The Stockholm Study: Over 30 years’ Observation of the Effect of Oral Infections on Systemic Health

The Stockholm Studies are a series of investigations started in 1985 and still ongoing. Out of 105,798 inhabitants, aged 30 and 40 years and living in the greater Stockholm area in Sweden, 3273 subjects were randomly selected. Of them, 1676 were clinically examined focusing on oral health. The subjects were then followed up using national population and health registers in order to study associations between oral health parameters and systemic health outcomes and finally death. The 35 years of observation provides unique possibilities to analyze, for example, how periodontitis links to a number of systemic health issues. The results have consequently provided numerous new associations and confirmed earlier observations on how poor oral health is associated with heart diseases and cancer

The Stockholm Study: Over 30 years’ Observation of the Effect of Oral Infections on Systemic Health

The Stockholm Studies are a series of investigations started in 1985 and still ongoing. Out of 105,798 inhabitants, aged 30 and 40 years and living in the greater Stockholm area in Sweden, 3273 subjects were randomly selected. Of them, 1676 were clinically examined focusing on oral health. The subjects were then followed up using national population and health registers in order to study associations between oral health parameters and systemic health outcomes and finally death. The 35 years of observation provides unique possibilities to analyze, for example, how periodontitis links to a number of systemic health issues. The results have consequently provided numerous new associations and confirmed earlier observations on how poor oral health is associated with heart diseases and cancer

The Stockholm Study : Over 30 years' Observation of the Effect of Oral Infections on Systemic Health

The Stockholm Studies are a series of investigations started in 1985 and still ongoing. Out of 105,798 inhabitants, aged 30 and 40 years and living in the greater Stockholm area in Sweden, 3273 subjects were randomly selected. Of them, 1676 were clinically examined focusing on oral health. The subjects were then followed up using national population and health registers in order to study associations between oral health parameters and systemic health outcomes and finally death. The 35 years of observation provides unique possibilities to analyze, for example, how periodontitis links to a number of systemic health issues. The results have consequently provided numerous new associations and confirmed earlier observations on how poor oral health is associated with heart diseases and cancer.Peer reviewe

Periodontal microorganisms and diagnosis of malignancy : A cross-sectional study

BACKGROUND: Oral infections associate statistically with cancer. OBJECTIVE: We hypothesized that certain periodontal microorganisms might specifically link to malignancies in general and set out to investigate this in our ongoing cohort study. METHODS: A sample of 99 clinically examined patients from our cohort of 1676 subjects was used to statistically investigate the associations between harboring periodontal microorganisms Aggregatibacter actinomycetemcomitans (A.a), Porphyromonas gingivalis (P.g), Prevotella intermedia (P.i), Tannerella forsythia (T.f) and Treponema denticola (T.d). We used oral infection indexes and the incidence figures of malignancies as registered in 2008-2016 in the Swedish National Cancer Register. RESULTS: The pathogen A.a showed strong association with malignancy in 32 out of the 99 patients while P.g and P.i were more prevalent among patients without malignancy. In principal component analyses, A.a appeared in the strongest component while the second strongest component consisted of a combination of T.f and T.d. The third component consisted of a combination of P.g and P.i, respectively. Of basic and oral health variables, gingival index appeared to be the strongest expression of inflammation (Eigen value 4.11 and Explained Variance 68.44 percent). CONCLUSIONS: The results partly confirmed our hypothesis by showing that harboring certain periodontal bacteria might link to malignancy. However, the associations are statistical and no conclusions can be drawn about causality.Peer reviewe

Periodontitis may predict the use of prescription medicines later in life, a database study

Medications used for the treatment of diseases also affect oral health. We investigated how having/not having periodontitis at baseline in 1985 was associated with purchases of medicines in the long term. The study paradigm is in the oral health-systemic health connections. We hypothesized that periodontitis links to purchases of medicines later in life. The study cohort consisted of 3,276 individuals from the greater Stockholm area, Sweden. Of them, 1,655 were clinically examined at baseline. Patients were followed-up for >35 years, using the national population and patient registers. The burden of systemic diseases and purchases of medicines were statistically analyzed comparing patients with (n = 285) and without (n = 1,370) periodontitis. The results showed that patients with periodontitis had purchased more of certain medications than non-periodontitis patients. Periodontitis patients purchased significantly more drugs used in diabetes (p = 0.035), calcium channel blockers (p = 0.016), drugs acting on the renin-angiotensin system (p = 0.024), and nervous system drugs (p = 0.001). Hence, patients with periodontitis indeed had purchased specific medications statistically significantly more than the periodontally healthy ones. This indicates that periodontitis, over time, might increase the risk for systemic diseases with the subsequent need for medication.Peer reviewe

Prevalence of cancer in relation to signs of periodontal inflammation

Funding Information: The study was supported by the Swedish Ministry of Health and Social Affairs (grant F84/ 189) and Karolinska Institutet, Stockholm, Sweden, and by grants from The Finnish Society of Sciences and Letters, the Finnish Medical Society, Finland, and the King Gustav V´s and Queen Victoria’ s Freemason´s Foundation, Sweden. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: © 2022 Meurman et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.We investigated the associations between periodontal inflammation (gingivitis and periodontitis) and all-kind malignancies, specifically breast and prostate cancer, in a cohort followed-up for 30 years. The study hypothesis was based on the oral inflammation vs. systemic health paradigm. A sample of 2,168 subjects from an original cohort of 105,718 individuals from the greater Stockholm area in Sweden that had been followed since 1985 was investigated. Swedish national health registers were used in the study. Chi-square tests and logistic multiple regression analyses were conducted. The results showed that periodontitis was significantly associated with any cancer after adjusting for gender, age, income, and education (p = 0.015). The probability of getting cancer increased on average by 38% if the patient had periodontitis vs. had not; the odds ratio was 1.380 (95% confidence interval l.066-1.786). No significant association was observed between periodontitis and breast cancer (p = 0.608), while the association between periodontitis and prostate cancer tended towards significance (p = 0.082). However, no statistically significant difference was found between the observed and the calculated distribution of any cancer in gingivitis groups (p = 0.079). Thus, the study hypothesis was partly confirmed by showing a statistically significant association between periodontitis and any cancer.Peer reviewe

Tobacco Products, Periodontal Health and Education Level: Cohort Study from Sweden

Background: The aim of this study is to investigate if using tobacco products (including snuff, smoking tobacco and dual-using) associates with periodontal health, education level and mortality in a Swedish cohort, hypothesizing that tobacco products affect periodontal health, associate with lower education and increase the risk of death. Method: Study cohort of 1080 subjects aged 31–40 years (528 men, 552 women) was clinically examined and interviewed in 1985 and followed for mortality until 2015. Subjects were classified into two groups: “tobacco users” and “non-users”. Associations between periodontal health parameters, tobacco products, education level and age of death were analysed. SPSS was used for analyses. Results: Tobacco products, as well as education level associated, with poor periodontal health. Tobacco users and lower education was linked to higher plaque-, calculus- and gingival-index scores than non-users (

Autoimmune Diseases and Oral Health : 30-Year Follow-Up of a Swedish Cohort

Aim: Oral infections up-regulate a number of systemic inflammatory reactions that, in turn, play a role in the development of systemic diseases. We investigated the association between oral health and autoimmune diseases in a cohort of Swedish adults. Hypothesis was that poor oral health associates with incidence of autoimmune diseases. Materials and Methods: Overall 1676 subjects aged 30–40 years old from Stockholm County (Sweden) participated in this study in 1985. Subjects were randomly selected from the registry file of Stockholm region and were followed-up for 30 years. Their hospital and open health care admissions (World Health Organization ICD 9 and 10 codes) were recorded from the Swedish national health registers. The association between the diagnosed autoimmune disease and the oral health variables were statistically analyzed. Results: In all, 50 patients with autoimmune diagnoses were detected from the data. Plaque index was significantly higher in the autoimmune disease group (≥median 35 (70%) vs. under median 872 (54%), p = 0.030). No statistical difference was found in gingival index, calculus index, missing teeth, periodontal pockets, smoking or snuff use between patients with and without autoimmune disease. Conclusions: Our study hypothesis was partly confirmed. The result showed that subjects with a higher plaque index, marker of poor oral hygiene, were more likely to develop autoimmune diseases in 30 years.Suuperäiset tulehdukset, kuten parodontiitti, vaikuttaa koko kehon tulehdusasteeseen. Infektiot kehossa voivat laukaista autoimmuunisairauksia, joten tutkimuksemme tavoitteena oli selvittää, voiko parodontiitilla ja autoimmuunisairauksilla olla yhteyttä. Tutkimukseen osallistui 1676 satunnaisesti valittua tukholmalaista potilasta, joiden ikä oli 30-40 vuotta tutkimuksen aloitusvuonna 1985. Potilaille tehtiin suun perustutkimus sekä heidän terveystottumuksia, kuten tupakointia ja nuuskan käyttöä, kysyttiin. Potilaita seurattiin 30 vuotta, jona aikana heidän sairaalan ja avoterveydenhuollon ICD9 ja ICD10 koodit kirjattiin tutkimukseen. Kaikkiaan 50 potilaalla oli todettu autoimmuunisairaus ja heidän suunterveysparametreja verrattiin terveisiin potilaihin (n=1626). Merkittävänä tuloksena saimme, että autoimmuunisairailla potilailla oli korkeampi plakki-indeksi (plakin määrä) verrattuna terveisiin. Tilastollisesti merkitseviä eroja emme löytäneet ryhmien välillä hammaskivi-indeksin, ientulehdus-indeksin, puuttuvien hampaiden lukumäärän, syventyneiden ientaskujen, tupakoinnin tai nuuskaamisen suhteen. Tutkimuksemme hypoteesi toteutui kuitenkin siltä osin, että potilaille, joilla oli suurempi plakki-indeksi, ja siten huono suuhygienia, kehittyi 30-vuoden seurannassa todennäköisemmin autoimmuunisairaus

Studies on plaque distribution and gingival crevicular fluid after non-surgical treatment in smokers and non-smokers with periodontal diseases

Birgitta Söder (1998). Studies on plaque distribution and gingival crevicularfluid after non-surgical treatment in smokers and non-smokers with periodontal diseases. Thesis, Karolinska Institutet. Dental plaque plays a key role in the complex process by which periodontal diseases are initiated. The basic treatment of these diseases is non-surgical, involving supragingival plaque control as well as supra- and subgingival scaling and root planing. The aim of the present thesis was to study plaque distribution and gingival crevicular fluid after non surgical treatment of subjects with periodontal diseases. The main findings in these studies were as follows: About 15% of the 1681 subjects examined showed signs of severe periodontal diseases. Smokers in the study had more severe symptoms than non-smokers. The amount of calculus, smoking and dental visits were significantly correlated to the severity of the periodontal diseases. A new computerized planimetric method for clinical plaque measurements (P%I) was found to have high reproducibility, good precision and accuracy. The individual mean P%I remained unchanged during a 3 month study. In contrast, marked variations in mean P%I were found between diffeerent tooth surfaces, as well as wide variations in interindividual levels of plaque. In a 5- year double-blind study, smokers responded less well than non-smokers to regular non surgical treatment, including systemic administration of metronidazole for one week at the start of the study. At the end of the study, there were reductions in all clinical parameters in all subjects, except for the bone heights in smokers. After 5 years, subjects with no innammation and no pocket depths 25 mm, were found only in the intervention group. Neutrophil elastase activity im gingival crevicular fluid was evaluated, from sites treated with scaling and root planing during 5 years. Sites classified as diseased, with no improvement, or initially healthy, but deteriorating, had significantdy higher elastase activity than consistently healthy sites or diseased, but improving, sites. Smokers had significantly higher mean levels of elastase activity in gingival crevicular fluid than non-smokers. In smokers pockets with high values of matrix metalloproteinase-8 (MMP-8) were significantly deeper compared to sites with low values of MMP-8. Sigmficantly higher prostaglandin E2 (PGE2) levels were also found in smokers in sites with high values of MMP-8 compared to sites with low values of MMP-8. The increased neutrophil elastase activity in gingival crevicular fluid in smokers with refractory periodontitis may enhance the risk for aggravation of the periodontal diseases. The risk seems to increase exceptionally at high levels of MMP-8 and PGE2. Severe periodontal diseases occur in a subset of subjects in a subset of sites. To find these subjects at enhanced risk for periodontal diseases, and to have the possibility to monitor the response to non surgical treatment and to predict the progression of the periodontal diseases there is a need for accurate methods. The present studies suggest that the inflammatory mediators, neutrophil elastase, PGE2, and MMP-8 could be used as markers for disease activity when monitoring a particular site over an extended period. Key words: Scaling, root planing, refractory periodontitis, long-term maintenance therapy, computerized planimetric plaque measurements (P%I), plaque distribution, smoking, systemic metronidazole, gingival crevicular fluid, neutrophil elastase, prostaglandin E2, matrix metalloproteinase-8. ISBN 91-628-2887-8 Repro Print AB Stockholm 199