RISK OF AGE-RELATED MACULAR DEGENERATION IN PATIENTS WITH PERIODONTITIS: A Nationwide Population-Based Cohort Study.

PURPOSE: Periodontitis is an inflammatory disease that results in loss of connective tissue and bone support. Evidence shows a possible relationship between periodontitis and age-related macular degeneration (AMD). METHODS: This population-based cohort study was conducted using data from the National Health Insurance Research Database in Taiwan, with a 13-year follow-up, to investigate the risk of AMD in patients with periodontitis. The periodontitis cohort included patients with newly diagnosed periodontitis between 2000 and 2012. The nonperiodontitis cohort was frequency-matched with the periodontitis cohort by age and sex, with a sample size of 41,661 in each cohort. RESULTS: Patients with periodontitis had an increased risk of developing AMD compared with individuals without periodontitis (5.95 vs. 3.41 per 1,000 person-years, adjusted hazard ratio = 1.58 [95% confidence interval, 1.46-1.70]). The risk of developing AMD remained significant after stratification by age (adjusted hazard ratio = 1.48 [1.34-1.64] for age <65 years and 1.76 [1.57-1.97] for age ≥65 years), sex (adjusted hazard ratio = 1.40 [1.26-1.55] for women and 1.82 [1.63-2.04] for men), and presence of comorbidity (adjusted hazard ratio = 1.52 [1.40-1.66] for with comorbidity and 1.92 [1.63-2.26] for without comorbidity). In addition, patients with periodontitis showed an increased incidence for both nonexudative type AMD (5.43 vs. 3.13 per 1,000 person-years) and exudative type AMD (0.52 vs. 0.28 per 1,000 person-years). CONCLUSION: People with periodontitis could be at a greater risk of developing AMD than those without periodontitis. However, we need more evidence to support this association.

The association between Type 1 diabetes mellitus and periodontal diseases.

BACKGROUND/PURPOSE: Type 1 diabetes mellitus (T1DM) is a chronic autoimmune disease affecting oral health. Evidence shows possible association between T1DM and periodontal diseases (PDs). We conducted a nationwide population-based study in Taiwan, with a 14-year follow-up to investigate the risk of PDs in T1DM patients. METHODS: We used data from the National Health Insurance Research Database in Taiwan. The T1DM cohort was identified with newly diagnosed T1DM from 1998 to 2011. The non-T1DM cohort was frequency matched with the T1DM cohort. Participants comprised 4248 patients in the T1DM cohort and 16992 persons in the non-T1DM cohort. RESULTS: The T1DM patients showed an increased risk of PDs compared to non-T1DM individuals [adjusted hazard ratio (aHR) = 1.45]. T1DM patients who visited the emergency room more than twice per year had a higher aHR of 13.0 for developing PDs. The aHR for PDs was 13.2 in the T1DM patients who had been hospitalized more than twice per year. CONCLUSION: T1DM patients are at higher risk of developing PDs than non-T1DM individuals. Our results further showed that the number of T1DM interventions; that is, annual emergency visits and hospitalizations were associated with increased the risk of developing PDs.

Risk of leukaemia in children infected with enterovirus: a nationwide, retrospective, population-based, Taiwanese-registry, cohort study.

BACKGROUND: The association between enterovirus infections in children and risk of leukaemia is unclear. We aimed to assess the risk of leukaemia after enterovirus infection in children. METHODS: We did a nationwide retrospective cohort study by analysing data from the National Health Insurance Research Database (NHIRD) in Taiwan. Children with enterovirus infections aged younger than 18 years were identified. With use of computer-generated random numbers, children not infected with enterovirus were randomly selected and frequency matched (1:1) with children infected with enterovirus by sex, age, urbanisation level, parental occupation, and index year of enterovirus infection. We only included children with complete baseline data for age and sex and who had at least three clinic visits with the diagnosis of enterovirus infection. The diagnosis date of the first clinic visit for the enterovirus infection was defined as the index date for initiation of follow-up person-year measurement and participants. All study patients were followed up until they developed leukaemia, were lost to follow-up, withdrew from the NHI programme, or until the end of the study without leukaemia (censored). Our primary endpoint was a diagnosis of leukaemia during follow-up. FINDINGS: Insurance claims data for 3 054 336 children younger than 18 years were randomly selected from all insured children in the NHIRD. We identified 282 360 children infected with enterovirus and 282 355 children not infected with enterovirus between Jan 1, 2000, and Dec 31, 2007. The incidence density rates of leukaemia were 3·26 per 100 000 person-years for the enterovirus-infected and 5·84 per 100 000 person-years for the non-enterovirus-infected cohorts. The risk of leukaemia was significantly lower in the enterovirus-infected cohort than in the non-enterovirus-infected cohort (adjusted subhazard ratio [SHR] 0·44, 95% CI 0·31-0·60; p<0·0001). Children infected with enterovirus have a reduced risk of both lymphocytic leukaemia (adjusted SHR 0·44, 0·30-0·65; p<0·0001) and acute myeloid leukaemia (adjusted SHR 0·40, 0·17-0·97; p=0·04). Herpangina and hand-foot-and-mouth disease were the main diseases associated with the reduced risk of leukaemia. INTERPRETATION: The association between enterovirus infection and the reduced risk of developing leukaemia supports Greaves' delayed infection hypothesis for the cause of childhood leukaemia.

Amphiphilic NLC-Gel formulation loaded with Sebacoyl dinalbuphine ester and Nalbuphine for localized postoperative pain management.

Opioids are powerful analgesics; however, their significant systemic adverse effects and the need for frequent administration restrict their use. Nalbuphine (NA) is a κ-agonist narcotic with limited adverse effects, but needs to be frequently administrated due to its short elimination half-life. Whereas sebacoyl dinalbuphine ester (SDE) is a NA prodrug, which can effectively prolong the analgesic effect, but lacks immediate pain relief. Therefore, in this study, a rapid and sustained local delivery formulation to introduce NA and SDE directly into surgical sites was developed. An amphiphilic nanostructured lipid carrier (NLC) poloxamer 407 (P407) gel (NLC-Gel) was developed to permit concurrent delivery of hydrophobic SDE from the NLC core and hydrophilic NA from P407, offering a dual rapid and prolonged analgesic effect. Benefiting from the thermal-sensitive characteristic of P407, the formulation can be injected in liquid phase and instantly transit into gel at wound site. NLC-Gel properties, including particle size, drug release, rheology, and stability, were assessed. In vivo evaluation using a rat spinal surgery model highlighted the effect of the formulation through pain behavior test and hematology analysis. NLC-Gels demonstrated an analgesic effect comparable with that of commercial intramuscular injected SDE formulation (IM SDE), with only 15 % of the drug dosage. The inclusion of supplemental NA in the exterior gel (PA12-Gel + NA) provided rapid drug onset owing to swift NA dispersion, addressing acute pain within hours along with prolonged analgesic effects. Our findings suggest that this amphiphilic formulation significantly enhanced postoperative pain management in terms of safety and efficacy.

Trends in Coprescription Among Taiwanese Children from 2002 to 2012.

Purpose: Coprescription means that patients use different prescription medications at the same time, which can lead to polypharmacy and subsequent complications. In Taiwan, prescriptions can be ordered by Western physicians, traditional Chinese physicians and dentists. It is essential to disclose the trends in coprescription to prevent possible polypharmacy among children. Patients and Methods: We used the Longitudinal Health Insurance Database 2000 in Taiwan. Children <18 years old who had coprescription from 2002 to 2012 are included. The odds ratio and 95% confidence interval are estimated by a logistic regression model to evaluate the correlation between basic characteristics and coprescription. Results: A total of 44,801 children are included in the analysis. The numbers of children with coprescription and the numbers of coprescriptions ordered for children increased with calendar years. Children aged 3-5 year and 6-8 years constituted the majority of coprescriptions, while those aged <3 years constituted the minority of coprescriptions. Compared to those in the Western medication-alone group, aged 3-5 years and children who lived in central and southern Taiwan are more likely to have coprescription. Conclusion: Coprescription among Taiwanese children is not uncommon. Healthcare providers, policymakers and parents should be aware of the real coprescription situation among the children.

Allergic rhinitis and dental-supporting tissue diseases in children.

ABSTRACT: The etiology of dental-supporting tissue diseases in children is multi factorial and not merely related to oral hygiene. Therefore, in the present study, we investigated the relationship between children <18 years old with allergic rhinitis (AR) and the risk of dental-supporting tissue diseases.Data from the National Health Insurance Research Database (NHIRD) of Taiwan were used to conduct a retrospective longitudinal cohort study. The study cohort comprised 378,160 patients with AR (AR group) and 378,160 patients without AR (non-AR group), who were selected through frequency matching based on age, sex, and the index year. The study patients were followed until dental-supporting tissue diseases occurrence, withdrawal from the National Health Insurance program, or December 31, 2013. Cox proportional hazards regression analysis was conducted to calculate the risk of dental-supporting tissue diseases in the AR group after adjustment for age, sex, and relative comorbidities.The adjusted HRs of periodontal, pulp, and periapical diseases in AR children were higher than those in the non-AR controls (1.51, 95% CI: 1.50 to 1.53; 1.06, 95% CI: 1.05 to 1.07, respectively). The AR to non-AR HRs of these inflammatory dental diseases were particularly higher in children <6 years old and in boys. The HRs of periodontal, pulp, and periapical diseases were greatest in those with >5 AR-related medical visits/year (5.57, 95% CI: 5.50 to 5.56; 4.06, 95% CI: 4.00 to 4.12, respectively).Children with AR had a greater risk of inflammatory dental-supporting tissue diseases, particularly those <6 years old with primary teeth, boys, and those with severe persistent AR.

Higher Risk of Gastric Helicobacter pylori Infection in Patients with Periodontitis: A Nationwide Population-Based Retrospective Cohort Study in Taiwan.

Periodontitis is the most prevalent chronic inflammatory oral disease that is characterized by tooth loss and is commonly associated with several systemic inflammatory diseases. Some epidemiological studies suggest that those suffering from periodontitis might be at a greater risk of developing gastric Helicobacter pylori (Hp) infection; however, evidence that showing the association between periodontitis and the risk of gastric Hp infection is less clear. We conducted a large-scale, population-based study in Taiwan with a 13-year follow-up period to evaluate the risk of gastric Hp in a periodontitis patient cohort. To conduct this study, we used epidemiological data from the Taiwanese Longitudinal National Health Insurance Research Database (NHIRD) from 2000 to 2013. We selected 134,474 participants (64,868 males and 69,606 females with a minimum age of 20 years), with and without periodontitis, and matched patient cohort groups for age, sex, index year, and co-morbidities. The Cox proportional hazards regression model was used to examine the risk of gastric Hp infection in patients with periodontitis. Patients with periodontitis exhibited a higher risk of developing gastric Hp infection compared to those individuals/groups without periodontitis (1.35 vs. 0.87 per 1000 person-years, adjusted the hazards ratio (aHR 1.52), and 95% confidence intervals (CIs) 1.38-1.67, p < 0.001). The risk of gastric Hp infection persisted even after stratifying by age (aHR = 1.96 (1.79-2.13) for 50-64 years and 1.70 (1.49-1.94) for ≥65 years), gender (aHR = 1.20 (1.11-1.29) for men), and presence of comorbidities of hypertension (aHR = 1.24 (1.11-1.38)), hyperlipidemia (aHR = 1.28 (1.14-1.42)), COPD (aHR = 1.45 (1.31-1.61)), CLD (aHR = 1.62 (1.47-1.77)) and CKD (aHR = 1.44 (1.04-1.99)). Overall, our findings showed that periodontitis patients have a greater risk for gastric Hp than individuals without periodontitis. Clinicians should perform regular good oral hygiene practices, along with newer treatments, for patients with periodontitis, especially those at higher risk of gastric Hp infection.

Gout can increase the risk of periodontal disease in Taiwan.

Objectives: To evaluate the risk of periodontal disease (PD) in gout patients. Methods: This retrospective cohort study was conducted using data from the Longitudinal Health Insurance Database 2000. The gout cohort included 31,759 patients newly diagnosed with gout from 2000 to 2012, and the comparison (nongout) cohort included 63,517 patients. Univariate and multivariable adjusted hazard ratios (aHRs), with corresponding 95% confidence intervals (CIs), were estimated using the Cox proportional hazard model for determining the occurrence of PD in both cohorts. We also measured the cumulative incidence of PD in these two cohorts using the Kaplan-Meier method and assessed the curve difference using the log-rank test. Results: The mean follow-up time was more than 6 years for both cohorts. The overall incidence rate of PD was significantly higher in the gout cohort than in the comparison cohort (5.04 vs 4.16 per 10,000 person-years; aHR = 1.13, 95% CI = 1.10-1.16). Only patients using colchicine had a significantly lower risk of PD (aHR = 0.85, 95% CI = 0.79-0.91). Conclusion: In our study, patients with gout showed an increased risk of PD, and treatment with colchicine could decrease the risk. Abbreviations: PD: periodontal disease; LHID: Longitudinal Health Insurance Research Database; NHIRD, National Health Insurance Research Database; ICD-9-CM: International Classification of Diseases, Ninth Revision, Clinical Modification; CI: confidence interval; HR: hazard ratio.

Association between intensive periodontal treatment and spontaneous intracerebral hemorrhage-a nationwide, population-based cohort study.

Periodontal disease is a chronic inflammation of periodontium and has a high prevalence. Periodontal disease has been discovered to be a possible risk factor for cerebrovascular diseases. The available evidence are not enough to set up a causal relationship between periodontal disease and cerebrovascular diseases. Patients with spontaneous intracerebral hemorrhage have high mortality rates. The present study investigated whether intensive periodontal treatment is a protective factor of spontaneous intracerebral hemorrhage and can reduce the risk of spontaneous intracerebral hemorrhage.In total, 64,960 patients with a history of periodontal disease were picked out from the National Health Insurance Research Databases as a case-cohort from January 01, 2000 to December 31, 2010. They were divided on the basis of whether periodontal disease patients received intensive surgical treatment (treatment cohort) or not (control cohort). The periodontal disease patients in treatment and control cohorts were selected by propensity score matching at a ratio of 1:1. Incidences of spontaneous intracerebral hemorrhage in both cohorts were analyzed and compared.The total hazard of spontaneous intracerebral hemorrhage was significantly decreased in the treatment cohorts compared with the control cohorts (adjusted hazard ratio = 0.60, 95% confidence interval = 0.45-0.79).Compared with the control cohort, intensive periodontal treatment may reduce the overall incidence of spontaneous intracerebral hemorrhage, particularly in elderly patients, males, and those who received more than 2 intensive treatments.

Impact of periodontal treatment on hospitalization for adverse respiratory events in asthmatic adults: A propensity-matched cohort study.

BACKGROUND: Periodontal disease is prevalent in asthmatics, but it is unclear whether periodontal treatment plays a role in adverse respiratory events in these patients. We evaluated risk of hospitalization for adverse respiratory events (acute exacerbation, pneumonia, and acute respiratory failure) and mortality in asthmatic adults with and without periodontal treatment. METHODS: We used National Health Insurance (NHI) claims data of Taiwan to identify 4771 asthmatic adults with periodontal disease who underwent periodontal treatment during 2000-2006. The control group consisted of asthmatic adults without periodontal disease at a 1:1 ratio matched by the propensity score. Both groups were followed up for 5years to estimate the risk of hospitalization for adverse respiratory events and mortality. RESULTS: Compared with controls, the periodontal treatment group had lower overall incidence of hospitalization for adverse respiratory events [5.41 vs. 6.07 per 100 person-years, 95% confidence interval (CI)=0.78-0.92] and intensive care unit admissions (1.14 vs. 1.25 per 100 person-years, 95% CI=0.79-0.99). In addition, the all-cause mortality rate was significantly lower in the periodontal treatment group than in the control group during the follow-up period (1.86 vs. 2.79 per 100 person-years, 95% CI=0.59-0.71). CONCLUSION: Asthmatic adults who underwent periodontal treatment were at lower risk of hospitalization for adverse respiratory events and mortality than those without periodontal disease. Asthmatic adults should adopt more precautionary oral hygiene and ensure that they undergo regular periodontal health checkups.

Risk of Periodontal Disease in Patients With Asthma: A Nationwide Population-Based Retrospective Cohort Study.

BACKGROUND: Studies have reported an association between asthma and oral diseases, including periodontal diseases. The aim of this retrospective study is to investigate risk of periodontal diseases for patients with asthma. METHODS: Using the claims data of National Health Insurance of Taiwan and patients without a history of periodontal diseases, 19,206 asthmatic patients, who were newly diagnosed from 2000 through 2010, were identified. For each case, four comparison individuals without history of asthma and periodontal disease were randomly selected from the general population and frequency matched (categorical matched) by sex, age, and year of diagnosis (n = 76,824). Both cohorts were followed to the end of 2011 to monitor occurrence of periodontal diseases. Adjusted hazard ratios (aHRs) of periodontal disease were estimated using Cox proportional hazards regression analysis. RESULTS: Overall incidence of periodontal diseases was 1.18-fold greater in the asthma cohort than in the comparison cohort (P <0.001). Patients with at least three emergency visits annually had an aHR of 55.9 (95% confidence interval [CI] = 50.6 to 61.7) for periodontal diseases compared with those with a mean of less than one visit. Patients with at least three admissions annually also had a similar aHR (51.8) for periodontal disease. In addition, asthmatic patients on inhaled corticosteroid (ICS) therapy had greater aHRs than non-users (aHR = 1.12; 95% CI = 1.03 to 1.23). CONCLUSIONS: In the studied population, asthmatic patients are at an elevated risk of developing periodontal diseases. The risk is much greater for those with emergency medical demands or hospital admissions and those on ICS treatment.

Periodontal Treatment Reduces Risk of Adverse Respiratory Events in Patients With Chronic Obstructive Pulmonary Disease: A Propensity-Matched Cohort Study.

Treatment of periodontal diseases has been associated with benefit outcomes for patients with chronic obstructive pulmonary disease (COPD). However, no population-based cohort study has been conducted. We evaluated this relationship by retrospective cohort study using a large population data.Using the National Health Insurance claims data of Taiwan, we identified 5562 COPD patients with periodontal diseases who had received periodontal treatment as the treatment group. The comparison group was selected at a 1:1 ratio matched by the propensity score estimated with age, sex, date of COPD diagnosis and periodontal treatment, and comorbidities. Both groups were followed up for 5 years to compare risks of acute exacerbation, pneumonia, and acute respiratory failure.The incidence rates of adverse respiratory events were significantly lower in the treatment group than in the comparison group: 3.79 versus 4.21 per 100 person-years for emergency room visits, 2.75 versus 3.65 per 100 person-years for hospitalizations, and 0.66 versus 0.75 per 100 person-years for intensive care unit admissions. The treatment group also had a 37% reduced risk of deaths (1.81 vs 2.87 per 100 person-years), with an adjusted hazard ratio of 0.57 (95% confidence interval 0.52-0.62).Periodontal treatment for COPD patients could reduce the risk of adverse respiratory events and mortality. The adequate periodontal health care is important for COPD patients with periodontal diseases.

Intensive Periodontal Treatment Reduces Risk of Infection-Related Hospitalization in Hemodialysis Population: A Nationwide Population-Based Cohort Study.

Periodontal disease (PD) is prevalent and correlated with malnutrition and inflammation in patients on hemodialysis (HD). Periodontal therapy improves systemic inflammatory and nutritional markers in HD population. The relationship between intensive PD therapy and clinical infectious outcomes in patients on HD remains unclear.In total, 4451 patients who underwent HD and intensive PD treatment between January 1, 1998 and December 31, 2010 were selected from the National Health Insurance Research Database as the case cohort. The comparison cohort was selected by matching a patient without PD with each PD treated patient at a 1:1 ratio according to a propensity score. The rates of hospitalizations for infectious diseases for both cohorts were analyzed and compared.Compared with the comparison cohort, the hazard ratio (HR) of hospitalization for overall infectious diseases was 0.72 (95% confidence interval [CI] = 0.66-0.78, P < 0.001) for the intensive PD treatment cohort. The intensive PD treated cohort had a significantly lower risk of acute and subacute infective endocarditis (HR = 0.54, 95% CI = 0.35-0.84, P < 0.01), pneumonia (HR = 0.71, 95% CI = 0.65-0.78, P < 0.001), and osteomyelitis (HR = 0.77, 95% CI = 0.62-0.96, P < 0.05) than did the comparison cohort.The intensive PD treatment of patients with HD was associated with reduced risks of overall infectious diseases, acute and subacute infective endocarditis, pneumonia, and osteomyelitis. Our study concurs the role of a conventional intervention in enhancing infectious diseases outcomes.

Risk of Periodontal Diseases in Patients With Chronic Obstructive Pulmonary Disease: A Nationwide Population-based Cohort Study.

Several studies have reported an association between chronic obstructive pulmonary disease (COPD) and periodontal diseases. However, a large-scale population-based cohort study was previously absent from the literature. Therefore, we evaluated the risk of periodontal diseases in patients with COPD in a nationwide population.From the National Health Insurance claims data of Taiwan, we identified 22,332 patients with COPD who were newly diagnosed during 2000 to 2010. For each case, two individuals without COPD were randomly selected and frequency matched by age, sex, and diagnosis year. Both groups were followed up till the end of 2011.The overall incidence of periodontal diseases was 1.19-fold greater in the COPD group than in the comparison group (32.2 vs 26.4 per 1000 person-years; 95% confidence interval [CI] 1.15-1.24). Compared with non-COPD patients, the adjusted hazard ratios of patients with COPD increased with the number of emergency room visits (from 1.14 [95% CI 1.10-1.19] to 5.09 [95% CI 4.53-5.72]) and admissions (from 1.15 [95% CI 1.10-1.20] to 3.17 [95% CI 2.81-3.57]). In addition, the adjusted hazard ratios of patients with COPD treated with inhaled corticosteroids (1.22, 95% CI 1.11-1.34) and systemic corticosteroids (1.15, 95% CI 1.07-1.23) were significantly higher than those of patients not treated with corticosteroids.Patient with COPD are at a higher risk of developing periodontal diseases than the general population. Our results also support that the risk of periodontal diseases is proportional to COPD control. In addition, patients who receive corticosteroid treatment are at a higher risk of developing periodontal diseases.

Periodontal disease with treatment reduces subsequent cancer risks.

AIM: The aim of our study was to evaluate the relationship between routine treatment of periodontal disease (PD) and the subsequent risks for cancers in Taiwan. METHODS: Study participants were selected from the Taiwan National Health Insurance (NHI) system database. The PD with a routine treatment cohort contained 38 902 patients. For each treatment cohort participant, two age- and sex-matched comparison (control) cohort participants were randomly selected. Cox's proportional hazards regression analysis was used to estimate the effects of PD with treatment on the subsequent risk of cancer. RESULTS: The overall risk of developing cancer was significantly lower in the treatment cohort than in the patients without treatment (adjusted Hazard ratio = 0.72, 95% confidence interval = 0.68-0.76). The risks of developing most gastrointestinal tract, lung, gynecological and brain malignancies were significantly lower in the treatment cohort than in the comparison cohort. In contrast, the risks of prostate and thyroid cancers were significantly higher in the treatment cohort than in the comparison cohort. CONCLUSIONS: Our findings suggest that PD with treatment is associated with a significantly reduced overall risk of cancer and reduced risks of certain types of cancers.

Surgical treatment for patients with periodontal disease reduces risk of end-stage renal disease: a nationwide population-based retrospective cohort study.

BACKGROUND: The association between periodontal disease treatment and end-stage renal disease (ESRD) remains unclear. This study aims to determine whether surgical periodontal treatment reduces ESRD risk. METHODS: From the insurance claims data of patients with periodontal disease who were free of ESRD from 1997 to 2009, 35,496 patients were identified who underwent surgery for subgingival curettage and/or periodontal flap and are considered the treatment cohort. For comparison, 141,824 patients who did not undergo these treatments were considered the no-treatment cohort. Follow-ups were performed until the end of 2009 to estimate the incidence and risk of ESRD in these two cohorts. Cox proportional hazard regression was used to estimate the related hazard ratio (HR) and 95% confidence interval (CI) of ESRD. RESULTS: The incidence of ESRD was lower in the treatment cohort than in the no-treatment cohort (4.66 versus 7.38 per 10,000 person-years), with an adjusted HR of 0.59 (95% CI = 0.46 to 0.75). Sex- and age-specific analysis showed that the incidence rate ratio of the treatment cohort to the no-treatment cohort was higher for women than for men and declined with age. The risks of ESRD were consistently lower in the treatment cohort even when compared by comorbidity. CONCLUSIONS: Patients with periodontal disease who undergo procedures for subgingival curettage and/or periodontal flap have a remarkably decreased risk of ESRD.

Non-apnea sleep disorder increases the risk of periodontal disease: a retrospective population-based cohort study.

BACKGROUND: The aim of this study is to determine whether patients with a non-apnea sleep disorder (NA-SD) and comorbidity have an increased risk of periodontal disease. METHODS: Patients newly diagnosed with NA-SDs in 1997 to 2010 were identified as the study cohort from the Taiwan National Health Insurance database. For each patient with NA-SD, two matched controls without sleep disorders were randomly selected for comparison. RESULTS: The overall incidence rate ratio of severe periodontal diseases was 39% higher in the NA-SD cohort than in the comparison cohort (7.93 versus 5.69 per 1,000 person-years), with an adjusted hazard ratio (HR) of 1.36 (95% confidence interval [CI]: 1.30 to 1.43). The effect of NA-SD on the risk of severe periodontal diseases was higher in young and middle-aged patients compared with patients >65 years of age (<35 years of age, HR: 1.13, 95% CI: 1.04 to 1.24; 35 to 49 years of age, HR: 1.73, 95% CI: 1.61 to 1.86; 50 to 64 years of age, HR: 1.69, 95% CI: 1.58 to 1.81; ≥65, HR: [reference] 1.0). CONCLUSION: NA-SD might increase the risk of periodontal disease.

Sleep disorders increase the risk of burning mouth syndrome: a retrospective population-based cohort study.

BACKGROUND: Sleep disorders (SD), including apnea and nonapnea, and burning mouth syndrome (BMS) have been mutually associated with systemic diseases. Based on our research, the association between BMS and SD has not been elucidated. We determined whether SD patients have an increased risk of BMS. METHODS: We used information from health insurance claims obtained from the Taiwanese National Health Insurance (NHI) program. We identified patients newly diagnosed with sleep apnea syndrome between 1998 and 2001 as the apnea SD cohort, and newly diagnosed patients with nonapnea SD as the nonapnea SD cohort. The non-SD cohort was 1:2 frequency matched the case group according to sex, age, and index year. We analyzed the risks of BMS by using Cox proportional hazards regression models. RESULTS: Compared with the non-SD cohort, both of the apnea SD (adjusted HR = 2.56, 95% CI = 1.30-5.05) and nonapnea SD (adjusted HR = 2.89, 95% CI = 2.51-3.34) were associated with a significantly higher risk of BMS. The hazard ratio (HR) increased with increased age in the apnea SD cohort and in the nonapnea SD cohort compared with patients younger than 40 years of age. Female apnea SD patients (IRR = 4.63, 95% CI = 3.82-5.61) had a higher risk of developing BMS than did male patients (IRR = 1.76, 95% CI = 1.39-2.24). CONCLUSIONS: Based on our research, SD might increase the risk of BMS.

Association between periodontitis needing surgical treatment and subsequent diabetes risk: a population-based cohort study.

BACKGROUND: It is well known that patients with diabetes have higher extent and severity of periodontitis, but the backward relationship is little investigated. The relationship between periodontitis needing dental surgery and subsequent type 2 diabetes mellitus (DMT2) in those individuals without diabetes was assessed. METHODS: This is a retrospective cohort study using data from the national health insurance system of Taiwan. The periodontitis cohort involved 22,299 patients, excluding those with diabetes already or those diagnosed with diabetes within 1 year from baseline. Each study participant was randomly frequency matched by age, sex, and index year with one individual from the general population without periodontitis. Cox proportional hazards regression analysis was used to estimate the influence of periodontitis on the risk of diabetes. RESULTS: The mean follow-up period is 5.47 ± 3.54 years. Overall, the subsequent incidence of DMT2 was 1.24-fold higher in the periodontitis cohort than in the control cohort, with an adjusted hazard ratio of 1.19 (95% confidence interval = 1.10 to 1.29) after controlling for sex, age, and comorbidities. CONCLUSIONS: This is the largest nation-based study examining the risk of diabetes in Asian patients with periodontitis. Those patients with periodontitis needing dental surgery have increased risk of future diabetes within 2 years compared with those participants with periodontitis not requiring dental surgery.