Type 2 Diabetes Mellitus and Periodontitis: Bidirectional Association in Population-based 15-year Retrospective Cohorts.

OBJECTIVE: A two-way relationship between periodontitis and diabetes has been proposed. However, bidirectional epidemiological observation is limited and inconsistent. OBJECTIVE: Using the National Health Insurance Research Database of Taiwan (covering over 99% of the entire population), we aimed to estimate the development of diabetes in periodontitis patients or that of periodontitis in patients with type 2 diabetes mellitus (T2DM), respectively. METHODS: A total of 11 011 patients with severe periodontitis were recruited from 2000 to 2015. After matching by age, sex, and index date, 11 011 patients with mild periodontitis and 11 011 non-periodontitis controls were registered. Additionally, 157 798 patients with T2DM and 157 798 non-T2DM controls were enrolled, in whom the development of periodontitis was traced. Cox proportional hazards model was performed. RESULTS: Periodontitis patients tended to have a statistically high risk for T2DM. The adjusted hazard ratio was 1.94 (95% CI, 1.49-2.63, P < .01) and 1.72 (95% CI, 1.24-2.52, P < .01) for severe and mild periodontitis groups, respectively. The patients with severe periodontitis had a higher risk of having T2DM relative to those with mild periodontitis (1.17 [95% CI, 1.04-1.26, P < .001]). Conversely, the risk of periodontitis increased significantly in patients with T2DM (1.99 [95% CI, 1.42-2.48, P < .01]). However, high risk was observed for the outcome of severe periodontitis (2.08 [95% CI, 1.50-2.66, P < .001]), but not for mild periodontitis (0.97 [95% CI, 0.38-1.57, P = .462]). CONCLUSION: We suggest that the bidirectional association is between T2DM and severe but not mild periodontitis.

Association of chronic periodontitis with prostatic hyperplasia and prostatitis: A population-based cohort study in Taiwan.

BACKGROUND: Association between periodontitis and prostate diseases of benign prostatic hyperplasia (BPH) and prostatitis is uncertain. METHODS: From the National Health Insurance Research Database of Taiwan, 5,510 patients with newly diagnosed chronic periodontitis and participated in therapies were selected from 2000 to 2015 as cohort 1. Matched with age and index year, 5,510 patients with periodontitis diagnosis without therapy were selected as cohort 2, and 5,510 participants without diagnosis were used as control. Cox proportional hazard and survival analysis were performed to compare the risks and the survival probabilities among cohorts. RESULTS: In two periodontitis cohorts, 636 and 638 participants compared with 550 in control (1,174 and 1,187 versus 989 per 100,000 person-years) had prostate disorder. Difference was identified for prostatitis (n = 68, 70 versus 34; rate = 125, 130 versus 61 /100,000 person-years; P <0.001) but not for BPH (n = 577, 575, versus 529; rate = 1,065, 1,070 versus 951 /100,000 person-years, respectively). Different survival probabilities for prostate disorder and prostatitis, but not for BPH, were observed among cohorts. Periodontitis patients were more likely to develop prostate disorder after adjustment (adjusted hazard ratio [aHR] of 2.590 to 2.641 by competing model). With stratification, risks between two periodontitis cohorts exhibited no difference. When BPH cases were excluded, the aHRs for prostatitis were 4.611 to 4.798. CONCLUSIONS: Despite treatment, the patients with periodontitis had higher risk of developing prostatitis than patients without periodontitis.

Comparison of the hospitalization period after microvascular reconstruction flap in trismus patients: free anterolateral thigh flap versus free forearm flap.

OBJECTIVES: The primary strategy for treating oral squamous cell carcinoma (OSCC) is therapeutic resection, with the trismus resection defect reconstructed via free flap. The most popular free flaps include the radial forearm free flap (RFFF) and anterolateral thigh free flap (ALT). This study investigated the relationships between the hospitalization period and a variety of surgical outcomes, as well as maximum inter-incisor distance (IID), in trismus patients who chewed betel nuts. MATERIALS AND METHODS: Forty-nine primary OSCC patients who chewed betel nuts and underwent surgical resection and reconstruction between 2010 and 2016 were enrolled in this retrospective study. The data were from a single center in Taiwan. The outcome variable after flap recovery surgery was the duration of postoperative hospitalization. Other factors that were analyzed comprised correlations between hospitalization and a variety of factors, including postoperative inter-incisor distances (IIDs), operative time, gender, and WBC count, upon stratification into two reconstruction groups. RESULTS: The mean postoperative hospitalization duration in the ALT group was 22.9 ± 7.2 days, which was significantly shorter than that in the RFFF group (27.8 ± 7.0 days; p = 0.019). Two-week postoperative IID (ALT group: 16.1 ± 0.8 mm; RFFF group: 7.0 ± 0.6 mm) was inversely related to the duration of hospitalization (p = 0.022, r = - 0.372). CONCLUSIONS: The ALT flap is more effective than the RFFF flap to reduce the length of hospitalization in trismus patients. CLINICAL RELEVANCE: The ALT flap should be considered as a first-line technique in OSCC reconstruction in trismus patient reconstruction.