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A cohort study of the impact of tooth loss and periodontal disease on respiratory events among COPD subjects: modulatory role of systemic biomarkers of inflammation.

TitleA cohort study of the impact of tooth loss and periodontal disease on respiratory events among COPD subjects: modulatory role of systemic biomarkers of inflammation.
Publication TypeJournal Article
Year of Publication2013
AuthorsBarros SP, Suruki R, Loewy ZG, Beck JD
Secondary AuthorsOffenbacher S
JournalPLoS One
Volume8
Issue8
Paginatione68592
Date Published2013
ISSN1932-6203
KeywordsBiomarkers, Cohort Studies, Female, Humans, Inflammation, Interleukin-6, Male, Middle Aged, Mouth, Edentulous, Periodontal Diseases, Proportional Hazards Models, Pulmonary Disease, Chronic Obstructive, Tooth Loss
Abstract

BACKGROUND: In COPD patients, fatal and non-fatal respiratory-related events are influenced by age, severity of respiratory disease, and comorbidities.

OBJECTIVES: Analyze the effects of edentulism, periodontal disease and systemic biomarkers of inflammation on the occurrence of serious fatal and non-fatal respiratory-related events among subjects with COPD.

METHODS: Cases were identified from Dental Atherosclerosis Risk in Communities study. Edentulism was defined as study participants without any natural teeth or implants. Participants with one or more natural teeth (comprising 11,378 subjects) were studied as dentate subjects. Periodontal disease status among dentate individuals was determined using the consensus definitions published by the joint Center for Disease Control/American Association of Periodontology working group). Adjusted Hazard Models are developed to evaluate the relationship between edentulism/periodontal disease and COPD Related Events. Models were then stratified by GOLD Stage I, II and III/IV. Serum biomarkers were also evaluated to explore the effect of systemic inflammation.

RESULTS: A statistically significant association was found between oral health status and COPD-related events, even adjusting for conditions such as hypertension, smoking and diabetes. Edentulous individuals who had been diagnosed with COPD had a higher incidence and were at greater risk of having a COPD related event (hospitalization and death) than individuals who had teeth and whose mouths had healthy periodontal status. However, being edentulous did not convey excess risk for COPD-related events for those study participants who were classified as GOLD III/IV at baseline. Finally, we showed that individuals who had levels of serum IL-6 in the highest two quartiles were at even higher risk for COPD-related events.

CONCLUSIONS: These findings suggest that the risk for COPD-related events after adjusting for potential confounders may be attributable to both edentulism and elevated serum IL-6 levels.

DOI10.1371/journal.pone.0068592
Alternate JournalPLoS One
PubMed ID23950871
PubMed Central IDPMC3738507