Association between oral health and cardiovascular outcomes in patients with hypertension: a nationwide cohort study

Renal hyperfiltration is associated with a reduced incidence of hypertension in individuals younger than 70

Although the connection between decreased kidney function and hypertension is commonly acknowledged, there is insufficient research examining the relationship between renal hyperfiltration (higher-than-normal estimated glomerular filtration rate (eGFR)) and the incidence risk of hypertension. Therefore, through a nationwide longitudinal study, our research aimed to explore the relationship between the eGFR and the incidence risk of hypertension in the general population. This research used the cohort records for the National Health Insurance Service in Korea, analyzing records from 1,873,550 individuals between the ages of 20 and 79 who underwent health check-ups between 2010 and 2011. The eGFR levels, determined by applying the 2009 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, were employed to evaluate the renal function. An incidence of hypertension was confirmed when a diagnosis of (primary or secondary) hypertension (International Classification of Diseases (ICD)-10 codes I10-I11) was noted at least once per year during outpatient or inpatient care with a prescription for antihypertensive medication or at least one more surpassing 140/90 mmHg from a health examination after the index date after excluding diagnosis of secondary hypertension. The mean age of subjects was 46.03 ± 11.24 years. The 411,029 (21.9%) hypertension cases were identified over a median follow-up of 9.53 years. In the multivariable Cox regression analysis, compared with the 5th decile, the 10th eGFR deciles (≥ 115.58 mL/min/1.73 m²) (hazard ratio (HR): 0.87, 95% confidence interval (CI)(0.85-0.88), p < 0.001) demonstrated a significant association with a reduced incidence of hypertension. Moreover, an eGFR exceeding 120 mL/min/1.73 m² was linked to a lowered likelihood of hypertension (HR: 0.78, 95% CI (0.76-0.80), p < 0.001) compared to normal eGFR levels (90 ~ 120 mL/min/1.73 m²). In contrast, in the subgroup analysis of ages over 70 years old, renal hyperfiltration was not associated with a reduced incidence of hypertension. In our study, renal hyperfiltration were associated with a reduced risk of hypertension, and this association was particularly significant in those younger than 70 years old. The association between renal hyperfiltration and a lower risk of hypertension incidence was likely to vary with age.

Persisting Chronic Periodontal Disease as a Risk Factor for Cardiovascular Disease: A Nationwide Population-Based Cohort Study

AIMS

Epidemiological studies have consistently established a positive association between periodontal disease (PD) and cardiovascular disease (CVD). However, large-scale investigations exploring the impact of changes in PD status on CVD risk are scarce. This study aimed to investigate the association between the dynamics in PD and the risk of incident CVD in a nationally representative population.

METHODS

Utilising data from the Korean National Health Insurance Service, a cohort of 1,242,570 participants who underwent oral health exams in 2003 and a follow-up exam in 2005-2006 was analysed. Participants were categorized into groups based on changes in PD status: absent, improvement, onset and persistent. Cox proportional hazard models were employed to assess the multivariate-adjusted hazard ratios (HRs) for composite CVD outcomes, including death, myocardial infarction and stroke.

RESULTS

Over a mean follow-up of 14.4 years, 79,810 (6.4%) cases of composite CVD occurred, including 14,296 (1.2%) myocardial infarctions, 3247 (0.3%) hemorrhagic strokes and 8900 (0.7%) ischemic strokes. Individuals with persistent PD showed the highest risk of CVD (HR: 1.04, 95% CI: 1.03-1.06, p < 0.001). In the pairwise comparisons, the PD improvement group exhibited a lower composite CVD risk than the PD persistent group (HR: 0.97, 95% CI: 0.96-0.99, p = 0.010); similarly, the PD onset group showed a lower risk than the PD persistent group (HR: 0.94, 95% CI: 0.93-0.96, p < 0.001). This pattern was consistent in the risk of death, with both the PD improvement and PD onset groups showing a lower risk of death than the PD persistent group.

CONCLUSION

This study suggests the dynamic nature of PD as a potential modifiable risk factor for CVD. Individuals with chronically persistent PD showed an elevated incidence risk of CVD, emphasizing the importance of managing PD in preventive strategies.

Association Between the Frequency of Tooth Brushing and the Risk of Cardiovascular Disease: A Systematic Review and Meta-analysis

Several epidemiological studies suggested that frequency of tooth brushing may be associated with cardiovascular disease (CVD) risk, but the results remain inconclusive. Therefore, the aim of this study was to synthesize frequency of tooth brushing and CVD risk using meta-analysis. Science Direct, PubMed, CINAHL, and OVID were searched through October 15, 2022. The random-effects model was used to quantitatively assess the combined risk estimation. In addition, we performed the sensitivity analysis to evaluate the robustness of the study results by excluding the included studies one by one. A total of 9 cohort studies containing 10 reports with 803,019 individuals were included in the meta-analysis. Pooled results showed that compared with the lowest brushing frequency, the highest brushing frequency (relative risk = 0.85, 95% confidence interval: 0.80-0.90) significantly reduced the risk of cardiovascular disease. There was moderate heterogeneity among included studies (P = .002, I2 = 65.4%). The exclusion of any one study did not materially change the combined risk estimates. Our meta-analysis supported the hypothesis that higher frequency of tooth brushing can reduce the risk of CVD, which may have important implications for conducting research on the prevention strategies of CVD.

Periodontitis and the Incidence of Inflammatory Bowel Diseases: A Nationwide Population-Based Cohort Study

INTRODUCTION

Periodontitis and other oral health indicators are reportedly related to systemic inflammation. Our study aimed to investigate a possible association of oral health status (periodontitis and number of missing teeth) and oral hygiene behaviors (frequency of tooth brushing, dental visit, and dental scaling) with the risk of inflammatory bowel disease (IBD) incidence.

METHODS

Using the Korean National Health Insurance Database, we conducted a nationwide, population-based cohort study involving participants from the 2003 national health screening program. We followed these individuals until December 2020 or the occurrence of censoring events. Crohn's disease (CD) and ulcerative colitis (UC) were defined by disease classification codes from the International Classification of Diseases-10 and national codes for rare intractable disease. The occurrence of IBD was analyzed using the Cox proportional hazard model, with propensity score matching performed to balance baseline characteristics between participants with and without periodontitis.

RESULTS

Our analysis involved a total of 2,272,012 participants with a median follow-up period of 17.0 years. The incidence rates for CD and UC were 11.6 and 32.4 per 100,000 person-years, respectively. In multivariable analysis after propensity score matching, the presence of periodontitis was associated with an increased risk of both CD (adjusted hazard ratio [aHR] 1.32, 95% confidence interval [CI] 1.14-1.52, P < 0.001) and UC (aHR 1.21, 95% CI 1.10-1.32, P < 0.001). Conversely, frequent tooth brushing ≥3 times a day was associated with a reduced risk of CD (aHR 0.81, 95% CI 0.65-0.99, P = 0.049), but no significant association was observed with UC.

DISCUSSION

Periodontitis may augment the risk of incidence for CD and UC. This association underscores the potential significance of periodontal health in the context of IBD, emphasizing the importance of comprehensive oral hygiene practices and potential preventive strategies to reduce the risk of CD and UC incidence.

Association between triglyceride/high density lipoprotein ratio and incidence risk of Parkinson's disease: a population-based cohort study

The association between insulin resistance and increased risk of Parkinson's disease (PD) has rarely been investigated. Our study aimed to investigate the association between the triglyceride/high-density lipoprotein (TG/HDL) ratio (which represents insulin resistance), and the incidence risk of PD in the general population. This study was conducted using data from the National Health Insurance Service-Health Screening Cohort Database of South Korea (2002-2019). We enrolled 310,023 participants who had no previous PD history and who had undergone more than three repeated measurements for the TG/HDL cholesterol ratio. The diagnosis of PD was determined using the International Classification of Diseases, 10th Revision code G20, specific reimbursement codes for Rare Intractable Diseases of V124, and a history of anti-PD drug prescription. During a median of 9.64 years (interquartile range 8.72-10.53), 4,587 individuals (1.47%) had an incidence of PD. Considering the multivariable time-dependent Cox proportional hazard model with repeated measures of average TG/HDL cholesterol ratio, a per unit increase in TG/HDL cholesterol ratio significantly increased the risk of PD in the entire cohort (hazard ratio (HR), 1.010; 95% confidence interval (CI), 1.001-1.020). These repeated measures of the average TG/HDL cholesterol ratio were associated with the incidence risk of PD in a J-shaped pattern for the entire diabetes mellitus (DM) and non-DM cohorts in restricted cubic spline analysis. Compared to the lowest tertiles (T1), the highest tertiles (T3) were positively associated with the incidence risk of PD (HR: 1.149, 95% CI 1.065-1.239 in the entire cohort, p for trend < 0.001; HR: 1.175, 95% CI 1.075-1.285 in the non-DM cohort, p for trend < 0.001). In contrast, the lowest (T1) and highest tertiles (T3) were not associated with the incidence risk of PD in the DM cohort (HR: 1.128, 95% CI 0.909-1.348) in fully adjusted multivariable analysis. Our study provides information that TG/HDL ratio may be positively associated with PD incidence risk in a non-DM population in longitudinal setting of the general population.

Association between the triglyceride/high-density lipoprotein (TG/HDL) ratio and incidence of gout: A nationwide cohort study

Introduction

The global burden of gout, a severe and painful arthralgia, is of note and is expected to increase in the future. We aimed to investigate the association between the triglyceride/high-density lipoprotein (TG/HDL) ratio, a simple and validated biomarker for insulin resistance, and the incidence of gout in a longitudinal setting in the general population.

Methods

Our study was conducted using the National Health Insurance Service-Health Screening Cohort database of Republic of Korea (2002-2019). We included 300,107 participants who had no previous history of gout and had data for more than three repeated measurements of the triglyceride-glucose (TyG) index. The incidence of gout was determined using at least two or more claims of the ICD-10 code M10.

Results

During a median 9.62 years (interquartile range 8.72-10.53), 14,116 individuals (4.72%) had a reported incidence of gout. In a fully adjusted multivariable time-dependent Cox proportional hazards model with repeated measures of the TyG index, a unit increase in the index significantly increased the risk of gout in the entire cohort (hazard ratio (HR) = 1.150, 95% confidence interval (CI) 1.116-1.184). In a multivariable Cox proportional model of average TyG index quartiles, comparison of the lowest (Q1) and highest quartiles (Q4) indicated a significant positive association with the incidence of gout (HR: 1.326, 95% CI: 1.260-1.397). This association was non-linear (J-shape) when assessing the entire cohort and the diabetes and non-diabetes cohorts.

Conclusion

Our study demonstrated that increased TyG index was associated with an incidence risk of gout in the general population. Additionally, this association was non-linear (J-shape) not only in the entire cohort, but also in diabetes mellitus and non-diabetes mellitus cohorts. The TyG index may be an important predictor of gout.

Periodontal pathogens and obesity in the context of cardiovascular risks across age groups

Background

Cardiovascular diseases (CVDs) are the leading cause of mortality and morbidity among noncommunicable diseases. Over the past decade, there has been a notable increase in the prevalence of CVDs among young individuals. Obesity, a well-known risk factor for CVDs, is also associated with various comorbidities that may contribute to cardiovascular risk. The relationship between periodontal pathogens and CVD risk factors, including obesity, smoking, lipid metabolism disorders, and inflammatory markers, remains underexplored.

Methods

This study examined the relationship between six periodontal pathogens (Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Treponema denticola, Tannerella forsythia, Prevotella intermedia, and Fusobacterium nucleatum) and CVD risk factors among 189 subjects stratified by age and body mass index (BMI). Body composition was assessed via bioimpedance analysis, and blood samples were analyzed for lipid profiles, glucose, and proinflammatory cytokines. Oral samples were collected for polymerase chain reaction (PCR) analysis to identify periodontal pathogens. Cardiovascular and diabetes risk scores were calculated using the SCORE and FINDRISC scales.

Results

The prevalence of periodontal pathogens in the population was 33.0% for P. gingivalis, 47.8% for P. intermedia, 63.4% for A. actinomycetemcomitans, 46.6% for T. forsythia, 46.6% for T. denticola, and 89.2% for F. nucleatum. Significant age- and BMI-related differences were observed in pathogen prevalence, particularly with P. gingivalis, P. intermedia, and T. denticola. Young obese individuals exhibited a higher prevalence of P. intermedia and T. forsythia. P. gingivalis was found to be associated with hypertension and dyslipidemia, while P. intermedia was linked to hypertension and obesity. T. denticola was associated with obesity, dyslipidemia and smoking, whereas T. forsythia was linked to dyslipidemia alone.

Conclusions

This study highlights the potential connection between periodontal pathogens and risk factors associated with cardiovascular disease, including smoking, elevated BMI, increased adipose tissue, hypertension, and dyslipidemia. Further research is required to determine the causal relationships between oral microbiome dysbiosis, obesity and, systemic diseases and to develop an effective strategy for preventing oral health-related CVD risk factors in young adults.

Association of Body Composition Changes with the Development of Diabetes Mellitus: A Nation-Wide Population Study

BACKGRUOUND

We investigated the association between body composition changes and new-onset diabetes mellitus (DM) development according to the body mass index (BMI) in a longitudinal setting in the general Korean population.

METHODS

From 2010 to 2011 (1st) and 2012 to 2013 (2nd), we included 1,607,508 stratified random sample participants without DM from the National Health Insurance Service-Health Screening dataset of Korean. The predicted appendicular skeletal muscle mass index (pASMMI), body fat mass index (pBFMI), and lean body mass index (pLBMI) were calculated using pre-validated anthropometric prediction equations. A prediction equation was constructed by combining age, weight, height, waist circumference, serum creatinine levels, alcohol consumption status, physical activity, and smoking history as variables affecting body composition.

RESULTS

Decreased pASMMI (men: hazard ratio [HR], 0.866; 95% confidence interval [CI], 0.830 to 0.903; P<0.001; women: HR, 0.748; 95% CI, 0.635 to 0.881; P<0.001), decreased pLBMI (men: HR, 0.931; 95% CI, 0.912 to 0.952; P<0.001; women: HR, 0.906; 95% CI, 0.856 to 0.959; P=0.007), and increased pBFMI (men: HR, 1.073; 95% CI, 1.050 to 1.096; P<0.001; women: HR, 1.114; 95% CI, 1.047 to 1.186; P=0.007) correlated with the development of new-onset DM. Notably, only in the overweight and obese BMI categories, decreases in pASMMI and pLBMI and increases in pBFMI associated with new-onset DM, regardless of gender.

CONCLUSION

Decreased pASMMI and pLBMI, and increased pBFMI with excess fat accumulation may enhance the risk of newonset DM. Therefore, appropriate changes in body composition can help prevent new-onset DM.

Persistent proteinuria is associated with the occurrence of cardiovascular disease: a nationwide population-based cohort study

Proteinuria is an important risk factor for cardiovascular disease (CVD) and acts as a surrogate marker of renal damage. This study aimed to determine the association between changes in proteinuria and the occurrence of CVD. In our study, 1,708,712 participants who consecutively underwent national health examinations from 2003-2004 (first period) to 2005-2006 (second period) were included. They were classified into four groups based on the presence of proteinuria at the two consecutive health examinations: (1) normal (0 → 0), (2) proteinuria-improved (participants who had improved proteinuria (+ 1 → 0, + 2 → ≤ +1 [0 or + 1], ≥ +3 → ≤ +2 [0, + 1 or + 2]), (3) proteinuria-progressed (0 → ≥ +1, + 1 → ≥ +2, + 2 → ≥ +3), and (4) proteinuria-persistent (+ 1 → +1, + 2 → +2, ≥ +3 → ≥ +3). We used a multivariate Cox proportional hazards model to assess the occurrence of CVD according to changes of presence and severity of proteinuria. During a median of 14.2 years of follow-up, 143,041 participants (event rate, 8.37%) with composite CVD were observed. Compared with the normal group, the risk of incident risk of CVD was increased according to the severity of proteinuria in each of the persistent, progressed, and improved groups (p for trend < 0.001). In a pairwise comparison, the risk of composite CVD in the improved (hazard ratio [HR]: 1.32, 95% confidence interval [CI]: 1.27-1.37), progressed (HR: 1.49, 95% CI: 1.44-1.54), and persistent groups (HR: 1.78, 95% CI: 1.64-1.94) were higher than that of the normal group. Furthermore, the improved group had a relatively lower risk of composite CVD compared to the persistent group (HR: 0.75, 95% CI: 0.69-0.83, p < 0.001). The incidence risk of composite CVD was associated with changes of presence and severity of proteinuria. Persistent proteinuria may be associated with increased risk of CVD, even compared with improved or progressed proteinuria status.

Comparison of perceived stress and oral health status using perceived stress scale and DMFT index between healthy, undiagnosed hypertensive, and known hypertensive dental patients

Subtle and asymptomatic nature of high blood pressure results in increase in mortality and morbidity. Dentists may play a vital role in identifying patients with suspected hypertension who are not yet diagnosed to refer them timely to physicians for diagnosis and management of the condition. The aim of this study was to compare the oral health status using decayed, missing, filled teeth (DMFT) index and perceived stress score using perceived stress scale (PSS-10) between systemically healthy dental patients, and patients with undiagnosed and known hypertension attending dental out-patient department of Combined Military Hospital (CMH) Lahore Medical College & Institute of Dentistry, Lahore, Pakistan. It is a cross-sectional descriptive study in which 108 patients participated selected through purposive sampling method, 36 in each group. According to Kruskal Wallis H test, there were significant associations seen among the three groups with age (p < 0.001), DMFT (p < 0.001), and PSS-10 scores (p = 0.003). According to Spearman's matrix correlations, moderate positive correlations were observed between mean arterial pressure (MAP) and DMFT (r = 0.46, p < 0.001), and MAP and age (r = 0.38, p = 0.001), DMFT and PSS-10 (r = 0.47, p < 0.001), and DMFT and age (r = 0.33, p = 0.004) in healthy and patients with undiagnosed hypertension. It may be concluded that patients with raised blood pressure have higher perceived stress and deteriorated oral health.

Impact of Oral Hygiene Practices in Reducing Cardiometabolic Risk, Incidence, and Mortality: A Systematic Review

Cardiometabolic diseases share many modifiable risk factors. However, periodontitis, a chronic inflammatory condition of the gums, is a risk factor that is rarely publicized. This systematic review aims to evaluate the impact of oral hygiene practices on the risk, incidence, and/or mortality rate of cardiovascular disease (CVD), type 2 diabetes mellitus (T2DM), and chronic kidney disease (CKD). Searches were conducted using MEDLINE, Embase, Scopus, and CINHAL. Randomized controlled trials (RCTs), quasi-RCTs, and observational studies were included. Eligible studies reported on associations of toothbrushing, interdental cleaning, mouthwash, or toothpaste use, either alone or in combination with CVD, CKD, and/or T2DM outcomes in adults ≥ 18 years. Fifty-five studies were included. Cochrane's risk of bias tool and the Newcastle-Ottawa Scale were used for quality assessment. Data synthesis is narratively presented. Toothbrushing and interdental cleaning were associated with lower risk of developing T2DM or hypertension HR 0.54 [p < 0.001] and a lower mortality risk in those with CVD HR = 0.25 [p = 0.03]. Mouthwash use reportedly increased the risk of developing hypertension and diabetes by 85% and 55%, respectively. This review highlights how simple oral hygiene practices can reduce cardiometabolic risk. Non-dental clinicians could integrate the findings into chronic disease health promotion.

Chronic periodontal disease is related with newly developing hypertension: a nationwide cohort study

BACKGROUND

Periodontal disease (PD) is a condition that can be treated and managed. This study aimed to determine if chronic PD status is associated with the risk of developing hypertension, utilizing data from the National Health Insurance Database of Korea.

METHODS

Participants who received oral health examinations both in 2003 and in 2005-2006 were included. Those with a history of hypertension were excluded. Hypertension was defined as at least one outpatient or inpatient claim diagnosis (primary or secondary) of hypertension (International Classification of Diseases (ICD)-10 codes I10-I11) with prescription for antihypertensive medication or at least one incident of systolic blood pressure greater than 140 mmHg or diastolic blood pressure greater than 90 mmHg during a health examination. Changes of PD status was determined during two oral examinations. Study participants were divided into 4 groups according to the changes of PD status: PD-free (those consistently free of disease in both exams), PD-recovered (individuals with disease initially but not in the second exam), PD-developed (no disease initially, but present in the second exam), and PD-chronic (disease throughout both exams). The incidence of hypertension after the second oral health examination (index date) was monitored. Participants were observed from the index date until the earliest occurrence of hypertension onset, mortality, or December 2020.

RESULTS

The study comprised 706,584 participants: 253,003(35.8%) in the PD-free group, 140,143(19.8%) in the PD-recovered group, 132,397(18.7%) in the PD-developed group, and 181,041(25.6%) in the PD-chronic group. Over a median follow-up duration of 14.3 years, 239,937 (34.0%) cases of hypertension were recorded. The PD-recovered group had a lower risk of hypertension compared to the PD-chronic group, while the PD-developed group had a higher risk of hypertension compared to the PD-free group.

CONCLUSION

Chronic PD is associated with an increased risk of developing hypertension. Although the increase in risk is modest, recovery from PD may have beneficial effects in reducing hypertension risk. Further studies are needed to confirm the importance of regular dental examinations and effective management of PD to reduce hypertension risk.

Association of Renal Hyperfiltration with Incidence of New-Onset Diabetes Mellitus: A Nationwide Cohort Study

Background and Objectives: While the connection between decreased kidney function and diabetes mellitus (DM) is commonly acknowledged, there is insufficient research examining the relationship between higher-than-normal estimated glomerular filtration rate (eGFR) and the incidence risk of new-onset DM. Our research aimed to explore the relationship between an eGFR and the incidence risk of new-onset DM in the Korean general population through a nationwide longitudinal study. Methods: This research employed the cohort records of the National Health Insurance Service in Korea, analyzing records from 2,294,358 individuals between the ages of 20 and 79 who underwent health check-ups between 2010 and 2011. The eGFR levels from the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation were used to assess the renal function. New-onset DM was defined as two or more claims with the International Classification of Diseases-10 classification codes E10 to E14, being prescribed any medication for lowering blood glucose, or having a record of fasting plasma glucose levels of ≥126 mg/dL from a health examination after the index date. Results: The mean age of subjects was 47.34 ± 13.76 years. The 150,813 (6.57%) new-onset DM cases were identified over a median follow-up of 9.63 years. In the multivariable Cox regression analysis, in comparison with the 5th decile, the 10th (≥114.12 mL/min/1.73 m2) (hazard ratio (HR): 0.52, 95% confidence interval (CI) (0.50-0.54), p < 0.001) eGFR decile was significantly associated with a decreased incidence of new-onset DM. Moreover, eGFR >120 mL/min/1.73 m2 was associated with a reduced risk of new-onset DM (HR: 0.40, 95% CI (0.39-0.42), p < 0.001). These results were consistent regardless of the presence of impaired glucose tolerance, age, or obesity. Conclusion: Our study showed higher-than-normal eGFR levels were associated with a lower risk of incidence for new-onset DM regardless of the presence of impaired glucose tolerance, age, or obesity. In general population, higher-than-normal eGFR may be associated with a lower risk of incidence of new-onset DM.

The Association of Dental Caries or Dental Implant Placement Within One Year of Primary Total Hip Arthroplasty on Medical and Implant Complications

BACKGROUND

Total hip arthroplasty (THA) adverse events among patients who have dental diagnoses remain unclear. We sought to determine if dental caries or dental implant placements increased (1) 90-day medical complications, (2) 90-day readmissions, and (3) 2-year implant-related complications, including periprosthetic joint infections (PJIs) after THA.

METHODS

A nationwide database for primary THAs from 2010 to 2021 was queried to compare 3 patient cohorts. Patients who had a history of dental implants or caries within 12 months prior to THA (n = 1,179) or 12 months after THA (n = 1,218) were case-matched to patients who did not have dental history (n = 6,090) by age and comorbidities. Outcomes included 90-day complications, 90-day readmissions, and 2-year implant-related complications. Logistic regression models computed the odds ratios (ORs) of complications and readmissions. P values less than .006 were significant.

RESULTS

Patients who had dental caries or implant placement 12 months before or after THA experienced 1.6-fold greater odds of 90-day medical complications compared to case-matched patients. Readmissions within 90 days increased for patients who had a dental history before (11.7% versus 8.3%; OR: 1.49, P < .0001) and after (14.2% versus 8.3%; OR: 1.84, P < .0001) THA compared to case-matched patients. A dental caries diagnosis or dental implant placement within 12 months following THA increased 2-year implant complications compared to case-matched patients (15.2% versus 9.3%; OR: 1.69, P < .0001), including PJIs (5.3% versus 2.8%; OR: 1.98, P < .0001), dislocations (4.4% versus 2.7%; OR: 1.63, P = .002), and THA revisions (3.9% versus 2.5%; OR: 1.61, P = .005).

CONCLUSIONS

Dental diagnoses within 12 months of THA are associated with increased medical complications. Dental diagnoses occurring 12 months after THA are associated with greater implant-related complications, including PJIs. Delaying invasive dental procedures for 12 months after THA may be advisable.

Improved Proteinuria May Attenuate the Risk of Atrial Fibrillation: A Nationwide Population-Based Cohort Study

Background/Objectives: Proteinuria is documented as a risk factor for atrial fibrillation (AF) and can manifest in either reversible or continued forms. Our objective was to examine the relationship between the change in status for proteinuria and the risk of AF in a longitudinal cohort study on the general population nationwide. Methods: We included participants (n = 1,708,103) who underwent repetitive health examinations. The presence of proteinuria was determined by dipstick urinalysis results. The outcome was the occurrence of AF (International Classification of Diseases-10 code: I48). Results: All included participants, 1,666,111 (97.5%), 17,659 (1.0%), 19,696 (1.2%), and 4637 (0.3%), were categorized into groups of proteinuria-free, improved, progressed, and persistent, respectively. During a median follow-up of 14.5 years, 41,190 (2.4%) cases of AF occurred. In the multivariable analysis, the risk of AF was increased as the initial severity was more severe in the proteinuria-improved and proteinuria-persistent groups (p for trend < 0.001). In a further pairwise comparison, the proteinuria-improved group had a relatively lower risk of AF compared to the proteinuria-persistent group (HR: 0.751, 95% CI: 0.652-0.865, p < 0.001). Conclusions: Our study showed that the risk of AF can change according to alterations in proteinuria status. Notably, recovering from proteinuria can also be considered a modifiable risk factor for AF.

Association of oral health with all-cause and cause-specific mortality in older Chinese adults: A 14-year follow-up of the Guangzhou Biobank Cohort study

Background

Poor oral hygiene is associated with overall wellness, but evidence regarding associations of oral health with all-cause mortality remain inconclusive. We aimed to examine the associations of oral health with all-cause and cause-specific mortality in middle-aged and older Chinese adults.

Methods

28 006 participants were recruited from 2003-2008 and followed up until 2021. Oral health was assessed by face-to-face interview and causes of death was identified via record linkage. Cox regression yielded hazard ratios (HRs) and 95% confidence intervals (CIs) with adjustment of multiple potential confounders.

Results

During an average of 14.3 years of follow-up, we found that a lower frequency of toothbrushing was associated with higher risks of all-cause mortality with a dose-response pattern (P for trend <0.001). Specially, the adjusted HR (95% CI) (vs. ≥ twice/d) was 1.16 (1.10, 1.22) (P < 0.001) for brushing once/d and 1.27 (1.00, 1.61) (P = 0.048) for < once/d. Similar associations were also found for cardiovascular disease (CVD), stroke, and respiratory disease mortality, but not for ischemic heart disease (IHD) and cancer mortality. A greater number of missing teeth was also associated with higher risks of all-cause, CVD, stroke, and respiratory disease mortality with a dose-response pattern (all P for trend <0.05). The association of missing teeth with all-cause mortality was stronger in lower-educated participants.

Conclusions

Both less frequent toothbrushing and a greater number of missing teeth were associated with higher risks of all-cause, CVD, stroke, and respiratory disease mortality, showing dose-response patterns, but not with IHD and cancer mortality. Moreover, the dose-response association of missing teeth with all-cause mortality was stronger in lower-educated participants.

Clinical Study and Microbiological Analysis of Periodontopathogenic Microflora Analyzed among Children and Adolescents with Cardiovascular Diseases Compared to Group with Good General Status

Periodontal diseases, as an important part of oral pathology, present different characteristics when affecting children and adolescents or young adults. Studies have shown that adolescence and childhood are closely related to a high risk of periodontal disease, but the follow-up for periodontal health or damage at this age has been insufficiently appreciated until now. The aim of this study was to identify subgingival microorganisms using a real-time polymerase chain reaction (PCR) in a group of children and adolescents aged 7-17 years with and without cardiovascular disease. The group of 62 subjects with gingival inflammation and poor hygiene was divided into two groups according to general condition: 31 subjects with carduivascular disease (group A) and 31 subjects without cardiovascular disease (group C). Subjects were examined in the initial consultation, the state of hygiene and periodontal inflammation was assessed using the plaque index (PI) and gingival index (GI), and samples were taken from the gingival sulcus using sterile paper cones to determine nine subgingival microorganisms. Nine subgingival microorganisms were identified: Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Treponema denticola (Td), Tannerella forsythias (Tf), Prevotella intermedia (Pi), Peptostreptococcus (Micromonas) micros (Pm), Fusobacterium nucleatum (Fn), Eubacterium nodatum (En), and Capnocytophaga gingivalis (Cg). The patients were included in a specialist treatment program which aimed to relieve the inflammatory condition, remove local irritative factors, and train the patients to perform proper oral hygiene at home by using primary and secondary oral hygiene products. Subjects were reevaluated 3 months after treatment, when measurements for the PI and GI and microbiological determinations were repeated. The results showed a predominance of subjects aged 16-17 years (12.4%). Among the subjects with marked gingival inflammation, the male gender was predominant (58.06%). The PI values changed considerably after treatment, with lower values in patients presenting a general condition without cardiovascular disease (PI = 8.10%) compared with the patients with cardiovascular disease (PI = 13.77%). After treatment, the GI showed considerable changes in both groups. Red, orange, and purple complex microorganisms were found before treatment and decreased considerably after treatment in both groups. The highest values were found for Treponema denticola (140,000 (1.4 × 105)) in patients with cardiovascular disease and generalized gingival inflammation. Of the pathogenic microorganisms, the most common was Tannerella forsythia in 52 patients before treatment, and red microorganisms considerably appeared in only 10 patients after treatment. Capnocytophaga gingivalis remained constant both in the diseased state and after treatment and was consistent with periodontal health. Children with cardiovascular diseases had a higher prevalence of gingival manifestations. The composition of the subgingival microbial plaque was directly influenced by the degree of oral hygiene, but the response to specialized treatment was also influenced by the general health status. The results of this study support the conclusion that periodontal pathogens appear and multiply in the absence of proper hygiene in childhood after the eruption of permanent teeth, and their action leads to the initiation of periodontal diseases.

The role of periodontitis in the development of atherosclerotic cardiovascular disease in participants with the components of metabolic syndrome: a systematic review and meta-analysis

OBJECTIVES

Prevention of atherosclerotic cardiovascular disease (ASCVD) is important in individuals with metabolic syndrome components (MetS), and periodontitis may play an important role in this process. This study aims to evaluate the association between periodontitis and ASCVD in participants with the components of MetS, including obesity, dysglycemia, hypertension, and dyslipidemia.

MATERIALS AND METHODS

This study conducted followed the MOOSE reporting guidelines and the PRISMA 2020 guidelines. EMBASE, MEDLINE, Web of Science, Cochrane Library, PubMed and OpenGrey were searched for observational studies about the linkage of periodontitis to ASCVD in people with MetS components up to April 9, 2023. Cohort, case-control and cross-sectional studies were included after study selection. Quality evaluation was carried out using the original and modified Newcastle-Ottawa Scale as appropriate. Random-effects model was employed for meta-analysis.

RESULTS

Nineteen studies were finally included in the quality analysis, and all of them were assessed as moderate to high quality. Meta-analyses among fifteen studies revealed that the participants with periodontitis were more likely to develop ASCVD in those who have dysglycemia (RR = 1.25, 95% CI = 1.13-1.37; p < 0.05), obesity (RR = 1.13, 95% CI = 1.02-1.24; p < 0.05), dyslipidemia (RR = 1.36, 95% CI = 1.13-1.65; p < 0.05), or hypertension (1.20, 95% CI = 1.05-1.36; p < 0.05).

CONCLUSIONS

Periodontitis promotes the development of ASCVD in participants with one MetS component (obesity, dysglycemia, hypertension or dyslipidemia).

CLINICAL RELEVANCE

In people with MetS components, periodontitis may contribute to the ASCVD incidence.

Utilization of machine learning models in predicting caries risk groups and oral health-related risk factors in adults

BACKGROUND

The aim of this study was to analyse the risk factors that affect oral health in adults and to evaluate the success of different machine learning algorithms in predicting these risk factors.

METHODS

This study included 2000 patients aged 18 years and older who were admitted to the Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Gaziantep University, between September and December 2023. In this study, patients completed a 30-item questionnaire designed to assess the factors that affect the decayed, missing, and filled teeth (DMFT). Clinical and radiological examinations were performed, and DMFT scores were calculated after completion of the questionnaire. The obtained data were randomly divided into a 75% training group and a 25% test group. The preprocessed dataset was analysed using various machine learning algorithms, including naive Bayes, logistic regression, support vector machine, decision tree, random forest and Multilayer Perceptron algorithms. Pearson's correlation test was also conducted to assess the correlation between participants' DMFT scores and oral health risk factors. The performance of each algorithm was evaluated to determine the most appropriate algorithm, and model performance was assessed using accuracy, precision, recall and F1 score on the test dataset.

RESULTS

A statistically significant difference was found between various factors and DMFT-based risk groups (p < 0.05), including age, sex, body mass index, tooth brushing frequency, socioeconomic status, employment status, education level, marital status, hypertension, diabetes status, renal disease status, consumption of sugary snacks, dry mouth status and screen time. When considering machine learning algorithms for risk group assessments, the Multilayer Perceptron model demonstrated the highest level of success, achieving an accuracy of 95.8%, an F1-score of 96%, and precision and recall rates of 96%.

CONCLUSIONS

Caries risk assessment using a simple questionnaire can identify individuals at risk of dental caries, determine the key risk factors, provide information to help reduce the risk of dental caries over time and ensure follow-up. In addition, it is extremely important to apply effective preventive treatments and to prevent the general health problems that are caused by the deterioration of oral health. The results of this study show the potential of machine learning algorithms for predicting caries risk groups, and these algorithms are promising for future studies.

Association of body composition indices with cardiovascular outcomes: a nationwide cohort study

BACKGROUND

Previous studies regarding BMI (kg/m2) and associated cardiovascular outcomes yield inconsistent results.

OBJECTIVES

We aimed to investigate the association between body composition and cardiovascular outcomes according to BMI categories in the Korean general population.

METHODS

A total of 2,604,401 participants were enrolled in this nationwide cohort study using the National Health Insurance Service-Health Checkup data set. Predicted lean BMI (pLBMI), body fat mass index (pBFMI), and appendicular skeletal muscle mass index (pASMMI) were calculated using validated anthropometric prediction equations. A multivariable time-dependent Cox regression analysis was conducted to assess the association with cardiovascular outcomes. The results were presented with adjusted hazard ratios (HRs) with 95% confidence intervals (CIs), considering BMI categories (BMI < 18.5, BMI 18.5-24.9, BMI 25-29.9, and BMI ≥ 30).

RESULTS

Higher pLBMI and pASMMI were correlated with a reduced risk of composite cardiovascular outcomes. For pLBMI, HR was 0.910 (95% CI: 0.908, 0.913, P < 0.001) for males and 0.905 (95% CI: 0.899, 0.910, P < 0.001) for females. For pASMMI, HR was 0.825 (95% CI: 0.820, 0.829, P < 0.001) for males and 0.788 (95% CI: 0.777, 0.800, P < 0.001) for females. Conversely, a higher pBFMI was associated with an increased risk, with HR of 1.082 (95% CI: 1.071, 1.093, P < 0.001) for males and 1.181 (95% CI: 1.170, 1.192, P < 0.001) for females. Subgroup analysis based on BMI categories revealed no significant risk association for pBFMI in the BMI < 18.5 group. In the group with BMI ≥ 30, neither pLBMI nor pASMMI demonstrated a significant risk association.

CONCLUSIONS

Our results highlight the value of pLBMI, pBFMI, and pASMMI as variables for assessing risk of composite cardiovascular outcomes. The significance of indicators may vary depending on BMI categories.

Causal relationship between PCOS and related sex hormones with oral inflammatory diseases: a bidirectional Mendelian randomization study

Background

Observational studies have identified a strong association between polycystic ovary syndrome (PCOS) and hormone levels related to oral inflammatory diseases. To better understand the relationship between them, we conducted an analysis using a two-sample Mendelian randomization (MR) approach.

Methods

We gathered summary statistical data from previously published genome-wide association studies (GWAS) on PCOS and three sex hormones (AMH, Estradiol, LH) along with four oral inflammatory diseases (painful gums, loose teeth, mouth ulcers, and toothache). We selected single nucleotide polymorphisms (SNPs) as instrumental variables and employed four types of MR analysis methods to evaluate causal relationships between exposure and outcome. Finally, the robustness of our results was further validated through sensitivity tests and reverse MR.

Results

We observed that PCOS could increase the risk of mouth ulcers (ORIVW= 1.0013, 95%CI: 1.0001-1.0025, PIVW = 0.0278), painful gums (ORIVW= 1.0015, 95%CI:1.0003-1.0027, PIVW = 0.0163), and loose teeth (ORIVW= 1.0014, 95%CI: 1.0001-1.0027, PIVW = 0.0328). Moreover, LH was also found to increase the risk of mouth ulcers (ORIVW= 1.0031, 95%CI: 0.0001-1.0062, PIVW = 0.0457). MR-Egger regression, weighted mode, and WE indicated similar results. Additionally, we discovered no causal link between PCOS and toothache (PIVW>0.05), LH and painful gums, loose teeth, or toothache (PIVW>0.05), or AMH and Estradiol level with any of the four oral diseases (PIVW>0.05).

Conclusion

Our research provides new insights and references for exploring the effects of PCOS and related hormones on oral inflammatory lesions. For patients with PCOS, especially those with elevated LH levels, early intervention measures should be taken to prevent the occurrence of oral inflammatory diseases.

Effect of Smoking Cessation on the Risk of Subarachnoid Hemorrhage: A Nested Case-Control Study in Korean Men

BACKGROUND

Smoking is a well-established risk factor for subarachnoid hemorrhage (SAH), and current smokers have an increased risk of SAH. However, there are insufficient data on whether smoking cessation in current smokers reduces the risk of SAH.

METHODS

A nested case-control study was conducted based on the National Health Insurance Service-National Health Screening Cohort, which comprises nationwide health claims data and a national health screening program in Korea (2002-2019). We constructed a cohort of current male smokers without a history of stroke at the baseline health screening (2002-2003). From this cohort, cases were defined as individuals who experienced a nontraumatic SAH during the follow-up period up to 2019. Five controls were matched to each case using incidence density sampling. Smoking status (continuation or cessation) before the occurrence of SAH was evaluated using the repeated national health screening program. We conducted a multivariable conditional logistic regression analysis, adjusting for alcohol consumption, physical activity, body mass index, systolic blood pressure, and fasting blood glucose levels, to evaluate the association between SAH risk and smoking cessation.

RESULTS

At baseline, there were 112 142 current male smokers. After excluding individuals with prior stroke or insufficient data, the cohort consisted of 105 223 eligible participants (mean age, 50.3±8.5 years). Among them, we identified 318 cases of SAH and 1590 matched controls. Those who quit smoking had a significantly lower risk of SAH compared with current smokers (adjusted odds ratio, 0.55 [95% CI, 0.41-0.73]). The risk of SAH decreased with a longer period of smoking cessation. The risk reduction with smoking cessation was consistent even among prior heavy smokers.

CONCLUSIONS

Smoking cessation in current male smokers reduced the risk of SAH, and the risk reduction was greater as the cessation period increased. These findings warrant intensive efforts to encourage smokers, even heavy smokers, to quit.

Association between changes in predicted body composition and occurrence of heart failure: a nationwide population study

Background

Large population-based studies on the association between changes in body composition and the occurrence of heart failure (HF) are rare. We aimed to determine the association between changes in body composition, including the predicted body fat mass index (pBFMI), predicted appendicular skeletal muscle mass index (pASMI), and predicted lean body mass index (pLBMI), and the occurrence of HF.

Methods

For present study, 2,036,940 people who consecutively underwent national health examinations from 2010~2011 (baseline period) to 2012~2013 (follow-up period) were included. The pBFMI, pASMI, and pLBMI were indirectly investigated using validated anthropometric prediction equations from the Korean National Health and Nutrition Examination Survey cohort. The outcome was defined as at least two or more claims of HF.

Results

During a median of 7.59 years of follow-up, 22,172 participants (event rate, 1.09%) with HF were observed. Decreased changes in the pASMI and pLBMI were associated with the occurrence of HF among males (hazard ratio [HR] 0.966, 95% confidence interval (CI) [0.944-0.988]; HR 0.939, 95%CI [0.923-0.955], respectively) and females (HR 0.924, 95%CI [0.900-0.947]; HR 0.951, 95%CI [0.939-0.963], respectively). An increased change in the pBFMI was associated with the occurrence of HF in males (HR 1.017, 95%CI [1.001-1.034]). However, paradoxically, a change in the pBFMI was associated with the occurrence of HF in females (HR 0.925, 95%CI [0.909-0.942]).

Conclusion

Decreased skeletal muscle mass was related to the occurrence of HF. However, the relationship between a change in fat mass and the occurrence of HF was different and even paradoxical depending on sex.

Association of predicted body composition with occurrence of atrial fibrillation

Background

Body mass index (BMI) is insufficient evidence as a risk factor for numerous health disorders. Body composition may be more appropriate for confirming the association with cardiovascular diseases, including atrial fibrillation (AF). This study aimed to examine the association between body composition and the occurrence of AF.

Methods

A total of 2,673,108 participants (48.6% women) without AF at baseline from the Korean national health insurance data were included. Body composition including appendicular skeletal muscle mass, body fat mass, and lean body mass were indirectly measured through validated anthropometric prediction equations. The diagnosis of AF and comorbidities were defined.

Results

With a median of 9.5 (interquartile range 9.2-10.1) years' follow-up, 25,841 (0.96%) cases of incident AF were included. In multivariable analysis, higher appendicular skeletal muscle was related to low risk of AF [hazard ratio (HR) 0.829, 95% confidence interval (CI) 0.753-0.912 for men (fifth quintile) and HR 0.888, 95% CI 0.792-0.995 for women (fifth quintile)]. In contrast, a higher body fat mass [HR 1.345, 95% CI 1.221-1.483 for men (fifth quintile) and HR 1.420, 95% CI 1.274-1.591 for women (fifth quintile)] and lean body mass [HR 2.241, 95% CI 2.182-2.303 for men (fifth quintile) and HR 1.516, 95% CI 1.368-1.667 for women (fifth quintile)] were associated with the occurrence of AF.

Conclusions

In this study, body composition parameters were associated with the occurrence of AF. It should be noted that when appendicular skeletal muscle mass decreases and body fat mass and lean body mass increase, the risk of AF may be increased in general population except underweighted BMI group.

Association between Proteinuria Status and Risk of Hypertension: A Nationwide Population-Based Cohort Study

Proteinuria is associated with cardiovascular disease. However, the relationship between changes in proteinuria status and hypertension remains unclear. This study aimed to explore the association between changes in proteinuria status and the risk of developing hypertension with the data from the Korean National Health Insurance Database. We included participants without prior hypertension history who underwent their first health examination in 2003-2004 and a second examination in 2005-2006. Based on their proteinuria status during these two examinations, participants were classified into four groups: the proteinuria-free, proteinuria-resolved, proteinuria-developed, and chronic proteinuria groups. The study outcome was the incidence of hypertension. The study included 935,723 participants followed for a median of 14.2 years (mean age: 40.96 ± 11.01, 62.5% male participants). During this period, 346,686 (37.1%) cases of hypertension were reported. The chronic proteinuria group had the highest hypertension risk, followed by the proteinuria-developed, proteinuria-resolved, and proteinuria-free groups (p < 0.001). Those who recovered from proteinuria had a lower risk of developing hypertension than those with chronic proteinuria (hazard ratio: 0.58; 95% confidence interval: 0.53-0.63, p < 0.001). In contrast, individuals who developed proteinuria had a higher risk of hypertension than proteinuria-free individuals (hazard ratio: 1.31; 95% confidence interval: 1.26-1.35, p < 0.001). Our findings suggest a significant association between proteinuria status changes and hypertension. Effective management of proteinuria may potentially decrease the risk of developing hypertension.

Better oral hygiene is associated with a reduced risk of osteoporotic fracture: a nationwide cohort study

Background

The aim of this study was to examine the longitudinal association between oral health parameters and osteoporotic fracture.

Methods

The study included participants who received oral health screening by dentists from the National Health Screening cohort database of Korea between 2003 and 2006. The primary outcome was osteoporotic fracture occurrence, which was defined using specific international classification of diseases-10 codes; vertebral fracture (S22.0, S22.1, S32.0, S32.7, T08, M48.4, M48.5, and M49.5), hip fracture (S72.0 and S72.1), distal radius fracture (S52.5 and S52.6), and humerus fracture (S42.2 and S42.3). The presence of periodontitis and various oral health examination findings, such as missing teeth, caries, frequency of tooth brushing, and dental scaling, were analyzed using a Cox proportional hazard model to assess their association with osteoporotic fracture occurrence.

Results

The analysis included a total of 194,192 participants, among whom 16,683 (8.59%) developed osteoporotic fracture during a median follow-up of 10.3 years. Poor oral health status, including periodontitis (adjusted hazard ratio [aHR]: 1.09, 95% confidence interval [CI]: 1.01-1.18, p = 0.039), a higher number of missing teeth (≥15; aHR: 1.59, 95% CI: 1.45-1.75, p < 0.001), and dental caries (≥6; aHR: 1.17, 95% CI: 1.02-1.35, p = 0.030), was associated with an increased risk of osteoporotic fracture. On the other hand, better oral hygiene behaviors such as brushing teeth frequently (≥3 times per day; aHR: 0.82, 95% CI: 0.78-0.86, p < 0.001) and having dental scaling within 1 year (aHR: 0.87, 95% CI: 0.84-0.90, p < 0.001) were negatively associated with the occurrence of osteoporotic fracture.

Conclusion

The study found that poor oral health, such as periodontitis, missing teeth, and dental caries, was associated with an increased risk of osteoporotic fracture. Conversely, good oral hygiene behaviors like frequent teeth brushing and dental scaling within 1 year were associated with a reduced risk. Further research is needed to confirm this association.

Association of high estimated glomerular filtration rate with risk of atrial fibrillation: a nationwide cohort study

Aim

While the relationship between impaired kidney function and atrial fibrillation (AF) is well established, there is limited research exploring the association between elevated estimated glomerular filtration rate (eGFR) and AF development. This study aimed to examine the association between higher-than-normal eGFR and AF risk using a nationwide longitudinal study of the general population in Korea.

Materials and methods

This study utilized the National Health Insurance Service cohort database of Korea, analyzing data from 2,645,042 participants aged 20-79 years who underwent health examinations between 2010 and 2011. Participants with a history of end-stage renal disease, renal transplantation, and AF prior to the index date were excluded. Renal function was assessed using eGFR levels, calculated with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Baseline characteristics were gathered through questionnaires, while comorbidities and AF occurrence outcomes were identified and validated using diagnostic codes and medication histories. The study employed Kaplan-Meier survival curves and Cox proportional hazard models to evaluate the association between eGFR and AF occurrence.

Results

The mean age of subjects was 48.82 ± 10.08 years. Over a median follow-up of 9.58 years, 27,469 (1.04%) AF cases were identified. The risk for AF increased in the higher-than-normal decile, as demonstrated by Kaplan-Meier survival curves (p < 0.001). The eGFR <30 mL/min/1.73 m2 group was associated with an increased risk of AF [hazard ratio (HR): 1.22, 95% confidence interval (CI) (1.01, 1.46), p = 0.039], while the eGFR >120 mL/min/1.73 m2 group was associated with a decreased risk of AF [HR: 0.88, 95% CI (0.78, 0.98), p = 0.045]. Compared to the 5th decile, the 1st [HR: 1.08, 95% CI (1.03, 1.13), p = 0.010] eGFR decile was significantly associated with an increased risk of AF, while the 10th [HR: 0.77, 95% CI (0.70, 0.85), p < 0.001] eGFR decile was significantly associated with a reduced risk of AF.

Conclusion

The study revealed that individuals with eGFR>120 mL/min/1.73 m2 or those falling within eGFR 10th decile (>113.41 mL/min/1.73 m2) demonstrated an inverse association linked to a reduced risk of AF. Our study suggests that general population with higher-than-normal eGFR levels may have a lower risk of developing AF.

Association between periodontal disease status and risk of atrial fibrillation: a nationwide population-based cohort study

BACKGROUND

Periodontal disease can activate an immune process linked to systemic diseases, including atrial fibrillation. However, the relationship between periodontal disease and atrial fibrillation remains unclear.

AIM

This study aimed to investigate whether changes in periodontal disease status are associated with the risk of atrial fibrillation.

METHODS

Using the National Health Insurance Database Korea, participants who underwent the first oral health examination in 2003 and a second examination in 2005-2006 without a history of atrial fibrillation were included. Participants were grouped according to changes in periodontal disease status during two oral examinations: periodontal disease-free, periodontal disease-recovered, periodontal disease-developed, and periodontal disease-chronic. The outcome was the incidence of atrial fibrillation.

RESULTS

The study included 1,254,515 participants, with a median follow-up of 14.3 years and 25,402 (2.02%) cases of atrial fibrillation occurred. During follow-up, the risk of atrial fibrillation was highest in the periodontal disease-chronic group, followed by the periodontal disease-developed, periodontal disease-recovered, and periodontal disease-free groups (p for trend < 0.001). Moreover, recovery from periodontal disease was associated with a reduced risk of atrial fibrillation compared to a chronic periodontal disease status (Hazard ratio: 0.97, 95% Confidence interval: 0.94-0.99, p = 0.045). The development of periodontal disease was associated with an increased risk of atrial fibrillation compared to being periodontal disease-free (Hazard ratio: 1.04, 95% Confidence interval: 1.01-1.08, p = 0.035).

CONCLUSION

Our findings suggest that changes in periodontal disease status impact the risk of atrial fibrillation. Management of periodontal disease may help prevent atrial fibrillation.

Associations between missing teeth and the risk of cancer in Korea: a nationwide cohort study

BACKGROUND

Poor dental health is correlated with an increased risk of cancer. Using a nationwide population cohort database, we investigated which cancer is highly associated with poor dental health and which dental indicator mostly influences cancer risk.

METHODS

This study was conducted using the National Health Checkups (NHC) and National Health Insurance System (NHIS) database in Korea. NHC in Korea includes dental examinations. We retrieved subjects who underwent NHC between 2002 and 2003 and their medical information in NHIS database was followed until December 31,2015.

RESULTS

Data for 200,170 who participated in the NHC between 2002 and 2003 were analysed. During the maximum follow-up period of 13 years, 15,506 (7.75%) subjects were diagnosed with cancer. The median time to cancer diagnosis after the dental examination was 87 months (range, 51-119 months). The proportion of people with missing teeth was higher in the cancer-diagnosed group than in the non-diagnosed group (26.27% vs. 22.59%, p < 0.001). Among several dental health factors, missing teeth were significantly associated with higher cancer risk. Subjects with missing teeth showed a 12% increased cancer risk compared to those without missing teeth (odds ratio [OR] 1.12, 95% confidence interval [CI], 1.08-1.16). The risk was significantly higher, especially in lung, head and neck, pancreatic, liver, biliary, and esophageal cancers (OR 1.27 [95% CI, 1.14-1.41], 1.32 [95% CI, 1.13-1.55], 1.27 [95% CI, 1.02-1.58], 1.24 [95% CI, 1.1-1.4], 1.28 [95% CI, 1.03-1.6], 1.4 [95% CI, 1.04-1.88], respectively).

CONCLUSIONS

Missing teeth were the most important dental indicator associated with cancer risk. Korean adults with missing teeth should be cautious about the risk of several cancers, particularly head and neck, lung, gastrointestinal, hepatobiliary, and pancreatic cancer.

The association of periodontal disease and oral health with hypertension, NHANES 2009-2018

BACKGROUND

Hypertension is a worldwide public health problem. We sought to explore the interaction of oral health and smoking on hypertension, and periodontal disease and smoking on hypertension.

METHODS

We included 21,800 participants aged ≧ 30 years from the National Health and Nutrition Examination Survey (NHANES) 2009-2018. Information of oral health and periodontal disease were self-reported. Blood pressure was taken by trained personnel and/or physicians at mobile testing center. Multiple logistic regression was used to estimate the association between oral health, periodontal disease and the prevalence of hypertension. The effects of oral health and periodontal disease on hypertension under smoking status and age were analyzed by stratified and interaction analysis.

RESULTS

A total of 21,800 participants were investigated, including 11,017 (50.54%) in hypertensive group and 10,783 (49.46%) in non-hypertensive group. Compared with the excellent/very good of oral health, the multivariable-adjusted OR of good, fair, and poor were 1.13 (95% CI, 1.02-1.27), 1.30 (95% CI, 1.15-1.47), and 1.48 (95% CI, 1.22-1.79) (p for trend < 0.001) for hypertension, respectively. Compared without periodontal disease group, the multivariable-adjusted OR of periodontal disease for hypertension was 1.21 (95% CI ,1.09-1.35) (p for trend < 0.001). Furthermore, we found the interactions between periodontal disease and smoking, oral health and smoking, periodontal disease and age, oral health and age were p < 0.001.

CONCLUSIONS

An association between oral health and periodontal disease with the prevalence of hypertension was identified. There exists interactive effect of periodontal disease and smoking, oral health and smoking, periodontal disease and age, oral health and age on hypertension in American population over 30 years of age and older.

Association of Oral Health with Risk of Rheumatoid Arthritis: A Nationwide Cohort Study

Periodontitis and rheumatoid arthritis (RA) are inflammatory diseases that share many similarities. We aimed to investigate the associations of periodontitis and oral hygiene status and behaviors with RA in a nationwide general population cohort. Participants from the National Health Screening cohort database of Korea who underwent oral health screening by dentists between 2003 and 2004 were included. The occurrence of RA was analyzed according to the presence of periodontitis, oral health examination findings, and behaviors. Overall, 2,239,586 participants were included. During a median of 16.7 years, RA occurred in 27,029 (1.2%) participants. The risk for incident RA was higher when participants had periodontitis (hazard ratio (HR) 1.2, 95% confidence interval (CI), 1.08-1.24) and an increased number of missing teeth (HR 1.5, 95% CI, 1.38-1.69). In contrast, better oral hygiene behaviors, such as a higher frequency of daily tooth brushing (HR 0.76, 95% CI 0.73-0.79, p for trend <0.001) and a recent history of dental scaling (HR 0.96, 95% CI 0.94-0.99), were associated with a lower occurrence of RA. Periodontitis and increased missing teeth were associated with an increased risk of RA. Maintaining good oral hygiene through frequent tooth brushing and regular dental scaling may reduce the risk of RA occurrence.

Association between oral health behavior and chronic diseases among middle-aged and older adults in Beijing, China

OBJECTIVES

To evaluate the association between oral health behavior and multiple chronic diseases among middle-aged and older adults.

METHODS

We obtained data of the Beijing Health Service Survey and used multivariate logistic models to estimate the association between oral hygiene behavior and the risk of chronic diseases.

RESULTS

The risk of any chronic diseases (OR = 1.27, 95% CI: 1.18-1.37), cardiovascular diseases (CVD, OR = 1.30, 95% CI: 1.21-1.39), and endocrine or nutritional metabolic disorders (OR = 1.11, 95% CI: 1.01-1.22) was higher in those who with poor oral health behavior. There was no significant correlation between oral health behavior and the risk of diseases of the musculoskeletal, respiratory, digestive, and genitourinary systems.

CONCLUSIONS

Poor oral hygiene practices were associated with higher risk of chronic diseases, CVD and diabetes mellitus (DM) among middle-aged and older adults. These findings motivate further studies to evaluate whether improved oral health behavior may prevent the incidence of chronic diseases.

Better oral hygiene is associated with a reduced risk of cataract: A nationwide cohort study

Objective

To investigate the association of oral health status and oral hygiene behaviors with cataract occurrence longitudinally.

Materials and methods

Based on the National Health Screening cohort database of Korea, participants who underwent oral health screening by dentists in 2003 were included. Cataract was defined as two or more claims of disease classification for the International Classification of Diseases-10 (E10.34, E11.34, E12.34, E13.34, E14.34, H25, and H26) with cataract specific treatment or surgery procedure claim codes. The occurrence of cataract was analyzed with Cox proportional hazard model according to the presence of periodontitis and oral health examination findings, including missing teeth, caries, tooth brushing, and dental scaling.

Results

Overall, 103,619 subjects were included. During a median follow-up of 12.2 years, cataract developed in 12,114 (11.7%) participants. Poor oral health status such as the presence of periodontitis (adjusted hazard ratio [HR] 1.08, 95% CI [confidence interval] 0.99-1.17, p = 0.088) and increased number of missing teeth (adjusted HR = 1.74, 95% CI = 1.55-1.96, p < 0.001) was associated with the increased cataract risk. Better oral hygiene behaviors such as increased frequency of tooth brushing (adjusted HR = 0.84, 95% CI = 0.79-0.88, p < 0.001) and performed dental scaling within 1 year (adjusted HR = 0.90, 95% CI = 0.86-0.94, p < 0.001) were negatively associated with cataract occurrence.

Conclusion

Periodontitis and increased number of missing teeth may increase the risk of cataract. However, maintaining good oral hygiene through tooth brushing and dental scaling may reduce the risk of future cataract occurrence. Further studies should be performed to confirm the association between chronic oral inflammation and cataract.

Impact of oral health management on mental health and psychological disease: a scoping review

OBJECTIVE

The relationship between oral and mental health has been controversial. Few studies have assessed the direct effects of oral health management on mental health and psychological disease. Using evidence from the last 5 years, this scoping review aimed to map and discuss recent progress in understanding this relationship.

METHODS

Electronic literature searches were performed using PubMed, Web of Science, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature databases. An additional manual search was performed using Google Scholar databases. Studies were selected using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 flow diagram.

RESULTS

An eligibility review process identified three randomized controlled trials for inclusion in this review. The oral health interventions and participants' target age, mental health status, and psychological diseases varied across these studies. The only study that reported an improvement included psychosocial support integrated with educational components of oral health as the intervention. The remaining two studies detected no significant impact of oral health interventions on mental health and psychological disease.

CONCLUSIONS

Evidence of the impact of oral health management on mental health and psychological disease is insufficient in studies published between 2017 and 2021.

Better Oral Hygiene Is Associated with a Decreased Risk of Meniere's Disease: A Nationwide Cohort Study

To investigate the association of the oral health parameters with Meniere’s disease in a nationwide population-based longitudinal cohort database. The data of the participants who underwent an oral health screening by dentists in 2003 (n = 2,415,963) were retrieved from the National Health Insurance Database of the Korean National Health Insurance Service. The main outcome was the occurrence of Meniere’s disease, defined as two or more claims of the diagnostic code H810 with a previous audiometric examination. The occurrence of Meniere’s disease was analyzed using a Cox proportional hazard model according to the presence of periodontitis and the oral health examination findings, including missing teeth, the frequency of tooth brushing and dental scaling. Overall, the analysis included 2,240,282 participants. During a median follow-up of 16.7 years, Meniere’s disease developed in 112,106 (5.0%) participants. Poor oral health status was characterized by the presence of periodontitis (adjusted hazard ratio [aHR]: 1.18, 95% confidence interval [CI]: 1.14−1.22, p < 0.001) and an increased number of missing teeth (≥15; aHR: 1.25, 95% CI: 1.18−1.32, p < 0.001) was associated with an increased risk of Meniere’s disease. Better oral hygiene behaviors, such as frequent tooth brushing (≥3 per day; aHR: 0.75, 95% CI: 0.73−0.76, p < 0.001) and dental scaling within 1 year (aHR: 0.98, 95% CI: 0.97−0.99, p = 0.003) were negatively associated with the occurrence of Meniere’s disease. The presence of periodontitis and an increased number of missing teeth may augment the risk of the occurrence of Meniere’s disease. However, maintaining good oral hygiene through tooth brushing and dental scaling may be associated with a decreased risk of Meniere’s disease. Further studies should confirm the association between oral health and Meniere’s disease.

Improved Oral Health Status Is Associated with a Lower Risk of Venous Thromboembolism: A Nationwide Cohort Study

Oral health is reportedly associated with several systemic diseases, particularly cardiovascular diseases, through systemic inflammatory and thrombotic mechanisms. This study aimed to investigate the association between oral health status, oral hygiene behavior, and venous thromboembolism (VTE) in a nationwide, population-based cohort database in a longitudinal setting. Data of participants who underwent oral health screening by dentists between January and December 2003 (n = 2,415,963) were retrieved from the National Health Insurance Database of the Korean National Health Insurance Service. Periodontitis was identified using claims or oral health screening data. Periodontal pockets and the number of missing teeth were examined by dentists during oral health screenings. Data on oral hygiene behaviors (tooth brushing, dental visits, and dental scaling) were collected. VTE was defined as two or more claims of one of the following ICD-10 codes: deep (I80.2−80.3), pulmonary (I26, I26.0, I26.9), intra-abdominal (I81, I82, I82.2, I82.3), and other (I82.8, I82.9) VTE and concurrent medication (anticoagulants and antiplatelets). VTE was analyzed using the Cox proportional hazard model according to periodontitis, number of missing teeth, tooth brushing frequency, dental visits, and dental scaling. VTE occurred in 39,851 (1.8%) participants within a median of 17.0 (interquartile range 16.3−17.7) years. Periodontitis was associated with VTE (adjusted hazard ratio (HR), 1.2; 95% confidence interval (CI), 1.15−1.28; p < 0.001). An increased number of missing teeth was associated with an increased risk of VTE; the adjusted HR (versus participants without missing teeth) was 1.58 (95% CI, 1.46−1.71; p < 0.001, p for trend < 0.001) for participants with ≥15 missing teeth. Furthermore, tooth brushing ≥3 times a day was negatively correlated with VTE (adjusted HR, 0.67; 95% CI, 0.65−0.69; p < 0.001, p for trend < 0.001). Dental scaling within one year was associated with a significantly lower risk of VTE (adjusted HR, 0.95; 95% CI, 0.93−0.98; p < 0.001). Improved oral hygiene, including tooth brushing and dental scaling, may be associated with a decreased risk of VTE. Periodontitis and an increased number of missing teeth may increase the risk of VTE.

Study protocol for a randomised controlled trial of a care partner assisted intervention to improve oral health of individuals with mild dementia

INTRODUCTION

Individuals with mild dementia are at high risk of poor oral health outcomes. To address this issue, we describe an intervention to teach care partners skills to guide individuals with mild dementia in proper oral hygiene techniques and provide reminders to practice oral hygiene care. By providing support to perform these tasks successfully, we aim to delay oral health decline among this vulnerable population.

METHODS AND ANALYSIS

This multisite study is a three-arm randomised controlled trial. The primary objective is to evaluate the efficacy of an intervention to improve oral hygiene outcomes by promoting positive oral hygiene behaviours and skills among individuals with mild dementia. Care partners' behaviour factors, such as oral care self-efficacy and implementation of the care plan, serve as mediators of the intervention. Participant-care partner dyads will be randomly assigned to either Treatment Group 1, Treatment Group 2 or the Control Group. All groups will receive an educational booklet. Treatment Group 1 and Treatment Group 2 will receive a smart electronic toothbrush. Treatment Group 2 (the intervention group) will also receive an oral hygiene care skill assessment, personalised oral hygiene instruction and treatment plan; and care partners will receive in-home and telephone coaching on behaviour change. Oral health outcomes will be compared across the three groups. The duration of the active intervention is 3 months, with an additional 3-month maintenance phase. Data collection will involve three home visits: baseline, 3 months and 6 months. The study enrollment started in November 2021, and the data collection will end in Spring 2024.

ETHICS AND DISSEMINATION

The study has been approved by the Institutional Review Board of the NYU Grossman School of Medicine and Duke University, and is registered at Clinicaltrials.gov. A Data Safety Monitoring Board has been constituted. The study findings will be disseminated via peer-reviewed publications, conference presentations and social media.

TRIAL REGISTRATION NUMBER

NCT04390750.

Clinical Condition of the Oral Cavity in the Adult Polish Population below 70 Years of Age after Myocardial Infarction-A Case-Control Study

According to recent scientific consensus, there is an increasing amount of evidence on the correlation between oral health and cardiovascular disease morbidity. The aim of the present study was to investigate the number of missing teeth, the presence of residual roots with necrotic pulp and teeth with caries, the type of teeth deficiencies, and periodontal status in patients after myocardial infarction (MI). A total of 151 patients after MI and 160 randomly selected controls without history of MI were enrolled in the study. Epidemiological data were collected, and dental examination was performed. Findings showed significantly more women, subjects with lower level of education, lower income, higher percentage of nicotine addiction, more frequent presence of arterial hypertension, diabetes, and obesity than in the study group. Moreover, oral status of the subjects who suffered from MI was inferior to the control group. An average patient from the study group had 11 missing teeth, when compared to four missing teeth in an average control subject (p < 0.0001). The majority of patients in the control group had occlusal contacts in intercuspal position in premolars and molars (group A), in contrast to the patients after MI, who had at least one missing supporting zone (group B) (p < 0.0001). Severe periodontitis was found in 50.3% of tests and in 30.4% of controls (p < 0.0001). A correlation was found between the edentulousness and the risk of myocardial infarction after adjusting for other known risk factors of cardiovascular diseases (OR = 3.8; 95% CI = 3.01−7.21; p < 0.0001). This case−control study showed that MI patients had more missing teeth, more residual roots with necrotic pulp, much higher incidence of edentulism and occlusal contacts in intercuspal position in fewer than four occlusal supporting zones, as well as worse periodontal status when compared to healthy subjects without a history of MI. Due to the methodology of unmatched controls, the presented results must be interpreted with caution.