Mouth the mirror of lungs: where does the connection lie?

Periodontal disease (PD), as a chronic bacterial infection, might cause cardiovascular and some other systemic diseases, with recent studies reporting that it exhibits some connection with lung cancer. While studies have shown that poor oral health might increase the risk of lung cancer, the veracity of these reports is questionable. Therefore, this meta‐analysis was undertaken to investigate the association between PD and the risk of lung cancer. A search was run in PubMed, EMBASE, MEDLINE, CENTRAL, and ClinicalTrials.gov databases up to January 1, 2020. Cohort and case‐control studies investigating the correlation between PD and lung cancer were included. Eligibility assessment and data extraction were conducted independently, and a meta‐analysis was performed to synthesize the data. The association between PD, edentulism, and lung cancer was measured by the adjusted hazard ratios (HRs) or odds ratios (ORs) and their 95% confidence intervals (CIs) provided in articles. We employed appropriate effect model in terms of I2 (a fixed‐effect model for PD and a random‐effect model for edentulism) to obtain summary effect estimates. Statistical heterogeneity was investigated by chi‐square test and I2 statistics. Newcastle‐Ottawa Scale (NOS) was used to assess the quality of their method. Six cohort studies (eight references) and two case‐control studies, assessed as high‐quality, involving 167 256 participants, were included in the review. The summary estimates based on adjusted data showed an association between PD and a significant risk of lung cancer both in cohort studies (HR = 1.40, 95% CI = 1.25‐1.58; I2 = 8.7%) and case‐control studies (OR = 1.51, 95% CI = 1.16‐1.98; I2 = 36.5%). Similar features were found in the sensitivity analysis and subgroups for six cohort studies, of male only (HR = 1.36, 95% CI = 1.15‐2.60), setting the lung cancer incidence as endpoint (HR = 1.39, 95% CI = 1.24‐1.57; I2 = 23.9%), and adjusting alcohol for multifactorial HR (HR = 1.38, 95% CI = 1.21‐1.57; I2 = 39.9%). The summary HR for edentulism was 1.93 (95% CI = 1.05‐3.57; I2 = 55.3%). No obvious publication bias was detected. This systematic review and meta‐analysis demonstrated a significant association between PD and the incidence of lung cancer. Further observational studies are required by using standardized measurements to assess the periodontal status and by eliminating confounding factors, such as alcohol and diabetes, to verify such a relationship.

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“…A study indicated that daily personal oral hygiene measures decrease the risk of respiratory diseases. 64 Meanwhile,…”

Section: Discussionmentioning

confidence: 99%

Relationship between periodontal disease and lung cancer: A systematic review and meta‐analysis

Wang

Yang

Zou

et al. 2020

J of Periodontal Research

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“…Obligate anaerobes are one of the common causative bacteria of pneumonia, especially aspiration pneumonia. Anaerobic lung infection can occur after aspiration of salivary secretions, especially in patients with periodontal disease, and the increase in gram‐negative anaerobes in the oral cavity induced by poor oral hygiene is thought to be responsible for causation of pneumonia …”

Section: Introductionmentioning

confidence: 99%

Poor oral hygiene is associated with the detection of obligate anaerobes in pneumonia

Hata

Noguchi

Kawanami

et al. 2019

Journal of Periodontology

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Background Oral cavity is a reservoir of various respiratory pathogens, and poor oral hygiene is associated with an increase in anaerobic bacteria in oral cavity. In addition, it positively relates higher risk of developing pneumonia and increased pneumonia‐related mortality. However, the association between poor oral hygiene and increase in obligate anaerobes in the lungs of pneumonia patients is unclear. Methods A total of 39 patients with pneumonia in whom bronchoscopic examination and oral hygiene evaluation were performed were prospectively enrolled. The microbiota of the bronchoalveolar lavage fluid (BALF) directly obtained from the pneumonia lesion was analysed by the clone library analysis. In addition, oral hygiene evaluations were performed using oral hygiene index (OHI), tongue coating score, oral dryness, and community periodontal index of treatment needs (CPITN). The association between the detection of oral streptococci and obligate anaerobes and oral hygiene status was evaluated. Results Using the clone library analysis of BALF, the phylotypes of oral streptococci and obligate anaerobes were detected in 31 (79.5%) and 26 (66.7%) patients, respectively. Increased oral dryness, OHI, and CPITN, but not the tongue coating score, significantly correlated with higher rate of detection of obligate anaerobes, although no significant associations between the detection of oral streptococci in the lungs and each oral hygiene evaluation were observed. Significantly higher number of obligate anaerobes were detected in the lungs in patients with total oral hygiene score of ≥ 5 (P = 0.008). Conclusion Poor oral hygiene is associated with increased obligate anaerobes in the lungs of patients with pneumonia.

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“…1,2 In this context, also oral health might play a key role, as a recent review article points the association between oral health, especially periodontal inflammation, and respiratory diseases. 3 Beside of that special condition, patients after organ transplantation in general should be early dental rehabilitated and the demand of a sufficient maintenance is present in literature. [4][5][6] In contrast, recent investigations on the oral health situation of transplant recipients show insufficient dental and periodontal health, as well as shortcomings in dental behavior of patients after solid organ transplantation, including lung, liver, and kidney.…”

Section: Introductionmentioning

confidence: 99%

Oral health related quality of life depending on oral health and specific factors in patients after lung transplantation

Schmalz

Wendorff

Marcinkowski

et al. 2017

Clinical Respiratory J

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Mouth the mirror of lungs: where does the connection lie?

Cited by 20 publications

References 34 publications

Relationship between periodontal disease and lung cancer: A systematic review and meta‐analysis

Relationship between periodontal disease and lung cancer: A systematic review and meta‐analysis

Poor oral hygiene is associated with the detection of obligate anaerobes in pneumonia

Oral health related quality of life depending on oral health and specific factors in patients after lung transplantation

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