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The Egyptian Journal of Bronchology
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Chronic obstructive pulmonary disease exacerbations and periodontitis: a possible association

Egyptian Journal of Bronchology volume 12, pages 303–309 (2018)Cite this article

Abstract

Background

There is an increasing interest concerning the potential link between both chronic obstructive pulmonary disease (COPD) and chronic periodontitis; therefore the association became the research focus.

Objective

This study intended to evaluate the potential association between the frequency of COPD exacerbations and chronic periodontitis.

Patients and methods

A total of 250 male patients with COPD were included in the study and were categorized into two groups according to the frequency of exacerbations per year: group 1 had patients with frequent exacerbations (having ≥2 exacerbations in last year) and group 2 had patients with infrequent exacerbations (having <2 exacerbations in last year). They were compared regarding age, smoking history, education background, information of their oral hygiene behaviors, calculated modified Medical Research Council dyspnea scale, calculated COPD assessment test, the number of exacerbations and hospitalizations in the past year, prebronchodilator and postbronchodilator spirometry, calculated plaque index, bleeding index, probing pocket depth, clinical attachment level, and measured high-sensitivity C-reactive protein. Correlations between variables were examined. Logistic regression test was performed to explore the concurrent influences of periodontal health variables on the frequency of exacerbations.

Results

This study evidenced that all periodontal health variables were significantly correlated with smoking status, modified Medical Research Council dyspnea scale, COPD assessment test, number of exacerbations and hospitalizations per year, and C-reactive protein level. Simplified oral hygiene index, plaque index, bleeding index, gingival index, probing pocket depth, and clinical attachment level were significantly correlated with most of the spirometry data.

Conclusion

Periodontal health variables were considerably associated with the frequency of COPD exacerbations.

References

  1. Listgarten MA. Pathogenesis of periodontitis. J Clin Periodontol 1986;13:418–425.

    Article  CAS  Google Scholar 

  2. Sapey E, Bayley D, Ahmad A, Newbold P, Snell N, Stockley RA. Interrelationships between inflammatory markers in patients with stable COPD with bronchitis:intra-patient and inter-patient variability. Thorax 2008;63:493–499.

    Article  CAS  Google Scholar 

  3. Hobbins S, Chapple ILC, Sapey E, Stockley RA. Is periodontitis a comorbidity of COPD or can associations be explained by shared risk factors/behaviors?. Int J Chron Obstruct Pulmon Dis 2017;12:1339–1349.

    Article  CAS  Google Scholar 

  4. Brito F, Almeida S, Cms F, Bregman R, Jhr S, Rg F. Extent and severity of chronic periodontitis in chronic kidney disease patients. J Periodontal Res 2012;47:426–430.

    Article  CAS  Google Scholar 

  5. AbdelHalim HA, AboElNaga HH. Is renal impairment an anticipated COPD comorbidity? Respir Care 2016;61:1201–1206.

    Article  Google Scholar 

  6. Shen TC, Chang PY, Lin CL, Wei CC, Tu CY, Hsia TC, et al. Impact of periodontal treatment on hospitalization for adverse respiratory events in asthmatic adults:a propensity-matched cohort study. Eur J Intern Med 2017;46:56–60.

    Article  Google Scholar 

  7. Zhou X, Wang Z, Song Y, Zhang J, Wang C. Periodontal health and quality of life in patients with chronic obstructive pulmonary disease. Respir Med 2011;105:67–73.

    Article  Google Scholar 

  8. GOLD. Global srategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Glob Initiat Chronic Obstr Lung Dis 2015;117:22–42.

    Google Scholar 

  9. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. ATS/ERS Task Force:ATS/ERS standardisation of spirometry. Eur Respir J 2005;26:319–338.

    Article  CAS  Google Scholar 

  10. Greene JG, Vermillion JR. The simplified oral hygiene index. J Am Dent Assoc 1964;68:7–13.

    Article  CAS  Google Scholar 

  11. Silness J, Loe H, Silness J, Loe H. Periodontal disease in pregnancy. II. Correlation between oral hygiene and periodontal condtion. Acta Odontol Scand 1964;22:121–135.

    Article  CAS  Google Scholar 

  12. Mazza JE, Newman MG, Sims TN. Clinical and antimicrobial effect of stannous fluoride on periodontitis. J Clin Periodontol 1981;8:203–212.

    Article  CAS  Google Scholar 

  13. Löe H. The gingival index, the plaque index and the retention index systems. J Periodontol 1967;38:610–616.

    Article  Google Scholar 

  14. Ramfjord SP. The periodontal disease index (PDI). J Periodontol 1967;38:602–610.

    Article  Google Scholar 

  15. [No authors listed]. American Academy of Periodontology Task Force Report on the Update to the 1999 Classification of Periodontal Diseases and Conditions. J Periodontol 2015;86:835–838.

    Article  Google Scholar 

  16. Zeng XT, Tu ML, Liu DY, Zheng D, Zhang J, Leng W. Periodontal disease and risk of chronic obstructive pulmonary disease:a meta-analysis of observational studies. PLoS One 2012; 7:e46508.

    Article  CAS  Google Scholar 

  17. Zhou X, Han J, Liu Z, Song Y, Wang Z, Sun Z. Effects of periodontal treatment on lung function and exacerbation frequency in patients with chronic obstructive pulmonary disease and chronic periodontitis:a 2-year pilot randomized controlled trial. J Clin Periodontol 2014;41:564–572.

    Article  Google Scholar 

  18. Bhavsar NV, Dave BD, Brahmbhatt NA, Parekh R. Periodontal status and oral health behavior in hospitalized patients with chronic obstructive pulmonary disease. J Nat Sci Biol Med 2015;6:S93–S97.

    Article  CAS  Google Scholar 

  19. Chung JH, Hwang HJ, Kim SH, Kim TH. Associations between periodontitis and chronic obstructive pulmonary disease:The 2010 to 2012 Korean National Health and Nutrition Examination Survey. J Periodontol 2016;87:864–871.

    Article  Google Scholar 

  20. Peter KP, Mute BR, Doiphode SS, Bardapurkar SJ, Borkar MS, Raje DV. Association between periodontal disease and chronic obstructive pulmonary disease:a reality or just a dogma? J Periodontol 2013;84:1717–1723.

    Article  Google Scholar 

  21. Bergström J, Cederlund K, Dahlén B, Lantz AS, Skedinger M, Palmberg L, et al. Dental health in smokers with and without COPD. PLoS One 2013; 8:e59492.

    Article  Google Scholar 

  22. Barros SP, Suruki R, Loewy ZG, Beck JD, Offenbacher S. A cohort study of the impact of tooth loss and periodontal disease on respiratory events among COPD subjects:modulatory role of systemic biomarkers of inflammation. PLoS One 2013; 8:e68592.

    Article  CAS  Google Scholar 

  23. Shen TC, Chang PY, Lin CL, Chen CH, Tu CY, Hsia TC, et al. Risk of periodontal diseases in patients with chronic obstructive pulmonary disease:a nationwide population-based cohort study. Medicine (Baltimore) 2015; 94:e2047.

    Article  Google Scholar 

  24. Prasanna SJ. Causal relationship between periodontitis and chronic obstructive pulmonary disease. J Indian Soc Periodontol 2011;15:359–365.

    Article  Google Scholar 

  25. Holtfreter B, Richter S, Kocher T, Dörr M, Völzke H, Ittermann T, et al. Periodontitis is related to lung volumes and airflow limitation:a cross-sectional study. Eur Respir J 2013;42:1524–1535.

    Article  CAS  Google Scholar 

  26. Liu Z, Zhang W, Zhang J, Zhou X, Zhang L, Song Y, et al. Oral hygiene, periodontal health and chronic obstructive pulmonary disease exacerbations. J Clin Periodontol 2012;39:45–52.

    Article  Google Scholar 

  27. Scannapieco FA. Role of oral bacteria in respiratory infection. J Periodontol 1999;70:793–802.

    Article  CAS  Google Scholar 

  28. Fourrier F, Duvivier B, Boutigny H, Roussel-Delvallez M, Chopin C. Colonization of dental plaque:a source of nosocomial infections in intensive care unit patients. Crit Care Med 1998;26:301–308.

    Article  CAS  Google Scholar 

  29. Labeau SO, van de Vyver K, Brusselaers N, Vogelaers D, Blot SI. Prevention of ventilator-associated pneumonia with oral antiseptics:a systematic review and meta-analysis. Lancet Infect Dis 2011;11:845–854.

    Article  CAS  Google Scholar 

  30. Chan EY, Ruest A, Meade MO, Cook DJ. Oral decontamination for prevention of pneumonia in mechanically ventilated adults:systematic review and meta-analysis. Br Med J 2007;334:889–893.

    Article  Google Scholar 

  31. Apps LD, Harrison SL, Williams JEA, Hudson N, Steiner M, Morgan MD, et al. How do informal self-care strategies evolve among patients with chronic obstructive pulmonary disease managed in primary care? a qualitative study. Int J Chron Obstruct Pulmon Dis 2014;9:257–263.

    PubMed  PubMed Central  Google Scholar 

  32. Marsh PD, Head DA, Devine DA. Dental plaque as a biofilm and a microbial community – implications for treatment. J Oral Biosci 2015;57:185–191.

    Article  Google Scholar 

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Authors and Affiliations

  1. Respiratory Medicine Department, Faculty of Medicine, Ain Shams University, 8C, Opera City Compound, P.O.: 12563, Cairo, Sheikh Zayed, Giza, Egypt

    Hesham A. AbdelHalim MD

  2. Respiratory Medicine Department, Faculty of Medicine, October 6 University, Giza, Egypt

    Heba H. AboElNaga

  3. Oral Medicine and Periodontology Department, Faculty of Dentistry, October 6 University, Egypt

    Reham L. Aggour

Authors
  1. Hesham A. AbdelHalim MD
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  2. Heba H. AboElNaga
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  3. Reham L. Aggour
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Corresponding author

Correspondence to Hesham A. AbdelHalim MD.

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AbdelHalim, H.A., AboElNaga, H.H. & Aggour, R.L. Chronic obstructive pulmonary disease exacerbations and periodontitis: a possible association. Egypt J Bronchol 12, 303–309 (2018). https://doi.org/10.4103/ejb.ejb_12_18

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  • DOI: https://doi.org/10.4103/ejb.ejb_12_18

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