Association between Periodontitis and Metabolic Syndrome in a Korean Nationally Representative Sample of Adults Aged 35-79 Years

Association between metabolic syndrome and salivary MMP-8, myeloperoxidase in periodontitis

OBJECTIVE

This study investigated the effect of metabolic syndrome (MetS) on periodontal clinical parameters and salivary biomarkers' matrix metalloproteinase-8 (MMP-8) and myeloperoxidase (MPO) in patients with periodontitis.

METHODS

A total of 120 participants aged 25-55 were categorized into three groups: MetS with periodontitis (n = 40); systemically healthy with periodontitis (n = 40); and systemically and periodontally healthy controls (n = 40). Data collected included systemic parameters like waist circumference (WC), blood pressure (BP), high- and low-density lipoproteins, triglycerides (TG), fasting blood sugar (FBS), and glycated hemoglobin (HbA1c). Periodontal parameters estimated included bleeding on probing score (BoP), full-mouth plaque score (FMPS), periodontal probing depth (PPD), clinical attachment loss (CAL), and the number of missing teeth. Unstimulated whole saliva was analyzed via ELISA for active MMP-8 (aMMP-8), total MMP-8 (tMMP-8), and MPO.

RESULTS

Participants with MetS and periodontitis exhibited significantly higher periodontal parameters, salivary aMMP-8, and MPO (26.26 vs. 24.1 ng/mL and 13.53 vs. 11.55 ng/mL compared to systemically healthy periodontitis patients) (all p < 0.01). Positive correlations occurred between aMMP-8 and WC, TG, and FBS (p < 0.01), and between MPO and WC, BP, and TG (p < 0.01).

CONCLUSIONS

The positive associations between these biomarkers and metabolic parameters indicate their potential utility for monitoring cardiovascular and glycemic risk in patients with periodontal disease.

Association between components of metabolic syndrome and periodontitis: a systematic review and meta-analysis

OBJECTIVES

To evaluate the role of metabolic syndrome (MetS) components in the association with periodontitis (PE) (#CRD42020218310).

MATERIALS AND METHODS

A systematic electronic search was performed in PUBMED, Scielo and Lilacs databases up to April 2022. Cross-sectional, case-control, and cohort studies presenting data on the association between MetS and PE in the adult and elderly populations were included. A random effect meta-analysis was performed to determine association effect estimates. Results interpretation followed the assessment of methodological quality (Joana Briggs Institute tool) together with the certainty of evidence (GRADE approach).

RESULTS

This review included 52 studies, totalling 140,434 participants, and 38 studies were meta-analyzed. Association between PE and MetS was observed (OR_adj from 1.27 to 1.90; PR_ajd = 1.19; RR_adj from 1.10 to 1.37) (low and very low certainty of evidence). Hyperglycaemia (OR = 1.18), HDL (OR = 1.16), obesity (OR = 1.08), and hypertension (OR = 1.11) were associated with PE, except triglycerides (low and very low certainty of evidence). There was a dose-response gradient between the number of MetS components and PE, with a gradual increase in the effect magnitude for 1 (OR = 1.14), 2 (OR = 1.52), 3 or more (OR = 1.79), and 4 or 5 components (OR = 2.02) (low to high certainty of evidence).

CONCLUSIONS

MetS was associated with PE, with a dose-response gradient between the number of MetS components and the occurrence of PE, with an increasing effect magnitude according to an increasing number of components.

CLINICAL RELEVANCE

Periodontal examination should be part of a comprehensive propaedeutic approach of MetS patients, particularly those presenting a great number of components.

Association between periodontitis and the metabolic syndrome in the Hamburg City Health Study

BACKGROUND

Previous studies demonstrated an association between severe chronic periodontitis (CP) and the metabolic syndrome (MetS). However, these studies mostly employed the meanwhile outdated NCEP-ATPIII case definition of the MetS. Additionally, CP was rarely diagnosed based on a full-mouth examination. Thus, the aim of the current study was to re-evaluate the potential association between CP and the MetS in the Hamburg City Health Study (HCHS), a large population-based survey of middle-aged and elderly men and women in Germany, in view of more current definitions of the MetS and CP.

METHODS

A cross-sectional study was performed with baseline-data from participants of the Hamburg City Health Study (HCHS). Periodontitis severity grades were determined in a random sample of 6,209 participants of which 5,456 had sufficient data to call absence or presence of the MetS. Variables defining the MetS according to the currently valid harmonized definition were determined and a full-mouth examination was performed, including determination of the clinical attachment loss (AL), bleeding on probing (BOP), and dental plaque (PI) index. CP was classified in three grades of severity (none/mild, moderate, and severe). The Kruskal-Wallis test or the Chi-squared test were used for descriptive statistics and multivariate logistic regression models with and without adjustments for potential confounders (age, sex, smoking, high sensitivity C-reactive protein (hsCRP), energy intake, and physical activity) were used to test for associations.

RESULTS

The prevalence of the MetS (39.0%) increased according to the severity grades of periodontitis (none/mild: 33.6%; moderate: 38.7%, and severe: 46.8%). Multivariate logistic regression analyses demonstrated that severe but not moderate CP was associated with the MetS after adjusting for age and sex (odds ratio [OR]: 1.24; 95% confidence interval [CI]: 1.03-1.48; p = 0.02). However, the association was attenuated after additional adjustment for smoking (OR: 1.19; 95% CI: 0.99-1.43; p = 0.058) and hsCRP, energy intake, and physical activity (OR: 1.11; 95% CI 0.91-1.36; p = 0.294).

CONCLUSIONS

The use of the more current definitions for the MetS and CP confirmed previous observations of an age- and sex-adjusted association between severe CP and the MetS. Smoking, high energy intake and low physical activity were identified as important lifestyle-related confounders. Abdominal obesity, as indicated by elevated waist circumference, came out as the most important component of the MetS in relation to CP. This article is protected by copyright. All rights reserved.

Implication of thyroid function in periodontitis: a nationwide population-based study

Possible links between periodontitis and various cardiometabolic and autoimmune diseases have been advocated on the basis of chronic inflammation or oxidative stress. However, the association between periodontitis and thyroid dysfunction is under-researched. Participants without previous thyroid disease or ongoing thyroid-related medication were included from a nationwide population-level survey. Participants were categorized into tertiles of thyroid stimulating hormone (TSH) levels (first tertile < 1.76 mIU/L; second tertile 1.76-2.83 mIU/L; third tertile > 2.83 mIU/L), and periodontal condition was assessed using the Community Periodontal Index. Of the total of 5468 participants, 1423 had periodontitis (26%). A significant difference in the weighted prevalence of periodontitis according to TSH tertiles was observed, with the highest prevalence in the first tertile (26.5%) and the lowest prevalence in the third tertile (20.9%, p = 0.003). Subjects in the first TSH tertile had higher odds for periodontitis than those in the third tertile (OR 1.36, 95% CI 1.10-1.68; p for trend = 0.005) after adjusting for covariates. This association was consistent across subgroups and within sensitivity analyses among subjects without specific factors affecting thyroid function or diseases reported to be related to periodontitis. The present study demonstrated that low TSH levels were associated with significantly higher odds for periodontitis.

Association Between Periodontitis and Metabolic Syndrome in Females: A Systematic Review and Meta-analysis

Background:

Metabolic syndrome (MetS) and periodontal diseases (PDs) have shown a bidirectional and vice versa relationship. Hence, this study aimed to identify the extent and magnitude between MetS and PDs in females.

Materials and Methods:

A published literature was explored by considering case–control, cross-sectional, and cohort studies that involved patients with measurements of MetS and PD. Ovid MEDLINE, EMBASE, LILACS, and Cochrane Library databases were used for the search. This study examined the relationship between the MetS and PD among females.

Results:

Of the initial 4150 titles screened, a total of 37 reported papers were eligible for quantitative review. A gender-wise analysis of the findings revealed a crude odds ratio (OR) of 1.385 [95% confidence interval (CI): 1.043–1.839, I² = 94.61%, P < 0.001] for the females relative to the average OR of 1.54 (95% CI: 1.39–1.71, I² = 90.95%, P < 0.001). Further subgroup analysis for directionality in females revealed the crude ORs of 1.28 (95% CI: 0.91–1.79, I² = 96.44%, P < 0.001) for the relationship between PD and MetS, whereas an OR of 2.12 (95% CI: 0.78–5.73, I² = 88.31%, P < 0.001) was found between MetS and PDs.

Conclusion:

This study lacks convincing proof of a link between MetS and PDs in females when compared with an overall association between MetS and PDs. Directionality indicated higher odds of linking between MetS and PD than PD and MetS among females. Further longitudinal and treatment trials are needed to confirm the association among females.

Smoking and Periodontitis Can Play a Synergistic Role in the Development of Psoriasis: A Nationwide Cohort Study

BACKGROUND

Periodontitis is a chronic inflammatory disorder involving the periodontium. The precise nature of the association between periodontitis and psoriasis has not been determined.

OBJECTIVE

This nationwide population-based study investigated the relationship between periodontitis and the risk of psoriasis.

METHODS

A health screening database, which is a sub-dataset of the Korean National Health Insurance System database, was used in this study. Subjects with (n = 1,063,004) and without (n = 8,655,587) periodontitis who underwent health examinations from January to December 2009 were followed for 9 years.

RESULTS

In multivariable analysis, compared to the non-periodontitis group, periodontitis patients had a significantly higher risk of developing psoriasis (hazard ratio 1.116, 95% confidence interval 1.101-1.13). Non-smokers with periodontitis had an 11% increase in risk of psoriasis and smokers with periodontitis had a 26.5% increase in risk of psoriasis compared to non-smokers without periodontitis.

CONCLUSION

Our study highlights periodontitis as a potential independent risk factor for psoriasis, increasing awareness of the synergistic role of smoking and periodontitis in the pathogenesis of psoriasis.

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.

Relationship between Apical Periodontitis and Metabolic Syndrome and Cardiovascular Events: A Cross-Sectional Study

Aim: Both apical periodontitis (AP) and metabolic syndrome (MetS) are associated with atherosclerotic cardiovascular disease (ACVD), the main cause of cardiovascular events. The aim of this study was to investigate the prevalence of AP and the oral inflammatory burden in control subjects and patients suffering cardiovascular events, analyzing the possible association between AP and the oral inflammatory burden with MetS. Materials and Methods: Using a cross-sectional design, 83 patients suffering a cardiovascular event were recruited in the study group (SG), and 48 patients without cardiovascular events were included in the control group (CG). Periapical index (PAI) was used to diagnose AP, and total dental index (TDI) was used to assess the total oral inflammatory burden. Diagnosis of MetS was made by meeting three or more American Heart Association Scientific Statement components. Results: In the multivariate logistic regression analysis, the number of teeth with AP (OR = 2.3; 95% C.I. = 1.3–4.3; p = 0.006) and TDI scores (OR = 1.5; 95% C.I. = 1.2–1.9; p = 0.001), significantly correlated with cardiovascular events. MetS was strongly associated (OR = 18.0; 95% C.I. = 6.5–49.7; p = 0000) with cardiovascular events. Higher TDI scores were significantly associated with MetS (OR = 1.3; 95% C.I. = 1.1–1.6; p = 0.003. Neither the number of root-filled teeth (RFT) (OR = 0.9; 95% C.I. = 0.6–1.3; p = 0.61) nor the number of teeth with apical periodontitis (OR = 1.1; 95% C.I. = 0.8–1.7; p = 0.49) were associated with MetS. Conclusions: Apical periodontitis is significantly associated with cardiovascular events. Total oral inflammatory burden assessed by TDI, but not AP alone, is associated with MetS.

Poor Oral Hygiene and High Levels of Inflammatory Cytokines in Saliva Predict the Risk of Overweight and Obesity

The study aimed to determine if oral hygiene influences not only oral health but also potentially metabolic disorders such as overweight or obesity. Participants were 94 patients: 40 with increased body mass and 54 with normal body mass. The methods included dental examination, a questionnaire concerning hygienic habits and an assessment of selected salivary inflammatory markers. The new parameter named “cleaning index” (describing the interaction between average time of tooth brushing in minutes and its frequency per day) significantly correlated with Body Mass Index (R_Spearman = 0.300). The multivariate regression model incorporating cleaning index, approximal plaque index, receptor 1 for tumor necrosis factor-alpha (TNFα-R1) and interleukin-15 (IL-15) had a high power to predict overweight or obesity (AUC = 0.894). Patients with poor oral hygiene (approximal plaque index >40%) were more than eight times more likely to suffer from obesity than patients with good oral hygiene. Cleaning index higher than 4 decreased the odds by about 85%. Oral hygiene habits, adjusted by salivary concentrations of selected inflammatory markers may allow predicting effectively overweight or obesity risk. Early proper dental prophylaxis and treatment could lead to the better prevention of metabolic disorders.

Association of Periodontitis With Metabolic Syndrome: A Case-Control Study

Aim:

This study was undertaken to assess the association between periodontitis and metabolic syndrome.

Materials and Methods:

A case-control study was designed among 100 cases as patients with metabolic syndrome aged 35–74 years, and age- and sex-matched 100 controls as apparently healthy relatives or friends accompanying the cases visiting the diabetic outpatient department at Victoria Hospital, Bengaluru, Karnataka, India, using convenience sampling method. Information related to diabetes, hypertension, and oral hygiene practices was collected. Periodontal health status was measured using community periodontal index. Metabolic syndrome was diagnosed based on the criteria of National Cholesterol Education Program Adult Treatment Panel III. Chi-square test and logistic regression were used for analysis.

Results:

Significantly more number of cases had shallow pockets 4–5 mm, deep pockets ≥ 6 mm, and also more number of loss of attachment code 1, code 2, code 3, and code 4 compared to controls. Bivariate analysis showed significant association between metabolic syndrome and body mass index, smoking, and tobacco chewing. The association between periodontitis and metabolic syndrome was significant with increased risk of developing metabolic syndrome among the subjects with community periodontal index code 3 and code 4 (odds ratio [OR] = 17) and among the subjects having loss of attachment code 1, code 2, code 3, and code 4 (OR = 12). Association remained significant even after adjustment with other variables (adjusted OR = 6).

Conclusion:

This study showed significant association between periodontitis and metabolic syndrome. Further prospective and randomized control trials are recommended to assess causal association between these two diseases.

Molecular identification and diversity analysis of dental bacteria in diabetic and non-diabetic females from Saudi Arabia

Periodontal disease is a chronic infectious disease, which is characterized by the damaged dental hard tissue by lactic acid generated by microorganisms after the fermentation of carbohydrates rich diet. The risk of periodontal disease is known to be higher in diabetic patients. We compared the diversity of five commonly occurring dental bacteria including Porphyromonas gingivalis, Tannerella forsythia, Capnocytophaga ochracea, Prevotella intermedia, and Aggregatibacter actinomycetemcomitans in 14 type-2 diabetic patients and equal numbers of healthy controls. The subgingival samples were collected using sterile paper points. We used 16S rRNA sequence specific primers for PCR-based identification of dental bacteria. Our results showed that A. actinomycetemcomitans was completely absent in control subjects but present in 43% of diabetic patients. C. ochracea was highly prevalent in diabetic patients (100%) as compared to controls (28.5%). The frequency of other three bacterial species was also higher in diabetic patients than control subjects. These findings indicate that dental bacteria are highly prevalent in subgingival pockets of diabetic patients. Therefore, proper monitoring of diabetic patients for dental care is important to prevent bacterial growth and its sequela in risky individuals. Further case-control studies using larger sample size would help in validating the association between oral diseases and diabetes.

Periodontal Diseases and the Risk of Metabolic Syndrome: An Updated Systematic Review and Meta-Analysis

Background: Periodontitis and metabolic syndrome (MetS) are two major global health problems that are widely prevalent in the world, although the former is a common infection in developing countries and the latter is a non-infectious but prevalent disease in developed countries. This study aims to provide an updated review on the existence and magnitude of the relationship between periodontal disease and the risk of MetS. Methods: We searched the PubMed, Web of Science, ScienceDirect, Chinese National Knowledge Infrastructure, and Wanfang databases for original studies assessing the association between periodontitis and MetS published before August 2019. We calculated the pooled crude and adjusted odds ratios (ORs) together with the 95% confidence intervals (95% CIs) to estimate the strength of this association. Subgroup analysis was performed by considering the diagnostic method or the country where the studies were performed. Results: We identified 43 potentially eligible articles for this systematic review, including 32 cross-sectional studies, eight case-control studies, and three cohort studies. Among them, 39 articles presented enough information to be included in the meta-analysis. The pooled crude and adjusted ORs were 1.99 (95% CI: 1.75-2.25) and 1.46 (95% CI: 1.31-1.61), respectively. Subgroup analysis showed a consistent relation stratified by either the diagnostic method or the country where the studies were performed. The pooled OR was 1.68 (95% CI: 1.41-2.00) for Japan, 1.75 (95% CI: 1.31-2.34) for the USA, 1.81 (95% CI: 1.35-2.42) for Korea, and 2.29 (95% CI: 1.53-3.41) for China. Conclusion: Our results provide compelling evidence for the association between periodontitis and MetS. Patients with periodontal disease are a critical screening population for MetS. We also recommend that people exhibiting components of MetS should receive a periodontal check-up and pay attention to their oral health.