Prolonged Exposure to Air Pollution Increases Periodontal Disease Risk: A Nationwide, Population-Based, Cohort Study

Abstract

(1) Background: No association between air pollution and periodontitis has yet been shown. Thus, we merged two nationwide databases to evaluate the risk of periodontitis in Taiwanese residents with long-term exposure to air pollution. (2) Methods: We conducted a nationwide retrospective cohort study using the Longitudinal Generation Tracking Database and the Taiwan Air Quality-Monitoring Database. The daily average air pollutant concentrations were categorized into quartiles (Q1, Q2, Q3, and Q4). We carried out Cox proportional hazards models to compute the hazard ratios of periodontitis, with 95% confidence intervals, in Q2–Q4 of the daily average air pollutant concentrations, compared with Q1. (3) Results: the adjusted HR (95 CI%) for periodontitis in Q2–Q4 increased with increased exposure to SO2, CO, NO, NO2, NOX, PM2.5, and PM10 from 1.72 (1.70, 1.76) to 4.86 (4.78–4.94); from 1.89 (1.85–1.93) to 2.64 (2.59–2.70); from 1.04 (1.02–1.06) to 1.52 (1.49–1.55); from 1.61 (1.58–1.64) to 2.51 (2.47–2.56); from 1.48 (1.45–1.51) to 2.11 (2.07–2.15); from 2.02 (1.98–2.06) to 22.9 (22.4–23.4, and from 2.71 (2.66–2.77) to 17.2 (16.8–17.6), respectively, compared to Q1. (4) Conclusions: Residents in Taiwan with long-term exposure to higher levels of air pollutants had a greater risk of periodontitis.

A Proposal for a Predictive Model for the Number of Patients with Periodontitis Exposed to Particulate Matter and Atmospheric Factors Using Deep Learning

“…Periodontitis is the result of bone destruction, which is caused by a localized inflammation process in the alveolar bone. In line with the current finding, studies in Taiwan and China also showed that people who were exposed to higher levels of air pollutants in the long-term have a greater risk of periodontitis 13,24) . Marruganti et al 12) suggested that air pollution is a potential modifiable risk factor for periodontitis, with direct exposure to pollutants potentially leading to increased local inflammation and oxidative stress in periodontal tissue.…”

“…Environ-mental pollutants such as PM and air pollution increase the risk of periodontal and respiratory disease, causing chronic inflammation and damage to respiratory and oral tissues 14,23) . The results of previous studies suggest the possible association between PM exposure and periodontitis occurence 12,13,24) . Air pollution could be a potential modifiable risk factor as it can induce biomarkers of inflammation and lead to periodontitis.…”

“…In addition, PM generally composed of sulfur dioxide 7) , carbon monoxide 8) , nitrogen dioxide 9) , and heavy metals, along with other atmospheric substances like ozone 10) , collectively play a role in affecting human health. While most of the research has been concentrated on respiratory and cardiovascular effects, there is growing evidence suggesting that PM may also have implications for oral health [11][12][13] . Studies have indicated that PM exposure can exacerbate respiratory disease, indirectly impacting oral health due to the interconnected nature of respiratory and oral systems 14) .…”

“…Studies have indicated that PM exposure can exacerbate respiratory disease, indirectly impacting oral health due to the interconnected nature of respiratory and oral systems 14) . Moreover, the potential risk of air pollution becoming a modifiable risk factor for periodontal disease has also been observed in Asian countries 12,13) .…”

Long‐term exposure to ambient fine particulate matter and periodontitis: An observational study using nationally representative survey data

“…Our findings regarding the associations between PM 2.5 and periodontitis and tendency in exposure–response relationship are consistent with one previous research, which is the only study linking ambient air pollution to periodontitis available to date. This retrospective study conducted in Taiwan demonstrated the risk of long‐term exposure to air pollution on periodontitis using health insurance data, and reported that the hazard ratio of periodontitis for residents with higher exposure levels could increase by more than fourfold compared with those with low exposure levels of PM 2.5 (<17.5 μg/m 3 ) (Lin et al, 2022). However, the periodontitis in this study was ascertained only by diagnostic codes formatted according to different revisions of the International Classification of Diseases (ICD) rather than a valid diagnostic method.…”