Relationship of periodontal disease and edentulism to stroke/TIA

Periodontitis has been shown to increase the systemic inflammatory response, which has been implicated in atherosclerosis and cerebrovascular events. We hypothesized an association between periodontitis or edentulism and Stroke/TIA in the ARIC Study. Data on 9415 dentate and 1491 edentulous adults included demographics, cardiovascular outcomes, lifestyle, laboratory measures, and, for 6436 of the dentate, a dental examination. The dependent variable was Stroke/TIA, and the exposure was extent (%) of attachment level 3+ millimeters (AL). Quartiles of AL and edentulism were compared for Stroke/TIA using odds ratios (OR) and 95% confidence intervals (CI), and confounders were controlled by logistic regression. Stroke/TIA was prevalent in 13.5% of periodontal examinees, 15.6% of dentate non-examinees, and 22.5% of edentulous persons. The highest quartile of AL (OR 1.3, CI 1.02-1.7) and edentulism (OR 1.4, CI 1.5-2.0) were associated with Stroke/TIA.     

Relationship of periodontal disease and tooth loss to prevalence of coronary heart disease

BACKGROUND: Studies relating periodontal disease to coronary heart disease (CHD) have provided equivocal results using tooth loss and/or clinical signs of periodontal disease as measures of periodontal exposure. METHODS: The purpose of this cross-sectional study was to evaluate the relationship of tooth loss and periodontitis to prevalent CHD at the Atherosclerosis Risk in Communities (ARIC) visit 4 using both tooth loss and clinical signs of disease in a population-based sample of 8,363 men and women aged 52 to 75 years from four U.S. communities. Each subject participated in a complete periodontal examination, assessment of missing teeth, assessment of prevalent CHD, and a number of laboratory tests and questionnaires. High attachment loss was defined as > or = 10% of sites with attachment loss > 3 mm and high tooth loss was defined as fewer than 17 remaining teeth. RESULTS: Individuals with both high attachment loss and high tooth loss (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.1 to 2.0) and edentulous individuals (OR 1.8, CI 1.4 to 2.4) had elevated odds of prevalent CHD compared to individuals with low attachment loss and low tooth loss, while controlling for a number of traditional risk factors for CHD. CONCLUSIONS: These results suggest that tooth loss and periodontal disease are associated with prevalent CHD, but only when both are present. The weaker relationships between periodontal disease and CHD that have been found among older adults may be due to older adults having fewer teeth. Future longitudinal studies should be designed to ascertain the cause of tooth loss during follow-up.     

白细胞介素-1B-511基因多态性与牙周炎进展的关系

目的 了解不同程度慢性牙周炎病程的自然发展及其与白细胞介素-1B-511（IL-1B-511）基因多态性的关系。方法 选取慢性牙周炎患者100例,分别在基线、6个月、12个月时检查全口余留牙的临床附着丧失量（AL）,每个牙检查6个位点。棉拭子刮取患者颊黏膜脱落细胞,采用聚合酶链反应检测IL-1B-511基因型分布。结果 1年内,100例患者平均AL增加1.43 mm;病情进展缓慢（全口年平均AL增加不超过1.0 mm）的16例,进展快速（全口年平均AL增加超过1.0 mm）的84例;IL-1B-511基因型分布及等位基因分布频率在病情进展缓慢和快速的患者间未发现统计学差异（P>0.05）。基线检查时为轻中度牙周炎的患者在1年的观察期内出现全口年平均AL增加超过1.0 mm的人数多于重度牙周炎患者（P<0.05）;从患牙部位看,两次复查时AL增加均超过2.0 mm的牙位以磨牙为多,多于前牙和前磨牙;且在重度牙周炎患者中更易出现,多于轻中度牙周炎患者（P<0.05）。结论 不同个体牙周炎的进展程度不一致;AL改变与白细胞介素-1基因多态性尚未发现有相关性。     

The association between gingival crevicular fluid TGF-beta1 levels and periodontal status in HIV-1(+) patients

BACKGROUND: The purpose of this study was to investigate the relationship between transforming growth factor-beta 1 (TGF-beta1) in gingival crevicular fluid (GCF) and the periodontal status of subjects who were positive for the human immunodeficiency virus (HIV)-1. METHODS: Medical and demographic variables, including age, cigarette smoking, CD4 cell count, and viral load values, were recorded. At the baseline and 6-month visits, gingival index (GI), plaque index, bleeding on probing, probing depth (PD), and attachment loss (AL) were recorded, and GCF samples were taken with paper strips from three periodontitis sites (GI >0; PD > or =5 mm; AL > or =3 mm), three gingivitis sites (GI >0; PD < or =3 mm; AL = 0), and two healthy sites (GI = 0; PD < or =3 mm; AL < or =2 mm) in 25 subjects who were HIV-1(+). GCF TGF-beta1 levels were determined by enzyme-linked immunosorbent assays. A statistical software package was used to analyze the data. RESULTS: The mean amounts of GCF TGF-beta1 were greater in gingivitis and periodontitis sites than in healthy sites (P <0.0001). GCF levels of TGF-beta1 correlated with PD, AL, age, smoking pack-years, CD4 cell count, and viral load at the baseline and 6-month visits (0.0001 < P <0.05). An active site was defined as a site that had > or =2 mm new AL during the 6-month study period. An active patient was defined as a patient who had one or more active site(s) during the study period. Repeated-measures analysis of 18 active sites versus 182 inactive sites indicated that GCF TGF-beta1 levels were higher in active sites than in inactive sites (P <0.0001). Eleven of the 25 study subjects had active sites at the end of the 6-month study period. The mean GCF TGF-beta1 level and the mean AL and PD for these 11 active subjects were higher than for the 14 inactive subjects (P <0.0001). CONCLUSION: In subjects who are HIV-1(+), sites with high GCF levels of TGF-beta1 are at significantly greater risk for the progression of established periodontitis.     

Aggressive periodontitis in an urban population in southern Brazil

BACKGROUND: There are limited data about the epidemiology and risk factors for aggressive periodontitis (AgP) in Latin American and Brazilian populations. The aim of this study was to assess the prevalence of AgP and the risk associated with demographic variables, smoking behavior, and other periodontal variables in a young urban population in southern Brazil. METHODS: A representative sample of 612 subjects aged 14 to 29 years were sampled using a multistage probability method. A full-mouth clinical examination of six sites per tooth and an interview were performed in a mobile examination center. Subjects in the age groups 14 to 19 years and 20 to 29 years were classified with AgP if they had four or more teeth with attachment loss > or =4 mm or > or =5 mm, respectively. RESULTS: AgP was found in 5.5% of the subjects. The disease occurred equally among males and females, but was twice as prevalent among non-whites than whites. In the age groups 20 to 24 years and 25 to 29 years, the AgP subjects had a significantly higher prevalence of tooth loss (90.2% versus 40.4% and 86.1% versus 43.4%, P <0.01) and mean number of missing teeth (2.6 versus 0.9 and 3.4 versus 1.5, P <0.05) than subjects without attachment loss. The AgP subjects also had significantly higher percentages of sites with dental plaque (P <0.0001), gingival bleeding (P <0.05), and supragingival calculus (P <0.0001) than normal subjects. The risk for AgP was higher in the 25- to 29-year than the 14- to 19-year age groups (odds ratio [OR] = 6.2), in the low than middle or high socioeconomic status (OR = 4.5), in moderate or heavy smokers than nonsmokers (OR = 3.1), and in subjects with > or =10% versus <10% sites with supragingival calculus (OR = 3.6). CONCLUSION: Socioeconomic status, smoking, and dental calculus were significant risk indicators of aggressive periodontitis in this population. Suitable periodontal prevention programs implementing these risk indicators may prevent or reduce the prevalence of aggressive periodontitis in this and similar populations.     

Association between periodontitis and low birth weight: a case-control study

OBJECTIVE: To verify a possible association between periodontitis and low-birth-weight babies. MATERIAL AND METHODS: One hundred and fifty-one mothers were examined. The case group included 76 mothers (mean age 25.6 years), whose babies at birth weighed <2500 g and had a gestational age (GA) <37 weeks, while 75 mothers (mean age 24.4 years), whose babies were born with a weight of >2500 g and with a GA>37 weeks, were the control group. Data from the mothers and the babies were collected from the Hospital registration records and during an interview with the mother. The periodontal examination included measurements of probing pocket depth (PPD) and clinical attachment loss (CAL) in six sites from all existing teeth, except for third molars. Mothers with periodontitis had at least four sites with PPD> or =4 and CAL> or =3 mm, while healthy mothers had PPD< or =3 mm and CAL< or =1 mm. RESULTS: The median number of sites with PPD> or =4 and CAL> or =3 mm was eight in the case group, and four in the control group. The significant associations with low birth weight (LBW) babies were periodontitis (odds ratio (OR)=3.48, 95% confidence interval (CI): 1.17; 10.36), arterial hypertension (OR=9.65, 95% CI: 2.22; 41.91), haemorrhage during pregnancy (OR=10.88, 95% CI: 1.95; 60.53), number of pre-natal examinations (OR=0.10, 95% CI: 0.02; 0.43) and genitourinary infection (OR=3.21, 95% CI: 1.25; 8.20). CONCLUSION: Periodontitis was considered a risk indicator for LBW in this sample, similar to other risk factors already recognized by obstetricians.     

Evidence of a substantial genetic basis for risk of adult periodontitis

BACKGROUND: A few previous studies have suggested that risk for adult periodontitis (AP) has a genetic (heritable) component. We estimated genetic and environmental variances and heritability for gingivitis and adult periodontitis using data from twins reared together. METHODS: One hundred seventeen (117) pairs of adult twins (64 monozygotic [MZ] and 53 dizygotic [DZ] pairs) were recruited. Probing depth (PD), attachment loss (AL), plaque, and gingivitis (GI) were assessed on all teeth by two examiners. Measurements were averaged over all sites, teeth, and examiners. Extent of disease in subjects was defined at four thresholds: the percentage of teeth with AL > or = 2, AL > or = 3, PD > or = 4, or PD > or = 5 mm. Genetic and environmental variances and heritability were estimated using path models with maximum likelihood estimation techniques. RESULTS: MZ twins were more similar than DZ twins for all clinical measures. Statistically significant genetic variance was found for both the severity and extent of disease. AP was estimated to have approximately 50% heritability, which was unaltered following adjustments for behavioral variables including smoking. In contrast, while MZ twins were also more similar than DZ twins for gingivitis scores, there was no evidence of heritability for gingivitis after behavioral covariates such as utilization of dental care and smoking were incorporated into the analyses. CONCLUSIONS: These results confirm previous studies and indicate that approximately half of the variance in disease in the population is attributed to genetic variance. The basis for the heritability of periodontitis appears to be biological and not behavioral in nature.     

Oral health of monozygotic twins with and without coronary heart disease: a pilot study

AIM: The purpose of this study was to investigate the oral health in monozygotic twins where one twin had coronary heart disease (CHD) and the other twin had no clinical signs of the disease. METHODS: Ten monozygotic twin pairs (age 55-81 years, eight male, and two female pairs) were recruited from the Swedish twin register. The inclusion criterion for participation was discordance regarding the presence of CHD within every twin pair. All participants underwent a full dental clinical examination including a panoramic radiograph. RESULTS: Twins with CHD had 51.5% bleeding on probing compared with 21.1% without CHD (p=0.01), and more pathological pockets (> or = 4 mm) were detected among those with CHD (20+/-15 versus 8+/-5), p=0.047). Twins with CHD had a reduced horizontal bone level in comparison with the healthy group (73%versus 78%, p=0.03). Logistic analyses using odds ratio (OR) showed that an increase of one periodontal pocket (> or = 4 mm) resulted in an increased risk for the actual twin of belonging to the CHD group (OR 1.17, p=0.03). CONCLUSIONS: This study indicates worsened periodontal conditions among twins with CHD compared with their siblings with no history of CHD. This strengthens the association between periodontal inflammation and the presence of atherosclerosis.     

不同程度慢性牙周炎患者病情的二年自然进展

目的　观察不同程度慢性牙周炎的自然进展规律。方法　纵向观察 16 9例轻、中、重度慢性牙周炎患者在 2年中的疾病自然进展 ,检查除第三磨牙外的全口牙 ,每颗牙 6个位点 ,以探诊深度、附着丧失为指标 ,两次检查之间附着丧失加重≥ 3mm的牙位定为活动性进展。结果　活动性发生率依基线时疾病的轻、中、重程度而逐渐增高 ,按位点活动性的发生率分别为 0 14 %、0 39%及0 73% ,按个体活动性的发生率分别为 15 5 6 %、2 9 89%及 4 3 2 4 % ,差异有统计学意义。结论　重度牙周炎患者是牙周破坏活动性进展的高危人群。     

Oral health behaviors, periodontal disease, and pathogens in preeclampsia: a case-control study in Korea

Background: The aim of this study is to confirm the association among oral health behaviors, periodontitis, and preeclampsia in Korean women. Methods: This study is designed as a case‐control study. Sixteen women with preeclampsia and 48 without preeclampsia post‐delivery were included in this study from November 2007 to January 2010. Information was collected on demographics, health behaviors, and obstetric and systemic diseases that may influence the periodontal condition and preeclampsia. Full‐mouth periodontal probing was conducted by one trained examiner (KHB). Localized periodontitis was defined as periodontal clinical attachment loss (AL) ≥3.5 mm on two or three sites not on the same tooth. In addition, generalized periodontitis was defined as clinical AL ≥3.5 mm on ≥4 sites not on the same tooth. Gingival crevicular fluid was collected using a sterilized paper point for quantitative analysis of Treponema denticola, Porphyromonas gingivalis, Prevotella intermedia (Pi), and Tannerella forsythia (previously T. forsythensis). Results: After adjusting for confounders, the adjusted odds ratio (OR) was 4.79 (95% confidence interval [CI]: 1.02 to 29.72) for localized periodontitis and 6.60 (95% CI: 1.25 to 41.61) for generalized periodontitis. In addition, the proportion of floss or interdental brush users in women with preeclampsia was lower than that in women without (adjusted OR: 0.21; 95% CI: 0.02 to 0.93). Pi was significantly more prevalent in women with preeclampsia (P = 0.028). Conclusion: These results indicate that preeclampsia could be associated with the maternal periodontal condition and interdental cleaning.     

Periodontal Disease,Hypertension, and Blood Pressure Among Older Adults in Puerto Rico

Background: Current scientific evidence addressing the relationship between periodontitis and hypertension is limited to studies producing inconsistent results. Methods: All participants of an ongoing representative cohort of Puerto Rican elderly who were ≥70 years old and residing in the San Juan metropolitan area were invited to this cross‐sectional study. Periodontal probing depth (PD) and attachment loss (AL) were summarized using the Centers for Disease Control and Prevention and the American Academy of Periodontology definition for severe periodontitis (≥2 teeth with AL ≥6 mm and ≥1 tooth with PD ≥5 mm). Three repeated blood pressure (BP) measurements taken were averaged using a standardized auscultatory method. Information on hypertension history, use of antihypertensive medications, and potential confounders (age, sex, smoking, heavy and binge drinking, diabetes, use of preventive dental services, flossing, body mass index, consumption of fruits, vegetables, whole wheat bread, and high‐fiber cereal) was collected during in‐person interviews. High BP was defined as average systolic BP ≥140 mm Hg or diastolic ≥90 mm Hg. Multivariate logistic regression models were used to study the relationship between severe periodontitis, hypertension history, and high BP. Results: The study population comprised 182 adults. In multivariate analysis, there was no association between severe periodontitis and hypertension history (odds ratio [OR] = 0.99; 95% confidence interval [CI]: 0.40 to 2.48). Severe periodontitis was associated with high BP, with OR of 2.93 (95% CI: 1.25 to 6.84), after adjusting for age, sex, smoking, and binge drinking. This association was stronger when restricted to those with hypertension or taking antihypertensive medications: OR = 4.20 (95% CI: 1.28 to 13.80). Conclusion: The results of this study suggest that periodontitis may contribute to poor BP control among older adults.     

Longitudinal evaluation of GCF MMP-3 and TIMP-1 levels as prognostic factors for progression of periodontitis

BACKGROUND: To determine whether matrix metalloproteinase-3 (MMP-3) and tissue inhibitor of metalloproteinases-1 (TIMP-1) in gingival crevicular fluid (GCF) could serve as prognostic factors for the progression of periodontitis, we monitored GCF MMP-3 and TIMP-1 and periodontal status of selected sites in 40 medically healthy subjects over a 6-month period. METHOD: Clinical measurements including gingival index (GI), plaque index, bleeding on probing, suppuration, probing depth (PD), attachment loss (AL), and GCF samples were taken from 2 healthy sites (including sites with gingival recession, GI=0 PD < or =3 mm; AL < or =2 mm) and 2 periodontitis sites (GI > or =1; PD > or =5 mm; AL > or =3 mm) of each patient at baseline, 3-month and 6-month visits by means of sterile paper strips. GCF levels of MMP-3 and TIMP-1 were determined by sandwich ELISA assays. RESULTS: The mean amounts of MMP-3 and TIMP-1 in diseased sites were significantly higher than in healthy sites (p<0.0001). Significantly higher GCF levels of MMP-3 and TIMP-1 were found at progressing sites than in nonprogressing periodontitis sites (0.001 or =2 mm loss of attachment during 6- month study period. GCF levels of MMP-3 were highly correlated with clinical measurements taken at baseline, 3-month and 6-month visits (p<0.001). TIMP-1 levels were only moderately correlated with probing depth and attachment level (p<0.01). Step-wise multiple regression analysis was performed to construct models for the prediction of probing depth and attachment loss increases. The most parsimonious regression models which had the best R2 values included the following variables and accounted for the indicated % of variability. The regression model for the prediction of probing depth increase included MMP-3, smoking pack-years, TIMP-1 and accounted for 53% of the variability. The best model for the prediction of attachment loss increase included MMP-3, smoking pack-years, age, TIMP-1 and explained 59% of the variability. CONCLUSION: These data indicate that sites with high GCF levels of MMP-3 and TIMP-1 are at significantly greater risk for progression of periodontitis.     

Untreated periodontal disease in Indonesian adolescents

BACKGROUND/AIMS: In an Indonesian population deprived of regular dental care, the experienced progression of disease between baseline (1987) and follow-up (1994) was investigated in relation to the composition of the subgingival microbiota at follow-up. At baseline the age ranged from 15 to 25 years. Clinical and microbiological evaluation was completed in 158 of the 167 subjects available at follow-up. METHODS: Plaque index (PI), pocket depth (PD), bleeding on probing (BOP), and attachment loss (AL) were scored at the approximal surfaces of all teeth and subgingival calculus on the approximal surfaces of the Ramfjord teeth only (number of sites with subgingival calculus: NSC). A pooled sample of the deepest pocket in each quadrant was evaluated using microbiological culture techniques. RESULTS: At baseline the mean values of the clinical parameters were AL=0.35 mm, PI=1.01, BOP=0.80 PD=3.25 mm and NSC=6.04 and at follow-up AL=0.75 mm, PI=1.16, BOP=1.19, PD=3.34 mm and NSC=5.85. All parameters except PD and NSC showed a statistically significant increase. At follow-up the prevalence of Actinobacillus actinomycetemcomitans was 40%, of Porphyromonas gingivalis 67%, of Prevotella intermedia 66%, of Fusobacterium nucleatum 79%, of Bacteroides forsythus 16%, of Campylobacter rectus 4%, and of P. micros 6%. No differences in clinical parameters were found between groups with or without these micro-organisms. In 129 subjects AL of > or =2 mm at > or =1 site was found. Logistic regression showed three significant odds-ratio's for experienced progressive periodontitis: Plaque index (12.2), gender (3.4) and Actinobacillus actinomycetemcomitans (2.9). CONCLUSIONS: The results of this retrospective study suggest that plaque is the most important parameter related to experienced disease progression, and that the presence of A. actinomycetemcomitans may be associated with increased chance of disease progression.     

A preliminary study on the relationship between stimulated saliva and periodontal conditions in community-dwelling elderly people

OBJECTIVES: The purpose of this study was to explore the relationship between flow rate and spinnbarkeit of stimulated whole saliva and periodontal conditions in healthy elderly people. METHODS: Three hundred and fifty-five dentate subjects aged 76 years were included. The pocket probing depth (PD), attachment level (AL), and bleeding on probing (BOP) were measured. Stimulated whole saliva was collected and the salivary flow rate (SFR) was calculated. Then, salivary spinnbarkeit (SS) was immediately measured. RESULTS: The mean SFR and SS were 1.44 ml/min and 1.91 mm, respectively. SFR was not significantly related to each periodontal parameter. On the other hand, subjects with SS2.00 mm exhibited a significantly higher mean PD (p<0.05), % of sites with PD>or=4mm (p<0.05), mean AL (p<0.01), % of site with AL>or=4mm (p<0.05) and % of sites with AL>or=6mm (p<0.01) than subjects in the other three groups (one-way ANOVA). In the logistic regression analysis, the factors significantly associated with the highest quintile of PD>or=4mm were: the low salivary flow and the high salivary spinnbarkeit (OR 3.84), current smokers (OR 5.08), cleaning interdental spaces rarely/never (OR 2.12), and frequent BOP (OR 5.20). CONCLUSION: These findings suggest that high salivary spinnbarkeit in addition to a low salivary flow rate might be a high risk for periodontal disease in elderly people.     

Scaling and root planing, systemic metronidazole and professional plaque removal in the treatment of chronic periodontitis in a Brazilian population. I. clinical results

OBJECTIVE: The current investigation evaluated the clinical effects of scaling and root planing (SRP) alone or in combination with systemic metronidazole and/or repeated professional removal of supragingival plaque in subjects with chronic periodontitis. METHODS: Fourty-four adult subjects (mean age: 45+/-6 years) with periodontitis were randomly assigned to four treatment groups; a control (C, n=10) that received SRP and placebo and three test groups treated as follows: Test 1 (T1) (n=12) received SRP and metronidazole (400 mg t.i.d., M) for 10 days; Test 2 (T2) (n=12) received SRP, weekly professional supragingival plaque removal for three months (professional cleaning (PC)) and placebo; and Test 3 (T3) (n=10) received SRP, M and PC. Pocket depth (PD), attachment level (AL), bleeding on probing (BOP) and presence of visible plaque and suppuration were measured at six sites per tooth at baseline and at 90 days post-therapy. Significance of differences over time was determined using the Wilcoxon test, and among groups using ancova. RESULTS: A reduction in full-mouth mean clinical parameters was observed at 90 days after all therapies. Sites with baseline PD<4 mm showed an increase in mean PD in the control group and in mean AL in all treatment groups. Sites with baseline PD of 4-6 mm in subjects who received PC as part of therapy (T2, T3) showed a marked reduction in PD, AL and in the % of sites with BOP. Subjects who received metronidazole (T1 and T3) showed the best clinical response at sites with an initial PD of >6 mm. The major clinical benefit occurred when the combination of SRP, M and PC was used. Group T3 showed the least attachment loss in initially shallow pockets. This group also exhibited the greatest reduction in the % of sites with BOP and suppuration as well as in mean PD and AL at sites with baseline PD>4 mm. CONCLUSION: The data suggest a significant clinical benefit in combining SRP, systemic metronidazole and weekly professional supragingival plaque removal for the treatment of chronic periodontitis.     

Relationship between professional dental care in childhood and coronary heart disease in adulthood in a single urban dental clinic

Purpose: A growing body of evidence supports an association between coronary heart disease (CHD) and dental diseases, particularly periodontitis (PD). The present study was designed to assess the relationship between childhood dental care and adult CHD in a single community dental clinic. Materials and Methods: Consecutive patients (n = 223) at a single urban U.S. dental clinic were asked to complete a questionnaire regarding the details of their childhood and present dental care as well as CHD and PD diagnoses. Results: A significantly greater proportion of patients who reported a lack of prophylactic dental care in childhood also reported a present diagnosis of CHD (54.2% vs 23.6%, P < 0.001). In a multivariate logistic regression model including the traditional CHD risk factors of smoking, family history, age and sex, the relationship between dental care in childhood and reduced CHD remained significant (OR = 0.318, 95% CI = 0.159-0.635, P = 0.001). This association cannot be explained wholly by a mechanism involving the development of PD in patients with poor childhood dental care, as PD was not significantly associated with CHD in the multivariate model (OR = 1.646, 95% CI = 0.836-3.239, P = 0.149). Conclusions: In our single dental clinic assessment, adequate childhood professional dental prophylactic care was associated with reduced CHD in adulthood, an association independent of traditional risk factors. Further studies are required to better define the magnitude of this association.     

The association between periodontal disease and obesity among adults in Jordan

Aim: To determine the relationship between periodontitis and overweight/obesity among Jordanians.
Material and Methods: A systematic random sample of 340 persons aged between 18 and 70 years was selected from those who accompanied patients during their visit to the outpatient clinics in the medical centre of Jordan University of Science and Technology in north of Jordan. All participants underwent periodontal examination, had anthropometric measurements, and completed the questionnaire. Periodontitis was defined as presence of four or more teeth with one or more sites with probing pocket depth 4 mm and clinical attachment loss 3 mm.
Results: Only 14% of normal weight participants had periodontal disease whereas 29.6% of overweight and 51.9% of obese participants had periodontal disease. Periodontitis was more prevalent among subjects with high waist circumference (WC) and among subjects with high waist-to-hip ratio. After adjusting for important variables, only body mass index (BMI)-defined obesity [odds ratio (OR)=2.9, 95% confidence interval (CI): 1.3, 6.1], high WC (OR=2.1, 95%CI: 1.2, 3.7), and high fat per cent (OR=1.8, 95% CI: 1.03, 3.3) remained significantly associated with increased odds of periodontitis.
Conclusion: BMI-defined obesity, high WC, and high fat per cent were significantly associated with increased odds of having periodontitis.     

Vitamin D receptor polymorphism (-1056 Taq-I) interacts with smoking for the presence and progression of periodontitis

Aim: The aim of this analysis was to investigate the relationship between a vitamin D receptor (VDR) polymorphism and the diagnosis and progression of periodontitis.
Material and Methods: Data were derived from two different studies, including 231 subjects with healthy periodontium, 224 aggressive periodontitis and 79 chronic periodontitis (CP) patients in a case–control investigation. Sixty-one of these CP patients also took part in an observational study with a 1-year follow-up, in which progression of periodontitis was determined at the subject level. All 534 subjects provided a blood sample from which genomic DNA was extracted to study VDR −1056 TaqI polymorphism.
Results: The interaction between smoking and VDR polymorphism was associated with the diagnosis of periodontitis in Caucasians [ p =0.001, odds ratio (OR)=1.33, 95% confidence intervals (CI)=1.12–1.57] and all subjects ( p =0.033, OR=1.60, 95% CI=1.04–2.48). In the longitudinal study, subjects were divided into two clusters at 1 year according to the median number of progressing sites (Δcumulative attachment loss >2 mm). Logistic regression analysis revealed that the interaction between VDR Taq-I polymorphism and smoking showed limited evidence of association with the "severe progression" cluster ( p =0.033, OR=15.24, 95% CI=1.24–187.42).
Conclusions: Vitamin D receptor Taq-I TT polymorphism was moderately associated with both the presence and the progression of periodontitis in smokers, while no association was detected in non-smoking individuals. VDR genetic factors may interact with smoking in the pathogenesis of periodontitis.     

Increased Periodontal Attachment Loss in Patients With Systemic Sclerosis

Background: Patients with inflammatory rheumatic diseases and periodontitis share common pathogenetic characteristics, such as proinflammatory traits causative for tissue degradation and loss of function. The aim of the present case control study is to investigate the association between systemic sclerosis (SSc) and periodontitis. Methods: The association between SSc and periodontitis was examined in 58 SSc patients and 52 control patients, matched for age and sex. The periodontal examination included periodontal attachment loss (AL), probing depth, bleeding on probing, plaque index (PI), and gingival index (GI). Potential risk factors of periodontitis were assessed through patients’ questionnaires. Results: In unadjusted analyses, patients with SSc had a significant 0.61 mm higher AL (95% confidence interval [CI] 0.24 to 0.97; P = 0.002) when compared with controls. In a stepwise logistic regression, including SSc status, age, sex, education, smoking, alcohol consumption, and body mass index, only SSc status, age, and sex remained significantly associated with periodontitis. Adjusted for age and sex, patients with SSc had a 0.52 mm higher AL compared with controls (95% CI 0.16 to 0.88; P = 0.005). The strength of the association of SSc with AL remained statistically significant after additional adjustment for PI (0.44 mm; 95% CI 0.02 to 0.86; P = 0.04) or GI (0.61 mm; 95% CI 0.24 to 0.97; P = 0.001). Conclusions: This study demonstrates higher AL in patients with SSc, which remained significant after adjustment. The study indicates a possible relationship between SSc and periodontitis.     

Inverse association between periodontitis and respiratory allergies in patients with type 1 diabetes mellitus

Aim: In a general adult population, we have demonstrated an inverse association between periodontitis and respiratory allergies that is in line with the hygiene hypothesis suggesting a protective effect of infections against the development of allergies. The objective of the present study was to investigate the association between periodontitis and respiratory allergies in a type 1 diabetes mellitus population. Material and Methods: The study population comprised 170 patients with type 1 diabetes mellitus aged 17–80 years. Respiratory allergies were present in 22 subjects. The attachment loss (AL) was measured. Periodontitis was defined according to the percentage of surfaces that exceeded 3 mm AL (healthy, mild, moderate, severe periodontal conditions). Results: Our adjusted analyses revealed an inverse association between periodontitis and respiratory allergies. For increasing AL, a trend towards a decreasing risk was present for respiratory allergies (p_trend<0.05). Compared with subjects with healthy periodontal conditions, individuals with severe periodontal conditions had the lowest risk of respiratory allergies [odds ratios (OR) 0.06 (95% confidence interval (CI) 0.01–0.39)], followed by subjects with moderate AL [OR 0.14 (95% CI 0.03–0.63)] and mild AL [OR 0.32 (95% CI 0.09–1.08)]. Conclusion: There is a strong inverse association between periodontitis and respiratory allergies in patients with type 1 diabetes mellitus. These findings further support the hygiene hypothesis.