Unmasking the Silent Threat: Periodontal Health’s Impact on COPD Severity and Hospitalization

Abstract

Objective: This study investigated the relationship between chronic obstructive pulmonary disease (COPD) and periodontitis, focusing on how periodontal health impacts COPD airflow limitation, exacerbations, and hospitalization. Background: Periodontitis, a multifactorial inflammatory disease, is characterized by destruction of tooth-supporting structures, while COPD is a global pulmonary disorder with high mortality. Methods: A total of 199 COPD patients aged over 40 years underwent lung function tests (spirometry), 6 min walk test, and St George’s Respiratory Questionnaire-COPD (SGRQ-C) to assess lung health. Periodontal indices such as probing depth (PD), clinical attachment loss (CAL), and plaque index (PI) were assessed. Results: We found a significant negative correlation between periodontal disease severity and lung function (lower FEV1, FVC, and FEV1/FVC ratio) after adjusting for smoking. Likewise, periodontal parameters (PPD, PI, and CAL) exhibited negative correlations with lung function. These periodontal indices were independently associated with airflow limitation severity, exacerbations frequency, and prior-year hospitalization. Linear regression indicated that each unit increase in PPD, PI, and CAL corresponded to estimated increases in GOLD airflow limitation grading (0.288, 0.718, and 0.193, respectively) and number of exacerbations (0.115, 0.041, and 0.109, respectively). In logistic regression, PPD, PI, and CAL adjusted odds ratios (ORs) were estimated to increase by 1.29 (95%CI: 1.03–1.62), 3.04 (95%CI: 1.28–7.2), and 1.26 (95%CI: 1.06–1.49), respectively, for hospitalization in previous year. Conclusion: Periodontitis is associated with COPD airflow limitation, exacerbation, and hospitalization, with PI being the most clinically relevant periodontal factor. Dentists and physicians should monitor and increase awareness among COPD patients to maintain oral hygiene for prevention of periodontal diseases and mitigate its effect on COPD progression.

Environmental exposures, the oral–lung axis and respiratory health: The airway microbiome goes on stage for the personalized management of human lung function

“…It affects tooth‐supporting tissues and is linked to pulmonary diseases. Epidemiological studies across various countries and regions indicate a positive correlation between the prevalence and severity of periodontitis with the onset and progression of COPD (Kelly et al., 2021 ; Lin, Liu, et al., 2023 ; Subbappa et al., 2023 ; Suzuki, Kamio, Kaneko, et al., 2022 ; Suzuki, Kamio, Sugimoto, et al., 2022 ; Vollmer et al., 2022 ). Advanced periodontal disease may lead to epithelial damage of the lower airways by inflammatory cytokine release in response to metabolites excreted by periodontal pathogens, which attracts inflammatory cells and subsequent release of metalloproteinases, contributing to COPD progression and exacerbations (Mammen et al., 2020 ; Natalini et al., 2023 ); mechanisms by which periodontitis affects COPD progression are under investigation (Xiong et al., 2024 ).…”

“…Understanding these inter‐connections should provide clinically valuable insights, and we argue that the oral health status should be systematically integrated in the management of COPD. Indeed, dentists and physicians should monitor and increase awareness among COPD patients on oral hygiene, not only for prevention of periodontal diseases, but also to potentially slow COPD progression (Subbappa et al., 2023 ). This notion is supported by interventional studies indicating that periodontal treatment may effectively improve COPD symptoms (Lin, Liu, et al., 2023 ).…”

“…Such an index could also be expanded towards personalized chronic disease prognostics as predictors of disease trajectory when applied longitudinally over time to COPD patients. In addition, the frequency of lung function decline and exacerbation in COPD patients with periodontitis is more serious than in those with good periodontal health (Kouanda et al., 2021 ; Lin, Liu, et al., 2023 ; Subbappa et al., 2023 ). Thus, integrating the oral–lung axis as a single niche with inter‐connected microenvironments may take multi‐omics microbiome studies into a next level, towards establishing more robust clinically meaningful interactions between exposure, microbial dysbiosis and disease outcomes.…”