Discipline of Periodontology, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.
Division of Cardiology, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
J Periodontol. 2019 Mar;90(3):225-233. doi: 10.1002/JPER.18-0224. Epub 2018 Oct 25.
Periodontal disease closely links to various systemic diseases. This l8-year retrospective cohort study investigated whether poor periodontal condition may increase the risk for onset of systemic comorbidities.
A total of 488 individual dental folders from 17 400 dental hospital attendees registered from 1996 to 1998 were randomly selected, and these participants were free of diabetes, cardiovascular disease, chronic obstructive pulmonary disease, cancer, stroke, cognitive impairment, hypertension, and dyslipidemia in the Clinical Management System. The records of periodontal examination and orthopantomogram on the first registration were obtained, and full-mouth bone level (BL) was measured. Onsets of the eight comorbidities concerned above until 2016 were retrieved from the system.
The participants with worse periodontal status on their first registration had significantly higher numbers of the eight comorbidities/mortality during the 18-year follow-ups than their counterparts (P < 0.05). BL presented as bone loss/age was independently correlated to the comorbidity profiles in two multivariate models (0 to 1 versus ≥2; 0 to 2 versus ≥3) after adjusting for age and sex (odds ratio [OR] = 1.87; OR = 2.18, P < 0.05), highlighting that the individuals with more bone resorption exhibited a greater number of the comorbidities as compared with their counterparts. Moreover, those with onsets of more comorbidities showed worse periodontal conditions according to four parameters employed (community periodontal index, BL, bone loss/age and number of remaining teeth) (P < 0.05).
Within the limitations of this 18-year retrospective cohort study, our findings provide the first evidence that periodontal disease experience to some extent reflects the host susceptibility to onset of common systemic comorbidities. Further studies with larger sample sizes and appropriate adjustment of critical confounders are highly warranted to substantiate the current observation.
牙周病与各种系统性疾病密切相关。本 18 年回顾性队列研究旨在探讨牙周状况不佳是否会增加系统性合并症发病的风险。
从 1996 年至 1998 年登记的 17400 名牙科医院就诊者中随机选择了 488 份个人牙科档案，这些参与者在临床管理系统中无糖尿病、心血管疾病、慢性阻塞性肺疾病、癌症、中风、认知障碍、高血压和血脂异常。获取了第一次注册时的牙周检查和全景片记录，并测量了全口骨水平（BL）。从系统中检索了上述 8 种合并症的发病情况，直至 2016 年。
首次注册时牙周状况较差的患者在 18 年的随访中，八种合并症/死亡率明显高于对照组（P<0.05）。BL 呈骨丢失/年龄相关性，在两个多变量模型中与合并症谱相关（0 至 1 与≥2；0 至 2 与≥3），校正年龄和性别后（比值比[OR]1.87；OR 2.18，P<0.05），提示骨吸收越多的患者发生合并症的数量也越多。此外，根据四个参数（社区牙周指数、BL、骨丢失/年龄和剩余牙齿数），发病的合并症越多，牙周状况越差（P<0.05）。
在这项 18 年回顾性队列研究的限制内，我们的研究结果首次提供了证据，证明牙周病的发病在一定程度上反映了宿主对常见系统性合并症发病的易感性。需要进一步进行更大样本量的研究，并适当调整关键混杂因素，以证实当前的观察结果。
