Oral health is a mediator for disease severity in patients with Behçet’s disease: A multiple mediation analysis study

Abstract

Summary Objectives The aim of the study was to examine whether oral health as an infection focus could mediate disease course in patients with Behçet's disease (BD). Methods In the study, oral health of 194 BD patients was examined at baseline and follow‐up periods. The reasons for last dental visits were recorded as tooth extraction or regular control visits/planned treatments at the end of follow‐up period. The Behçet's disease severity score was calculated with higher scores indicating a more severe course. Mediation analysis was carried out to assess the effects of oral health on disease severity score at follow‐up period in the study. Results Dental and periodontal indices were found to be higher at follow‐up visit compared to those of baseline (P < 0.05). Disease severity score was found to be higher in males (5.3 ± 2.4) compared to females (4.4 ±2.5) in the whole group (P = 0.005). Moreover, patients having tooth extraction at their last dental visit and patients with dental caries had a more severe disease course (5.4 ± 2.4; 5.5 ± 2.5) compared to others (4.2 ± 2.3; 4.4 ± 2.4; P < 0.0001). In multiple mediation analysis, disease severity score was a dependent variable and was directly mediated by male gender (B = −0.8822, P = 0.0145) and indirectly mediated through the presence of dental caries (B = 0.9509 P = 0.0110) and need of tooth extraction (B = 0.8758, P = 0.0128). Conclusion Both presence of dental caries and need of tooth extraction were observed to be effective mediators for a more severe disease course in BD. Therefore, better oral health should be aimed to eliminate microbial factors, which are a part of pathogenic processes.

Elevated serum TREM-1 is associated with periodontitis and disease activity in rheumatoid arthritis

“…In the MA, a bootstrap resampling up to 5000 replications was applied to generate a 95% CI and thereby allow accurate estimation of mediation effects. The mediation effect was considered to be present since the lower and upper intervals did not contain zero 34,35 .…”

“…Patients affected by BD as a chronic and relapsing systemic inflammatory disorder were additionally recruited herein to serve as a disease control group associated with oral health impairment 34 . BD patients were diagnosed according to the International Study Group for Behçet's disease criteria 39 and the cohort was characterized by a disease severity score of 3.9 ± 1.4 (mucocutaneous involvement: n = 31; i.e.…”

“…A mediation analysis (MA) could be a suitable option to evaluate this association. MAs commonly serve to statistically explore the mechanisms that underlie the relationship between an independent and a dependent variable, considering a potential indirect effect mediated by a so-called mediator variable 34,35 .…”

Novel and known periodontal pathogens residing in gingival crevicular fluid are associated with rheumatoid arthritis

“…RA activity was assessed using the 28‐joint Disease Activity Score (DAS‐28) 19 . BD‐affected patients were diagnosed according to the classification criteria implemented by the International Study Group of Behçet disease and were recruited herein to serve as an inflammatory disease group associated with oral health impairment 21,22 . Participants included in the HC group were matched for gender and socio‐economic status.…”

“…19 BD-affected patients were diagnosed according to the classification criteria implemented by the International Study Group of Behçet disease and were recruited herein to serve as an inflammatory disease group associated with oral health impairment. 21,22 Participants included in the HC group were matched for gender and socio-economic status. HC participants were selected among family-unrelated individuals devoid of any systemic inflammatory disorders who accompanied patients attending the Rheumatology outpatient clinic.…”