Background Recent studies suggest a possible association between periodontal disease and hypertension; however, prospective evidence is limited. Methods The study population consisted of 31,543 participants of the HPFS prospective cohort who were 40 to 75 years old at baseline, had no prior hypertension history and had complete baseline information on oral health. Information on periodontal disease, hypertension and potential confounders was updated biennially. We used Cox proportional hazards models to study the relation between periodontal disease at baseline, during follow-up, periodontal bone loss severity, baseline number of teeth and tooth loss during follow-up, and the risk of developing hypertension. Multivariate models included age, calendar time, race, comprehensive smoking index, diabetes, alcohol consumption, family history of hypertension, dental profession, BMI, physical activity, fruit and vegetable intake, multivitamin use, calcium, vitamin D and vitamin E intake. Results We identified 10,828 cases of incident hypertension over 20 years of follow-up. After adjusting for potential confounders, we did not observe significant associations between incident hypertension and periodontal disease at baseline (RR=1.04; 95% CI: 0.98–1.10), periodontitis during follow-up (RR=1.01; 95% CI: 0.96–1.05), tooth loss during follow-up (RR=1.03; 95% CI: 0.98–1.09), or when comparing men with 0–10 teeth to men with ≥25 teeth at baseline (RR=1.05; 95% CI: 0.91–1.21). Participants reporting severe periodontal bone loss had a relative risk for incident hypertension of 1.02 compared to those without bone loss (95% CI: 0.77–1.35). Conclusions We did not observe an association between periodontal disease measures and incident hypertension in this cohort of middle-aged men.
Background Current scientific evidence addressing the relation between periodontitis and hypertension is limited to a few studies producing inconsistent results. Methods All participants of an on-going representative cohort of Puerto Rican elderly who were 70 years and older and residing in San Juan metropolitan area were invited to this cross-sectional study. Periodontal probing depth (PD) and attachment loss (AL) were summarized using CDC-AAP definition for severe periodontitis (≥2 teeth with AL ≥6mm and ≥1 tooth with PD ≥5mm). We averaged three repeated blood pressure (BP) measurements taken using a standardized auscultatory method. Information on hypertension history, use of anti-hypertensive medications and potential confounders (age, gender, smoking, heavy and binge drinking, diabetes, utilization of preventive dental services, flossing, body mass index, fruit and vegetable, whole wheat bread and high-fiber cereal consumption) was collected during in-person interviews. High BP was defined as average systolic BP ≥140 mmHg or diastolic ≥90 mmHg. Multivariate logistic regression models were used to study the relation between severe periodontitis, hypertension history and high BP. Results The study population comprised 182 adults. In multivariate analysis, there was no association between severe periodontitis and hypertension history (OR=0.99, 95% CI: 0.40–2.48). Severe periodontitis was associated with high BP, with OR of 2.93 (95% CI: 1.25–6.84), after adjusting for age, gender, smoking, and binge drinking. This association was stronger when restricted to those with hypertension or taking anti-hypertensive medications: OR=4.20 (95% CI: 1.28–13.80). Conclusion Our results suggest that periodontitis may contribute to poor blood pressure control among older adults.
BackgroundGingivitis is a common oral health problem. Untreated gingivitis may progress to periodontitis, a common cause of tooth loss. The prevalence of gingivitis and calculus among Puerto Rican children is unknown. Understanding this prevalence can support early public health preventative strategies. This study aims to estimate the prevalence of gingivitis and calculus among 12-year-old Puerto Ricans by health region and to explore differences in distribution by school type (proxy for socio-economic status) and gender.MethodsA probability-based sample of 113 schools was selected proportional to enrollment size and stratified by health region, school type, and gender. Two trained examiners evaluated the presence of gingivitis and both supragingival and subgingival dental calculus. Gingivitis was defined as the presence of gingival bleeding upon gentle probing (BOP) in at least one site, and the extent of the problem was classified according to the percentage of teeth whose gingiva presented BOP (limited: 25–49% of the teeth tested; extensive: >50% of teeth tested). Logistic and linear regression models, adjusted for health regions, were used to compare gingivitis and calculus prevalence and extent between genders and school types.ResultsGingivitis was found in 80.41% of the 1586 children evaluated. Urban-public schoolchildren had a slightly higher prevalence (83.24%) compared to private (79.15%, p = 0.16); those in rural-public (77.59%) and private schools had similar prevalence (p = 0.15). Extensive gingivitis was present in 60.81% of all children. The mean percentage of sites presenting BOP (BOP%) was 17.79%. Rural and urban public schoolchildren presented significantly higher BOP% compared to children from private schools (p = 0.0005, p = 0.002, respectively). Dental calculus was detected in 61.59% of the sample, boys presenting significantly higher (p = 0.005) total and supragingival calculus. Rural-public schoolchildren had a significantly higher prevalence of subgingival calculus compared to private schoolchildren (p = 0.02).ConclusionsGingivitis prevalence is higher among 12-year-old Puerto Ricans compared to data reported for U.S. adolescents. Public schoolchildren presented significantly higher BOP% sites compared to private schoolchildren. Boys presented a significantly higher total and supragingival calculus prevalence than girls. Oral health disparities related to gender and school type were identified by this study. Studies exploring the reasons for these disparities are recommended.Electronic supplementary materialThe online version of this article (10.1186/s12903-017-0471-5) contains supplementary material, which is available to authorized users.
Objective: To identify the types, food sources, and pattern of carbohydrates that significantly contribute to dental caries in Puerto Rican children. Methods: As part of an island-wide cross-sectional oral health study in 1,587 twelve-year-olds, diet intake was assessed in a representative subset (n = 801) with a 24-hour dietary recall. Carbohydrate intake was quantified using a computer-based diet analysis program. Caries was assessed using the National Institute of Dental and Craniofacial Research diagnostic criteria. Odds ratios were used to associate carbohydrate intake quartiles with caries, after controlling for important confounders. Results: A total of 723 subjects had complete data. Most were females (54%) and attended public schools (77%). The caries prevalence was 33%. The highest quartile intake for the following sugars significantly increased the odds of caries compared to the lowest quartile: total carbohydrates (OR = 1.93, 95% CI = 1.08-3.46), total sugars (OR = 1.88, 95% CI = 1.01-351), sucrose (OR = 2.05, 95% CI = 1.13-3.70), fructose (OR = 1.95, 95% CI = 1.05-3.62), and inositol (OR = 2.52, 95% CI = 1.38-4.63). The main food sources of these sugars were juices, including natural juices with no added sugars, and sweetened beverages. The odds of caries also increased significantly in children whose 10% of total energy intake was from total sugars (OR = 3.76, 95% CI = 1.03-13.7). Conclusion: After adjusting for important caries risk factors, total carbohydrates, total sugars, ≥10% kilocaloric energy from total sugars, and sucrose, fructose, and inositol intake significantly increased caries risk. Our findings can help raise awareness about the potential caries risk from the main sources of these sugars, natural fruit juices and sweetened beverages, which are consumed in great quantities in many societies.
Background There are limited validated FFQs for infants and toddlers, most of which were evaluated in Europe or Oceania and the available ones for use in the US have important limitations. Objective To assess the validity of a food frequency questionnaire (FFQ) developed for infants and toddlers. Design A semi-quantitative FFQ was developed including 52 food items, their source and portion sizes. It enquired about diets over the previous 7 days. Its validity was assessed in a cross-sectional study. Participants completed the FFQ followed by a 24-hour recall on two occasions with one week between data collection. Participants/setting A total of 296 caregivers of infants and toddlers aged 0–24 months enrolled in WIC-Puerto Rico. Main outcome measures Intake of nutrients and food groups were averaged for the two FFQs and the two 24-h food recalls and adjusted for energy intake. Statistical analyses performed Spearman correlations were performed for intakes of energy, nutrients, and foods between administrations and between instruments. Correlation coefficients were de-attenuated to account for variation in the 24 hour recalls. Results A total of 241 participants completed the study. Intake of all nutrients and foods were significantly correlated between FFQs, 24-h recalls and between the average of FFQs and 24-h food recalls. The de-attenuated correlation for nutrients between the FFQs and 24-h recalls ranged from 0.26 (folate) to 0.77 (energy), with an average correlation of 0.53. The de-attenuated correlation for food groups between the FFQs and 24-h recalls ranged from 0.28 (sweets) to 0.80 (breast-milk) with an average correlation of 0.55. When analyses were restricted to those consuming foods other than breast milk or formula (N=186), results were similar. Conclusions This semi-quantitative FFQ is a tool that offers reasonably valid rankings for intake of energy, nutrients, foods and food groups in this sample of infants and toddlers.
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