Fan Ziqiu, Yue Guangna, Yu Dongming, Zhang Min, Kitaura Hideki
Shanghai Engineering Research Center of Tooth Restoration and Regeneration & Tongji Research Institute of Stomatology & Department of Implantology, Stomatological Hospital and Dental School, Tongji University, Shanghai, China.
Department of Stomatology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
Int Dent J. 2025 Jun 27;75(5):100879. doi: 10.1016/j.identj.2025.100879.
Heavy metals (HMs) and polycyclic aromatic hydrocarbons (PAHs) are significant environmental pollutants, raising growing concerns about their potential impact on human health, particularly oral health. This study aimed to investigate the combined effects of these pollutants on periodontitis (PD) - a prevalent chronic inflammatory disease affecting tooth-supporting structures.
This study utilized the National Health and Nutrition Examination Survey data to examine interactions between HMs, PAHs, and PD. A comprehensive analytical approach included survey-weighted multivariate logistic regression to evaluate individual pollutant exposures, restricted cubic splines to assess dose-response relationships, and advanced models such as Weighted Quantile Sum regression, Quantile G-Computation (qgcomp), and Bayesian Kernel Machine Regression to analyse joint pollutant effects.
Findings revealed significant associations between high levels of certain blood HMs - particularly cadmium (Cd) and lead (Pb) - and increased PD risk. Elevated urinary levels of PAH metabolites were similarly linked to higher risk. Importantly, the study highlights that risk is substantially amplified by the synergistic effects of combined HMs and PAHs exposure. Weighted Quantile Sum, qgcomp, and Bayesian Kernel Machine Regression consistently demonstrated that simultaneous exposures lead to a notably higher PD risk, suggesting that traditional single-pollutant assessments may underestimate health risks.
This study provides robust evidence that exposure to both individual and combined HMs and PAHs significantly elevates PD risk. These findings underscore the importance of considering cumulative and interactive pollutant effects in public health risk assessments.
重金属（HMs）和多环芳烃（PAHs）是重要的环境污染物，人们越来越关注它们对人类健康，尤其是口腔健康的潜在影响。本研究旨在调查这些污染物对牙周炎（PD）的联合影响，牙周炎是一种影响牙齿支持结构的常见慢性炎症性疾病。
本研究利用国家健康与营养检查调查数据来研究重金属、多环芳烃与牙周炎之间的相互作用。一种综合分析方法包括调查加权多元逻辑回归以评估个体污染物暴露情况，受限立方样条以评估剂量反应关系，以及加权分位数和回归、分位数G计算（qgcomp）和贝叶斯核机器回归等先进模型来分析联合污染物效应。
研究结果显示，某些血液重金属水平升高，特别是镉（Cd）和铅（Pb），与牙周炎风险增加之间存在显著关联。尿中多环芳烃代谢物水平升高也同样与较高风险相关。重要的是，该研究强调，重金属和多环芳烃联合暴露的协同效应会大幅放大风险。加权分位数和、qgcomp以及贝叶斯核机器回归一致表明，同时暴露会导致牙周炎风险显著更高，这表明传统的单一污染物评估可能低估健康风险。
本研究提供了有力证据，表明接触单一和联合的重金属及多环芳烃会显著提高牙周炎风险。这些发现强调了在公共卫生风险评估中考虑污染物累积和交互作用的重要性。
