Body mass index and self-rated oral health in Korean adults in 2017.

OBJECTIVE: To investigate the association between obesity and self-rated oral health (SROH). This study examined the cross-sectional associations between body mass index (BMI) and SROH in Korean adults. MATERIALS AND METHODS: This study used data from 217 304 adults (100 110 men and 117 194 women aged > 19 years) from the 2017 Korean Community Health Survey. Participants were categorised into six ordinal groups based on BMI: underweight (<18.5 kg/m2 ), normal weight (18.5-22.9 kg/m2 ), overweight (23.0-24.9 kg/m2 ), obese-I (25.0-27.4 kg/m2 ), obese-II (27.5-29.9 kg/m2 ) or obese-III (≥30.0 kg/m2 ). SROH was assessed using responses to the question, "How do you rate your oral health, including your teeth and gums?" rated on a 5-point scale. SROH was categorised as "good" (reported as "fair," "good" or "very good") or "poor" or "very poor." Age- and sex-stratified associations between BMI categories and poor SROH were assessed using ordinal logistic regression analysis with sampling weights. RESULTS: The age-adjusted odds ratio (OR) for poor SROH according to BMI levels was lowest in the overweight group in both men and women. In men, the OR for poor SROH was 2.03 (99% confidence interval [CI], 1.72-2.39) in the underweight group, 1.17 (99% CI, 1.17-1.25) in the normal group, 1.05 (99% CI, 0.98-1.13) in the obese-I group, 1.08 (99% CI, 0.98-1.18) in the obese-II group and 1.36 (99% CI, 1.20-1.55) in the obese-III group. In women, the OR was 1.18 (99% CI, 1.07-1.31) in the underweight group, 1.01 (99% CI, 0.95-1.07) in the normal group, 1.07(99% CI, 0.99-1.16) in the obese-I group, 1.16 (99% CI, 1.04-1.30) in the obese-II group and 1.39 (99% CI, 1.20-1.62) in the obese-III group. From the restricted cubic spline models in both sexes, BMI showed a J-shaped association with poor and very poor SROH in men and women. In a stratified analysis by age group and sex, men and older women in the underweight group had poorer SROH than those in overweight group. CONCLUSION: In a nationally representative sample of Korean adults, there was a J-shaped association between BMI and poor SROH, with the highest risk in the underweight group amongst men and in the obese-III group amongst women. Furthermore, in men and women over 65 years of age, underweight and obesity were associated with poorer SROH.

Digital panoramic radiographs are useful for diagnosis of osteoporosis in Korean postmenopausal women.

OBJECTIVE: The purpose of this study was to determine whether digital panoramic radiographs could be used for the diagnosis of osteoporosis through evaluation of the radiographs based on the correlation with bone mineral density (BMD). METHODS: One hundred and ninety-four post-menopausal women were selected from participants who had participated in the Dong-gu study. Panoramic radiographic indices measured are mental index (MI), mandibular cortical index (MCI) and simple visual estimation (SVE). BMD at the lumbar spine and proximal femur was measured by dual-energy X-ray absorptiometry (DXA). The Pearson's correlation test was performed to analyse the correlation between MI and age and BMD at the lumbar spine, femoral neck and total hip. Multiple linear regression analysis was performed to analyse the association of MI, MCI and SVE with BMD after adjusting for age, height and weight. To determine the optimal cut-off point of MI for the diagnosis of osteoporosis, the receiver operating characteristic analysis was performed. RESULTS: The MI was positively correlated with BMDs: lumbar spine: r = 0.36, femoral neck: r = 0.59 and total hip: r = 0.58 (p < 0.001). As age increased, MI decreased (r = -0.46). BMD at the lumbar spine and total hip were significantly lower in participants with reduction of mandibular width, thinning and resorption of mandibular cortex by the MI, SVE and MCI, respectively. The optimal cut-off value of MI for the diagnosis of spinal osteoporosis was 2.22 mm. CONCLUSION: Thickness and morphological changes of mandibular inferior cortical bone are associated with BMD, independent of age, height and weight. These results suggest that MI, MCI and SVE may be useful indices for the diagnosis of osteoporosis in a Korean population.

Periodontal disease associated with blood glucose levels in urban Koreans aged 50 years and older: the Dong-gu study.

OBJECTIVE: To investigate the association of periodontal disease and the number of teeth present with the risk of prediabetes and diabetes as well as with blood glucose and HbA1c levels in adult Koreans. BACKGROUND: The relationship between periodontal disease and diabetes has not been fully elucidated. MATERIALS AND METHODS: Cross-sectional data from 5535 participants aged ≥50 years were obtained from 2008 to 2010. Periodontal status was measured as pocket depth (PD), clinical attachment loss (CAL) and bleeding on probing (BOP) recorded. The percentage of sites with a PD ≥4 mm, CAL ≥4 mm (CAL4) and BOP (BOP%) were recorded. Participants were divided into three groups according to PD4, CAL4 and BOP% measurements. Number of teeth present was divided into four groups. Participants were classified as normoglycaemic, prediabetic or diabetic based on HbA1c and fasting glucose levels. RESULTS: After full adjustment, the highest tertile of CAL4 (OR: 1.47, 95% CI: 1.18-2.02, p < 0.001), PD4 (OR: 1.58, 95% CI: 1.26-1.97, p < 0.001) and BOP% (OR: 1.37, 95% CI: 1.07-1.75, p = 0.012) had significantly increased odds of diabetes. The number of teeth present was inversely related to diabetes (p < 0.001) and prediabetes (p = 0.032) risk. Periodontal disease severity was positively associated with HbA1c and glucose levels. The number of teeth present was positively associated with HbA1c, but not glucose, levels. CONCLUSION: Periodontal disease and the number of teeth present are associated with an increased risk of diabetes and increased blood glucose and HbA1c levels in Koreans aged ≥50 years.

Relationship between periodontal disease and subclinical atherosclerosis: the Dong-gu study.

AIM: We assessed the association of periodontal disease and number of missing teeth with subclinical atherosclerosis in an adult Korean population. MATERIALS AND METHODS: Cross-sectional data from 5404 individuals aged ≥50 years were obtained from the 2008-2010 Dong-gu study. Periodontal examinations were conducted to determine the number of missing teeth, pocket depth (PD), clinical attachment loss (CAL), and bleeding on probing (BOP). The percentages of sites with PD ≥ 4 mm (PD 4%), CAL ≥ 4 mm (CAL 4%), and BOP (BOP%) were recorded for each participant. B-mode ultrasound was performed to determine common carotid artery intima-media thickness (CCA IMT) and the presence of carotid plaques. Multivariate linear regression models were used to assess the associations between periodontal parameters and CCA IMT and carotid plaque. RESULTS: Number of missing teeth was associated with increased CCA IMT, and BOP% was associated with increased CCA IMT in females only. This association was robust in never smokers. CONCLUSIONS: The number of missing teeth was associated with CCA IMT, and BOP% was associated with CCA IMT in females only. These associations were robust in never smokers. Our results suggest that tooth loss due to oral disease may play a role in subclinical carotid atherosclerosis.

The association between periodontal disease, tooth loss and bone mineral density in a Korean population.

OBJECTIVE: We aimed to evaluate whether clinical attachment loss (CAL), a measure of the severity of periodontal disease or number of teeth present is associated with bone mineral density (BMD). METHODS: The study population consisted of 5383 people aged 50 years and older who participated in the Dong-gu Study. BMD at the lumbar spine and femoral neck was measured by dual-energy X-ray absorptiometry. Oral examination included assessments of the number of teeth present and CAL. Number of teeth present was categorized into three equal categories. CAL values were divided into tertiles in terms of the percentage of sites with CAL ≥4 mm. Analysis of covariance was used to compare the adjusted means of BMD according to the tooth number and the tertiles of CAL. RESULTS: There was a significant association between the number of teeth present and BMD in men. Compared with men with 22 or more teeth, men with 10 and less teeth had lower BMD. CAL was significantly associated with lower BMD at the lumbar spine in women. CONCLUSION: Our data indicate that tooth loss and CAL were associated with low BMD. However, the magnitude of these associations was relatively small and the clinical significance was unclear.

Low serum 25-hydroxyvitamin D levels, tooth loss, and the prevalence of severe periodontitis in Koreans aged 50 years and older.

PURPOSE: Vitamin D deficiency may cause bone loss and increased inflammation, which are well-known symptoms of periodontal disease. This study investigated whether serum 25-hydroxyvitamin D (25(OH)D) levels are associated with periodontal disease status and tooth loss. METHODS: Cross-sectional data from 5,405 individuals aged ≥50 years (2,253 males and 3,152 females) were obtained from the 2008-2010 Dong-gu study, a prospective cohort study of risk factors for chronic diseases. Periodontal examinations were conducted to evaluate the number of remaining teeth, the periodontal probing depth (PPD), the clinical attachment level (CAL), and bleeding on probing. The percentages of sites with PPD ≥4 mm and CAL ≥4 mm were recorded for each participant. The severity of periodontitis was classified using the Centers for Disease Control and Prevention and the American Academy of Periodontology case definitions. Serum 25(OH)D levels were classified as reflecting severe deficiency, deficiency, insufficiency, or sufficiency. Multivariate linear regression analysis was performed to assess the associations of serum 25(OH)D levels with periodontal parameters and the number of remaining teeth after adjusting for confounders including age, smoking status, alcohol consumption status, month of blood collection, and physical activity. Multivariate logistic regression was used to evaluate the association between serum vitamin D levels and severe periodontitis. An overall statistical analysis and a stratified analysis by sex were performed. RESULTS: Overall, the rates of severe deficiency, deficiency, insufficiency, and sufficiency were 6.5%, 67.9%, 22.4%, and 3.2%, respectively. After adjustment for confounders, vitamin D levels were directly associated with the number of remaining teeth, an association that was significant in males, but not in females. Sufficient serum 25(OH)D was associated with a low frequency of severe periodontitis. CONCLUSIONS: This population-based cross-sectional study indicates that low serum 25(OH)D is significantly associated with tooth loss and severe periodontitis in Koreans aged 50 years and older.

Humoral immune responses to periodontal pathogens in the elderly.

PURPOSE: Elderly people are thought to be more susceptible to periodontal disease due to reduced immune function associated with aging. However, little information is available on the nature of immune responses against putative periodontal pathogens in geriatric patients. The purpose of this study was to evaluate the serum IgG antibody responses to six periodontal pathogens in geriatric subjects. METHODS: The study population consisted of 85 geriatric patients and was divided into three groups: 29 mild (MCP), 27 moderate (MoCP) and 29 severe (SCP) chronic periodontitis patients. Serum levels of IgG antibody to Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum and Prevotella intermedia were measured by enzyme-linked immunosorbent assay (ELISA) and compared among the groups. RESULTS: All three groups showed levels of serum IgG in response to P. gingivalis, A. actinomycetemcomitans, and P. intermedia that were three to four times higher than levels of IgG to T. forsythia, T. denticola, and F. nucleatum. There were no significant differences among all three groups in IgG response to P. gingivalis (P=0.065), T. forsythia (P=0.057), T. denticola (P=0.1), and P. intermedia (P=0.167), although the IgG levels tended to be higher in patients with SCP than in those with MCP or MoCP (with the exception of those for P. intermedia). In contrast, there were significant differences among the groups in IgG levels in response to F. nucleatum (P=0.001) and A. actinomycetemcomitans (P=0.003). IgG levels to A. actinomycetemcomitans were higher in patients with MCP than in those with MoCP or SCP. CONCLUSIONS: When IgG levels were compared among three periodontal disease groups, only IgG levels to F. nucleatum significantly increased with the severity of disease. On the contrary, IgG levels to A. actinomycetemcomitans decreased significantly in patients with SCP compared to those with MCP. There were no significant differences in the IgG levels for P. gingivalis, T. forsythia, T. denticola, and P. intermedia among geriatric patients with chronic periodontitis.

The correlation of carotid artery calcification on panoramic radiographs and determination of carotid artery atherosclerosis with ultrasonography.

OBJECTIVES: To investigate the association of carotid artery calcification (CAC) on panoramic radiographs and determine carotid artery atherosclerosis with ultrasonography. STUDY DESIGN: The study included 4050 subjects aged 50 years and older. Panoramic radiographs for the presence of CAC were interpreted. Common carotid artery intima-media thickness (CCA-IMT), carotid bulb IMT (CB-IMT), carotid plaques, and the diameter of the common carotid artery (CCA-diameter) were measured by using ultrasonography. RESULTS: CB-IMT was significantly greater in male subjects with CAC than in those without CAC. CCA-diameter was significantly greater in subjects with CAC than in those without CAC in both genders. However, there was no significant difference in CCA-IMT. CAC was associated with carotid plaque (for men, odds ratio [OR] 2.14; 95% confidence interval [CI] 1.01-3.36; for women, OR 1.19; 95% CI 0.84-1.67). CONCLUSION: CAC on panoramic radiographs was positively associated with IMT and plaque in men and positively associated with carotid diameter in both sexes. CAC on panoramic radiographs was positively associated with carotid atherosclerosis.

KITENIN represents a more aggressive phenotype in a murine model of oral cavity squamous carcinoma.

OBJECTIVE: To investigate the tumor invasiveness and early lung metastasis associated with KITENIN in a murine model of oral cavity squamous carcinoma. STUDY DESIGN: Cross-sectional study with planned data collection. SETTING: Department of Otolaryngology-Head and Neck Surgery, Medical Research Center for Gene Regulation, and Pathology, Chonnam National University Medical School and Hwasun Hospital. SUBJECTS AND METHODS: The cDNA of KITENIN and vector only were transfected into the SCC VII (murine squamous cell line) cells. The suspension of 5 x 10(5)/mL viable KITENIN- or vector-transfected SCC VII cells was injected into the floor of the mouth of C3H/HeJ syngeneic mice, deep into the mylohyoid muscle via the intraoral approach. From the first to the sixth week after injection, tumor, lung, liver, and brain tissues were obtained. RESULTS: For all groups, the tumor invaded the superficial musculature of the floor of the mouth, the deep musculature of the floor of the mouth, the salivary glands, perineural tissue, bone, and skin, sequentially. Lung metastases developed multiple focal nodular patterns at first and then became more extensive. Earlier and more aggressive tumor invasion into the deep floor of the mouth musculature, salivary glands, perineural tissue, bone, and skin was observed in the KITENIN-transfected group compared to the vector-only group. An earlier and more extensive lung metastasis was observed in the KITENIN group. CONCLUSION: An antisense KITENIN strategy might inhibit distant metastasis and the progression of head and neck squamous cell carcinoma.