Periodontal Inflammatory Conditions Among Gutka Chewers and Non‐chewers With and Without Prediabetes

Background: It is known that gutka chewing jeopardizes periodontal health; however, severity of periodontal inflammation in gutka chewers with and without prediabetes remains unknown. The aim of this study is to investigate the association of periodontal inflammatory conditions with gutka chewing and prediabetes. Methods: In this cross‐sectional study, the effect of gutka use on periodontal health is investigated among 44 individuals with prediabetes and 44 without prediabetes. Demographic information regarding age, sex, duration of prediabetes, and gutka‐chewing habits was collected using a questionnaire. Periodontal inflammatory conditions (plaque index [PI], bleeding on probing [BOP], probing depth [PD], marginal bone loss [MBL]) and fasting blood glucose levels (FBGLs) were recorded. Group differences in periodontal inflammatory parameters were tested using univariate and multivariable analyses (α ≤5%). Results: Periodontal inflammatory parameters (PI, BOP, and PD) were significantly higher in individuals with prediabetes irrespective of gutka‐chewing habit (P <0.05). Odds of periodontal inflammation in individuals with prediabetes were nine times higher than in healthy controls (95% confidence interval [CI] = 3.4 to 23.6). Gutka chewing alone, chewing among individuals with prediabetes, and chewing among healthy controls did not significantly increase the odds of periodontal inflammatory conditions. Individuals with prediabetes were significantly more likely to have periodontal inflammation than individuals without prediabetes even after controlling for sex and gutka chewing (odds ratio = 13.2; 95% CI = 4.3 to 40.7). Conclusion: In medically healthy individuals, periodontal inflammatory conditions are worse in gutka chewers compared to non‐chewers; in patients with prediabetes, the severity of periodontal inflammation is governed by hyperglycemia when compared to habitual gutka usage.     

Maternal periodontal disease and preterm low birthweight: case-control study

Periodontal disease has been suggested to be an important risk factor for preterm low birthweight (PLBW). Here we report a case-control study of 236 cases (infants < 37 wks and weighing < 2499 g) and a daily random sample of 507 controls (> or = 38 wks and weighing > or = 2500 g). Clinical periodontal indices were measured on the labor wards. Associated risk factors for periodontal disease and PLBW were ascertained by means of a structured questionnaire and maternity notes. The risk for PLBW decreased with increasing pocket depth (odds ratio [OR] 0.83, 95% confidence interval [CI] 0.68 to 1.00). After adjustment for maternal age, ethnicity, maternal education, smoking, alcohol consumption, infections, and hypertension during pregnancy, this decreased further (OR 0.78, 95% CI 0.64 to 0.99). We found no evidence for an association between PLBW and periodontal disease. Our results do not support a specific drive to improve periodontal health of pregnant women as a means of improving pregnancy outcomes.     

The effect of periodontal disease on medical and dental costs in a middle-aged Japanese population: a longitudinal worksite study

BACKGROUND: Although periodontal disease is one of the most common chronic diseases, it is not clear whether periodontal disease is associated with increased health care costs. The authors examined the effect of periodontal disease on medical and dental costs and use for 3.5 years prospectively. METHODS: The data were derived from health and dental examinations and health insurance claims of 4,285 Japanese civil officers aged 40 to 59 years. The subjects were divided into three categories: no pathological pocket, moderate periodontitis, and severe periodontitis. Age, gender, smoking, body mass index, and hypertension were adjusted in a multivariate analysis after excluding subjects with any history of liver disease, heart disease, or diabetes mellitus. RESULTS: The cumulative cost for subjects with severe periodontitis was approximately 21% higher than for subjects with no pathological pocket, and the hospital admission rates of subjects with severe periodontitis were highest (male: odds ratio [OR]=.34; 95% confidence interval [CI]: 1.00 to 1.80; female: OR=1.29; 95% CI: 0.75 to 2.20). In males, the annual hospital costs of subjects with severe periodontitis were 75% higher than for subjects with no pathological pocket. There was no clear trend identified for outpatient care. The annual dental visit rates and costs for subjects with severe periodontitis were highest in both genders. Periodontal disease might increase the medical care costs for diabetes mellitus, digestive disease, and liver disease. CONCLUSION: Periodontal disease may have played an important role in the cumulative health care cost increases in middle-aged adults over a period of only a few years.     

Reliability of third molar probing measures and the systemic impact of third molar periodontal pathology.

PURPOSE: This study examined the reliability of assessing clinical periodontal measures on third molars, and the association between oral inflammation with periodontal pathology including third molars, and systemic inflammation including negative obstetric outcomes. PATIENTS AND METHODS: Reliability of third molar probing depth (PD) was assessed for 41 patients by trained examiners. The data for the association between oral inflammation with periodontal pathology and systemic outcomes were derived from an IRB-approved study, "Oral Conditions and Pregnancy." Full mouth periodontal exams including third molars were conducted at less than 24 weeks of pregnancy. Periodontal status, moderate/severe periodontal disease (15 or more sites PD > or =4 mm) was considered as a possible predictor of systemic inflammation and pre-term birth. The upper quartile of the extent of PD for third molars alone (PD > or =4 mm) also was considered as a possible exposure variable for the same outcomes. Chi-square and t tests were used to determine statistical significance (0.05). Significant predictor variables were included in multivariate models. Unconditional logistic multivariate models were used to derive odds ratios (OR) and 95% confidence intervals (CI). RESULTS: Reliability of PD within 1 mm was excellent, and similar for third molars and non-third molars. Data from 1,020 obstetric patients were available for analysis. Eighteen percent of the patients delivered preterm, at less than 37 weeks. Having moderate/severe periodontal disease excluding third molars, was significantly associated with preterm birth (P = .008). Results were more significant if third molars were included (P = .0005). With multivariate models moderate/severe periodontal disease at enrollment including third molar PD, was associated with preterm birth (OR, 1.7; 95% CI, 1.1, 2.6). If only the extent of third molar PD was considered, odds also were increased for preterm birth (OR, 2.4; 95% CI, 1.1, 5.2). If only the extent of third molar PD was considered at enrollment, odds were increased for serum markers of systemic inflammation, elevated serum CRP, and oxidative stress, 8-isoPGF(2alpha). CONCLUSIONS: Dental examiners could reliably assess clinical periodontal measures on third molars. Third molars should be included in studies of systemic outcomes associated with oral inflammation. Women of child-bearing age should be made aware of the systemic risks of oral inflammation with third molar periodontal pathology.     

Effect of Fluoxetine on Periodontal Status in Patients With Depression: A Cross‐Sectional Observational Study

Background: Fluoxetine, a selective serotonin reuptake inhibitor, has been reported to reduce periodontal disease severity in a rat ligature‐induced periodontitis model. The objective of the present study is to investigate the influence of fluoxetine intake on periodontal parameters in patients with periodontitis with clinical depression. Methods: A sample of 236 patients with chronic periodontitis and clinical depression were assessed for clinical parameters of periodontal disease. Of these, 115 patients were taking fluoxetine (20 mg/day) for ≥2 months, and 121 patients were not. Participants taking fluoxetine were further analyzed for correlation between duration of drug intake and periodontal parameters. Results: All periodontal parameters, except plaque index, were significantly lower in participants taking fluoxetine (P <0.01). Partial correlation analysis, adjusted for confounders, revealed a significant and negative correlation between duration of fluoxetine intake and attachment loss (AL) (R² = ?0.321, P <0.05). Logistic regression analysis revealed that fluoxetine intake was associated with a lower risk of having AL ≥3 (odds ratio [OR] = 0.55, 95% confidence interval [CI] = 0.31 to 0.96) and lower odds of increased bleeding on probing (BOP) percentage values (OR = 0.62, 95% CI = 0.34 to 0.97). Conclusion: In this observational study, use of fluoxetine was associated with lower BOP percentages and reduced AL.     

Investigating the Association Between Obstructive Sleep Apnea and Periodontitis

Background: Obstructive sleep apnea (OSA) is a sleep disorder characterized by disruptions of normal sleep architecture. Chronic periodontitis is a chronic disease of the periodontium that elicits a general inflammatory response to local dental plaque. It has been suggested that periodontal disease may increase in severity with increasingly severe OSA because both disease entities share common inflammatory pathways, acting synergistically to alter the host response. The aim of this study is to analyze the association between severity of OSA and the prevalence/severity of periodontitis. Methods: One hundred patients from a large veterans administration sleep study center (n = 26 normal, n = 21 mild, n = 19 moderate, n = 34 severe) diagnosed with an overnight polysomnogram underwent a comprehensive periodontal examination. Periodontal parameters measured included the following: 1) mean periodontal probing depth (PD); 2) clinical attachment level (CAL); 3) gingival recession; and 4) percentage of sites with bleeding on probing, plaque, PD ≥5 mm, and CAL ≥3 mm. Results: Seventy‐three percent of the sampled population had moderate/severe periodontal disease. χ² analyses revealed no significant differences in the prevalence of periodontal disease between the apnea–hypopnea index (AHI) groups, with a negligible Spearman correlation coefficient of 0.246 between AHI severity and periodontal disease severity categories. Analysis of covariance indicated a significant association between AHI severity categories and percentage of sites with plaque, after adjusting for age. Multivariable logistic regression analysis predicting moderate/severe periodontitis with AHI score, age, and smoking status indicated a significant association with age (P = 0.028) but no significant association with the other two predictors. Conclusion: OSA was not significantly associated with the prevalence of moderate/severe periodontitis and the periodontal parameters examined, except percentage plaque.     

Change of Periodontal Disease Status During and After Pregnancy

Background: This study explored whether there is any change of periodontal disease status during and after pregnancy. We also examined whether the change is different between females with a history of gestational diabetes mellitus (GDM) and females without GDM during pregnancy. Methods: A follow‐up study was conducted at Woman's Hospital, Baton Rouge, Louisiana. Thirty‐nine females who were previously enrolled in a case‐control study during pregnancy were followed an average of 22 months postpartum. Periodontal status was assessed through dental examinations performed both during and after pregnancy. Clinical periodontal parameters included bleeding on probing (BOP), mean probing depth (PD), and mean clinical attachment level (CAL). Periodontitis was defined as the presence of ≥1 sites exhibiting PD ≥4 mm or CAL ≥4 mm. We used generalized estimating equation analysis to examine the change of periodontal status. Results: Mean number and percentage of sites with BOP decreased from 10.7 ± 11.6 (mean ± SD) and 6.5% ± 7.0% during pregnancy to 7.1 ± 8.8 and 4.3% ± 5.3% at 22 months postpartum (P <0.05), respectively. Mean levels of PD and CAL decreased from 1.8 ± 0.4 mm and 1.9 ± 0.3 mm to 1.6 ± 0.3 mm and 1.6 ± 0.3 mm (P <0.01), respectively. The prevalence of periodontitis decreased from 66.7% to 33.3% (P <0.01, adjusted risk ratio = 2.1, 95% confidence interval = 1.3 to 3.4). There was no difference in the change of periodontal status between females with GDM and females without GDM during pregnancy. Conclusions: Pregnancy may be associated with an increased risk of periodontal disease. The association is not different between females with GDM and females without GDM during pregnancy.     

Periodontal disease early in pregnancy is associated with maternal systemic inflammation among African American women

BACKGROUND: Maternal periodontal disease is a chronic oral infection with local and systemic inflammatory responses and may be associated with adverse pregnancy outcomes. This study determined whether maternal periodontal disease in early pregnancy is associated with elevated serum C-reactive protein (CRP) levels and whether maternal race influences the relationship between maternal periodontal disease and systemic inflammatory responses. METHODS: A secondary analysis of prospectively collected data from the Oral Conditions and Pregnancy study was conducted. Healthy women at <26 weeks of gestation underwent an oral health examination and had blood collected. Periodontal disease was categorized by clinical criteria, and maternal serum was analyzed for CRP levels using highly sensitive enzyme-linked immunosorbent assay kits. An elevated CRP level was defined as >75th percentile. Demographic and medical data were obtained from the women's charts. Chi-square and multivariable logistic regression models were used to determine maternal factors associated with an elevated CRP. An adjusted odds ratio (OR) for elevated CRP levels was calculated and stratified by race and periodontal disease category. RESULTS: The median (interquartile) CRP level was 4.8 (0.6 to 15.7) microg/ml, and an elevated CRP level (>75th percentile) was 15.7 microg/ml. African American race and moderate/severe periodontal disease were significantly associated with elevated CRP levels. When stratified by race, moderate/severe periodontal disease remained associated with an elevated CRP level among African American women (adjusted OR: 4.0; 95% confidence interval [CI]: 1.2 to 8.5) but not among white women (adjusted OR: 0.9; 95% CI: 0.2 to 3.6) after adjusting for age, smoking, parity, marital status, insurance status, and weight. CONCLUSION: Among African American women, moderate/severe periodontal disease is associated with elevated CRP levels early in pregnancy.     

The association of psychosocial factors and smoking with periodontal health in a community population

Chiou L‐J, Yang Y‐H, Hung H‐C, Tsai C‐C, Shieh T‐Y, Wu Y‐M, Wang W‐C, Hsu T‐C. The association of psychosocial factors and smoking with periodontal health in a community population. J Periodont Res 2009; doi: 10.1111/j.1600‐0765.2008.01194.x. © 2009 John Wiley & Sons A/S Background and Objective: The association between psychosocial factors and periodontal disease has been widely reported and might be modified by smoking status. This study investigated the association of periodontal status with psychosocial factors and smoking in a community population. Material and Methods: A structured questionnaire was administered to a total of 1764 civilian noninstitutional (general population excluding from nursing homes, sanitariums and hospitals) Taiwanese individuals to assess the presence and severity of psychosocial factors [using the 12‐item Chinese health questionnaire (CHQ‐12)], smoking habits and other related factors. Periodontal status was established using the community periodontal index and by measuring clinical loss of attachment. Results: Psychological factors and smoking were significantly associated with loss of attachment (odds ratio = 1.69, 95% confidence interval = 1.01–2.77, comparing the CHQ‐12 score of ≥ 6 with the CHQ‐12 score of 0–2 and p = 0.032 for linear trend; odds ratio = 2.21, 95% confidence interval = 1.45–3.37, comparing smokers with nonsmokers) but not with community periodontal index. The association was found to be stronger among smokers than among nonsmokers. Smokers with a CHQ‐12 score of ≥ 6 had a higher odds ratio of loss of attachment (odds ratio = 2.49, 95% confidence interval = 0.91–6.49) than nonsmokers (odds ratio = 1.43, 95% confidence interval = 0.76–2.58). For periodontal health measured using the community periodontal index, married and divorced/widowed subjects tended to have poorer periodontal health (odds ratio = 3.38, 95% confidence interval = 1.26–10.81 and odds ratio = 3.83, 95% confidence interval = 1.21–13.83, respectively) than single subjects among nonsmokers but not among smokers. Conclusion: Poor mental health had a stronger association with periodontal disease among smokers than among nonsmokers, especially in accumulative attachment loss. Our findings suggest that mental health and smoking might have a synergistic effect on the risk of developing periodontal disease.     

Association between metabolic syndrome and periodontal disease

Background: Metabolic syndrome has been suggested as a potential risk factor for periodontal disease. Data based on NHANES III, with 7431 subjects aged 20 years or older, were analysed to confirm the association between metabolic syndrome and periodontal disease, and identify which components of metabolic syndrome might play a role in this association. Methods: Clinical criteria for metabolic syndrome included: (1) abdominal obesity; (2) increased triglycerides; (3) decreased HDL cholesterol; (4) hypertension or current use of hypertension medication; and (5) high fasting plasma glucose. Periodontal disease was evaluated by probing pocket depth (PPD) and was defined as mean PPD ≥2.5 mm. Results: Women with two or more metabolic components had significantly increased odds of having periodontal disease as compared to those with no component [(two components, OR = 5.6 (95% CI: 2.2–14.4); three or more, OR = 4.7 (2.0–11.2)]. Using the definition of metabolic syndrome as having three to five metabolic components (reference group with <3 components), the adjusted odds ratios were 1.0 (0.7–1.6) for men and 2.1 (1.2–3.7) for women. Abdominal obesity was the largest contributory factor in both genders. Conclusions: While the association between metabolic syndrome and periodontal disease was particularly significant for women, abdominal obesity appeared to be the contributing metabolic factor for both genders.     

Association Between Obesity and Periodontitis in Pregnant Females

Background: The purpose of this study is to investigate whether overweight and obesity before pregnancy are associated with periodontitis during pregnancy. Methods: This study examined a total of 315 pregnant females at 21 to 24 weeks of gestation. Overweight and obesity were defined based on criteria proposed by the World Health Organization Expert Consultation. Periodontal conditions were assessed by measuring clinical periodontal attachment loss (AL). To investigate whether obese pregnant females have increased risk according to the extent of periodontitis, the data were divided into two groups: 1) generalized periodontitis and 2) localized periodontitis. A comparison among underweight, normal‐weight, and overweight/obese groups for explanatory variables was analyzed using the χ² test for categorical variables and an analysis of variance for continuous variables. Multivariate logistic regression analysis was performed with adjustments for age, health and oral health behaviors, and obstetric information. Results: Age, age at first delivery, periodontitis, and periodontal conditions (two or more interproximal sites with AL ≥4 mm not on the same tooth) were significantly associated with body mass index (BMI) (P <0.05). The adjusted odds ratio of periodontitis was 4.57 (95% confidence interval = 2.30 to 9.07) for overweight and obese females (BMI ≥23 kg/m²), after adjusting for all of the covariates. Conclusion: There is a strong association between prepregnancy overweight/obesity and periodontitis in pregnant females.     

Calcium and the risk for periodontal disease

BACKGROUND: Dietary calcium has long been a candidate to modulate periodontal disease. Animal as well as human studies of calcium intake, bone mineral density, and tooth loss provide a rationale for hypothesizing that low dietary intake of calcium is a risk factor for periodontal disease. METHODS: We evaluated the role of dietary calcium intake as a contributing risk factor for periodontal disease utilizing the Third National Health and Nutrition Examination Survey (NHANES III), which is representative of the U.S. civilian non-institutionalized population. Dietary calcium intake was determined from a 24-hour dietary recall. The U.S. Department of Agriculture Nutrient Database was used as a source of nutrient composition data. Periodontal disease was measured by attachment loss. In addition, serum calcium was assessed using venous blood samples. Logistic regression analysis was used to examine the association between periodontal disease and dietary calcium intake or serum calcium levels after adjusting for covariants including age, gender, tobacco consumption, and gingival bleeding. RESULTS: The association of lower dietary calcium intake with periodontal disease was found for young males and females (20 to 39 years of age), and for older males (40 to 59 years of age). The relationship between low dietary calcium intake and increased levels of periodontal disease showed an estimated odds ratio (OR) of 1.84 (95% CI: 1.36 to 2.48) for young males, 1.99 (95% CI: 1.34 to 2.97) for young females, and 1.90 (95% CI: 1.41 to 2.55) for the older group of males. These odds ratios were adjusted for gingival bleeding and tobacco consumption. The dose response was also seen in females, where there was 54% greater risk of periodontal disease for the lowest level of dietary calcium intake (2 to 499 mg) and 27% greater risk in females who took moderate levels of dietary calcium (500 to 799 mg) as compared to those who took 800 mg or more dietary calcium per day. A statistically significant association between low total serum calcium and periodontal disease was found in younger females aged 20 to 39 with OR = 6.11 (95% CI: 2.36 to 15.84) but not for males or older females, after adjusting for tobacco use, gingival bleeding, and dietary calcium intake. CONCLUSIONS: These results suggest that low dietary intake of calcium results in more severe periodontal disease. Further studies will be needed to better define the role of calcium in periodontal disease and to determine the extent to which calcium supplementation will modulate periodontal disease and tooth loss.     

Periodontal disease in children and adolescents with type 1 diabetes in Serbia

BACKGROUND: The purpose of this study was to evaluate periodontal health in young patients with type 1 diabetes mellitus in Serbia. METHODS: Periodontal disease was clinically assessed and compared in 187 children and adolescents (6 to 18 years of age) with type 1 diabetes mellitus and 178 control subjects without diabetes. RESULTS: Children and adolescents with type 1 diabetes mellitus had significantly more plaque, gingival inflammation, and periodontal destruction than control subjects. The main risk factors for periodontitis were diabetes (odds ratio [OR] = 2.78; 95% confidence interval [CI]: 1.42 to 5.44), bleeding/plaque ratio (OR = 1.25; 95% CI: 1.06 to 1.48), and age (OR = 1.10; 95% CI: 1.01 to 1.21). In case subjects, the number of teeth affected by periodontal destruction was associated with mean hemoglobin A1c (regression coefficient 0.17; P = 0.026), duration of diabetes (regression coefficient 0.19; P = 0.021), and bleeding/plaque ratio (regression coefficient 0.17; P = 0.021). CONCLUSIONS: Compared to children and adolescents without diabetes, periodontal disease is more prevalent and widespread in children and adolescents with type 1 diabetes mellitus and depends on the duration of disease, metabolic control, and the severity of gingival inflammation. Gingival inflammation in young patients with diabetes is more evident and more often results in periodontal destruction.     

Periodontitis and Gestational Diabetes Mellitus in Non‐Smoking Females

Background: Chronic inflammation has been implicated in the pathogenesis of gestational diabetes mellitus (GDM). Periodontal disease is associated with increased levels of inflammatory mediators and may be a risk factor for GDM. The authors aimed to examine the association between periodontitis and GDM among non‐smoking pregnant females. Methods: This case‐control study included 50 females who were diagnosed with GDM and 50 age‐ and hospital‐matched females without diabetes in Khon Kaen, Thailand. Full‐mouth periodontal examinations were performed during pregnancy by two calibrated dentists who were unaware of the case‐control status. Periodontitis was defined as ≥1 site with probing depth (PD) ≥5 mm and clinical attachment level (CAL) ≥2 mm at the same site. Serum samples were collected to measure C‐reactive protein (CRP), tumor necrosis factor‐α, and interleukin‐6 levels. Analyses were performed using conditional logistic regression. Results: Fifty percent of the case females had periodontitis compared to 26% of the controls. Females with GDM had significantly higher mean PD and CAL, more sites with bleeding on probing, and increased levels of CRP compared to the controls. Periodontitis was significantly associated with GDM (odds ratio = 3.00, 95% confidence interval = 1.19 to 7.56). The association remained significant with additional adjustment for family history of diabetes, prepregnancy body mass index, and weight gain during pregnancy. Conclusions: The results suggest that periodontitis is associated with GDM. Therefore, clinicians should assess periodontal conditions of pregnant females.     

Periodontal disease and its connection to systemic biomarkers of cardiovascular disease in young American Indian/Alaskan natives

1 Background

Periodontal disease has been shown to be associated with cardiovascular disease (CVD). No known studies evaluate the relationship between periodontal disease status and biomarkers of CVD risk in the American Indian/Alaskan Native (AI/AN) population despite their disproportionately high rates of poor oral health and cardiovascular disease–related outcomes. This study compared levels of interleukin (IL)‐6 and C‐reactive protein (CRP) across increasing severity of periodontal disease status among younger adults between the ages of 21 and 43 years.

2 Methods

Plasma levels of IL‐6 and CRP were measured in adult participants (ages 21 to 43 years) as part of a study of periodontal disease and CVD risk among an AI/AN population in southern California (n = 59). Periodontal evaluations were performed and disease status was classified into three categories based on highest probing depth (none/mild: < 3 mm; moderate: 4 to 5 mm; severe: ≥6 mm). Participants with known systemic disease or active infection were excluded.

3 Results

Severe periodontitis was significantly associated with increased levels of IL‐6 compared with those with none or mild periodontitis before controlling for other variables (P = 0.02), but lacked significance after controlling for sex, BMI, smoking status, and high‐density lipoprotein (P = 0.09). Moderate periodontal disease was positively associated with IL‐6 levels after controlling for potential confounders (P = 0.01). Periodontal status was not associated with CRP, before or after adjusting for covariates.

4 Conclusions

In this otherwise healthy AI/AN adult sample, moderate periodontal disease compared with none or mild periodontal disease was associated with increased levels of IL‐6. High levels of CRP found in this population warrant further research.     

Cessation of periodontal care during pregnancy: effect on infant birthweight

The goal of this study was to assess whether interruption of care for chronic periodontitis during pregnancy increased the risk of low-birthweight infants. A population-based case-control study was designed with 793 cases (infants < 2,500 g) and a random sample of 3,172 controls (infants >or= 2,500 g). Generalized estimating equation models were used to relate periodontal treatment history to low birthweight risk and to common risk factors. The results indicate that periodontal care utilization was associated with a 2.35-fold increased odds of self-reported smoking during pregnancy (95% confidence interval: 1.48-3.71), a 2.19-fold increased odds for diabetes (95% confidence interval: 1.21-3.98), a 3.90-fold increased odds for black race (95% confidence interval: 2.31-6.61), and higher maternal age. After adjustment for these factors, interruption of periodontal care during pregnancy did not lead to an increased risk for a low-birthweight infant when compared to women with no history of periodontal care (odds ratio, 0.96; 95% confidence interval, 0.60-1.52). In conclusion, women receiving periodontal care had genetic and environmental characteristics, such as smoking, diabetes and race, that were associated with an increased risk for low-birthweight infants. Periodontal care patterns, in and of themselves, were unrelated to low-birthweight risk.     

Expression of periodontal interleukin‐6 protein is increased across patients with neither periodontal disease nor diabetes,patients with periodontal disease alone and patients with both diseases

Ross JH, Hardy DC, Schuyler CA, Slate EH, Mize TW, Huang Y. Expression of periodontal interleukin‐6 protein is increased across patients with neither periodontal disease nor diabetes, patients with periodontal disease alone and patients with both diseases. J Periodont Res 2010; 45: 688–694. © 2010 John Wiley & Sons A/S Background and Objective: Epidemiological studies have established that patients with diabetes have an increased prevalence and severity of periodontal disease. Interleukin (IL)‐6, a multifunctional cytokine, plays a role in the tissue inflammation that characterizes periodontal disease. Our recent study has shown a trend of increase in periodontal IL‐6 expression at the mRNA level across patients with neither periodontal disease nor diabetes, patients with periodontal disease alone and patients with both diseases. However, the periodontal IL‐6 expression at the protein level in these patients has not been investigated. Material and Methods: Periodontal tissue specimens were collected from eight patients without periodontal disease and diabetes (group 1), from 17 patients with periodontal disease alone (group 2) and from 10 patients with both periodontal disease and diabetes (group 3). The frozen sections were prepared from these tissue specimens and IL‐6 protein expression was detected and quantified. Results: The nonparametric Kruskal–Wallis test showed that the difference in IL‐6 protein levels among the three groups was statistically significant (p = 0.035). Nonparametric analysis using the Jonckheere–Terpstra test showed a tendency of increase in periodontal IL‐6 protein levels across group 1 to group 2 to group 3 (p = 0.006). Parametric analysis of variance (ANOVA) on IL‐6 protein levels showed that neither age nor gender significantly affected the difference of IL‐6 levels among the groups. Conclusion: Periodontal IL‐6 expression at the protein level is increased across patients with neither periodontal disease nor diabetes, patients with periodontal disease alone and patients with both diseases.     

Relationship between drinking and periodontitis: the Hisayama Study

BACKGROUND: Although recent studies suggest a relationship between alcohol consumption and periodontal disease, the dose-response relationship between drinking and the severity of periodontitis is unclear. METHODS: Alcohol consumption was evaluated using the frequency of drinking and the daily alcohol intake for 961 individuals aged 40 to 79 years. Periodontal status was evaluated using probing depth (PD) and clinical attachment loss (CAL). RESULTS: Alcohol consumption was linearly associated with the extent of PD and CAL in univariate analyses (P <0.001). In multivariate logistic regression analyses, the subjects drinking 15 to 29.9 g alcohol per day (odds ratio [OR] = 2.7; 95% confidence interval [CI] = 1.1 to 6.6) or more than 30 g per day (OR = 2.5; 95% CI = 1.1 to 5.7) had a significantly higher risk of having more than 35% of their teeth with PD > or = 4 mm than non-drinkers, independent of other confounding variables. No significant relationship between drinking and CAL was observed in the multivariate analysis. CONCLUSION: These results suggest that the effect of drinking on periodontal condition is limited to subjects with deep periodontal pockets associated with more than one-third of their teeth.     

Association between periodontitis and chronic obstructive pulmonary disease in a chinese population

Background: A relationship between periodontitis and chronic respiratory disease has been suggested by recent studies. The aim of this study is to explore the association between periodontitis and chronic obstructive pulmonary disease (COPD) in a Chinese population. Methods: We conducted a case-control study of 581 COPD cases and 438 non-COPD controls. Lung function examination, a 6-minute walk test, and the British Medical Research Council questionnaire were performed. Periodontal clinical examination index included probing depth (PD), attachment loss (AL), bleeding index (BI), plaque index (PI), and alveolar bone loss. A validated index for predicting COPD prognosis, the body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index, was also calculated. Results: Participants with more severe COPD were more likely to have severe periodontal disease. PD, AL, PI, alveolar bone loss, and the number of teeth were significantly associated with all stages of COPD (all P <0.001). When compared to controls (BODE = 0), participants with higher BODE scores had significantly higher AL (P <0.001), BI (P = 0.027), PI (P <0.001), alveolar bone loss (P <0.001), and the number of teeth (P <0.001). PI appeared to be the main periodontal health-related factor for COPD, with an odds ratio (OR) = 9.01 (95% CI = 3.98 to 20.4) in the entire study population OR = 8.28 (95% CI = 2.36 to 29.0), OR = 5.89 (95% CI = 2.64 to 13.1), and OR = 2.46 (95% CI = 1.47 to 4.10) for current, smokers, and non-smokers, respectively. Conclusion: Our study found a strong association between periodontitis and COPD, and PI seemed to be a major periodontal factor for predicting COPD among Chinese adults.     

Association between maternal periodontitis and an increased risk of preeclampsia

BACKGROUND: Periodontal disease has been considered a systemic exposure implicated in a higher risk of adverse pregnancy outcomes. The aim of the present study was to determine whether maternal periodontitis is associated with an increased risk of preeclampsia. METHODS: A case-control study was conducted in a public hospital in Belo Horizonte, Brazil. During the study period, 588 women, aged 14 to 46 years, were deemed eligible and had data available for analysis. Maternal demographic and medical data were collected from medical records. Preeclampsia was defined as blood pressure >140/90 mm Hg and > or =1+ proteinuria after 20 weeks of gestation. A periodontal examination was performed postpartum. Maternal periodontitis was defined as the presence of four or more teeth with one or more sites with a probing depth > or =4 mm and clinical attachment loss > or =3 mm at the same site. The effects of maternal age, chronic hypertension, primiparity, smoking, alcohol use, and number of prenatal visits were analyzed. Adjusted odds ratios (ORs) for preeclampsia were calculated using multivariate logistic regression. RESULTS: The prevalence of periodontitis was 63.9% and preeclampsia was 18.5%. Variables associated with preeclampsia were chronic hypertension (OR = 4.10; 95% confidence interval [CI] = 2.0 to 8.4; P = 0.001), primiparity (OR = 2.40; 95% CI = 1.5 to 3.9; P = 0.004), maternal age (OR = 1.07; 95% CI = 1.0 to 1.1; P = 0.001), and maternal periodontitis (OR = 1.88; 95% CI = 1.1 to 3.0; P = 0.001). CONCLUSION: Maternal periodontitis was determined to be associated with an increased risk of preeclampsia.