Is periodontitis a comorbidity of COPD or can associations be explained by shared risk factors/behaviors?

Abstract

COPD is recognized as having a series of comorbidities potentially related to common inflammatory processes. Periodontitis is one of the most common human inflammatory diseases and has previously been associated with COPD in numerous observational studies. As periodontitis and COPD are both chronic, progressive conditions characterized by neutrophilic inflammation with subsequent proteolytic destruction of connective tissue, it has been proposed that they share common pathophysiological processes. The mechanisms proposed to link COPD and periodontitis include mechanical aspiration of oral contents into the respiratory tree, overspill of locally produced inflammatory mediators into the systemic circulation or oral or lung-derived bacteremia activating an acute-phase response and also reactive oxygen species (ROS) and cytokine release by systemic neutrophils at distant sites. Studies of systemic neutrophils in COPD and chronic periodontitis describe altered cellular functions that would predispose to inflammation and tissue destruction both in the lung and in the mouth, again potentially connecting these conditions. However, COPD and periodontitis also share risk factors such as age, chronic tobacco smoke exposure, and social deprivation that are not always considered in observational and interventional studies. Furthermore, studies reporting associations have often utilized differing definitions of both COPD and periodontitis. This article reviews the current available evidence supporting the hypothesis that COPD and inflammatory periodontal disease (periodontitis) could be pathologically associated, including a review of shared inflammatory mechanisms. It highlights the potential limitations of previous studies, in particular, the lack of uniformly applied case definitions for both COPD and periodontitis and poor recognition of shared risk factors. Understanding associations between these conditions may inform why patients with COPD suffer such a burden of comorbid illness and new therapeutic strategies for both the diseases. However, further research is needed to clarify factors that may be directly causal as opposed to confounding relationships.

Oral health of adults with intellectual disabilities: a systematic review

“…; Cullinan, Ford, & Seymour ; Hobbins et al . ; Holmstrup et al . ; Khader, Dauod, El‐Qaderi, Alkafajei, & Batayha ; Kudiyirickal & Pappachan ; Meurman, Sanz, & Janket ; Montebugnoli et al .…”

“…Periodontitis is associated with bone loss and can lead to missing teeth and may be more prevalent in adults with Down syndrome as well as intellectual disabilities (Khocht, Janal, & Turner 2010). Additionally, there is a wealth of research in the general population demonstrating periodontitis to be associated with cardiovascular disease, coronary heart disease, diabetes mellitus, respiratory diseases and obesity (Bahekar et al 2007;Cullinan, Ford, & Seymour 2009;Hobbins et al 2017;Holmstrup et al 2017;Khader, Dauod, El-Qaderi, Alkafajei, & Batayha 2006;Kudiyirickal & Pappachan 2015;Meurman, Sanz, & Janket 2004;Montebugnoli et al 2004;Nibali et al 2007;Spahr et al 2006;Virtanen et al 2017;Yu, Chasman, Buring, Rose, & Ridker 2015). Therefore, as well as periodontitis presenting an oral health burden for adults with intellectual disabilities, it is also related to other systemic diseases which have an elevated prevalence in adults with intellectual disabilities (diabetes, respiratory disease, obesity and multimorbidity) (Cooper et al 2015).…”

“…). Furthermore, there is increasing evidence that poor oral health (namely periodontal disease) is associated with cardiovascular disease, coronary heart disease, diabetes mellitus, respiratory disease and obesity (Bahekar, Singh, Saha, Molnar, & Arora ; Hobbins, Chapple, Sapey, & Stockley ; Kudiyirickal & Pappachan ; Nibali et al ; Spahr et al . ; U.S. Department of Health and Human Services ; Virtanen et al .…”

“…People with intellectual disabilities experience poor health in general, often with multimorbidity and complex additional care needs Hughes-McCormack et al 2017;Kinnear et al 2018). Furthermore, there is increasing evidence that poor oral health (namely periodontal disease) is associated with cardiovascular disease, coronary heart disease, diabetes mellitus, respiratory disease and obesity (Bahekar, Singh, Saha, Molnar, & Arora 2007;Hobbins, Chapple, Sapey, & Stockley 2017;Kudiyirickal & Pappachan 2015;Nibali et al 2007;Spahr et al 2006;U.S. Department of Health and Human Services 2012; Virtanen et al 2017).…”

Relationship among clinical periodontal, microbiologic parameters and lung function in participants with chronic obstructive pulmonary disease

“…One of the mechanisms proposed to link periodontitis and COPD involves mechanical aspiration of oral contents into the respiratory tree . Greater than 750 taxa of bacteria can be detected in the oral cavity.…”