Research finds connection between risk factors for periodontitis and general health

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Image credit: Cedric Fauntleroy from Pexels

Periodontitis is a disease that affects the supporting tissues of the teeth and is associated with other types of disease. A study conducted by the College of Dentistry showed that patients with severe periodontitis also had a higher prevalence of cardiovascular disease, diabetes, and chronic obstructive pulmonary disease.

The research is published in the journal BMC Oral Health Previously published relevant research Journal of Clinical Periodontology.

Ida Haukåen Stødle is a specialist in periodontology who has just completed her PhD at the Faculty.

She shares the following:

The overall purpose of my thesis is to investigate the prevalence of periodontitis and to examine whether we can identify diseases that may be associated with periodontitis. Because periodontitis affects many people and these associations may be relevant to many people, it is our responsibility to address these potential associations with our patients, Ada said.

Oral health is important to overall health. Perhaps instead of thinking about oral health as a separate thing, we should think about health as a whole. Simply emphasizing oral health requires artificial attention. The interplay between different diseases demonstrates that we must consider overall health as part of periodontal treatment. Ada continued that patients should be informed and encouraged to speak to their GP if they have severe periodontitis and other health problems.

Periodontitis is an inflammatory disease that can lead to tooth loss and is caused by bacteria naturally found in the oral flora. If these bacteria overgrow, you can develop this disease, but it's not suitable for everyone. Susceptibility varies from person to person.

New classification of periodontitis

Part of the task was to understand the prevalence of periodontitis in the survey population. A new, globally accepted classification of periodontal disease was published in 2018, which formed the basis of the initial investigation, Stødle said.

We report the overall and further prevalence of periodontitis of varying severity. Once we identified participants as having periodontitis, we further examined whether they had any other co-morbidities, such as cardiovascular disease and diabetes.

We know that there are several conditions associated with periodontitis. We selected a few to see how they are expressed using the new classification. The findings are generally consistent with previous observations. We also found that people with severe periodontitis and severe periodontal bone loss also had a higher prevalence of other diseases than people with little or no periodontitis.

We also included rheumatic disease in this study but found no association with periodontitis in patients with rheumatic disease. Ada explained that this was a bit surprising because we already knew about this association, and since rheumatoid arthritis is also an inflammatory disease, one would expect these diseases to occur together.

There may be several reasons why we did not observe any association. For example, how we include rheumatism in the material, whether we thoroughly differentiate between healthy and diseased individuals, and whether the dataset is large enough. We did not attempt to differentiate between the various forms of rheumatoid arthritis. These factors contribute to our findings.

Inconclusive results for celiac disease and its association with periodontitis

We also looked at celiac disease. This is a separate study; this is exciting because there is so little research on these two diseases. We did not expect any difference in periodontal bone loss between individuals with and without celiac disease.

Nonetheless, we found that humans with celiac disease had less frequent bone loss, just as celiac disease protects against periodontitis. We don't know what's behind this observation or how to explain this relationship, and because of this uncertainty it's difficult to draw any conclusions. Ada said it would be exciting if further research could be conducted on this.

Materials are extensive and comprehensive

The studies are based on extensive data and involved nearly 5,000 adults from the Nord-Trøndelag district. Transferability is advantageous for small towns and rural areas. Populations from large cities (whose demographic structure may differ) are not included. Therefore, the findings are not necessarily representative of all population groups in Norway. Several population studies (HUNT studies) have been conducted on this population in the Nord-Trøndelag district and is particularly suitable precisely because of its stability.

The Public Dental Service in Trøndelag (DOT) in collaboration with the Oral Health Competence Center TkMidt carried out the clinical oral and dental health examinations used in the PhD's work. Dentists and dental hygienists do a lot of work collecting large amounts of data.

Nearly 5,000 participants all underwent X-ray examinations, periodontal examinations, dental caries examinations and mucosal examinations. The X-ray consisted of a panoramic X-ray image and four smaller images of each participant.

I collaborated with my supervisors Odd Carsten Koldsland and Anders Verket on the analysis of X-rays and further work. The results of the X-ray analysis are compared with data from the clinical examination. Statistical calculations are also an important part of analysis. Several TkMidt employees contributed to this effort. Ada explained that this work resulted in three articles.

self-reported illness

The approach is based in part on self-reported illnesses, not just physical exams. Self-reported data are weaker than our confirmed medical diagnoses, and this must be considered when interpreting the results. Blood samples, including blood glucose measurements, were obtained from all participants.

This reinforces material that studies show that when the disease is well-defined, such as diabetes, there is a good correlation between self-reported disease and actual diagnosis. Self-reporting is a limitation of our data, but not to the extent that we don't trust the results.

Medical staff also obtained a number of other variables such as weight, height and blood pressure. We have a wealth of data on inflammatory mediators or cells. We didn't use it because some choices had to be made. But HUNT's data are extensive and good, making them ideal for this type of hypothesis-generating study, Ada said.

Prevent periodontitis and periodontitis-related diseases

We know that treatment of periodontitis can reduce inflammation and, in some cases, improve blood sugar control in people with diabetes. These are the links that we need to pay close attention to. We need to exchange information so that patients and healthcare professionals can benefit from this knowledge – to treat and prevent disease.

Risk factors are often the same for many diseases and conditions, including periodontitis, such as smoking. By reducing smoking, the risk of many diseases is also reduced. We can discuss this with the patient and refer them further if required.

We should be particularly concerned about the segment of the population who visit the dentist but may not readily seek other health care services. Ida concluded that collaboration between healthcare professionals and good information flow should be central to the prevention of periodontitis and periodontitis-related diseases.

More information:
Ida Haukåen Stødle et al., Association between periodontitis stage and self-reported disease in a Norwegian population: the HUNT study, BMC Oral Health (2023). DOI: 10.1186/s12903-023-03743-z

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