Association of oral fungal profiles with health status and bacterial composition in elderly adults receiving community support and home care service.

Fungi compose a minority but a common component of normal oral microbiota and contribute to oral and systemic health by interacting with bacterial inhabitants. This study investigated the relationship of oral fungal profiles to health status and bacterial profiles of 159 elderly adults receiving community support and home care services. Fungal and bacterial densities and compositions were determined based on the fungal ribosomal internal transcribed spacer region and bacterial 16S rRNA gene amplicon analyses, respectively. The total fungal density of 87 individuals exceeded 5,000 copies, and their microbiota was characterized by significantly less dense bacterial populations and lower relative abundances of oral health-associated taxa, such as Neisseria perflava and Porphyromonas pasteri, compared with those with less than 5,000 copies of fungi. These individuals were significantly older, had fewer teeth, had lower physical function, and comprised more denture users and individuals with cognitive decline. Fungal compositions were classified into three profiles (Candida albicans-dominant, non-albicans Candida-dominant, and non-Candida-dominant), and individuals with a non-albicans Candida-dominant profile exhibited significantly lower physical and cognitive function than those with the Candida albicans-dominant profile. These results demonstrate that a high-density fungal population co-occurs with poor oral and systemic health status of the host and dysbiosis of the bacterial community, and particularly, the overgrowth of non-albicans Candida species may be implicated in worsening systemic conditions. IMPORTANCE: The interaction between fungal and bacterial components involved in the virulence of oral microbiota has received attention. This study demonstrates that an increase in fungal components is associated with a dysbiotic bacterial community and poor health status in elderly adults. Among individuals with a high-density fungal population, particularly, those with a non-albicans Candida-dominant profile had lower physical and cognitive functions than those with a C. albicans-dominant profile. These findings indicate that the evaluation of fungal components, in addition to the bacterial components, is important to understand the involvement of oral microbiota in oral and systemic diseases in elderly adults.

Possible association between oral health status and appetite loss in community-dwelling older adults.

This study aimed to evaluate the association between the oral health status and appetite in community-dwelling older adults. We enrolled 100 people aged ≥65 years who had participated in long-term care prevention projects between December 2018 and January 2019. Appetite was assessed using the Council on Nutrition Appetite Questionnaire score. The oral health status was assessed based on the number of teeth, occlusal condition, swallowing function, tongue coating, and the Oral Health Assessment Tool. A multiple linear regression analysis was performed with appetite as the dependent variable and each variable related to oral health status as an independent variable. The analysis was adjusted for sex, age, activities of daily living, cognitive function, smoking habit, and alcohol consumption. Dental pain was associated with poor appetite in community-dwelling older adults. No other oral health status parameter was associated with appetite. Thus, controlling dental pain is critical to prevent appetite loss while considering other factors.

Longitudinal association between periodontal condition and glycaemic status in middle-aged adults: A cross-lagged panel analysis.

AIM: To investigate the existence of a bidirectional temporal relationship between periodontal condition and glycaemic status. MATERIALS AND METHODS: This longitudinal study included 2198 participants with mean age 43.4 ± 7.7 years, who underwent dental examinations in Yokohama, Japan, at two time points, 2003-2004 and 2008-2009, at an interval of 5 years. Periodontal condition was assessed by the mean value of probing pocket depth (PPD) and clinical attachment level (CAL). Glycaemic status was assessed by fasting glucose and glycated haemoglobin (HbA1c). RESULTS: The cross-lagged panel models showed the effect of HbA1c at baseline on mean PPD at follow-up (ß = 0.044, p = .039). There was a marginal effect of fasting glucose on the mean PPD (ß = 0.037, p = .059). It was similar to the effect of fasting glucose or HbAlc on mean CAL. However, in the opposite direction, no effect of mean PPD or CAL at baseline on fasting glucose or HbAlc at follow-up was identified. CONCLUSIONS: This study demonstrated a unidirectional relationship between glycaemic status and periodontal condition. The study population, however, had mostly mild periodontitis. Future studies are needed to investigate the effect of periodontal condition on glycaemic status in patients with severe periodontitis.

Yogurt product intake and reduction of tooth loss risk in a Japanese community.

AIM: To evaluate the longitudinal association between yogurt product intake and oral health in a population-based study. MATERIALS AND METHODS: This study included 1967 Japanese residents aged 40-79 years who underwent dental examinations in 2012. Among them, 1469 participants were followed up in 2017 for the incidence of tooth loss, which was defined as two or more teeth lost over 5 years. The intake of yogurt products, defined as yogurt and lactic acid beverages, was estimated using a semi-quantitative food frequency questionnaire. The composition of the salivary microbiota was evaluated. RESULTS: The Poisson regression model showed that a higher intake of yogurt products was negatively associated with the incidence of tooth loss (p for trend = .020), adjusted for potential confounding factors. Mediation analysis confirmed that periodontal condition partly mediated the effect of yogurt product intake on tooth loss, while dental caries experience did not. Additionally, we confirmed the association of a high intake of yogurt products with a low percentage of the salivary microbiota pattern, which was associated with poor oral health. CONCLUSION: These findings suggest that the intake of yogurt products is associated with a lower risk of tooth loss resulting from periodontal disease, probably via modulation of the oral microbiome composition.

Number of teeth, denture wearing and cognitive function in relation to nutritional status in residents of nursing homes.

BACKGROUND: Although statistical associations between tooth loss and cognitive decline have been reported, there are few previous studies on denture wearing. Additionally, it remains unclear whether nutritional status mediates this association. OBJECTIVE: Our purpose was to test for the hypothesis that the association between the number of teeth and denture wearing with cognitive function is mediated by nutritional status in residents of nursing homes. MATERIALS AND METHODS: We enrolled 162 participants who required long-term care (mean age: 87.7 ± 7.5 years, 26 men and 136 women) and were admitted to eight nursing homes in Fukuoka city, from September 2013 to March 2014. A trained dentist conducted dental and swallowing examinations, and the care-staff assessed nutritional status, comorbid conditions and cognitive function using the Clinical Dementia Rating (CDR). RESULTS: Poisson regression analysis showed that 0-19 teeth without dentures were associated with severe cognitive impairment (CDR 3) (prevalence ratio = 2.00; 95% confidence interval: 1.13-3.55) after adjustment for sex, age, suspected swallowing dysfunction and comorbid conditions. Mediation analysis confirmed that the nutritional status as a mediator of this association (the percentage mediated effect through nutritional status was 23.1%). CONCLUSION: There is an association between dental status and cognitive impairment in elder individuals, and dentures and poor nutrition are involved in this association. However, due to the cross-sectional design of this study, there is a possibility that this association is bidirectional.

Association between periodontitis and fibrotic progression of non-alcoholic fatty liver among Japanese adults.

AIM: Non-alcoholic fatty liver (NAFL) is known to develop into liver fibrosis, which increases the risk of liver cirrhosis and liver cancer. The association between periodontal condition and fibrotic progression of NAFL is unclear. This study aimed to clarify this longitudinal association. MATERIALS AND METHODS: Among 4812 participants aged 35-64 years undergoing annual health check-ups between 2003 and 2004, and follow-up 5 years later, 392 participants were diagnosed with NAFL. After excluding participants with liver fibrosis at baseline, 341 participants were followed up for 5 years. NAFL disease fibrosis score of ≥-1.455 was used to evaluate the probability of the presence of liver fibrosis. RESULTS: During the follow-up period, 10.6% of participants progressed to liver fibrosis. A higher clinical attachment level (CAL) tended to be associated with the incidence of liver fibrosis in the logistic regression analysis (odds ratio [OR] 1.82, 95% confidence interval [CI], 0.94-3.49, p = .074). The stratified analysis by obesity revealed a significant association with higher CAL in obese participants (OR 2.87, 95% CI, 1.23-6.69, p = .015), but not in non-obese participants. CONCLUSION: Higher CAL was associated with an increased probability of liver fibrosis in obese adults with NAFL.

Longitudinal Associations of Toothbrushing With Obesity and Hyperglycemia.

BACKGROUND: Toothbrushing is a health-related lifestyle habit and has been reported to contribute not only to oral health but also to some parameters of general health; however, little research has been conducted to understand the association of the frequency and timing of toothbrushing with the development of comprehensive metabolic abnormalities, with consideration of oral health condition. In this study, using longitudinal data, we examined this association in Japanese adults, adjusting for periodontal condition. METHODS: A 5-year longitudinal study was performed with 4,537 participants between 35 and 64 years old who underwent an annual dental examination in both 2003 and 2008. Data about toothbrushing habits and metabolic abnormalities, such as obesity, hyperglycemia, diabetes, hypertension, hypertriglyceridemia, and low levels of high-density lipoprotein-cholesterol, were analyzed using Poisson regression analysis. RESULTS: The percentage of participants with a toothbrushing frequency ≤1 time/day was 29.4%, and that for those not brushing their teeth at night was 21.4%. The incidences of obesity and hyperglycemia after 5 years were 5.5% and 28.4%, respectively. A toothbrushing frequency ≤1 time/day was associated with development of obesity (prevalence rate ratio [PRR] 1.77; 95% confidence interval [CI], 1.12-2.80), after adjusting for periodontal condition and potential risk factors. A significant association between not brushing teeth at night and hyperglycemia (PRR 1.30; 95% CI, 1.02-1.66) was observed in participants with toothbrushing frequency of 1 time/day. No association was found between toothbrushing habits and other metabolic abnormalities. CONCLUSIONS: This study suggests that toothbrushing habits are associated with the development of obesity and hyperglycemia.

A multilevel analysis of the importance of oral health instructions for preventing tooth loss: The 8020 Promotion Foundation Study of Japanese Dental Patients.

BACKGROUND: Many studies have reported risk factors for tooth loss. Oral health instruction is considered effective at improving oral health behavior and oral health. However, few studies have examined the relationship of dental clinic factors, such as the number of dental hygienists and implementation of oral health instructions, with tooth loss. Here, we conducted a multilevel analysis to clarify the dental clinic risk factors associated with tooth loss. METHODS: Baseline surveys were conducted at 1216 dental clinics in 46 prefectures in Japan, and 12,399 dental patients aged 20 years and over underwent oral examinations and completed a questionnaire. The dental clinics also completed a questionnaire at baseline. A 3-year follow-up survey included 2488 patients in 585 dental clinics. Multilevel multivariate logistic regression analysis was used to examine the risk of tooth loss at the patient and clinic levels. RESULTS: Of the patient variables, older age, higher mean probing pocket depth, current or past smoking, and bleeding during tooth brushing were associated with higher risks of tooth loss. Individuals with many teeth who visited dental clinics for maintenance were at significantly lower risk of tooth loss. Of the clinic variables, patients attending dental clinics with four or more dental hygienists had a significantly lower risk of tooth loss (OR 0.68, 95% CI 0.50-0.99). Patients attending dental clinics that provide oral health instructions for 20 min or more had a significantly lower risk of tooth loss (OR 0.69, 95% CI 0.50-0.96). CONCLUSIONS: In addition to individual risk factors for tooth loss, dental clinic factors such as length of oral health instruction and number of dental hygienists are associated with tooth loss. In dental clinics, ensuring sufficient time for dental hygienists to provide oral health instructions can help prevent tooth loss in dental patients.

Association between intensive health guidance focusing on eating quickly and metabolic syndrome in Japanese middle-aged citizens.

PURPOSE: The purpose of this intervention study was to investigate whether intensive health guidance focusing on eating quickly can prevent metabolic syndrome (MetS) more effectively than standard routine guidance in Japanese citizens living in rural areas. METHODS: This controlled, non-randomized, intervention study analyzed 141 participants with MetS at baseline. Participants in the intervention group received health guidance focusing on eating quickly and standard health guidance about MetS in accordance with the guidelines of the Ministry of Health, Labour and Welfare in Japan, whereas participants in the control group received only standard health guidance about MetS. The primary study outcome was the prevalence of MetS at a 1-year follow-up. RESULTS: At 1-year follow-up, the prevalence of MetS in the intervention group was significantly lower than that in the control group (p = 0.003). The decreases in body weight, body mass index, waist circumference and triglycerides from baseline to 1 year were significantly greater in the intervention group than in the control group (p < 0.05). CONCLUSION: Intensive health guidance focusing on eating quickly is more effective for improving MetS than standard Japanese health guidance alone. LEVEL OF EVIDENCE: Level II, Evidence obtained from well-designed controlled trials without randomization. TRIAL REGISTRY NAME, REGISTRATION IDENTIFICATION NUMBER, AND URL FOR THE REGISTRY: UMIN, UMIN000030600, http://www.umin.ac.jp/ctr/index-j.htm.

Relationship of toothbrushing to metabolic syndrome in middle-aged adults.

AIM: To examine the effect of toothbrushing on the development of metabolic syndrome (MetS), including assessment of periodontal status, in middle-aged adults. METHODS: This 5-year follow-up retrospective study was performed in 3,722 participants (2,897 males and 825 females) aged 35-64 years who underwent both medical check-ups and dental examinations. Metabolic components included obesity, elevated triglycerides, blood pressure, fasting glucose and reduced high-density lipoprotein. Toothbrushing frequency was assessed using a questionnaire. Periodontal disease was defined as having at least one site with a pocket depth of ≥4 mm. Logistic regression analysis was performed to evaluate the relationship between toothbrushing frequency at the baseline examination and the development of MetS (≥3 components). RESULTS: During follow-up, 11.1% of participants developed MetS. After adjusting for potential confounders including periodontal disease, participants with more frequent daily toothbrushing tended to have significantly lower odds of developing MetS (p for trend = .01). The risk of development of MetS was significantly lower in participants brushing teeth ≥3 times/day than in those brushing teeth ≤1 time/day (odds ratio = 0.64, 95% confidence interval = 0.45-0.92). CONCLUSIONS: Frequent daily toothbrushing was associated with lower risk of development of MetS.

Decreased cognitive function is associated with dysphagia risk in nursing home older residents.

OBJECTIVE: To examine the association between cognitive function and dysphagia risk among Japanese nursing home residents. BACKGROUND: Reduction in cognitive function can influence the intake of food during swallowing, and may be an aggravating factor in dysphagia. METHODS: This cross-sectional study included 236 residents aged ≥60 years from eight nursing homes. Screening of dysphagia, especially aspiration risk, was conducted using the Modified Water Swallow Test, whose scores from one to three were classified as at risk of dysphagia. Cognitive function was evaluated using Mini-Mental State Examination (MMSE). Number of teeth and occlusal support were evaluated by clinical examination. The participants were stratified into dentulous and edentulous groups, because the number of teeth could influence swallowing function. The odds ratio (OR) and 95% confidence interval (CI) for dysphagia risk based on the scores of MMSE were calculated using logistic regression. Demographic characteristics, activity of daily living, comorbidities, health behaviour and occlusal support were used as covariates. RESULTS: Among the 236 participants (111 dentulous participants and 125 edentulous participants) included in our analysis, 16.9% belonged to risk of dysphagia. Dentulous participants with higher scores of MMSE tended to have significantly lower odds of dysphagia risk after adjusting for covariates (OR = 0.87, 95% CI = 0.80-0.96). Despite the lack of significant differences, edentulous participants with higher score of MMSE tended to have lower odds of dysphagia risk (OR = 0.92, 95% CI = 0.83-1.00). CONCLUSION: Decreased cognitive function may be an independent predictor of dysphagia among dentulous and edentulous adults.

Exploration of bacterial species associated with the salivary microbiome of individuals with a low susceptibility to dental caries.

OBJECTIVE: Dental caries is caused by acidogenic plaque microbiota formed on saliva-bathed tooth surfaces, in which multiple organisms act collectively to initiate and expand a cavity. We explored bacterial species associated with the salivary microbiome of individuals with low susceptibility to dental caries. MATERIALS AND METHODS: The bacterial composition of saliva from 19 young adults was analyzed using barcoded pyrosequencing of the 16S rRNA gene; we compared 10 caries-experienced (CE) and nine caries-free (CF) individuals. A quantitative PCR assay of saliva from 139 orally healthy adults aged 40-59 years was carried out to confirm the result obtained by pyrosequencing analysis. RESULTS: The microbiomes of CF individuals showed more diverse communities with a significantly greater proportion of the genus Porphyromonas. Among operational taxonomic units (OTUs) corresponding to the genus Porphyromonas, the OTU corresponding to P. pasteri was the most predominant and its relative abundance in CF individuals was significantly greater than in CE individuals (P < 0.001, Wilcoxon rank sum test). A quantitative PCR assay of saliva confirmed that the amounts of P. pasteri were significantly higher in individuals with lower caries experience (filled teeth <15, n = 67) than in those with higher caries experience (filled teeth ≥15, n = 72) (P < 0.001, Student's t test). CONCLUSION: These results revealed an association between a greater abundance of P. pasteri and lower susceptibility to dental caries. CLINICAL RELEVANCE: P. pasteri may be a bacterial species that could potentially be used as a marker for maintaining a healthy oral microbiome against dental caries.

Tooth loss and metabolic syndrome in middle-aged Japanese adults.

AIM: Metabolic syndrome is associated with periodontal disease and dental caries; however, little attention has been given to the association between metabolic syndrome and tooth loss, which is the endpoint of these two diseases. This study examined this association in middle-aged adults over a 5-year period. METHODS: A retrospective study was performed in 2107 participants (1718 males and 389 females) aged 35-60 years who underwent annual dental check-ups, to evaluate tooth loss and metabolic components, including obesity, elevated triglycerides, blood pressure, fasting glucose, and reduced high-density lipoprotein. Logistic regression analysis was performed to evaluate the association between metabolic syndrome (≥3 components) at the baseline examination and tooth loss. RESULTS: Over a 5-year period, 10.8% of the participants lost at least one tooth. Compared to those with no metabolic components, participants with ≥3 components had an increased risk of tooth loss (odds ratio = 1.54; 95% confidence interval: 1.01-2.37), adjusting for age, gender, dental caries experience, attachment loss, oral hygiene status, number of teeth, tooth brushing frequency, smoking, and occupational status. CONCLUSIONS: Metabolic syndrome was associated with the incidence of tooth loss among middle-aged adults.

Associations among oral health-related quality of life, subjective symptoms, clinical status, and self-rated oral health in Japanese university students: a cross-sectional study.

BACKGROUND: The present study aimed to elucidate the associations among self-rated oral health, clinical oral health status, oral health behaviors, subjective oral symptoms, and oral health-related quality of life (OHRQoL) in a group of Japanese university students. METHODS: Of 2051 participants, 2027 (98.83%) students received an optional oral examination and answered a questionnaire including items regarding age, sex, self-rated oral health, oral health behaviors, subjective oral symptoms, and OHRQoL [The Oral Health Impact Profile (OHIP)-14]. On oral examination, the decayed, missing, and filled teeth (DMFT) score, Community Periodontal Index (CPI), the percentage of teeth showing bleeding on probing (%BOP), and malocclusion were recorded. Structural equation modelling (SEM) analysis was used to test associations. RESULTS: The mean score (± SD) of OHIP-14 was 1.92 ± 5.47. In the SEM analysis, the final model showed that self-rated oral health, oral pain, malocclusion, and the DMFT score were directly associated with the OHRQoL, and subjective symptoms of temporomandibular disorders (TMD) and recurrent aphthous stomatitis were both directly and indirectly associated (p < 0.05). CPI, %BOP, and oral health behaviors were excluded from the final model. CONCLUSIONS: OHRQoL was associated with self-related oral health, subjective symptoms of TMD, oral pain and stomatitis, DMFT, and malocclusion in this group of Japanese university students.

Serum antibody to Porphyromonas gingivalis and periodontitis progression: the Hisayama Study.

AIM: To assess the effectiveness of serum titres of antibody to Porphyromonas gingivalis in the prediction of periodontitis progression in a community-dwelling adult population. MATERIALS AND METHODS: This 4-year follow-up cohort study included 183 Japanese individuals (75 men and 108 women) aged 40-49 years. The clinical attachment level was measured at two sites on all teeth present at baseline and follow-up, and periodontitis progression was defined as progression in attachment loss of ≥3 mm at ≥2 measurement sites. Serum titres of antibody to Porphyromonas gingivalis were evaluated at baseline and served as the primary predictor variable for periodontitis progression. RESULTS: Periodontitis progression was found in 8.7% subjects. In a multivariate logistic regression model, higher titres of antibody to Porphyromonas gingivalis and male gender were significantly associated with greater odds of periodontitis progression, even after adjustment for other confounding variables (titres of antibody to Porphyromonas gingivalis per 10 units: odds ratio, 1.66; 95% confidence interval, 1.16-2.36; male gender: odds ratio, 4.13; 95% confidence interval, 1.20-14.27). CONCLUSIONS: Elevated serum titres of antibody to Porphyromonas gingivalis may be a risk factor for periodontitis progression.

Relationship between increases in BMI and changes in periodontal status: a prospective cohort study.

AIM: The purpose of this prospective cohort study was to investigate whether body mass index (BMI) and oral health behaviour are related to changes in periodontal status in Japanese university students. MATERIALS AND METHODS: Students (n = 224) who were interested in receiving oral health examinations before entering university and before graduation were included in the analysis. Subjects were investigated regarding the correlations of oral health behaviours and increases in BMI with the percentage of bleeding on probing (%BOP) and Community Periodontal Index (CPI) scores as indicators of changes in periodontal status. RESULTS: The risk of increased %BOP was associated with the non-use of dental floss (adjusted odds ratio [OR]: 3.11; 95% confidence interval [CI]: 1.31-7.37; p < 0.05), whereas the risk of increased CPI score was associated with increases in BMI (OR: 1.95; 95% CI: 1.05-3.65; p < 0.05) and simplified oral hygiene index score (OR: 2.28; 95% CI: 1.23-4.22; p < 0.01). CONCLUSION: Increases in BMI were associated with worsening of periodontal status, defined as increased CPI score in Japanese university students, whereas lack of inter-dental cleaning was associated with exacerbated gingival bleeding.

Oral-to-rectum microbial transmission in orthopedic patients without a history of intestinal disorders.

The enrichment of oral taxa in the gut has recently been reported as a notable alteration in the microbial balance in patients with intestinal disorders. However, translocation in populations without such diseases remains controversial. In this study, we examined 49 pairs of tongue and rectal samples collected from orthopedic patients without a history of intestinal disorders to verify the presence of oral taxa in the rectal microbiota. The bacterial composition of each sample was determined using 16S rRNA gene sequencing and amplicon sequence variant (ASV) analysis. Although the bacterial compositions of the tongue and rectal microbiota were distinctly different, tongue ASVs were detected in 67.3% of the participants and accounted for 0.0%-9.37% of the rectal microbiota. Particularly, Streptococcus salivarius, Fusobacterium nucleatum, and Streptococcus parasanguinis were abundant in the rectal microbiota. According to the network analysis, tongue taxa, such as S. salivarius and S. parasanguinis, formed a cohabiting group with Klebsiella pneumoniae and Alistipes finegoldii in the rectal microbiota. The total abundance of tongue ASVs in the rectal microbiota was significantly higher in participants with older age, hypertension, and proton pump inhibitor (PPI) use. Our study presents an extensive translocation of oral taxa to the rectum of a population without intestinal disorders and suggests that aging, hypertension, and PPI use are associated with an increased abundance of oral taxa and potential pathogenic bacteria in the rectal microbiota.

Gender differences in the association between metabolic syndrome and periodontal disease: the Hisayama Study.

AIMS: Periodontal disease and metabolic syndrome (MS) are more prevalent in males than in females. However, whether there is a gender difference in the association between these health conditions has not yet been investigated. This study examined the gender difference in this association, considering the definition of periodontal disease. MATERIALS AND METHODS: We recruited 1040 males and 1330 females, aged ≥40 years, with at least ten teeth from subjects of the 2007 Hisayama health examination. We performed a logistic regression analysis with various definitions of periodontal disease the dependent variable and MS as the independent variable. Following the analysis, the data were reanalysed with the structural equations model. RESULTS: The logistic regression analysis suggested a stronger association between periodontal disease and MS in females than that in males when periodontal disease was more severely defined. When we constructed the structural equations model in each gender, the model showed a good fit to the data of females, suggesting the association between periodontal disease and MS in females, but not in males. CONCLUSIONS: Gender differences seem to exist in the association between periodontal disease and MS; MS might show a stronger association with periodontal disease in females than in males.

Self-reported aural symptoms, headache and temporomandibular disorders in Japanese young adults.

BACKGROUND: To investigate the associations of aural symptoms, headache and depression with the presence of temporomandibular disorder (TMD) symptoms in a young adult population in Japan. METHODS: A personal interview survey was conducted on first-year university students (n = 1,930) regarding symptoms of TMD, aural problems, headache, shoulder pain and depression. Logistic regression was applied to assess the associations of these problems with the presence of TMD symptoms after controlling for age and gender. RESULTS: Among the 1,930 students, 543 students exhibited TMD symptoms and were classified into 7 groups: clicking only (Group I, n = 319), pain in the TMJ only (Group II, n = 21), difficulty in mouth opening only (Group III, n = 18), clicking and pain (Group IV, n = 29), clicking and difficulty in mouth opening (Group V, n = 48), difficulty in mouth opening and pain (Group VI, n = 11), and combination of three symptoms (Group VII, n = 97). The control group (n = 1,387) were subjects without any TMD symptoms. After adjusting for age and gender, a strong association was observed between TMD symptoms (Group II and IV) and tinnitus (OR = 12.1 and 13.2, respectively). TMD symptoms (Group I, II and III) were also associated with vertigo and headache. Otalgia and depression were significantly associated with the presence of clicking only. CONCLUSIONS: TMD symptoms were significantly correlated to aural symptoms and headache. A functional evaluation of the stomatognathic system should be considered in subjects with unexplained aural symptoms and headache.

Relationship between periodontal inflammation and fetal growth in pregnant women: a cross-sectional study.

PURPOSE: Periodontal disease in pregnant women, evaluated by probing pocket depth (PPD) or clinical attachment level (CAL), significantly increases the risk of subsequent preterm birth (PB) and/or low birth weight (LBW). However, PPD and CAL do not always reflect current periodontal tissue inflammation. Therefore, assessment of bleeding on probing index (BOP), an indicator of periodontal inflammation, may be appropriate. The objective of this cross-sectional study was to investigate the relationship between periodontal inflammation and fetal growth in pregnant women after periodontal treatment. METHODS: We recruited 203 pregnant women (mean age 31.8 ± 4.5 years), including 20 subjects with periodontal inflammation and 183 periodontally healthy controls, after periodontal treatment. Fetal growth parameters as well as periodontal conditions were recorded. RESULTS: Perinatal gestational age was 39.4 ± 1.3 weeks; 8 subjects had a PB and 12 had an infant with a LBW. Results of multiple stepwise regression analysis indicated that birth length was negatively correlated with BOP% (ß = -0.175; p = 0.002). Fetal femur length, and birth length and weight among mothers with low periodontal inflammation were significantly higher than those among mothers with high periodontal inflammation (p < 0.05). The LBW rate in the high periodontal inflammation group was significantly higher than that in the low periodontal inflammation group (p < 0.05). CONCLUSIONS: These results suggest that periodontal inflammation is correlated with fetal femur length, birth weight, and birth length.