Dong-Hun Han

The association of metabolic syndrome with periodontal disease is confounded by age and smoking in a Korean population: the Shiwha–Banwol Environmental Health Study

AIM Because metabolic syndrome (MS) is pro-inflammatory and periodontitis is inflammatory, we issued the hypothesis that MS (the explanatory variable) is associated with periodontitis (the outcome variable). This study aimed to examine the link between MS and periodontitis among Koreans. MATERIALS AND METHODS From the Shiwha-Banwol Environmental Health Study, 1046 subjects aged 18 years or older were cross-sectionally surveyed. All participants underwent comprehensive dental and medical health examinations. The community periodontal index was used to assess periodontitis. Age, gender, monthly family income, smoking, drinking, frequency of daily teeth brushing, and physical activity were evaluated as confounders. RESULTS MS was strongly associated with periodontitis [odds ratio (OR): 1.7, 95% confidence interval (CI): 1.22-2.37], and MS with more components had a higher association. The association was higher for elders aged 65 years or more, males, and smokers. MS including both high glucose and hypertension had a higher association with the OR of 2.19 (95% CI: 1.23-3.90) comparing with other types of MS. CONCLUSIONS Our results suggested that MS might be associated with periodontitis and the association was confounded by age, gender, and smoking. MS with high glucose and hypertension showed the higher impact on this link.

Association Between Periodontitis and Hemorrhagic Stroke Among Koreans: A Case‐Control Study

BACKGROUND Several studies suggested that periodontitis is a risk factor for stroke, but the relationship between periodontitis and hemorrhagic stroke has not been widely reported. This study aims to evaluate the association between periodontitis and hemorrhagic stroke and to identify the risk group for this association. METHODS We recruited 165 patients who were diagnosed via computed tomography brain imaging as having had a hemorrhagic stroke and 214 non-stroke control subjects for a case-control study. All participants underwent a clinical periodontal examination using clinical attachment level (CAL) as a marker. Information about sociodemographic factors, behavioral factors, systemic health, and a familial history of systemic health was gathered through an interview using structured questionnaires. The association between periodontitis and hemorrhagic stroke was evaluated using multivariate logistic regression analyses with adjustment for age, gender, income, education, hypertension, diabetes, body mass index, cardiac disease, familial hypertension history, familial diabetes history, familial cardiac disease history, smoking, and alcohol consumption. Subgroup analyses were also performed to investigate potential risk groups. RESULTS After controlling for potential confounders, periodontitis (CAL > or =6 mm) was found to be significantly associated with hemorrhagic stroke (odds ratio: 2.5; 95% confidence interval: 1.1 to 5.6), but this association did not exhibit a dose-dependent response for periodontitis (percentile of sites of periodontal pockets with CAL > or =5 mm among total probed pockets). The association between periodontitis (CAL > or =6 mm) and hemorrhagic stroke was significant for males, patients who had a lower income than control subjects, obese patients, and patients without diabetes. CONCLUSIONS Periodontitis may be an independent risk factor for hemorrhagic stroke. Risk groups include males, patients without diabetes, and obese subjects.

Visceral fat area-defined obesity and periodontitis among Koreans.

AIM Although the association of periodontitis with body mass index (BMI)-defined obesity has been studied, it remains controversial. Hence, this study aims to determine whether the obesity is associated with periodontitis among Koreans and to determine the most significant indicator of the obesity on the link. MATERIALS AND METHODS From the Sihwa-Banwol Environmental Health Cohort, 1046 subjects 15 years of age or older were cross-sectionally surveyed. All participants underwent periodontal and medical health examinations. Age, gender, monthly family income, smoking, drinking, frequency of daily teeth brushing and physical activity were evaluated through interviews. The community periodontal index (CPI) was used to assess periodontitis. BMI, waist circumference (WC), waist hip ratio and visceral fat area (VFA) were used to assess obesity. Multivariate linear and logistic regression analyses were applied. RESULTS BMI, WC and VFA had a dose-effect relationship with the number of sextants with periodontitis. Although subgroup analysis revealed several significant associations between obesity and periodontitis (CPI 3-4), the greatest association between VFA and periodontitis was found in males, age 45-54 (odds ratio=3.30; 95% confidence interval: 1.53-7.09). CONCLUSIONS Obesity was associated with periodontitis. VFA was the most suitable indicator of obesity in relation to periodontitis. Obesity may be a substantial risk factor for periodontitis.

The Association of Smoking and Diabetes With Periodontitis in a Korean Population

BACKGROUND Smoking and diabetes are well-known risk factors for periodontitis. The aims of this study are to examine whether these factors are associated with periodontitis in representative samples of Koreans and to estimate the interaction impact of smoking and diabetes on periodontitis in this population. METHODS The Korean National Oral Health Survey (KNOHS) 2006 collected nationally representative samples of oral epidemiologic data. A community periodontal index (CPI) of 3 to 4 and a CPI value of 0 to 2 were classified as periodontitis and non-periodontitis, respectively. A total of 4,118 participants from KNOHS 2006 were interviewed on smoking and diabetes. Periodontitis was the outcome variable. Smoking and diabetes were the major explanatory variables. The confounders consisted of age, sex, education, occupation, monthly income, and residential area. Logistic regression analyses were used to evaluate the associations of smoking and diabetes with periodontitis after adjustment for confounders. RESULTS The overall prevalence of periodontitis, current smoking, and self-reported diabetes in Korean adults was 10.1%, 25.9%, and 4.5%, respectively. Associations of smoking and diabetes with periodontitis were : current smokers, odds ratio (OR) = 1.40, 95% confidence interval (CI) = 1.02 to 1.90; and diabetes, OR = 1.21, 95% CI = 0.82 to 1.77. The association between diabetes and periodontitis was not significant and there were no synergistic interactions of smoking and diabetes on periodontitis. CONCLUSIONS The results suggest that smoking has a significant impact on the periodontal health of Korean adults, but the combined effect of smoking and diabetes had no significant impact.

Group of serum inflammatory markers and periodontitis-metabolic syndrome coexistence in Koreans.

BACKGROUND Recent epidemiologic studies have shown that individuals with periodontitis have a significantly increased risk of metabolic syndrome (MetS). Chronic infection and subsequent production of systemic inflammatory markers may be associated with this increased risk. The aim of present study is to determine whether the presence of periodontitis and MetS is associated with a group or an individual of C-reactive protein (CRP), interleukin (IL)-1β, IL-6, IL-8, tumor necrosis factor-α (TNF-α), and homocysteine (HCY) in the serum of a Korean population. METHODS Medical and periodontal parameters, including CRP, IL-1β, IL-6, IL-8, TNF-α, and HCY, were evaluated in 118 individuals (73 healthy; 20 with periodontitis only; 13 with MetS only; and 12 with both). The community periodontal index was used to assess periodontitis. Age, sex, monthly household income, smoking, and drinking were evaluated as confounders. Analysis of covariance, linear regression analysis, and factor analysis were applied. RESULTS The group of serologic cytokines was synergistically associated with the periodontitis-MetS coexistence. TNF-α and IL-6 were two representing serologic cytokines in the group. CONCLUSIONS Our results suggest that a group of systemic biologic markers represented by TNF-α and IL-6 might mediate the association between MetS and periodontitis adjusted for various confounders. Additional evidence is needed to generalize our results more widely.

Association Between Periodontitis and Salivary Nitric Oxide Metabolites Among Community Elderly Koreans

BACKGROUND Nitric oxide (NO) is known to play an important role in many biologic systems, although the relationship between NO metabolites and periodontitis remains controversial. Moreover, little evidence of an association between salivary NO (S-NO) and periodontitis in the general population has been reported. This study aims to investigate the relationship between S-NO and periodontitis in an elderly Korean population. METHODS A cross-sectional study was conducted using participants and salivary samples from Sunchang Elderly Cohort Study. The total number of final participants was 242 (91 males and 151 females; 48 to 93 years old). Periodontitis was determined by a clinical attachment loss of >6 mm at six probe points on 12 index teeth. NO was measured in unstimulated saliva via the Griess reaction. Sociodemographic status, general/oral health, and health-related behaviors were investigated as confounders. Bivariate analysis and multivariable linear regression analyses including confounders were applied. RESULTS After controlling for age, sex, education, salivary flow rate, number of teeth, smoking status, physical activity, hypertension, and diabetes, three metabolites of S-NO (total NO, nitrite, and nitrate) were independently associated with the percentage of probe points exhibiting periodontitis. Of these linear associations, total NO was found to have the strongest correlation with periodontitis (partial r = 0.181, P = 0.009). These associations were most pronounced in females (except for nitrate), non-smokers, those without hypertension, and those without diabetes. CONCLUSIONS Our data suggest that high concentrations of S-NO are associated with severe periodontitis. Thus, S-NO may serve as a potential biologic marker for detecting and monitoring periodontitis.

Gingival crevicular fluid levels of matrix metalloproteinases cross-sectionally related to periodontitis and metabolic syndrome in community Koreans.

BACKGROUND Metabolic syndrome (MetS) may be associated with periodontitis. This study aimed to investigate whether the existence of periodontitis and MetS is cross-sectionally associated with matrix metalloproteinase (MMP) in gingival crevicular fluid (GCF) among community Koreans. MATERIALS AND METHODS Medical and periodontal parameters were evaluated by physicians and dentists in 314 subjects (199 healthy, 58 only periodontitis, 34 only MetS and 23 both). The community periodontal index was used to assess periodontitis. MMP-8, 9, 13 were determined by enzyme-linked immunosorbent assay. Age, gender, monthly household income, smoking and drinking were interviewed as confounders. Analysis of covariance (ANCOVA) was applied. Gender-stratified analyses were applied. RESULTS After controlling for various confounders, MMP-8, MMP-9 and MMP-13 in GCF were significantly associated with periodontitis in both genders and MMP-9, MMP-13 were associated with MetS in women. MMP-8, MMP-9 and MMP-13 showed association with periodontitis-MetS coexistence non-synergistically in both genders. MMP-9 was synergistically associated with periodontitis-MetS coexistence in women. CONCLUSION Our results suggest that MMP-8, MMP-9, MMP-13 in GCF were independently related to coexistence of periodontitis and MetS. MMP-9 and MMP-13 could be an appropriate common indicator of periodontitis and MetS in women. Further studies might guarantee that MMPs in GCF could screen periodontitis and MetS.

Korean Version of Child Perceptions Questionnaire and Dental Caries among Korean Children

Although dental caries has been a major oral health problem for children, the association between dental caries and oral health related quality of life has been still controversial. This study aims to evaluate the association between the Korean version of the Child Perceptions Questionnaire (K-CPQ) and dental caries among Korean children. Eight hundred one school children aged 8 to 14 years participated in this study. After the K-CPQ was validated we performed an association study. The K-CPQ was self-reported. Dental caries were evaluated by dentists using the World Health Organization Index. Correlation analyses (intraclass correlation coefficient, Cronbach’s alpha and Pearson’s correlation coefficient [r]) and linear regression models (partial r) including age, gender and type of school were applied. Untreated deciduous dental caries was associated with the K-CPQ8-10 overall score (partial r = 0.15, P <0.05). The link was highlighted in the domains of functional limitation and emotional well-being. Filled teeth due to caries (FT) was associated with the K-CPQ11-14 overall domain (partial r = 0.14, P = 0.002) as well as with the oral symptoms domain (partial r = 0.16, P = 0.001). This association was highlighted among public school children. Our data indicate that K-CPQ was independently associated with dental caries. The K-CPQ could be a practical tool to evaluate the subjective oral health among Korean children aged 8 to 14.

Exploring the determinants of secular decreases in dental caries among Korean children

OBJECTIVE The aim of this study was to determine the contributions of sealant and water fluoridation to the time trends in dental caries from 2003 to 2010. MATERIALS AND METHODS Data were from three waves of the Korean National Oral Health Surveys between 2003 and 2010, including a total of 23 059 children (11 889 boys and 11 170 girls) aged 8, 10, and 12 years. The impacts of sealant and water fluoridation on dental caries were obtained by logistic regression for each age group of children. The contributions of sealant and water fluoridation to the time trends in the prevalence of dental caries were examined by a series of logistic regression models, and changes in the adjusted odds ratios for each survey year were also calculated. RESULTS Over the past 7 years, the prevalence of dental caries decreased dramatically. Although sealant had a significant impact on dental caries in each survey year, remarkable decreases in dental caries from 2003 to 2010 were not explained by the secular changes in the dental sealant or water fluoridation factor. CONCLUSION We observed important population declines in dental caries in Korea in children aged 8-12 years; however, the likely causes for these secular trends remain to be determined.

Early-life socioeconomic position and periodontal status in Korean adults.

OBJECTIVES The aim of this study was to assess the association between different life-course socioeconomic positions (SEPs) and periodontitis in a large representative sample of the Korean population. METHODS With data from Korean adults aged 30-59, periodontitis was assessed with the community periodontal index. Parental education, own education, and income as indicators of early childhood SEP, adolescence SEP, and adulthood SEP, respectively, were categorized by four groups (1-4). The association between the different life-course SEPs and periodontitis was estimated according to three different life-course models: individual impact of the three SEPs, cumulative impact by the sum of the three SEP values (sum ranges 3-12), and the pathways of the three SEPs through lifetime to the periodontitis. Covariates were demographic factors, health behaviors, and health problems. The prevalence ratios (PRs) and relative index of inequality (RII) for periodontitis were obtained. RESULTS In an individual impact model, significant associations of each SEP with periodontitis were found after adjusting for all covariates (RII = 1.16 for parental education, 1.19 for own education, and 1.27 for income). For a cumulative impact model, there were higher risks for periodontitis as the sum of the three SEP values increased (RII = 1.51). For the intergenerational social mobility model, prevalence of current periodontal disease was highest in the persistently low group. (RII = 1.54 and PR = 1.51). CONCLUSIONS These results show that the individual and cumulative SEPs measured by the parental education, own education, and income were independently associated with the periodontal status of Korean adults. The pathway and cumulative hypotheses for the life-course SEP effects on periodontitis could be salient in oral epidemiology.