Associations Among Oral Hygiene Behavior and Hypertension Prevalence and Control: The 2008 to 2010 Korea National Health and Nutrition Examination Survey

Chronic periodontal disease is related with newly developing hypertension: a nationwide cohort study

BACKGROUND

Periodontal disease (PD) is a condition that can be treated and managed. This study aimed to determine if chronic PD status is associated with the risk of developing hypertension, utilizing data from the National Health Insurance Database of Korea.

METHODS

Participants who received oral health examinations both in 2003 and in 2005-2006 were included. Those with a history of hypertension were excluded. Hypertension was defined as at least one outpatient or inpatient claim diagnosis (primary or secondary) of hypertension (International Classification of Diseases (ICD)-10 codes I10-I11) with prescription for antihypertensive medication or at least one incident of systolic blood pressure greater than 140 mmHg or diastolic blood pressure greater than 90 mmHg during a health examination. Changes of PD status was determined during two oral examinations. Study participants were divided into 4 groups according to the changes of PD status: PD-free (those consistently free of disease in both exams), PD-recovered (individuals with disease initially but not in the second exam), PD-developed (no disease initially, but present in the second exam), and PD-chronic (disease throughout both exams). The incidence of hypertension after the second oral health examination (index date) was monitored. Participants were observed from the index date until the earliest occurrence of hypertension onset, mortality, or December 2020.

RESULTS

The study comprised 706,584 participants: 253,003(35.8%) in the PD-free group, 140,143(19.8%) in the PD-recovered group, 132,397(18.7%) in the PD-developed group, and 181,041(25.6%) in the PD-chronic group. Over a median follow-up duration of 14.3 years, 239,937 (34.0%) cases of hypertension were recorded. The PD-recovered group had a lower risk of hypertension compared to the PD-chronic group, while the PD-developed group had a higher risk of hypertension compared to the PD-free group.

CONCLUSION

Chronic PD is associated with an increased risk of developing hypertension. Although the increase in risk is modest, recovery from PD may have beneficial effects in reducing hypertension risk. Further studies are needed to confirm the importance of regular dental examinations and effective management of PD to reduce hypertension risk.

Oral Health and Risk of Retinal Vascular Occlusions: A Nationwide Cohort Study

Retinal vascular occlusions are a common cause of visual loss. The association between oral health and the risk of retinal vascular occlusions remains unknown. We investigated whether oral health was associated with the risk of retinal vascular occlusions. We conducted a retrospective cohort study including 138,484 participants who completed a national health screening program with an oral health examination from the National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS) 2002-2015. Oral health markers, such as the presence of periodontitis, tooth loss, and dental caries, and the frequency of daily tooth brushing, were evaluated. The primary outcome was the occurrence of retinal vascular occlusions up to December 2015. In total, 2533 participants developed retinal vascular occlusions (215 with retinal artery occlusion, 1686 with retinal vein occlusion, 632 with unspecified retinal vascular occlusion). In the multivariable Cox regression analysis, periodontitis was an independent risk factor for retinal vascular occlusions (adjusted hazard ratio: 1.18; 95% confidence interval: 1.02-1.36; p = 0.024). Frequent tooth brushing was negatively associated with the risk of retinal vascular occlusions (adjusted hazard ratio: 0.89; 95% confidence interval: 0.80-0.98; p = 0.022). Improving oral hygiene may contribute to the attenuation of the risk of retinal vascular occlusions.

Home oral hygiene is associated with blood pressure profiles: Results of a nationwide survey in Italian pharmacies

AIM

Periodontal diseases are associated with cardiovascular risk factors/diseases, and whether home oral hygiene practices are inversely related to the same conditions could carry relevant practical implications. We investigated the association of home oral hygiene habits with hypertension.

MATERIALS AND METHODS

During World Hypertension Day 2020, a nationwide cross-sectional survey was conducted on volunteers ≥18 years at 733 Italian pharmacies. Participants underwent standardized blood pressure (BP) measurement and answered a questionnaire on cardiovascular risk factors, oral health status, and home oral hygiene habits (toothbrushing daily frequency and manual/electric toothbrush). The association between home oral care habits and BP was assessed using multivariate logistic regression. Interactions between exposures and outcome were formally tested.

RESULTS

Among the 4506 participants (44.8% males, 66.1 ± 37.8 years), 47.6% reported brushing ≥3 times/day and 23.4% declared using the electric toothbrush. Brushing ≥3 versus <3 times/day and use of electric versus manual toothbrush were associated with 19% (odds ratio [OR]: 0.81, 95% confidence interval [CI] 0.70-0.94) and 28% (OR: 0.72, 95% CI 0.61-0.85) lower odds of hypertension, respectively. No significant additive interaction was observed in the association of exposures with the outcome.

CONCLUSIONS

Regular daily brushing and electric toothbrushing are associated with a better BP profile in a real-world context. Future interdisciplinary research is warranted to test these findings.

A comparison of unhealthy lifestyle practices among adults with hypertension aware and unaware of their hypertensive status: results from the 2013 WHO STEPS survey in Burkina Faso

BACKGROUND

We compared the prevalence of unhealthy lifestyle factors between the hypertensive adults who were aware and unaware of their hypertensive status and assessed the factors associated with being aware of one's hypertension among adults in Burkina Faso.

METHODS

We conducted a secondary analysis of data from the World Health Organization Stepwise approach to surveillance survey conducted in 2013 in Burkina Faso. Lifestyle factors analysed were fruits and vegetables (FV) consumption, tooth cleaning, alcohol and tobacco use, body mass index and physical activity.

RESULTS

Among 774 adults living with hypertension, 84.9% (95% CI: 82.2-87.3) were unaware of their hypertensive status. The frequencies of unhealthy lifestyle practices in those aware vs. unaware were respectively: 92.3% vs. 96.3%, p = 0.07 for not eating, at least, five FV servings daily; 63.2% vs. 70.5%, p = 0.12 for not cleaning the teeth at least twice a day; 35.9% vs. 42.3%, p = 0.19 for tobacco and/or alcohol use; 53.9% vs. 25.4%, p = 0.0001 for overweight/obesity and 17.1% vs, 10.3%, p = 0.04 for physical inactivity. In logistic regression analysis, older age, primary or higher education, being overweight/obese [adjusted odds ratio (aOR) = 3.2; p < 0.0001], intake of adequate FV servings daily (aOR = 2.9; p = 0.023) and non-use of alcohol and tobacco (aOR = 0.6; p = 0.028) were associated with being aware of one's hypertensive status.

CONCLUSION

Undiagnosed hypertension was very high among Burkinabè adults living with hypertension. Those aware of their hypertension diagnosis did not necessarily practise healthier lifestyles than those not previously aware of their hypertension. Current control programmes should aim to improve hypertension awareness and promote risk reduction behaviour.

Effect of Coffee on Lipopolysaccharide-Induced Immortalized Human Oral Keratinocytes

Periodontitis is a common inflammatory disease that is strongly influenced by dietary habits. Coffee is one of the most common dietary components; however, current research on the relationship between coffee consumption and periodontitis, as well as its underlying mechanisms, is limited. Based on a previous report, caffeine (CA) and chlorogenic acid (CGA) were formulated into artificial coffee (AC) for this experiment. Cell viability, prostaglandin E2 release, Western blotting, cellular reactive oxygen species (ROS) production, and NF-E2-related factor 2 (Nrf2) translocation analyses were performed to explore the effects of AC on lipopolysaccharide (LPS)-induced immortalized human oral keratinocytes (IHOKs) and elucidate their underlying mechanisms. AC pretreatment attenuated LPS-induced inflammatory mediator release, ROS production, and nuclear factor kappa B translocation in IHOKs. CA and CGA promoted AMP-activated protein kinase phosphorylation and down-regulated the nuclear factor-κB pathways to exert anti-inflammatory effects. Additionally, CGA promoted Nrf2 translocation and heme oxygenase-1 expression and showed anti-oxidative effects. Furthermore, AC, CA, and CGA components showed synergistic effects. Thus, we predict that coffee consumption may be beneficial for alleviating periodontitis. Moreover, the main coffee components CA and CGA seem to play a synergistic role in periodontitis.

Meta-analysis on the association between the frequency of tooth brushing and hypertension risk

It is unclear whether the frequency of tooth brushing affects the risk of hypertension; thus, we conducted the first meta-analysis to focus on this topic. In this meta-analysis, we systematically searched the PubMed, Scopus, and Web of Science databases from their inception to October 2021 to identify eligible studies, while reference lists from retrieved review paper were also reviewed. We then conducted a meta-analysis of the highest compared with the lowest tooth brushing frequency, along with a dose-response meta-analysis, to explore this association. Subgroup and sensitivity analyses were conducted to identify the sources of heterogeneity. Publication bias was evaluated using Begg's and Egger's tests. We found eight relevant studies, three cohort and five cross-sectional, involving a total of 274 124 patients. Compared to the highest tooth brushing frequency, the lowest increased the risk of hypertension by 84.0% (OR 1.84; 95% CI, 1.44-2.35). Furthermore, a nonlinear dose-response relationship was observed (P < .05). The exclusion of any studies did not significantly alter the combined risk estimate, and no publication bias was detected. In conclusions, we report that epidemiological evidence supports the hypothesis that a lower frequency of tooth brushing is significantly associated with a higher risk of hypertension. Preventive interventions, such as adopting a good oral health routine, should be encouraged to maintain good general health.

Association of periodontitis, missing teeth, and oral hygiene behaviors with the incidence of hypertension in middle-aged and older adults in Korea: A 10-year follow-up study

BACKGROUND

The relationship between periodontitis and hypertension remains controversial. This study aimed to investigate the association of periodontitis, missing teeth, and oral hygiene behaviors with the incidence of hypertension.

METHODS

A total of 104,349 participants were selected from the National Health Insurance System-Health Screening cohort. Incident hypertension and periodontitis were diagnosed based on the patients' clinical records and health examinations. A multivariable Cox proportional hazards regression analysis was performed after adjusting for socioeconomic factors, coexisting disease, and health behaviors.

RESULTS

The mean age of the participants was 51.1 years (range, 40-79 years) at baseline, and 55.1% were men. A total of 52,855 incident hypertension cases were identified during the median follow-up period of 9.6 years. Among the participants, periodontitis (hazard ratio [HR]: 1.02, 95% confidence interval [95% CI]: 1.00-1.04), number of missing teeth (for ≥15 group, HR: 1.40, 95% CI: 1.29-1.52), dental scaling (HR: 0.93, 95% CI: 0.91-0.95), and tooth brushing frequency (for ≥3 group, HR: 0.85, 95% CI: 0.83-0.88) were significantly associated with incident hypertension after full adjustments for covariates. While periodontitis was significantly associated with incident hypertension (HR: 1.04, 95% CI: 1.02-1.06) in the middle-aged group (40-64 years), the effect was insignificant in the older group (≥65 years).

CONCLUSION

Oral inflammation could contribute to the incidence of hypertension; thus, efforts to reduce oral inflammation should be encouraged. Future intervention studies are warranted to determine whether oral health care could be beneficial in the management of hypertension. This article is protected by copyright. All rights reserved.

Associations of oral hygiene with incident hypertension and type 2 diabetes mellitus: A population based cohort study in Southwest China

Oral health has been previously reported to be related with cardiovascular diseases (CVD). This study aimed to evaluate whether oral hygiene could reduce the risk of incident hypertension and type 2 diabetes mellitus (T2DM) in a population-based cohort. A total of 9280 people aged 18 years or above in Guizhou province were recruited from November 20th, 2010 to December 19th, 2012. Sociodemographic characteristics, lifestyles, anthropometric measurements, oral health status and care were collected by trained interviewers. The occurrences of hypertension and T2DM were ascertained until 2020. Cox proportional hazard models were used to evaluate the associations between oral hygiene and the occurrence of hypertension and T2DM, respectively. Compared with almost no tooth brushing, tooth brushing at least twice a day was associated with a 45% reduction (HR: .55; 95% CI: .42-.73) in hypertension events and reduced diabetes risk by 35% (HR: .65; 95% CI: .45-.94). For hypertension, those associations tended to be more pronounced in participants with Han ethic, or living in urban area, while those aged less than 60 or without baseline hypertension were more likely to have T2DM when they brush teeth less than twice a day. Frequent tooth brushing was associated with reduced risks of incident hypertension and T2DM. Tooth brushing at least twice a day may prevent future hypertension and T2DM events.

Evaluation of the Effects of Mouthwash on the Morphology and Cell Viability of Osteoblast-Like Cells

This study evaluated the effects of multiple mouthwashes on the cellular viability or the morphology of preosteoblasts. Mouse calvarial osteoblast-like cells were cultured and treated with mouthwashes of (1) benzydamine hydrochloride; (2) cetylpyridinium chloride and benzalkonium chloride; (3) methyl salicylate, menthol, eucalyptol, and thymol; and (4) sodium fluoride, xylitol, and chitosan. The treatment times were 30 seconds, 90 seconds, and 270 seconds. Cell morphology was evaluated with a microscope, and the viability of the treated cells was analyzed quantitatively using a commercially available kit. The untreated control group exhibited well-stretched fibroblast-like morphology. Treatment with mouthwash resulted in morphological changes in all groups. Treatment with sodium fluoride resulted in more noticeable changes. Treatment with mouthwash for 30 seconds produced a significant decrease in cell viability. An increase in time to 90 and 270 seconds did not produce additional noticeable changes. To conclude, commercially available mouthwashes created changes in cell morphology and decreased the cell viability of osteoblast-like cells irrespective of ingredients and treatment time.

Oral health and atherosclerotic cardiovascular disease: A review

Periodontal disease (PD) is common in the US and globally. Evidence suggests that poor oral health is associated with atherosclerotic cardiovascular disease (ASCVD); however, this relationship has not been a major focus in clinical cardiology. This manuscript will review the growing evidence linking PD to ASCVD, including pathophysiologic mechanisms and coexistent risk factors. Public health considerations with a focus on disparities, social determinants, preventive strategies, and a call to action to reduce the burden of coincident ASCVD and PD are also reviewed.

Association between Oral Hygiene and Metabolic Syndrome: A Systematic Review and Meta-Analysis

Emerging evidence has linked poor oral hygiene to metabolic syndrome (MetS), but previously, no summary of evidence has been conducted on the topic. This systematic review and meta-analysis aims to evaluate the associations of oral hygiene status and care with MetS. A systematic search of the PubMed and Web of Science databases from inception to 17 March 2021, and examination of reference lists was conducted to identify eligible observational studies. A random-effects model was applied to pool the effects of oral hygiene status and care on MetS. Thirteen studies met the inclusion criteria and had sufficient methodological quality. Good oral hygiene status (OR = 0.30 (0.13-0.66); I2 = 91%), frequent tooth brushing (OR = 0.68 (0.58-0.80); I2 = 89%), and frequent interdental cleaning (OR = 0.89 (0.81-0.99); I2 = 27%) were associated with a lower risk of MetS. Only one study examined the association between dental visits and MetS (OR = 1.10 (0.77-1.55)). Our findings suggested that there might be inverse associations of oral hygiene status, tooth-brushing frequency, and interdental cleaning with MetS. However, substantial heterogeneity for tooth-brushing frequency and inconsistent results for oral hygiene status in subgroup analyses were observed. There was insufficient evidence for the association between dental visits and MetS. Further longitudinal studies are needed to investigate these associations.

Tooth loss is associated with an increased risk of hypertension: A nationwide population-based cohort study

Tooth loss is closely associated with suboptimal oral care. Suboptimal oral care can facilitate local infections. These can lead to systemic inflammation and endothelial dysfunction, which are important pathological mechanisms of hypertension. The aim of this study was to investigate the link between tooth loss and the risk of hypertension. From the national health insurance system-health screening cohort in Korea, 19,680 participants who underwent three or more health examinations, including blood pressure measurements, between January 2003 and December 2008, without any history or diagnosis of hypertension were included in this study. Hypertension was defined as the diagnosis of hypertension (International Classification of Diseases-10 code “I10–11”) accompanied by the prescription of an antihypertensive agent or at least one health examination result of blood pressure of ≥140/90 mmHg. Kaplan-Meier survival curves with the log-rank test were used to evaluate the relationship between oral hygiene indicators and the incidence of hypertension. Cox proportional hazard models were applied to determine the association between oral hygiene indicators and the development of hypertension. During a median follow-up of 7.4 years, 1,853 patients developed hypertension. The estimated incidence of hypertension within seven years was 8.8%. Multivariable analysis confirmed a significant relationship between the number of lost teeth and hypertension (hazard ratio: 2.26; 95% confidence interval [1.24–4.10], p = 0.007, p for trend = 0.005). There was a positive association between the number of lost teeth and the risk of hypertension in a longitudinal research. In conclusion, the number of lost teeth may be associated with the risk of development of hypertension.

Association between toothbrushing and non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) is considered the hepatic manifestation of metabolic syndrome. Periodontitis, as chronic inflammatory destructive disease, is associated metabolic syndromes bidirectionally. Toothbrushing is an essential and important way to manage periodontitis through mechanical removal of biofilm at periodontal tissue. We aimed to assess the association between toothbrushing frequency and the prevalent NAFLD in nationally representative Korean adults. Among adults aged 19 years and older who participated in the Korea National Health and Nutrition Examination Survey in 2010, a total of 6,352 subjects were analyzed. NAFLD was defined as fatty liver index ≥60. Multiple logistic regression analysis was used to estimate multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs). An inverse association between toothbrushing frequency and NAFLD was found. The adjusted ORs (95% CIs) of NALFD was 0.56 (0.35-0.91) in the group who performed toothbrushing ≥ 3 per day compared to the group that performed toothbrushing ≤ 1 per day. For those with toothbrushing frequency ≤1 per day, the adjusted OR (95% CIs) of NAFLD was 2.26 (1.22-4.19) in smokers and 4.52 (1.97-10.38) in subjects with diabetes mellitus (DM), compared to those without the disease and with toothbrushing frequency ≥2 per day, respectively. Our results indicate that higher frequency of toothbrushing is inversely associated with NAFLD. As a modifiable oral habit, regular toothbrushing may be recommended to lower risk of NAFLD, especially in high risk groups such as smokers and diabetic patients.

Association Between Periodontitis and Blood Pressure Highlighted in Systemically Healthy Individuals: Results From a Nested Case-Control Study

[Figure: see text].

[Arterial hypertension and oral disease in adolescents]

AIM

To establish significant associations between hypertension and the presence and severity of common oral diseases in adolescents.

MATERIAL AND METHODS

A cross-sectional study was conductedWith participation of 130 adolescents, from which 2 groups were formed, matched by sex and age (n=65; 38 boys and 28 girls in each group). Inclusion criteria: age 10-17 years; hypertension for inclusion in the group of «cases» and a normal level of blood pressure for inclusion in the control group; informed voluntary consent to participate in the study. A diagnosis of hypertension was confirmed by daily monitoring of blood pressure. The frequency and severity of the clinical manifestations of the main oral diseases: caries, gingivitis, periodontitis were evaluated in the groups. Regression models have been adjusted for the index of oral hygiene and body weight.

RESULTS

Hypertensive adolescents were significantly likely to have dental caries (50 (77% vs 32 (49%), p=0.001), periodontitis (26 (40%) vs 6 (9%), p=0.001) and moderate to severe gingivitis (12 (18%) vs 2 (3%), p=0.009), than in the control group. In the adjusted regression models, significant associations of hypertension with periodontitis (OR 3.9, 95% CI 1.4-10.5) and dental caries (OR 3, 95% CI 1.3-7.1) were established. It is also shown that hypertension is associated with more pronounced signs of periodontal inflammation (OR 3, CI 1.6-5.6).

CONCLUSION

Results suggest that hypertension in adolescents is associated with poorer oral health. It is advisable to take this into account when developing a synergistic approach to the medical support of these patients, aimed at reducing cardiovascular risk in the long term.

Active gingival inflammation is linked to hypertension

BACKGROUND

Cardiovascular diseases (CVD) including hypertension, are characterized by underlying systemic inflammation. Periodontitis, which can impact the systemic inflammatory burden has recently been linked to high blood pressure (BP). However, the relationship of gingival bleeding, as an easily accessible marker of periodontal disorder, with hypertension, remains unclear.

METHODS

Survey-based propensity score matching (PSM) incorporating major confounders shared between hypertension and periodontal diseases was applied to cross-sectional NHANES III data from 5396 adults at least 30 years old who underwent BP measurement and periodontal examination, identifying two matched groups with and without gingival bleeding. The association of bleeding gums with SBP (mmHg) and high/uncontrolled BP was then assessed with generalized additive models incorporating inflammatory markers. Stratification by periodontal status (healthy; gingivitis; stable periodontitis; unstable periodontitis) was performed. Variables importance was estimated using machine learning.

RESULTS

Gingival bleeding (gingivitis; unstable periodontitis) was independently associated with +2.6 mmHg (P < 0.001) SBP compared with no bleeding (healthy periodontium; stable periodontitis), and with greater odds (OR = 1.42; 95% CI = 1.19-1.68; P < 0.001) of high/uncontrolled BP. Participants with unstable periodontitis had higher SBP than those with stable periodontitis (+2.1 mmHg; P < 0.001) or gingivitis (+5.3 mmHg; P < 0.001). Unstable periodontitis and gingivitis were consistently associated with increased risk of high/uncontrolled BP (OR = 1.65, 95% CI = 2.14-1.82; OR = 1.49, 95% CI = 1.22-1.82, respectively). Inflammatory markers allowed a maximum of 12% gain in the models' predictive power.

CONCLUSION

Gingival bleeding contributes to shaping the relationship between periodontal diseases and BP, but the burden represented by periodontitis is also crucial. Periodontal evaluation might be of importance in difficult to control hypertension.

Tooth loss and risk of end-stage renal disease: A nationwide cohort study

BACKGROUND

The association between renal disease and oral health has been studied in previous researches. The purpose of this study is to evaluate whether oral health, depicted by number of natural teeth was associated with an increased risk of kidney diseases.

METHODS

The present study analysed data from the Korean National Health Insurance from 2007 to 2008. Database of 4,544,610 individuals who received routine health checkups and dental examinations were included in this study.

RESULTS

There was an increase in end-stage renal disease with lower number of natural teeth and longer follow-up periods. Hazard ratios and their 95% confidence intervals for end-stage renal disease in participants with a number of natural teeth of 28, 24 to 27, 20 to 23, and <20 were one (reference), 1.066(0.997,1.139), 1.285(1.161,1.422), and 1.285(1.155,1.429), respectively. The association was significantly noted with age and body mass index (P < 0.05). In general, the substantial increase in hazard ratios is seen with loss of teeth and smoking. Hazard ratios and their 95% confidence intervals for end-stage renal disease in male smoking participants with a number of natural teeth <28 is 1.631(1.339,1.988). However, this association was not noted in female group.

CONCLUSIONS

The association between number of natural teeth and end-stage renal disease was suggested after adjusting for confounding factors by using multiple logistic regression analyses from the entire South Korean population. Oral health, depicted by the number of tooth loss showed strong and dose-dependent association with end-stage renal disease in a large population-based cohort.

The effectiveness of an oral hygiene program combined with health-promoting counseling for rural adults with cardiometabolic risks: A quasi-experimental design

AIM

The aim of this study was to explore the effectiveness of an oral hygiene program combined with home-phone health promoting counseling for rural adults with metabolic syndrome.

BACKGROUND

Metabolic syndrome is an important risk factor for cardiometabolic diseases. Evidence indicates that the poor oral hygiene and unhealthy lifestyles are closely related to metabolic syndrome.

METHODS

A prospective quasi-experimental design involved a total of 136 community adults, with metabolic syndrome living in two rural townships, were clustered and conveniently assigned to intervention and control group between June 2017 and December 2018. The primary outcome was the change in cardiometabolic biomarkers. The secondary outcome comprised changes in the health-promoting behaviors. The intervention effect was assessed using a generalized estimating equation model.

RESULTS

There were 80 and 56 participants in the intervention and control group, respectively. The mean age was 56 years and ranged from 33 to 70 years. The intervention group exhibited a greater improvement in body mass index (P < 0.01), waist circumference (P < 0.05), body fat percentage (P < 0.05), triglyceride level (P < 0.05), use of dental floss (P < 0.05), regular tooth scaling (P < 0.05), physical activity (P < 0.001), and total score of health-promoting behaviors (P < 0.001) than the control group.

CONCLUSION

This study supports the use of an oral hygiene program combined with home-phone counseling, which offers more advantages than its counterpart. Considering the global epidemic of cardiometabolic diseases, this is a community health nursing model worth to replicate and evaluate. Further study should consider innovative strategies to improve the awareness and adoption of a healthy lifestyle in residents with cardiometabolic risks.

Relationship between oral health behaviour and handgrip strength: a cross-sectional study with 7589 Korean adults

Objective: This cross-sectional study investigated the relationship between handgrip strength and oral health behaviours among Koreans.Methods: The data of 7589 individuals (3384 men and 4205 women) aged ≥19 years who participated in the Korea National Health and Nutrition Examination Survey 2014-2015 were analyzed. Oral health behaviour was assessed based on the number of daily toothbrushing sessions and the use of secondary oral-care products. The association between oral-health behaviour and handgrip strength was investigated adjusting for confounders. Multivariable logistic regression analysis was performed (α = 0.05).Results: The proportion of participants diagnosed with sarcopenia was significantly higher in the group with poor oral-health behaviours. After adjusting for confounders including age, the adjusted odds ratios and 95% confidence intervals of female participants with low handgrip strength in groups toothbrushing thrice or more per day, twice per day, and once or less per day were 1 (reference), 1.18 (0.99-1.4), and 1.24 (0.89-1.71), respectively. There were significantly more participants with low handgrip strength in the group that did not use secondary oral products for both sexes.Conclusions: Oral health behaviour is associated with handgrip strength among adults. Poor oral self-care habits may constitute a risk indicator for low muscle strength.

The state of periodontum and cardiovascular risk factors in adolescents with high blood pressure

Objective — To establish significant associations between periodontium status, circadian blood pressure (BP) profile and cardiovascular risk factors in adolescents with high BP. Material and Methods — The cross-sectional study involved 113 adolescents (78 boys) aged 10 to 17 years, with a BP level (during repeated office measurements) of ≥95 percentile for age, height and sex, or ≥140/90 mmHg in adolescents older than 16 years. All adolescents were subjected to 24-hour blood pressure monitoring, anthropometric measurements, laboratory blood tests (lipids, uric acid, alanine aminotransferase, aspartate aminotransferase, fasting glucose), echocardiography (left ventricular myocardial mass index, relative wall thickness), assessment of the stage of puberty, dental examination (complex periodontal index (CPI), oral hygiene index). The association between the periodontium status and cardiovascular risk factors was assessed using univariant and multiple regression analysis, adjusted by sex, age, Tanner stage, body mass index, and oral hygiene index. Results — Clinical features of periodontitis were found in 32.7% of adolescents. Multiple regression analysis showed the presence of significant associations of CPI with the levels of systolic, mean and pulse BP during 24 hours (β=0.42, р=0.0001; β=0.31, р=0.003 and β=0.26, р=0.018, respectively), diastolic BP in the daytime (β=0.23, р=0.019), as well as the indices of load with high systolic BP within 24 hours (β=0.42, р=0.0001) and diastolic BP in the daytime (β=0.25, р=0.006). None of the other cardiovascular risk factors showed meaningful relationships with periodontium status in the multivariate analysis. Conclusion — The relationship between periodontium status and blood pressure level exists already in adolescence. That may, on the one hand, justify assessment of periodontium status and (if necessary) timely implementation of prophylactic measures in adolescents with high blood pressure and, on the other hand, recommend BP assessment in adolescents with diagnosed periodontitis.

Association between periodontitis and cardiometabolic risk: Results from the Korean National Health and Nutrition Examination Survey 2008-2014

Background

Periodontitis and cardiovascular disease (CVD) share inflammation as common pathogenesis. Evaluating the association between periodontitis and CVD would be helpful to better understand the pathophysiology and various complications of periodontitis. We aimed to determine whether there is an independent relationship between periodontitis and various CVD risk indicators or prevalence.

Patients and methods

Our study used representative data from the Korea National Health and Nutrition Examination Survey. Finally, data from 26,097 participants were used for analysis. Periodontitis was defined as a community periodontal index (CPI) ≥3. Participants were classified into 3 groups according to CPI score: Non-PO (participants without periodontitis, CPI score <3), NS-PO (participants with non-severe periodontitis, CPI score = 3), and Severe PO (participants with severe periodontitis, CPI score = 4). Cardiometabolic risk was evaluated based on metabolic syndrome, future CVD risk, and prevalent CVD. Prevalent CVD was defined as participants with cerebrovascular accidents and/or coronary artery disease. Framingham risk score (FRS) was calculated in participants without prevalent CVD.

Results

The numbers of participants in Non-PO, NS-PO, and Severe PO groups were 17,237, 6,738, and 2,122, respectively. The proportions of participants with high FRS and/or prevalent CVD increased as the severity of periodontitis increased. In participants without prevalent CVD, the FRS according to severity of periodontitis increased in both univariate and multivariate analyses as the severity of periodontitis increased. Logistic regression showed that the odds ratio for metabolic syndrome increased as the severity of periodontitis increased on univariate analysis and that the presence of periodontitis was associated with a higher odds ratio for metabolic syndrome on multivariate analysis. Trends for prevalent CVD were similar to those of metabolic syndrome. For participants without prevalent CVD, the odds ratio for high FRS increased as the severity of periodontitis increased in both univariate and multivariate analyses. Subgroup analyses according to sex and age showed similar trends.

Conclusion

Periodontitis was associated with CVD in the Korean population. Therefore, those with periodontitis, especially young adults with severe periodontitis, may be closely monitored for CVD.

Oral care practices in non-mechanically ventilated intensive care unit patients: An integrative review

AIMS AND OBJECTIVES

To explore current oral care practices in nonmechanically ventilated ICU patients.

BACKGROUND

Oral hygiene is an important aspect of nursing care in hospitalised populations. Oral care is a disease preventive and cost-effective measure for patients, particularly in ICU patients. Numerous studies support the value of oral care practices in mechanically ventilated ICU patients. Due to evidence supporting the benefits of oral care in nonmechanically ventilated patients, it would be beneficial to examine the literature for oral care practices in this population.

METHODOLOGY

Literature searches of the following databases were performed: CINAHL Plus, MEDLINE, PsychInfo, Academic Search Premier, Cochrane Database of Systematic Reviews, and Web of Science. Three peer-reviewed articles were included in the review after inclusion criteria were applied. Findings were appraised, organised conceptually and synthesised using Torraco (2016b) as a guiding framework. Evidence was appraised using the Johns Hopkins Nursing Evidence-based Practice Rating Scale. PRISMA reporting guidelines were followed, when applicable.

RESULTS

Findings support the existing gap in the literature of oral hygiene practices in nonmechanically ventilated ICU patients. Themes included the type of oral care products used, frequencies of oral care, documented oral care practices and personnel that performed the care.

STUDY IMPLICATIONS

This integrative review identified an important gap in the literature for oral care practices in nonmechanically ventilated ICU patient populations. Further research on current oral care practices and development of evidence-based guidelines for this population are recommended.

RELEVANCE TO CLINICAL PRACTICE

Nurses should provide oral care to all hospitalised patients and follow oral care guidelines specific to their population, if available.

Clinical implication of fasting glucose and systolic/diastolic blood pressure on the prevalence of periodontitis in non-diabetic and non-hypertensive adults using nationally representative data

The prevalence of diabetes mellitus and hypertension is increasing worldwide and an association between fasting glucose/blood pressure and periodontitis has been suggested. The present study was performed to assess the association between fasting glucose and systolic/diastolic blood pressure on the prevalence of periodontitis in non-diabetic and non-hypertensive adults using nationally representative data. Subgroup analysis was performed to evaluate the combined effects of obesity/abdominal obesity and impaired fasting glucose. This study involved a cross-sectional analysis using data from the Republic of Korean National Health and Nutrition Examination Survey from 2013 to 2015. A total of 8,341 respondents without diabetes and hypertension over 19 years old without missing values were included in the present study. A significant increase was observed in the prevalence of periodontitis with increasing systolic blood pressure and diastolic blood pressure. The percentage of periodontitis increased with increased glucose levels, with similar trends in glycated hemoglobin. The odds ratios (ORs) and 95% confidence intervals (CIs) for systolic blood pressure of 90≤x<100, 100≤x<110, 110≤x<120, 120≤x<130 and 130≤x<140 were 1.116 (0.591-2.107), 1.165 (0.624-2.175), 1.238 (0.673-2.278), 1.008 (0.538-1.888) and 1.042 (0.545-1.993), respectively, when systolic blood pressure <90 was considered as a reference. The ORs and 95% CIs for glucose of 90≤x<100, 100≤x<110 and 110≤x<126 were 1.074 (0.92-1.253), 1.214 (0.986-1.494) and 1.358 (1.005-1.834), respectively when glucose <90 was considered as a reference. The association between fasting glucose/blood pressure and periodontitis was confirmed by multiple logistic regression analyses after adjusting for confounding factors among non-diabetic and non-hypertensive Republic of Korean adults. Subgroup analysis revealed that higher ORs of periodontitis were observed in participants with impaired glucose level and obesity when compared with individuals without impaired glucose level or obesity. The results of the present study suggest that detection of fasting glucose and blood pressure may serve as a risk indicator for periodontal disease.

Nitrate, the oral microbiome, and cardiovascular health: a systematic literature review of human and animal studies

Background

Dietary nitrate is an important source of nitric oxide (NO), a molecule critical for cardiovascular health. Nitrate is sequentially reduced to NO through an enterosalivary nitrate-nitrite-NO pathway that involves the oral microbiome. This pathway is considered an important adjunct pathway to the classical l-arginine-NO synthase pathway.

Objective

The objective of this study was to systematically assess the evidence for dietary nitrate intake and improved cardiovascular health from both human and animal studies.

Design

A systematic literature search was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by using key search terms in Medline and EMBASE databases and defined inclusion and exclusion criteria.

Results

Thirty-seven articles on humans and 14 articles on animals were included from 12,541 screened references. Data on the effects of dietary nitrate on blood pressure, endothelial function, ischemic reperfusion injury, arterial stiffness, platelet function, and cerebral blood flow in both human and animal models were identified. Beneficial effects of nitrate on vascular health have predominantly been observed in healthy human populations, whereas effects in populations at risk of cardiovascular disease are less clear. Few studies have investigated the long-term effects of dietary nitrate on cardiovascular disease clinical endpoints. In animal studies, there is evidence that nitrate improves blood pressure and endothelial function, particularly in animal models with reduced NO bioavailability. Nitrate dose seems to be a critical factor because there is evidence of cross-talk between the 2 pathways of NO production.

Conclusions

Evidence for a beneficial effect in humans at risk of cardiovascular disease is limited. Furthermore, there is a need to investigate the long-term effects of dietary nitrate on cardiovascular disease clinical endpoints. Further animal studies are required to elucidate the mechanisms behind the observed effects.

Association between the number of natural teeth and diabetic retinopathy among type 2 diabetes mellitus: The Korea national health and nutrition examination survey

The aim of this study was to investigate the relationship between the number of teeth and diabetic retinopathy among Korean population.This was a retrospective analysis using data of total 45,811 individuals who participated in the Korea National Health and Nutrition Examination Survey (KNHANES) 2008 to 2012. Among these, 2593 (5.7%) participants were identified as having type 2 diabetes mellitus. After excluding participants without ophthalmic evaluation or other variables, 2078 (80%) participants were included. Demographic factors including dental status were analyzed and compared between participants with and without diabetic retinopathy.Among the 2078 type 2 diabetes, 358 (17.2%) had diabetic retinopathy. Type 2 diabetes with fewer teeth were more likely to have diabetic retinopathy (P < .001). Multivariate analysis showed that type 2 diabetes with < 20 teeth had an 8.7-fold risk of having vision-threatening diabetic retinopathy when compared with type 2 diabetes with ≥28 teeth (95% confidence interval: 2.69-28.3) after adjusting for age, sex, body mass index, smoking, drinking, exercise, hypertension, diabetes mellitus duration, and glycated hemoglobin level.The number of teeth was found to be an independent risk factor for diabetic retinopathy. Thus, a comprehensive approach of dentists and ophthalmologists is needed to minimize the complications of diabetes mellitus. Whether the teeth number reflects microvascular changes of the retina among type 2 diabetes warrants further investigation.

Periodontitis is associated with diabetic retinopathy in non-obese adults

PURPOSE

Patients with diabetes retinopathy appear to show increased susceptibility to periodontal disease. This study was performed to assess the relationship between periodontitis and the prevalence of diabetic retinopathy in a large probability sample of the Korean population. A subgroup analysis was performed using body mass index <25 kg/m² as the criterion to evaluate the effect of obesity on this relationship.

METHODS

This study is based on data from the Korean National Health and Nutrition Examination Survey of the Korean population, conducted between 2008 and 2010. The presence of diabetic retinopathy in relation to demographic variables and anthropometric characteristics of the participants is presented as means with their standard errors. The presence of periodontitis and presence of retinopathy categorized by body mass index (<25 and ≥25 kg/m²) were evaluated. Multiple logistic regression analyses were used to assess the associations between periodontitis and diabetic retinopathy after adjustment with variables, including age, sex, smoking, drinking, exercise, hypertension, metabolic syndrome, HbA1c, and duration of diabetes mellitus.

RESULTS

There was a statistically significant increase in the prevalence of periodontitis in individuals who had proliferative diabetic retinopathy. The odds ratios [95% confidence intervals] of prevalence of diabetic retinopathy were 1.193 [0.757-1.881] for the whole population after adjustments with confounding factors. Subgroup analysis after adjustments with confounding factors showed that the odds ratios [95% confidence intervals] of prevalence were 2.206 [1.114-4.366] and 0.588 [0.326-1.061] among participants with body mass index <25 kg/m² and body mass index 37 ≥25 kg/m², respectively.

CONCLUSIONS

The diabetic retinopathy was positively associated with the presence of periodontitis in non-obese diabetic Korean adults after adjustment with confounding variables. Our findings suggest that when a periodontist finds the presence of periodontitis in non-obese diabetic patients, timely evaluation of the patient's ophthalmic evaluation should be 44 recommended.

Enterosalivary nitrate metabolism and the microbiome: Intersection of microbial metabolism, nitric oxide and diet in cardiac and pulmonary vascular health

Recent insights into the bioactivation and signaling actions of inorganic, dietary nitrate and nitrite now suggest a critical role for the microbiome in the development of cardiac and pulmonary vascular diseases. Once thought to be the inert, end-products of endothelial-derived nitric oxide (NO) heme-oxidation, nitrate and nitrite are now considered major sources of exogenous NO that exhibit enhanced vasoactive signaling activity under conditions of hypoxia and stress. The bioavailability of nitrate and nitrite depend on the enzymatic reduction of nitrate to nitrite by a unique set of bacterial nitrate reductase enzymes possessed by specific bacterial populations in the mammalian mouth and gut. The pathogenesis of pulmonary hypertension (PH), obesity, hypertension and CVD are linked to defects in NO signaling, suggesting a role for commensal oral bacteria to shape the development of PH through the formation of nitrite, NO and other bioactive nitrogen oxides. Oral supplementation with inorganic nitrate or nitrate-containing foods exert pleiotropic, beneficial vascular effects in the setting of inflammation, endothelial dysfunction, ischemia-reperfusion injury and in pre-clinical models of PH, while traditional high-nitrate dietary patterns are associated with beneficial outcomes in hypertension, obesity and CVD. These observations highlight the potential of the microbiome in the development of novel nitrate- and nitrite-based therapeutics for PH, CVD and their risk factors.

Associations between Periodontal Microbiota and Death Rates

It is conceived that specific combinations of periodontal bacteria are associated with risk for the various forms of periodontitis. We hypothesized that such specificity is also related to human cause-specific death rates. We tested this hypothesis in a representative sample of the US population followed for a mean duration of 11 years and found that two specific patterns of 21 serum antibodies against periodontal bacteria were significantly associated with increased all-cause and/or diabetes-related mortalities. These data suggested that specific combinations of periodontal bacteria, even without inducing clinically significant periodontitis, may have a significant impact on human cause-specific death rates. Our findings implied that increased disease and mortality risk could be transmittable via the transfer of oral microbiota, and that developing personalized strategies and maintaining healthy oral microbiota beyond protection against periodontitis would be important to manage the risk.

Association between periodontitis and arterial hypertension: A systematic review and meta-analysis

BACKGROUND

Several studies have shown that periodontal diseases are associated with hypertension (HT). However, heterogeneity among populations, diagnosis criteria, and shared risk factors represent some difficulties in terms of interpretation. Therefore, the aim of this study was to determine the magnitude of the association between periodontal diseases and HT.

METHODS AND RESULTS

A systematic review and meta-analysis, including studies published up to June 2016, have been performed. Sixteen studies assessing the association between periodontal diseases and HT have been included. The meta-analysis considering all included studies (moderate to severe periodontitis) showed that the presence of HT was associated with the presence of periodontal diseases (OR, 1.50; 95% CI, 1.27-1.78). To reduce potential bias, a stratified analysis has been performed illustrating the impact of inclusion criteria and adjustments on the magnitude of the association. Interestingly, when only studies with secure diagnosis of severe periodontitis and HT were considered, an OR=1.64 (95% CI, 1.23-2.19) has been measured.

CONCLUSIONS

Periodontal diseases are associated with a higher risk of HT especially for severe periodontitis. However, no conclusions could be made regarding the causative involvement of periodontal diseases mainly due to the reduced number of available prospective studies and remaining questions regarding underlying biological mechanisms.

Associations between the number of natural teeth and renal dysfunction

The purpose of the present study was to investigate the association between the number of natural teeth and measures of kidney dysfunction, such as urinary albumin/creatinine ratio (ACR) and estimated glomerular filtration (eGFR) rate, using nationally representative data.The data used were from the Korea National Health and Nutrition Examination Survey with cross-sectional design, which was conducted between 2011 and 2012; the sample analyzed in this study consisted of a total of 10,388 respondents, each of whom was 19 years or older and had no missing outcome variables. The association between the number of natural teeth and kidney function was assessed by multiple logistic regression and model was adjusted for age, sex, waist conference, smoking, drinking, exercise, education, income, frequency of tooth brushing per day, diabetes, metabolic syndrome, urinary ACR, and eGFR.The mean age, body mass index, and waist circumference were significantly higher among those with lower kidney function (urinary ACR ≥30 mg/g and eGFR <60 mL/min/1.73m). Urinary ACR and eGFR were associated with loss of natural teeth. As urinary ACR increased, the number of natural teeth decreased accordingly. Conversely, the number of natural teeth increased with an increase in eGFR.This study showed that the number of natural teeth is inversely associated with the presence of kidney disease. Severity of tooth loss may be considered an independent risk indicator for kidney disease among Koreans. More epidemiological studies are warranted to investigate the role of tooth loss in kidney disease, to confirm this relationship and to test possible underlying mechanisms.

Association between Consumption of Coffee and the Prevalence of Periodontitis: The 2008-2010 Korea National Health and Nutrition Examination Survey

Background

This study was performed to assess the relationship between the consumption of coffee and periodontitis using nationally representative data.

Methods

The data from the Korea National Health and Nutrition Examination Survey were used; the analysis in this study was confined to a total of 16,730 respondents over 19 years old who had no missing values for the consumption of coffee or outcome variables. A community periodontal index greater than or equal to code 3 was defined as periodontal disease.

Results

Consumption of coffee was significantly higher in the individuals with periodontitis in males. The odds ratios of the percentage of individuals with periodontitis tended to increase with the consumption of coffee. Adjusted odds ratios and their 95% confidence intervals of the male participants were 1, 1.131(0.792–1.617), 1.161(0.857–1.573), 1.053(0.805–1.379), 1.299(1.007–1.676), and 1.458(1.141–1.862) for once per month or less, once per month<x≤3 times per week, three times per week<x≤6 times per week, once per day, twice per day, and three or more per day, respectively.

Conclusions

Consumption of coffee may be considered an independent risk indicator of periodontal disease in Korean male adults, and we suggest that the periodontal health of male may benefit from reduction of coffee consumption.

Associations between the consumption of carbonated beverages and periodontal disease: The 2008-2010 Korea national health and nutrition examination survey

Consumption of carbonated beverages was reported to be associated with obesity and other adverse health consequences. This study was performed to assess the relationship between the consumption of carbonated beverages and periodontal disease using nationally representative data.The data from the Korea National Health and Nutrition Examination Survey conducted between 2008 and 2010 were used; the analysis in this study was confined to a total of 5517 respondents >19 years old who had no missing values for the consumption of carbonated beverages or outcome variables. The community periodontal index greater than or equal to code 3 was defined as periodontal disease.The odds ratios of the percentage of individuals with periodontal treatment needs tended to increase with the consumption of carbonated beverages. Adjusted odds ratios and their 95% confidence intervals adjusted for various factors including age, sex, body mass index, smoking, drinking, exercise, metabolic syndrome, frequency of tooth brushing per day, use of secondary oral products, dental checkup within a year, consumption of coffee of the individuals with the consumption of carbonated beverages once or less per month, once or less per week and twice or more per week were 1.109(0.804,1.528), 1.404(1.035,1.906), and 1.466(1.059,2.029), respectively. A subgroup analysis revealed that in individuals with body mass index < 25 or waist circumference < 90 cm for males or < 80 cm for females, the prevalence of periodontal disease increased with higher consumption of carbonated beverages (P for trend < 0.05).Consumption of carbonated beverages was positively associated with the risk of periodontal disease in Korean adults. In a subgroup analysis, the individuals consuming carbonated beverages with body mass index < 25 or waist circumference < 90 cm for males or < 80 cm for females were more likely to have periodontal disease. Consumption of carbonated beverages may be considered to be an independent risk indicator for periodontal disease and periodontal health of nonobese individuals may benefit from reduction of carbonated beverage consumption.