Periodontitis is related to lung volumes and airflow limitation: a cross-sectional study

Abstract

This study aimed to assess the potential association of periodontal diseases with lung volumes and airflow limitation in a general adult population.Based on a representative population sample of the Study of Health in Pomerania (SHIP), 1463 subjects aged 25-86 years were included. Periodontal status was assessed by clinical attachment loss (CAL), probing depth and number of missing teeth. Lung function was measured using spirometry, body plethysmography and diffusing capacity of the lung for carbon monoxide. Linear regression models using fractional polynomials were used to assess associations between periodontal disease and lung function. Fibrinogen and high-sensitivity C-reactive protein (hs-CRP) were evaluated as potential intermediate factors.After full adjustment for potential confounders mean CAL was significantly associated with variables of mobile dynamic and static lung volumes, airflow limitation and hyperinflation (p,0.05). Including fibrinogen and hs-CRP did not change coefficients of mean CAL; associations remained statistically significant. Mean CAL was not associated with total lung capacity and diffusing capacity of the lung for carbon monoxide. Associations were confirmed for mean probing depth, extent measures of CAL/probing depth and number of missing teeth.Periodontal disease was significantly associated with reduced lung volumes and airflow limitation in this general adult population sample. Systemic inflammation did not provide a mechanism linking both diseases. @ERSpublications Periodontal disease was significantly associated with reduced lung volumes and airflow limitation in an adult population

Relationship among clinical periodontal, microbiologic parameters and lung function in participants with chronic obstructive pulmonary disease

“…OHI‐S indicates the level of oral hygiene, whereas CAL is the major periodontal clinical parameter indicating the severity of chronic periodontitis. Furthermore, previous studies have reported a relationship between the respiratory function index (FEV1%) and the degree of periodontal inflammation …”

Is periodontitis a comorbidity of COPD or can associations be explained by shared risk factors/behaviors?

“…The COPD patients in Prasanna’s study were also noted to belong to a lower income group, were more illiterate, and were of a lower socioeconomic status regardless of periodontal status 40. Holtfreter et al found that patients with higher indices of periodontitis were less well educated and more often current smokers and had higher levels of systemic inflammation and worse lung function 101. All these studies indicate significant confounders that likely impact on results published to date even though Bhavsar et al did not find any differences in socioeconomic status or educational qualifications between their COPD cohort and control groups 95…”

“…However, some authors used pre-bronchodilator spirometry,107 which could lead to an overestimation of the prevalence of COPD, others report lung function measurements but not whether pre- or post-bronchodilation,40,98 and one study failed to mention how COPD was confirmed 99. A German prospective study used body plethysmography to determine lung function,101 whereas Shen et al used International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes that do not provide details of how the diagnosis was established 33…”

Shared microbiome in gums and the lung in an outpatient population

“…32 Although no data exists to date that compared simultaneously microbiota of the periodontal pocket and the bronchial compartment, several recent studies have shown an association of periodontal health and airflow limitation. 12,16,33 Although not statistically significant, it is an interesting finding of the current study that in subjects with key pathogenic marker species exhibited more often amounts of activated MMP8 (>40 ng/ml) as compared to subjects who did not harbor these bacteria in the lung. MMP8 has been shown to be elevated in bronchoalveolar lavage fluid under different inflammatory circumstances of the lung such as ventilator induced lung injury 34 or bacterial pneumonia.…”

“…8 The microorganisms detected in the subgingival plaque of affected patients predominantly consist of Gram-negative fastidious anaerobic rods. 9 Periodontal inflammation has been associated with several lung diseases such as COPD, 10e15 airflow limitation 16 or pneumonia. 17 In a pilot study we were able to detect periodontal pathogens in the lungs of lung transplant recipients in spite of the frequent use of antibiotics in this specific population.…”