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Robert J Genco - One of the best experts on this subject based on the ideXlab platform.
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risk factors for Periodontal Disease
Periodontology 2000, 2013Co-Authors: Robert J Genco, Wenche S BorgnakkeAbstract:Risk factors play an important role in an individual’s response to Periodontal infection. Identification of these risk factors helps to target patients for prevention and treatment, with modification of risk factors critical to the control of Periodontal Disease. Shifts in our understanding of Periodontal Disease prevalence, and advances in scientific methodology and statistical analysis in the last few decades, have allowed identification of several major systemic risk factors for Periodontal Disease. The first change in our thinking was the understanding that Periodontal Disease is not universal, but that severe forms are found only in a portion of the adult population who show abnormal susceptibility. Analysis of risk factors and the ability to statistically adjust and stratify populations to eliminate the effects of confounding factors have allowed identification of independent risk factors. These independent but modifiable, risk factors for Periodontal Disease include lifestyle factors, such as smoking and alcohol consumption. They also include Diseases and unhealthy conditions such as diabetes mellitus, obesity, metabolic syndrome, osteoporosis, and low dietary calcium and vitamin D. These risk factors are modifiable and their management is a major component of the contemporary care of many Periodontal patients. Genetic factors also play a role in Periodontal Disease and allow one to target individuals for prevention and early detection. The role of genetic factors in aggressive periodontitis is clear. However, although genetic factors (i.e., specific genes) are strongly suspected to have an association with chronic adult periodontitis, there is as yet no clear evidence for this in the general population. It is important to pursue efforts to identify genetic factors associated with chronic periodontitis because such factors have potential in identifying patients who have a high susceptibility for development of this Disease. Many of the systemic risk factors for Periodontal Disease, such as smoking, diabetes and obesity, and osteoporosis in postmenopausal women, are relatively common and can be expected to affect most patients with Periodontal Disease seen in clinics and dental practices. Hence, risk factor identification and management has become a key component of care for Periodontal patients.
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effect of Periodontal Disease on diabetes systematic review of epidemiologic observational evidence
Journal of Periodontology, 2013Co-Authors: Wenche S Borgnakke, George W Taylor, Pekka Ylostalo, Robert J GencoAbstract:Background: Periodontal Disease and diabetes mellitus are common, chronic Diseases worldwide. Epidemiologic and biologic evidence suggest Periodontal Disease may affect diabetes. Objective: To systematically review non-experimental, epidemiologic evidence for effects of Periodontal Disease on diabetes control, complications and incidence. Data sources: Electronic bibliographic databases, supplemented by hand searches of recent and future issues of relevant journals. Study eligibility criteria and participants: Longitudinal and cross-sectional epidemiologic, non-interventional studies that permit determination of directionality of observed effects were included. Study appraisal and synthesis methods: Four reviewers evaluated pair-wise each study. Review findings regarding study results and quality were summarized in tables by topic, using the PRISMA Statement for reporting and the NewcastleOttawa System for quality assessment, respectively. From 2246 citations identified and available abstracts screened, 114 full-text reports were assessed and 17 included in the review. Results: A small body of evidence supports significant, adverse effects of Periodontal Disease on glycaemic control, diabetes complications, and development of type 2 (and possibly gestational) diabetes. Limitations: There were only a limited number of eligible studies, several of which included small sample sizes. Exposure and outcome parameters varied, and the generalizability of their results was limited. Conclusions and implications of key findings: Current evidence suggests that Periodontal Disease adversely affects diabetes outcomes, and that further longitudinal studies are warranted.
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cdc Periodontal Disease surveillance project background objectives and progress report
Journal of Periodontology, 2007Co-Authors: Paul I Eke, Robert J GencoAbstract:This supplement contains papers presented at the 2006 International Association of Dental Research (IADR) symposium entitled “Development of Self-Reported Measures for Population-Based Surveillance of Periodontitis.” These papers highlight activities of an independent Periodontal Disease surveillance workgroup convened by the Division of Oral Health (DOH), Centers for Disease Control and Prevention (CDC), in collaboration with the American Academy of Periodontology, to examine the feasibility of using self-reported measures for population-based surveillance of Periodontal Disease in the United States. This workgroup was convened in 2003 as part of a CDC Periodontal Disease surveillance project.
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Periodontal Disease and mortality in type 2 diabetes
Diabetes Care, 2005Co-Authors: Aramesh Saremi, Robert J Genco, George W Taylor, Robert G Nelson, Marshall K Tullochreid, Robert L Hanson, Maurice L Sievers, Marc Shlossman, Peter H Bennett, William C KnowlerAbstract:OBJECTIVE — Periodontal Disease may contribute to the increased mortality associated with diabetes. RESEARCH DESIGN AND METHODS — In a prospective longitudinal study of 628 subjects aged 35 years, we examined the effect of Periodontal Disease on overall and cardiovascular Disease mortality in Pima Indians with type 2 diabetes. Periodontal abnormality was classified as no or mild, moderate, and severe, based on panoramic radiographs and clinical dental examinations. RESULTS — During a median follow-up of 11 years (range 0.3–16), 204 subjects died. The age- and sex-adjusted death rates for all natural causes expressed as the number of deaths per 1,000 person-years of follow-up were 3.7 (95% CI 0.7– 6.6) for no or mild Periodontal Disease, 19.6 (10.7–28.5) for moderate Periodontal Disease, and 28.4 (22.3–34.6) for severe Periodontal Disease. Periodontal Disease predicted deaths from ischemic heart Disease (IHD) (P trend 0.04) and diabetic nephropathy (P trend 0.01). Death rates from other causes were not associated with Periodontal Disease. After adjustment for age, sex, duration of diabetes, HbA1c, macroalbuminuria, BMI, serum cholesterol concentration, hypertension, electrocardiographic abnormalities, and current smoking in a proportional hazards model, subjects with severe Periodontal Disease had 3.2 times the risk (95% CI 1.1–9.3) of cardiorenal mortality (IHD and diabetic nephropathy combined) compared with the reference group (no or mild Periodontal Disease and moderate Periodontal Disease combined). CONCLUSIONS — Periodontal Disease is a strong predictor of mortality from IHD and diabetic nephropathy in Pima Indians with type 2 diabetes. The effect of Periodontal Disease is in addition to the effects of traditional risk factors for these Diseases. Diabetes Care 28:27–32, 2005
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Periodontal Disease and cardiovascular Disease: Epidemiology and possible mechanisms
The Journal of the American Dental Association, 2002Co-Authors: Robert J Genco, Steven Offenbacher, James D. BeckAbstract:ABSTRACT Background Many early epidemiologic studies reported an association between Periodontal Disease and cardiovascular Disease. However, other studies found no association or nonsignificant trends. This report summarizes the evidence from epidemiologic studies and studies that focused on potential contributing mechanisms to provide a more complete picture of the association between Periodontal and heart Disease. Types of Studies Reviewed The authors summarize the longitudinal studies reported to date, because they represent the highest level of evidence available regarding the connection between Periodontal Disease and heart Disease. The authors also review many of the case-control and cross-sectional studies published, as well as findings from clinical, animal and basic laboratory studies. Results The evidence suggests a moderate association—but not a causal relationship—between Periodontal Disease and heart Disease. Results of some case-control studies indicate that subgingival Periodontal pathogenic infection may be associated with myocardial infarction. Basic laboratory studies point to the biological plausibility of this association, since oral bacteria have been found in carotid atheromas and some oral bacteria may be associated with platelet aggregation, an event important for thrombosis. Animal studies have shown that atheroma formation can be enhanced by exposure to Periodontal pathogens. Conclusions The accumulation of epidemiologic, in vitro, clinical and animal evidence suggests that Periodontal infection may be a contributing risk factor for heart Disease. However, legitimate concerns have arisen about the nature of this relationship. These are early investigations. Since even a moderate risk contributed by Periodontal Disease to heart Disease could contribute to significant morbidity and mortality, it is imperative that further studies be conducted to evaluate this relationship. One particularly important study to be carried out is the investigation of a possible clinically meaningful reduction in heart Disease resulting from the prevention or treatment of Periodontal Disease.
Kaumudi Joshipura - One of the best experts on this subject based on the ideXlab platform.
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Periodontal Disease tooth loss and cancer risk in male health professionals a prospective cohort study
Lancet Oncology, 2008Co-Authors: Dominique S Michaud, Kaumudi Joshipura, Mara S Meyer, Edward Giovannucci, Yan LiuAbstract:Summary Background Studies suggest that tooth loss and Periodontal Disease might increase the risk of developing various cancers; however, smoking might have confounded the reported associations. We aimed to assess whether Periodontal Disease or tooth loss is associated with cancer risk. Methods The analysis was done in a prospective study (the Health Professionals Follow-Up Study [HPFS]), which was initiated in 1986 when US male health professionals aged 40–75 years responded to questionnaires posted by the Department of Nutrition, Harvard University School of Public Health, Boston, MA, USA. In addition to the baseline questionnaires, follow-up questionnaires were posted to all living participants every 2 years and dietary questionnaires every 4 years. At baseline, participants were asked whether they had a history of Periodontal Disease with bone loss. Participants also reported number of natural teeth at baseline and any tooth loss during the previous 2 years was reported on the follow-up questionnaires. Smoking status and history of smoking were obtained at baseline and in all subsequent questionnaires. Additionally at baseline, participants reported their mean frequency of food intake over the previous year on a 131-item semiquantitative food-frequency questionnaire. Participants reported any new cancer diagnosis on the follow-up questionnaires. Endpoints for this study were risk of total cancer and individual cancers with more than 100 cases. Multivariate hazard ratios (HRs) and 95% CIs were calculated by use of Cox proportional hazard models according to Periodontal Disease status and number of teeth at baseline. Findings In the main analyses, 48 375 men with median follow-up of 17·7 years (1986 to Jan 31, 2004) were eligible after excluding participants diagnosed with cancer before 1986 (other than non-melanoma skin cancer, n=2076) and those with missing data on Periodontal Disease (n=1078). 5720 incident cancer cases were documented (excluding non-melanoma skin cancer and non-aggressive prostate cancer). The five most common cancers were colorectal (n=1043), melanoma of the skin (n=698), lung (n=678), bladder (n=543), and advanced prostate (n=541). After adjusting for known risk factors, including detailed smoking history and dietary factors, participants with a history of Periodontal Disease had an increased risk of total cancer (HR 1·14 [95% CI 1·07–1·22]) compared with those with no history of Periodontal Disease. By cancer site, significant associations for those with a history of peridontal Disease were noted for lung (1·36 [1·15–1·60]), kidney (1·49 [1·12–1·97]), pancreas (1·54 [1·16–2·04]; findings previously published), and haematological cancers (1·30 [1·11–1·53]). Fewer teeth at baseline (0–16) was associated with an increase in risk of lung cancer (1·70 [1·37–2·11]) for those with 0–16 teeth versus those with 25–32 teeth. In never-smokers, Periodontal Disease was associated with significant increases in total (1·21 [1·06–1·39]) and haematological cancers (1·35 [1·01–1·81]). By contrast, no association was noted for lung cancer (0·96 [0·46–1·98]). Interpretation Periodontal Disease was associated with a small, but significant, increase in overall cancer risk, which persisted in never-smokers. The associations recorded for lung cancer are probably because of residual confounding by smoking. The increased risks noted for haematological, kidney, and pancreatic cancers need confirmation, but suggest that Periodontal Disease might be a marker of a susceptible immune system or might directly affect cancer risk. Funding National Cancer Institute, National Institutes of Health, Bethesda, MD, USA (grant number P01CA055075).
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a review of the relationship between tooth loss Periodontal Disease and cancer
Cancer Causes & Control, 2008Co-Authors: Mara S Meyer, Dominique S Michaud, Kaumudi Joshipura, Edward GiovannucciAbstract:Recent studies have investigated the association between Periodontal Disease, tooth loss, and several systemic Diseases including cancer, cardiovascular Disease, and preterm birth. Periodontal Disease, a chronic inflammatory condition, is highly prevalent in adult populations around the world, and may be preventable. Estimates of prevalence vary between races and geographic regions, with a marked increase in the occurrence of Periodontal Disease with advancing age. Worldwide estimates for the prevalence of severe Periodontal Disease generally range from 10 to 15%. The relationship between oral health and cancer has been examined for a number of specific cancer sites. Several studies have reported associations between Periodontal Disease or tooth loss and risk of oral, upper gastrointestinal, lung, and pancreatic cancer in different populations. In a number of studies, these associations persisted after adjustment for major risk factors, including cigarette smoking and socioeconomic status. This review provides a summary of these findings, discusses possible biological mechanisms involved, and raises methodological issues related to studying these relationships.
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a prospective study of Periodontal Disease and pancreatic cancer in us male health professionals
Journal of the National Cancer Institute, 2007Co-Authors: Dominique S Michaud, Kaumudi Joshipura, Edward Giovannucci, Charles S FuchsAbstract:Two previous cohort studies reported positive associations between tooth loss or periodontitis and pancreatic cancer risk. Data on Periodontal Disease were obtained at baseline and every other year thereafter in a cohort of 51,529 male health professionals aged 40-75 years. A total of 216 patients were diagnosed with incident pancreatic cancer during 16 years of follow-up. Multivariable relative risks (RRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models controlling for potential confounders, including detailed smoking history. All statistical tests were two-sided. Compared with no Periodontal Disease, history of Periodontal Disease was associated with increased pancreatic cancer risk (overall, multivariable RR = 1.64, 95% CI = 1.19 to 2.26; P = .002; crude incidence rates: 61 versus 25 per 100,000 person-years; among never smokers, multivariable RR = 2.09, 95% CI = 1.18 to 3.71; P = .01; crude incidence rates: 61 versus 19 per 100,000 person-years). In contrast, baseline number of natural teeth and cumulative tooth loss during follow-up were not strongly associated with pancreatic cancer. The association between Periodontal Disease and increased risk of pancreatic cancer may occur through plausible biologic mechanisms, but confirmation of this association is necessary.
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validation of self reported Periodontal Disease a systematic review
Journal of Dental Research, 2005Co-Authors: Brooke Blicher, Kaumudi Joshipura, Paul I EkeAbstract:Self-report is an efficient and accepted means of assessing many population characteristics, risk factors, and Diseases, but has rarely been used for Periodontal Disease (chronic periodontitis). The availability of valid self-reported measures of Periodontal Disease would facilitate epidemiologic studies on a much larger scale, allow for integration of new studies of Periodontal Disease within large ongoing studies, and facilitate lower-cost population surveillance of periodontitis. Several studies have been conducted to validate self-reported measures for Periodontal Disease, but results have been inconsistent. In this report, we conducted a systematic review of the validation studies. We reviewed the 16 studies that assessed the validity of self-reported Periodontal and gingivitis measures against clinical gold standards. Seven of the studies included self-reported measures specific to gingivitis, four included measures only for periodontitis, and five included both gingivitis and Periodontal measures. Three of the studies used a self-assessment method where they provided the patient with a detailed manual for performing a self-exam. The remaining 13 studies asked participants to self-report symptoms, presence of Periodontal Disease itself, or their recollection of a dental health professional diagnosing them or providing treatment for Periodontal Disease. The review indicates that some measures showed promise, but results varied across populations and self-reported measures. One example of a good measure is, "Has any dentist/hygienist told you that you have deep pockets?", which had a sensitivity of 55%, a specificity of 90%, positive predictive value of 77%, and negative predictive value of 75% against clinical pocket depth. Higher validity could be potentially obtained by the use of combinations of several self-reported questions and other predictors of Periodontal Disease.
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Periodontal Disease tooth loss and incidence of ischemic stroke
Stroke, 2003Co-Authors: Kaumudi Joshipura, Hsinchia Hung, Eric B Rimm, Walter C Willett, Alberto AscherioAbstract:Background and Purpose— Periodontal and other infections have been suggested as potential risk factors for stroke. This study evaluates Periodontal Disease and tooth loss as risk factors for ischemic stroke. Methods— The study population consisted of 41 380 men who were free of cardiovascular Disease and diabetes at baseline. Periodontal Disease history was assessed by mailed validated questionnaires. During 12 years of follow-up, stroke incidence was assessed and subclassified by use of medical history, medical records, and imaging reports. Hazard ratios (HRs) were adjusted for age, amount smoked, obesity, alcohol, exercise, family history of cardiovascular Disease, multivitamin use, vitamin E use, profession, baseline reported hypertension, and hypercholesterolemia. Sex and socioeconomic status were inherently controlled for by restriction. Confounding variables were updated in the analyses for each 2-year follow-up interval. Results— We documented 349 ischemic stroke cases during the follow-up period. ...
Dominique S Michaud - One of the best experts on this subject based on the ideXlab platform.
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Periodontal Disease and risk of non hodgkin lymphoma in the health professionals follow up study
International Journal of Cancer, 2017Co-Authors: Kimberly A Bertrand, Edward Giovannucci, Janki Shingala, Andrew M Evens, Brenda M Birmann, Dominique S MichaudAbstract:Periodontal Disease is a chronic inflammatory condition that has been associated with chronic Diseases, including cancer. In an earlier prospective cohort analysis within the Health Professionals Follow-Up Study (HPFS), we observed a 31% higher risk of non-Hodgkin lymphoma (NHL) among participants with severe Periodontal Disease at baseline. Here, we extend the study with an additional 8 years of follow-up, and conduct analyses with updated Periodontal Disease status and NHL subtypes. The HPFS is an ongoing prospective cohort study of 51,529 men in the USA Between baseline in 1986 and 2012, 875 cases of NHL were diagnosed, including 290 chronic lymphocytic leukemia/small lymphocytic lymphomas (CLL/SLL), 85 diffuse large B-cell lymphomas and 91 follicular lymphomas. We performed multivariable Cox proportional hazards regression to evaluate associations of interest. History of Periodontal Disease at baseline was positively associated with risk of NHL overall (hazard ratio (HR) = 1.26, 95% confidence interval (CI): 1.06–1.49) and CLL/SLL (HR = 1.41, 95% CI: 1.04–1.90). With updated Periodontal status, HRs were 1.30 (95% CI: 1.11–1.51) for NHL overall and 1.41 (95% CI: 1.08–1.84) for CLL/SLL. In contrast, after adjusting for Periodontal Disease, tooth loss was inversely associated with NHL, suggesting that other causes or consequences of tooth loss may have different implications for NHL etiology. Our findings suggest that Periodontal Disease is a risk factor for NHL. Whether Periodontal Disease is a direct or indirect cause of NHL, or is a marker of underlying systemic inflammation and/or immune dysregulation, warrants further investigation.
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Periodontal Disease tooth loss and cancer risk
Epidemiologic Reviews, 2017Co-Authors: Dominique S Michaud, Jian Shi, Mei ChungAbstract:Periodontal Disease, which includes gingivitis and periodontitis, is highly prevalent in adults and Disease severity increases with age. The relationship between Periodontal Disease and oral cancer has been examined for several decades, but there is increasing interest in the link between Periodontal Disease and overall cancer risk, with systemic inflammation serving as the main focus for biological plausibility. Numerous case-control studies have addressed the role of oral health in head and neck cancer, and several cohort studies have examined associations with other types of cancers over the past decade. For this review, we included studies that were identified from either 11 published reviews on this topic or an updated literature search on PubMed (between 2011 and July 2016). A total of 50 studies from 46 publications were included in this review. Meta-analyses were conducted on cohort and case-control studies separately when at least 4 studies could be included to determine summary estimates of the risk of cancer in relation to 1) Periodontal Disease or 2) tooth number (a surrogate marker of Periodontal Disease) with adjustment for smoking. Existing data provide support for a positive association between Periodontal Disease and risk of oral, lung, and pancreatic cancers; however, additional prospective studies are needed to better inform on the strength of these associations and to determine whether other cancers are associated with Periodontal Disease. Future studies should include sufficiently large sample sizes, improved measurements for Periodontal Disease, and thorough adjustment for smoking and other risk factors.
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Periodontal Disease tooth loss and cancer risk in male health professionals a prospective cohort study
Lancet Oncology, 2008Co-Authors: Dominique S Michaud, Kaumudi Joshipura, Mara S Meyer, Edward Giovannucci, Yan LiuAbstract:Summary Background Studies suggest that tooth loss and Periodontal Disease might increase the risk of developing various cancers; however, smoking might have confounded the reported associations. We aimed to assess whether Periodontal Disease or tooth loss is associated with cancer risk. Methods The analysis was done in a prospective study (the Health Professionals Follow-Up Study [HPFS]), which was initiated in 1986 when US male health professionals aged 40–75 years responded to questionnaires posted by the Department of Nutrition, Harvard University School of Public Health, Boston, MA, USA. In addition to the baseline questionnaires, follow-up questionnaires were posted to all living participants every 2 years and dietary questionnaires every 4 years. At baseline, participants were asked whether they had a history of Periodontal Disease with bone loss. Participants also reported number of natural teeth at baseline and any tooth loss during the previous 2 years was reported on the follow-up questionnaires. Smoking status and history of smoking were obtained at baseline and in all subsequent questionnaires. Additionally at baseline, participants reported their mean frequency of food intake over the previous year on a 131-item semiquantitative food-frequency questionnaire. Participants reported any new cancer diagnosis on the follow-up questionnaires. Endpoints for this study were risk of total cancer and individual cancers with more than 100 cases. Multivariate hazard ratios (HRs) and 95% CIs were calculated by use of Cox proportional hazard models according to Periodontal Disease status and number of teeth at baseline. Findings In the main analyses, 48 375 men with median follow-up of 17·7 years (1986 to Jan 31, 2004) were eligible after excluding participants diagnosed with cancer before 1986 (other than non-melanoma skin cancer, n=2076) and those with missing data on Periodontal Disease (n=1078). 5720 incident cancer cases were documented (excluding non-melanoma skin cancer and non-aggressive prostate cancer). The five most common cancers were colorectal (n=1043), melanoma of the skin (n=698), lung (n=678), bladder (n=543), and advanced prostate (n=541). After adjusting for known risk factors, including detailed smoking history and dietary factors, participants with a history of Periodontal Disease had an increased risk of total cancer (HR 1·14 [95% CI 1·07–1·22]) compared with those with no history of Periodontal Disease. By cancer site, significant associations for those with a history of peridontal Disease were noted for lung (1·36 [1·15–1·60]), kidney (1·49 [1·12–1·97]), pancreas (1·54 [1·16–2·04]; findings previously published), and haematological cancers (1·30 [1·11–1·53]). Fewer teeth at baseline (0–16) was associated with an increase in risk of lung cancer (1·70 [1·37–2·11]) for those with 0–16 teeth versus those with 25–32 teeth. In never-smokers, Periodontal Disease was associated with significant increases in total (1·21 [1·06–1·39]) and haematological cancers (1·35 [1·01–1·81]). By contrast, no association was noted for lung cancer (0·96 [0·46–1·98]). Interpretation Periodontal Disease was associated with a small, but significant, increase in overall cancer risk, which persisted in never-smokers. The associations recorded for lung cancer are probably because of residual confounding by smoking. The increased risks noted for haematological, kidney, and pancreatic cancers need confirmation, but suggest that Periodontal Disease might be a marker of a susceptible immune system or might directly affect cancer risk. Funding National Cancer Institute, National Institutes of Health, Bethesda, MD, USA (grant number P01CA055075).
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a review of the relationship between tooth loss Periodontal Disease and cancer
Cancer Causes & Control, 2008Co-Authors: Mara S Meyer, Dominique S Michaud, Kaumudi Joshipura, Edward GiovannucciAbstract:Recent studies have investigated the association between Periodontal Disease, tooth loss, and several systemic Diseases including cancer, cardiovascular Disease, and preterm birth. Periodontal Disease, a chronic inflammatory condition, is highly prevalent in adult populations around the world, and may be preventable. Estimates of prevalence vary between races and geographic regions, with a marked increase in the occurrence of Periodontal Disease with advancing age. Worldwide estimates for the prevalence of severe Periodontal Disease generally range from 10 to 15%. The relationship between oral health and cancer has been examined for a number of specific cancer sites. Several studies have reported associations between Periodontal Disease or tooth loss and risk of oral, upper gastrointestinal, lung, and pancreatic cancer in different populations. In a number of studies, these associations persisted after adjustment for major risk factors, including cigarette smoking and socioeconomic status. This review provides a summary of these findings, discusses possible biological mechanisms involved, and raises methodological issues related to studying these relationships.
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a prospective study of Periodontal Disease and pancreatic cancer in us male health professionals
Journal of the National Cancer Institute, 2007Co-Authors: Dominique S Michaud, Kaumudi Joshipura, Edward Giovannucci, Charles S FuchsAbstract:Two previous cohort studies reported positive associations between tooth loss or periodontitis and pancreatic cancer risk. Data on Periodontal Disease were obtained at baseline and every other year thereafter in a cohort of 51,529 male health professionals aged 40-75 years. A total of 216 patients were diagnosed with incident pancreatic cancer during 16 years of follow-up. Multivariable relative risks (RRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models controlling for potential confounders, including detailed smoking history. All statistical tests were two-sided. Compared with no Periodontal Disease, history of Periodontal Disease was associated with increased pancreatic cancer risk (overall, multivariable RR = 1.64, 95% CI = 1.19 to 2.26; P = .002; crude incidence rates: 61 versus 25 per 100,000 person-years; among never smokers, multivariable RR = 2.09, 95% CI = 1.18 to 3.71; P = .01; crude incidence rates: 61 versus 19 per 100,000 person-years). In contrast, baseline number of natural teeth and cumulative tooth loss during follow-up were not strongly associated with pancreatic cancer. The association between Periodontal Disease and increased risk of pancreatic cancer may occur through plausible biologic mechanisms, but confirmation of this association is necessary.
Craig S Miller - One of the best experts on this subject based on the ideXlab platform.
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salivary biomarkers of Periodontal Disease in response to treatment
Journal of Clinical Periodontology, 2011Co-Authors: William Michael Sexton, Richard J Kryscio, Yushun Lin, Dolphus R Dawson, Jeffrey L Ebersole, Craig S MillerAbstract:Sexton WM, Lin Y, Kryscio RJ, Dawson III DR, Ebersole JL, Miller CS. Salivary biomarkers of Periodontal Disease in response to treatment. J Clin Periodontol 2011; 38: 434–441. doi: 10.1111/j.1600-051X.2011.01706.x Abstract Background: Salivary biomarkers of periodontitis were assessed longitudinally to determine response to therapy. Methods: A 6-month case-controlled study of adults with chronic periodontitis was performed, with 33 participants receiving oral hygiene instructions (OHI) alone and 35 with scaling and root planing (SRP) combined with OHI. Saliva samples collected at week 0, 16 and 28 were analysed for interleukin (IL)-1β, IL-8, macrophage inflammatory protein (MIP)-1α, matrix metalloproteinase-8 (MMP-8), osteoprotegerin (OPG), and tumour necrosis factor-α (TNF)-α. Clinical measures of Periodontal Disease were recorded at each visit. Results: All parameters of Periodontal health improved significantly in both groups by week 16 (p<0.0001) with the SRP group demonstrating greater benefit at week 16 and 28. Baseline OPG and TNF-α levels changed significantly at both follow-up visits (p<0.03), regardless of treatment group. IL-1β and MMP-8 levels decreased significantly from baseline (p<0.04) in the SRP group only. OPG, MMP-8, and MIP-1α were significantly reduced in responders compared with non-responders (p=0.04, 0.01, 0.05, respectively). In receiver-operating characteristic analyses, MMP-8 produced the highest area under the curve (0.7; p=0.01). Conclusion: Salivary levels of IL-1β, MMP-8, OPG, and MIP-1α reflected Disease severity and response to therapy suggesting their potential utility for monitoring Periodontal Disease status.
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salivary biomarkers of existing Periodontal Disease a cross sectional study
Journal of the American Dental Association, 2006Co-Authors: Craig S Miller, Charles P King, Chris M Langub, Richard J Kryscio, Mark V ThomasAbstract:ABSTRACT Background The authors conducted a study to determine if salivary biomarkers specific for three aspects of periodontitis—inflammation, collagen degradation and bone turnover—correlate with clinical features of Periodontal Disease. Methods The relationship between Periodontal Disease and the levels of interleukin-1 beta (IL-1β), matrix metalloproteinase (MMP)-8, and osteoprotegerin (OPG) in whole saliva of 57 adults (28 “case” subjects with moderate-to-severe Periodontal Disease and 29 healthy control subjects) was examined in a case-control trial. Results Mean levels of IL-1β and MMP-8 in saliva were significantly higher in case subjects than in controls. Both analytes correlated with Periodontal indexes, whereas, after adjustment for confounders, OPG did not. Elevated salivary levels of MMP-8 or IL-1β (more than two standard deviations above the mean of the controls) significantly increased the risk of Periodontal Disease (odds ratios in the 11.3–15.4 range ). Combined elevated salivary levels of MMP-8 and IL-1β increased the risk of experiencing Periodontal Disease 45-fold, and elevations in all three biomarkers correlated with individual clinical parameters indicative of Periodontal Disease. Conclusion Salivary levels of MMP-8 and IL-1β appear to serve as biomarkers of periodontitis. Clinical Implications Qualitative changes in the composition of salivary biomarkers could have significance in the diagnosis and treatment of Periodontal Disease.
Edward Giovannucci - One of the best experts on this subject based on the ideXlab platform.
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Periodontal Disease tooth loss and risk of oesophageal and gastric adenocarcinoma a prospective study
Gut, 2020Co-Authors: Sohee Kwon, Edward Giovannucci, Shuji Ogino, Andrew T Chan, Liang Wang, Georgios Polychronidis, Markus Dines Knudsen, Rong Zhong, Yin Cao, Mingyang SongAbstract:We read with great interest the study by Coker et al 1 that provided supportive evidence for the role of oral microbiota in gastric cancer. A few studies also highlighted the possible link with oesophageal cancer.2–4 However, there is a lack of robust epidemiologic data on whether Periodontal Disease and tooth loss, indicators of oral microbial dysbiosis, are associated with these two cancers. Here, we prospectively examined the association of history of Periodontal Disease and tooth loss with the risk of oesophageal and gastric adenocarcinoma in 98 459 women from the Nurses’ Health Study (1992–2014) and 49 685 men from the Health Professionals Follow-up Study (1988–2016). Dental measures, demographics, lifestyle, and diet were assessed using validated follow-up questionnaires. Self-reported cancer diagnosis was confirmed by review of medical records. We used Cox proportional hazards models to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs). We also examined the independent association of history of Periodontal Disease and tooth loss in a joint analysis. Over 22–28 years of follow-up, we documented 199 cases of oesophageal adenocarcinoma and 238 cases of gastric adenocarcinoma. History of Periodontal Disease was associated with a 43% and 52% increased risk of oesophageal adenocarcinoma (multivariable-adjusted HR (aHR) 1.43, 95% CI 1.05 to 1.96) and gastric adenocarcinoma (aHR 1.52, 95% CI 1.13 to 2.04) (table …
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gastric and duodenal ulcers Periodontal Disease and risk of bladder cancer in the health professionals follow up study
Cancer Causes & Control, 2020Co-Authors: Dong Hoon Lee, Edward Giovannucci, Nana KeumAbstract:Studies suggest that peptic ulcer and Periodontal Disease are positively associated with bladder cancer risk. These two factors are likely to share common biologic mechanisms such as inflammation and dysbiosis. We examined the joint association of peptic ulcer (gastric/duodenal) and Periodontal Disease on bladder cancer risk. We conducted a prospective analysis among 45,185 men (563 invasive bladder cancer cases) in the Health Professionals Follow-Up Study (follow-up 1986–2016). History of ulcer and Periodontal Disease was self-reported at baseline and updated during the follow-up. Cox proportional hazards models estimated hazard ratio (HR) and 95% confidence interval (CI) for the joint associations of ulcers (gastric, duodenal) and Periodontal Disease, adjusting for age and other potential confounders. We tested for interaction using the Wald test for product terms. Compared with men having no history of ulcer and Periodontal Disease, men with a history of peptic ulcer only (HR 1.22, 95% CI 0.90–1.66) and men with a history of Periodontal Disease only (HR 1.19, 95% CI 0.98–1.46) were associated with higher risk of invasive bladder cancer. The highest bladder cancer risk was observed in men with a history of both peptic ulcer and Periodontal Disease (HR 1.52, 95% CI 1.05–2.20). Similar results were found when we stratified by ulcer types. The interactions between ulcer and Periodontal Disease were not statistically significant for all ulcer types (p-interaction ≥ 0.59). We did not find sufficient evidence for interaction between gastric/duodenal ulcers and Periodontal Disease on bladder cancer risk.
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Periodontal Disease and risk of non hodgkin lymphoma in the health professionals follow up study
International Journal of Cancer, 2017Co-Authors: Kimberly A Bertrand, Edward Giovannucci, Janki Shingala, Andrew M Evens, Brenda M Birmann, Dominique S MichaudAbstract:Periodontal Disease is a chronic inflammatory condition that has been associated with chronic Diseases, including cancer. In an earlier prospective cohort analysis within the Health Professionals Follow-Up Study (HPFS), we observed a 31% higher risk of non-Hodgkin lymphoma (NHL) among participants with severe Periodontal Disease at baseline. Here, we extend the study with an additional 8 years of follow-up, and conduct analyses with updated Periodontal Disease status and NHL subtypes. The HPFS is an ongoing prospective cohort study of 51,529 men in the USA Between baseline in 1986 and 2012, 875 cases of NHL were diagnosed, including 290 chronic lymphocytic leukemia/small lymphocytic lymphomas (CLL/SLL), 85 diffuse large B-cell lymphomas and 91 follicular lymphomas. We performed multivariable Cox proportional hazards regression to evaluate associations of interest. History of Periodontal Disease at baseline was positively associated with risk of NHL overall (hazard ratio (HR) = 1.26, 95% confidence interval (CI): 1.06–1.49) and CLL/SLL (HR = 1.41, 95% CI: 1.04–1.90). With updated Periodontal status, HRs were 1.30 (95% CI: 1.11–1.51) for NHL overall and 1.41 (95% CI: 1.08–1.84) for CLL/SLL. In contrast, after adjusting for Periodontal Disease, tooth loss was inversely associated with NHL, suggesting that other causes or consequences of tooth loss may have different implications for NHL etiology. Our findings suggest that Periodontal Disease is a risk factor for NHL. Whether Periodontal Disease is a direct or indirect cause of NHL, or is a marker of underlying systemic inflammation and/or immune dysregulation, warrants further investigation.
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Periodontal Disease tooth loss and cancer risk in male health professionals a prospective cohort study
Lancet Oncology, 2008Co-Authors: Dominique S Michaud, Kaumudi Joshipura, Mara S Meyer, Edward Giovannucci, Yan LiuAbstract:Summary Background Studies suggest that tooth loss and Periodontal Disease might increase the risk of developing various cancers; however, smoking might have confounded the reported associations. We aimed to assess whether Periodontal Disease or tooth loss is associated with cancer risk. Methods The analysis was done in a prospective study (the Health Professionals Follow-Up Study [HPFS]), which was initiated in 1986 when US male health professionals aged 40–75 years responded to questionnaires posted by the Department of Nutrition, Harvard University School of Public Health, Boston, MA, USA. In addition to the baseline questionnaires, follow-up questionnaires were posted to all living participants every 2 years and dietary questionnaires every 4 years. At baseline, participants were asked whether they had a history of Periodontal Disease with bone loss. Participants also reported number of natural teeth at baseline and any tooth loss during the previous 2 years was reported on the follow-up questionnaires. Smoking status and history of smoking were obtained at baseline and in all subsequent questionnaires. Additionally at baseline, participants reported their mean frequency of food intake over the previous year on a 131-item semiquantitative food-frequency questionnaire. Participants reported any new cancer diagnosis on the follow-up questionnaires. Endpoints for this study were risk of total cancer and individual cancers with more than 100 cases. Multivariate hazard ratios (HRs) and 95% CIs were calculated by use of Cox proportional hazard models according to Periodontal Disease status and number of teeth at baseline. Findings In the main analyses, 48 375 men with median follow-up of 17·7 years (1986 to Jan 31, 2004) were eligible after excluding participants diagnosed with cancer before 1986 (other than non-melanoma skin cancer, n=2076) and those with missing data on Periodontal Disease (n=1078). 5720 incident cancer cases were documented (excluding non-melanoma skin cancer and non-aggressive prostate cancer). The five most common cancers were colorectal (n=1043), melanoma of the skin (n=698), lung (n=678), bladder (n=543), and advanced prostate (n=541). After adjusting for known risk factors, including detailed smoking history and dietary factors, participants with a history of Periodontal Disease had an increased risk of total cancer (HR 1·14 [95% CI 1·07–1·22]) compared with those with no history of Periodontal Disease. By cancer site, significant associations for those with a history of peridontal Disease were noted for lung (1·36 [1·15–1·60]), kidney (1·49 [1·12–1·97]), pancreas (1·54 [1·16–2·04]; findings previously published), and haematological cancers (1·30 [1·11–1·53]). Fewer teeth at baseline (0–16) was associated with an increase in risk of lung cancer (1·70 [1·37–2·11]) for those with 0–16 teeth versus those with 25–32 teeth. In never-smokers, Periodontal Disease was associated with significant increases in total (1·21 [1·06–1·39]) and haematological cancers (1·35 [1·01–1·81]). By contrast, no association was noted for lung cancer (0·96 [0·46–1·98]). Interpretation Periodontal Disease was associated with a small, but significant, increase in overall cancer risk, which persisted in never-smokers. The associations recorded for lung cancer are probably because of residual confounding by smoking. The increased risks noted for haematological, kidney, and pancreatic cancers need confirmation, but suggest that Periodontal Disease might be a marker of a susceptible immune system or might directly affect cancer risk. Funding National Cancer Institute, National Institutes of Health, Bethesda, MD, USA (grant number P01CA055075).
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a review of the relationship between tooth loss Periodontal Disease and cancer
Cancer Causes & Control, 2008Co-Authors: Mara S Meyer, Dominique S Michaud, Kaumudi Joshipura, Edward GiovannucciAbstract:Recent studies have investigated the association between Periodontal Disease, tooth loss, and several systemic Diseases including cancer, cardiovascular Disease, and preterm birth. Periodontal Disease, a chronic inflammatory condition, is highly prevalent in adult populations around the world, and may be preventable. Estimates of prevalence vary between races and geographic regions, with a marked increase in the occurrence of Periodontal Disease with advancing age. Worldwide estimates for the prevalence of severe Periodontal Disease generally range from 10 to 15%. The relationship between oral health and cancer has been examined for a number of specific cancer sites. Several studies have reported associations between Periodontal Disease or tooth loss and risk of oral, upper gastrointestinal, lung, and pancreatic cancer in different populations. In a number of studies, these associations persisted after adjustment for major risk factors, including cigarette smoking and socioeconomic status. This review provides a summary of these findings, discusses possible biological mechanisms involved, and raises methodological issues related to studying these relationships.
