RESPIRATORY DISEASE

Periodontal health, oral health behaviors, and chronic

obstructive pulmonary disease
Rosanna Young, AS, BS
Graduate Learner at UCSF Master of Science in Dental Hygiene
Rosanna.young@ucsf.edu
November 15, 2016
Chronic obstructive Pulmonary Disease
(COPD)
One of the most common and costly respiratory disease
High prevalence and mortality
Lack effective preventive and
treatment strategies
Chronic obstructive Pulmonary Disease
(COPD)
Etiology:
Complex and multifactorial

Oral pathogens and cytokines from periodontal lesion

Induce systemic inflammation

Pathogenesis of COPD
Chronic obstructive Pulmonary Disease
(COPD) Type 2
Diabetes
Mellitus
- Oral hygiene index
- Alveolar bone loss,
- Periodontal attachment

Periodontal
Disease
Cardiovas- Respiratory
cular system
Disease diseases
Chronic obstructive Pulmonary Disease
(COPD)
Significant association between periodontal disease and airway
obstruction
Particularly former smoker

Worse periodontal diseases significantly increase the risk of COPD

subjects who were current smoker

Dental plaque in patients with chronic lung diseases often serves as

reservoir of bacteria known to cause nosocomial pneumonia
Study Purpose

To examine the relation of periodontal health status and oral

health-related behaviors with the risk of COPD in a Chinese
population.
Methodology
Type: Case-Control Study

Study population:
306 with COPD vs 328 with normal pulmonary function

Recruited from hospitals from Beijing

30 years of age or older

More than 15 teeth, stable stage, no exacerbation of symptoms in the

past 1 month
Methodology
Study population:
COPD were clinically diagnosed and confirmed by lung function
examination
Controls randomly selected from all eligible patients with
normal lung function in the same hospitals
Methodology
Periodontal examination:
Conducted by 2 trained dentists who were blinded to the study
design and patients COPD status
Replicate examinations intra-examiner reliability

Periodontal probing (probing depth and recession to calculate

CAL, bleeding index), OH (Plaque index), number of teeth
present, x-ray exam of alveolar bone (FM PA)
Methodology
COPD Diagnosis:
Global Initiative for Chronic Obstructive Lung Disease
spirometry guidelines
Spirometric measurements were conducted by trained and
certified technicians
Out of 5 forced expiration, 3 acceptable spirogram obtained with
at least 2 of which show similar results
Methodology
Oral health behavior related variables:
Standardized questionnaire (validated and widely used in a
Chinese National Oral Health Epidemiology Survey)
Tooth brushing times and methods, dental floss use, frequency
of dental visits, periodontal treatments, assessment of oral
health knowledge
Smoking status and alcohol drinking status were also asked
using the same questionnaire
Methodology
Statistical Analysis:
t-test and chi-square were used to compare the baseline
characteristics and periodontal status between case and control
Logistic regression calculate the OR and 95% CI
Evaluate the associations of periodontal health status and oral health
behaviors with the risk of COPD
Age, gender, BMI were adjusted for potential confounding

Stratified by smoking status (non, former, current smoker)

Results - Demographic

GENDER and SMOKING STATUS

are significantly different between the COPD and the Control
Group
Results - Demographic
Results Periodontal Health status

NUMBER OF REMAINING TEETH

PLAQUE INDEX
CAL 3mm SITE PERCENTAGE
CAL 4mm SITE PERCENTAGE
Are significantly different between
the COPD group and the Control group
Results Periodontal Health status
Results Periodontal health status stratified by
smoking status

Clinical parameter Smoking status

Number of remaining teeth Non-smokers
Plaque index Current smoker
Results Results Periodontal health status stratified
by smoking status
Results Oral Health Behaviors

COPD group patients had significantly:

LOWER TOOTH BRUSHING TIMES

LOWER ORAL HEALTH KNOWLEDGE SCORE
HIGHER PROPORTION OF HORIZONTAL STROKE
Results Oral Health Behaviors
LOWER PROPORTION OF VERTICAL STROKE
LOWER PROPORTION OF DENTAL FLOSS USE
LESS LIKELY TO HAVE DENTAL VISIT
LESS LIKELY TO RECEIVE SUPRAGINGIVAL SCALING
TREATMENT
Compared to the Control group patients
Results Oral Health Behaviors
Results Oral health behaviors stratified by smoking
status

Oral Health Behaviors Smoking Status

Horizontal tooth brushing method Non-smokers
Less regular supra-gingival scaling Non-smokers and former smokers
Poor oral health knowledge Non-smokers, former smokers,
current smokers
Results Oral health behaviors stratified by smoking
status
Conclusion of authors
Poor periodontal health, dental care, oral health knowledge

Associated with an increased risk of COPD

Promoting oral health knowledge, generalizing the appropriate

tooth brushing method, and clinical periodontal health care in
COPD patients may help to prevent the progression of COPD
Limitations
1. Retrospective study does not reflect a causal effect
Further studies required to assess the efficacy of oral health care in the
development and progression of COPD

2. Type II error (false negative) small sample size for subgroups

Not enough number of current smoker

3. Possibility of residual confounding variables

4. Imprecise measures of oral health behavior
My Evaluation of the study
1. Based on the findings, I agree with the authors conclusion
2. Method bias:
No inter-examiner reliability
Recall bias
Social bias
My Evaluation of the study
Implication of the study:
Important public health and clinical Implications for the
prevention and treatment of both conditions
Importance of oral health care and education in the
management of the care of patients with COPD
My evaluation of the study
No effect to the current theories of etiology and pathogenesis of
periodontal disease study did not show casual effect
Somewhat affect the current practice of treating periodontal
disease at the prevention level
promotion of oral health knowledge, oral hygiene habits, regular dental
care
Reference
Periodontal health, oral health behaviours, and chronic
obstructive pulmonary disease. Wang Z et al., J Clin Periodontol
36:750-755, 2006.
QUESTIONS?