Chronic disease burden associated with periodontal disease: a retrospective cohort study using UK primary care data
Poor oral health is extremely common and is often characterized by chronic inflammation. Advanced stages manifest as periodontitis where there is irreversible damage to the bone and local tissue. Earlier stages include gingivitis, a reversible inflammation of the gum initiated by dental plaque.
This spectrum, from gingivitis to periodontitis, is widely called "periodontal disease . " Although the exact etiological mechanisms have yet to be fully elucidated, the development of a dysbiotic microbial biofilm, overactivation of inflammatory pathways, and genetic susceptibility are all implicated.
Progressive periodontal disease leads to a reduced quality of life due to problems related to chewing (due to tooth loss), aesthetics (due to gum recession), and verbal communication.
Periodontal disease also results in a systemic proinflammatory state that itself is implicated in the etiology of chronic diseases including cardiovascular disease (CVD), cardiometabolic disease (CMD), mental illness (MIH), and autoimmune disease (AID), each of which are highly prevalent and potentially preventable causes of global morbidity and mortality.
Therefore, a high prevalence of periodontal disease could translate into a substantial burden of associated morbidity and mortality. Epidemiological data have demonstrated associations between periodontitis and all-cause mortality in Western European men (adjusted HR (aHR); 95% CI: 1.04 to 2.36).
Although this relationship could be explained through the activation of a pro-inflammatory state, there is a lack of solid epidemiological evidence since many of these chronic diseases share similar pathogenic pathways, often mediated by lifestyle factors, including smoking and blood pressure. socioeconomic.
The association between periodontal disease and CVD is one of the most investigated. In 2012, the American Heart Association highlighted that although the literature supports an association between periodontitis and atherosclerotic disease regardless of known confounding factors, due to methodological limitations of the available observational studies, they were unable to confirm a relationship. causal.
Existing studies are limited by the inability to distinguish reverse causality or account for recall bias (cross-sectional or case-control designs), lack of adequate control for confounding factors, lack of generalization to other populations and heterogeneity in definitions of exposure and outcomes.
It is important to strengthen the understanding of the link between oral health and chronic diseases, as there are cost-effective dental interventions that could be preventative and reduce the subsequent public health burden of disease. Therefore, we have conducted the first retrospective cohort study using a large medical data set to explore the association between poor oral health and a variety of chronic diseases, including CVD, CMD, MIH and AID.
Goals
Identify the association between periodontal diseases (gingivitis and periodontitis) and chronic diseases, including cardiovascular diseases, cardiometabolic diseases, autoimmune diseases and poor mental health.
Retrospective cohort design.
IQVIA Medical Research Data-UK configuration between January 1, 1995 and January 1, 2019.
Participants 64,379 adult patients with a recorded diagnosis of periodontal disease by a general practitioner (exposed patients) were compared with 251,161 unexposed patients by age, sex, deprivation and date of registration.
Main outcome measures
Logistic regression models accounting for clinically important covariates were performed to estimate the adjusted OR (aOR) of having chronic diseases at baseline in the exposed group compared with the unexposed group.
Incidence rates were then provided for each outcome of interest, followed by calculation of adjusted HRs using Cox regression models to describe the risk of outcome development in each group.
Results
The average age at entry into the cohort was 45 years and the median follow-up was 3.4 years.
At study entry, the exposed cohort was more likely to have a diagnosis of cardiovascular disease (aOR 1.43, 95% CI 1.38 to 1.48), cardiometabolic disease (aOR 1.16, 95% CI %: 1.13 to 1.19), autoimmune disease (aOR 1.33, 95% CI: 1.28 to 1.37), and mental illness (aOR 1.79, 95% CI: 1.75 to 1.83) compared to the non-exposed group.
During follow-up of individuals without preexisting outcomes of interest, the exposed group had a higher risk of developing cardiovascular disease (HR 1.18; 95% CI 1.13 to 1.23), cardiometabolic disease (HR 1.07; 95% CI % 1.03 to 1.10), autoimmune disease (HR 1.33, 95% CI 1.26 to 1.40), and mental illness (HR 1.37, 95% CI 1.33 to 1 .42) compared to the non-exposed group.
Conclusions In this cohort, periodontal diseases appeared to be associated with an increased risk of developing cardiovascular, cardiometabolic, autoimmune, and mental health problems. Periodontal diseases are very common; Therefore, increased risk of other chronic diseases represents a substantial public health burden. |
Strengths and limitations of this study
This is the largest epidemiological study exploring the health outcomes of periodontal disease using primary care registries.
This was the first study to explore and quantify the association between poor mental health and periodontal diseases.
Periodontal coding was not validated prior to this study, so there may be misclassification bias.
Outcomes of interest were adjusted for known covariates recorded in primary care.
Discussion
Summary of key results
To our knowledge, this is the first attempt to synthesize data exploring the relationship between periodontal disease and chronic disease development in a retrospective UK cohort derived from medical records.
Our study demonstrates that the presence of a GP-recorded diagnosis of periodontal disease is moderately associated with an 18%, 7% (although 26% risk of T2DM), 33% and 37% increased risk of CVD, CMD, AID and MIH, respectively. This risk persisted when analyzing patients who were diagnosed with periodontal disease during the study period. However, in patients specifically with periodontitis, this risk was not evident for CMD or AID.
