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ORAL/SYSTEMIC DISEASE CONNECTION
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Age-dependent associations between chronic periodontitis/edentulism and risk of coronary heart disease
Dietrich T, Jiminez M, Krall Kaye EA, Vokonas PS, Garcia RI. Circulation 2008;117(13):1668–1674.[Abstract/Free Full Text]
The authors evaluated chronic periodontitis and edentulism as risk factors for incident coronary heart disease (CHD) in a cohort of 1,203 men participating in the Veterans Affairs (VA) Normative Aging Study and VA Dental Longitudinal Study. The subjects received comprehensive medical and dental examinations every three years for periods of up to 35 years, with a median follow-up period of 24 years. The investigators considered CHD events to include myocardial infarction, angina pectoris and fatal CHD (that is, the primary cause of death was recorded as CHD according to International Classification of Diseases-8 codes). A periodontist assessed the subjects’ periodontal status clinically and radiographically at each three-year examination and assigned bone loss and maximum probing depth scores on the basis of full-mouth disease severity.
The authors used a series of statistical models applicable to epidemiologic studies to evaluate the data. They found that the association between chronic periodontitis and CHD was modified by age, with a positive association among men younger than 60 years independent of established CHD risk factors. The association for this group was periodontitis "dose-dependent"—that is, the rate of CHD increased by 39 percent for each 20 percent increase in mean bone loss, and there was a similar statistically significant linear trend for increased CHD and increasing cumulative pocket depth. In men 60 years or older, they found a higher risk of CHD in edentulous men than in dentate men who had the lowest severity of periodontitis. The authors note that the finding of a significant association between periodontitis and CHD incidence among younger men is consistent with the hypothesis that a large part of the association is due to proinflammatory susceptibility factors common to both diseases.
Significance.
This study is significant in its investigation of the association between CHD and periodontitis for a prolonged time in a population receiving periodic thorough medical and dental evaluations. Nevertheless, although the study results suggested an association between periodontitis and the incidence of CHD in younger men, thereby supporting the findings of some previously published studies, the cohort examined consisted almost entirely of white men, and it is not clear to what extent the findings can be generalized to other populations.
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ORAL/SYSTEMIC DISEASE CONNECTION
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Periodontal disease definition may determine the association between periodontitis and pregnancy outcomes
Manau C, Echeverria A, Agueda A, Guerrero A, Echeverria JJ. J Clin Periodontol 2008;35(5):385–397.[Medline]
The authors conducted this study to determine whether inconsistent findings in previously reported studies of the role of periodontal disease as a risk factor for preterm birth (PTB) or low birth weight (LBW) might be explained by the lack of a consistent definition of periodontitis across studies. To examine the hypothesis that the significance of the association between periodontal disease and adverse pregnancy outcomes may be determined by the way in which periodontal disease severity is defined, they performed a secondary analysis of data from one of their previous studies using 14 definitions of periodontal disease and at least 50 continuous clinical measurements of periodontal disease that had been used in studies reported by other investigators. Their data set was derived from information on 1,296 pregnant women and their newborn babies. PTB was defined as delivery before 37 weeks of gestation, and LBW was defined as a birth weight of less than 2,500 grams. All subjects received a full-mouth periodontal examination including determination of plaque index and of full mouth bleeding on probing, pocket depths and clinical attachment levels at six sites per tooth.
The authors found that the prevalence of periodontitis in their sample depended on the definition of periodontitis and ranged from 2.2 to 70.8 percent. Moreover, the statistical significance of the association between periodontitis and adverse pregnancy outcomes also was determined by the definition of periodontitis or the periodontal parameter used. The authors found that when a statistically significant association was shown, it generally was based on clinical attachment loss measurements. They note that the purpose of this study was not to confirm or refute an association between periodontal disease and PTB or LBW but, rather, to show that the conclusions from epidemiologic studies may be influenced by the definition of periodontitis used. Accordingly, they support the establishment of uniform criteria for the determination and definition of periodontitis to enable researchers to compare results from different study groups.
Significance.
While numerous publications have reported studies of the association between periodontal disease and adverse pregnancy outcomes, not all of them have consistently shown such an association. The reasons for discrepant results are not always apparent. It may be, for example, that when a significant association was found, it was characteristic of the specific patient population studied and not generalizable to all populations. This study provides an additional basis for interpreting the literature and points to an additional and important reason for inconsistent findings across studies.
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ORAL MEDICINE/ORAL PATHOLOGY
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HIV infection and tooth loss
Engeland CG, Jang P, Alves M, Marucha PT, Califano J. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105(3):321–326.[Medline]
The authors conducted this retrospective cross-sectional study to determine if patients with HIV experience a greater amount of tooth loss than do systemically healthy patients. They hypothesized that tooth loss in patients with HIV would be greater because of two factors:
- – a previously reported relationship between HIV infection and periodontal diseases;
- – the potential for a higher caries incidence, resulting from therapy-associated xerostomia, in patients receiving highly active antiretroviral therapy (HAART).
The study population consisted of 193 randomly selected patients with HIV and 192 matched systemically healthy control subjects between the ages of 20 and 70 years. All patients had been treated at the University of Illinois at Chicago College of Dentistry and were seen every four to six months for maintenance visits for at least two years after completing active therapy.
The authors found no statistically significant difference in number of missing teeth between the two groups at baseline, at follow-up after active therapy or during the two-year maintenance period. Even among the 27 subjects who lost teeth during the maintenance period, there was no difference between groups. The number of missing teeth increased with increasing age in both groups. The authors attribute their findings to improvements in the management of HIV infection with the advent of such treatments as HAART and suggest that dental treatment and dental health maintenance can be as successful in patients with HIV as in people without HIV. They also suggest the need for well-designed prospective clinical trials of longer duration to confirm the lack of association between HIV infection and tooth loss.
Significance.
Clinical and epidemiologic studies have produced conflicting results regarding the role of HIV infection as a risk factor for periodontal disease and tooth loss. This may be, in part, a function of the period in which the study was conducted; studies conducted after the introduction of the antiretroviral therapies that reduced the prevalence of HIV-associated infections might be expected to yield findings different from those of earlier studies. This study reflects the positive effects of new therapies and provides information important for the dental care of patients with HIV.
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ORAL MEDICINE
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Anxiety and salivary cortisol levels in patients with burning mouth syndrome: case-control study
Amenabar JM, Pawlowski J, Hilgert JB, et al. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105(4):460–465.[Medline]
The authors conducted this case-control study to assess the anxiety and salivary cortisol levels in patients with burning mouth syndrome (BMS). They studied 30 patients who had experienced oral burning, pain or both for at least six months, had no mucosal lesions or other clinical signs of disease and whose results from a battery of laboratory tests were within the range of normal values. The patients (case subjects) included 24 women and six men with a mean age of 61.6 years. Thirty control subjects without oral complaints were matched to the case subjects by sex, race, marital status, income and educational level. The authors measured anxiety levels by using the Beck Anxiety Inventory, which is used to evaluate symptoms of anxiety perceived by the subject during the week preceding the assessment. The investigators assessed stimulated and unstimulated flow rates of whole saliva and had all subjects collect stimulated saliva for measurement of cortisol levels at three points during a single day.
The patients with BMS reported experiencing pain for periods that ranged from six to 96 months, with an average of 32.8 months. The respective stimulated and unstimulated salivary flow rates in the case and control groups were not statistically significantly different from each other, although the patients with BMS reported subjective xerostomia significantly more frequently than did the control subjects (60.0 percent versus 26.7 percent). The authors found that members of the BMS group had higher anxiety levels than did members of the control group; 13 percent of patients with BMS and none of the control subjects had severe anxiety. In addition, the subjects with BMS had significantly higher salivary cortisol levels at each of the three sampling times than did the control subjects.
The results of this study confirmed that patients with BMS have significantly higher levels of anxiety than do people without this syndrome and showed an association between high anxiety levels and salivary cortisol levels, a physiological indicator of stress. Moreover, they showed that the subjective reports of xerostomia by patients with BMS generally are not related to an actual reduction in salivary flow.
Significance.
The absence of clinical signs associated with BMS provides a challenge to understanding the etiology and pathogenesis of this disorder. This study provides additional support for an association between anxiety and BMS on the basis of both a psychological assessment and a physiological marker.
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ORAL/SYSTEMIC DISEASE CONNECTION
ORAL/SYSTEMIC DISEASE CONNECTION
