Risk of Periodontal Diseases in Patients With Chronic Obstructive Pulmonary Disease

Abstract

Several studies have reported an association between chronic obstructive pulmonary disease (COPD) and periodontal diseases. However, a large-scale population-based cohort study was previously absent from the literature. Therefore, we evaluated the risk of periodontal diseases in patients with COPD in a nationwide population.From the National Health Insurance claims data of Taiwan, we identified 22,332 patients with COPD who were newly diagnosed during 2000 to 2010. For each case, two individuals without COPD were randomly selected and frequency matched by age, sex, and diagnosis year. Both groups were followed up till the end of 2011.The overall incidence of periodontal diseases was 1.19-fold greater in the COPD group than in the comparison group (32.2 vs 26.4 per 1000 person-years; 95% confidence interval [CI] 1.15–1.24). Compared with non-COPD patients, the adjusted hazard ratios of patients with COPD increased with the number of emergency room visits (from 1.14 [95% CI 1.10–1.19] to 5.09 [95% CI 4.53–5.72]) and admissions (from 1.15 [95% CI 1.10–1.20] to 3.17 [95% CI 2.81–3.57]). In addition, the adjusted hazard ratios of patients with COPD treated with inhaled corticosteroids (1.22, 95% CI 1.11–1.34) and systemic corticosteroids (1.15, 95% CI 1.07–1.23) were significantly higher than those of patients not treated with corticosteroids.Patient with COPD are at a higher risk of developing periodontal diseases than the general population. Our results also support that the risk of periodontal diseases is proportional to COPD control. In addition, patients who receive corticosteroid treatment are at a higher risk of developing periodontal diseases.

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

“…For example, the longitudinal study by Shen et al failed to correct for smoking status, dental habits, or socioeconomic status,33 and no adjustment was made for socioeconomic factors in the radiographic study by Leuckfeld et al99 Where appropriate allowance had occurred, the OR for having COPD in the populations with periodontitis (OR 1.78; 95% CI 1.23–2.58) was lower than initially reported 36…”

“…Of note, not all patients with common risk factors (chronic cigarette smoke inhalation for both condition and poor dental hygiene for periodontitis) develop disease, for example, only 20% of smokers go on to develop significant COPD,35 supporting the concept of susceptibility. They also share several other common risk factors including age and poor socioeconomic status 33,36…”

“…Alternatively, data from a large longitudinal COPD cohort study found that patients had a significantly increased cumulative incidence of periodontitis with adjusted hazard ratio (HR) of 1.20 (95% CI 1.15–1.25) rising to 3.17 (95% CI 2.81–3.57) in the subgroup that had required hospitalization for COPD 33. The risk of developing periodontitis increased proportionately with the annual number of emergency room visits and admissions for COPD 33.…”

“…However, some authors used pre-bronchodilator spirometry,107 which could lead to an overestimation of the prevalence of COPD, others report lung function measurements but not whether pre- or post-bronchodilation,40,98 and one study failed to mention how COPD was confirmed 99. A German prospective study used body plethysmography to determine lung function,101 whereas Shen et al used International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes that do not provide details of how the diagnosis was established 33…”

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

“…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 pathophysiologic processes …”