Association of obesity and weight gain with alveolar bone loss: Results of the Northern Finland Birth Cohort 1966 study.

AIM: To investigate whether long-term obesity, long-term central obesity and weight gain are associated with alveolar bone loss. MATERIALS AND METHODS: A sub-population (n = 1318) of the Northern Finland Birth Cohort 1966 was categorized based on body mass index (BMI: normal weight, overweight and obesity) and waist circumference (WC: no central obesity, central obesity) at ages 31 and 46. These categories were combined to define whether the participants stayed in the same categories or passed on to a higher category (weight gain). Alveolar bone level (BL) data were collected at age 46. RESULTS: The associations of long-term obesity and weight gain with BL ≥ 5 mm were stronger in smokers than in the total population and in never smokers. Males who passed on to higher BMI and WC categories showed a higher likelihood for BL ≥ 5 mm (range in relative risks [RRs] 1.3-2.2) than males who stayed in the same categories (range in RRs 0.7-1.1). The associations with BL ≥ 5 mm were weak or non-existent in females. CONCLUSIONS: The relation between obesity and periodontal diseases seems more complex than previously presumed. The role of gender and smoking should be taken into account in future studies.

The association of medications with sedative properties with oral health behaviour in community-dwelling older people.

OBJECTIVES: The objective of this study was to determine whether drugs with sedative properties are related to oral health behaviour-such as frequency of toothbrushing, using toothpaste and dental visits-and oral hygiene, measured by the number of teeth with dental plaque, among community-dwelling older people. METHODS: The study population consisted of 159 community-dwelling, dentate, non-smoking, older people from the Oral Health GeMS study (Geriatric Multidisciplinary Strategy for the Good Care of Older People study). The data were collected by interviews and clinical examinations during 2004-2005. Sedative properties of drugs were assessed using the sedative load (SL) model. Logistic and Poisson regression models were used to estimate odds ratios/relative risks (OR/RR) and 95% confidence intervals (CI). RESULTS: After adjusting for confounding factors, SL associated with infrequent toothbrushing (OR 1.72, CI: 0.61-4.89), toothpaste use less than twice a day (OR 3.34, CI: 1.39-8.12), non-regular dental visits (OR 2.28 CI: 0.91-5.30) and the number of teeth with dental plaque (RR 1.20 CI: 1.04-1.39) compared to participants without a SL. CONCLUSIONS: The results of this study suggest that use of drugs with sedative properties indicates poor oral health behaviour among older people.

Low serum level of 1,25(OH)2 D is associated with chronic periodontitis.

BACKGROUND AND OBJECTIVES: Vitamin D has been studied primarily for its involvement in calcium and phosphate absorption and bone metabolism. The active form of vitamin D-1,25(OH)2 D-has also been investigated for its immune modulatory properties. We explored associations between serum levels of 25(OH)D and 1,25(OH)2 D and periodontal health. SUBJECTS AND METHODS: This case-control study included 55 subjects with chronic periodontitis (cases) and 30 periodontally healthy subjects (controls). Their serum levels of 25(OH)D, 1,25(OH)2 D, ultrasensitive C-reactive protein and high-density lipoprotein cholesterol were determined. Associations between vitamin D and periodontal health status were studied using logistic regression analysis. RESULTS: A statistically significant association was found between serum 1,25(OH)2 D level and periodontal health status; in that subjects with a low 1,25(OH)2 D were more likely to belong to the periodontitis group (OR = 0.97, 95% CI = 0.95-1.00). There was practically no association between 25(OH)D level and periodontal health status. CONCLUSION: In this case-control study low serum 1,25(OH)2 D level appeared to be associated with periodontitis, which was in line with the previously reported associations between serum 1,25(OH)2 D levels and other inflammatory diseases. Whether this association is causal in nature, remains to be confirmed in future studies.

Body mass index and periodontal infection in a sample of non-smoking older individuals.

OBJECTIVE: The aim of this study was to investigate the association between BMI and periodontal infection in a sample of non-smoking individuals aged 75 years or older. SUBJECTS AND METHODS: The study sample included 157 non-smoking dentate persons (110 women, 47 men, mean age 80.6 years) belonging to the Geriatric Multidisciplinary Strategy for the Good Care of Older People study in Kuopio, Finland. The data were gathered by interview together with geriatric and oral clinical examination. The outcome variable was the number of teeth with periodontal pockets measuring 4 mm or more in depth. Poisson regression models were used to estimate relative risk (RR) and 95% confidence intervals (CI). RESULTS: After adjustment for confounding factors, the relative risk for the number of teeth with deepened periodontal pockets (≥4 mm) was 0.7 (CI: 0.6-0.9) among those with a BMI 25-29.99 and 1.1 (CI: 0.8-1.4) among those with a BMI ≥30, compared with those having a BMI <25. CONCLUSION: Within the limitations of this study, including small sample size, possibility of confounding and other biases, the results do not provide evidence that elevated body weight would be a risk for periodontal infection among older people.

Salivary flow rate and periodontal infection - a study among subjects aged 75 years or older.

OBJECTIVE: To analyse the relation of stimulated and unstimulated salivary flow rates to periodontal infection in home-dwelling elderly people aged 75 years or older. SUBJECTS AND METHODS: This study was based on a subpopulation of 157 (111 women, 46 men) home-dwelling, dentate, non-smoking elderly people (mean age 79.8, SD 3.6 years) from the Geriatric Multidisciplinary Strategy for the Good Care of the Elderly Study). The data were collected by interview and oral clinical examination. RESULTS: Persons with very low (< 0.7 ml min⁻¹) and low stimulated salivary flow rates (0.7- < 1.0 ml min⁻¹) had a decreased likelihood of having teeth with deepened (≥ 4 mm) periodontal pockets, RR: 0.7, CI: 0.5-0.9 and RR: 0.7, CI: 0.5-0.9, respectively, when compared with those with normal stimulated salivary flow. Persons with a very low unstimulated salivary flow rate (< 0.1 ml min⁻¹) had a decreased likelihood of having teeth with deepened (≥ 4 mm) periodontal pockets, RR 0.8, CI: 0.6-1.0, when compared with subjects with low/normal unstimulated salivary flow. CONCLUSIONS: In a population of dentate, home-dwelling non-smokers, aged 75 years or older, low stimulated and unstimulated salivary flow rates were weakly associated with a decreased likelihood of having teeth with deep periodontal pockets.

Cynical hostility as a determinant of poor oral health status in an adult population.

Our aim in this study was to determine whether there is an association between cynical hostility and clinically determined poor oral health, and whether this association is confounded by socioeconomic position and mediated by health behavior. The sample consisted of 4,207 dentate Finns, 30-64 yr of age. Oral health was measured in terms of numbers of missing teeth, of decayed teeth, and of teeth with periodontal pockets (> or = 4 mm). Cynical hostility was measured using the cynical distrust self-administered questionnaire. The subjects with the highest level of cynical hostility had fewer teeth, and a greater number of decayed teeth as well as teeth with deepened periodontal pockets compared to subjects with the lowest level of cynical hostility. The associations between cynical hostility and number of missing and decayed teeth were clearly confounded by level of education. Poor oral health behavior was shown to be a possible mediator between cynical hostility and number of decayed teeth, but not of missing teeth or teeth with deepened periodontal pockets. General health-related behavior did not serve as a possible mediator in any of the associations. In conclusion, cynical hostility can be considered as a risk marker for poor oral health. Interventions aimed to improve oral health should focus on psychosocial factors and on less-educated subjects.

Serum sCD14, polymorphism of CD14(-260) and periodontal infection.

BACKGROUND AND AIMS: CD14 is a co-receptor involved in the recognition of Gram-negative and positive bacteria. Infections are known to influence serum sCD14 levels, and CD14 gene promoter polymorphism (CD14 C-260T) has been reported to be associated with many infectious diseases. Our aim was to investigate whether serum sCD14 concentration is associated with periodontal infection and the CD14(-260) genotype. SUBJECTS AND METHODS: The periodontal status of 56 subjects with chronic periodontitis and 28 controls was clinically examined. Serum sCD14 concentration was analyzed using ELISA and CD14(-260) genotype using polymerase chain reaction (PCR). RESULTS: The mean concentration of sCD14 in serum was significantly higher in subjects with periodontitis than in control subjects (4.9 microg ml(-1)vs 3.8 microg ml(-1), P < 0.001). Serum sCD14 concentration associated significantly with the extent of advanced periodontal disease. In a regression analysis including both subject groups, the CD14(-260) genotype was a significant determinant for serum sCD14 concentration. After stratification by periodontal health status (periodontitis vs controls), the influence of the CD14(-260) genotype on serum sCD14 concentration was seen only in the control group. CONCLUSIONS: Periodontal infection is associated with the serum concentration of sCD14. Moderate to severe periodontal infection overshadows the influence of the genotype on serum sCD14 concentration.

Sense of coherence associates with oral and general health behaviours.

OBJECTIVE: Our aim was to investigate the mutual relationship between oral and general health behaviours and oral and general subjective health among adults, and to explore whether sense of coherence (SOC) could be a common health-promoting correlate for them. PARTICIPANTS: The present study included data for 4096 30- to 64-year-old dentate adults (2177 females and 1919 males). BASIC RESEARCH DESIGN: In the nationally representative, cross-sectional sample including 8028 persons aged 30, or more, 88% were surveyed. The questionnaire and home interview included information about socio-economic and demographic factors, behavioural and psycho-social variables. Chi-square test and logistic regression models were used in the data analysis. MAIN OUTCOME MEASURES: The main outcome measures were oral health behaviours (regular dental attendance, twice a day tooth-brushing frequency), general health behaviours (non-smoking habits, physical activity at least twice a week), subjective oral and general health and the SOC (12-item) scale. RESULTS: Among females, positive health behaviours tended to occur together significantly more often than among males. Thus, 83% of females with more than once a week physical exercise frequency, and 79% of the non-smoking females, brushed their teeth at least twice a day, while the corresponding figures for the males were merely 55% and 50%. A strong SOC was associated with uniformly positive health behaviours and subjective oral and general health. CONCLUSIONS: Our results suggest that a strong SOC has a universal positive association with several health behaviours and subjective health measures, also concerning oral health. Thus, the role of psycho-social factors should not be underestimated in health promotion.

Role of Employment in 11-Year Changes of Clinical Oral Health: A Multilevel Longitudinal Analysis.

The objective was to investigate the role of employment in the 11-y changes of clinically determined oral health. We used data from the longitudinal Health 2011 Survey, including reinvited subjects from the Health 2000 Survey. Data were gathered by clinical oral examinations, interviews, and questionnaires of those aged 30 to 63 y ( n = 1,031) in 2000. Exposures were change in employment from baseline to follow-up and length of unemployment. Outcomes measures were the numbers of missing teeth, sound teeth, filled teeth, decayed teeth, and teeth with periodontal pockets (≥4 mm and ≥6 mm). Separate mixed-effects and conventional negative binomial regression models were fitted for each oral health outcome. Demographic, socioeconomic, and oral health-related behaviors were added as covariates to the analyses. The findings showed that unemployment was inconsistently associated with poorer clinically determined oral health over 11 y. These effects were attributed to income and education and, to a lesser extent, to oral health-related behaviors. The length of unemployment was also inconsistently associated with oral health. The study concluded that one socioeconomic factor, unemployment, had a partial impact on oral health. Knowledge Transfer Statement: The findings of this study can help clinicians and oral health policy makers to reorient oral health services toward those who are unemployed as a risk group for poor oral health. The research highlights the role of employment in the longitudinal changes of clinically determined oral health, taking into consideration other socioeconomic factors. The study concluded that unemployment seemed to have a role in social inequalities of oral health.

Comparison of the effect of gluconate, lactose, and xylitol on bone recalcification in calcium-deficient rats.

The therapeutic value of three calcium absorption promoting carbohydrates, lactose, gluconate and xylitol, in bone calcification was evaluated in 7-week-old male rats which were fed on a semisynthetic Ca-deficient diet for 3 weeks. Lactose + CaCO3, xylitol + CaCO3, Ca-gluconate, or CaCO3 alone were administered to the Ca-deficient rats for 2 weeks; the carbohydrate and Ca contents of the diets were 5% and 0.5%, respectively. The Ca-deficient rats showed a decrease in serum total Ca and ionized Ca2+ and in tibial Ca, Mg, P and density, with a concomitant increase in bone hydroxyproline concentration. Bone and serum tartrate-resistant acid phosphatase activities were increased 2-fold and the serum 1,25(OH)2D3 level 5-fold. Smaller increases were found in serum calcitonin, PTH, alkaline phosphatase and osteocalcin levels. These changes (except calcitonin) were reversed by the administration of Ca and the carbohydrates. It was observed that all three agents improved the recalcification of bones compared with the effect of CaCO3 alone. The effect of lactose and xylitol was superior to that of gluconate. These results suggest advantages in the use of xylitol in Ca-supplements.

Dietary xylitol supplementation prevents osteoporotic changes in streptozotocin-diabetic rats.

The effects of 10% and 20% dietary xylitol supplementation on the biomechanical properties, trabeculation, and mineral content of long bones were studied in streptozotocin-diabetic rats. Forty 3-month-old male Wistar rats were divided randomly into four groups of 10. Rats in three groups were administered a single injection of streptozotocin (50 mg/kg body weight) to induce type I diabetes, while animals in the fourth group were given a sham injection of physiological saline. The sham-injected group and one of the streptozotocin-diabetic groups were fed the basal diet, while the two diabetic groups were fed the same diet supplemented with 10% and 20% xylitol (wt/wt). After 3 months, the rats were killed and the long bones were prepared for analysis. The 10% and 20% dietary xylitol supplementation significantly prevented the type I diabetes-induced decrease in the mechanical stress resistance of the tibia in the three-point bending test, the shear stress of the femur in the torsion test, and the stress resistance of the femoral neck in the loading test. No statistically significant differences were found between any groups in the values for strain or Young's modulus in the three-point bending test, or in the values for the shear modulus of elasticity in the torsion test. These findings indicate that dietary xylitol protects against the weakening of the bone strength properties of both cortical and trabecular bone without affecting the elastic-plastic properties. Supplementation with 10% and 20% dietary xylitol significantly prevented the type I diabetes-induced decrease of humeral ash weight and tibial density. Histomorphometric data for the secondary spongiosa of the proximal tibia showed that 10% and 20% dietary xylitol supplementation also significantly prevented the type I diabetes-induced loss of trabecular bone volume. In conclusion, dietary xylitol supplementation protects against the weakening of bone biomechanical properties in streptozotocin-diabetic rats. This is related to the preserved bone mineral content and preserved trabecular bone volume.

Improved bone biomechanical properties in xylitol-fed aged rats.

Our previous studies have shown that dietary xylitol protects against weakening of bone biomechanical properties in experimental postmenopausal osteoporosis. To study whether xylitol preserves bone biomechanics also during aging, a long-term experimental study was performed with rats. Twenty-four male Sprague-Dawley rats were divided into 2 groups. The rats in the control group (NON-XYL group) were fed a basal rat and mouse no. 1 maintenance (RM1) diet, while the rats in the experimental group (XYL group) were continuously fed the same diet supplemented with 10% xylitol (wt/wt). The rats were killed after 20 months. Their femurs were prepared for biomechanical analyses and scanning analyses with peripheral quantitative computed tomography (pQCT). In 3-point bending of the femoral diaphysis, maximum load, maximum elastic load, stiffness, energy absorption, elastic energy absorption, ultimate stress, and yield stress were significantly greater in the XYL group than in the NON-XYL group. This indicates a xylitol-induced improvement of both structural and material strength properties of cortical bone. Accordingly, the maximum load of femoral neck was significantly greater in the XYL group. In the pQCT analysis of femoral diaphysis, cortical bone area, cortical thickness (CtTh) periosteal circumference, and cross-sectional moment of inertia were greater in the XYL group. The endosteal circumference was smaller in the XYL group. In the pQCT analysis of the femoral neck cortical area of the midneck was significantly greater in the XYL group. This data indicates that xylitol exerted beneficial effects on the cross-sectional architecture of the bones. In conclusion, continuous moderate dietary xylitol supplementation leads to improved bone biomechanical properties in aged rats concerning both bone structural and material strength properties.

The antibacterial action of the various components of the lactoperoxidase system on a cariogenic strain of Streptococcus mutans.

Physiological activity of lactoperoxidase and in vivo concentration of thiocyanate ions were shown to be inhibitory against a cariogenic strain of Streptococcus mutans. However, the amount of H2O2 in vivo may be too low for optimum inhibition by lactoperoxidase system. H2O2 alone also inhibited the growth of S mutants to some degree.

Antibacterial effect of salivary peroxidases on a cariogenic strain of Streptococcus mutans.

The antibacterial effect of purified human salivary lactoperoxidase on a cariogenic strain of Streptococcus mutans was demonstrated while another oral peroxidase, probably of leukocytic origin, did not affect the growth. Lactoperoxidase was rapidly adsorbed by bacterial cells indicating the necessity of the contact between the enzyme and the cells before inhibition.

Optimism and life satisfaction as determinants for dental and general health behavior-oral health habits linked to cardiovascular risk factors.

Oral infections and cardiovascular diseases share common biological and behavioral risk factors. Psychosocial determinants could act as a link between general health behavior and dental health behavior. Our objective was to study optimism and life satisfaction as determinants of general and dental health behavior and to evaluate whether these are connected with cardiovascular risk factors and dental diseases. The 1966 Northern Finland Birth Cohort (N = 12,058) is a general population birth cohort. In a postal questionnaire, respondents (N = 8690) were asked about their health behavior and dental status. Cardiovascular risk factors were assessed in health examinations (N = 6033). Generalized linear regression models were used in analysis. The results showed that health orientation increases with strengthening life satisfaction and optimism. Dental health behavior and general health behavior were associated with both cardiovascular risk factors and self-reported dental diseases, which support the assumption that they share a common behavioral background.

Effects of dietary xylitol on collagen content and glycosylation in healthy and diabetic rats.

The effects of three-month dietary xylitol supplementation on the amounts and hexose contents of acid-soluble collagen as well as on the amounts and fluorescence of collagenase-soluble collagen were studied in healthy and streptozotocin-diabetic male rats. Collagen was extracted from skin samples. In the healthy rats, supplementation with xylitol (10%) increased the hydroxyproline content of the acid-soluble fraction and skin thickness. In diabetic rats receiving and not receiving xylitol, the acid-soluble collagen fraction was markedly lower than in healthy rats. However, its amount was significantly elevated when xylitol had been added to the diet. Supplementation with xylitol caused no changes in the amounts of collagenase-soluble fraction in either healthy or diabetic rats. Supplementation with xylitol (10%) significantly decreased the hexose content of acid-soluble collagen and the fluorescence of the collagenase-soluble fraction in both healthy and diabetic rats. The results indicate that dietary xylitol affects collagen synthesis and collagen glycosylation.

Interaction between Li, Ni and Sr content in human cancellous bone.

Li, Sr and Ni content of human cancellous bone and their relation to elemental composition was studied in specimens obtained from 88 subjects with a normal mineral status and from 50 subjects having osteoporotic changes due to chronic immobilizing diseases. The concentrations of Ca, Mg, Cd, Co, Cu, Mn, Ni, Li, Pb, Sr and Zn were analyzed with an atomic absorption spectrophotometer and fluoride with an ion selective electrode. The data was analyzed with the linear multiple regression analysis. Ni had a statistically significant inverse relation to Li. There was a significant positive correlation between Sr and Ni contents. Chronic immobilizing diseases did not affect significantly Li, Sr and Ni contents. Also no age dependent changes of these elements were found. The mean concentration S.D. of Li was 0.23 +/- 0.14 microgram/g, of Sr 65.5 +/- 40.7 micrograms/g and Ni 1.29 +/- 0.83 micrograms/g, respectively. The strong interrelation between Li, Sr and Ni suggest that these elements should be analyzed together in studying the role of these elements in the mineralization.

Macrophages and lymphocyte subpopulations in nifedipine- and cyclosporin A-associated human gingival overgrowth.

BACKGROUND: Nifedipine and cyclosporin A (CsA) induce gingival overgrowth. Both drugs have immunomodulating effects. It has been suggested that altered immune response is associated with drug-induced gingival overgrowth. In this study, we evaluated whether there were differences in macrophages and lymphocyte subpopulations in human nifedipine- and CsA-associated gingival overgrowth as compared with those in normal gingiva. METHODS: Biopsy samples of overgrown gingiva were obtained from 9 nifedipine-treated cardiac outpatients, 13 CsA-treated renal transplant recipients including 9 patients who were also receiving nifedipine, and 30 healthy control individuals undergoing dental treatment. Serial 5 microm thick cryostat sections were stained with mAbs for CD20 (B-pan), CD68 (macrophages), CD4 (T-helper/inducer), and CD8 (T-cytotoxic/suppressor) using an avidin-biotin-horseradish peroxidase complex method. Numbers of mAb-labeled and all nucleated cells were determined in 3 areas: the connective tissue beneath the sulcular epithelium, the middle connective tissue, and the connective tissue beneath the oral epithelium. Distributions of each type of cell were expressed as percentages of mAb-labeled cells in relation to total number of nucleated cells in a counting zone. Significances of differences between groups were tested by means of the Kruskal-Wallis test, and between pairs of results by means of the Mann-Whitney U-test. RESULTS: The proportion of CD8-labeled cells was significantly higher in connective tissue beneath the sulcular epithelium in the nifedipine group than in the controls (P = 0.014). In both medicated groups, the proportions of CD68-labeled cells were higher in all counting zones than in the controls, but statistically significantly only in the nifedipine group in the connective tissue beneath the oral epithelium (P = 0.008). No intergroup differences were found with respect to CD4- and CD20-labeled cells. The CD4/CD8 ratio was significantly lower in connective tissue beneath the sulcular epithelium in the nifedipine group than in the controls (P= 0.013). CONCLUSION: The results support the idea that immune response may be altered in drug-induced gingival overgrowth.

Relation between control of diabetes and gingival bleeding.

The periodontal health status of 50 adult diabetics and 53 healthy controls was examined. The diabetic group was further divided into three subgroups according to the control of diabetes. Comparison between the entire diabetic group and the control group did not reveal any differences in either the amount of etiologic factors or in the degree of gingival changes. On the other hand when the subgroups of diabetic patients were examined, those with poorly controlled diabetes suffered significantly more from gingival bleeding than those with good or moderate control. The difference in the amount of gingival bleeding between diabetics with poor control and the control group was also statistically significant. The amount of etiologic factors, however, was similar in all the studied diabetic subgroups indicating an independent significance of the degree of control of diabetes. No correlation was found between duration, complications and medication of diabetes and gingival bleeding. The reason for increased bleeding in poorly controlled diabetics could be either inflammation or vascular changes in the gingiva.

Effect of chlorhexidine on the hamster cheek pouch. Microcirculation and penetration studies.

The application of chlorhexidine gluconate on the intact cheek pouch of hamsters led to an immediate increase of flow velocity determined in venules beneath the epithelium. The application of [14C]chlorhexidine on the intact cheek pouch led to accumulation of labeled material in the liver and kidneys. Both findings indicate that penetration of the drug occurred through the epithelium of the cheek pouch.