Predictors and systemic effects of periodontal disease progression
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Periodontal disease is a chronic and inflammatory oral condition, common among adults, with important outcomes such as tooth loss and systemic inflammatory-related events such as coronary heart disease [CHD]. Studies of periodontal disease occurrence permeate the literature; however, longitudinal studies of disease progression are rare. Using data from the Veterans Administration Dental Longitudinal Study and Normative Aging Study we compiled a population of adult men suffering from periodontal disease. Within this population we conducted three prospective cohort studies; two examined the impact of exposures on the progression of disease and one that examined the impact of disease progression on the incidence of CHD events. In the first study, we estimated the effect of smoking on progression of disease. After restricting the population according to age and periodontal disease status at entry, smokers displayed greater progression of periodontal disease over time than nonsmokers (Difference in slopes: 0.14; 95% CI: 0.05, 0.23) after controlling for heavy alcohol use, body mass index [BMI] and diabetic diagnoses. The second study estimated the effect of uric acid on progression of periodontal disease. After implementing marginal structural modeling to address the influence of time-varying covariates and adjusting for heavy alcohol use and smoking, we did not observe any effect of high uric acid levels (Difference in slopes: 0.01; 95% CI: -0.003, 0.02). In the third study, we evaluated the continuous effect of periodontal disease progression on incident CHD events. After restricting the population according to periodontal disease status at entry, incremental increases in periodontal disease were found to be associated with a two-fold increase in risk of CHD events (HR: 1.99; 95% CI: 0.45, 8.83), adjusting for age, SES, BMI, diabetic diagnoses, heavy alcohol use and smoking. This association also appeared to depend on smoking status and heavy alcohol use with smokers and heavy alcohol users observed to have a higher risk of CHD. The results of the current studies provide initial insight into the possible predictors and effects of periodontal disease progression. Most importantly, they highlight the influence of prevalent cohort biases studies of progression and the unique intricacies of studying periodontal health over time.
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