Periodontitis is associated with incidental valvular heart disease: A nationwide population-based cohort study.

AIM: Periodontitis and valvular heart disease (VHD) are common diseases. Both diseases are related to chronic inflammation and share many common risk factors. Previous periodontal studies had focused mainly on atherosclerotic cardiovascular disease. This study aimed to determine whether periodontitis is associated with the development of VHD. MATERIALS AND METHODS: This was a retrospective nationwide cohort study using Taiwan's Longitudinal Health Insurance Database. Using ICD-9-CM coding, both the periodontitis and non-periodontitis groups were matched. RESULTS: There were 8483 cases and 4919 cases of VHD diagnosed in the periodontitis group and non-periodontitis group, respectively. The cumulative incidence of VHD was significantly higher in the periodontitis group (log-rank test, p < .001), with the incidence density of 6.44 (95% CI, 6.31-6.58) per 1000 person-years in the periodontitis group compared to 4.65 (95% CI, 4.52-4.78) in the non-periodontitis group. The relative risk for VHD was 1.39 (95% CI, 1.34-1.44). After multivariate analysis, periodontitis was independently associated with a risk for VHD (HR, 1.38; 95% CI, 1.33-1.42, p < .001). Intensive treatment of periodontitis significantly lowered the risk for VHD (HR, 0.68; 95% CI, 0.60-0.77, p < .001). CONCLUSIONS: Periodontitis was significantly associated with the development of VHD. Treatment of periodontitis reduced the risk for VHD.

Changes in prevalence of precancerous oral submucous fibrosis from 1996 to 2013 in Taiwan: A nationwide population-based retrospective study.

BACKGROUND/PURPOSE: Oral submucous fibrosis (OSF) has been regarded as a precancerous condition. Research examining the prevalence of OSF could be the first step in preventing or reducing malignant transformation. In this study, we probed a nationwide registered database to assess the prevalence, gender distribution, age, income, and urbanization status of OSF patients in Taiwan. METHODS: A retrospective study was conducted to analyze the registered database compiled by the National Health Insurance provided by the Ministry of Health and Welfare, Taiwan. We identified dental visit patients diagnosed with OSF during the period between January 1, 1996 and December 31, 2013. In addition, demographic characteristics were analyzed by multivariate Poisson regression. RESULTS: The prevalence of OSF increased significantly from 8.3 (per 105) in 1996 to 16.2 (per 105) in 2013 (p < 0.0001). Men had a significantly higher OSF prevalence than women (p < 0.001). The mean age of patients with OSF increased from 1996 to 2013. Individuals living in rural areas had a higher risk of OSF compared with those living in urban areas [relative risk (RR), 1.10; 95% confidence interval (CI), 1.07-1.13]. The higher income group had a lower risk of OSF compared with the lower income group (RR, 0.76; 95% CI, 0.73-0.80). CONCLUSION: This large-scale government-centered survey demonstrates that the prevalence of OSF in Taiwan significantly increased from 1996 to 2013. The prevalence was higher among men than among women.

A registry-based study of tooth-colored restorative materials for decayed teeth in Taiwan.

Background/purpose: As esthetic demands with direct restorations, tooth-colored materials were used to replace amalgam filling gradually. However, little is known about the tooth-colored restorative materials for decayed teeth in Taiwan. In this study, the use of composite resin, glass ionomer cement, and compomer was analyzed by National Health Insurance Research Database (NHIRD). Materials and methods: A retrospective study was conducted to analyze the registered database compiled by Taiwanese NHIRD from 1997 to 2013. The results were further to analyze the application of tooth-colored restorative materials by sex and age. In addition, time trends of dental visits for each tooth-colored restorative material were also investigated. Results: The average annual composite resin filling (CRF) ratio was 18.41% of nationwide population in Taiwan. The prevalence of CRF stratified by sex and age was significantly increased from 1997 to 2013 (P for trend <0.0001). The time trends of dental visits for CRF were significantly increased (P for trend <0.0001). The average annual glass ionomer cement filling (GICF) ratio was 1.79% of Taiwanese population. The prevalence of GICF stratified by sex and age was demonstrated a decreased pattern (P for trend <0.0001). The time trends of dental visits for GICF were significantly decreased (P for trend <0.0001). The average annual compomer filling ratio was 0.57% of whole population in Taiwan. Conclusion: Form the results of this registry-based study, a significant increased trend of CRF for decayed teeth was observed in Taiwanese population during past 17 years.

Decreased trends of using dental amalgam filling for decayed teeth in Taiwan from 1997 to 2013.

Background/purpose: Mercury within dental amalgam has been criticized for the potential toxicity and environmental hazard. Phasing down the use of dental amalgam is the transition for amalgam free dentistry. However, little is known about dental amalgam filling (AMF) in Taiwan. In this study, time trends of AMF were measured by using National Health Insurance Research Database (NHIRD). Materials and methods: A retrospective study was conducted to analyze the AMF data in registered database compiled by Taiwanese NHIRD from 1997 to 2013. The AMF data were further analyzed according to sex, age, and geographic location, respectively. Time trends of dental visits for AMF and medical expenses for AMF were also evaluated. Results: The average annual AMF ratio was 8.965% of nationwide population in Taiwan. The prevalence of AMF was significantly decreased both in male and female from 1997 to 2013 (P for trend <0.0001). The decreased pattern of AMF was found by the age stratification (P for trend <0.0001). The significant fall of AMF was also displayed in six districts (P for trend <0.0001). The number of dental visits were ranged from 821,749 in 1997 to 1,313,734 in 2013. However, time trends of dental visits for AMF were significantly decreased (P for trend <0.0001). The medical expenses for AMF were simultaneous significantly decreased from 1997 to 2013 (P for trend <0.0001). Conclusion: Form the results of this nationwide population-based database, a significant decrease of AMF in Taiwan was observed during past 17 years.

The implementation of domiciliary dental care from a university hospital: A retrospective review of the patients and performed treatments in central Taiwan from 2010 to 2020.

BACKGROUND/PURPOSE: People who suffer with chronic illness, functional impairment, or cognitive impairment are not easily to visit dental clinics. Domiciliary dental care (DDC) can provide the feasible alternative for these clients. In this study, we first reported the DDC services from a university hospital in central Taiwan from 2010 to 2020. MATERIALS AND METHODS: This retrospective study collected the DDC data from Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan. The data including age, sex, geographic locations, place of residence, grade of disability, and type of dental treatment for the patients were obtained and analyzed. RESULTS: A total of 419 patients (168 females and 251 males) who received dental treatment were included in the study. The average age was 57.4 years old. The total DDC services were up to 2444 visits. The top of place of residence for DDC is patient's home (231/419; 55.13%). Scaling was the most common type of dental treatment for DDC (317/419; 75.67%). The male patients whose age <60 years old had received more DDC (p = 0.002). The profound grade of disability had higher DDC in age <60 years old group (p < 0.001). CONCLUSION: Taken together, this study demonstrates the demographic data of DDC in central Taiwan. The results may be valuable for governmental policy to improve the availability of DDC and in turn to facilitate oral health in this specific group of dental patients.

Tonsillectomy as a risk factor of periodontitis: A population-based cohort study.

BACKGROUND: To determine whether patients who had undergone tonsillectomy would have higher risks of postoperative periodontitis. METHODS: Data were collected from the Taiwan Longitudinal Health Insurance Dataset from 1999 to 2013, a population-based cohort study consisting of cases of newly-onset sleep apnoea, chronic diseases of tonsils and adenoids, peritonsillar abscess, and periodontal diseases. A total of 1482 tonsillectomy cases and 14,796 non-tonsillectomy controls were selected. Propensity score matching37 between the tonsillectomy group and the non-tonsillectomy group was conducted to exclude the confounding effect resulting from indications of tonsillectomy. Cox proportional hazard model and subgroup analyses were conducted to identify subpopulations at risk of tonsillectomy-associated periodontitis, and a sub-outcome analysis was applied to identify the subtype of tonsillectomy-associated periodontitis. RESULTS: A total of 648 patients who had undergone tonsillectomy and 648 out of 6509 propensity score-matched controls were retrieved, among which 230 cases in the tonsillectomy group were associated with post-surgical periodontitis (adjusted HR = 1.31, 95% CI = 1.08 to 1.59). The association persisted in a subpopulation of patients with periodontitis who received mechanical and surgical treatments for periodontitis (adjusted HR = 1.33, 95% CI = 1.09 to 1.63). The incidence of periodontitis was significantly high in the individuals who underwent tonsillectomy and was particularly high in those that were below 12 years of age (HR = 1.58, 95% CI = 1.10 to 2.27). The risk of periodontitis increased 4 years after tonsillectomy (HR = 1.82; 95% CI = 1.29 to 2.59). The majority of post-tonsillectomy periodontitis was aggressive and acute periodontitis (HR = 1.37; 95% CI = 1.10 to 1.71). CONCLUSIONS: Tonsillectomy performed in pediatric patients of < 12 years old, increased the risk of developing periodontitis. Aggressive and acute periodontitis as a long-term, postoperative adverse event took place at 4 years or longer after tonsillectomy.

Risk of Peripheral Arterial Occlusive Disease with Periodontitis and Dental Scaling: A Nationwide Population-Based Cohort Study.

Periodontitis (PD) is a common oral disease associated with various other diseases, particularly those affecting the cardiovascular system. This study explored whether peripheral artery occlusive disease (PAOD) is associated with PD and dental scaling. This study was a retrospective cohort study design from 2000 to 2018. The study population was newly diagnosed with periodontitis. The comparison group was defined as never diagnosed with periodontitis. The outcome variable was defined with the diagnosis of peripheral arterial occlusive disease (PAOD). The propensity score matching was performed by age, sex, comorbidities, and dental scaling between the two groups. Kaplan-Meier analysis was used to calculate the cumulative incidence of PAOD among the two groups. To perform the independent risk of the PAOD group, the multivariate Cox proportional hazard model was used to estimate the hazard ratios. First, 792,681 patients with PD and 458,521 patients with no history of PD were selected from Taiwan's Longitudinal Health Insurance Database, which comprises the data of two million beneficiaries. After propensity score matching between the PD and non-PD groups for age, sex, comorbidities, and dental scaling, 357,106 patients in each group were analyzed for PAOD risk. The incidence density, relative risk, and cumulative incidence of PAOD were higher in the PD group than in the non-PD group. After adjusting for all variables, the risk of PAOD for the PD group was greater than for the non-PD group (adjusted hazard ratio = 1.03; 95% CI, 1.01-1.06). Undergoing at least one dental scaling procedure reduced the risk of PAOD. Age over 65 years was also a risk factor. In conclusion, patients with PD have an increased risk of PAOD. In addition, our results can lead to increased attention to oral hygiene, as dental scaling has a trend towards a lower risk of PAOD.

A nationwide register-based study of the prevalence of burning mouth syndrome in Taiwan from 2004 to 2013.

BACKGROUND/PURPOSE: Burning mouth syndrome (BMS) is defined as a chronic burning pain of the oral mucosa with no associated clinical signs or apparent extraneous cause. Limited epidemiologic data have been published. In this study, we probed the nationwide registered database to assess the prevalence of BMS in Taiwan. MATERIALS AND METHODS: A retrospective study was conducted to analyze the dental dataset compiled by the Taiwan's National Health Insurance Research Database from 2004 to 2013. The diagnosis of BMS was identified in accordance with the International Classification of Disease, Ninth revision. In addition, sex and age were analyzed by multivariate Poisson regression. RESULTS: The prevalence of BMS revealed from 2.24 (per 104) to 3.11 (per 104) over past 10 year period. Female has higher risk of BMS than male (RR: 1.39; 95% CI: 1.37-1.41). The 50-59 years old group, 60-69 years old group, and >70 years old group had 1.55-, 2.06-, and 2.58-fold risk than 40-49 years old group for BMS (p < 0.001), respectively. CONCLUSION: Taken together, this is the first reported nationwide population based prevalence data for BMS in Taiwan. The risk for BMS is highly associated with female and advancing age.

Association between obesity and chronic periodontitis: A nationwide population-based cohort study in Taiwan.

ABSTRACT: Previous studies have suggested that obesity might be associated with chronic periodontitis (CP); however, no clear conclusions have been reached so far. In this retrospective cohort study, we aimed to investigate the association between obesity and CP by using a large population-based dataset in Taiwan.A population-based retrospective cohort study was conducted using the Longitudinal Health Insurance Database 2010 (LHID2010) derived from the National Health Insurance Research database in Taiwan, from 2000 to 2013. Obesity and non-obesity groups were matched with sex, age, urbanization level, socioeconomic status, and the related comorbidities by using the propensity score method at a 1:2 ratio.An obese cohort (n = 4140) and a non-obese cohort (n = 8280) were included in this study, with an average age of 41.7 ±â€Š13.8 years and 42.0 ±â€Š14.0 years, respectively. The risk of CP for the patients with obesity was 1.12-fold compared with those without obesity (hazard ratio, 1.12; 95% confidence interval, 1.01-1.25). In the subgroup analysis according to age and sex, the hazard ratio of CP were 1.98 (95% confidence interval, 1.22-3.22) in the subgroup of age equal to or older than 65 years. The risk of CP showed no difference between obesity and non-obesity groups in both sex.This population-based cohort study demonstrated that obesity was associated with the development of CP in Taiwan.

Increased Risk of Migraine in Patients with Chronic Periodontitis: A Population-Based Cohort Study.

Migraine is considered to be a neurovascular disease that manifests as a throbbing headache, possibly caused by the activation of the trigeminovascular system. Several studies have supported the role of inflammation in the pathogenesis of migraine. Chronic periodontitis (CP) is an infectious inflammatory disease triggered by bacterial products evoking an immune response which could result in the destruction of the periodontium. However, little is known about the longitudinal association between CP and migraine. In this study, we designed a nationwide population-based cohort study to investigate the risk of migraine and CP exposure in Taiwan. In total, 68,282 patients with CP were identified from the National Health Insurance Research Database (NHIRD), and 68,282 comparisons were randomly captured and matched by age, sex, monthly income, urbanization and comorbidities. The association between CP exposure and migraine risk was evaluated by Cox proportional hazards regression models. In this study, 785 migraine patients were identified in the CP cohort, and 641 migraine cases were found in the non-CP cohort. The incidence rate of migraine was significantly higher in the CP cohort than the non-CP cohort (adjusted HR: 1.21, 95% CI: 1.09-1.34, p < 0.001) during the 13-year follow-up period. Females had a 2.69-fold higher risk for migraine than males (95% CI: 2.38-3.04, p < 0.001). In summary, CP is associated with an increased risk of subsequent migraine in Taiwan.

Chronic Periodontitis Is Associated with the Risk of Bipolar Disorder: A Population-Based Cohort Study.

Bipolar disorder (BD) is a psychiatric mood disturbance manifested by manic, hypomanic, or major depressive periods. Chronic inflammation was evidenced as an important etiologic factor of BD. Chronic periodontitis (CP) is an inflammatory disease triggered by bacterial products, leading to the destruction of periodontium. The relationship between BD and CP is of interest to investigate. Therefore, a nationwide population-based cohort study was used to investigate the risk of BD and CP exposure from 2001 to 2012. We identified 61,608 patients with CP from the Taiwanese National Health Insurance Research Database (NHIRD). The 123,216 controls were randomly captured and matched by age, sex, index year, and co-morbidities. The association between CP exposure and BD risk was examined by Cox proportional hazards regression models. In this study, 61,608 CP patients and 123,216 controls were followed up for 7.45 and 7.36 years, respectively. In total, 138 BD patients were identified in the CP cohort and 187 BD cases were found in the non-CP cohort. The incidence rate of BD was significantly higher in the CP cohort than in the non-CP cohort (adjusted HR: 1.46, 95% CI: 1.17-1.81) according to the multivariate Cox regression analysis. Females had a 1.47-fold increased risk (95% CI: 1.16-1.86) for BD compared to males. Taken together, CP may be associated with an increased risk of subsequent BD in Taiwan.

Cardiovascular Protection of Hydroxychloroquine in Patients with Sjögren's Syndrome.

Sjögren's syndrome (SS) is a chronic systemic inflammation disease with clinical presentation of dry eye, dry mouth, and polyarthralgia. Active inflammation is associated with an increased risk of associated arterial stiffness or subclinical atherosclerosis-related cardiovascular events. We used the longitudinal health insurance database of Taiwan, which includes one million participants, to evaluate the relationship between the clinical medication of hydroxychloroquine (HCQ) and the development of coronary artery disease (CAD). In total, 1674 patients with SS receiving HCQ medication were included after exclusion for previous CAD. Altogether, 1142 SS patients were included for evaluation after follow-up for more than one year. After adjusting for age, gender, medications, and chronic comorbidities, a significantly decreased hazard ratio (HR) for developing CAD was found among SS patients with higher medication possession ratio (MPR) of HCQ (HR = 0.49, 95% confidence interval, CI: 0.26-0.94) when compared with low MPR of HCQ. A low HR for CAD was observed in SS patients with a high cumulative dose of at least 100,267 mg of HCQ (HR = 0.25, 95% CI: 0.09-0.66). Long-term HCQ therapy may decrease the HR of CAD in SS patients. The significant cardiovascular protective effect of HCQ therapy was observed in our study.

The Association of Periodontal Treatment and Decreased Pneumonia: A Nationwide Population-Based Cohort Study.

Pneumonia is a common respiratory infectious disease that involves the inflammation of the pulmonary parenchyma. Periodontal disease is widespread and correlated with pneumonia. However, the relationship between periodontal treatment and clinical infectious outcomes in patients with pneumonia has remained undetermined. The aim of this study was to investigate the association between periodontal treatment and the risk of pneumonia events in the Taiwanese population. A nationwide population-based cohort study was conducted using data from the Taiwanese National Health Insurance Research Database (NHIRD). A total of 49,400 chronic periodontitis patients who received periodontal treatment from 2001 to 2012 were selected. In addition, 49,400 healthy individuals without periodontal diseases were picked randomly from the general population after propensity score matching according to age, gender, monthly income, urbanization, and comorbidities. The Cox proportional hazard regression analysis was adopted to assess the hazard ratio (HR) of pneumonia between the periodontal treatment cohort and the comparison cohort. The average ages of the periodontal treatment and comparison groups were 44.25 ± 14.82 years and 44.15 ± 14.5 years, respectively. The follow up durations were 7.66 and 7.41 years for the periodontal treatment and comparison groups, respectively. We found 2504 and 1922 patients with newly diagnosed pneumonia in the comparison cohort and the periodontal treatment cohort, respectively. The Kaplan-Meier plot revealed that the cumulative incidence of pneumonia was significantly lower over the 12 year follow-up period in the periodontal treatment group (using the log-rank test, p < 0.001). In conclusion, this nationwide population-based study indicated that the patients with periodontal treatment exhibited a significantly lower risk of pneumonia than the general population.

Increased Risk of Carotid Atherosclerosis in Male Patients with Chronic Periodontitis: A Nationwide Population-Based Retrospective Cohort Study.

Carotid artery stenosis is a narrowing or constriction of any part of the carotid arteries, usually caused by atherosclerosis. However, no studies have specifically evaluated the association between carotid atherosclerosis (CA) and chronic periodontitis (CP). This study was to investigate the role of CP in increasing the subsequent risk of CA in the overall Taiwanese population. We carried out this retrospective cohort study, employing data derived from the National Health Insurance Research Database. A total of 72,630 patients who were newly diagnosed with CP from 2001 to 2012 were selected. For a propensity-matched control group, 72,630 healthy patients without CP were picked at random, matched according to age, sex, and index year from the general population. Cox proportional hazard regression analysis, which included sex, age, and comorbidities, was adopted to assess the hazard ratio (HR) of CA between the CP cohort and non-CP cohort. The average ages of the CP and non-CP groups were 44.02 ± 14.63 years and 44.15 ± 14.41 years, respectively. The follow up durations were 8.65 and 8.59 years for CP and non-CP groups, respectively. The results demonstrated that 305 and 284 patients with newly diagnosed CA were found in the CP cohort and non-CP cohort, respectively. There was no significant difference of developing CA in the CP cohort compared with the non-CP cohort (adjusted HR) 1.01, 95% confidence interval (CI, 0.86-1.19). However, multivariate Cox regression analysis indicated that the male group had significantly higher incidence risk of CA (log rank p = 0.046). In conclusion, this nationwide retrospective cohort study indicated that male patients with CP exhibited a significantly higher risk of CA than those without CP.

Increased Risk of Polycystic Ovary Syndrome in Taiwanese Women with Chronic Periodontitis: A Nationwide Population-Based Retrospective Cohort Study.

Background: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders among women of reproductive age. Both hormonal and inflammatory influences are assumed to affect periodontal tissues. Previous studies have shown that PCOS patients could have higher prevalence of gingival inflammation. However, the relationship between PCOS and chronic periodontitis (CP) is not clear. Materials and Methods: In this study, we evaluated the risk of PCOS from CP exposure in a nationwide population-based retrospective cohort study in Taiwan. We studied the claims data of Taiwanese population from 2001 to 2012. The 24,410 female patients with CP were identified from the National Health Insurance Database. The 24,410 controls were selected with randomly frequency matched by age, sex, and index year from the general population. The risk of PCOS was analyzed by Cox proportional hazards regression models, including sex, age, and comorbidities. Results: In this study, 24,410 female patients with CP (mean age: 35.14 ± 8.81 years) and 24,410 controls (mean age: 35.14 ± 8.8 years) were observed for 8.89 and 8.85 years, respectively. A total of 441 cases of PCOS were identified in CP cohort and 304 cases in non-CP cohort. Multivariate Cox regression analysis indicated that the incidence rate of PCOS was significantly higher in CP cohort than those in non-CP cohort (adjusted hazard ratio: 1.44, 95% confidence interval: 1.24-1.67). Conclusions: Taken together, this nationwide retrospective cohort study demonstrated that the risk of PCOS was significantly higher in female patients with CP than those without CP in Taiwan.

Exposure to Dental Filling Materials and the Risk of Dementia: A Population-Based Nested Case Control Study in Taiwan.

When studying the range of toxic substances triggering dementia, special attention should be paid to the materials used in dental practice, particularly to dental fillings containing amalgam. This necessitated conducting large-scale epidemiologic studies. The aim of our research was to determine the risk factors for developing dementia when filling materials containing amalgam are used in dental practice. In order to achieve the set goals, the following tasks were undertaken: (1) The social and demographic characteristics of the examined patients were studied; (2) the spectrum of concomitant somatic diseases was determined in patients of different gender and age; and (3) the relationship between dementia incidence and the volume of dental filling material containing amalgam was identified in patients with different somatic diseases. In general, the research conducted did not reveal any direct relationship between the development of dementia and the volume of filling material containing amalgam. However, among the people with dementia, there were persons for whom its progression was accelerated in cases where a large volume of dental filling material containing amalgam was present.

Time trends in the prevalence of diagnosed sialolithiasis from Taiwanese nationwide health insurance dental dataset.

BACKGROUND/PURPOSE: Sialolithiasis, the so-called salivary gland stone, is a condition forming salivary calculi within a salivary gland or ducts. Little is known about the epidemiological survey of sialolithiasis in Taiwanese population. In this study, we conducted an age-period-cohort (APC) analysis evaluating the prevalence of sialolithiasis. MATERIALS AND METHODS: A retrospective study was conducted to analyze the registered database compiled by the Taiwanese National Health Insurance Research Database from 1996 to 2013. The APC analysis was performed to investigate the effects of age, diagnosis period, and birth cohort with sialolithiasis. RESULTS: We found that the prevalence of sialolithiasis varied from 1.4 (105) to 2.3 (105). The mean age ±standard deviation with sialolithiasis from 1996 to 2013 was 37.7 ±â€¯18.5 and 46.2 ±â€¯18.6 years old, respectively. The prevalence was higher among male than female (RR: 1.10; 95% CI: 1.05-1.15, p < 0.001). The age >65 group had higher risk compared to age <40 group (RR: 2.27; 95% CI: 2.13-2.43, p < 0.001). The relative risk for sialolithiasis demonstrated significant age effect (p < 0.001). The relative risk for sialolithiasis did not show the significant period effect (p = 0.742). The relative risk for sialolithiasis demonstrated significant cohort effect (p = 0.01). The relative risk for sialolithiasis demonstrated significant APC effect (p = 0.002). CONCLUSION: Form this nationwide population-based database, the prevalence of sialolithiasis occurs more frequently in male than in female. In addition, the relative risk for sialolithiasis demonstrated the significant APC effects.