Periodontal disease, sleep duration, and white blood cell markers in the 2009 to 2014 National Health and Nutrition Examination Surveys

Abstract

Background: Elevated levels of inflammatory biomarkers are consistently associated with chronic conditions, for which periodontitis and sleep are established risk factors. We examined the relationships between periodontitis, hours of sleep and white blood cell (WBC) markers among a nationally representative sample of US adults.Methods: Cross-sectional study using existing demographic, examination, laboratory and questionnaire data on 11,813 participants (5,814 men and 5,999 women, mean age ± SE; range: 52.74 ± 0.24; 30 to 80 years) from the 2009 to 2014 National Health and Nutrition Examination Surveys. Unadjusted, sex-and age-adjusted, as well as fully adjusted linear and logistic regression models were conducted in addition to generalized structural equations models, while considering sampling design complexity., odds ratios with their 95% confidence intervals, indirect effects and mediation proportions were estimated. Results:The weighted mean WBC count was 7,130 cells/µL, with the WBC 5-part differential estimated in terms of percentages of lymphocytes (29.50%), monocytes (7.99%), neutrophils (59.03%), eosinophils (2.84%), and basophils (71.88%). Furthermore, 36.2% of participants reported <7 hours of sleep and 49.8% had periodontitis. In fully adjusted models controlling for sociodemographic, lifestyle, and health characteristics, neither WBC markers nor periodontitis were related to hours of sleep.By contrast, periodontitis was directly related to WBC count and %neutrophils and inversely related to %lymphocytes, especially among men. However, the relationship of periodontitis with %neutrophils and %lymphocytes may be modified by hours of sleep, as it was specific to individuals reporting ≥7 hours of sleep. Conclusion:Periodontitis may be directly related to WBC count and %neutrophils and inversely related to %lymphocytes, especially among men and individuals reporting ≥7 hours of sleep, with implications for primary and secondary prevention. K E Y W O R D Sinflammation, leukocytes, periodontitis, sleep, surveys and questionnaires 582

White Blood Cell Count Mediates the Association Between Periodontal Inflammation and Cognitive Performance Measured by Digit Symbol Substitution Test Among Older U.S. Adults

“…The results well confirm our initial theoretical framework (ie, inflammatory hypothesis), which expects the decreased cognitive test scores through exposure to systemic inflammatory factors and leads us to explore the possible mechanisms of the association. The neuroinflammation pathogenesis of dementia gives biological plausibility to these mediating effects (39,40). The periodontal infection leads to leakage of various pathogenic products (ie, host inflammatory factors, pathogenic oral bacteria, and its products) through the gingival epithelium into the bloodstream in the active phases of the disease (6).…”

Elevated neutrophil‐to‐lymphocyte ratio but not platelet‐to‐lymphocyte ratio is associated with generalized aggressive periodontitis in a Chinese population

“…Host immune responses determine the severity of tissue destruction during GAgP. Many studies reported elevated leukocytes counts in patients with periodontitis, 3,6,26,27 indicating that GAgP may have effects on markers of systemic inflammation, and the pathogenesis of periodontitis might lead to the increased output of neutrophils. NLR is considered a marker of systematic inflammation, because it is related to many biochemical and cellular activities, and shows correlations with inflammatory markers such as CPR 28 .…”

An 8-week randomized controlled trial comparing the effect of a novel oscillating-rotating toothbrush versus a manual toothbrush on plaque and gingivitis

“…Periodontal disease is highly prevalent in the United States, with up to 90% of adults reported to have gingivitis and nearly 50% of adults estimated to have periodontitis 1‐3 . The development of periodontal disease is initiated through a host immune response to the oral bacteria present in dental plaque 4,5 .…”