Effect of being overweight and obese on periodontal treatment costs.

BACKGROUND: Obesity can increase a person's risk of developing periodontal disease, and patients with obesity have greater health care costs. However, the effect of obesity on periodontal treatment costs has not been examined. METHODS: This retrospective cohort study used data from the electronic dental records of adult patients examined from July 1, 2010, through July 31, 2019 at a US dental school. Primary exposure was body mass index, which was categorized as obese, overweight, or normal. Periodontal disease was categorized using clinical probing measures. Fee schedules and procedure codes were used to compute the primary outcome, which was total periodontal treatment costs. A generalized linear model with gamma distribution was used to examine the relationship between body mass index and periodontal costs after controlling for initial periodontal disease severity and other confounding variables. Parameter coefficients and mean ratios with 95% CIs were estimated. RESULTS: The study sample included 3,443 adults, of whom 39% were normal weight, 37% were overweight, and 24% were obese. Mean (SD) total periodontal treatment costs for patients who were obese were considerably higher ($420 [$719]) than those for patients who were overweight ($402 [$761]) and patients who were normal weight ($268 [$601]). After controlling for covariates and disease severity, patients who were obese had 27% higher periodontal treatment costs than patients who were normal weight. The additional periodontal treatment costs attributable to obesity were greater than those attributable to either diabetes or smoking. CONCLUSIONS: The study results suggest that among patients at a dental school, those who were obese incurred substantially higher periodontal treatment costs than patients who were normal weight, independent of initial periodontal disease severity. PRACTICAL IMPLICATIONS: The study findings have important implications for clinical guidelines and dental benefit design and coverage policies.

Trends in use of dental care provider types and services in the United States in 2000-2016: Rural-urban comparisons.

BACKGROUND: The authors conducted a study to assess recent trends in dental care provider mix (type of dental professionals visited) and service mix (types of dental procedures) use in the United States and to assess rural-urban disparities. METHODS: Data were from the 2000 through 2016 Medical Expenditure Panel Survey. The sample was limited to respondents who reported at least 1 dental visit to a dental professional in the survey year (N = 138,734 adults ≥ 18 years). The authors estimated rates of visiting 3 dental professionals and undergoing 5 dental procedures and assessed the time trends by rural-urban residence and variation within rural areas. Multiple logistic regression was used to assess the association between rural and urban residence and service and provider mix. RESULTS: A decreasing trend was observed in visiting a general dentist, and an increasing trend was observed in visiting a dental hygienist for both urban and rural residents (trend P values < .001). An increasing trend in having preventive procedures and a decreasing trend in having restorative and oral surgery procedures were observed only for urban residents (trend P values < .001). The combined data for 2000 through 2016 showed that rural residents were less likely to receive diagnostic services (adjusted odds ratio [AOR], 0.82; 95% confidence interval [CI], 0.72 to 0.93) and preventive services (AOR, 0.87; 95% CI, 0.78 to 0.96), and more likely to receive restorative (AOR, 1.11; 95% CI, 1.02 to 1.21) and oral surgery services (AOR, 1.23; 95% CI, 1.11 to 1.37). CONCLUSIONS: Although preventive dental services increased while surgical procedures decreased from 2000 through 2016 in the United States, significant oral health care disparities were found between rural and urban residents. PRACTICAL IMPLICATIONS: These results of this study may help inform future initiatives to improve oral health in underserved communities. By understanding the types of providers visited and dental services received, US dentists will be better positioned to meet their patients' oral health needs.

Predictors of self-reported oral health in the Black Women's Health Study.

OBJECTIVES: To describe the self-reported oral health of participants in the Black Women's Health Study (BWHS), a national cohort of 59,000 Black women, and to assess factors associated with this self-report. METHODS: Annual follow-up of the BWHS cohort occurs via surveys. The 2011 questionnaire included oral health self-report items, on which 38,573 respondents had complete data. Sample characteristics were summarized using descriptive statistics. We assessed correlations with several covariates by estimating odds ratios using multivariable-adjusted logistic regression models. RESULTS: Those who reported fair or poor oral health were more likely to report current smoking, recent tooth loss, diabetes or hypertension diagnoses, lower education levels, obesity, and higher parity. Few factors were related to self-reported gum disease with bone loss. CONCLUSIONS: The oral health of US Black women is poorly understood. Correlates of oral health in the BWHS are largely consistent with what has been observed in other populations.

The Healthy Eating Index and coronal dental caries in US adults: National Health and Nutrition Examination Survey 2011-2014.

BACKGROUND: The purpose of this cross-sectional study was to determine if Healthy Eating Index (HEI-2015) scores are associated with coronal caries and the odds of untreated coronal caries in adults 20 years and older. METHODS: Data on decayed, missing, and filled teeth (DMFT), untreated coronal caries, and HEI-2015 scores were obtained from 7,751 adults who completed a dental examination and two 24-hour dietary recalls in National Health and Nutrition Examination Survey cycles 2011-2012 and 2013-2014. HEI-2015 scores were categorized into quintiles, with HEI-2015 quintile 1 scores indicating the least compliance with 2015-2020 Dietary Guidelines for Americans. The authors used multivariable linear regression to assess associations of HEI-2015 with DMFT and logistic regression for associations with untreated coronal caries. All regression models were controlled for age, sex, race or ethnicity, current cigarette use, family income to poverty threshold ratio, last dental visit, education, and whether participants were ever told they had a heart attack. RESULTS: Relative to HEI-2015 quintile 1, the adjusted odds of any untreated coronal caries were quintile 5 (odds ratio [OR], 0.61; 95% confidence interval [CI], 0.46 to 0.80), quintile 4 (OR, 0.66; 95% CI, 0.53 to 0.84), quintile 3 (OR, 0.76; 95% CI, 0.56 to 1.04), and quintile 2 (OR, 0.93; 95% CI, 0.66 to 1.31). Participants who met the recommendations for the total fruits, whole fruits, greens and beans, and added sugars components of the HEI-2015 score were less likely to have untreated coronal caries than those who did not meet the recommendations. Overall, mean coronal DMFT also decreased as HEI-2015 scores increased, but trends were not consistent in all racial or ethnic groups. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Greater compliance with the Dietary Guidelines for Americans is associated with lower prevalence and the odds of untreated caries in adults. Dietary counseling for caries prevention by dental professionals should incorporate comprehensive dietary guidelines that are consistent with those intended for enhancing overall health and reducing the risk of developing common systemic diseases.

Wearable Sensors for Monitoring of Cigarette Smoking in Free-Living: A Systematic Review.

Globally, cigarette smoking is widespread among all ages, and smokers struggle to quit. The design of effective cessation interventions requires an accurate and objective assessment of smoking frequency and smoke exposure metrics. Recently, wearable devices have emerged as a means of assessing cigarette use. However, wearable technologies have inherent limitations, and their sensor responses are often influenced by wearers' behavior, motion and environmental factors. This paper presents a systematic review of current and forthcoming wearable technologies, with a focus on sensing elements, body placement, detection accuracy, underlying algorithms and applications. Full-texts of 86 scientific articles were reviewed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines to address three research questions oriented to cigarette smoking, in order to: (1) Investigate the behavioral and physiological manifestations of cigarette smoking targeted by wearable sensors for smoking detection; (2) explore sensor modalities employed for detecting these manifestations; (3) evaluate underlying signal processing and pattern recognition methodologies and key performance metrics. The review identified five specific smoking manifestations targeted by sensors. The results suggested that no system reached 100% accuracy in the detection or evaluation of smoking-related features. Also, the testing of these sensors was mostly limited to laboratory settings. For a realistic evaluation of accuracy metrics, wearable devices require thorough testing under free-living conditions.

Oral Health Disparities Across the Life Span.

Despite improvements in the oral health status of the US population as a whole, a disproportionately higher burden of oral diseases and disorders are borne by those individuals from low-income and racial and ethnic minority groups. These differences in health status, health outcomes, or health care use between distinct socially disadvantaged and advantaged groups are well documented and known as health disparities. It is vital that members of the dental profession understand the distribution of oral health and disease across different populations and the life span and participate in developing innovative and sustainable approaches to eliminate oral health disparities.

Recognizing cigarette smoke inhalations using hidden Markov models.

Previous studies with the Personal Automatic Cigarette Tracker (PACT) wearable system have found that smoking presents a distinct temporal breathing pattern, which might be well-suited for recognition by hidden Markov models (HMMs). In this work, we explored the feasibility of using HMMs to characterize the temporal information of smoking inhalations contained in the respiratory signals such as tidal volume, airflow, and the signal from the hand-to-mouth proximity sensor. Left-to-right HMMs were built to classify smoking and non-smoking inhalations using either only the respiratory signals, or both respiratory and hand proximity signals. Using a data set of 20 subjects, a leave-one-out cross-validation was performed on each HMM. In the recognition of smoke inhalations, the highest average recall, precision and F-score perceived by the HMMs was 42.39%, 88.19% and 56.38%, respectively, providing a 7.3% improvement in recall against a previously reported Support Vector Machines.

Development of a Multisensory Wearable System for Monitoring Cigarette Smoking Behavior in Free-Living Conditions.

This paper presents the development and validation of a novel multi-sensory wearable system (Personal Automatic Cigarette Tracker v2 or PACT2.0) for monitoring of cigarette smoking in free-living conditions. The contributions of the PACT2.0 system are: (1) the implementation of a complete sensor suite for monitoring of all major behavioral manifestations of cigarette smoking (lighting events, hand-to-mouth gestures, and smoke inhalations); (2) a miniaturization of the sensor hardware to enable its applicability in naturalistic settings; and (3) an introduction of new sensor modalities that may provide additional insight into smoking behavior e.g., Global Positioning System (GPS), pedometer and Electrocardiogram(ECG) or provide an easy-to-use alternative (e.g., bio-impedance respiration sensor) to traditional sensors. PACT2.0 consists of three custom-built devices: an instrumented lighter, a hand module, and a chest module. The instrumented lighter is capable of recording the time and duration of all lighting events. The hand module integrates Inertial Measurement Unit (IMU) and a Radio Frequency (RF) transmitter to track the hand-to-mouth gestures. The module also operates as a pedometer. The chest module monitors the breathing (smoke inhalation) patterns (inductive and bio-impedance respiratory sensors), cardiac activity (ECG sensor), chest movement (three-axis accelerometer), hand-to-mouth proximity (RF receiver), and captures the geo-position of the subject (GPS receiver). The accuracy of PACT2.0 sensors was evaluated in bench tests and laboratory experiments. Use of PACT2.0 for data collection in the community was validated in a 24 h study on 40 smokers. Of 943 h of recorded data, 98.6% of the data was found usable for computer analysis. The recorded information included 549 lighting events, 522/504 consumed cigarettes (from lighter data/self-registered data, respectively), 20,158/22,207 hand-to-mouth gestures (from hand IMU/proximity sensor, respectively) and 114,217/112,175 breaths (from the respiratory inductive plethysmograph (RIP)/bio-impedance sensor, respectively). The proposed system scored 8.3 ± 0.31 out of 10 on a post-study acceptability survey. The results suggest that PACT2.0 presents a reliable platform for studying of smoking behavior at the community level.

Influence of Obesity on Periodontitis Progression Is Conditional on Interleukin-1 Inflammatory Genetic Variation.

BACKGROUND: This study evaluates whether specific patterns of interleukin (IL)-1 gene variants, known to affect periodontitis severity, influence the previously reported association between obesity and subsequent periodontitis progression in a longitudinal database. The study population included 292 men (aged 29 to 64 years at entry) from the Veterans Affairs Dental Longitudinal Study from whom DNA and dental and anthropometric endpoints were collected during multiple examinations (approximately every 3 years for up to 27 years). METHODS: Key variables assessed included: 1) periodontitis; 2) body mass index; 3) waist circumference to height (WHTR) ratio for central adiposity; 4) age; 5) smoking; 6) glucose tolerance; and 7) two previously reported versions of IL-1 genetic patterns associated with periodontitis severity and progression. Disease progression was determined using predefined criteria that used a combination of change in classification of disease severity based on alveolar bone loss and tooth loss during follow-up. Extended Cox regression analyses were used to estimate hazards of experiencing periodontal disease progression with or without adjustments for appropriate covariates. RESULTS: In hazard ratio analyses, men with WHTR >50% at baseline and positive for either IL-1 genotype version were at significantly higher risk (two-fold) for disease progression (P for interaction = 0.04). Participants positive for IL-1 genotype version 2 exhibited earlier progression (fewer years from baseline to first incidence of progression) than those who were negative (P = 0.02, adjusted for age and smoking). CONCLUSION: In this longitudinally monitored male population, observed effect of baseline central adiposity on future periodontitis progression is conditional on proinflammatory IL-1 genetic variations.

Using respiratory signals for the recognition of human activities.

Human activity recognition through wearable sensors is becoming integral to health monitoring and other applications. Typically, human activity is captured through signals from inertial sensors, while signals from other sensors have been utilized less frequently. In this study, we explored the feasibility of classifying human activities by analyzing the temporal information of respiratory signals through hidden Markov models (HMMs). Left-to-right HMMs were trained for five activities: sedentary, walking, eating, talking, and cigarette smoking. The temporal information from every breathing segment was captured by fragmenting the tidal volume and airflow signals into smaller frames and computing features for each frame. These frames were used as observations to model the states of the HMMs through mixture of Gaussians. Using leave-one-out cross-validation, the classification performance showed an average precision, recall, and F-score of 60.37%, 67.01%, and 62.78%, respectively. Results suggest that respiratory signals can potentially be used as a primary or secondary source in the recognition of some human activities.

The Dietary Approaches to Stop Hypertension Diet and New and Recurrent Root Caries Events in Men.

OBJECTIVES: To examine the effect of overall dietary quality on number of teeth with new or recurrent root caries events during follow-up (root caries increment). DESIGN: Prospective study with dental examinations approximately every 3 years over 20 years. SETTING: Veterans Affairs Dental Longitudinal Study in greater Boston, Massachusetts, area. PARTICIPANTS: Men aged 47 to 90 (N = 533). MEASUREMENTS: A single calibrated examiner assessed root caries and restorations, calculus, probing pocket depth, and attachment loss on each tooth at each examination. The adjusted root caries increment (root-ADJCI) was computed from new and recurrent root caries events on teeth with recession of 2 mm or more. Dietary information was obtained from food frequency questionnaires. An adherence score was computed by comparing consumption frequency of 10 food groups (fruits, vegetables, total dairy, low-fat dairy, meat, total grains, high-fiber grains, legumes, fats, sweets) from the Dietary Approaches to Stop Hypertension (DASH) diet guidelines. Mean root-ADJCIs were compared according to DASH adherence score quartile using generalized linear negative binomial regression models, controlling for age, number of teeth at risk of root caries, time at risk of root caries, calculus, presence of removable denture, history of dental prophylaxis, body mass index, and smoking status. RESULTS: Men with DASH adherence scores in the highest quartile had a 30% lower mean root-ADJCI (1.86 teeth) than those in the lowest quartile (2.68 teeth) (P = .03). Root-ADJCI was lower with greater adherence to recommendations for vegetables and total grains and greater with greater sugar-sweetened carbonated beverage consumption. Root caries incidence rate did not vary significantly between quartiles. CONCLUSION: A higher-quality diet may reduce root caries risk in older men.

Coffee consumption and periodontal disease in males.

BACKGROUND: Coffee is a major dietary source of antioxidants as well as of other anti-inflammatory factors. Given the beneficial role of such factors in periodontal disease, whether coffee intake is associated with periodontal disease in adult males was explored. METHODS: Existing data collected by a prospective, closed-panel cohort study of aging and oral health in adult males was used. Participants included the 1,152 dentate males in the Veterans Affairs (VA) Dental Longitudinal Study who presented for comprehensive medical and dental examinations from 1968 to 1998. Mean age at baseline was 48 years; males were followed for up to 30 years. Participants are not VA patients; rather, they receive their medical and dental care in the private sector. Periodontal status was assessed by probing depth (PD), bleeding on probing, and radiographic alveolar bone loss (ABL), measured on intraoral periapical radiographs with a modified Schei ruler method. Moderate-to-severe periodontal disease was defined as cumulative numbers of teeth exhibiting PD ≥4 mm or ABL ≥40%. Coffee intake was obtained from participant self-reports using the Cornell Medical Index and food frequency questionnaires. Multivariate repeated-measures generalized linear models estimated mean number of teeth with moderate-to-severe disease at each examination by coffee intake level. RESULTS: It was found that higher coffee consumption was associated with a small but significant reduction in number of teeth with periodontal bone loss. No evidence was found that coffee consumption was harmful to periodontal health. CONCLUSION: Coffee consumption may be protective against periodontal bone loss in adult males.

High-fiber foods reduce periodontal disease progression in men aged 65 and older: the Veterans Affairs normative aging study/Dental Longitudinal Study.

OBJECTIVES: To determine whether foods that are good to excellent sources of fiber reduce periodontal disease progression in men. DESIGN: Prospective, observational study. SETTING: Greater Boston, Massachusetts, metropolitan area. PARTICIPANTS: Six hundred twenty-five community-dwelling men participating in the Department of Veterans Affairs Dental Longitudinal Study. MEASUREMENTS: Dental and physical examinations were conducted every 3 to 5 years. Diet was assessed using food frequency questionnaires (FFQs). Mean follow-up was 15 years (range: 2-24 years). Periodontal disease progression on each tooth was defined as alveolar bone loss (ABL) advancement of 40% or more, probing pocket depth (PPD) of 2 mm or more, or tooth loss. Good and excellent fiber sources provided 2.5 g or more of fiber per serving. Multivariate proportional hazards regression estimated hazard ratios (HRs) and 95% confidence intervals (CIs) of periodontal disease progression and tooth loss in relation to fiber sources, stratified according to age younger than 65 versus 65 and older, and controlled for smoking, body mass index, calculus, baseline periodontal disease level, caries, education, exercise, carotene, thiamin and caffeine intake, and tooth brushing. RESULTS: In men aged 65 and older, each serving of good to excellent sources of total fiber was associated with lower risk of ABL progression (HR = 0.76, 95% CI = 0.60-0.95) and tooth loss (HR = 0.72, 95% CI = 0.53-0.97). Of the different food groups, only fruits that were good to excellent sources of fiber were associated with lower risk of progression of ABL (HR = 0.86 per serving, 95% CI = 0.78-0.95), PPD (HR = 0.95, 95% CI = 0.91-0.99), and tooth loss (HR = 0.88, 95% CI = 0.78-0.99). No significant associations were seen in men younger than 65. CONCLUSION: Benefits of higher intake of high-fiber foods, especially fruits, on slowing periodontal disease progression are most evident in men aged 65 and older.

Overweight and obesity predict time to periodontal disease progression in men.

AIMS: To examine whether overweight and obesity indicators - body mass index (BMI), waist circumference (WC), and WC-to-height ratio - predict progression of periodontal disease in men. MATERIAL AND METHODS: Participants were 1038 medically healthy, non-Hispanic, white males in the VA Dental Longitudinal Study who were monitored with triennial oral and medical examinations between 1969 and 1996. Periodontal disease progression in an individual was defined as having two or more teeth advance to levels of alveolar bone loss ≥40%, probing pocket depth ≥5 mm, or clinical attachment loss ≥5 mm after baseline. Extended Cox regression analyses estimated hazards of experiencing periodontal disease progression events due to overweight/obesity status, controlling for age, smoking, education, diabetes, recent periodontal treatment, recent prophylaxis, and number of filled/decayed surfaces. RESULTS: Body mass index and WC-to-height ratio were significantly associated with hazards of experiencing periodontal disease progression events regardless of periodontal disease indicator. Adjusted hazard ratios for periodontal disease progression were 41-72% higher in obese men (BMI ≥30 kg/m(2)) relative to men with both normal weight and WC-to-height ratio (≤50%). CONCLUSION: Both overall obesity and central adiposity are associated with an increased hazards of periodontal disease progression events in men.

Association of salivary lysozyme and C-reactive protein with metabolic syndrome.

INTRODUCTION: Salivary lysozyme (SLZ) is a proteolytic enzyme secreted by oral leucocytes and contains a domain that has an affinity to advanced glycation end products (AGE). Thus, we hypothesized that SLZ would be associated with metabolic syndrome (metS), a pro-inflammatory state. METHODS: Utilizing cross-sectional data from 250 coronary artery disease (CAD) and 250 non-CAD patients, the association of SLZ with metS was tested by logistic regression analyses controlling for age, sex, smoking, total cholesterol and C-reactive protein (CRP) levels. The analyses were stratified by CAD status to control for the possible effects of CAD. RESULTS: MetS was found in 122 persons. The adjusted odds ratio (OR) for metS associated with the highest quartile of SLZ was 1.95 with 95% confidence interval (CI) 1.20-3.12, p-value=0.007, compared with the lower three quartiles combined. Among the 40 subjects with metS but without CAD, the OR was 1.63 (CI: 0.64-4.15, p=0.31), whereas in the CAD group, SLZ was significantly associated with metS [OR=1.96 (1.09-3.52), p=0.02]. In both subgroups, CRP was not significantly associated with metS. CONCLUSION: SLZ was significantly associated with metS (OR=1.95) independent of CRP level. Future longitudinal research is warranted.

Cumulative lead exposure and tooth loss in men: the normative aging study.

BACKGROUND: Individuals previously exposed to lead remain at risk because of endogenous release of lead stored in their skeletal compartments. However, it is not known if long-term cumulative lead exposure is a risk factor for tooth loss. OBJECTIVES: We examined the association of bone lead concentrations with loss of natural teeth. METHODS: We examined 333 men enrolled in the Veterans Affairs Normative Aging Study. We used a validated K-shell X-ray fluorescence (KXRF) method to measure lead concentrations in the tibial midshaft and patella. A dentist recorded the number of teeth remaining, and tooth loss was categorized as 0, 1-8 or > or = 9 missing teeth. We used proportional odds models to estimate the association of bone lead biomarkers with tooth loss, adjusting for age, smoking, diabetes, and other putative confounders. RESULTS: Participants with > or = 9 missing teeth had significantly higher bone lead concentrations than those who had not experienced tooth loss. In multivariable-adjusted analyses, men in the highest tertile of tibia lead (> 23 microg/g) and patella lead (> 36 microg/g) had approximately three times the odds of having experienced an elevated degree of tooth loss (> or = 9 vs. 0-8 missing teeth or > or = 1 vs. 0 missing teeth) as those in the lowest tertile [prevalence odds ratio (OR) = 3.03; 95% confidence interval (CI), 1.60-5.76 and OR = 2.41; 95% CI, 1.30-4.49, respectively]. Associations between bone lead biomarkers and tooth loss were similar in magnitude to the increased odds observed in participants who were current smokers. CONCLUSION: Long-term cumulative lead exposure is associated with increased odds of tooth loss.

Root proximity as a risk factor for progression of alveolar bone loss: the Veterans Affairs Dental Longitudinal Study.

BACKGROUND: The purpose of the present longitudinal study was to evaluate the association between root proximity and the risk for alveolar bone loss (ABL). METHODS: We used data from the Veterans Affairs Dental Longitudinal Study, a closed-panel longitudinal cohort study of 1,231 men enrolled in 1968 with triennial follow-up examinations. Periapical radiographs of mandibular incisors from subjects with > or =10 years of follow-up were selected. Interradicular distance (IRD) at the cemento-enamel junction and alveolar bone levels at baseline and last follow-up were measured using digitized radiographs. The rate of progressive ABL was determined and expressed as millimeters per 10 years. Site-specific multivariate regression models were fit to evaluate the association between IRD and ABL rate, adjusting for age and smoking. Empirical standard errors and generalized estimating equations were used to account for the correlation among sites within subjects. RESULTS: There were 473 dentate subjects, aged 28 to 71 years at baseline, with > or =10 years of follow-up data available for analyses. The mean follow-up time was 23 years. The mean IRD was 1.0 +/- 0.3 mm, and the mean ABL rate during 10 years was 0.61 +/- 0.59 mm. There was a significant non-linear association between IRD and ABL rate (P <0.005). Compared to sites with IRD > or =0.8 mm, sites with IRD <0.6 mm were 28% (95% confidence interval [CI]: 11% to 48%) more likely to lose > or =0.5 mm of bone during 10 years (relative risk: 1.28 [95% CI: 1.11 to 1.48]) and 56% (95% CI: 11% to 117%) more likely to lose > or =1.0 mm of bone during 10 years (relative risk: 1.56 [95% CI: 1.11 to 2.17]). CONCLUSIONS: IRD <0.8 mm is a significant local risk factor for alveolar bone loss in mandibular anterior teeth. Measurement of IRD may have important prognostic value in making treatment decisions.

Age-dependent associations between chronic periodontitis/edentulism and risk of coronary heart disease.

BACKGROUND: Several epidemiological studies have suggested periodontitis as a risk factor for coronary heart disease (CHD), but results have been inconsistent. METHODS AND RESULTS: We evaluated the association between clinical and radiographic measures of periodontitis, edentulism, and incident CHD (angina, myocardial infarction, or fatal CHD) among 1203 men in the VA Normative Aging and Dental Longitudinal Studies who were followed up with triennial comprehensive medical and dental examinations up to 35 years (median 24 years). Cox proportional hazards models with time-varying effects of exposure and potential confounders were fit. We found a significant dose-dependent association between periodontitis and CHD incidence among men < 60 years of age (hazard ratio 2.12, 95% confidence interval 1.26 to 3.60 comparing highest versus lowest category of radiographic bone loss, P for trend=0.02), independent of age, body mass index, smoking, alcohol intake, diabetes mellitus, fasting glucose, total cholesterol, high-density lipoprotein cholesterol, triglycerides, hypertension, systolic and diastolic blood pressure, education, marital status, income, and occupation. No association was found among men > 60 years of age. Similar results were found when the sum of probing pocket depths was used as a measure of periodontitis. Among men > or = 60 years of age, edentulous men tended to have a higher risk of CHD than dentate men in the lowest bone loss (hazard ratio 1.61, 95% confidence interval 0.95 to 2.73) and lowest pocket depth (hazard ratio 1.72, 95% confidence interval 1.03 to 2.85) categories, independent of confounders. CONCLUSIONS: Chronic periodontitis is associated with incidence of CHD among younger men, independent of established cardiovascular risk factors.

Adverse events associated with chlorhexidine use: results from the Department of Veterans Affairs Dental Diabetes Study.

BACKGROUND: The authors report adverse events (AEs) related to the use of chlorhexidine gluconate mouthrinse in a clinical trial of the efficacy of periodontal treatment in older adults with diabetes. METHODS: Participants were U.S. veterans with uncontrolled diabetes (hemoglobin A(1c) value > or =8.5 percent) and periodontal disease. Treatment included periodontal scaling, 0.12 percent chlorhexidine lavage during ultrasonic scaling and use of chlorhexidine mouthrinse at home. RESULTS: Forty-four (31 percent) of 140 subjects reported having AEs. Most common were taste changes and tooth staining, sore mouth and/or throat, tongue irritation and wheezing/shortness of breath; the latter was reported more commonly before chlorhexidine use than after. Only body mass index greater than 30 was significantly related to AEs. CONCLUSIONS: AEs are common among subjects using chlorhexidine mouthrinse. Most AEs (taste change and staining) were resolved easily by subjects' discontinuing mouthrinse use and receiving dental prophylaxis. No serious AEs were reported. CLINICAL IMPLICATIONS: Clinicians should advise patients using chlorhexidine mouthrinse of possible side effects. If necessary, patients should discontinue mouthrinse use and obtain medical care. Careful monitoring of AEs in patients using chlorhexidine is warranted.

The effects of cigarette smoking on C-reactive protein concentrations in men and women and its modification by exogenous oral hormones in women.

BACKGROUND: Previous studies have shown dose-dependent and time-dependent effects of cigarette smoking and smoking cessation on C-reactive protein (CRP) concentrations in men, but results were inconsistent for women. The aim of this study was to evaluate the dose-dependent and time-dependent association of smoking and smoking cessation with CRP concentrations in men and women using a novel comprehensive smoking index (CSI). DESIGN: Cross-sectional study of representative US survey data (National Health and Nutrition Examination Survey 1999-2002). METHODS: The CSI simultaneously accounts for intensity, duration and time since cessation of smoking. We analyzed data of 3505 men and 3896 women using sex-specific multiple linear regression models adjusting for other determinants of CRP concentrations, including age, race/ethnicity, body mass index, alcohol intake, diabetes, physical activity, oral hormone use among women, and history of coronary heart disease, stroke, chronic obstructive pulmonary disease and arthritis. RESULTS: A positive association of similar strength was found between smoking and CRP concentrations in both men and women who did not use exogenous oral hormones. Among women who used exogenous oral hormones, no association with smoking was found. In older men and women it took several years after smoking cessation for CRP concentrations to return to that of individuals who never smoked. CONCLUSION: Smoking is associated with dose-dependent and time-dependent increases in CRP concentrations in both men and women. Furthermore, the effect of exogenous oral hormones on CRP concentrations in women is affected by smoking in a dose-dependent fashion.