Periodontitis and hypertension are linked through systemic inflammation: A 5-year longitudinal study.

AIM: To investigate the associations between periodontitis and hypertension and potential mediation via systemic inflammation through a 5-year longitudinal study. MATERIALS AND METHODS: The severity and extent of periodontitis were determined using probing depth (PD). Oral hygiene was assessed using plaque scores. The associations between periodontal variables and 5-year blood pressure changes or incident hypertension were analysed using linear or Poisson regression, adjusting for potential confounders. Mediation analysis of two systemic inflammatory biomarkers, namely white blood cell count (WBC) and C-reactive protein (CRP) levels, was performed. RESULTS: The study population included 901 hypertension-free participants, aged 50-73 years. Greater mean PD, higher percentage of sites with PD ≥ 6 mm and poor oral hygiene were associated with elevated systolic blood pressure and increased hypertension risk (relative risks = 1.17 [95% confidence interval [CI]: 1.02-1.34], 1.13 [95% CI: 1.02-1.26] and 1.08 [95% CI: 1.03-1.13], respectively). Periodontitis and poor oral hygiene were associated with higher WBC and CRP levels (p < .05), which, in turn, were associated with increased hypertension risk (p < .05). WBC and CRP jointly mediated 14.1%-26.9% of the associations between periodontal variables and incident hypertension. CONCLUSIONS: Periodontitis and poor oral hygiene were associated with increased hypertension risk, and systemic inflammation was, in part, a mediator of these associations.

The Potential Effect of Periodontal Disease on the Development of Metabolic Syndrome: A 10-Year Observational Study in a Thai Adult Cohort.

AIM: As data are sparse on the long-term association between periodontal diseases and development of metabolic syndrome (MetS), we investigated their relationship in a Thai cohort over a 10-year observational period. METHODS: Medical records and data on periodontal assessments of 2161 employees of the Electricity Generating Authority of Thailand collected at two time points, 2003 and 2013, were used. Experienced periodontists used standard national and international criteria to define periodontitis and MetS. The impact of baseline periodontitis on subsequent MetS incidence and its components was evaluated using regression analyses. RESULTS: The severity and extent of periodontitis significantly predicted MetS incidence over a decade, with a higher incidence of MetS in individuals with poorer periodontal health. A single percentage increase in the periodontitis extent raised the risk of MetS incidence by 0.4% and the risk of developing individual components of MetS by 0.2%. Independent of periodontal health, age of an individual emerged as a factor impacting MetS development. CONCLUSION: This study highlights the potential effect of the severity and extent of periodontitis on the increased incidence and progression of MetS. Hyperglycaemia and hypertension were the two MetS components most significantly affected by the existence of periodontitis.

Decreased bone mineral density is associated with an increased number of teeth with periodontitis progression: a 5-year retrospective cohort study.

OBJECTIVE: Longitudinal studies on the systemic bone loss-periodontitis relationship are limited with disparate results. The aim of this study was to investigate the association between bone mineral density (BMD) and periodontitis progression, controlling for other covariables in a Thai population. MATERIALS AND METHODS: In 2,418 participants, BMD values of the lumbar spine, femoral neck, and total hip were measured with dual-energy X-ray absorptiometry at baseline. Each participant's BMD status was classified as normal, osteopenia, or osteoporosis. Full mouth periodontal examinations on 6 sites/tooth were performed at baseline and 5-year follow-up visits. Periodontitis progression was defined as a tooth presenting an additional proximal CAL loss of ≥ 3 mm or an additional lost tooth with a baseline CAL ≥ 5 mm. The risk effects of BMD status on the number of teeth with periodontitis progression were analyzed using multivariate Poisson regression. RESULTS: Baseline BMD status of osteoporosis was associated with an increased number of teeth with periodontitis progression in the subgroups of postmenopausal women, non-smokers, and participants with periodontitis stage III/IV with adjusted risk ratios of 1.31 (95% CI = 1.09-1.58), 1.19 (95% CI = 1.04-1.36), and 1.13 (95% CI = 1.00-1.28), respectively. CONCLUSION: Baseline BMD in the osteoporosis range increased the risk of having a greater number of teeth with periodontitis progression in specific participant subgroups. CLINICAL RELEVANCE: Decreased BMD is a potential factor affecting periodontitis progression risk in some individuals. Multidisciplinary approaches in educating and maintaining patients' bone-oral health may help improve their quality of life.

The effect of obesity on periodontitis progression: the 10-year retrospective cohort study.

OBJECTIVE: Due to inconsistent findings in limited previous cohort studies, the aim of this study was to estimate the obesity effect on periodontitis progression in Thai adults. MATERIALS AND METHODS: This 10-year retrospective cohort study comprised 2216 employees of the Electric Generation Authority of Thailand (EGAT). Their demographic, medical, and periodontal status was collected. Subjects with periodontitis progression were defined as having ≥ 2 teeth with progression. Additional proximal clinical attachment loss ≥ 3 mm or tooth loss with severe periodontitis at baseline were used to identify disease progression at the tooth level. Central obesity was classified using the waist-hip ratio. Multi-level Poisson regression was used to determine the effect of obesity on periodontitis progression by adjusting for age, sex, education, income, smoking, alcohol drinking, exercise, diabetes mellitus, and hypertension. RESULTS: The cumulative incidence of periodontitis progression during the 10-year period was 59.6 cases per 100 persons (95% CI: 57.5, 61.6). The univariate analysis indicated that obese subjects had 15% higher risk of progression than that of healthy subjects. However, when confounders were analyzed simultaneously, the effect of obesity was not significant with a risk ratio of 0.98 (95% CI: 0.88, 1.08). CONCLUSIONS: Despite the higher incidence of disease progression in the obese, obesity is not an independent risk factor for periodontitis progression. CLINICAL RELEVANCE: Obesity and periodontitis progression share many common risk factors. Using the obesity as a preliminary screening for periodontitis progression may be an alternative prevention protocol.

The severity and extent of periodontitis is associated with cardio-ankle vascular index, a novel arterial stiffness parameter.

OBJECTIVES: To evaluate the association between the severity and extent of periodontitis and arterial stiffness using the cardio-ankle vascular index (CAVI). MATERIALS AND METHODS: A cross-sectional study of 2888 Electricity Generation Authority of Thailand (EGAT) employees aged 44-78 years was conducted. The severity of periodontitis was evaluated based on mean clinical attachment level (CAL). The percentage of sites with CAL ≥ 5 mm was used to divide the extent of periodontitis into healthy (0%), localized (> 0-< 30%), and generalized (≥ 30%). The CAVI value, a novel blood pressure-independent arterial stiffness parameter, was analyzed as both continuous and categorical data (low: < 9 or high: ≥ 9). Regression analysis was used to estimate the level of association. RESULTS: The participants demonstrated a mean CAL, % sites with CAL ≥ 5 mm, and a CAVI value of 3.2 ± 1.2 mm, 16.0 ± 20.8%, and 8.24 ± 1.12, respectively. Higher mean CAVI was observed with greater mean CAL and % sites with CAL ≥ 5 mm. The mean CAVI of the healthy, localized, and generalized periodontitis groups were 8.01 ± 1.11, 8.22 ± 1.12, and 8.51 ± 1.04, respectively (p < 0.01). Linear and logistic regression analysis demonstrated a significant relationship between CAVI and all periodontal variables with ß = 0.004-0.17 and OR = 1.01-1.58, respectively. CONCLUSIONS: There is a significant dose-dependent association between the severity and extent of periodontitis and arterial stiffness measured by CAVI in Thai adults. CLINICAL RELEVANCE: Preventing arterial stiffness, an early sign of cardiovascular events, by controlling the emerging risk factors, such as periodontitis, might have a high impact on health promotion.

Interplay between vitamin D receptor FokI polymorphism and smoking influences Porphyromonas gingivalis proportions in subgingival plaque.

AIM: This cross-sectional study investigated the effect of the vitamin D receptor (VDR) FokI polymorphism and its interactions with smoking/drinking on the proportions of periodontal pathogens and periodontitis severity. MATERIALS AND METHODS: FokI genotyping and bacterial quantification were performed using real-time polymerase chain reaction. Periodontitis severity was determined using mean clinical attachment level (CAL). Regression analyses examined the associations between the FokI polymorphism (rs2228570) and bacterial proportions or periodontitis severity. Effect modification by smoking or drinking was assessed. RESULTS: The study population comprised 1,460 individuals, aged 39-66 years. After multivariable adjustment, the FokI risk genotypes (CC + CT) were associated with elevated Porphyromonas gingivalis proportions (regression coefficient (ß) =0.294 ± 0.139; p = .034) and increased mean CAL (ß = 0.130 ± 0.048; p = .007). The effect of the FokI polymorphism on P. gingivalis proportions was greater in smokers (ß = 0.897 ± 0.328; p = .006) compared to non-smokers (ß = 0.164 ± 0.153; p = .282) and in drinkers (ß = 0.668 ± 0.242; p = .006) compared to non-drinkers (ß = 0.114 ± 0.169; p = .500). The genotype*smoking interaction for P. gingivalis proportions was significant (p = .043), whereas the genotype*drinking interaction was not (p = .061). Similar results were found for the effect of the genotype*smoking/drinking interaction on mean CAL. CONCLUSIONS: These findings suggest that the interplay between the host genotype and smoking is important in determining the subgingival microbial composition and periodontitis severity.

Metabolic syndrome and severe periodontitis were associated in Thai adults: A cross-sectional study.

BACKGROUND: Studies support the relationship between metabolic syndrome (MetS) and periodontitis. However, age is the major confounding factor for both conditions. Therefore, this cross-sectional study was performed to investigate the relationship between MetS and severe periodontitis in different Thai adult age groups. METHODS: Data on the medical history, medical examination, and full mouth oral examination of 5,690 Electricity Generating Authority of Thailand employees aged 25 to 77 years were collected. The prevalence ratio (PR) between risk variables, MetS, and periodontitis was determined using Poisson regression analysis. Moreover, the subgroup analysis and effect modification by age on severe periodontitis were performed. RESULTS: Overall, MetS was significantly associated with severe periodontitis compared with non-severe periodontitis (adjusted PR, 1.11; 95% confidence interval [CI], 1.01 to 1.13). The association was modified by age, with negative effect modification observed on the multiplicative and additive scales. The subgroup analysis revealed a significant relationship between MetS and severe periodontitis only in participants aged <45 years with an adjusted PR of 1.69 (95% CI, 1.29 to 2.21). All MetS components, except hypertension, were associated with severe periodontitis in this group. CONCLUSIONS: There is a significant relationship between MetS and severe periodontitis in adults aged <45 years. Therefore, attempts to control the risk of MetS and periodontitis should be emphasized for early adults to reduce the incidence of these conditions and related complications when they become elderly.