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Merchant AT, Zhao L, Bawa EM, Yi F, Vidanapathirana NP, Lohman M, Zhang J. Association between clusters of antibodies against periodontal microorganisms and Alzheimer disease mortality: Evidence from a nationally representative survey in the USA. J Periodontol 2024; 95:84-90. [PMID: 37452709 PMCID: PMC10788377 DOI: 10.1002/jper.23-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/26/2023] [Accepted: 07/09/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Alzheimer disease (AD) has been linked with periodontal microorganisms such as Porphyromonas gingivalis in observational and mechanistic studies. IgG antibodies against periodontal microorganisms which are markers of past and current periodontal infection have been correlated with cognitive impairment. We examined associations between empirically derived groups of 19 IgG antibodies against periodontal microorganisms and AD mortality. METHODS Individuals participating in the Third National Health and Nutrition Examination Survey (NHANES III) with complete data on IgG titers were followed up between 1988 and December 31, 2019. The outcome was AD mortality, and the main exposures were IgG antibodies against periodontal microorganisms classified into four mutually exclusive groups using cluster analysis. Survey-weighted Cox proportional hazard models were used to evaluate adjusted hazard ratios (aHR) and 95% confidence intervals (CI) for the relationship between clusters and AD mortality. RESULTS With up to 21 years of follow-up, 160 AD-related deaths were documented. In the multivariable-adjusted model, AD mortality overall was not associated with the Red-Green (aHR 1.18; 95% CI, 0.46-3.07), Yellow-Orange (aHR 1.36; 95% CI, 0.58-3.19), Orange-Blue (aHR 0.63; 95%, CI, 0.33-1.21), and the Orange-Red (aHR 0.79; 95% CI, 0.37-1.70) when the upper tertiles were compared to the bottom tertiles. However, the subgroup of middle-aged individuals in the highest tertile of the Red-Green cluster, but not older individuals, had a 13% higher risk of AD mortality (aHR 1.13; 95% CI, 1.02-1.26) compared with those in the bottom tertile. CONCLUSION Clusters of IgG antibodies against periodontal microorganisms did not predict AD mortality in this study.
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Affiliation(s)
- Anwar T Merchant
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Longgang Zhao
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Eric Mishio Bawa
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Fanli Yi
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Nadeesha P Vidanapathirana
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Matthew Lohman
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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Shen MT, Shahin B, Chen Z, Adami GR. Unexpected lower level of oral periodontal pathogens in patients with high numbers of systemic diseases. PeerJ 2023; 11:e15502. [PMID: 37465146 PMCID: PMC10351517 DOI: 10.7717/peerj.15502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/14/2023] [Indexed: 07/20/2023] Open
Abstract
Background Periodontal disease is associated with systemic conditions such as diabetes, arthritis, and cardiovascular disease, all diseases with large inflammatory components. Some, but not all, reports show periopathogens Porphyromonas gingivialis and Tannerella forsythia at higher levels orally in people with one of these chronic diseases and in people with more severe cases. These oral pathogens are thought to be positively associated with systemic inflammatory diseases through induction of oral inflammation that works to distort systemic inflammation or by directly inducing inflammation at distal sites in the body. This study aimed to determine if, among patients with severe periodontal disease, those with multi-morbidity (or many chronic diseases) showed higher levels of periodontal pathogens. Methods A total of 201 adult subjects, including 84 with severe periodontal disease were recruited between 1/2017 and 6/2019 at a city dental clinic. Electronic charts supplied self-reported diseases and conditions which informed a morbidity index based on the number of chronic diseases and conditions present. Salivary composition was determined by 16S rRNA gene sequencing. Results As expected, patients with severe periodontal disease showed higher levels of periodontal pathogens in their saliva. Also, those with severe periodontal disease showed higher levels of multiple chronic diseases (multimorbidity). An examination of the 84 patients with severe periodontal disease revealed some subjects despite being of advanced age were free or nearly free of systemic disease. Surprisingly, the salivary microbiota of the least healthy of these 84 subjects, defined here as those with maximal multimorbidity, showed significantly lower relative numbers of periodontal pathogens, including Porphyromonas gingivalis and Tannerella Forsythia, after controlling for active caries, tobacco usage, age, and gender. Analysis of a control group with none to moderate periodontal disease revealed no association of multimorbidity or numbers of medications used and specific oral bacteria, indicating the importance of severe periodontal disease as a variable of interest. Conclusion The hypothesis that periodontal disease patients with higher levels of multimorbidity would have higher levels of oral periodontal pathogens is false. Multimorbidity is associated with a reduced relative number of periodontal pathogens Porphyromonas gingivalis and Tannerella forsythia.
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Affiliation(s)
- Michael T Shen
- Oral Medicine and Diagnostic Sciences, College of Dentistry, University of Illinois Chicago, Chicago, IL, United States of America
| | - Betti Shahin
- Restorative Dentistry, University of Illinois Chicago, Chicago, IL, United States of America
| | - Zhengjia Chen
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, United States of America
- Biostatistics Shared Resource Core, University of Illinois Cancer Center, University of Illinois Chicago, Chicago, IL, United States of America
| | - Guy R Adami
- Oral Medicine and Diagnostic Sciences, College of Dentistry, University of Illinois Chicago, Chicago, IL, United States of America
- University of Illinois Cancer Center, University of Illinois Chicago, Chicago, IL, United States of America
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Merchant AT, Yi F, Vidanapathirana NP, Lohman M, Zhang J, Newman-Norlund RD, Fridriksson J. Antibodies against Periodontal Microorganisms and Cognition in Older Adults. JDR Clin Trans Res 2023; 8:148-157. [PMID: 35139675 PMCID: PMC10029137 DOI: 10.1177/23800844211072784] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Markers of poor oral health are associated with impaired cognition and higher risk of Alzheimer disease (AD) and thus may help predict AD. OBJECTIVES The aim of this study was to evaluate the cross-sectional association between empirically derived groups of 19 IgG antibodies against periodontal microorganisms and cognition in middle-aged and older adults. METHODS The study population consisted of participants of the third National Health and Nutrition Examination Survey (NHANES III) (1988 to 1994), who were 60 y and older, among whom cognition and IgG antibodies against 19 periodontal microorganisms were measured (N = 5,162). RESULTS In multivariable quantile regression analyses, the Orange-Red (Prevotella melaninogenica, Prevotella intermedia, Prevotella nigrescens, Porphyromonas gingivalis) and Yellow-Orange (Staphylococcus intermedius, Streptococcus oralis, Streptococcus mutans, Fusobacterium nucleatum, Peptostreptococcus micros, Capnocytophaga ochracea) cluster scores were negatively associated with cognition. A 1-unit higher cluster score for the Orange-Red cluster was associated on average with a lower cognitive score (β for 30th quantile = -0.2640; 95% confidence interval [CI], -0.3431 to -0.1848). Similarly, a 1-unit higher score for the Yellow-Orange cluster was associated with a lower cognitive score (β for 30th quantile = -0.2445; 95% CI, -0.3517 to -0.1372). CONCLUSION Groups of IgG antibodies against periodontal microorganisms were associated with lower cognition among free living adults 60 years and older, who were previously undiagnosed with cognitive impairment. Though poor oral health precedes the development of dementia and AD, oral health information is currently not used, to our knowledge, to predict dementia or AD risk. Combining our findings with current algorithms may improve risk prediction for dementia and AD. KNOWLEDGE TRANSLATION STATEMENT IgG antibodies against periodontal microorganisms were associated with lower cognition among adults 60 years and older previously undiagnosed with cognitive impairment. Periodontal disease may predict cognition among older adults.
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Affiliation(s)
- A T Merchant
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - F Yi
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - N P Vidanapathirana
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - M Lohman
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - J Zhang
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - R D Newman-Norlund
- Communication Sciences and Disorders, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - J Fridriksson
- Communication Sciences and Disorders, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Puṣcaṣu CM, Tecău AS, Nemet GC. Ranking of cardiovascular risk factors in Romania- regional epidemiological approach. Balneo and PRM Research Journal 2023. [DOI: 10.12680/balneo.2023.509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
An extensive epidemiological investigation was applied regarding the risk factors, to a cohort of patients with pre-existing heart disease, hospitalized for tertiary prophylaxis in a rehabilitation hospital. The group of 499 patients from all regions of the country respected the proportions of gender and environment of origin for the general population of Romania and was adjusted according to regional proportions.
The ranking of risk factors and protection factors present in the studied population was made, at the level of each of the 8 regions of the country and for the whole country consolidated. The profile of the cardiovascular patient was identified. We used risk factors for population characterization, not for aggregation into tools for assessing total cardiovascular risk (as is the trend in large cohort studies since Framingham)
The data processing was done to be able to develop prevention strategies in the interest of the specific individual, not to standardize population characteristics and translate them to the individual thus decreasing their appropriateness.
Keywords: 1 cardiovascular risk-factors, 2 cardiovascular diseases prevention , 3 cardiovascular rehabilitation.
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Affiliation(s)
| | - Alina-Simona Tecău
- “Transilvania” University of Brasov,Faculty of Economics and Business Administration, Braṣov, Romania
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Du M, Xu S, Qiu B, Hu S, Tjakkes GHE, Li A, Ge S. Serum antibodies to periodontal pathogens are related to allergic symptoms. J Periodontol 2023; 94:204-216. [PMID: 35960608 DOI: 10.1002/jper.22-0346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/02/2022] [Accepted: 08/02/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The association between periodontitis and allergic symptoms has been investigated. However, the difference in immune signatures between them remains poorly understood. This cross-sectional study assessed the relationship between serum immunoglobulin G (IgG) antibodies to periodontal pathogens and allergic symptoms in a nationwide population cohort. METHODS Two phases of the Third National Health and Nutrition Examination Survey (NHANES III) were used as discovery dataset (n = 3700) and validation dataset (n = 4453), respectively. Based on the antibodies against 19 periodontal pathogens, we performed an unsupervised hierarchical clustering to categorize the population into three clusters. In the discovery dataset, cluster 1 (n = 2847) had the highest level of IgG antibodies, followed by clusters 2 (n = 588) and 3 (n = 265). Data on allergic symptoms (asthma, hay fever, and wheezing) were obtained using a self-reported questionnaire. Survey-weighted multivariable logistic regression evaluated the association between these clusters and allergic symptoms. RESULTS In the discovery dataset, the participants with lower levels of antibodies to periodontal pathogens exhibited a higher risk of asthma (odds ratio [OR]cluster 3 vs. cluster 1 = 1.820, 95% confidence interval [CI]: 1.153-2.873) and wheezing (ORcluster 3 vs. cluster 1 = 1.550, 95% CI: 1.095-2.194) compared to those with higher periodontal antibodies, but the non-significant association with hay fever. Consistent results were found in the validation dataset. CONCLUSIONS Serum IgG titers to periodontal pathogens were inversely associated with the risk of asthma and wheezing, suggesting the potentially protective role against allergic conditions.
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Affiliation(s)
- Mi Du
- School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration, Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Shulan Xu
- Center of Oral Implantology, Stomatological Hospital, Southern Medical University, Guangzhou, China
| | - Bingjiang Qiu
- Department of Radiology & Guangdong Cardiovascular Institute & Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Data Science Center in Health (DASH) & 3D Lab, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - Shixian Hu
- Institute of Precision Medicine, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Department of Gastroenterology and Hepatology, UMCG, University of Groningen, Groningen, The Netherlands
| | - Geerten-Has E Tjakkes
- Department of Periodontology, Center for Dentistry and Oral Hygiene, UMCG, University of Groningen, Groningen, The Netherlands
| | - An Li
- Center of Oral Implantology, Stomatological Hospital, Southern Medical University, Guangzhou, China.,Department of Periodontology, Center for Dentistry and Oral Hygiene, UMCG, University of Groningen, Groningen, The Netherlands
| | - Shaohua Ge
- School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration, Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
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Schulz S, Hofmann B, Grollmitz J, Friebe L, Kohnert M, Schaller HG, Reichert S. Campylobacter Species of the Oral Microbiota as Prognostic Factor for Cardiovascular Outcome after Coronary Artery Bypass Grafting Surgery. Biomedicines 2022; 10:biomedicines10081801. [PMID: 35892701 PMCID: PMC9332846 DOI: 10.3390/biomedicines10081801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 11/21/2022] Open
Abstract
Background: The oral microbiota has been implicated in a variety of systemic diseases, including cardiovascular (CV) disease. The main objective of this study (DRKS-ID: DRKS00015776) was to evaluate the prognostic importance of the oral microbiota for further CV events in patients undergoing coronary artery bypass grafting surgery (3-year follow-up). Methods: In this longitudinal cohort study, 102 CV patients were enrolled, of whom 95 completed the 3-year follow-up. The CV outcome was assessed using the major adverse cardiac and cerebrovascular events criteria. To evaluate subgingival colonization, 16S rRNA genes were amplified, targeting the V3/V4 region (Illumina MiSeq). Results: Regarding the specific number of operational taxonomic units (OTUs), no significant differences in CV outcome were determined (alpha diversity, Shannon index). In linear discriminant analyses and t-tests, the disease-specific differences in the beta diversity of the microbiota composition were evaluated. It was evident that bacteria species of the genus Campylobacter were significantly more prevalent in patients with a secondary CV event (p = 0.015). This hierarchical order also includes Campylobacter rectus, which is considered to be of comprehensive importance in both periodontal and CV diseases. Conclusions: Here, we proved that subgingival occurrence of Campylobacter species has prognostic relevance for cardiovascular outcomes in CV patients undergoing coronary artery bypass grafting.
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Affiliation(s)
- Susanne Schulz
- Department of Operative Dentistry and Periodontology, Martin-Luther-University Halle-Wittenberg, 06112 Halle, Germany; (J.G.); (L.F.); (M.K.); (H.-G.S.); (S.R.)
- Correspondence:
| | - Britt Hofmann
- Department of Cardiothoracic Surgery, Heart Centre of the University Clinics Halle (Saale), Martin-Luther-University Halle-Wittenberg, 06112 Halle, Germany;
| | - Julia Grollmitz
- Department of Operative Dentistry and Periodontology, Martin-Luther-University Halle-Wittenberg, 06112 Halle, Germany; (J.G.); (L.F.); (M.K.); (H.-G.S.); (S.R.)
| | - Lisa Friebe
- Department of Operative Dentistry and Periodontology, Martin-Luther-University Halle-Wittenberg, 06112 Halle, Germany; (J.G.); (L.F.); (M.K.); (H.-G.S.); (S.R.)
| | - Michael Kohnert
- Department of Operative Dentistry and Periodontology, Martin-Luther-University Halle-Wittenberg, 06112 Halle, Germany; (J.G.); (L.F.); (M.K.); (H.-G.S.); (S.R.)
- Department of Cardiothoracic Surgery, Heart Centre of the University Clinics Halle (Saale), Martin-Luther-University Halle-Wittenberg, 06112 Halle, Germany;
| | - Hans-Günter Schaller
- Department of Operative Dentistry and Periodontology, Martin-Luther-University Halle-Wittenberg, 06112 Halle, Germany; (J.G.); (L.F.); (M.K.); (H.-G.S.); (S.R.)
| | - Stefan Reichert
- Department of Operative Dentistry and Periodontology, Martin-Luther-University Halle-Wittenberg, 06112 Halle, Germany; (J.G.); (L.F.); (M.K.); (H.-G.S.); (S.R.)
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L.j. Visseren F, Mach F, M. Smulders Y, Carballo D, C. Koskinas K, Bäck M, Benetos A, Biffi A, Manuel Boavida J, Capodanno D, Cosyns B, Crawford C, H. Davos C, Desormais I, Di Angelantonio E, H. Franco O, Halvorsen S, Richard Hobbs F, Hollander M, A. Jankowska E, Michal M, Sacco S, Sattar N, Tokgozoglu L, Tonstad S, P. Tsioufis K, van Dis I, C. van Gelder I, Wanner C, Williams B. Guía ESC 2021 sobre la prevención de la enfermedad cardiovascular en la práctica clínica. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Czerniuk MR, Surma S, Romańczyk M, Nowak JM, Wojtowicz A, Filipiak KJ. Unexpected Relationships: Periodontal Diseases: Atherosclerosis-Plaque Destabilization? From the Teeth to a Coronary Event. Biology (Basel) 2022; 11:biology11020272. [PMID: 35205138 PMCID: PMC8869674 DOI: 10.3390/biology11020272] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/01/2022] [Accepted: 02/04/2022] [Indexed: 02/06/2023]
Abstract
Simple Summary Periodontal disease and atherosclerotic cardiovascular disease are very common around the world. Coronary artery disease is the leading cause of death. The main factor involved in the pathogenesis of atherosclerosis is inflammation. Therefore, a number of studies have indicated that periodontal disease (causes chronic inflammation) is a risk factor for the progression of atherosclerosis. The presence of periodontal pathogens has been found in human atherosclerotic plaques. A number of pathomechanisms have been demonstrated, thanks to which periodontal pathogens, especially Porphyromonas gingivalis, can directly increase the progression of atherosclerosis and the risk of cardiovascular disease. Observational studies found that patients with periodontal disease were at higher risk of developing atherosclerotic cardiovascular disease. Moreover, periodontal treatment leads to a reduction in cardiovascular risk therefore taking care of oral hygiene should be an important cardiovascular disease preventive measure. Abstract Atherosclerotic cardiovascular disease (ASCVD) and periodontal disease (PD) are global health problems. High frequency of ASCVD is associated with the spread of many risk factors, including poor diet, sedentary lifestyle, diabetes, hyperlipidemia, obesity, smoking, hypertension, chronic kidney disease, hypertension, hyperhomocysteinemia, hyperuricemia, excessive stress, virus infection, genetic predisposition, etc. The pathogenesis of ASCVD is complex, while inflammation plays an important role. PD is a chronic, multifactorial inflammatory disease caused by dysbiosis of the oral microbiota, causing the progressive destruction of the bone and periodontal tissues surrounding the teeth. The main etiological factor of PD is the bacteria, which are capable of activating the immune response of the host inducing an inflammatory response. PD is associated with a mixed microbiota, with the evident predominance of anaerobic bacteria and microaerophilic. The “red complex” is an aggregate of three oral bacteria: Tannerella forsythia Treponema denticola and Porphyromonas gingivalis responsible for severe clinical manifestation of PD. ASCVD and PD share a number of risk factors, and it is difficult to establish a causal relationship between these diseases. The influence of PD on ASCVD should be treated as a factor increasing the risk of atherosclerotic plaque destabilization and cardiovascular events. The results of observational studies indicate that PD significantly increases the risk of ASCVD. In interventional studies, PD treatment was found to have a beneficial effect in the prevention and control of ASCVD. This comprehensive review summarizes the current knowledge of the relationship between PD and ASCVD.
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Affiliation(s)
- Maciej R. Czerniuk
- Department of Dental Surgery, Medical University of Warsaw, 02-091 Warsaw, Poland; (M.R.C.); (J.M.N.); (A.W.)
| | - Stanisław Surma
- Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland;
- Correspondence: ; Tel.: +48-32-208-83-00
| | - Monika Romańczyk
- Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland;
| | - Jacek M. Nowak
- Department of Dental Surgery, Medical University of Warsaw, 02-091 Warsaw, Poland; (M.R.C.); (J.M.N.); (A.W.)
| | - Andrzej Wojtowicz
- Department of Dental Surgery, Medical University of Warsaw, 02-091 Warsaw, Poland; (M.R.C.); (J.M.N.); (A.W.)
| | - Krzysztof J. Filipiak
- Department of Clinical Sciences, Maria-Sklodowska-Curie Medical Academy, 03-411 Warsaw, Poland;
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Merchant AT, Vidanapathirana N, Yi F, Celuch O, Zhong Z, Jin Q, Zhang J. Association between groups of immunoglobulin G antibodies against periodontal microorganisms and diabetes related mortality. J Periodontol 2022; 93:1083-1092. [PMID: 35139234 DOI: 10.1002/jper.21-0608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/11/2022] [Accepted: 01/11/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Immunoglobulin G (IgG) antibodies against periodontal microorganisms can be markers of periodontal infection because their levels rise following infection and remain elevated several years later. METHODS We evaluated the relation between groups of IgG antibodies against 19 periodontal microorganisms and diabetes related mortality over 27 years among participants of the National Health and Nutrition Examination Survey III (1988 to 1992) 40 years and older at the time of examination (N = 8153). RESULTS Individuals in the highest versus lowest antibody tertiles were at 86% higher risk of dying due to diabetes related causes in the Red-Green antibody cluster (T. forsythia, T. denticola, A. actinomycetemcomitans, E. corrodens, S. noxia, V. parvula, C. rectus) (HR = 1.86, 95% CI 1.09 to 3.20) and 55% lower in the Orange-Blue antibody cluster (E. nodatum, A. naeslundii) (HR = 0.45, 95% CI 0.32 to 0.63) in multivariable models. In these models, individuals with diabetes at the time of examination had a 16-fold higher risk of dying due to diabetes related causes (HR = 16.4, 95% CI 11.0 to 24.7). CONCLUSION As a subset of periodontal microorganisms are associated with adverse systemic outcomes, antibody profiles may help in prediction of diabetes related mortality and identify sub-groups of individuals among whom periodontal treatment may impact diabetes related outcomes. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Anwar T Merchant
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Nadeesha Vidanapathirana
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Fanli Yi
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Owen Celuch
- Honors College, University of South Carolina, Columbia, South Carolina, USA
| | - Zihang Zhong
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Qi Jin
- Clinical Programming and Writing Group, Pfizer China Research and Development Center, Shanghai, China
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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Gianos E, Jackson EA, Tejpal A, Aspry K, O'Keefe J, Aggarwal M, Jain A, Itchhaporia D, Williams K, Batts T, Allen KE, Yarber C, Ostfeld RJ, Miller M, Reddy K, Freeman AM, Fleisher KE. Oral health and atherosclerotic cardiovascular disease: A review. Am J Prev Cardiol 2021; 7:100179. [PMID: 34611631 PMCID: PMC8387275 DOI: 10.1016/j.ajpc.2021.100179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Periodontal disease (PD) is common in the US and globally. Evidence suggests that poor oral health is associated with atherosclerotic cardiovascular disease (ASCVD); however, this relationship has not been a major focus in clinical cardiology. This manuscript will review the growing evidence linking PD to ASCVD, including pathophysiologic mechanisms and coexistent risk factors. Public health considerations with a focus on disparities, social determinants, preventive strategies, and a call to action to reduce the burden of coincident ASCVD and PD are also reviewed.
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Affiliation(s)
- Eugenia Gianos
- Division of Cardiology, Lenox Hill Hospital, Northwell Health, New York, NY, United States
| | - Elizabeth A Jackson
- Division of Cardiovascular Disease, Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Astha Tejpal
- Division of Cardiology, Lenox Hill Hospital, Northwell Health, New York, NY, United States
| | - Karen Aspry
- Lifespan Cardiovascular Institute, and Division of Cardiology, Brown University, Alpert Medical School, Providence, RI, United States
| | - James O'Keefe
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City School of Medicine, Kansas City, MI, United States
| | - Monica Aggarwal
- Division of Cardiology, University of Florida, Gainesville, FL, United States
| | - Ankur Jain
- Division of Cardiology, University of Florida, Gainesville, FL, United States
| | - Dipti Itchhaporia
- Jeffrey M. Carlton Heart & Vascular Institute, Hoag Memorial Hospital, Newport Beach, CA, United States
| | - Kim Williams
- Department of Medicine, Division of Cardiology, Rush University Medical Center, Chicago, IL, United States
| | - Travis Batts
- Division of Cardiology, Department of Medicine, Wilford Hall Ambulatory Surgical Center, San Antonio, TX, United States
| | - Kathleen E Allen
- Geisel School of Medicine at Dartmouth, Hanover, NY, United States
| | - Clark Yarber
- Department of Internal Medicine, Montefiore Health System, Bronx, NY, United States
| | - Robert J Ostfeld
- Division of Cardiology, Department of Medicine, Montefiore Health System, Bronx, NY, United States
| | - Michael Miller
- Department of Cardiovascular Medicine, Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Koushik Reddy
- Division of Cardiology, James A. Haley VA Medical Center, University of South Florida, Tampa, FL, United States
| | - Andrew M Freeman
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, CO, United States
| | - Kenneth E Fleisher
- Department of Oral and Maxillofacial Surgery, NYU College of Dentistry, New York, NY, United States
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11
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Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, Benetos A, Biffi A, Boavida JM, Capodanno D, Cosyns B, Crawford C, Davos CH, Desormais I, Di Angelantonio E, Franco OH, Halvorsen S, Hobbs FDR, Hollander M, Jankowska EA, Michal M, Sacco S, Sattar N, Tokgozoglu L, Tonstad S, Tsioufis KP, van Dis I, van Gelder IC, Wanner C, Williams B. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur J Prev Cardiol 2021; 29:5-115. [PMID: 34558602 DOI: 10.1093/eurjpc/zwab154] [Citation(s) in RCA: 181] [Impact Index Per Article: 60.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Alessandro Biffi
- European Federation of Sports Medicine Association (EFSMA).,International Federation of Sport Medicine (FIMS)
| | | | | | | | | | | | | | | | | | | | - F D Richard Hobbs
- World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) - Europe
| | | | | | | | | | | | | | | | | | | | | | - Christoph Wanner
- European Renal Association - European Dialysis and Transplant Association (ERA-EDTA)
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12
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Joshi C, Bapat R, Anderson W, Dawson D, Cherukara G, Hijazi K. Serum antibody response against periodontal bacteria and coronary heart disease: Systematic review and meta-analysis. J Clin Periodontol 2021; 48:1570-1586. [PMID: 34545592 DOI: 10.1111/jcpe.13550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 08/28/2021] [Accepted: 09/02/2021] [Indexed: 12/25/2022]
Abstract
AIM The present systematic review and meta-analysis assessed the strength of a reported association between elevated serum anti-periodontal bacterial antibody responses and coronary heart disease (CHD). MATERIALS AND METHODS Twenty original studies were identified after systematically searching five databases. The majority (n = 11) compared serum anti-Porphyromonas gingivalis (Pg) and/or anti-Aggregatibacter actinomycetemcomitans (Aa) IgG antibody responses between CHD patients and control participants. The strength of the association between serum anti-Pg antibodies and CHD (n = 10) and serum anti-Aa antibodies and CHD (n = 6) was investigated using a meta-analysis approach separately. RESULTS Most studies (61%) reported that the serum IgG antibody responses were elevated in CHD patients than in controls. The meta-analyses showed a significant association between elevated serum IgG antibody responses (anti-Pg and anti-Aa) and CHD, with pooled odds ratios of 1.23 [95% confidence interval (CI): 1.09-1.38, p = .001] and 1.25 (95% CI: 1.04-1.47, p = .0004), respectively. CONCLUSIONS A modest increase of CHD events in individuals with higher serum anti-Pg and anti-Aa IgG antibody responses may support their use as potential biomarkers to detect and monitor at-risk populations. However, the observed inconsistencies with the design and interpretation of immunoassays warrant standardization of the immunoassays assessing antibody responses against periodontal bacteria.
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Affiliation(s)
- Chaitanya Joshi
- Institute of Dentistry, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Ranjeet Bapat
- School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - William Anderson
- Institute of Dentistry, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Dana Dawson
- Department of Cardiology, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - George Cherukara
- Institute of Dentistry, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Karolin Hijazi
- Institute of Dentistry, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
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13
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Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, Benetos A, Biffi A, Boavida JM, Capodanno D, Cosyns B, Crawford C, Davos CH, Desormais I, Di Angelantonio E, Franco OH, Halvorsen S, Hobbs FDR, Hollander M, Jankowska EA, Michal M, Sacco S, Sattar N, Tokgozoglu L, Tonstad S, Tsioufis KP, van Dis I, van Gelder IC, Wanner C, Williams B. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 2021; 42:3227-3337. [PMID: 34458905 DOI: 10.1093/eurheartj/ehab484] [Citation(s) in RCA: 1986] [Impact Index Per Article: 662.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - Alessandro Biffi
- European Federation of Sports Medicine Association (EFSMA)
- International Federation of Sport Medicine (FIMS)
| | | | | | | | | | | | | | | | | | | | - F D Richard Hobbs
- World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) - Europe
| | | | | | | | | | | | | | | | | | | | | | - Christoph Wanner
- European Renal Association - European Dialysis and Transplant Association (ERA-EDTA)
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14
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Holtfreter B, Stubbe B, Gläser S, Trabandt J, Völzke H, Ewert R, Kocher T, Ittermann T, Schäper C. Periodontitis Is Related to Exercise Capacity: Two Cross-sectional Studies. J Dent Res 2021; 100:824-832. [PMID: 33655783 DOI: 10.1177/0022034521995428] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Although a potential link between periodontitis and cardiorespiratory fitness might provide a reasonable explanation for effects of tooth-related alterations seen on cardiometabolic diseases, evidence is currently limited. Thus, we investigated the association between clinically assessed periodontitis and cardiopulmonary exercise testing (CPET). Data from 2 independent cross-sectional population-based studies (5-y follow-up of the Study of Health in Pomerania [SHIP-1; N = 1,639] and SHIP-Trend-0 [N = 2,439]) were analyzed. Participants received a half-mouth periodontal examination, and teeth were counted. CPET was based on symptom limited-exercise tests on a bicycle ergometer. Associations of periodontitis parameters with CPET parameters were analyzed by confounder-adjusted multivariable linear regression. In the total sample, mean pocket probing depth (PPD), mean clinical attachment levels, and number of teeth were consistently associated with peak oxygen uptake (peakVO2) and exercise duration in both studies, even after restriction to cardiorespiratory healthy participants. Statistically significant associations with oxygen uptake at anaerobic threshold (VO2@AT), slope of the efficiency of ventilation in removing carbon dioxide, and peak oxygen pulse (VÉ/VCO2 slope) occurred. Further, interactions with age were identified, such that mainly older individuals with higher levels of periodontal disease severity were associated with lower peakVO2. Restricted to never smokers, associations with mean clinical attachment levels and the number of teeth mostly diminished, while associations of mean PPD with peakVO2, VO2@AT, VÉ/VCO2 slope, and exercise duration in SHIP-1 and SHIP-Trend-0 were confirmed. In SHIP-1, mean peakVO2 was 1,895 mL/min in participants with a mean PPD of 1.6 mm and 1,809 mL/min in participants with a mean PPD of 3.7 mm. To conclude, only mean PPD reflecting current disease severity was consistently linked to cardiorespiratory fitness in 2 cross-sectional samples of the general population. If confirmed in well-designed large-scale longitudinal studies, the association between periodontitis and cardiorespiratory fitness might provide a biologically plausible mechanism linking periodontitis with cardiometabolic diseases.
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Affiliation(s)
- B Holtfreter
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - B Stubbe
- Department of Internal Medicine B, Cardiology, Pneumology, Weaning, Infectious Diseases, Intensive Care Medicine, University Medicine Greifswald, Greifswald, Germany
| | - S Gläser
- Department of Internal Medicine, Vivantes Kliniken Berlin, Neukölln, Germany
| | - J Trabandt
- Department of Internal Medicine, Vivantes Kliniken Berlin, Neukölln, Germany
| | - H Völzke
- Institute for Community Medicine, SHIP/Clinical-Epidemiological Research, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
| | - R Ewert
- Department of Internal Medicine B, Cardiology, Pneumology, Weaning, Infectious Diseases, Intensive Care Medicine, University Medicine Greifswald, Greifswald, Germany
| | - T Kocher
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - T Ittermann
- Institute for Community Medicine, SHIP/Clinical-Epidemiological Research, University Medicine Greifswald, Greifswald, Germany
| | - C Schäper
- Department of Internal Medicine B, Cardiology, Pneumology, Weaning, Infectious Diseases, Intensive Care Medicine, University Medicine Greifswald, Greifswald, Germany
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15
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Schulz S, Reichert S, Grollmitz J, Friebe L, Kohnert M, Hofmann B, Schaller HG, Klawonn F, Shi R. The role of Saccharibacteria (TM7) in the subginival microbiome as a predictor for secondary cardiovascular events. Int J Cardiol 2021; 331:255-261. [PMID: 33529661 DOI: 10.1016/j.ijcard.2021.01.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/27/2020] [Accepted: 01/24/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The composition of the subgingival microbiota is of great importance in both oral and systemic diseases. However, a possible association of the oral microbiome and cardiovascular (CV) outcome has not yet been considered in a complex model. The primary objective of the study (DRKS-ID: DRKS00015776) was to assess differences in complex subgingival bacterial composition, depending on the CV outcome in patients undergoing Coronary Artery Bypass Grafting Surgery (CABG). MATERIAL AND METHODS We conducted a longitudinal cohort study enrolling 102 CV patients. After a one-year follow-up, the postoperative outcome was evaluated applying MACCE (Major Adverse Cardiac and Cerebrovascular Events) criteria. The complex oral microbiome was evaluated depending on CV outcome. The mathematical data processing included Qiime 2 software workflow and DADA2 pipeline as well as Human Oral Microbiome Database (HOMD) and Greengenes database classification. For identifying biomarkers distinguishing patients suffering from secondary CV events, the Cox Proportional Hazard Model for survival analysis was applied. RESULTS In total, 19,418 Operational Taxonomic Units (OTU) were mapped according to the HOMD and Greengenes database. No significant differences in alpha and beta diversity were linked to CV outcomes (Shannon index; Principal Coordinates Analysis). No biomarker predicting secondary CV events were identified applying the area under the receiver operating characteristic curve (AUC) model. However, in survival analysis, one biomarker of Saccharibacteria phylum (class: TM7-3, order: CW040, family: F16) was associated with the incidence of a secondary CV event (p = 0.016). CONCLUSIONS For the first time, a subgingival biomarker has been identified that supports a cardiovascular prognosis in CV patients undergoing coronary artery bypass grafting.
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Affiliation(s)
- Susanne Schulz
- Department of Operative Dentistry and Periodontology, Martin-Luther-University Halle-Wittenberg, Germany.
| | - Stefan Reichert
- Department of Operative Dentistry and Periodontology, Martin-Luther-University Halle-Wittenberg, Germany
| | - Julia Grollmitz
- Department of Operative Dentistry and Periodontology, Martin-Luther-University Halle-Wittenberg, Germany
| | - Lisa Friebe
- Department of Operative Dentistry and Periodontology, Martin-Luther-University Halle-Wittenberg, Germany
| | - Michael Kohnert
- Department of Operative Dentistry and Periodontology, Martin-Luther-University Halle-Wittenberg, Germany
| | - Britt Hofmann
- Department of Cardiothoracic Surgery, Heart Centre of the University Clinics Halle (Saale), Martin-Luther-University Halle-Wittenberg, Germany
| | - Hans-Günter Schaller
- Department of Operative Dentistry and Periodontology, Martin-Luther-University Halle-Wittenberg, Germany
| | - Frank Klawonn
- Biostatistics, Helmholtz Centre for Infection Research, Braunschweig, Germany; Department of Computer Science, Ostfalia University of Applied Sciences, Wolfenbüttel, Germany
| | - Ruibing Shi
- Biostatistics, Helmholtz Centre for Infection Research, Braunschweig, Germany
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16
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Sadiq N, Probst JC, Merchant AT, Martin AB, Shrestha D, Khan MM. The role of dental insurance in mitigating mortality among working-age U.S. adults with periodontitis. J Clin Periodontol 2020; 47:1294-1303. [PMID: 32939782 DOI: 10.1111/jcpe.13366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 07/28/2020] [Accepted: 08/27/2020] [Indexed: 12/12/2022]
Abstract
AIM To assess the relationship of dental insurance with all-cause mortality and mortality due to cardiovascular diseases (CVD), diabetes mellitus (DM), and cerebrovascular diseases (CBD) among those with periodontitis. MATERIALS AND METHODS NHANES III and its associated mortality data set were used in this study. The outcome variables were "all-cause mortality" and "combined mortality" due to CVD, DM, and CBD. The independent variable was dental insurance stratified over periodontitis status. Unweighted frequencies with weighted column percentages were used for descriptive statistics, and chi-square test was applied for significance. Cox proportional hazard models were used for stratified multivariable analyses. All analyses were performed in SAS v9.4 accounting for survey data complexities. Significance level was kept at 5%. RESULTS The mortality was 14.58% for all-cause mortality and 4.06% for combined mortality among those with periodontitis in this study. Dental insurance significantly reduced the hazard of all-cause mortality among those with periodontitis (HR: 0.75; 95% CI: 0.61 - 0.93), adjusted for covariates. However, no association of dental insurance with combined mortality was observed among periodontitis group. CONCLUSIONS Dental insurance reduces hazard of all-cause mortality among those with periodontitis. Dental insurance ensures access to dentists and improves oral and dental health. Longitudinal study is needed to establish causality.
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Affiliation(s)
- Naveed Sadiq
- Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan.,Department of Health Services Policy & Management, University of South Carolina, Columbia, SC, USA
| | - Janice C Probst
- Department of Health Services Policy & Management, University of South Carolina, Columbia, SC, USA
| | - Anwar T Merchant
- Department of Epidemiology & Biostatistics, University of South Carolina, Columbia, SC, USA
| | - Amy B Martin
- College of Dental Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Deepika Shrestha
- Data Management and Analysis Division, Center for Policy, Planning and Evaluation, DC Department of Health, Washington, DC, USA
| | - M Mahmud Khan
- Department of Health Policy & Management, University of Georgia, Athens, GA, USA
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17
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Do KY, Moon S. Relationship between Subjective Oral Discomfort and Health-Related Quality of Life in the South Korean Elderly Population. Int J Environ Res Public Health 2020; 17:ijerph17061906. [PMID: 32183433 PMCID: PMC7143639 DOI: 10.3390/ijerph17061906] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/06/2020] [Accepted: 03/12/2020] [Indexed: 12/30/2022]
Abstract
This study examined the relationship between oral discomfort and health-related quality of life (HRQOL) in the Korean elderly, using the datasets provided by the Korea National Health and Nutrition Examination Survey (KHNANES) over 6 consecutive years (2010-2015). A total of 13,618 participants aged 65 years and over were included in the final analysis. A complex sample logistic regression was performed to determine the impact of oral discomfort on HRQOL. The results revealed that toothache, masticatory discomfort, and pronunciation problems caused by oral health conditions were all risk factors for decreased HRQOL. In particular, masticatory discomfort (adjusted odds ratio (AOR) 1.63, Model III (adjusted for all covariates)) and pronunciation problems (AOR 1.64, Model III) negatively impacted the HRQOL of the elderly to a great extent. Masticatory discomfort had a stronger negative impact on HRQOL in the domains of "self-care" (AOR 1.83) and "usual activities" (AOR 1.66), while pronunciation problems had a similar impact on all five domains of the EuroQol 5-Dimension (EQ-5D). These findings could serve as baseline data for setting up early intervention programs for the timely prevention of oral health-related discomfort problems that greatly affect the QOL of the elderly population, and for the development of comprehensive and efficient dental insurance policies.
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Affiliation(s)
- Kyung-Yi Do
- Department of Dental Hygiene, Hanseo University, 46 Hanseo 1-ro, Haemi-Myun Seosan-Si, Chungcheognam-do 31962, Korea;
| | - Sook Moon
- Department of Dental Hygiene, Daejeon Health Institute of Technology, 21, Chungjeong-ro, Dong-gu, Daejeon 34504, Korea
- Correspondence: ; Tel.: +82-42-670-9199
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