Association Between Periodontal Disease and Metabolic Syndrome

Objectives: Metabolic syndrome is a complex medical disorder characterized by visceral fat‐type obesity involving hypertension, and abnormal glucose and lipid metabolism. The objective of this study was to investigate the relationship between periodontal disease and components of metabolic syndrome (obesity, lipid abnormality, hypertension, and hyperglycemia) in industrial workers of a single company in Tokyo, Japan. Methods: The study subjects consisted of 2,478 adult employees (2,028 men and 450 women; mean age: 43.3 years). The association between the presence of periodontal pockets and components of metabolic syndrome was investigated cross‐sectionally using multiple logistic regression analysis, odds ratios (ORs), and 95 percent confidence intervals (CIs). Results: Body mass index, blood pressure, triglycerides, fasting blood glucose, and hemoglobin A1c (HbA1c) were significantly elevated (P < 0.05) in patients with periodontal pockets of 4 mm or more. We found that the OR of the presence of periodontal pockets adjusted for age, gender, and smoking habit was 1.8 (96 percent CI = 1.4‐2.3) when the subjects with two positive components and without positive component were compared. And it was 2.4 (96 percent CI = 1.7‐2.7) when the subjects with three or four positive components and without positive component were compared. Conclusions: Our findings suggest an association between periodontal disease and metabolic syndrome in Japanese workers between the ages of 20 and 60 years.     

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.     

Obesity and periodontitis in Australian adults: A population-based cross-sectional study

Objectives: Obesity and periodontitis are public health issues in Australia. This study aimed to determine the association between overweight/obesity and periodontitis in Australian adults. Materials and methods: The cross-sectional National Survey of Adult Oral Health 2004–2006 data were analysed. Body mass index was calculated, and a self-reported questionnaire was used to measure the estimated daily intake of added sugar. The mean number of sites with probing depth (PD) ≥ 4 mm and clinical attachment loss (CAL) ≥ 4 mm and presence of periodontitis were used as outcome measures. CDC/AAP periodontitis case definition was adopted. Bivariate analyses and multiple variable regression models were constructed. Results: The study sample was 4,170 participants. The proportion of people that were overweight/obese was 51.9% [95% confidence interval (CI): 48.1%, 54.1%]. Overall 21.3% (95% CI: 19.3%, 23.5%) people experienced periodontitis. The mean number of sites with PD ≥ 4 mm and CAL ≥ 4 mm were recorded as 0.7 (95% CI: 0.5, 0.9) and 2.4 (95% CI: 2.1, 2.6), respectively. Multiple variable analysis suggested that periodontal parameters [sites with PD ≥ 4 mm (0.13, 95% CI: −0.86, 0.35) and sites with CAL ≥ 4 mm (0.11, 95% CI: −0.58, 0.35) and presence of periodontitis (1.23, 95% CI: 0.96, 1.57)] were not associated with overweight/obesity when controlled for putative confounders. Conclusion: A positive association was found between overweight/obesity and periodontitis (PD and CAL). However, the statistical significance disappeared in the multiple variable regression analysis, where age, sex, smoking and dental visiting behaviour were found to be key determinants of periodontitis.Key words: Periodontal disease, obesity, oral health, public health, chronic disease, body mass index     

The Association Between Periodontal Disease and Chronic Migraine: A Systematic Review

Migraine is a neurologic illness that produces intense throbbing pain on one side of the head and affects roughly 1 billion people worldwide. Recent research indicates a relationship between periodontitis and chronic migraines. This study aimed to review the association between chronic migraines and periodontitis through a systematic literature review.Four research databases (Google Scholar, PubMed, ProQuest, and SpringerLink) were searched according to PRISMA guidelines to retrieve the studies included in this review. A search strategy was developed to answer the study question with appropriate inclusion and exclusion criteria. Out of 34 published studies, 8 studies were included in this review. Three of the studies were cross-sectional, 3 were case-control, and 2 were clinical report and medical hypothesis papers. Seven of the 8 included studies showed that there is an association between periodontal disease and chronic migraine. The elevated blood levels of some biomarkers such as leptins, ProCalcitonin (proCT), calcitonin gene-related peptides (CGRPs), Pentraxin 3 (PTX3), and Soluble Tumor Necrosis Factor-like Weak Inducer Of Apoptosis (sTWEAK) play a significant role in this association. The limitations include a small sample size, the influence of anti-inflammatory drugs, and a self-reported headache measure that is subject to misclassification bias.This systematic review reveals a supposed correlation between periodontal disease and chronic migraine, as evidenced by various biomarkers and inflammatory mediators. This suggests that periodontal disease could potentially contribute to the development of chronic migraine. However, to further assess the potential benefits of periodontal treatment in patients with chronic migraine, additional longitudinal studies with larger sample sizes and interventional studies are needed.     

Association Between Metabolic Syndrome and Periodontal Disease Measures in Postmenopausal Women: The Buffalo OsteoPerio Study

Background: The objective of this study is to characterize the association between metabolic syndrome (MetS) and periodontitis in women, for which there is limited evidence. Methods: Cross‐sectional associations between MetS and periodontitis were examined in 657 postmenopausal women aged 50 to 79 years enrolled in a periodontal disease study ancillary to the Women's Health Initiative Observational Study. Whole‐mouth measures of alveolar crest height (ACH), clinical attachment level (CAL), probing depth (PD), gingival bleeding, and supragingival plaque and measures to define MetS using National Cholesterol Education Program criteria were from a clinical examination. Study outcomes were defined as: 1) mean ACH ≥3 mm, two sites ≥5 mm, or tooth loss to periodontitis; 2) ≥2 sites with CAL ≥6 mm and ≥1 site with PD ≥5 mm; 3) gingival bleeding at ≥50% of sites; and 4) supragingival plaque at ≥50% of sites. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results: In unadjusted analyses, MetS (prevalence: 25.6%) was significantly associated with supragingival plaque (OR = 1.74; 95% CI: 1.22 to 2.50) and non‐significantly associated with periodontitis defined by ACH (OR = 1.23; 95% CI: 0.81 to 1.85) and gingival bleeding (OR = 1.20; 95% CI: 0.81 to 1.77). Adjustment for age, smoking, and other confounders attenuated observed associations, though supragingival plaque remained significant (OR = 1.47; 95% CI: 1.00 to 2.16; P = 0.049). MetS was not associated with periodontitis defined by CAL and PD. Conclusions: A consistent association between MetS and measures of periodontitis was not seen in this cohort of postmenopausal women. An association between MetS and supragingival plaque requires further investigation.     

Association Between Alcohol Consumption and Periodontal Disease: The 2008 to 2010 Korea National Health and Nutrition Examination Survey

Background: A positive association has been reported between alcohol and periodontal disease. Therefore, this study is conducted to assess the relationship between alcohol intake and severity of periodontal disease in a large probability sample of the Korean population using the Korea National Health and Nutrition Examination Survey (KNHANES). Methods: Data from KNHANES, conducted between 2008 and 2010 by the Division of Chronic Disease Surveillance under the Korea Centers for Disease Control and Prevention and the Korean Ministry of Health and Welfare, were used for this study. The presence of periodontal treatment needs according to demographic variables and anthropometric and hematologic characteristics of the participants are presented as means with their standard errors. Multivariate logistic regression analyses were used to assess the associations of periodontal treatment needs with the amount of alcohol intake and other variables including smoking and the number of times of toothbrushing per day. Results: An association between drinking alcohol and periodontal treatment needs could be seen in men after adjustment for variables. Adjusted odds ratios (ORs) and their 95% confidence intervals (CIs) in males were 1.271 (1.030 to 1.568) for heavy drinkers after controlling for age, smoking, body mass index, exercise, education, income, white blood cell count, diabetes, hypertension, metabolic syndrome, and number of toothbrushing episodes per day (model 3). Adjusted ORs and their 95% CIs in males were 1.569 (1.284 to 1.916) for alcohol use disorders identification test (AUDIT) level ≥20 in model 3. ORs increased with the increase in alcohol consumption levels and AUDIT levels. Statistically significant correlations between drinking and periodontal treatment needs could not be seen in female heavy drinkers or female drinkers with AUDIT levels ≥20. Conclusions: Men with higher alcohol intake were more likely to have a higher prevalence of treatment needs regardless of their age, socioeconomic factors, systemic conditions (including diabetes, hypertension, and metabolic syndrome), and number of times of toothbrushing per day in multivariable adjusted models. By contrast, in women, alcohol intake was not independently associated with periodontal treatment needs. Alcohol consumption was discovered to be a potential risk indicator for periodontal treatment needs in men in this study.     

Obesity,dietary sugar and dental caries in Australian adults

Objectives: To determine the association of overweight/obesity, dental caries and dietary sugars in Australian adults. Materials and methods: The National Survey of Adult Oral Health (NSAOH) 2004–2006 provided data for analysis of dental caries experience. Self-reported body weight and height were used to calculate body mass index (BMI) for a subsample (n = 3,745, 89.8%) of the NSAOH data. A self-report questionnaire of 13 food items estimated the daily intake of added sugar, total sugars and total carbohydrate, using food composition estimates from the AUSNUT2011–2013. Bivariate analyses (Pearson’s Chi-square with Rao–Scott adjustment and Student’s t-tests) were used to determine the association of overweight/obesity, dental caries, sugar variables and putative confounders. Poisson regression models for the Decayed, Missing and Filled Teeth Index and individual measures of decayed, missing and filled teeth were constructed, with models containing BMI, dietary added sugar, total sugar and total carbohydrate, controlling for putative confounders. Results: There was a positive association between dental caries experience and being overweight or obese compared with having normal weight or being underweight as well as between sugar consumption with all four dental caries outcome measures. When controlled for putative confounders where sugar consumption was identified as a key determinant, the statistical significance between dental caries experience and being overweight or obese disappeared. The demographic and socioeconomic factors associated with dental caries experience were age, sex, education, smoking status and usual reason for dental visit. Conclusion: Analysis of the relationship between dental caries and obesity must include data about sugar and carbohydrate consumption.     

Validity of Self‐Reported Periodontal Disease: A Systematic Review and Meta‐Analysis

Background: Periodontal disease (PdD) has been shown to be related to other systemic diseases. However, to assess this relationship, large epidemiologic studies are required. Such studies need validated self‐report measures. The aim of this systematic review is to assess the validity of self‐reported measures in the diagnosis of PdD. Methods: The review followed Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Medline, Embase, and Google Scholar were searched up to January 2016. Two periodontal journals were searched manually. Two reviewers independently made selected studies and extracted data. All disagreements were resolved after discussion with a third reviewer. Risk of bias was evaluated. Sensitivity, specificity, diagnostic odds ratio, and 95% confidence interval (CI) were calculated. Of 933 papers found, 11 were selected for the review. All studies, except two, had acceptable quality. Four comparable studies were selected for meta‐analysis. Results: Study size ranged from 114 to 1,426 participants. Sensitivity and specificity ranged from 4% to 93% and 58% to 94%, respectively. Diagnostic odds ratio was 1.4 (95% CI: 0.9 to 2.2) for the question on bleeding gums and 11.7 (95% CI: 4.1 to 33.4) for the question on tooth mobility. Heterogeneity was low for most questions except those on painful gums and tooth mobility. Conclusions: Self‐reported PdD has acceptable validity and can be used for surveillance of PdD in large epidemiologic studies. However, there is a need for large, well‐designed diagnostic studies.     

Probiotic Bifidobacteria in Managing Periodontal Disease: A Systematic Review

Although various probiotic organisms have been evaluated for their utility in the management of periodontitis, their strain-specific mechanisms of action are still unclear. We aimed to systematically review the effect of bifidobacterial probiotics on periodontopathogens and host immune responses in periodontal diseases. An electronic search of articles published until June 2022 in Medline, PubMed, Web of Science, and Cochrane Library databases was performed. Randomised controlled trials (RCTs) and in vitro and animal studies were assessed, and the data regarding antimicrobial properties, immunomodulation, and clinical outcomes were analysed. A total of 304 studies were screened, but only 3 RCTs and 6 animal and in vitro studies met the inclusion criteria. The use of different strains of bifidobacteria led to (1) a reduction of key players of the red complex periodontopathogens; (2) reduced levels of pro-inflammatory cytokines (eg, interleukin [IL]1-β and IL-8) and higher levels of anti-inflammatory cytokines (IL-10); (3) enhanced levels of osteoprotegerin and reduced levels of receptor activator of nuclear factor kappa-B ligand; and (4) a reduction of the dental plaque, bleeding on probing, alveolar bone loss, and clinical attachment loss. Bifidobacterial probiotic adjuvant supplementation, especially with Bifidobacterium animalis subspecies lactis, appears to help improve clinical periodontal parameters and develop a healthy plaque microbiome through microbiological and immunomodulatory pathways. Further human and animal studies are warranted prior to the therapeutic use of bifidobacteria in the routine management of periodontal infections.     

Association Between Periodontitis and Gestational Diabetes Mellitus: A Case‐Control Study

Background: Some studies have reported an association between gestational diabetes mellitus (GDM) and periodontitis. The aim of the present study is to analyze this potential association and the influence of risk variables associated with GDM. Methods: This case‐control study includes 360 women, 90 with GDM and 270 controls. Participants received a full‐mouth periodontal examination with a record of bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL). Periodontitis is defined as the presence in ≥4 teeth of ≥1 sites with PD ≥4 mm and CAL ≥3 mm associated with BOP. The influence of risk variables in the occurrence of GDM is tested through univariate analysis and multivariate logistic and multinomial regression. Odds ratio (ORs) and respective confidence intervals (CIs) are calculated and reported. Results: The prevalence of periodontitis was 40% in the case group (GDM) and 46.3% in the control group. There was a lack of association between periodontitis and GDM (OR = 0.74; 95% CI = 0.40 to 1.38). The multivariate final logistic regression model retained the following as significant variables associated with GDM: maternal age (OR = 2.65; 95% CI = 1.97 to 3.56), chronic hypertension (OR = 3.16; 95% CI = 1.35 to 7.42), and body mass index (OR = 1.99; 95% CI = 1.41 to 2.81). Conclusions: A high prevalence of periodontitis was found among cases and controls, with no association between periodontitis and GDM. The present study suggests the need for implementation of health policies directed to the periodontal care of pregnant women.