Associations Between Periodontitis and Chronic Obstructive Pulmonary Disease: The 2010 to 2012 Korean National Health and Nutrition Examination Survey

Severe chronic obstructive pulmonary disease is associated with reduced oral health conditions

OBJECTIVES

This study aimed to investigate the association of explicitly severe chronic obstructive pulmonary disease (COPD) with oral conditions considering in-depth shared risk factors.

METHODS

A case-control study was conducted with 104 participants, 52 with severe COPD and 52 matched controls without COPD. Dental and periodontal status were clinically assessed and oral health-related quality of life (OHRQoL) by OHIP-G14-questionnaire.

RESULTS

Between COPD- and control-group, there were no statistically significant differences regarding age (66.02 ± 7.30), sex (female: 52 [50%]), smoking history (44.69 ± 23.23 pack years) and number of systemic diseases (2.60 ± 1.38). COPD patients demonstrated significantly fewer remaining teeth (12.58 ± 9.67 vs. 18.85 ± 6.24, p < 0.001) besides higher DMFT (decayed, missing and filled teeth) index (21.12 ± 5.83 vs. 19.10 ± 3.91, p = 0.036). They had significantly greater probing pocket depths (PPD: 3.24 mm ± 0.71 mm vs. 2.7 mm ± 0.37 mm, p < 0.001) and bleeding on probing (BOP: 34.52% ± 22.03% vs. 22.85% ± 17.94%, p = 0.003) compared to controls, but showed no significant difference in clinical attachment level or staging of periodontitis. The OHIP-G14 sum score was significantly higher in COPD patients (7.40 ± 7.28 vs. 3.63 ± 4.85, p = 0.002). Common risk factors such as educational status, physical activity, dentist visit frequency, oral hygiene regimens and dietary habits were less favourable in patients with COPD.

CONCLUSIONS

COPD was significantly associated with higher tooth loss, PPD, BOP and DMFT besides lower OHRQoL.

Association between periodontal disease and chronic obstructive pulmonary disease

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

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

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

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

Background

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

Aim

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

Materials and Methods

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

Results

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

Conclusion

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

Objectives

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

Design

A systematic review and meta-analysis.

Data sources

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

Eligibility criteria for studies

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

Data extraction and synthesis

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

Results

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

Conclusions

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

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

AIM

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

The impact of gingivitis reduction on lung function: a randomized trial under intensified oral hygiene

BACKGROUND

Periodontal disease and lung function impairment were found to be associated with low-grade systemic or local inflammation, and it might be that gingival/periodontal inflammation triggers lung function due to systemic inflammation or the transfer of oral bacteria or its components to the lung. A recent observational study in non-smoking subjects showed that lung volumes and flow rates were significantly reduced by 71-185 ml for severe gingivitis regardless of the adjustment for potential confounders. The result did not show any confounding by smoking, and the association between gingivitis and lower lung function was not modified by systemic inflammation. The designed interventional trial primarily aims to test the hypothesis that gingivitis reduction by optimized daily oral hygiene, professional tooth cleaning and antibacterial chlorhexidine (CHX)-containing mouth rinse improves lung function in terms of forced vital capacity (FVC) by at least 2%. The secondary objective will test the hypothesis that gingivitis reduction improves forced expiratory volume in 1 s (FEV1) and forced expiratory flow at 25-75% of the pulmonary volume (FEF25-75) by at least 2%. Furthermore, the influence of the oral microbiome will be taken into account.

METHODS

The study has to include 120 non-smoking subjects aged between 18 and 30 years with biofilm-induced gingivitis. The chosen "waiting control group design" will compare the immediate intervention group with the delayed intervention group, which serves as a control group. Dental and gingival status, lung function and oral microbiome will be recorded. The intensified preventive intervention-professional tooth cleaning, one-stage full-mouth disinfection with CHX and safeguarding an optimal daily oral hygiene by each subject-cannot be blinded, but the outcome measurement in terms of lung function tests is blind.

DISCUSSION

This proposed multidisciplinary study has several strengths. Only one previous intervention study with patients with severe periodontitis (mostly smokers) has been performed. It is novel to include non-smoking subjects with mild and potentially reversible oral inflammation. Furthermore, this research is innovative, because it includes evidence-based interventions for gingivitis reduction, standardized measures of the outcome on lung function and oral microbiome and combines expertise from dentistry, lung physiology, oral microbiology and epidemiology/statistical modelling.

TRIAL REGISTRATION

German Clinical Trial Register DRKS00028176. Registered on February 2022.

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

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

The role of Th17 cells: explanation of relationship between periodontitis and COPD?

Periodontitis and chronic obstructive pulmonary disease (COPD) are chronic inflammatory diseases with common risk factors, such as long-term smoking, age, and social deprivation. Many observational studies have shown that periodontitis and COPD are correlated. Moreover, they share a common pathophysiological process involving local accumulation of inflammatory cells and cytokines and damage of soft tissues. The T helper 17 (Th17) cells and the related cytokines, interleukin (IL)-17, IL-22, IL-1β, IL-6, IL-23, and transforming growth factor (TGF)-β, play a crucial regulatory role during the pathophysiological process. This paper reviewed the essential roles of Th17 lineage in the occurrence of periodontitis and COPD. The gaps in the study of their common pathological mechanism were also evaluated to explore future research directions. Therefore, this review can provide study direction for the association between periodontitis and COPD and new ideas for the clinical diagnosis and treatment of the two diseases.

Pulmonary disease and periodontal health: a meta-analysis

OBJECTIVE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Is periodontitis a risk factor of benign or malignant colorectal tumor? A population-based cohort study

OBJECTIVE

To examine the risk of developing benign or malignant colorectal tumors in patients with periodontitis within 15 years using Taiwan's National Health Insurance Database.

BACKGROUND

Studies have shown that colorectal carcinoma often develops under inflammatory conditions and changes of microbiota in the gut. Recently, a link between Fusobacterium nucleatum, a periodontal pathogen, and colorectal carcinoma has been proposed. However, whether periodontitis is a risk of developing colorectal tumor remains uncertain.

METHODS

In total, 35 124 participants were enrolled from 2000 to 2015 to examine the development risk of benign colorectal tumors, including 11 708 patients with periodontitis who received therapy (group 1), 11 708 patients with periodontitis not receiving periodontal treatment (group 2), and 11 708 non-periodontitis controls after matching for gender, age, and index year. To examine the risk of developing colorectal malignancy, 11 720 participants were assigned to each of the three groups. Cox proportional hazards model and Kaplan-Meier methods were used to compare the risks. Sensitivity analysis was performed, excluding the diagnoses during the first 1 or 5 years.

RESULTS

After the follow-up, 177, 154, and 63 participants in group 1, group 2, and control group had benign colorectal tumors. Patients with periodontitis tended to be associated with a greater rate of having a benign colorectal tumor. The adjusted hazard ratios (aHRs) were 3.77 (95% confidence interval [CI] 2.01-4.82, p < .001) and 2.85 (95% CI 1.62-3.74, p < .001) for groups 1 and 2, respectively. Regarding the risk of malignant colorectal tumor, 20, 18, and 14 participants who developed malignant tumors were included in group 1, group 2, and control group; however, no significant increase in malignancy was observed in periodontitis groups (aHR1.92, 95% CI 0.74-2.36, p = .482; aHR 1.50, 95% CI 0.68-1.97, p = .529, for the two periodontitis groups, respectively).

CONCLUSIONS

The results of this study suggest that patients with periodontitis may have an increased risk of developing benign, but not malignant, colorectal tumors.

The association between periodontitis and lung function: results from NHANES 2009-2012

BACKGROUND

We aimed to explore the association between periodontitis and lung function in the United States of America.

METHODS

The data was based on the National Health and Nutrition Examination Survey (NHANES) 2009-2012. Periodontitis was defined following the CDC/AAP (Centers for Disease Control and Prevention/American Academy of periodontology) classification. Lung function measurements included forced expiratory volume in one second (FEV1) , forced vital capacity (FVC) , and FEV1/FVC ratio. Linear regression and binary logistic regression were used to explore the association between periodontitis and lung function measurements. Restricted cubic spline was used to assess the dose-response relationships between the mean attachment loss, the mean probing depth and spirometry-defined airflow obstruction (FEV1/FVC < 0.7) .

RESULTS

A total of 6313 adults aged 30 years or older were included. Compared to those with non-periodontitis, the multivariate-adjusted odds ratios (ORs) of airflow obstruction for moderate and severe periodontitis were 1.38 (95%CI: 1.01-1.75) and 1.47 (95%CI: 1.06-2.01) , the β coefficients of FEV1 for moderate and severe periodontitis were -130.16 (95%CI: -172.30 to -88.01) and -160.46 (95%CI: -249.94 to -70.97) , the β coefficients of FVC for moderate and severe periodontitis were -100.96 (95%CI: -155.08 to -46.85) and -89.89 (95%CI: -178.45 to -1.33) , the β coefficients of FEV1/FVC for moderate and severe periodontitis were -0.01 (95%CI: -0.02 to -0.01) and -0.02 (95%CI: -0.03 to -0.01) . In stratified analyses, the multivariate-adjusted odds ratios of airflow obstruction for the moderate and severe periodontitis were 1.27 (95%CI: 0.84-1.93) and 2.31 (95%CI: 1.10-4.83) in former smokers, 1.84 (95%CI: 1.03-3.30) and 1.79 (95%CI: 1.02-3.16) in current smokers, with no significant association observed in never smokers. Mean clinical attachment loss and mean probing depth were negatively associated with FEV1, FVC and FEV1/FVC in never, former and current smokers. Dose-response relationship analysis showed that the risk of airflow obstruction increased with increasing mean clinical attachment loss and mean probing depth, and showed a non-linear dose-response relationship.

CONCLUSION

Our study suggested that moderate and severe periodontitis might be associated with the decline of lung function in the United States of America. This article is protected by copyright. All rights reserved.

The Association of Periodontitis and Alzheimer's Disease: How to Hit Two Birds with One Stone

Alzheimer's disease (AD) is the leading cause of cognitive impairment in the elderly. Recent evidence suggests that preventive interventional trials could significantly reduce the risk for development of dementia. Periodontitis is the most common dental disease characterized by chronic inflammation and loss of alveolar bone and perialveolar attachment of teeth. Growing number of studies propose a potential link between periodontitis and neurodegeneration. In the first part of the paper, we overview case-control studies analyzing the prevalence of periodontitis among AD patients and healthy controls. Second, we survey observational libraries and cross-sectional studies investigating the risk of cognitive decline in patients with periodontitis. Next, we describe the current view on the mechanism of periodontitis linked neural damage, highlighting bacterial invasion of neural tissue from dental plaques, and periodontitis induced systemic inflammation resulting in a neuroinflammatory process. Later, we summarize reports connecting the four most common periodontal pathogens to AD pathology. Finally, we provide a practical guide for further prevalence and interventional studies on the management of cognitively high-risk patients with and without periodontitis. In this section, we highlight strategies for risk control, patient information, dental evaluation, reporting protocol and dental procedures in the clinical management of patients with a risk for periodontitis and with diagnosed periodontitis. In conclusion, our review summarizes the current view on the association between AD and periodontitis and provides a research and intervention strategy for harmonized interventional trials and for further case-control or cross-sectional studies.

Airflow limitation and tongue microbiota in community-dwelling elderly individuals

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

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

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

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

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

Analysis of the Relation between Periodontitis and Chronic Gastritis/Peptic Ulcer: A Cross-Sectional Study Using KoGES HEXA Data

The aim of the present study was to investigate the association between periodontitis and chronic gastritis/peptic ulcer using a cross-sectional study design. The present prospective cohort study used epidemiological data from the Korean Genome and Epidemiology Study (KoGES) recorded from 2004 to 2016. Among 173,209 participants, 9983 with periodontitis and 125,336 with no periodontitis were selected. Histories of chronic gastritis and peptic ulcer between periodontitis and no periodontitis participants were analyzed. The participants were questioned around any history of hypertension, diabetes mellitus, hyperlipidemia, cerebral stroke, ischemic heart disease, periodontitis, body mass index, smoking, alcohol consumption, nutritional intake, and financial income. Chi-square tests, independent t-tests, two-tailed analyses were used in statistical analysis of the data. The adjusted odds ratio of chronic gastritis was 2.22 (95% confidence interval [CI] = 2.10–2.34, p < 0.001) and that of peptic ulcer was 1.86 (95% CI = 1.74–1.98, p < 0.001) in model 2. This study demonstrated that periodontitis was associated with an increased risk of chronic gastritis/peptic ulcer. These findings provide additional evidence for an association between periodontitis and chronic gastritis/peptic ulcer.

A Diet Rich in Saturated Fat and Cholesterol Aggravates the Effect of Bacterial Lipopolysaccharide on Alveolar Bone Loss in a Rabbit Model of Periodontal Disease

Increasing evidence connects periodontitis with a variety of systemic diseases, including metabolic syndrome, atherosclerosis, and non-alcoholic fatty liver disease (NAFLD). The proposal of this study was to evaluate the role of diets rich in saturated fat and cholesterol in some aspects of periodontal diseases in a lipopolysaccharide (LPS)-induced model of periodontal disease in rabbits and to assess the influence of a periodontal intervention on hyperlipidemia, atherosclerosis, and NAFLD progression to non-alcoholic steatohepatitis. Male rabbits were maintained on a commercial standard diet or a diet rich in saturated fat (3% lard w/w) and cholesterol (1.3% w/w) (HFD) for 40 days. Half of the rabbits on each diet were treated 2 days per week with intragingival injections of LPS from Porphyromonas gingivalis. Morphometric analyses revealed that LPS induced higher alveolar bone loss (ABL) around the first premolar in animals receiving standard diets, which was exacerbated by the HFD diet. A higher score of acinar inflammation in the liver and higher blood levels of triglycerides and phospholipids were found in HFD-fed rabbits receiving LPS. These results suggest that certain dietary habits can exacerbate some aspects of periodontitis and that bad periodontal health can contribute to dyslipidemia and promote NAFLD progression, but only under certain conditions.

Association between periodontitis and pulmonary function based on the Third National Health and Nutrition Examination Survey (NHANES III)

OBJECTIVES

The purpose of this study was to investigate the association between impaired pulmonary function and periodontitis.

MATERIALS AND METHODS

From the Third National Health and Nutrition Examination Survey data, we examined the association between pulmonary function and severity of periodontitis using the univariate and multivariate regression models. Moreover, the association between obstructive or restrictive spirometry patterns and periodontitis status was also determined by multivariable logistic regression analysis.

RESULTS

A total of 10,645 participants were included in our study. The values of predicted FEV1%, predicted FVC%, and FEV1/FVC were found to gradually decline with increasing severity of periodontitis (p < .001). Obstructive and restrictive pulmonary functions were significantly associated with severity of periodontitis.

CONCLUSION

Individuals with a greater degree of periodontitis had poor pulmonary function. However, further long-term cohort studies are required for a comprehensive evaluation.

Periodontitis and airflow limitation in older Swedish individuals

AIM

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

Dental problems and chronic diseases in mentally ill homeless adults: a cross-sectional study

Background

Dental problems (DPs) and physical chronic diseases (CDs) are highly prevalent and incident in people with low socioeconomic status such as homeless individuals. Yet, evidence on the association between DPs and physical CDs in this population is limited. In the present study, we assessed the association between DPs and type and number of CDs in individuals experienced chronic homelessness and serious mental health problems.

Methods

We analyzed cross-sectional baseline data from 575 homeless adults with serious mental health problems participating in the Toronto site of the At Home/Chez Soi randomized controlled trial. Chronic DPs (lasting at least 6 months) were the primary exposure variable. Presence of self-reported CDs, including heart disease, effect of stroke, hypertension, diabetes, asthma, chronic bronchitis/emphysema, stomach or intestinal ulcer, inflammatory bowel disease, migraine, thyroid problems, arthritis, kidney/bladder problems, liver disease (other than hepatitis), and iron-deficiency anemia, were the primary outcomes. The total number of CDs was also analyzed as a secondary outcome.

Logistic regression models were used to assess the association between DPs with each of the studied CDs, and negative binomial regression was used to test the association between DPs with the number of CDs.

Results

In our 575 homeless participants (68.5% males) with mean age 40.3 (11.8) years, a high proportion had DPs (42.5%). The presence of DPs was positively associated with heart disease (adjusted odds ratio (AOR):4.19,1.67–10.52), diabetes (AOR:2.17,1.13–4.17), chronic bronchitis (AOR:2.34,1.28–4.29), stomach or intestinal ulcer (AOR:3.48,1.80–6.73), inflammatory bowel disease (AOR:2.52,1.38–4.60), migraine (AOR:1.80,1.20–2.72), arthritis (AOR:2.71,1.71–4.29), kidney/bladder problems (AOR:2.43,1.30–4.54), and iron-deficiency anemia (AOR:3.28,1.90–5.65). DPs were also associated with a higher number of CDs (IRR: 1.62,1.38–1.90).

Conclusion

Dental health problems in homeless individuals with serious mental disorders are associated with several CDs. Dental care should be better integrated into existing social and health programs serving this population to improve their overall health status.

The AH/CS study is registered with the International Standard Randomized Control Trial Number Register (ISRCTN42520374).

Periodontitis increases the risk of respiratory disease mortality in older patients

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

Hematopoietic and lymphatic cancers in patients with periodontitis: a systematic review and meta-analysis

Background

Numerous studies have explored the correlation of periodontal disease (PD) with risk of hematopoietic and lymphatic cancers, but the findings were inconsistent. Therefore, we did a meta-analysis to ascertain the correlation of PD with risk of incident hematopoietic and lymphatic cancers.

Material and Methods

The authors searched relevant studies in databases (PubMed, Web of Science, and MEDLINE). The summary relative risk (RR) along with 95% confidence interval (CI) was calculated by use of random or fixed effects models.

Results

Six studies were included in qualitative synthesis. The pooled analysis revealed that PD was significantly associated with an increased risk of hematopoietic and lymphatic cancers (RR = 1.17; 95% CI = 1.07–1.27; P = 0). Stratified analysis showed the association of PD with hematopoietic and lymphatic cancers remained significant in the never smokers (RR = 1.28; 95% CI = 1.07–1.54; P = 0.007), and in the American population (RR = 1.17; 95% CI = 1.05–1.30; P = 0.003), respectively.

Conclusions

Never smokers population and the American population with PD have a higher risk of developing hematopoietic and lymphatic cancers. PD might be considered as a risk factor for hematopoietic and lymphatic cancers.

Key words:Periodontal disease, hematopoietic and lymphatic cancer, meta-analysis, systematic review.

Periodontitis and respiratory diseases: A systematic review with meta-analysis

OBJECTIVE

To conduct a systematic review and meta-analysis to evaluate the recent scientific literature addressing the association between periodontitis and asthma, chronic obstructive pulmonary disease (COPD), and pneumonia.

MATERIALS AND METHODS

The search for studies was carried out using MEDLINE/PubMed, EMBASE, Lilacs, Web of Science, Scopus, and SciELO databases, including the gray literature (ProQuest). Reference lists of selected articles were also searched. Studies having varying epidemiological designs assessing the association between periodontitis and respiratory diseases in human subjects were eligible for inclusion. Three independent reviewers performed the selection of articles and data extraction. Fixed and random effects meta-analysis were performed for the calculation of the association measurements (Odds Ratio-OR) and 95% confidence intervals (95% CI).

RESULTS

A total of 3,234 records were identified in the database search, with only 13 studies meeting the eligibility criteria and 10 studies contributed data for meta-analysis. Using a random effects models periodontitis was associated with asthma: ORadjusted: 3.54 (95% CI: 2.47-5.07), I²  = 0%; with COPD: OR adjusted: 1.78 (95% CI: 1.04-3.05), I²  = 37.9%; and with pneumonia: OR adjusted: 3.21 (95% CI: 1.997-5.17), I²  = 0%.

CONCLUSIONS

The main findings of this systematic review validated an association between periodontitis and asthma, COPD and pneumonia.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

PRACTICAL IMPLICATIONS

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

Periodontitis Is Associated with Chronic Obstructive Pulmonary Disease

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

Relationship between Respiratory and Periodontal Health in Adults: A Case-Control Study

Aims and Objectives

The colonization of the respiratory pathogens has been found in the oral cavity. In the high-risk patients for lung infection; the risk factor is the high colonization of the respiratory pathogens in the oral cavity. The present study was performed with an aim to investigate the relationship between periodontal health and respiratory diseases.

Material and Methods

The present cross-sectional study was conducted in the individuals who were attending the outpatient department of dentistry and those who signed the informed consent to participate in the study. A total of 198 patients were included in the present study. Ninety-nine patients with respiratory diseases were included in the test group and 99 patients with normal pulmonary function were added in the control group. Spirometry was used for the confirmation of the lung diseases. We had assessed the clinical parameters such as plaque index, gingival index, loss of attachment, and community periodontal index with the help of SPSS software 15 and compared between cases and controls.

Results

The mean age of control patients were 35.12 and for respiratory patients was 43.32. There were 65 males and 34 females in case group with respiratory diseases. The controls consisted of 63 males and 36 females. The high scores for various gingival and periodontal indexes in respiratory patients confirmed more periodontal destruction with respect to that group, compared to the nonrespiratory group.

Conclusion

It is concluded that a strong association between periodontitis and chronic obstructive pulmonary disease was found. The assessment of the risk factors along with patient education regarding the risk should be done so that suitable intervention strategies can be implemented.

Is COPD associated with periodontal disease? A population-based study in Spain

Background

Periodontal disease is more prevalent and more severe among men and women suffering from chronic obstructive pulmonary disease (COPD) compared with healthy adults. The objectives of this paper were to assess the association between periodontal disease and COPD, controlling the effect of sociodemographic characteristics, oral health status, lifestyle variables, and comorbidities. Second, we identified which of the variables analyzed were independently associated with periodontal disease among COPD sufferers.

Methods

This descriptive study was done with data from the National/European Health Interview Surveys, conducted in years 2006, 2011/12, and 2014 in Spain. We included subjects ≥40 years of age. COPD status was self-reported. One non-COPD patient was matched by age, gender, and the year of survey for each COPD case. The presence of periodontal disease was defined using the answers "my teeth bleed spontaneously or while brushing" or/and "my teeth move" to the question: "Do you suffer of any of these dental and oral disorders or diseases?" Independent variables included demographic, socioeconomic, and health care-related variables, oral health status, and presence of comorbidities.

Results

The prevalence of periodontal disease was higher among COPD patients than their matched non-COPD controls (26.5% vs 22.2%; P<0.001). Adjusted odds ratio (AOR) of periodontal disease for subjects with COPD was 1.21 (95% CI: 1.12-1.30). Suffering mental disorders (AOR: 1.61; 95% CI: 1.32-1.97) was positively associated with higher risk of periodontal disease. Older age, having a private dental health insurance, and university education were variables associated with lower rates of periodontal disease.

Conclusion

Prevalence of periodontal disease was higher among those with COPD compared to non-COPD controls. Dentists and physicians should increase their awareness with their COPD patients, especially those who are younger, with lower education, and suffer depression and/or anxiety.

Evaluation of oral hygiene services in selected public health facilities in Lusaka district of Zambia

Around the globe many people are suffering from oral pain and other problems of the mouth or teeth. This public health problem is growing rapidly in developing countries where oral health services are limited. This study was conducted in the public health centers and first level hospitals with dental units (DUs) in Lusaka district. Adequacy of dental equipment, instruments and materials required for scaling and polishing (S&P) and oral hygiene instructions (OHI) was evaluated. Challenges faced by the dental therapists (DTs) in the entire DUs were also evaluated. This was a mixed method study; quantitative data was collected using a structured questionnaire which contained a standard facility assessment check list. Qualitative data was collected by conducting in-depth interviews. The study results showed that the oral hygiene services offered by the selected DUs in Lusaka district were inadequate. A fully functional dental chair was available only in fifty percent of the DUs, only twenty percent of the facilities had fully functional ultrasonic scaling unit, none of the facilities had all the instruments for polishing. The DTs work under stressful conditions as sixty percent of the facilities were understaffed; the supply of dental instruments and materials was poor; delay in repairing faulty equipment; risk of exposure to air borne infections as most of the facilities have space and ventilation problems. Recommendations of this study point towards an urgent need to improve and coordinate the oral health care system.

Periodontal status and lung function decline in the community: the Hisayama study

This study aimed to determine whether periodontal status is related to a decline in lung function in a general Japanese population. We followed a total of 1,650 community-dwelling individuals (≥40 years) without chronic obstructive pulmonary disease, with at least one teeth, for 3 years. Periodontal status was assessed at baseline by clinical attachment loss (CAL) and probing pocket depth (PPD) at two sites for each tooth, and the mean values were calculated for each subject. Lung function was measured at baseline and follow-up using spirometry, and longitudinal decline in forced expiratory volume in one second (FEV1) was calculated. Multivariate Poisson regression with robust error variance was used to estimate risk ratio (RR). After adjusting for potential confounders including smoking status, there was a tendency for the adjusted RR of developing rapid lung function decline (≥160 mL/3years, the highest quartile of the distribution of FEV1 declines) to increase as mean CAL levels increased (P trend = 0.039). Likewise, a positive association was observed between mean PPD levels and RR of developing rapid lung function decline (P trend = 0.047). Our findings suggest deterioration of periodontal status could be a risk factor for rapid lung function decline in the general Japanese population.

Inflammatory bowel disease as a risk factor for periodontitis under Taiwanese National Health Insurance Research database

BACKGROUND/PURPOSE

Inflammatory bowel disease (IBD), comprised Crohn's disease and ulcerative colitis, is a mucosal immune response that affects gastroenterological tract. The association between IBD and periodontitis was inconclusive. In this study, we aimed to investigate the association between IBD and periodontitis by using a register-based dataset.

MATERIALS AND METHODS

The dataset conducting in this retrospective cohort study was obtained from the National Health Insurance Research database (NHIRD) in Taiwan. For IBD group, conditionally selected control subjects were matched in 1:4 ratio from general population. The risk of periodontitis among IBD group comparing with non-IBD group was calculated by multivariable Cox proportional hazards model.

RESULTS

In IBD cohort, 27 IBD patients (7 Crohn's disease and 20 ulcerative colitis) with catastrophic illness registry were identified. 108 controls were selected as non-IBD cohort. The median follow-up period was 3.00 years in the IBD group and 3.15 years in the non-IBD group. The cumulative incidence of IBD was 4.32 per 100,000 persons. After adjusting for several confounding factors, IBD group had higher risk for developing periodontitis than non-IBD group (adjusted HR: 1.82; 95% CI: 1.09-3.03). To further stratification with subtype, Crohn's disease group had significantly higher risk of periodontitis (adjusted HR: 3.95; 95% CI: 1.59-9.82).

CONCLUSIONS

Taken together, this retrospective cohort study showed that patients with IBD increase risk of having periodontitis comparing with non-IBD group, especially in Crohn's disease subgroup.

Association between oral health and colorectal adenoma in a screening population

Although periodontal disease and gastrointestinal tract health are closely associated, few studies have investigated whether periodontitis is a risk factor for colorectal adenoma. The aim of this study was to investigate whether there is an association between periodontitis and the risk of colorectal adenoma in asymptomatic healthy people.From January 2013 to October 2015, we retrospectively enrolled 42,871 patients who underwent health screening at Kangbuk Samsung Hospital in South Korea. Demographic and clinical data were collected before colonoscopy. We calculated the odds ratio (OR) for adenoma in these patients.The median age was 39.3 ± 8.7 years and 70.4% of the patients were men; 32.5% had a body mass index (BMI) 25.0 kg/m. The frequency of adenoma was 12% (n = 5136). A higher risk of adenoma was associated with the following factors: BMI 25.0 kg/m (OR 1.51, 95% confidence interval [CI]: 1.42-1.61), current smoker (OR 1.51, 95% CI: 1.42-1.61), former smoker (OR 1.28, 95% CI: 1.19-1.37), periodontitis (OR 1.95, 95% CI: 1.82-2.0), moderate alcohol intake (OR 1.8, 95% CI: 1.69-1.93), and heavy alcohol intake (OR 2.67, 95% CI: 2.24-3.18).Being male or a former or current smoker, alcohol intake above the moderate level, and periodontitis increase the risk of colorectal adenoma. These findings suggest that controlling oral disease is important to the prevention and management of colorectal adenoma. The findings of this study could be applied to risk stratification and colorectal cancer prevention programs, including screening guidelines.

Mortality rate and oral health - a cohort study over 44 years in the county of Stockholm

OBJECTIVE

To study the association between oral health and all-cause mortality rate over 44 years. In addition, the specific relations between oral health and death caused by cardiovascular disease (CVD), cancer or other reasons were investigated.

MATERIALS AND METHODS

An epidemiological investigation studying the oral health of the population consisting of 1393 randomly selected subjects was performed in the County of Stockholm. The individuals were invited to a clinical examination, an interview and a radiographic examination. The incidence of mortality during the years 1970-2014 as well as the causes of death according to the death certificate were registered in 2015. Cox regression survival analysis was used for investigating the effect of several variables upon the time to the outcome of death.

RESULTS

Forty-six percent of the subjects were still alive at the end of the year 2014. Cancers caused 27% of the deaths, while 22% died due to CVD. The mortality risk was positively and significantly correlated to oral health when compensated for age, sex, smoking and social status. In addition, the mortality risk caused by CVD, cancer or other reasons was significantly increased for those with poor oral health.

CONCLUSIONS

Oral health was found to be a risk indicator of death caused by CVD and cancer as well as for all-cause mortality. Thus, the associations are unspecific. Harmful lifestyle factors impact dental health behavior as well as mortality risk. This might contribute to the association between oral health and mortality risk.

Patients with Chronic Obstructive Pulmonary Disease Suffer from Worse Periodontal Health-Evidence from a Meta-Analysis

Background and Objective: It is widely accepted that there is an association between chronic obstructive pulmonary disease (COPD) and periodontitis. However, whether the periodontal status of the COPD patients is worse than that of the non-COPD subjects is seldom assessed. The findings currently available are inconsistent, some even contradictory. Therefore, we performed this meta-analysis to compare the periodontal health status of COPD patients and non-COPD subjects. Methods: PubMed and Embase were searched for all of the eligible studies which comparing the periodontal status between COPD patients and non-COPD subjects. The results of periodontal parameters in each study were extracted and the mean differences and 95% confidence intervals (CIs) for each parameter were calculated to determine their overall effects. Results: In total, 14 studies involving 3348 COPD patients and 20612 non-COPD controls were included and 9 periodontal indexes were analyzed. The mean differences (95% CIs) between COPD and non-COPD subjects for probing depth, clinical attachment loss, level of alveolar bone loss, plaque index, oral hygiene index, bleeding index, bleeding on probing, gingival index, and remaining teeth were 0.261 (0.020-0.501), 0.480 (0.280-0.681), 0.127 (0.000-0.254), 0.226 (0.043-0.408), 0.802 (0.326-1.279), 0.241 (-0.106 to 0.588), 6.878 (5.489-8.266), 0.364 (0.036-0.692), and -3.726 (-5.120 to -2.331), respectively. Conclusion: In summary, this meta-analysis demonstrates that the COPD patients suffer from worse periodontal health status, indicated by deeper periodontal pockets, high level of clinical attachment loss, worse oral hygiene, more inflammation and bleeding in the gingival tissue, and lower number of remaining teeth. Nevertheless, considering the limitations in our meta-analysis, more high-quality, and well-designed studies focusing on the periodontal health of the COPD patients are required to validate our conclusion.

Periodontal health status and lung function in two Norwegian cohorts

RATIONALE AND OBJECTIVES

The oral cavity is united with the airways, and thus poor oral health may affect respiratory health. However, data on the interaction of periodontal and respiratory health is limited. We aimed to evaluate whether periodontal health status, assessed by the Community Periodontal Index (CPI), was related to lung function among young and middle-aged adults in two Norwegian cohorts.

METHODS

Periodontal health status and lung function were measured among 656 participants in the Norwegian part of the European Community Respiratory Health Survey (ECHRS III) and the RHINESSA offspring study. Each participant was given a CPI-index from 0 to 4 where higher values reflect poorer periodontal status. The association between CPI and lung function was estimated with linear regression adjusting for age, gender, smoking, body mass index, exercise, education, use of antibiotics, inhaled medication and corrected for clustering within families.

MAIN RESULTS

Participants with CPI 3-4 had significantly lower FEV1/FVC ratio compared to participants with CPI 0, b (95% CI) = -0.032 (-0.055, -0.009). Poorer periodontal health was associated with a significant decrease in the FEV1/FVC ratio with an adjusted regression coefficient for linear trend b (95% CI) = -0.009 (-0.015, -0.004) per unit increase in CPI. This negative association remained when excluding asthmatics and smokers (-0.014 (-0.022, -0,006)).

CONCLUSIONS

Poorer periodontal health was associated with increasing airways obstruction in a relatively young, healthy population. The oral cavity is united with the airways and our findings indicate an opportunity to influence respiratory health by improving oral health.

Relationship between long working hours and periodontitis among the Korean workers

We aimed to investigate the association between long working hours and periodontitis, and whether such an association constitutes an exposure-response relationship. Data for this study were collected from the Korea National Health and Nutrition Examination Surveys conducted from 2007 to 2014; 17,533 workers (9,483 of men and 8,050 of women) were included. The odds ratios (OR) and 95% confidence intervals (CI) for the analysis of periodontitis defined as positive of Community Periodontal Index in relation to working hours were calculated using multiple logistic regression models with various stratifications. Compared to participants who worked ≤40 hours per week, the prevalence ratio (95% CI) for the periodontitis was 1.19 (1.14–1.24) and full adjusted OR (95% CI) was 1.09 (1.02–1.18) in participants who worked over 40 hours per week. The OR (95% CI) for periodontitis were 1.09 (0.99–1.19) in working group of 40< and ≥52 and 1.10 (1.01–1.20) in working group of >52 hours per week with a significant trend (p = 0.0233) even after adjusting for age, socioeconomic status, healthy behaviour, chronic disease, and dental care status. Long working hours are associated with periodontitis among Korean workers in an exposure-response manner.

Is periodontitis a comorbidity of COPD or can associations be explained by shared risk factors/behaviors?

COPD is recognized as having a series of comorbidities potentially related to common inflammatory processes. Periodontitis is one of the most common human inflammatory diseases and has previously been associated with COPD in numerous observational studies. As periodontitis and COPD are both chronic, progressive conditions characterized by neutrophilic inflammation with subsequent proteolytic destruction of connective tissue, it has been proposed that they share common pathophysiological processes. The mechanisms proposed to link COPD and periodontitis include mechanical aspiration of oral contents into the respiratory tree, overspill of locally produced inflammatory mediators into the systemic circulation or oral or lung-derived bacteremia activating an acute-phase response and also reactive oxygen species (ROS) and cytokine release by systemic neutrophils at distant sites. Studies of systemic neutrophils in COPD and chronic periodontitis describe altered cellular functions that would predispose to inflammation and tissue destruction both in the lung and in the mouth, again potentially connecting these conditions. However, COPD and periodontitis also share risk factors such as age, chronic tobacco smoke exposure, and social deprivation that are not always considered in observational and interventional studies. Furthermore, studies reporting associations have often utilized differing definitions of both COPD and periodontitis. This article reviews the current available evidence supporting the hypothesis that COPD and inflammatory periodontal disease (periodontitis) could be pathologically associated, including a review of shared inflammatory mechanisms. It highlights the potential limitations of previous studies, in particular, the lack of uniformly applied case definitions for both COPD and periodontitis and poor recognition of shared risk factors. Understanding associations between these conditions may inform why patients with COPD suffer such a burden of comorbid illness and new therapeutic strategies for both the diseases. However, further research is needed to clarify factors that may be directly causal as opposed to confounding relationships.

Interaction between periodontitis and liver diseases

Periodontitis is an oral disease that is highly prevalent worldwide, with a prevalence of 30–50% of the population in developed countries, but only ~10% present with severe forms. It is also estimated that periodontitis results in worldwide productivity losses amounting to ~54 billion USD yearly. In addition to the damage it causes to oral health, periodontitis also affects other types of disease. Numerous studies have confirmed the association between periodontitis and systemic diseases, such as diabetes, respiratory disease, osteoporosis and cardiovascular disease. Increasing evidence also indicated that periodontitis may participate in the progression of liver diseases, such as non-alcoholic fatty liver disease, cirrhosis and hepatocellular carcinoma, as well as affecting liver transplantation. However, to the best of our knowledge, there are currently no reviews elaborating upon the possible links between periodontitis and liver diseases. Therefore, the current review summarizes the human trials and animal experiments that have been conducted to investigate the correlation between periodontitis and liver diseases. Furthermore, in the present review, certain mechanisms that have been postulated to be responsible for the role of periodontitis in liver diseases (such as bacteria, pro-inflammatory mediators and oxidative stress) are considered. The aim of the review is to introduce the hypothesis that periodontitis may be important in the progression of liver disease, thus providing dentists and physicians with an improved understanding of this issue.

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.