Relationship between periodontal status and chronic obstructive pulmonary disease

Hye-Jung Jin; Eun-Kyong Kim; Seo-Young An; Sang-Uk Im; Keun-Bae Song; Youn-Hee Choi

doi:10.11149/jkaoh.2013.37.3.147

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Jin, Kim, An, Im, Song, and Choi: Relationship between periodontal status and chronic obstructive pulmonary disease

Original Article

J Korean Acad Oral Health 2013;37(3):147-153.

Published online: 12 September 2013

DOI: https://doi.org/10.11149/jkaoh.2013.37.3.147

Relationship between periodontal status and chronic obstructive pulmonary disease

Hye-Jung Jin¹, Eun-Kyong Kim¹, Seo-Young An², Sang-Uk Im¹, Keun-Bae Song¹, Youn-Hee Choi¹

¹Department of Preventive Dentistry, Kyungpook National University School of Dentistry, Daegu, Korea

²Department of Oral and Maxillofacial Radiology, Kyungpook National University School of Dentistry, Daegu, Korea

Corresponding Author: Youn-Hee Choi Department of Preventive Dentistry, Kyungpook National University School of Dentistry, 2177 Dalgubeol-daero, Jung-gu, Daegu 700-412, Korea Tel: +82-53-660-6871 Fax: +82-53-423-2947 E-mail: cyh1001@knu.ac.kr

Received 15 May 2013 Revised 30 May 2013 Accepted 19 July 2013

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

The aim of this study was to examine the relationship between periodontal health and chronic obstructive pulmonary disease (COPD) in a Korean population.

Methods

The Community Periodontal Index (CPI) data of 7,264 subjects, aged over 25 years, who participated in the Fourth Korea National Health and Nutrition Examination Survey was used to assess the periodontal status of the population. Severity of COPD in the subjects was classified according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) definition.

Results

Subjects with more severe COPD were more likely to have severe periodontal disease. After adjustment for gender, age, monthly income, education, economic activity, and occupation, the odds ratio of COPD was 1.18 (95% Confidence interval [CI], 0.63-2.21) for severe periodontal disease in the study sample. When stratified by smoking status, the odds ratio of current smokers was 0.92 (95% CI, 0.41-2.05) and that of non-smokers was 1.29 (95% CI, 0.64-2.59).

Conclusions

Periodontal health was not significantly related to the severity of the COPD, even though smoking was a common risk factor. This is the first study examining the relationship between periodontal health and COPD in a Korean population. Studies that further investigate the causal relationship between the two are recommended.

Keywords: Chronic obstructive pulmonary disease, Periodontal diseases, Respiratory diseases

References

1. Lopez AD, Shibuya K, Rao C, Mathers CD, Hansell AL, Held LS, et al. Chronic obstructive pulmonary disease: current burden and future projections. Eur Respir J. 2006; 27:397–412.

2. Kim DS, Kim YS, Jung KS, Chang JH, Lim CM, Lee JH, et al. Prevalence of chronic obstructive pulmonary disease in Korea: a population-based spirometry survey. Am J Respir Crit Care Med. 2005; 172:842–847.

3. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006; 3:e442.

4. Lee GD, Doh SR, Lee JS, Noh CS, Lee SD, Kim DS, et al. Trends and factors in health care utilization of patients with chronic obstructive pulmonary disease in Korea: A nationwide survey from 1990 through 2008. Tuberc Respir Dis. 2011; 70:307–314.

5. Lee GY. Review: Epidemiology of chronic obstructive pulmonary disease. Tuberc Respir Dis. 2003; 55:333–343.

6. Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007; 176:532–555.

7. Seymour GJ, Ford PJ, Cullinan MP, Leishman S, Yamazaki K. Relationship between periodontal infections and systemic disease. Clin Microbiol Infect. 2007; 13(Suppl 4):S3–10.

8. Wang Z, Zhou X, Zhang J, Zhang L, Song Y, Hu FB, et al. Periodontal health, oral health behaviours, and chronic obstructive pulmonary disease. J Clin Periodontol. 2009; 36:750–755.

9. Sharma N, Shamsuddin H. Association between respiratory disease in hospitalized patients and periodontal disease: a cross-sectional study. J Periodontol. 2011; 82:1155–1160.

10. Terpenning MS. The relationship between infections and chronic respiratory diseases: an overview. Ann Periodontol. 2001; 6:66–70.

11. Hayes C, Sparrow D, Cohen M, Vokonas PS, Garcia RI. The association between alveolar bone loss and pulmonary function: the VA Dental Longitudinal Study. Ann Periodontol. 1998; 3:257–261.

12. Scannapieco FA, Ho AW. Potential associations between chronic respiratory disease and periodontal disease: analysis of National Health and Nutrition Examination Survey III. J Periodontol. 2001; 72:50–56.

13. Liu Z, Zhang W, Zhang J, Zhou X, Zhang L, Song Y, et al. Oral hygiene, periodontal health and chronic obstructive pulmonary disease exacerbations. J Clin Periodontol. 2012; 39:45–52.

14. Didilescu AC, Skaug N, Marica C, Didilescu C. Respiratory pathogens in dental plaque of hospitalized patients with chronic lung diseases. Clin Oral Investig. 2005; 9:141–147.

15. Ministry of Health and Welfare. 2009 Korean National Oral Health Survey. Seoul: Ministry of Health and Welfare;2009. p. 7–12.

16. WHO. Oral health surveys: basic methods. 4th ed. Geneva: World Health Organization;1997. p. 16–52.

17. Viegi G, Scognamiglio A, Baldacci S, Pistelli F, Carrozzi L. Epidemiology of chronic obstructive pulmonary disease (COPD). Respiration. 2001; 68:4–19.

18. Garcia RI, Henshaw MM, Krall EA. Relationship between periodontal disease and systemic health. Periodontol 2000. 2001; 25:21–36.

19. Prasanna SJ. Causal relationship between periodontitis and chronic obstructive pulmonary disease. J Indian Soc Periodontol. 2011; 15:359–365.

20. Vestbo J, Hurd SS, Agusti AG, Jones PW, Vogelmeier C, Anzueto A, et al. Global Strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease: GOLD Executive Summary. Am J Respir Crit Care Med. 2013; 187:347–365.

21. Deo V, Bhongade ML, Ansari S, Chavan RS. Periodontitis as a potential risk factor for chronic obstructive pulmonary disease: a retrospective study. Indian J Dent Res. 2009; 20:466–470.

22. Scannapieco FA, Wang B, Shiau HJ. Oral bacteria and respiratory infection: effects on respiratory pathogen adhesion and epithelial cell proinflammatory cytokine production. Ann Periodontol. 2001; 6:78–86.

23. Wan ES, DeMeo DL, Hersh CP, Shapiro SD, Rosiello RA, Sama SR, et al. Clinical predictors of frequent exacerbations in subjects with severe chronic obstructive pulmonary disease (COPD). Respir Med. 2011; 105:588–594.

24. Katancik JA, Kritchevsky S, Weyant RJ, Corby P, Bretz W, Crapo RO, et al. Periodontitis and airway obstruction. J Periodontol. 2005; 76:2161–2167.

25. Hyman JJ, Reid BC. Cigarette smoking, periodontal disease: and chronic obstructive pulmonary disease. J Periodontol. 2004; 75:9–15.

Table 1.

Criteria used for the diagnosis of COPD

COPD stage	FEV₁/FVC	FEV₁/Predictred FEV₁
Normal to at risk	≥70%	≥80%
Mild	<70%	≥80%
Moderate	<70%	≥30% and <80%
Severe	<70%	<30%

Base on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) spirometry guidelines

⁶⁾ .

Table 2.

Demographic distribution according to periodontitis

	Non-periodontitis (n=5,093)	Periodontitis (n=2,171)	P-value
Age (yrs, mean±SD)	35.60±0.21	43.75±0.26	<0.001*
Gender			<0.001^†
Male	1,990 (48.1)	1,240 (64.5)
Female	3,103 (51.9)	931 (35.5)
Education (yrs)			<0.001^†
<6	314 (5.4)	271 (11.3)
6-8	473 (8.4)	329 (14.9)
9-11	2,202 (43.5)	907 (42.6)
≥12	2,084 (42.6)	653 (31.1)
Occupation			<0.001^†
Non-manual	2,331 (48.3)	896 (44.4)
Manual	1,069 (20.8)	749 (34.0)
Non-economic activity	1,636 (21.3)	505 (6.7)
Income states			<0.001^†
Low	1,132 (22.3)	605 (27.1)
Milddle-low	1,195 (23.3)	499 (26.8)
Milddle-high	1,325 (26.9)	499 (24.2)
High	1,358 (27.5)	458 (21.8)
Marital status			<0.001^†
Married	4,045 (77.2)	1,853 (84.4)
Divorced	358 (6.5)	192 (8.7)
Unmarried	686 (16.3)	123 (6.9)
Region			0.289
Metropolitan	2,351 (47.4)	1,023 (48.9)
City	1,913 (38.1)	741 (34.7)
Rural	829 (14.5)	407 (16.3)
BMI
Normal	3,384 (65.8)	1,338 (61.4)	0.026^†
Overweight	1,471 (29.7)	729 (34.1)
Obese	228 (4.5)	95 (4.5)
Smoking status			<0.001^†
Current smoker	1,155 (27.1)	797 (41.2)
Non-smoker	3,920 (72.9)	1,369 (58.9)
Number of cigarettes smoked in a day among current smokers	16.35±9.04	18.76±9.33	0.003*
WBC	6.27±0.04	6.74±0.06	<0.001*

BMI, body mass index; WBC, white blood cell. The data were analysed by complex samples. *P-value obtained from t-test.

^† P-value obtained from chi-square test.

Table 3.

Periodontal disease and dental behavior distribution according to COPD status

	Non-COPD		COPD severity
	Non-COPD	COPD	P-value*	Mild	Moderate	Severe	P-value^†
CPI code
Normal	1,437 (20.3)	49 (18.5)	<0.001	16 (26.9)	31 (67.8)	2 (5.2)	<0.001
Gingival bleeding	515 (6.9)	25 (7.9)		9 (37.7)	14 (58.8)	2 (3.5)
Calculus	2,964 (42.3)	103 (31.5)		29 (25.8)	67 (69.3)	7 (4.9)
Shallow periodontal pocket	1,644 (24.1)	90 (28.8)		37 (46.1)	51 (52.3)	2 (1.6)
Deep periodontal pocket	406 (6.3)	31 (13.3)		9 (29.2)	19 (56.2)	3 (14.7)
Frequency of daily toothbrushing
≤2	3,433 (50.5)	164 (60.3)	0.006	51 (33.1)	102 (60.2)	11 (6.7)	0.035
≥3	3,516 (49.5)	129 (39.7)		48 (35.9)	76 (60.8)	5 (3.4)
Dental visit (1 yr)
Yes	2,203 (33.8)	93 (32.4)	0.752	37 (45.3)	48 (45.6)	8 (9.2)	0.085
No	4,728 (65.9)	198 (67.2)		62 (29.1)	128 (67.3)	8 (3.6)

*P-value obtained from complex samples crosstabs for comparing the distribution of periodontitis between non-COPD group and COPD group.

^† P-value obtained from complex samples crosstabs for comparing the distribution of periodontitis among different COPD group.

Table 4.

Relationship between periodontal health and chronic obstructive pulmonary disease

	Crude OR	95% CI	Adjust OR*	95% CI
Periodontitis severity
Normal		1.00		1.00
Gingival bleeding	1.26	0.70-2.25	0.96	0.07-1.80
Calculus	0.82	0.53-1.27	0.74	0.46-1.17
Shallow periodontal pocket	1.32	0.84-2.06	0.79	0.50-1.25
Deep periodontal pocket	2.31	1.27-4.19	1.18	0.63-2.21

OR, odds ratio; CI, 95% confidence intervals. *Gender, age, monthly income, education, economic activity, occupation, WBC and smoking status.

Table 5.

Adjusted odds ratios (OR) and 95% confidence intervals of COPD in relation to periodontal health and stratification of smoking status

	Crude OR	95% CI	Adjusted OR*	95% CI
Current smoker
Normal (CPI 0)		1.00		1.00
Gingival bleeding (CPI 1)	0.77	0.21-2.81	0.58	0.15-2.20
Calculus (CPI 2)	0.84	0.43-1.64	0.66	0.33-1.32
Shallow periodontal pocket (CPI 3)	1.69	0.89-3.23	0.88	0.44-1.74
Deep periodontal pocket (CPI 4)	2.12	1.00-4.49	0.92	0.41-2.05
Non-smoker
Normal (CPI 0)		1.00		1.00
Gingival bleeding (CPI 1)	1.36	0.75-2.45	1.30	0.72-2.35
Calculus (CPI 2)	1.02	0.67-1.56	0.93	0.60-1.42
Shallow periodontal pocket (CPI 3)	1.04	0.63-1.70	0.83	0.50-1.38
Deep periodontal pocket (CPI 4)	1.71	0.87-3.35	1.29	0.64-2.59

Non-smoker; ex-smoker and never smoker. OR, odds ratio; CI, 95% confidence intervals. *Gender, age, monthly income, education, economic activity, occupation and WBC.

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