Tonsillectomy as a risk factor of periodontitis: A population‐based cohort study

Abstract

Background To determine whether patients who had undergone tonsillectomy would have higher risks of postoperative periodontitis. Methods Data were collected from the Taiwan Longitudinal Health Insurance Dataset from 1999 to 2013, a population‐based cohort study consisting of cases of newly‐onset sleep apnoea, chronic diseases of tonsils and adenoids, peritonsillar abscess, and periodontal diseases. A total of 1482 tonsillectomy cases and 14,796 non‐tonsillectomy controls were selected. Propensity score matching37 between the tonsillectomy group and the non‐tonsillectomy group was conducted to exclude the confounding effect resulting from indications of tonsillectomy. Cox proportional hazard model and subgroup analyses were conducted to identify subpopulations at risk of tonsillectomy‐associated periodontitis, and a sub‐outcome analysis was applied to identify the subtype of tonsillectomy‐associated periodontitis. Results A total of 648 patients who had undergone tonsillectomy and 648 out of 6509 propensity score‐matched controls were retrieved, among which 230 cases in the tonsillectomy group were associated with post‐surgical periodontitis (adjusted HR = 1.31, 95% CI = 1.08 to 1.59). The association persisted in a subpopulation of patients with periodontitis who received mechanical and surgical treatments for periodontitis (adjusted HR = 1.33, 95% CI = 1.09 to 1.63). The incidence of periodontitis was significantly high in the individuals who underwent tonsillectomy and was particularly high in those that were below 12 years of age (HR = 1.58, 95% CI = 1.10 to 2.27). The risk of periodontitis increased 4 years after tonsillectomy (HR = 1.82; 95% CI = 1.29 to 2.59). The majority of post‐tonsillectomy periodontitis was aggressive and acute periodontitis (HR = 1.37; 95% CI = 1.10 to 1.71). Conclusions Tonsillectomy performed in pediatric patients of < 12 years old, increased the risk of developing periodontitis. Aggressive and acute periodontitis as a long‐term, postoperative adverse event took place at 4 years or longer after tonsillectomy.

Bidirectional Relationship Between Osteoarthritis and Periodontitis: A Population-Based Cohort Study Over a 15-year Follow-Up

“…To assure the validity and consistency of the diagnosis used in the cohort, both osteoarthritis and periodontitis were confirmed in at least two outpatient visits or at least one inpatient discharge note within one year; all medical records, along with the diagnoses, were peer-reviewed for quality control by rheumatologists and dentists, respectively. Moreover, the validity of diagnoses has been confirmed in previous studies (31)(32)(33).The database was de-identified, and the current study was approved by the Institutional Review Board of Chung Shan Medical University Hospital (approval number CS15134).…”

Human Papillomavirus Infection and the Risk of Erectile Dysfunction: A Nationwide Population-Based Matched Cohort Study

“…In this cohort study, we employed a nationwide population-based registry to provide epidemiological evidence on the risks of new-onset ED in patients with HPV infection. The effect of measurable confounders was minimized by PS matching [ 71 , 72 , 73 , 74 , 75 ]. Sensitivity and negative control analyses were conducted to manage residual confounding and to ascertain the impact of HPV infection on ED development.…”

Fibromyalgia and periodontitis: Bidirectional associations in population‐based 15‐year retrospective cohorts

“…Periodontitis has been proposed to initiate or exacerbate several systemic inflammatory diseases, including RA and SLE 3,7 . The prevalence of fibromyalgia has been observed to be greater in these inflammatory diseases 16,17 .…”

“…4 These findings suggest role of periodontal micro-organisms in autoimmune pathogenesis. 5,6 Furthermore, the association between periodontitis and the risk of systemic lupus erythematous (SLE) 7 has been shown to involve antineutrophil cytoplasmic antibodies (ANCA) and B cell activation in response to periodontal bacteria invasion. 8 Systematic reviews and meta-analyses support that periodontitis is also associated with inflammatory conditions such as chronic obstruction pulmonary disease (COPD), 9 chronic kidney disease, 10 preeclampsia during pregnancy, 11 and neuroinflammation-involved cognitive impairment.…”

“…Periodontitis has been proposed to initiate or exacerbate several systemic inflammatory diseases, including RA and SLE. 3,7 The prevalence of fibromyalgia has been observed to be greater in these inflammatory diseases. 16,17 Thus, we aimed to identify the potential association between periodontitis and the risk for fibromyalgia in a cohort study, and to determine whether the association was bidirectional.…”