Dental health, lifestyle and cardiovascular risk factors—a study among a cohort of young adult population in northern Finland

Abstract To date, most epidemiological studies have shown a weak or moderate association between dental diseases such as periodontal infections, dental caries and tooth loss, and atherosclerotic vascular diseases. However, the nature of this association is not known; it may be due to the biological effect of oral infections on initiation or progress of atherosclerosis or it may be non-causal due to determinants in common, either biological or behavioural. Methodological shortcomings, inconsistent results and a lack of definite proof from intervention studies have led to the conclusion that causality between dental diseases and atherosclerotic vascular diseases has not been established. The aim of this study was to produce evidence on the nature of the association between dental diseases and atherosclerotic vascular diseases. The study uses data from the 1966 Birth Cohort of Northern Finland (N = 11,637). The data were collected in 1997–1998, when the cohort members had reached 31 years of age. The respondents were asked through a postal questionnaire about their oral health. In addition, respondents were asked about their general health and oral and general health habits. The response rate was 75.3%. Those who lived in Northern Finland or the capital city region were invited to clinical health examination (N = 8,463). Altogether 5,696 subjects supplied the data, representing 67.3% of those who were invited to the clinical examination. While the study showed an association of self-reported gingivitis, dental caries and tooth loss with the prevalent angina pectoris, it also showed that these self-reported dental diseases were not important determinants for elevated C-reactive protein levels. This suggests that the associations that were found between dental conditions and prevalent angina pectoris are mainly caused by factors other than biological mechanisms related to infection or inflammation. The lack of a biological explanation related to infections or inflammatory processes suggests that other biological mechanisms or biases, including confounding, should be considered as an alternative explanation. However, it must be noted that the possibility that oral infections also contribute to the development of atherosclerosis should not be rejected either

Genome-wide association study of periodontal pocketing in Finnish adults

Abstract Background: A genome‐wide association study is an analytical approach that investigates whether genetic variants across the whole genome contribute to disease progression. The aim of this study was to investigate genome-wide associations of periodontal condition measured as deepened periodontal pockets (≥ 4 mm) in Finnish adults. Methods: This study was based on the data of the national Health 2000 Survey (BRIF8901) in Finland and the Northern Finland Birth Cohort 1966 Study totalling 3,245 individuals. The genotype data were analyzed using the SNPTEST v.2.4.1. The number of teeth with deepened periodontal pockets (≥ 4 mm deep) was employed as a continuous response variable in additive regression analyses performed separately for the two studies and the results were combined in a meta-analysis applying a fixed effects model. Results: Genome-wide significant associations with the number of teeth with ≥ 4 mm deep pockets were not found at the p-level of < 5 × 10⁻⁸, while in total 17 loci reached the p-level of 5 × 10⁻⁶. Of the top hits, SNP rs4444613 in chromosome 20 showed the strongest association (p = 1.35 × 10⁻⁷). Conclusion: No statistically significant genome-wide associations with deepened periodontal pockets were found in this study

Anticholinergic burden, oral hygiene practices, and oral hygiene status:cross-sectional findings from the Northern Finland Birth Cohort 1966

Abstract Objectives: To study the association between anticholinergic burden and oral hygiene practices and oral hygiene status among 46-year-old people. Materials and methods: The study included 1945 participants from the Northern Finland Birth Cohort 1966 (NFBC1966), who had a complete dental status. The participants underwent clinical medical and dental examinations, and their medication data were gathered by combining self-reported drug use with information from the National Prescription Register. Anticholinergic burden was measured using nine previously published anticholinergic scales. Oral hygiene practices were assessed with toothbrushing frequency and oral hygiene status with the presence of visible dental plaque. Poisson regression with robust variance estimation and negative binomial regression models were used to estimate relative risks (RR). Results: Thirty percent of the participants reported brushing their teeth twice a day and about 25% of their teeth had dental plaque on them. Fifteen percent of the participants used at least one anticholinergic drug or had an anticholinergic burden according to the nine anticholinergic scales. After adjustments for confounding factors, the RRs of anticholinergic burden varied between 0.95 and 1.11 for toothbrushing frequency. Anticholinergic burden (according to Anticholinergic Activity Scale, Anticholinergic Cognitive Burden, Chew’s scale) was associated statistically significantly with the number of teeth with dental plaque. For the three scales, RRs varied from 1.24 to 1.50. Conclusions: Anticholinergic burden associated with poor oral hygiene. Clinical relevance: The findings stress the importance of providing oral hygiene instructions and prophylactic measures to patients taking anticholinergic drugs

Anticholinergic burden and dry mouth in middle-aged people

Abstract Introduction: Anticholinergic burden refers to the cumulative effect of taking 1 or more drugs with anticholinergic properties. At the moment, little is known about the association between the anticholinergic burden and dry mouth. Objectives: The objective of this article was to study, whether an anticholinergic burden is associated with dry mouth among middle-aged people. Methods: The study population included 1,345 people aged 46 y from the Northern Finland Birth Cohort 1966 (NFBC1966) study, who took part in a clinical medical and dental examination during 2012–2013. Medication data comprised both self-reported drug use and information obtained from the national register. Anticholinergic burden was measured using 10 different anticholinergic scales. Dry mouth was defined on the basis of having either a subjective feeling of dry mouth (xerostomia) or objectively measured low unstimulated or stimulated whole salivary flow rates (hyposalivation). Poisson regression models with robust error variance were used to estimate relative risk (RR). Regression models were adjusted for sex, smoking, diabetes, rheumatoid diseases, depressive symptoms, anxiety, total number of drugs, and antihypertensive drugs. Results: Approximately 14% of the participants reported having xerostomia and about 2% had hyposalivation. The RRs of different anticholinergic scales for xerostomia varied from 1.05 to 1.68. The scales’ RRs were between 0.89 and 2.03 for low unstimulated whole salivary flow (<0.1 mL/min) and between 0.59 and 1.80 for low stimulated whole salivary flow (<0.7 mL/min). Seven of 10 studied anticholinergic scales associated statistically significantly with dry mouth, either with xerostomia or hyposalivation. Conclusion: Most of the anticholinergic scales were associated with dry mouth, either with xerostomia or hyposalivation. There was considerable variation in the strength of the associations between anticholinergic scales and dry mouth. Knowledge Transfer Statement: The findings of this study suggest that dentists should take notice of the use of drugs with anticholinergic properties and their harmful effects among middle-aged people. Dentists should provide these patients with necessary guidance on how to cope with dry mouth and give them prophylactic measures against oral diseases associated with dry mouth

Association of long-term obesity and weight gain with periodontal pocketing:results of the Northern Finland Birth Cohort 1966 study

Abstract Aim: To investigate whether obesity, central obesity, and weight gain are associated with periodontal pocketing. Materials and methods: A never-smoking sub-population (n = 725) of the Northern Finland Birth Cohort 1966 was categorized based on body mass index (BMI; participants with normal weight, overweight, and obesity) and waist circumference (WC; participants without central obesity and with central obesity) at ages 31 and 46. The categories were combined to define whether the participants stayed in the respective BMI and WC categories or moved on to a higher category during follow-up. A periodontal examination was done at age 46. Results: WC was more consistently associated with periodontal pocketing than BMI. The relative risks for the number of sites with periodontal pocket depth (PPD) ≥4 mm and bleeding PPD ≥4 mm in participants with central obesity both at age 31 and at age 46 were 1.7 (95% confidence interval [CI] 1.4–2.0) and 2.1 (95% CI 1.6–2.6). The corresponding values for participants who had no central obesity at age 31 but had central obesity at age 46 were 1.6 (95% CI 1.4–1.8) and 1.9 (95% CI 1.6–2.3). Conclusion: Of all the studied measures, central obesity appeared to be most strongly associated with the inflammatory condition of the periodontium

Association of hyperglycaemia with periodontal status:results of the Northern Finland Birth Cohort 1966 study

Abstract Aim: To investigate the association of hyperglycaemia and changes in glycaemic control with periodontal status in non‐diabetic individuals. Materials and methods: A sub‐population (n = 647) of the Northern Finland Birth Cohort 1966 was studied. We categorized long‐term glucose balance based on fasting plasma glucose (FPG) at ages 31 and 46: FPG <5.0 mmol/l (strict normoglycaemia), FPG 5.0–5.59 mmol/l (slightly elevated FPG) and FPG 5.6–6.9 mmol/l (prediabetes). Probing pocket depth (PPD) and alveolar bone level (BL) data were collected at age 46. Relative risks (RR, 95% CI) were estimated using Poisson regression models. Results: Periodontal status was poorer in individuals whose glucose balance worsened from age 31 to 46 years than in those with a stable glucose balance. In the case of strict normoglycaemia at age 31 and slightly elevated FPG or prediabetes at age 46, the RRs for PPD ≥4 mm were 1.8 (95% CI 1.4–2.2) and 2.8 (95% CI 2.0–3.8) and for BL ≥5 mm 1.1 (95% CI 0.8–1.4) and 1.8 (95% CI 1.2–2.8), respectively. Conclusion: The results of this population‐based cohort study suggest that impairment in glucose control in non‐diabetic individuals is associated with periodontal pocketing and alveolar bone loss

Long-term metabolic syndrome is associated with periodontal pockets and alveolar bone loss

Abstract Aim: To investigate whether the metabolic syndrome (MetS) is associated with deepened periodontal pockets and alveolar bone loss. Materials and Methods: This study was based on a subpopulation of the Northern Finland Birth Cohort 1966 survey (n = 1964). The criteria of the AHA/NHLBI were used to determine MetS. The analyses were based on the metabolic data at ages 31 and 46, and probing pocket depth and alveolar bone level data at age 46. Relative risks (RR, 95% CI) were estimated using Poisson regression models. Results: Relative risks for PD ≥ 4 mm and BL ≥ 5 mm were higher in individuals with an exposure to MetS ≥ 15 years (RR 1.8, 95% CI 1.6–2.1 and RR 1.5, 95% CI 1.3–1.9, respectively) than in those whose exposure was <15 years (RR 1.2, 95% CI 1.1–1.3 and RR 1.1, 95% CI 1.0–1.3, respectively). Consistently stronger associations were found in never smokers. Women showed stronger associations of MetS with PD ≥ 4 mm than men. The association with BL ≥ 5 mm was observed only in men. Conclusion: A long‐term exposure by MetS was associated independently and in an exposure‐dependent manner with periodontal pockets and alveolar bone level

Waist circumference and waist-to-height ratio are associated with periodontal pocketing:results of the Health 2000 Survey

Abstract Background: Body mass index (BMI) has been found to associate with different parameters of chronic periodontal disease in previous studies. It is reasonable to expect that central adiposity measures, such as waist circumference and waist-to-height ratio, which indirectly takes into account visceral fat, are more accurate measures of obesity-related oral health risks than BMI. The aim of this study was to examine whether central obesity is associated with periodontal pocketing, an indication of infectious chronic periodontal disease. Methods: The study was based on a subpopulation from the national Health 2000 Survey in Finland. It included dentate, non-diabetic, never-smoking subjects aged 30–49 (n = 1287). The outcome variable was the number of teeth with deepened periodontal pockets (4 mm or more) and the number of teeth with deep periodontal pockets (6 mm or more). Central obesity was measured by means of waist circumference (WC) and waist-to-height ratio (WHtR). Poisson regression models were used to estimate prevalence rate ratios (PRR) and their 95% confidence intervals. Results: Our main finding was that both WC and WHtR were associated with the number of teeth with deeper (4 mm or more) periodontal pockets; the PRR for the fifth quintile in WC was 1.5, CI: 1.2–1.9 and in WHtR 1.4, CI: 1.1–1.7, when compared to the lowest quintile. Corresponding figures for deep (6 mm or more) periodontal pockets were 2.3, CI: 0.9–6.1 for WC and 1.9, CI: 0.8–4.4 for WHtR. There were no essential differences in the strengths of the associations between WC and WHtR and the number of teeth with deepened periodontal pockets. Conclusion: Both central adipose measures—WC and WHtR—seem to be associated with periodontal pocketing in non-diabetic, never-smoking subjects aged 30–49 years old

Periodontal condition in relation to the adherence to nutrient recommendations in daily smokers

Abstract Aim: To examine whether a healthy diet based on nutrient recommendations is associated with periodontal condition in smokers. Material and Methods: Daily smokers from the cross‐sectional Health 2000 Survey (BRIF 8901) in Finland were analysed in two age groups (30–49 and 50–79 years, n = 704 and 267) and according to the level of oral hygiene. Periodontal condition was measured as the number of sextants with gingival bleeding and teeth with ≥4 mm deepened periodontal pockets. Information on nutrition was collected by a validated food frequency questionnaire and measured using the Baltic Sea Diet Score (BSDS) and the Recommended Finnish Diet Score (RFDS). Results: In the total study population, no association between the scores and periodontal condition was observed. Among 30‐ to 49‐year‐old participants with good oral hygiene, diet scores associated inversely with the number of teeth with deepened periodontal pockets (p = .078 (BSDS) and p = .027 (RFDS)). Conclusions: In a representative sample of Finnish adults who smoke, a healthy diet was not associated with periodontal condition. Among a younger age group with good oral hygiene, a healthy diet associated with better periodontal condition. Age and oral hygiene appeared to modify the association between diet and periodontal condition

Effect of smoking on periodontal health and validation of self-reported smoking status with serum cotinine levels

Abstract Objectives: To investigate whether self-reported smoking and serum cotinine levels associate with periodontal pocket development and to determine the accuracy of self-reported smoking using serum cotinine. Materials and methods:This 4-year prospective cohort study included data from 294 dentate adults, aged ≥30 years, who participated in both the Health 2000 Survey and the Follow-up Study of Finnish Adults’ Oral Health. Subjectively reported smoking status (daily smokers n = 62, occasional smokers n = 12, quitters n = 49, and never-smokers n = 171), serum cotinine levels, demographic factors, education level, dental behaviours and medical history were collected at baseline. The outcome measure was the number of teeth with periodontal pocketing ≥4 mm over 4 years. Results:Self-reported daily smokers had 1.82 (95% CI: 1.32–2.50) higher incidence of deepened periodontal pockets than never-smokers. A positive association was observed between serum cotinine (≥42.0 μg/L) and the development of periodontal pockets. The misclassification rate of self-reported smoking was 6%. Conclusions:Both self-reported daily smoking and higher serum cotinine were associated with periodontal pocket development. Self-reported smoking was fairly accurate in this study. However, higher cotinine levels among a few self-reported never-smokers indicated misreporting or passive smoking. Thus, self-reports alone are not enough to assess the smoking-attributable disease burden