Association between periodontitis and pulmonary function based on the Third National Health and Nutrition Examination Survey (NHANES III).

OBJECTIVES: The purpose of this study was to investigate the association between impaired pulmonary function and periodontitis. MATERIALS AND METHODS: From the Third National Health and Nutrition Examination Survey data, we examined the association between pulmonary function and severity of periodontitis using the univariate and multivariate regression models. Moreover, the association between obstructive or restrictive spirometry patterns and periodontitis status was also determined by multivariable logistic regression analysis. RESULTS: A total of 10,645 participants were included in our study. The values of predicted FEV1%, predicted FVC%, and FEV1/FVC were found to gradually decline with increasing severity of periodontitis (p < .001). Obstructive and restrictive pulmonary functions were significantly associated with severity of periodontitis. CONCLUSION: Individuals with a greater degree of periodontitis had poor pulmonary function. However, further long-term cohort studies are required for a comprehensive evaluation.

The prevalence of clinically meaningful malocclusion among US adults.

OBJECTIVE: The primary purpose of this study was to statistically evaluate age, ethnic and sex differences in the prevalence of clinically meaningful malocclusions among adults. SETTING AND SAMPLE POPULATION: A random sample of 8804 untreated US adults between 17 and 46 years of age was selected from the Third National Health and Nutrition Examination Survey data. MATERIALS & METHODS: Three ethnic (non-Hispanic White, non-Hispanic Black and Mexican Americans) and three age (17-26, 27-36 and 37-46 years) groups were evaluated. Subjects with and without clinically meaningful malocclusions were categorized based on the established cut-off values. Chi-square analyses were performed to determine differences in prevalence. RESULTS: The prevalence of clinically meaningful mandibular incisor irregularity, overjet and overbite increased significantly (P < 0.05) with age, while posterior crossbite decreased. There were statistically significant ethnic differences in the prevalence of incisor irregularity, overbite, overjet, open bite and reverse overjet. Males had a significantly higher prevalence of clinically meaningful mandibular incisor irregularity, overbite, open bite and reverse overjet than females. One-third of US adults exhibited no clinically meaningful malocclusions. CONCLUSIONS: There are age, ethnic and sex differences in the prevalence of clinically meaningful malocclusions that characterize approximately two-thirds of untreated US adults.

Association between Periodontitis and Diabetes Mellitus in the General Population.

Purpose-: This study aimed to examine the association between periodontitis and diabetes mellitus. Methods: Participants with natural teeth in one jaw from the Third United States National Health and Nutrition Examination Survey (1988-1994) were included in this analysis. Participants with moderate (> 4mm attachment loss in ≥ 2 mesial sites or 5mm pocket depth in ≥ 2 mesial sites) or severe (> 6mm attachment loss in ≥ 2 mesial sites and > 5mm pocket depth in ≥ 1 mesial site) periodontitis were classified as having periodontal disease. The rest of the participants were considered without periodontal disease. Diabetes mellitus was defined as fasting glucose ≥ 126mg/dL, hemoglobin A1c ≥ 6.5% or the use of antihyperglycemic medications. Multivariable logistic regression was used to examine the association between periodontitis and diabetes mellitus in all study population and subgroups stratified by demographics and comorbidities. Results: This analysis included 13,000 participants [mean age 43.8 ± 19.1 years, 47.5% male, 30% whites]. About 12.7% (n = 1,656) of the study population had periodontitis, and 9.2% (n = 1,200) had diabetes. In a multivariable-adjusted model, presence (vs. absence) of periodontitis was associated with 66% increased odds of diabetes (OR (95% CI):1.66 (1.43-1.94); p < 0.001). Compared to those without periodontitis, the odds of diabetes among those with severe periodontitis was much higher (OR (95% CI): 2.31(1.72-3.11); p < 0.001) than in those with moderate periodontitis (OR (95% CI): 1.54(1.30-1.82); p < 0.001). Conclusions: Periodontitis is associated with prevalent diabetes in a dose-response fashion, suggesting a bidirectional relationship between those two diseases. Patients with periodontal disease should be counseled regarding their elevated risk of diabetes. Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-022-01010-6.

Association of environmental cadmium exposure with pediatric dental caries.

BACKGROUND: Although animal experiments have shown that cadmium exposure results in severe dental caries, limited epidemiologic data are available on this issue. OBJECTIVES: We aimed to examine the relationship between environmental cadmium exposure and dental caries in children 6-12 years of age. METHODS: We analyzed cross-sectional data, including urine cadmium concentrations and counts of decayed or filled tooth surfaces, from the Third National Health and Nutrition Examination Survey. We used logistic and zero-inflated negative binomial (ZINB) regression to estimate the association between urine cadmium concentrations and caries experience, adjusting these analyses for potential confounders including environmental tobacco smoke (ETS). RESULTS: Urine cadmium concentrations ranged from 0.01 to 3.38 ng/mL. Approximately 56% of children had experienced caries in their deciduous teeth, and almost 30% had been affected by caries in their permanent dentition. An interquartile range (IQR) increase in creatinine-corrected cadmium concentrations (0.21 microg/g creatinine) corresponded to a 16% increase in the odds of having experienced caries in deciduous teeth [prevalence odds ratio (OR)=1.16; 95% confidence interval (CI), 0.96-1.40]. This association was statistically significant in children with low ETS exposure (prevalence OR=1.30; 95% CI, 1.01-1.67). The results from the ZINB regression indicated that, among children with any caries history in their deciduous teeth, an IQR increase in cadmium was associated with 17% increase in the number of decayed or filled surfaces. We observed no association between cadmium and caries experience in permanent teeth. CONCLUSIONS: Environmental cadmium exposure may be associated with increased risk of dental caries in deciduous teeth of children.

Non-linear association of periodontal pathogen antibodies with mortality.

BACKGROUND: Periodontal pathogens are associated with predisposition to chronic diseases and death. Antibody levels against them reflect flora burden, although high levels might indicate a protective response. We studied all-cause and cause specific mortality in relation to antibody levels in a representative US sample. METHODS: Adults ≥ 20 years (n=6993) from the second phase of the Third National Health and Nutrition Examination Survey (NHANES III) were followed for a median of 13.2 years. Serum antibodies against Porphyromonas gingivalis (antiPG) and Actinobacillus actinomycetemcomitans (antiAA) were quantified by ELISA at baseline (1991-1994). Mortality hazard ratios (HRs) were calculated across antibody quartiles using the quartile with highest mortality as reference. RESULTS: Median (25th, 75th percentiles) antiPG was 72 (63, 93) ELISA Units (EU) and median antiAA was 70 (64, 89) EU. After adjustment for potential confounders, mortality was highest for participants with antibodies in the third antiPG quartile (72-92 EU), with lower mortality risk for values not only below but also above this range [HR for the 1st to 4th quartiles: 0.81 (95% CI: 0.65, 1.01), 0.67 (95% CI: 0.55, 0.82), 1.00 (Reference), 0.79 (95% CI: 0.64, 0.97)]. In spline regression models the association had an inverted U-shape and mortality exhibited a peak at 84 EU (67th percentile). Mortality was not associated with antiAA. CONCLUSIONS: Mortality was highest for those just above the median antiPG and a reduced risk was present among those with low or high levels of the antibody. Future studies should confirm this downward trend in upper levels and investigate a potential protective role of immunity against P. gingivalis.

Association of environmental cadmium exposure with periodontal disease in U.S. adults.

BACKGROUND: Periodontal disease is a complex, multifactorial, chronic inflammatory disease that involves degradation of periodontal structures, including alveolar bone. Cadmium adversely affects bone remodeling, and it is therefore possible that environmental Cd exposure may be a risk factor for periodontal-disease-related bone loss. OBJECTIVE: We examined the relationship between environmental Cd exposure and periodontal disease in U.S. adults. METHODS: We analyzed cross-sectional data from the third National Health and Nutrition Examination Survey (NHANES III). We defined periodontal disease as clinical attachment loss of at least 4 mm in > 10% of sites examined. We used multivariable-adjusted logistic regression analyses to estimate the association between creatinine-corrected urinary Cd levels and periodontal disease. RESULTS: Of the 11,412 participants included in this study, 15.4% had periodontal disease. The age-adjusted geometric mean urine Cd concentration (micrograms per gram creatinine) was significantly higher among participants with periodontal disease [0.50; 95% confidence interval (CI), 0.45-0.56] than among those without periodontal disease (0.30; 95% CI, 0.28-0.31). Multivariable-adjusted analyses, which included extensive adjustments for tobacco exposure, showed that a 3-fold increase in creatinine-corrected urinary Cd concentrations [corresponding to an increment from the 25th (0.18 microg/g) to the 75th (0.63 microg/g) percentile] was associated with 54% greater odds of prevalent periodontal disease (odds ratio = 1.54; 95% CI, 1.26-1.87). We observed similar results among the subset of participants who had limited exposure to tobacco, but only after removing six influential observations. CONCLUSION: Environmental Cd exposure was associated with higher odds of periodontal disease.