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      The Link between Oral and General Health

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          The relationship between oral health and general health has been the focus of research interests for decades. While the impact and oral manifestations of certain systemic conditions have been identified very early [1, 2], later research examined the potential impact of oral diseases on chronic systemic conditions. To list a few, periodontal diseases have been linked to cardiovascular diseases, high blood pressure, stroke, diabetes, dementia, respiratory diseases, and mortality, where an inflammatory pathway was depicted [3, 4]. Another line of research examined the association between the number of teeth, severe dental caries, and general health among older adults [5, 6] and children [7], suggesting a nutritional pathway. While a causal relationship between oral health and general health is still unconfirmed, comorbidities due to common risk factors appear to be a more acceptable explanation in view of the current evidence [8]. This highlights the importance of integrating oral health and general health policies and health-promoting interventions and the importance of considering oral health status among individuals with compromised medical conditions. In this special issue, ten articles pertaining to the oral health/general health relationship and care for medically compromised patients have been published. J. Kowar et al. compared mortality rates among 3,902 Swedish patients who received dental implants in the edentulous arch to the national death register. The authors concluded that while the edentulous patients younger than 60 years were at a higher risk of mortality from cardiovascular diseases than the general population, those over 79 years who had implant were at a significantly lower risk of all-cause mortality than the general population. A few of the articles examined the relationship between periodontal diseases and general health. P. B. Linhartova et al. examined 1,016 participants in a case-control study to assess the variability in the interleukin-1 (IL-1) gene cluster and IL-1β plasma levels in patients with chronic periodontitis and diabetes. Their analysis suggested that variability in the IL-1 gene cluster may be one of the factors implicated in the relationship between chronic periodontitis and type 1 diabetes pathogenesis. Similarly, P. Naiff et al. reviewed the literatures on the relationship between chronic periodontitis and type II diabetes and concluded that periodontal screening should be part of the clinical examination of patients with diabetes. R. A. G. Khammissa et al. reviewed the literatures on the role of vitamin D serum level in maintaining periodontal health. While the authors acknowledged the limitation of the available evidence, mostly from cross-sectional studies, they acknowledged a potential role of vitamin D in maintaining good oral health. One article examined the relationship between dental caries and maternal and child health. C. W. J. Africa and M. Turton examined oral health status and treatment needs of 443 pregnant women attending antenatal clinics in KwaZulu-Natal, South Africa. While identifying pregnant women at risk of dental caries and tooth mobility, the authors recommended early oral health screening during pregnancy to ensure wellbeing of the mother and the fetus. A. A. Alshihri et al. conducted a narrative review on the relationship between dental caries and obesity among children and adolescents. The review concluded that there is an inconsistent relationship between dental caries and body measurements. While dietary habits could explain a positive relationship between obesity and caries, the impact of severe dental pain and dental inflammation could negatively affect children's weight gain. Others examined the oral manifestation of chronic health conditions. R. B. Chebil et al. examined 30 patients with Sjogren's syndrome to assess oral lichen planus and oral lichenoid lesions and concluded that these two lesions were common among patients with Sjogren's syndrome. F. Costantinides et al. reviewed manifestation of end-stage renal disease and hemodialysis to describe the dental operative protocols for patients awaiting kidney transplantation. The authors highlighted the need for coordination between nephrologist and dental providers and the importance of early detection of oral conditions to minimize the need for extensive care. A. Peteuil et al. examined the feasibility of the therapeutic educational program in oral health for persons with schizophrenia using the qualitative method and concluded that oral health representation evolved after the therapeutic educational program. Further study will be conducted on a larger sample to produce stronger evidence. The manuscripts published in this special issue covered a number of different topics pertaining to the relationship between oral and general health, thus highlighting the diversity of research in this area. While few studies examined a potential relationship between oral health and mortality, diabetes, and obesity, others have addressed dental care for patients under medical care and those with medically compromised conditions. With the increasing interest in research on the oral health and general health relationship, and the high demands for providing efficient and comprehensive medical and dental care, this special issue is a timely contribution to research on this topic that will undoubtedly be beneficial to researchers working in this field of research and to oral and general health practitioners.

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          Most cited references 7

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          Is periodontal inflammation associated with raised blood pressure? Evidence from a National US survey.

          There is incomplete and inconclusive evidence for the association between periodontal disease markers and arterial blood pressure, particularly from large national epidemiological studies. This study assessed the relationship between different markers of periodontal inflammation and disease with arterial blood pressure in people aged 17 years and over in USA. We analysed data from the Third National Health and Nutrition Examination Survey on 6617 men and 7377 women who received a periodontal examination. Blood pressure was analysed in both a continuous format and a binary variable for case definition of hypertension. Periodontal disease markers (extent of gingival bleeding, pocket depth, and loss of attachment, and a case definition of periodontitis) were associated on the arterial blood pressure outcomes through a series of regression models, incrementally adjusting for confounders (demographic, inflammation markers, chronic conditions, smoking, BMI, socio-economic status). All periodontal measures had significant crude associations with SBP and hypertension. Gingival bleeding, a marker of current periodontal inflammation, was the only measure consistently and significantly associated with raised SBP and an increased odds of hypertension in the US adult population throughout the adjustment process. For a 10% greater extent of gingival bleeding, the average SBP was higher by 0.5 (0.3, 0.6) mmHg in the fully adjusted model. By referring to the general population and the whole distribution of blood pressure, not only to those at higher risk for hypertension, this association might have some important implications for clinical practice and public health strategies.
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            Relationship between periodontal status and levels of glycated hemoglobin.

            The objective of this study was to assess whether there is a bi-directional relationship between periodontal status and diabetes. Study 1 included 5,856 people without periodontal pockets of ≥ 4 mm at baseline. Relative risk was estimated for the 5-year incidence of periodontal pockets of ≥ 4 mm (CPI scores 3 and 4, with the CPI probe), in individuals with glycated hemoglobin (HbA1c) levels of ≥ 6.5% at baseline. Study 2 included 6,125 people with HbA1c < 6.5% at baseline. The relative risk was assessed for elevation of HbA1c levels in 5 years, with baseline periodontal status, assessed by CPI. Relative risk of developing a periodontal pocket was 1.17 (p = 0.038) times greater in those with HbA1c of ≥ 6.5% at baseline, adjusted for body mass index (BMI), smoking status, sex, and age. Relative risks for having HbA1c ≥ 6.5% at 5-year follow-up in groups with periodontal pockets of 4 to 5 mm and ≥ 6 mm at baseline were 2.47 (p = 0.122) and 3.45 (p = 0.037), respectively, adjusted for BMI, alcohol consumption, smoking status, sex, and age. The risk of developing periodontal disease was associated with levels of HbA1c, and the risk of elevations of HbA1c was associated with developing periodontal pockets of more than 4 mm.
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              Association between oral health and frailty: A systematic review of longitudinal studies


                Author and article information

                Int J Dent
                Int J Dent
                International Journal of Dentistry
                29 May 2019
                : 2019
                1King's College London, Faculty of Dentistry, Oral & Craniofacial Sciences, Denmark Hill, London SE5 9RW, UK
                2Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
                3Preventive Dental Sciences Department, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia
                Copyright © 2019 Wael Sabbah et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.




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