Association between periodontitis and preeclampsia in never-smokers: a prospective study.

AIM: The aim of this prospective study was to investigate the relationship between periodontitis and preeclampsia in never-smokers. MATERIALS AND METHODS: Pregnant women were recruited at 21 to 24 weeks of gestation from March 2009 to June 2013. Information on demographics, health behaviours, obstetric history, and systemic diseases that can influence periodontal status and preeclampsia was collected. Full-mouth periodontal probing was performed by two trained examiners. The inter-examiner Kappa value was 0.822 for clinical attachment loss (CAL). Periodontitis was defined as clinical periodontal attachment loss (CAL) of 4.0 mm or greater on 2 or more sites not on the same tooth. Information on the occurrence of preeclampsia was collected by five obstetricians. RESULTS: We studied a total of 283 subjects, comprised of 67 subjects with periodontitis and 216 subjects without periodontitis. Of these, 13 (4.6%) women were diagnosed with preeclampsia. After adjusting for all confounders, the adjusted odds ratio of periodontitis for preeclampsia was 5.56 (95% confidence interval of 1.49-20.71). CONCLUSIONS: There was a significant relationship between periodontitis and the occurrence of preeclampsia among never-smokers.

Enhancing the quality of life in elderly women through a programme to improve the condition of salivary hypofunction.

OBJECTIVE: The purposes of this study were to examine the effects of oral exercise intended to improve the function of the oral cavity in the elderly and their quality of life to pave the way for the development of oral-health promotion programmes geared towards the elderly. METHODS: The subjects were 78 female Koreans who resided in Seoul and were aged 65 years and older. During a 3-month period, an oral function promotion programme was conducted twice a week, between 10.00 am and 12.00 pm, applying oral exercise suggested by a Japanese public health centre. A survey was conducted by interviewing the selected women to determine the state of their subjective dry mouth, quality of life related to oral health and jaw functional limitation. Their opening, unstimulated whole saliva and pronunciation speed were measured before and after the oral function exercise programme. RESULTS: The subjects showed a significant improvement in subjective dry mouth symptoms, relevant behaviour, the level of discomfort caused by dry mouth and subjective jaw functional limitation during mastication and swallowing and emotional expression after receiving the oral exercise. After the oral exercise, there was a significant increase in mouth opening, unstimulated whole saliva and speaking speed ('patakala' pronunciation) after oral exercise. There was also significant progress in their quality of life related to oral health. Overall improvement in subjective dry mouth symptoms and relevant behaviour over time after oral exercise had a positive correlation with the level of improvement in discomfort triggered by dry mouth and mastication. The level of improvement in OHIP-14 had a positive correlation with the level of overall improvement in dry mouth symptoms and behaviour, the level of improvement in discomfort by dry mouth and that in mastication and swallowing. CONCLUSION: This study showed the effects of the oral function promotion programme and correlation of oral condition and oral health-related quality of life. It is suggested that this oral function promotion programme has positive effects on both objective and subjective oral conditions. It is strongly recommended that this programme, along with other oral health promotion programmes, be implemented to improve oral function and oral health-related quality of life for the elderly.

The relationship between periodontitis and metabolic syndrome among a Korean nationally representative sample of adults.

AIMS: The aim of this study was to examine whether metabolic syndrome (MS) is associated with periodontitis in a representative sample of Korean adults, who were involved in the Fourth Korea National Health and Nutrition Examination Survey (KNHANES). MATERIALS AND METHODS: A total of 7178 subjects over the age of 19 years who participated in KNHANES were examined. MS was defined as the definition proposed by the National Cholesterol Education Program Adult Treatment Panel III and the abdominal obesity cut-off line based on Korean Society for the Study of Obesity. The periodontal status was assessed by the Community Periodontal Index. Multivariate logistic regression analysis was carried out adjusting for the sociodemographics, oral health behaviours and status, and health behaviour. All analyses considered a complex sampling design, and multivariate analysis was also performed in the subgroups (age, gender, current smoking status). RESULTS: Multivariate logistic regression analysis revealed significant associations between MS and periodontitis. After adjusting for all covariates, the adjusted odds ratio (OR) of periodontitis (community periodontal index ≥ 3) was 1.55 (1.32-1.83) for MS. In subgroup analysis, periodontitis is associated with MS in subjects over age 40 and the adjusted ORs were higher in females and in the smoker group than in males and in non-smokers. CONCLUSIONS: MS is associated with periodontitis.

Periodontitis and the risk for non-fatal stroke in Korean adults.

BACKGROUND: The association between periodontal inflammation and non-fatal stroke is still controversial and limited to evidence in Western countries. The aim of this study was to investigate whether periodontitis is independently associated with non-fatal stroke in Korean adults. METHODS: A case-control study was conducted on 265 non-fatal chronic stroke cases at the National Rehabilitation Center, Seoul, Korea, and 214 non-stroke population controls. Medical specialists diagnosed stroke by using brain imaging from magnetic resonance imaging and/or computerized tomography. A dentist recorded the clinical attachment level (CAL), the distance between the cemento-enamel junction and the probed base of the periodontal pocket, using a University of North Carolina-15 manual probe. An interview assessed 17 sociodemographic, behavioral, systemic/oral health-related possible confounders. Multiple logistic regression analysis was used to evaluate the association between periodontitis and stroke while controlling for age, gender, income, education, smoking, drinking, history of systemic disease, body mass index, familial cardiovascular risk factors, and oral health behaviors. Subgroup analyses were also performed. RESULTS: Stroke was strongly associated with periodontitis (presence of CAL > or =6 mm): the odds ratio was 4.0 (95% confidence interval: 2.3 to 7.0) after controlling for all possible confounders. The association with periodontitis (tertiary percentage of CAL > or =5 mm) had a dose-response effect. The association between periodontitis and stroke was higher among adults younger than age 60 (6.0 versus 2.6) and normotensives (4.8 versus 3.2). CONCLUSION: Our data suggested that periodontitis is independently associated with non-fatal stroke, and its impact seems to be greater among younger or normotensive Korean adults.

Validation of the Korean version of the oral health impact profile among the Korean elderly.

OBJECTIVES: This study aimed to validate a Korean version of the oral health impact profile (OHIP) and to develop a short-form of OHIP for the Korean elderly. METHODS: The original English version of OHIP was translated into Korean using a forward-backward method. Internal consistency was measured by Cronbach's alpha among 1098 subjects aged 56 or more. Test-retest reliability was assessed by intraclass correlation coefficients (ICCs) with a 3-month interval among 155 subjects aged 57 or more. The validity of the Korean version of OHIP (OHIP-K) was assessed by comparing OHIP scores with the perceived dental treatment needs and by identifying associations between OHIP scores and the number of natural teeth among 128 subjects aged 54 or more. The short-form of OHIP for the Korean elderly (OHIP-14K) was developed using linear regression models and was also validated and compared with the short-form of OHIP by Slade (OHIP-14S). RESULTS: The Cronbach's alpha value for OHIP-K was 0.97. The ICC for OHIP-K was 0.64. Adults with perceived dental treatment needs had a higher OHIP score than adults without any such needs (P < 0.001). The number of natural teeth was negatively associated with the OHIP score (r = -0.44, P < 0.001). OHIP-14K and OHIP-14S shared seven identical items out of a total of 14 items. OHIP-14K results correlated with OHIP-K almost exactly (r(2) = 0.96), as did OHIP-14S (r(2) = 0.95). CONCLUSIONS: OHIP-K showed excellent reliability and validity. OHIP-14S may be a better choice for the evaluation of oral health-related quality of life among the Korean elderly for an international comparison.

Occupational exposure to acidic chemicals and occupational dental erosion.

OBJECTIVE: This study investigated the association between occupational acidic chemicals (ACs) exposure and occupational dental erosion. METHODS: A cross-sectional study was conducted in which three dentists surveyed 951 subjects from 42 factories using five types of ACs below Korean Threshold Limit Values (K-TLVs). Subjects agreed to participate by a written consent; 519 were acid exposed workers and 431 were non-exposed. The modified ten Bruggen Cate's criteria was used to classify erosion. Length and type of exposure to ACs were assessed using questionnaires. Logistic regression analysis including interaction terms was applied. RESULTS: ACs exposure was associated with erosion severity. Multiple exposures to ACs were found to be strongly associated with severe erosion. Interaction between wearing masks and AC exposure was significant. CONCLUSIONS: This study showed a clear association between AC exposure below K-TLVs and erosion. Hence, the authors propose to lower K-TLVs of five types of ACs.

The cariogenicity of hydrolyzed starch foods by measuring the polyacrylamide hydroxyapatite (PAHA) disc.

OBJECTIVES: This study measured the degree of demineralization of starch foods affected by hydrolyzed starch in total starch using the polyacrylamide hydroxyapatite (PAHA) disc. DESIGN: A total of 10 ml of test food was added to a PAHA disc and 5 ml artificial saliva, followed by inoculation with 1 µl of S. mutans and incubation at 37 °C for 180 min. The demineralization effects were then determined using CLSM. RESULTS: The proportion of hydrolyzed starch in total starch in potato increased over time, while hydrolyzed starch in other test food decreased. When the amount of hydrolyzed starch in total starch increased after 180 min (p=0.000), the surface roughness of the PAHA disc in potato was significantly decreased. Wheat-based sugary snacks, such as chips and cookie, had relatively high cariogenic potentials, whereas baked potato had a relatively low cariogenic potential. CONCLUSIONS: Hydrolyzed starch in total starch increased over time, and cariogenic potential was notably decreased. Measurement of PAHA disc may be a valid method for assessing the cariogenic potential of hydrolyzed starch foods.

Risk factors for dental caries in childhood: a five-year survival analysis.

OBJECTIVES: The purpose of this study was to examine the risk factors of dental caries at the level of an individual person with survival analysis of the prospective data for 5 years. METHODS: A total of 249 first-grade students participated in a follow-up study for 5 years. All participants responded to a questionnaire inquiring about socio-demographic variables and oral health behaviors. They also received an oral examination and were tested for Dentocult SM and LB. Over 5 years, the participants received yearly oral follow-up examinations to determine the incidence of dental caries. The incidence of one or more dental caries (DC1) and four or more dental caries (DC4) were defined as one or more and four or more decayed, missing, and filled permanent teeth increments, respectively. Socio-demographic variables, oral health behaviors, and status and caries activity tests were assessed as risk factors for DC1 and DC4. The adjusted hazard ratios (HRs) of risk factors for DC1 and DC4 were calculated using Cox proportional hazard regression models. RESULTS: During the 5-year follow-up period, DC1 and DC4 occurred in 87 and 25 participants, respectively. In multivariate hazard models, five or more decayed, missing, and filled primary molar teeth [HR 1.93, 95% confidence interval (CI) 1.19-3.13], and Dentocult LB of two or three (HR 2.21, 95% CI 1.37-3.56) were independent risk factors of DC1. For DC4, only Dentocult LB of two or three was an independent risk factor (HR 2.95, 95% CI 1.11-7.79). CONCLUSIONS: Our results suggest that dental caries incidence at an individual level can be associated with the experience of dental caries in primary teeth and Dentocult LB based on the survival models for the 5-year prospective data.

Association between vitamin D deficiency and periodontal status in current smokers.

OBJECTIVES: The aim of this study was to examine whether vitamin D level is associated with periodontitis using a representative sample of Korean adults. METHODS: A total of 6011 subjects who participated in the fourth Korea National Health and Nutrition Examination Survey (KNHANES) were examined. Vitamin D deficiency was defined as 25-hydroxyvitamin D serum concentrations to be under or equal to 20 ng/ml. We assessed periodontal conditions by Community Periodontal Index (CPI) and defined higher CPI as ≥code 3. Multivariate logistic regression analyses were performed adjusting for sociodemographics, oral and general health behaviors, and systemic health status. All analyses considered a complex sampling design, and a subgroup analysis was performed to determine estimates stratified according to the effect modifier. RESULTS: There was no association between vitamin D deficiency and higher CPI after adjusting for the covariates in the total sample. According to the strata of smoking, the significant association was found in only current smokers after adjusting for the covariates including pack-years (odds ratio: 1.53, 95% confidence interval: 1.07-2.18). CONCLUSIONS: A significant association between vitamin D deficiency and periodontal status was found in only current smokers. Smoking could modify the effect of vitamin D on periodontitis.

Early childhood caries: prevalence and risk factors in Seoul, Korea.

OBJECTIVE: The purpose of this study was to determine the prevalence of early childhood caries (ECC), including noncavitated lesions (d1), in children 6-59 months of age in relation to socioeconomic factors, feeding practices, and oral health behaviors in Seoul, Korea. METHODS: The children attended child care facilities and were selected from 32 primary sampling units. Two dentists examined 470 children. Parents of 383 of the subjects were interviewed by phone regarding caries risk factors. RESULTS: For children 6-59 months of age, the prevalence of ECC and severe ECC were 56.5 percent and 47.0 percent respectively. In bivariate analysis, the children whose nursing bottle contained sweetened solution had higher severe ECC prevalence (P=.035), and children whose parents reported a lower frequency of between-meal snacks showed lower ECC prevalence (P=.046). By logistic regression analysis, age and frequency of between-meal snacks were associated with the prevalence of ECC (P<.05). CONCLUSION: This study demonstrates that the prevalence of ECC was high among children in Seoul. Early educational intervention programs for pregnant women and mothers of young children should be developed based on the risk factors identified in this study.

Association of dental caries with socioeconomic status in relation to different water fluoridation levels.

OBJECTIVES: The aim of this study was to assess the prevalence of dental caries in 11-year-old children, related to water fluoridation and family affluence scale (FAS), as an indicator of socioeconomic status (SES) in Korea. METHODS: A total of eight areas were selected for study: four areas with fluoridated piped water (WF areas) and four areas with nonfluoridated piped water (non-WF areas). Non-WF areas had a similar economic level and population size compared with the WF areas. A total of 1446 elementary school students, 11 years of age, were included. They were examined, and questionnaires completed by their parents were analyzed. In the questionnaire, information about gender, FAS as an indicator of SES, occasions of daily cariogenic snack intake, occasions of daily cariogenic beverage intake, drinking of piped water, cooking with piped water, and usage of oral hygiene supplemental measures were surveyed. The bivariate association between the characteristics of the subjects and the number of decayed, filled, and missing permanent teeth (DMFT score) was analyzed through an independent samples t-test. The difference in the mean DMFT score between different FAS groups was analyzed by DMFT ratio, after adjusting for gender, oral health behaviors, and usage of piped water variables. The DMFT ratio was calculated from a Poisson regression model, because the DMFT score was not normally distributed. RESULTS: There was no significant association between FAS and the mean DMFT score in both areas, by bivariate analysis. After adjusting for each group of confounders, a significant association (95% CI: 1.032-1.513) was found between the FAS and mean DMFT scores in non-WF areas; however, no significant difference was observed in the WF areas (95% CI: 0.766-1.382). CONCLUSIONS: This study supported that water fluoridation could not only lead to a lower prevalence of dental caries, but also help to reduce the effect of SES inequalities on oral health.

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 χ(2) 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/m(2)), after adjusting for all of the covariates. CONCLUSION: There is a strong association between prepregnancy overweight/obesity and periodontitis in pregnant females.

Systemic effect of water fluoridation on dental caries prevalence.

OBJECTIVES: The aim of this study was to evaluate the systemic effect of water fluoridation on dental caries prevalence and experience in Cheongju, South Korea, where water fluoridation ceased 7 years previously. METHODS: A cross-sectional survey was employed at two schools where water fluoridation had ceased (WF-ceased area) and at two schools where the water had never been fluoridated (non-WF area). The schools in the non-WF area were of a similar population size to the schools in the WF-ceased area. Children of three age groups were examined in both areas: aged 6 (n = 505), 8 (n = 513), and 11 years (n = 467). The differences in the mean number of decayed or filled primary teeth (dft) and the mean number of decayed, missing, or filled permanent teeth (DMFT) scores between areas after adjusting for oral health behaviors and socio-demographic factors were analyzed by a Poisson regression model. RESULTS: The regression model showed that the DMFT ratio for children aged 11 years in the WF-ceased area was 0.581 (95% CI 0.450-0.751). In contrast, the dft ratio for age 6 in the WF-ceased area was 1.158 (95% CI 1.004-1.335). Only the DMFT ratio for age 8 (0.924, 95% CI 0.625-1.368) was not significant. CONCLUSIONS: While 6-year-old children who had not ingested fluoridated water showed higher dft in the WF-ceased area than in the non-WF area, 11-year-old children in the WF-ceased area who had ingested fluoridated water for approximately 4 years after birth showed significantly lower DMFT than those in the non-WF area. This suggests that the systemic effect of fluoride intake through water fluoridation could be important for the prevention of dental caries.

Measurement of the cariogenicity of snacks using a radioisotope PAHA disc.

OBJECTIVES: This study aimed to establish a method for measuring the cariogenic potential of foods with high reproducibility in vitro. METHODS: Streptococcus mutans (S. mutans) was incubated in test foods with radioisotope polyacrylamide hydroxyapatite (PAHA) for 150 min at 37 °C. Then, the amount of radioisotope (32)P released from PAHA was measured using a liquid scintillation counter and scanning electron microscopy (SEM). RESULTS: The radioisotope PAHA discs that were soaked in 10% sucrose solutions had a high cariogenic potential and showed a remarkably demineralized surface (p < 0.05). The radioisotope PAHA disc that was incubated with snacks that had a high cariogenic potential showed a remarkably demineralized surface via SEM. Candy had a relatively high cariogenic potential, whereas xylitol gum had a relatively low potential. CONCLUSIONS: The cariogenicity of snacks can easily be evaluated by measuring the amount of (32)P released from radioisotope PAHA discs.

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.

Mercury exposure and periodontitis among a Korean population: the Shiwha-Banwol environmental health study.

BACKGROUND: The oral effect of chronic low-level mercury exposure is not completely understood. This study examined whether mercury exposure is associated with periodontitis. METHODS: This study cross-sectionally surveyed 1,328 residents (598 males and 730 females) from the prospective Shiwha and Banwol cohort in Korea from July 2005 to August 2006 at baseline. Two dentists assessed periodontitis, an outcome, using the Community Periodontal Index (CPI): CPI 3 or 4 and CPI 0 to 2 were classified as periodontitis and non-periodontitis, respectively. The hair mercury level, the predictor, was analyzed. The mercury level was categorized according to the reference dose of the Environmental Protection Agency of the United States: normal = <1 ppm and high = > or =1 ppm. Age, gender, economic status, smoking, frequency of daily toothbrushing, diabetes mellitus, hyperlipidemia, and obesity were assessed as confounders. Logistic regression analysis was used to evaluate the adjusted association. Subgroup analyses for gender were also performed. RESULTS: Mercury exposure was independently associated with periodontitis (odds ratio = 3.17). Males with high mercury levels had a 50.0% higher probability of having periodontitis than females with normal mercury levels. Of them, the interaction effect between the body burden of mercury and gender was 39.0%. The odds ratio between periodontitis and high mercury levels was higher for males than females (95% confidence interval: 0.99 to 2.23 versus 0.59 to 1.26, respectively). CONCLUSIONS: These results suggest that mercury exposure had an independent association with periodontitis. High body-burden mercury in males might be a contributory factor linked with periodontitis.

Chewing function impacts oral health-related quality of life among institutionalized and community-dwelling Korean elders.

OBJECTIVE: The aim of this study was to assess the association of chewing ability to oral health-related quality of life (OHRQoL) measured by the Oral Health Impact Profile-14 (OHIP-14) controlling for clinical oral health status, self-reported health status, demographic factors, and socioeconomic conditions among community-dwelling and institutionalized Korean elders. METHODS: This cross-sectional study comprised a sample of 307 community-dwelling and 102 institutionalized people over the age of 60, using a cluster sampling procedure. A questionnaire was implemented and a clinical oral examination was completed for each subject. The outcome variable of interest was the OHIP-14 score, and its associations with chewing ability, objective oral health status, self-reported health status, demographic factors, and socioeconomic conditions were assessed. Because of highly-skewed distribution of the OHIP-14 scores, nonparametric analytic methods were used. The final model was developed using a multivariable two-level logistic regression model for a dichotomized OHIP-14 score to account for the cluster sampling method applied to this study. RESULTS: The mean age of the participants was 75.4 years, with 67.7% being women. The median OHIP-14 score was 7. Negative oral health impacts were experienced fairly often or very often by a total of 36.4% of elderly. In the final model, elders who could chew none to three and four to six foods among seven indicator foods were 3.4 (P = 0.010) and 2.0 (P = 0.040) times more likely, respectively, to have worse OHRQoL compared with elders who could chew all seven food types. Also significant associations with worse OHRQoL were shown for being concerned about oral health [Odds Ratio (OR) = 4.9, P = 0.002], fair or better self-reported oral health (OR = 0.12, P = 0.002), very good/good self-reported general health (OR = 0.38, P = 0.008), being married (OR = 2.0, P = 0.054), and having a favourable economic status (OR = 0.43, P = 0.042). CONCLUSIONS: This study showed highly significant association between chewing ability and OHRQoL measured by the OHIP-14 score after controlling for related factors. Amelioration of chewing ability might independently contribute to improving the OHRQoL of elders.