77, 0.91) between the active group and the inactive group (P < 0.01), which indicated an inverse relationship between exercise and periodontitis.

CONCLUSION

Overall, the increase in exercise presents an inverse association with the presence and severity of periodontitis. Accordingly, taking exercise might be a potential approach that contributes to improvements in periodontitis.

Long-term training improves clinical signs of periodontal disease in type 2 diabetic patients: a pilot trial

BACKGROUND

Systemic inflammation is related to diabetes mellitus. Periodontal disease may be considered a local manifestation of systemic inflammation in association with diabetes mellitus. Physical activity may have a positive effect on inflammatory diseases. We investigated the effects of exercise training on periodontal inflammation in diabetic patients.

METHODS

Out of 69 diabetic patients with periodontitis, 40 subjects participated in a recreational training, while 29 subjects performed no training. All underwent a periodontal examination before and after 6.14±1.24 months and completed a dental hygiene questionnaire.

RESULTS

In the long-term training group the following parameters decreased: hemoglobin A1c from 6.7±1.0% to 6.3±0.7% (P<0.007), papillary bleeding score 3 by 60% (P<0.0003), and the mean of all probing pocket depths 4 - 6 mm by 40% (P<0.0001). No significant weight changes and no improvements in oral health behavior were observed in either of the groups. No correlation between hemoglobin A1c or weight and periodontal parameters was found.

CONCLUSIONS

A six-months recreational training was independently related to improved clinical signs of periodontal disease in diabetic subjects.

Oral health problems in high-performance athletes at 2019 Pan American Games in Lima: a descriptive study

INTRODUCTION

Dental care is provided for high-performance athletes at national and international sports events. Elite athletes may seek care for sports-related injuries and pre-existing oral diseases. Previous studies indicate an association between oral health problems and negative performance impacts in elite athletes.

OBJECTIVES

To determine the prevalence of the most common oral pathologies in high-performance athletes during the emergency dental care performed at the Lima 2019 Pan American Games (JPL-19).

METHODOLOGY

All reports of athletes (≥18 years old, of both sexes, from 41 countries) who received emergency dental care at Pan American Villas during the JPL-19 were included. Injuries and types of oral diseases were classified according to the Injury and Disease Surveillance System proposed by the International Olympic Committee.

RESULTS

Of the 6680 participating athletes, 76 (1.14%) presented as dental emergencies, 90.8% (69/76) of the athletes seen presented pre-existing oral pathological conditions, the most frequent were periodontal diseases (34%, 26/76) and dental caries (29%, 22/76). Among the sports with the most cases, there were 22 (29%) in athletics, 6 (8%) in soccer, and 6 (8%) in taekwondo. The most frequent dental emergencies came from Peru, Puerto Rico, Bahamas, Grenada, and Venezuela.

CONCLUSIONS

Pre-existing oral diseases were more frequent than sports-related accidents. The most prevalent diseases were periodontal disease and dental caries disease. It is necessary to implement new care strategies for athletes, based on prevention, before and during sports competitions.

Periodontitis Is Related to Exercise Capacity: Two Cross-sectional Studies

Although a potential link between periodontitis and cardiorespiratory fitness might provide a reasonable explanation for effects of tooth-related alterations seen on cardiometabolic diseases, evidence is currently limited. Thus, we investigated the association between clinically assessed periodontitis and cardiopulmonary exercise testing (CPET). Data from 2 independent cross-sectional population-based studies (5-y follow-up of the Study of Health in Pomerania [SHIP-1; N = 1,639] and SHIP-Trend-0 [N = 2,439]) were analyzed. Participants received a half-mouth periodontal examination, and teeth were counted. CPET was based on symptom limited-exercise tests on a bicycle ergometer. Associations of periodontitis parameters with CPET parameters were analyzed by confounder-adjusted multivariable linear regression. In the total sample, mean pocket probing depth (PPD), mean clinical attachment levels, and number of teeth were consistently associated with peak oxygen uptake (peakVO₂) and exercise duration in both studies, even after restriction to cardiorespiratory healthy participants. Statistically significant associations with oxygen uptake at anaerobic threshold (VO₂@AT), slope of the efficiency of ventilation in removing carbon dioxide, and peak oxygen pulse (VÉ/VCO₂ slope) occurred. Further, interactions with age were identified, such that mainly older individuals with higher levels of periodontal disease severity were associated with lower peakVO₂. Restricted to never smokers, associations with mean clinical attachment levels and the number of teeth mostly diminished, while associations of mean PPD with peakVO₂, VO₂@AT, VÉ/VCO₂ slope, and exercise duration in SHIP-1 and SHIP-Trend-0 were confirmed. In SHIP-1, mean peakVO₂ was 1,895 mL/min in participants with a mean PPD of 1.6 mm and 1,809 mL/min in participants with a mean PPD of 3.7 mm. To conclude, only mean PPD reflecting current disease severity was consistently linked to cardiorespiratory fitness in 2 cross-sectional samples of the general population. If confirmed in well-designed large-scale longitudinal studies, the association between periodontitis and cardiorespiratory fitness might provide a biologically plausible mechanism linking periodontitis with cardiometabolic diseases.

The impact of oral health on physical fitness: A systematic review

Background

Oral health problems may have numerous effects on general health, including physical fitness and performance. In this review, we aimed to systematically review the available evidence to assess the effect of oral health on general physical fitness.

Methods

We systematically performed a literature search in two different databases (PUBMED and EMBASE) without restriction to the year of publication. Articles were included if the subjects were humans and the primary aim was to assess the effects of dental and/or oral health problems on physical activity using either objective physical measurements or physical performance tests. The quality of the studies was then assessed using a Joanna Briggs Institute (JBI) Critical Appraisal tool.

Results

A total of 2651 articles were initially retrieved from the systematic search of the literature. Of these, a final total of 11 articles following the inclusion criteria were included in the review. All of the 11 articles included in the review had good methodological quality. Of the 11 articles, ten articles suggested a correlation between dental and oral condition toward physical fitness, body balance, cardiorespiratory function, and also cognitive function. Only one article found contradictory results, which showed that periodontal conditions did not correlate with the cardiorespiratory function. Malocclusion, including the number of remaining teeth, was reported in five studies (45.4%), periodontal disease was evaluated in six studies (54.5%), along with slight evaluation of periapical inflammation.

Conclusion

This review suggests that there is a negative effect of poor dental and/or oral health on physical fitness and performance.

The Impact of Oral Health on Work Performance of Japanese Workers

OBJECTIVE

The aim of this study was to investigate the association between oral health and work performance measured as absenteeism and presenteeism.

METHODS

Study participants were employees (mean age: 42.7 ± 11.4 years) of 11 companies in Japan. Oral examination and self-administered questionnaires provided information on industrial category, work schedule, work performance (absenteeism and presenteeism), and smoking status.

RESULTS

The proportion of absenteeism (2.7%) or presenteeism (6.8%) of workers caused by oral health problems was low. Logistic regression analysis showed that the risk of absenteeism due to oral health problems was not significantly related to occupation or oral health status. However, the risk of presenteeism caused by oral health problems was 2.01 (95% confidence interval, 1.03 to 3.92) times higher among participants with periodontitis.

CONCLUSIONS

Periodontal disease is associated with presenteeism of workers. It is considered that the periodontal disease countermeasure in the workplace should be provided.

Clinical periodontal status and inflammatory cytokines in primary Sjögren syndrome and rheumatoid arthritis

BACKGROUND

The aim of the present study is to compare the clinical periodontal findings as well as gingival crevicular fluid (GCF) and plasma levels of tumor necrosis factor-alpha (TNF-α), interleukin-1beta (IL-1β), interferon gamma (IFN-γ) and caspase-1 in primary Sjögren syndrome (pSS) and rheumatoid arthritis (RA) subjects.

METHODS

In the present case control study plasma and GCF samples were collected, full-mouth recordings comprising plaque index (PI), bleeding on probing (BOP) and probing depth (PD) were performed in 44 subjects with pSS, 39 subjects with RA and 30 systemically healthy subjects. Plasma and GCF TNF-α, IL-1β, IFN-gamma and caspase-1 levels were determined by enzyme-linked immunosorbent assay.

RESULTS

There were no differences in GCF and plasma levels of IFN-γ and TNF-α in all the study groups (p > 0.05). GCF levels of IL-1β were higher in pSS group than healthy group (p = 0.035). Caspase-1 GCF levels were significantly higher in pSS group than RA group (p = 0.032). Highest plasma IL-1β levels were detected in pSS compared to RA and healthy groups (p < 0.001). Healthy group has higher caspase-1 plasma levels than pSS and RA groups (p < 0.001).

CONCLUSIONS

The results of the present study reveal that the periodontal status of patients with pSS does not differ from systemically healthy subjects. Further studies involving longitudinal assessments on larger populations with standardized patient inclusion criteria are needed to confirm the findings.

Physical Activity Reduces the Prevalence of Periodontal Disease: Systematic Review and Meta-Analysis

Background: Regular physical activity boosts several physical capacities and reduces many inflammatory markers of several diseases. In this sense, periodontal disease is a multifactorial inflammatory disease of tooth supporting tissues that has been claimed to trigger processes of systemic alterations. The aim of this systematic review and meta-analysis was to assess the effects of physical activity on periodontal disease.

Methods: Observational studies published until August 2018 were searched in online databases (PubMed, Scopus, Web of Science, The Cochrane Library, LILACS, OpenGrey, and Google Scholar) after developing a PECO statement that focused on the comparison between adults that followed a routine of exercises or presented a sedentary lifestyle and its effects on periodontal disease. Searching and data extraction were conducted by following PRISMA guidelines. Registration protocol: CRD42016049661. Quality assessment and risk of bias were analyzed by following Fowkes and Fulton protocol.

Results: A total of 512 references were retrieved, while only seven were considered eligible. Two meta-analysis involving the prevalence of periodontal disease and unadjusted/adjusted Odds ratio were performed. One of studies did not find association between clinical periodontal parameters and physical activity. Six articles suggested an association between periodontal disease and regular practice of physical activity since a reduction of periodontal prevalence was observed. Moderate level of evidence was demonstrated on GRADE analysis.

Conclusion: Physical activity was associated as a potential tool for reduction of periodontal disease prevalence. The frequency of physical activity is directly related to a low occurrence of periodontitis. However, it is important that further investigations evaluate the effects of other exercise variables, such as volume and intensity, on the periodontal disease prevalence.

Experimental Periodontitis in the Potentialization of the Effects of Immobilism in the Skeletal Striated Muscle

This study aims to evaluate if ligature-induced periodontitis can potentiates the deleterious effects of immobilization in the skeletal striated muscle, contributing to the development of muscle atrophy due to disuse. Forty Wistar rats were divided into four groups: (1) Control Group (CG), (2) Periodontal Disease (PDG), (3) Immobilized (IG), and (4) Immobilized with Periodontal Disease (IPDG). Periodontal disease was induced for 30 days, with ligature method, and the immobilization was performed with cast bandage for 15 days. Prior to euthanasia, nociceptive threshold and muscular grasping force were evaluated. Afterwards, the soleus muscle was dissected and processed for sarcomere counting and morphological/morphometric analysis. For data analysis, was used the one-way ANOVA and post-test Tukey (p < 0.05). The IG and IPDG presented lower muscle weight, lower muscular grip strength, and less number of sarcomeres compared to CG. The PDG showed reduction of muscle strength and nociceptive threshold after 15 days of periodontal disease and increased connective tissue compared to CG. The IPDG presented lower muscle length and nociceptive threshold. The IG presented reduction in cross-sectional area and smaller diameter, increase in the number of nuclei and a nucleus/fiber ratio, decrease in the number of capillaries and capillary/fiber ratio, with increase in connective tissue. The IPDG had increased nucleus/fiber ratio, decreased capillaries, and increased connective tissue when compared to the IG. The IPDG presented greater muscle tissue degeneration and increased inflammatory cells compared to the other groups. Ligature-induced periodontitis potentiated the deleterious effects of immobilization of the skeletal striated muscle.