Chronic obstructive pulmonary disease exacerbations and periodontitis: a possible association

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. ResultsThis 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.

Periodontal Health and Chronic Obstructive Pulmonary Disease (COPD) Exacerbations: A Systematic Review

“…For the primary outcome it appears that higher plaque scores were associated with an increased frequency of COPD exacerbations for the majority of included studies, except for Baldomero et al [28] study. Moreover, the included clinical trials, (Zhou et al 2014 [31] and Kucukcoskun et al 2013 [30]) concluded that periodontal therapy in COPD patients may improve lung function and decrease the frequency of COPD exacerbations. Improving oral health by treating periodontal disease, which in turn improved plaque scores, also showed a similar trend.…”

“…Median exacerbations declined from 3 to 2 in the test group, and increased from 2 to 3 in the control group. Zhou et al [31] concluded that the frequency of COPD exacerbation was signi cantly lower in periodontal therapy group when compared with the control group at 2-year follow-up (p < 0.05). Moreover, (FEV1/FVC) and FEV1 were signi cantly higher in the therapy groups when compared with the control group during the follow-up period (p < 0.05).…”

“…Three observational studies assessed the frequency of COPD exacerbations related to measures of periodontal health. Two of the studies (Liu et al 2012) [29] and (Baldemero et al 2019 ) [30] were assessed to be of good quality while that of (AbdelHalim et al 2018) [31] was graded as poor (Supplementary Table 3). AbdelHalim et al, 2018 [29], found that frequent exacerbation is associated with plaque scores more than 2mm (p<0.029), moderate to severe clinical attachment loss (CAL) and probing pocket depth (PPD) (p<0.001).…”

“…Two intervention studies that investigated the effect of periodontal treatment on the frequency of exacerbations in patients with COPD were identi ed. Zhou et al [31] and Kucukcoskun et al [30] found that periodontal therapy in COPD patients improve lung function and decrease the frequency of COPD exacerbations. Kucukcoskun et al [30] concluded that there was a signi cant reduction in exacerbation frequency during the follow-up period (P=0.01).…”

“…Four studies included an assessment of hospitalisation frequency as a result of COPD exacerbations (Table 4). Two studies concluded better baseline oral health or providing periodontal treatment reduced hospital admissions, AbdelHalim et al 2018, [31], Barros et al 2013[36]. Baldomero et al 2019 [30] concluded that while those affected by COPD with poorer periodontal examination outcomes had an increased risk of hospitalisation or emergency department visits, compared to those with better periodontal status, this did not reach statistical signi cance.…”