Markers of Dental Health Correlate with Daily Respiratory Symptoms in COPD

Abstract

Background: Poor dental health occurs in patients with chronic obstructive pulmonary disease (COPD); some evidence suggests that it may correlate with lower forced expiratory volume in 1 second (FEV1) and 6-minute walk distance, and an increased rate of exacerbations. However, there is no data that examines how dental health may impact the daily respiratory symptoms that COPD patients experience. We prospectively studied indices of dental health and hygiene in patients with COPD and determined their impact on daily respiratory symptoms. Methods: A total of 20 individuals with COPD (median [interquartile range (IQR)] % FEV1 37 [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43]) and 10 healthy control individuals with no lung disease were recruited. Dental questionnaires, spirometry, and a dental examination were administered on their initial visit. COPD participants were given an electronic COPD daily diary to document peak expiratory flow and the presence and magnitude of daily breathlessness, cough, sputum production, and wheeze. Results: Compared to healthy controls, COPD participants had less teeth (median 16.5 versus 28, p=0.0001), a trend to a higher plaque index (median 2.2 versus 1.7, p=0.15), and worse oral health-related quality of life (median Oral Health Impact Profile score 12.0 versus 4.5, p=0.02). A greater number of teeth correlated with higher percentage of days with cough (r=0.48, p<0.05) and wheeze (r=0.47, p<0.05). Conclusion: Individuals with severe COPD have poor oral hygiene and oral health-related quality of life. In the setting of poor dentition, a greater number of teeth correlates with more daily respiratory symptoms. More teeth may create a larger reservoir for inflammatory proteins and pathogenic bacteria to be aspirated into the airways. AbstractAbbreviations: chronic obstructive pulmonary disease, COPD; forced expiratory volume in 1 second, FEV1; interquartile range, IQR; National Health and Nutrition Survey, NHANES; plaque index, PI; forced vital capacity, FVC; oral health impact profile, OHIP; oral health impact profile summative score, OHIP-S; oral health impact profile weighted score, OHIP-W

<p>The relationship between oral health and COPD exacerbations</p>

“…A meta-analysis of 14 observational studies by Zeng et al showed an association between periodontitis and COPD diagnosis with a pooled OR of 2.09 (95% CI: 1.48–2.91) 10. Published studies also show that COPD patients have fewer remaining teeth compared with healthy controls 25–28. However, few studies have evaluated the relationship between COPD exacerbation rates with periodontitis and dentition status 11–14…”

The Oral-Lung Axis: The Impact of Oral Health on Lung Health

“…COPD patients have few remaining teeth, more dental plaque, and worse oral health-related quality of life. 64,65 Additionally, COPD patients do not brush their teeth, use dental floss, or visit the dentist as frequently as those without COPD. 64,66 Whether these correlations, which are likely multifactorial, play a causative role in COPD pathogenesis is unknown.…”

Exploring the inclusion of dental providers on interprofessional healthcare teams treating patients with chronic obstructive pulmonary disease: a rapid review

“…While a variety of healthcare professionals (respiratory therapists, family physicians, nurses, pulmonary technicians, etc.) are involved in caring for patients with COPD, dental providers are often overlooked 5 . Despite this gap in practise, the relationship between oral health and COPD has been explored in scientific, clinical, and educational domains, pointing to a vital need for integrating dental care into COPD treatment 5 .…”

“…Studies have shown that the microbiome in both the lung and oral cavity is similar and connected through a bi-directional relationship 5,6 ; a pathogen exchange between the lung and oral cavities occurs through saliva aspiration and hematogenous spread 6 . Infected teeth or gums act as a reservoir for anaerobic bacteria that provoke respiratory symptoms like wheezing, and the same bacteria can also be isolated in infected lungs 5,6 . The most common dental condition associated with COPD is periodontitis: a chronic inflammatory disease of the periodontal tissue, or gums, caused by bacterial infection [5][6][7] .…”

“…Infected teeth or gums act as a reservoir for anaerobic bacteria that provoke respiratory symptoms like wheezing, and the same bacteria can also be isolated in infected lungs 5,6 . The most common dental condition associated with COPD is periodontitis: a chronic inflammatory disease of the periodontal tissue, or gums, caused by bacterial infection [5][6][7] . If a patient has COPD or periodontitis, it is highly likely that the severity of disease progression for both conditions is exacerbated by the other 6 .…”