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Impact of periodontal treatment on hospitalization for adverse respiratory events in asthmatic adults: A propensity-matched cohort study

  • Te-Chun Shen
    Affiliations
    Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan

    Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
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  • Pei-Ying Chang
    Affiliations
    Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan

    Department of Dentistry, China Medical University Hospital, Taichung, Taiwan
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  • Cheng-Li Lin
    Affiliations
    Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
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  • Chang-Ching Wei
    Affiliations
    Children's Hospital, China Medical University Hospital, Taichung, Taiwan
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  • Chih-Yen Tu
    Affiliations
    Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
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  • Te-Chun Hsia
    Affiliations
    Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
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  • Chuen-Ming Shih
    Affiliations
    Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
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  • Wu-Huei Hsu
    Affiliations
    Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
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  • Author Footnotes
    1 Fung-Chang Sung and Chia-Hung Kao contributed equally.
    Fung-Chang Sung
    Correspondence
    Correspondence to: F.-C. Sung, Department of Health Services Administration, China Medical University, No. 91 Hsueh-Shih Road, Taichung 404, Taiwan.
    Footnotes
    1 Fung-Chang Sung and Chia-Hung Kao contributed equally.
    Affiliations
    Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan

    Department of Health Services Administration, China Medical University, Taichung, Taiwan

    Mahidol University Faculty of Public Health, Bangkok, Thailand
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  • Author Footnotes
    1 Fung-Chang Sung and Chia-Hung Kao contributed equally.
    Chia-Hung Kao
    Correspondence
    Correspondence to: C.-H. Kao, Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, No. 91 Hsueh-Shih Road, Taichung 404, Taiwan.
    Footnotes
    1 Fung-Chang Sung and Chia-Hung Kao contributed equally.
    Affiliations
    Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan

    Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan

    Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
    Search for articles by this author
  • Author Footnotes
    1 Fung-Chang Sung and Chia-Hung Kao contributed equally.

      Highlights

      • The effect of periodontal treatment in asthma control remains unclear.
      • Asthmatics underwent periodontal treatment were at lower risk of hospitalization for adverse respiratory events.
      • Periodontal treatment group had lower intensive care demands for these events.
      • All-cause mortality was also significantly lower in the periodontal treatment group.

      Abstract

      Background

      Periodontal disease is prevalent in asthmatics, but it is unclear whether periodontal treatment plays a role in adverse respiratory events in these patients. We evaluated risk of hospitalization for adverse respiratory events (acute exacerbation, pneumonia, and acute respiratory failure) and mortality in asthmatic adults with and without periodontal treatment.

      Methods

      We used National Health Insurance (NHI) claims data of Taiwan to identify 4771 asthmatic adults with periodontal disease who underwent periodontal treatment during 2000–2006. The control group consisted of asthmatic adults without periodontal disease at a 1:1 ratio matched by the propensity score. Both groups were followed up for 5 years to estimate the risk of hospitalization for adverse respiratory events and mortality.

      Results

      Compared with controls, the periodontal treatment group had lower overall incidence of hospitalization for adverse respiratory events [5.41 vs. 6.07 per 100 person-years, 95% confidence interval (CI) = 0.78–0.92] and intensive care unit admissions (1.14 vs. 1.25 per 100 person-years, 95% CI = 0.79–0.99). In addition, the all-cause mortality rate was significantly lower in the periodontal treatment group than in the control group during the follow-up period (1.86 vs. 2.79 per 100 person-years, 95% CI = 0.59–0.71).

      Conclusion

      Asthmatic adults who underwent periodontal treatment were at lower risk of hospitalization for adverse respiratory events and mortality than those without periodontal disease. Asthmatic adults should adopt more precautionary oral hygiene and ensure that they undergo regular periodontal health checkups.

      Keywords

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      References

        • Global Strategy for Asthma Management and Prevention
        Global Initiative for Asthma 2017 Update.
        (Available from)
        • Pihlstrom B.L.
        • Michalowicz B.S.
        • Johnson N.W.
        Periodontal diseases.
        Lancet. 2005; 366: 1809-1820
        • Armitage G.C.
        Periodontal diagnoses and classification of periodontal diseases.
        in: Periodontol 2000. 34. 2004: 9-21
        • Laurikainen K.
        • Kuusisto P.
        Comparison of the oral health status and salivary flow rate of asthmatic patients with those of nonasthmatic adults – results of a pilot study.
        Allergy. 1998; 53: 316-319
        • Stensson M.
        • Wendt L.K.
        • Koch G.
        • Oldaeus G.
        • Ramberg P.
        • Birkhed D.
        Oral health in young adults with long-term, controlled asthma.
        Acta Odontol Scand. 2011; 69: 158-164
        • Hyyppä T.M.
        • Koivikko A.
        • Paunio K.U.
        Studies on periodontal conditions in asthmatic children.
        Acta Odontol Scand. 1979; 37: 15-20
        • Mehta A.
        • Sequeira P.S.
        • Sahoo R.C.
        • Kaur G.
        Is bronchial asthma a risk factor for gingival diseases? A control study.
        N Y State Dent J. 2009; 75: 44-46
        • Scannapieco F.A.
        • Stewart E.M.
        • Mylotte J.M.
        Colonization of dental plaque by respiratory pathogens in medical intensive care patients.
        Crit Care Med. 1992; 20: 740-745
        • Borgnakke W.S.
        Does treatment of periodontal disease influence systemic disease?.
        Dent Clin N Am. 2015; 59: 885-917
        • de Melo Neto J.P.
        • Melo M.S.
        • dos Santos-Pereira S.A.
        • Martinez E.F.
        • Okajima L.S.
        • Saba-Chujfi E.
        Periodontal infections and community-acquired pneumonia: a case-control study.
        Eur J Clin Microbiol Infect Dis. 2013; 32: 27-32
        • Gomes-Filho I.S.
        • de Oliveira T.F.
        • da Cruz S.S.
        • Passos-Soares Jde S.
        • Trindade S.C.
        • Oliveira M.T.
        • et al.
        Influence of periodontitis in the development of nosocomial pneumonia: a case control study.
        J Periodontol. 2014; 85: e82-e90
        • Huang S.T.
        • Lin C.L.
        • Yu T.M.
        • Wu M.J.
        • Kao C.H.
        Intensive periodontal treatment reduces risk of infection-related hospitalization in hemodialysis population: a nationwide population-based cohort study.
        Medicine. 2015; 94e1436
        • Shen T.C.
        • Lin C.L.
        • Wei C.C.
        • Chen C.H.
        • Tu C.Y.
        • Hsia T.C.
        • et al.
        Risk of obstructive sleep apnea in adult patients with asthma: a population-based cohort study in Taiwan.
        PLoS One. 2015; 10e0128461
        • Lee Y.C.
        • Lee C.T.
        • Lai Y.R.
        • Chen V.C.
        • Stewart R.
        Association of asthma and anxiety: a nationwide population-based study in Taiwan.
        J Affect Disord. 2016; 189: 98-105
        • Lee C.F.
        • Lin M.C.
        • Lin C.L.
        • Yen C.M.
        • Lin K.Y.
        • Chang Y.J.
        • et al.
        Non-apnea sleep disorder increases the risk of periodontal disease: a retrospective population-based cohort study.
        J Periodontol. 2014; 85: e65-e71
        • Craig R.G.
        Periodontal therapy is associated with decreased risk of developing end-stage renal disease - a study using the Taiwan National Health Insurance Database.
        J Evid Based Dent Pract. 2014; 14: 62-64
        • Hsing A.W.
        • Ioannidis J.P.A.
        Lessons from the Taiwan National Health Insurance research.
        JAMA Intern Med. 2015; 175: 1527-1529
        • Christiansen S.C.
        • Schatz M.
        • Yang S.J.
        • Ngor E.
        • Chen W.
        • Zuraw B.L.
        Hypertension and asthma: a comorbid relationship.
        J Allergy Clin Immunol Pract. 2016; 4: 76-81
        • Milanese M.
        • Di Marco F.
        • Corsico A.G.
        • Rolla G.
        • Sposato B.
        • Chieco-Bianchi F.
        • et al.
        Asthma control in elderly asthmatics. An Italian observational study.
        Respir Med. 2014; 108: 1091-1099
        • Yonas M.A.
        • Marsland A.L.
        • Emeremni C.A.
        • Moore C.G.
        • Holguin F.
        • Wenzel S.
        Depressive symptomatology, quality of life and disease control among individuals with well-characterized severe asthma.
        J Asthma. 2013; 50: 884-890
        • Thomas M.S.
        • Parolia A.
        • Kundabala M.
        • Vikram M.
        Asthma and oral health: a review.
        Aust Dent J. 2010; 55: 128-133
        • Widmer R.P.
        Oral health of children with respiratory diseases.
        Paediatr Respir Rev. 2010; 11: 226-232
        • Young W.G.
        The oral medicine of teeth wear.
        Aust Dent J. 2001; 46: 236-250
        • Bansal M.
        • Khatri M.
        • Taneja V.
        Potential role of periodontal infection in respiratory diseases - a review.
        J Med Life. 2013; 6: 244-248
        • O'Reilly P.G.
        • Claffey N.M.
        A history of oral sepsis as a cause of disease.
        in: Periodontol 2000. 23. 2000 (13–8)
        • Greenberg S.
        Asthma exacerbations: predisposing factors and prediction rules.
        Curr Opin Allergy Clin Immunol. 2013; 13: 225-236
        • Kucukcoskun M.
        • Baser U.
        • Oztekin G.
        • Kiyan E.
        • Yalcin F.
        Initial periodontal treatment for prevention of chronic obstructive pulmonary disease exacerbations.
        J Periodontol. 2013; 84: 863-870
        • Zhou X.
        • Han J.
        • Liu Z.
        • Song Y.
        • Wang Z.
        • Sun Z.
        Effects of periodontal treatment on lung function and exacerbation frequency in patients with chronic obstructive pulmonary disease and chronic periodontitis: a 2-year pilot randomized controlled trial.
        J Clin Periodontol. 2014; 41: 564-572
        • Shen T.C.
        • Chang P.Y.
        • Lin C.L.
        • Chen C.H.
        • Tu C.Y.
        • Hsia T.C.
        • et al.
        Periodontal treatment reduces risk of adverse respiratory events in patients with chronic obstructive pulmonary disease: a propensity-matched cohort study.
        Medicine. 2016; 95e3735
        • Vargas M.H.
        • Macedo-Sánchez F.
        • Solís-Torres C.
        • Rubio-Monteverde H.
        • Furuya M.E.
        Oral hygiene and dental status as factors related to asthma in high school and college students.
        J Asthma. 2015; 52: 376-381