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Chien WC, Fu E, Chung CH, Cheng CM, Tu HP, Lee WC, Chen WL, Shih KC. Type 2 Diabetes Mellitus and Periodontitis: Bidirectional Association in Population-based 15-year Retrospective Cohorts. J Clin Endocrinol Metab 2023; 108:e1289-e1297. [PMID: 37224522 DOI: 10.1210/clinem/dgad287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/18/2023] [Accepted: 05/23/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE A two-way relationship between periodontitis and diabetes has been proposed. However, bidirectional epidemiological observation is limited and inconsistent. OBJECTIVE Using the National Health Insurance Research Database of Taiwan (covering over 99% of the entire population), we aimed to estimate the development of diabetes in periodontitis patients or that of periodontitis in patients with type 2 diabetes mellitus (T2DM), respectively. METHODS A total of 11 011 patients with severe periodontitis were recruited from 2000 to 2015. After matching by age, sex, and index date, 11 011 patients with mild periodontitis and 11 011 non-periodontitis controls were registered. Additionally, 157 798 patients with T2DM and 157 798 non-T2DM controls were enrolled, in whom the development of periodontitis was traced. Cox proportional hazards model was performed. RESULTS Periodontitis patients tended to have a statistically high risk for T2DM. The adjusted hazard ratio was 1.94 (95% CI, 1.49-2.63, P < .01) and 1.72 (95% CI, 1.24-2.52, P < .01) for severe and mild periodontitis groups, respectively. The patients with severe periodontitis had a higher risk of having T2DM relative to those with mild periodontitis (1.17 [95% CI, 1.04-1.26, P < .001]). Conversely, the risk of periodontitis increased significantly in patients with T2DM (1.99 [95% CI, 1.42-2.48, P < .01]). However, high risk was observed for the outcome of severe periodontitis (2.08 [95% CI, 1.50-2.66, P < .001]), but not for mild periodontitis (0.97 [95% CI, 0.38-1.57, P = .462]). CONCLUSION We suggest that the bidirectional association is between T2DM and severe but not mild periodontitis.
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Affiliation(s)
- Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan, ROC
- School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan, ROC
| | - Earl Fu
- Department of Dentistry, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Xindian, New Taipei City 23142, Taiwan, ROC
- Department of Dentistry, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan, ROC
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan, ROC
- School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan, ROC
| | - Chia-Mao Cheng
- Department of Dentistry, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Xindian, New Taipei City 23142, Taiwan, ROC
| | - Hsiao-Pei Tu
- Department of Oral Hygiene, Hsin-Sheng Junior College of Medical Care and Management, Taoyuan City 32544, Taiwan, ROC
| | - Wei-Cheng Lee
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan, ROC
| | - Wei-Liang Chen
- Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan, ROC
- School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan, ROC
| | - Kuang-Chung Shih
- School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan, ROC
- Division of Endocrinology & Metabolism, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan, ROC
- Division of Endocrinology & Metabolism, Cheng Hsin General Hospital, Taipei 11220, Taiwan, ROC
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Medina Gómez OS, Villegas Lara B, Escobedo DE LA Peña J. Impact of social marginalization on oral health-related quality of life in older adults. Braz Oral Res 2023; 37:e095. [PMID: 37820253 DOI: 10.1590/1807-3107bor-2023.vol37.0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/15/2023] [Indexed: 10/13/2023] Open
Abstract
The aim of this study was to determine the association between oral health-related quality of life (OHRQoL) and social marginalization in people aged 60 years and older enrolled in social security in Mexico. A cross-sectional and analytical study was carried out in older adults. To assess the OHRQoL, the OHIP-14 instrument was applied, and the degree of social marginalization and sociodemographic characteristics were analyzed. Measures of central tendency and dispersion, simple frequencies and proportions were estimated. Student's t-test was used for comparison of means, and prevalence ratio (PR) and logistic regression were used to assess associations, all with a significance value of 0.05 and 95% confidence intervals. Perceived OHRQoL in the population measured through the OHIP-14 reached an average value of 9.84 ± 8.91, with the highest value in the dimension of physical pain (2.06 ± 1.91). Perceived treatment need was higher among people with social marginality (p = 0.011). The multivariate analysis shows that marginalized people have a lower OHRQoL. Socially marginalized older adults showed a low a better perception of OHRQoL, independent of demographic and clinical factors.
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Affiliation(s)
- Oswaldo Sinoe Medina Gómez
- Instituto Mexicano del Seguro Social,HGR 1 Carlos MacGregor Sánchez Navarro, Unidad de Investigación en Epidemiología Clínica, Ciudad de México, México
| | - Beatriz Villegas Lara
- Instituto Mexicano del Seguro Social,HGR 1 Carlos MacGregor Sánchez Navarro, Unidad de Investigación en Epidemiología Clínica, Ciudad de México, México
| | - Jorge Escobedo DE LA Peña
- Instituto Mexicano del Seguro Social,HGR 1 Carlos MacGregor Sánchez Navarro, Unidad de Investigación en Epidemiología Clínica, Ciudad de México, México
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Weijdijk LPM, Ziukaite L, Van der Weijden GA(F, Bakker EWP, Slot DE. The risk of tooth loss in patients with diabetes: A systematic review and meta-analysis. Int J Dent Hyg 2022; 20:145-166. [PMID: 33973353 PMCID: PMC9291053 DOI: 10.1111/idh.12512] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 04/09/2021] [Accepted: 05/05/2021] [Indexed: 01/02/2023]
Abstract
AIM The aim of this systematic review was to comprehensively and critically summarize and synthesize the risk of losing teeth among with diabetes mellitus (DM) compared to those without DM, as established in observational studies. MATERIALS AND METHODS MEDLINE-PubMed and Cochrane databases were searched through a period from their inception through October 2020 to identify eligible studies. Papers that primarily evaluate the number of teeth in DM patients compared to non-DM individuals were included. A descriptive analysis of the selected studies was conducted, and when feasible, a meta-analysis was performed. The quality of the studies was assessed. RESULTS A total of 1087 references were generated, and screening of the papers resulted in 10 eligible publications. A descriptive analysis demonstrated that six of these studies indicate a significantly higher risk of tooth loss in DM patients. This was confirmed by the meta-analysis risk ratio of 1.63 95% CI (1.33; 2.00, p < 0.00001). Subgroup analysis illustrates that this is irrespective of the risk-of-bias assessment. The higher risk of tooth loss in DM patients was also higher when only DM type II patients or studies with a cross-sectional design were considered. Patients with a poor DM control status presented a significantly increased risk of tooth loss. When the data were separated by the world continent where the study was performed, Asia and South America had numerically higher risks and a 95% CI that did not overlap with Europe and North America. CONCLUSION There is moderate certainty for a small but significantly higher risk of tooth loss in DM patients as compared to those without DM.
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Affiliation(s)
- Lotte P. M. Weijdijk
- Department of Oral and Maxillofacial SurgeryAmsterdam UMC and Academic Center for Dentistry Amsterdam (ACTA)ACTA is a joint venture between the Faculty of Dentistry of the University of Amsterdam and the Faculty of Dentistry of the Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Clinic for DentistryDental Care Utrecht (DCU)UtrechtThe Netherlands
- Department of PeriodontologyAcademic Center for Dentistry Amsterdam (ACTA)ACTA is a joint venture between the Faculty of Dentistry of the University of Amsterdam and the Faculty of Dentistry of the Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Laura Ziukaite
- Department of PeriodontologyAcademic Center for Dentistry Amsterdam (ACTA)ACTA is a joint venture between the Faculty of Dentistry of the University of Amsterdam and the Faculty of Dentistry of the Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - G. A. (Fridus) Van der Weijden
- Department of PeriodontologyAcademic Center for Dentistry Amsterdam (ACTA)ACTA is a joint venture between the Faculty of Dentistry of the University of Amsterdam and the Faculty of Dentistry of the Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Eric W. P. Bakker
- Division Clinical Methods and Public Health Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Dagmar Else Slot
- Department of PeriodontologyAcademic Center for Dentistry Amsterdam (ACTA)ACTA is a joint venture between the Faculty of Dentistry of the University of Amsterdam and the Faculty of Dentistry of the Vrije Universiteit AmsterdamAmsterdamThe Netherlands
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Association between Diabetes Mellitus and Oral Health Status in Patients with Cardiovascular Diseases: A Nationwide Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094889. [PMID: 34064391 PMCID: PMC8125754 DOI: 10.3390/ijerph18094889] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/28/2021] [Accepted: 05/02/2021] [Indexed: 12/30/2022]
Abstract
Diabetes mellitus (DM) can lead to poor oral health. However, oral health among diabetic patients with cardiovascular diseases (CVDs) is scarcely studied. This study aimed to elucidate the prevalence of oral health complications and the relationship between DM and oral health status in diabetic patients with CVDs. This retrospective nationwide cross-sectional study evaluated 3495 patients aged ≥40 years with CVD, with DM (n = 847) and without DM (n = 2648). The participant's characteristics between the two groups were compared using the Chi-square test and t-test. Logistic regression analyses were performed to identify associations between DM and oral health status. The prevalence of periodontitis (54.3% vs. 43.2%) and <20 number of remaining teeth (30.9% vs. 22.8%) was significantly higher in the DM than in the non-DM group. In the multivariate regression analysis, the incidence of periodontitis was 1.4 times higher in the DM group than in the non-DM after adjusting for confounders; however, the number of remaining teeth and active caries were not associated with DM. In conclusion, the oral health status of patients with coexisting CVD and DM should be assessed closely and actively. Healthcare professionals should provide accessible dental care services and develop strategies to improve patients' oral health.
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Association between periodontal disease and tooth loss and mortality in an elderly Chinese population. Aging Clin Exp Res 2020; 32:2375-2382. [PMID: 32020486 DOI: 10.1007/s40520-019-01446-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 12/11/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Poor oral health is a risk indicator of poor quality of life and mortality. However, whether these associations remain potent in elderly subjects after adequately considering the confounding factors is not yet clearly elucidated. The present study aimed to investigate the associations between periodontal disease and tooth loss and total mortality and cardiovascular disease (CVD) outcomes in the elderly > 75 years old. METHODS A total of 1385 individuals, receiving periodontal treatment in Shanghai, participated in this retrospective study. Data on oral status were obtained from radiographs to calculate the proportion of residual bone. The information about mortality was collected from the Shanghai Municipal Center for Disease Control and Prevention (SCDC). Univariate Cox proportional hazards model, multivariable-adjusted model, and competing risk hazard model were used to analyze the association between periodontal disease or tooth loss and mortality. RESULTS Those with severe periodontitis were associated with higher risk of total mortality than healthy individuals [hazard ratio (HR) = 1.48, 95% confidence interval (95% CI) 1.11-1.98]. Further, missing teeth increased the risk of total mortality (HR = 1.02, 95% CI 1.01-1.03). However, no significant difference was detected in the association between periodontitis or tooth loss and CVD mortality. In competing risk hazard model, an increased risk was observed for other-cause mortality, not CVD mortality, in those with severe periodontitis and missing teeth. CONCLUSION Periodontal diseases and tooth loss were the potential predictors of total mortality even after adjustment for confounding factors. However, these were not independent indicators for CVD mortality.
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Meisel P, Pink C, Pitchika V, Nauck M, Völzke H, Kocher T. Competing interplay between systemic and periodontal inflammation: obesity overrides the impact of oral periphery. Clin Oral Investig 2020; 25:2045-2053. [PMID: 32827080 PMCID: PMC8238770 DOI: 10.1007/s00784-020-03514-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/06/2020] [Indexed: 12/19/2022]
Abstract
Objectives We aimed at investigating whether the interaction between the local inflammation, periodontitis, and obesity is independently associated with systemic inflammation. Methods From the population-based Study of Health in Pomerania, 3366 participants, without (2366) and with (1000) obesity, were studied for the association of periodontitis, measured as probing depth (PD) and plaque together with body mass index (BMI) on C-reactive protein (CRP). Quantile regression was used to evaluate the association between periodontal, anthropometric, and inflammatory variables (outcomes). Results The overall prevalence of obesity in this adult population was 31.4% in men and 28.1% in women. Both PD and plaque were positively associated with CRP, revealing an increasing impact across the CRP concentration distribution. Adjusting the regression of CRP or fibrinogen on PD for waist circumference attenuated but did not abolish the PD coefficients. Dental plaque was similarly associated with these interrelations. Association between PD and a dental plaque was different among participants with low-, medium-, or high-risk CRP concentrations. Conclusion Local and systemic sources of inflammation contribute to blood levels of inflammatory markers. The respective contributions depend on the relative rate in each of the inflammation-inducing risks and are dominated by adiposity. Clinical relevance Keeping systemic inflammation low in order to prevent age-related disease sequelae. Electronic supplementary material The online version of this article (10.1007/s00784-020-03514-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Peter Meisel
- Dental Clinics, Department of Periodontology, School of Dentistry, University Medicine Greifswald, Fleischmann-Strasse 42, D-17475, Greifswald, Germany.
| | - Christiane Pink
- Dental Clinics, Department of Periodontology, School of Dentistry, University Medicine Greifswald, Fleischmann-Strasse 42, D-17475, Greifswald, Germany
| | - Vinay Pitchika
- Dental Clinics, Department of Periodontology, School of Dentistry, University Medicine Greifswald, Fleischmann-Strasse 42, D-17475, Greifswald, Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Diagnostics, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, University Medicine, Greifswald, Germany
| | - Henry Völzke
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, University Medicine, Greifswald, Germany.,Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Thomas Kocher
- Dental Clinics, Department of Periodontology, School of Dentistry, University Medicine Greifswald, Fleischmann-Strasse 42, D-17475, Greifswald, Germany
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Islas-Granillo H, Borges-Yañez SA, Navarrete-Hernández JDJ, Veras-Hernández MA, Casanova-Rosado JF, Minaya-Sánchez M, Casanova-Rosado AJ, Fernández-Barrera MÁ, Medina-Solís CE. Indicators of oral health in older adults with and without the presence of multimorbidity: a cross-sectional study. Clin Interv Aging 2019; 14:219-224. [PMID: 30787597 PMCID: PMC6363395 DOI: 10.2147/cia.s170470] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose The aim of this study was to determine whether there are differences in the distribution of various indicators of oral health among elderly people with and without multimorbidity (ie, two or more chronic diseases). Subjects and methods A cross-sectional, comparative study was conducted using a sample of Mexican elderly individuals aged ≥60 years. The average age of the cohort was 79.06±9.78 years, and 69.1% were women. The variables indicating oral health were as follows: functional dentition, edentulism, hyposalivation, xerostomia, root caries and periodontitis. The multimorbidity variable was operationally categorized as follows: 0= subjects with no chronic disease or one chronic disease and 1= subjects with two or more chronic diseases. Questionnaires were used to collect information on various variables regarding general health. Likewise, the participants underwent a clinical oral examination. The analysis was performed using Stata 11.0. Results The overall prevalence of multimorbidity was 27.3%. The prevalences of various oral health indicators were as follows: without functional dentition 89.9%; hyposalivation 59.7%; edentulism 38.9% and self-reported xerostomia 25.2%. Dental caries were observed in 95.3% of the subjects, and the prevalence of severe periodontitis was 80%. We found a significant difference only in edentulism; its prevalence was higher among subjects with multimorbidity (55.3% vs 32.7%, P=0.015) than among those without multimorbidity. Conclusion The presence of edentulism in this sample of Mexican older adults was higher in subjects with multimorbidity. Multimorbidity and oral diseases constitute a true challenge in elderly people, because they affect quality of life and are associated with high health care costs.
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Affiliation(s)
- Horacio Islas-Granillo
- Academic Area of Dentistry, Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca, Mexico,
| | | | | | | | | | | | | | | | - Carlo Eduardo Medina-Solís
- Academic Area of Dentistry, Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca, Mexico, .,Advanced Studies and Research Center in Dentistry "Dr Keisaburo Miyata", Faculty of Dentistry, Autonomous University State of Mexico, Toluca, Mexico
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