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ABSTRACT: To determine whether foods that are good to excellent sources of fiber reduce periodontal disease progression in men.
Prospective, observational study.
Greater Boston, Massachusetts, metropolitan area.
Six hundred twenty-five community-dwelling men participating in the Department of Veterans Affairs Dental Longitudinal Study.
Dental and physical examinations were conducted every 3 to 5 years. Diet was assessed using food frequency questionnaires (FFQs). Mean follow-up was 15 years (range: 2-24 years). Periodontal disease progression on each tooth was defined as alveolar bone loss (ABL) advancement of 40% or more, probing pocket depth (PPD) of 2 mm or more, or tooth loss. Good and excellent fiber sources provided 2.5 g or more of fiber per serving. Multivariate proportional hazards regression estimated hazard ratios (HRs) and 95% confidence intervals (CIs) of periodontal disease progression and tooth loss in relation to fiber sources, stratified according to age younger than 65 versus 65 and older, and controlled for smoking, body mass index, calculus, baseline periodontal disease level, caries, education, exercise, carotene, thiamin and caffeine intake, and tooth brushing.
In men aged 65 and older, each serving of good to excellent sources of total fiber was associated with lower risk of ABL progression (HR = 0.76, 95% CI = 0.60-0.95) and tooth loss (HR = 0.72, 95% CI = 0.53-0.97). Of the different food groups, only fruits that were good to excellent sources of fiber were associated with lower risk of progression of ABL (HR = 0.86 per serving, 95% CI = 0.78-0.95), PPD (HR = 0.95, 95% CI = 0.91-0.99), and tooth loss (HR = 0.88, 95% CI = 0.78-0.99). No significant associations were seen in men younger than 65.
Benefits of higher intake of high-fiber foods, especially fruits, on slowing periodontal disease progression are most evident in men aged 65 and older.
Journal of the American Geriatrics Society 02/2012; 60(4):676-83. · 3.74 Impact Factor
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ABSTRACT: To examine whether overweight and obesity indicators - body mass index (BMI), waist circumference (WC), and WC-to-height ratio - predict progression of periodontal disease in men.
Participants were 1038 medically healthy, non-Hispanic, white males in the VA Dental Longitudinal Study who were monitored with triennial oral and medical examinations between 1969 and 1996. Periodontal disease progression in an individual was defined as having two or more teeth advance to levels of alveolar bone loss ≥40%, probing pocket depth ≥5 mm, or clinical attachment loss ≥5 mm after baseline. Extended Cox regression analyses estimated hazards of experiencing periodontal disease progression events due to overweight/obesity status, controlling for age, smoking, education, diabetes, recent periodontal treatment, recent prophylaxis, and number of filled/decayed surfaces.
Body mass index and WC-to-height ratio were significantly associated with hazards of experiencing periodontal disease progression events regardless of periodontal disease indicator. Adjusted hazard ratios for periodontal disease progression were 41-72% higher in obese men (BMI ≥30 kg/m(2)) relative to men with both normal weight and WC-to-height ratio (≤50%).
Both overall obesity and central adiposity are associated with an increased hazards of periodontal disease progression events in men.
Journal Of Clinical Periodontology 12/2011; 39(2):107-14. · 3.00 Impact Factor
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ABSTRACT: To develop a brief measure of oral health-related quality of life (OHQL) in children and demonstrate its reliability and validity in a diverse population.
We administered the initial 20-item Pediatric Oral Health-Related Quality of Life (POQL) to children (Child Self-Report) and parents (Parent Report on Child) from diverse populations in both school-based and clinic-based settings. Clinical oral health status was measured on a subset of children. We used factor analysis to determine the underlying scales and then reduced the measure to 10 items based on several considerations. Multitrait analysis on the resulting 10-item POQL was used to reaffirm the discrimination of scales and assess the measure's internal consistency and interscale correlations. We established discriminant and convergent validity with clinical status, perceived oral health and responses on the PedsQL, and determined sensitivity to change with children undergoing ECC surgical repair.
Factor analysis returned a four-scale solution for the initial items--Physical Functioning, Role Functioning, Social Functioning, and Emotional Functioning. The reduced items represented the same four scales--two each on Physical and Role and three each on Social and Emotional. Good reliability and validity were shown for the POQL as a whole and for each of the scales.
The POQL is a valid and reliable measure of OHQL for use in preschool and school-aged children, with high utility for both clinical assessments and large-scale population studies.
Journal of Public Health Dentistry 01/2011; 71(3):185-93. · 1.19 Impact Factor
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ABSTRACT: Salivary lysozyme (SLZ) is a proteolytic enzyme secreted by oral leucocytes and contains a domain that has an affinity to advanced glycation end products (AGE). Thus, we hypothesized that SLZ would be associated with metabolic syndrome (metS), a pro-inflammatory state.
Utilizing cross-sectional data from 250 coronary artery disease (CAD) and 250 non-CAD patients, the association of SLZ with metS was tested by logistic regression analyses controlling for age, sex, smoking, total cholesterol and C-reactive protein (CRP) levels. The analyses were stratified by CAD status to control for the possible effects of CAD.
MetS was found in 122 persons. The adjusted odds ratio (OR) for metS associated with the highest quartile of SLZ was 1.95 with 95% confidence interval (CI) 1.20-3.12, p-value=0.007, compared with the lower three quartiles combined. Among the 40 subjects with metS but without CAD, the OR was 1.63 (CI: 0.64-4.15, p=0.31), whereas in the CAD group, SLZ was significantly associated with metS [OR=1.96 (1.09-3.52), p=0.02]. In both subgroups, CRP was not significantly associated with metS.
SLZ was significantly associated with metS (OR=1.95) independent of CRP level. Future longitudinal research is warranted.
Journal Of Clinical Periodontology 09/2010; 37(9):805-11. · 3.00 Impact Factor
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ABSTRACT: The elimination of oral health disparities in the US will require enhancing access to oral health care services. The workshop convened in 2009 by the Institute of Medicine on the "US Oral Health Workforce in the Coming Decade" highlighted both the current workforce's failure to meet the nation's needs as well as the promising opportunities presented by various workforce strategies to significantly enhance access and improve oral health outcomes. In this article, we have briefly reviewed and expanded on the contributions in this special issue of the Journal of Public Health Dentistry, with the goal of identifying common themes and providing a framework for evaluation. There are several key areas where change is critically needed in order to ensure successful implementation of any new workforce models. These areas include a) the public and private financing of dental care, b) the dental educational system, and c) state and federal policies.
Journal of Public Health Dentistry 06/2010; 70 Suppl 1:S58-65. · 1.19 Impact Factor
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ABSTRACT: To determine whether rates of tooth loss, periodontal disease progression, and caries incidence predict cognitive decline in men.
Prospective study.
Community-dwelling men enrolled in the Veterans Affairs Dental Longitudinal Study.
Five hundred ninety-seven dentate men aged 28 to 70 at study baseline who have been followed up to 32 years.
Oral examinations were conducted approximately every 3 years. Periodontal disease measures included probing pocket depth and radiographic alveolar bone height. Participants underwent cognitive testing beginning in 1993. Low cognitive status was defined as less than 25 points or less than 90% of the age- and education-specific median on the Mini-Mental State Examination (MMSE) and less than 10 points on a spatial copying task.
Each tooth lost per decade since the baseline dental examination increased the risks of low MMSE score (hazard ratio (HR)=1.09, 95% confidence interval (CI)=1.01-1.18) and low spatial copying score (HR=1.12, CI=1.05-1.18). Risks were greater per additional tooth with progression of alveolar bone loss (spatial copying: HR=1.03, CI=1.01-1.06), probing pocket depth (MMSE: HR=1.04, CI=1.01-1.09; spatial copying: HR=1.04, CI=1.01-1.06), and caries (spatial copying: HR=1.05, CI=1.01-1.08). Risks were consistently higher in men who were older than 45.5 at baseline than in younger men.
Risk of cognitive decline in older men increases as more teeth are lost. Periodontal disease and caries, major reasons for tooth loss, are also related to cognitive decline.
Journal of the American Geriatrics Society 04/2010; 58(4):713-8. · 3.74 Impact Factor
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ABSTRACT: OBJECTIVES: To determine whether rates of tooth loss, periodontal disease progression, and caries incidence predict cognitive decline in men.DESIGN: Prospective study.SETTING: Community-dwelling men enrolled in the Veterans Affairs Dental Longitudinal Study.PARTICIPANTS: Five hundred ninety-seven dentate men aged 28 to 70 at study baseline who have been followed up to 32 years.MEASUREMENTS: Oral examinations were conducted approximately every 3 years. Periodontal disease measures included probing pocket depth and radiographic alveolar bone height. Participants underwent cognitive testing beginning in 1993. Low cognitive status was defined as less than 25 points or less than 90% of the age- and education-specific median on the Mini-Mental State Examination (MMSE) and less than 10 points on a spatial copying task.RESULTS: Each tooth lost per decade since the baseline dental examination increased the risks of low MMSE score (hazard ratio (HR)=1.09, 95% confidence interval (CI)=1.01–1.18) and low spatial copying score (HR=1.12, CI=1.05–1.18). Risks were greater per additional tooth with progression of alveolar bone loss (spatial copying: HR=1.03, CI=1.01–1.06), probing pocket depth (MMSE: HR=1.04, CI=1.01–1.09; spatial copying: HR=1.04, CI=1.01–1.06), and caries (spatial copying: HR=1.05, CI=1.01–1.08). Risks were consistently higher in men who were older than 45.5 at baseline than in younger men.CONCLUSION: Risk of cognitive decline in older men increases as more teeth are lost. Periodontal disease and caries, major reasons for tooth loss, are also related to cognitive decline.
Journal of the American Geriatrics Society 03/2010; 58(4):713 - 718. · 3.74 Impact Factor
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Raul I Garcia
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ABSTRACT: A cross-sectional study was conducted.
A random sample of women was used from the participants in a Prospective Population Study of women in Gothenburg that had been initiated in 1968.
Dental examinations were conducted by dentists and included panoramic radiography; a clinical inspection of the teeth, gums and oral mucosa; colour photography of the dentition, and a questionnaire. Myocardial infarction was diagnosed if at least two of the following criteria were present: 1) central chest pain >30 min; 2) transient rise of transaminase activities; and 3) typical electrocardiogram changes of recent onset. Angina pectoris was diagnosed using a questionnaire. The other independent variables were obtained from the medical part of the study and constituted other well-known risk factors for IHD.
Among the dentate women in this study (N = 847), 74 had ischemic heart disease (IHD) and 773 did not. There was no statistically significant difference between numbers of pathological gingival pockets between these groups (58.1% had one or more pathological pockets in the IHD group versus 57.6% in the non-IHD group). Bivariate analysis of dentate individuals showed significant associations between IHD and number of missing teeth, age, body mass index, waist/ hip ratio, life satisfaction, hypertension, and levels of cholesterol and triglycerides. In the final multivariate logistic regression model, however, with the exception of age, only number of teeth [B17 teeth; odds ratio, 2.13; 95% confidence interval (CI), 1.20-3.77] was found to be significantly associated with IHD. Moreover, edentulous women had an odds ratio of 1.94 (95% CI, 1.05-3.60) in relation to IHD (age-adjusted model).
In the present study, periodontitis did not seem to have a statistically significant relationship with IHD. The number of missing teeth showed a strong association with IHD, and this may act as a proxy variable tapping an array of different risk factors and behaviours.
Evidence-based dentistry 01/2010; 11(1):20-1.
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ABSTRACT: To identify associations between periodontitis and incidence of cerebrovascular disease.
We analyzed data of 1,137 dentate men in the Veterans Affairs Normative Aging and Dental Longitudinal Study who were followed with triennial medical/dental exams for up to 34 years (mean, 24 years). We evaluated incidence of cerebrovascular events consistent with stroke or transient ischemic attack in relation to mean radiographic alveolar bone loss (a measure of periodontitis history) and cumulative periodontal probing depth (a measure of current periodontal inflammation). Cox proportional hazards models were fit controlling for age, baseline socioeconomic status, and time-varying effects of established cardiovascular risk factors.
Eighty incident cases of cerebrovascular disease occurred from 27,506 person-years. Periodontal bone loss was significantly associated with an increased hazard rate (HR) of cerebrovascular disease (HR, 3.52; 95% confidence interval [CI], 1.59-7.81 comparing highest to lowest bone loss category; p for trend, <0.001). There was a stronger effect among men aged <65 years (HR, 5.81; 95% CI, 1.63-20.7) as compared with men aged > or =65 years (HR, 2.39; 95% CI, 0.91-6.25). Periodontal probing depth was not associated with a significantly increased rate of cerebrovascular disease in the combined or age-stratified analyses.
These results support an association between history of periodontitis-but not current periodontal inflammation-and incidence of cerebrovascular disease in men, independent of established cardiovascular risk factors, particularly among men aged <65 years.
Annals of Neurology 10/2009; 66(4):505-12. · 11.09 Impact Factor
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Periodontology 2000 02/2009; 50:65-77. · 3.96 Impact Factor
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ABSTRACT: The authors evaluated racial/ethnic differences and their socioeconomic determinants in the oral health status of U.S. children, as reported by parents.
The authors used interview data from the 2003 National Survey of Children's Health, a large representative survey of U.S. children. They calculated weighted, nationally representative prevalence estimates for non-Hispanic whites, non-Hispanic blacks and Hispanics, and they used logistic regression to explore the association between parents' reports of fair or poor oral health and various socioeconomic determinants of oral health.
The results showed significant racial/ethnic differences in parental reports of fair or poor oral health, with prevalences of 6.5 percent for non-Hispanic whites, 12.0 percent for non-Hispanic blacks and 23.4 percent for Hispanics. Although adjustments for family socioeconomic status (poverty level and education) partially explained these racial/ethnic disparities, Hispanics still were twice as likely as non-Hispanic whites to report their children's oral health as fair or poor, independent of socioeconomic status. The authors did find differences in preventive-care attitudes among groups. However, in multivariate models, such differences did not explain the disparities.
Significant racial/ethnic disparities exist in parental reports of their children's oral health, with Hispanics being the most disadvantaged group. Disparities appear to exist independent of preventive-care attitudes and socioeconomic status.
Journal of the American Dental Association (1939) 12/2008; 139(11):1507-17. · 1.77 Impact Factor
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Raul I Garcia
The journal of evidence-based dental practice 07/2008; 8(2):78-80.
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ABSTRACT: Demographic changes over the coming decades will heighten the challenges to both the dental profession and the nation. The expected growth in the numbers of racial and ethnic minorities and the concomitant growth of immigrant populations are likely to lead to worsening of oral health disparities. Their consequences are becoming increasingly evident, as the profession strives to improve the oral health of all Americans. The increasing diversity of the population, together with the importance of cultural beliefs and behaviors that affect health outcomes, will require ways to enhance provider-patient communications and oral health literacy. One important means by which to promote oral health in diverse populations is to develop a dental workforce that is both culturally and linguistically competent, as well as one that is as culturally diverse as the American population.
Dental Clinics of North America 05/2008; 52(2):319-32, vi.
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ABSTRACT: Several epidemiological studies have suggested periodontitis as a risk factor for coronary heart disease (CHD), but results have been inconsistent.
We evaluated the association between clinical and radiographic measures of periodontitis, edentulism, and incident CHD (angina, myocardial infarction, or fatal CHD) among 1203 men in the VA Normative Aging and Dental Longitudinal Studies who were followed up with triennial comprehensive medical and dental examinations up to 35 years (median 24 years). Cox proportional hazards models with time-varying effects of exposure and potential confounders were fit. We found a significant dose-dependent association between periodontitis and CHD incidence among men < 60 years of age (hazard ratio 2.12, 95% confidence interval 1.26 to 3.60 comparing highest versus lowest category of radiographic bone loss, P for trend=0.02), independent of age, body mass index, smoking, alcohol intake, diabetes mellitus, fasting glucose, total cholesterol, high-density lipoprotein cholesterol, triglycerides, hypertension, systolic and diastolic blood pressure, education, marital status, income, and occupation. No association was found among men > 60 years of age. Similar results were found when the sum of probing pocket depths was used as a measure of periodontitis. Among men > or = 60 years of age, edentulous men tended to have a higher risk of CHD than dentate men in the lowest bone loss (hazard ratio 1.61, 95% confidence interval 0.95 to 2.73) and lowest pocket depth (hazard ratio 1.72, 95% confidence interval 1.03 to 2.85) categories, independent of confounders.
Chronic periodontitis is associated with incidence of CHD among younger men, independent of established cardiovascular risk factors.
Circulation 05/2008; 117(13):1668-74. · 14.74 Impact Factor
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Raul I Garcia
The journal of evidence-based dental practice 04/2008; 8(1):13-4.
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ABSTRACT: The purpose of the present longitudinal study was to evaluate the association between root proximity and the risk for alveolar bone loss (ABL).
We used data from the Veterans Affairs Dental Longitudinal Study, a closed-panel longitudinal cohort study of 1,231 men enrolled in 1968 with triennial follow-up examinations. Periapical radiographs of mandibular incisors from subjects with > or =10 years of follow-up were selected. Interradicular distance (IRD) at the cemento-enamel junction and alveolar bone levels at baseline and last follow-up were measured using digitized radiographs. The rate of progressive ABL was determined and expressed as millimeters per 10 years. Site-specific multivariate regression models were fit to evaluate the association between IRD and ABL rate, adjusting for age and smoking. Empirical standard errors and generalized estimating equations were used to account for the correlation among sites within subjects.
There were 473 dentate subjects, aged 28 to 71 years at baseline, with > or =10 years of follow-up data available for analyses. The mean follow-up time was 23 years. The mean IRD was 1.0 +/- 0.3 mm, and the mean ABL rate during 10 years was 0.61 +/- 0.59 mm. There was a significant non-linear association between IRD and ABL rate (P <0.005). Compared to sites with IRD > or =0.8 mm, sites with IRD <0.6 mm were 28% (95% confidence interval [CI]: 11% to 48%) more likely to lose > or =0.5 mm of bone during 10 years (relative risk: 1.28 [95% CI: 1.11 to 1.48]) and 56% (95% CI: 11% to 117%) more likely to lose > or =1.0 mm of bone during 10 years (relative risk: 1.56 [95% CI: 1.11 to 2.17]).
IRD <0.8 mm is a significant local risk factor for alveolar bone loss in mandibular anterior teeth. Measurement of IRD may have important prognostic value in making treatment decisions.
Journal of Periodontology 04/2008; 79(4):654-9. · 2.60 Impact Factor
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ABSTRACT: The authors report adverse events (AEs) related to the use of chlorhexidine gluconate mouthrinse in a clinical trial of the efficacy of periodontal treatment in older adults with diabetes.
Participants were U.S. veterans with uncontrolled diabetes (hemoglobin A(1c) value > or =8.5 percent) and periodontal disease. Treatment included periodontal scaling, 0.12 percent chlorhexidine lavage during ultrasonic scaling and use of chlorhexidine mouthrinse at home.
Forty-four (31 percent) of 140 subjects reported having AEs. Most common were taste changes and tooth staining, sore mouth and/or throat, tongue irritation and wheezing/shortness of breath; the latter was reported more commonly before chlorhexidine use than after. Only body mass index greater than 30 was significantly related to AEs.
AEs are common among subjects using chlorhexidine mouthrinse. Most AEs (taste change and staining) were resolved easily by subjects' discontinuing mouthrinse use and receiving dental prophylaxis. No serious AEs were reported.
Clinicians should advise patients using chlorhexidine mouthrinse of possible side effects. If necessary, patients should discontinue mouthrinse use and obtain medical care. Careful monitoring of AEs in patients using chlorhexidine is warranted.
Journal of the American Dental Association (1939) 02/2008; 139(2):178-83. · 1.77 Impact Factor
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ABSTRACT: Previous studies have shown dose-dependent and time-dependent effects of cigarette smoking and smoking cessation on C-reactive protein (CRP) concentrations in men, but results were inconsistent for women. The aim of this study was to evaluate the dose-dependent and time-dependent association of smoking and smoking cessation with CRP concentrations in men and women using a novel comprehensive smoking index (CSI).
Cross-sectional study of representative US survey data (National Health and Nutrition Examination Survey 1999-2002).
The CSI simultaneously accounts for intensity, duration and time since cessation of smoking. We analyzed data of 3505 men and 3896 women using sex-specific multiple linear regression models adjusting for other determinants of CRP concentrations, including age, race/ethnicity, body mass index, alcohol intake, diabetes, physical activity, oral hormone use among women, and history of coronary heart disease, stroke, chronic obstructive pulmonary disease and arthritis.
A positive association of similar strength was found between smoking and CRP concentrations in both men and women who did not use exogenous oral hormones. Among women who used exogenous oral hormones, no association with smoking was found. In older men and women it took several years after smoking cessation for CRP concentrations to return to that of individuals who never smoked.
Smoking is associated with dose-dependent and time-dependent increases in CRP concentrations in both men and women. Furthermore, the effect of exogenous oral hormones on CRP concentrations in women is affected by smoking in a dose-dependent fashion.
European Journal of Cardiovascular Prevention and Rehabilitation 11/2007; 14(5):694-700. · 2.63 Impact Factor
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ABSTRACT: We are conducting a clinical trial of the efficacy of periodontal therapy in the improvement of glycaemic control in veterans with poorly controlled diabetes. This report describes study design, recruitment and randomization and compares baseline characteristics of the sample frame with those randomized into study groups.
Veterans with poorly controlled diabetes were randomized in two groups: immediate periodontal therapy ("early treatment") or usual care followed by periodontal therapy ("deferred treatment"). Half of each group continued care for 12 months; the other half returned to their usual care. We studied baseline patient characteristics, self-reported health measures, and clinical examination data. We examined means for continuous variables, frequencies for categorical variables and compared groups using t-tests and chi(2) tests (alpha=0.05 for both).
The 193 randomized participants were younger (58 years) and had slightly higher HbA1c (10.2%) than the 2534 non-randomized participants (64 years, HbA1c =9.8%). The deferred treatment group was more likely than the early treatment group to have a history of stroke, transient ischaemic attacks, and less likely to be current or former smokers.
The mechanism for randomization was largely successful in this study.
Journal Of Clinical Periodontology 02/2007; 34(1):40-5. · 3.00 Impact Factor
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ABSTRACT: Report results of a randomized-clinical trial of the efficacy of periodontal care in the improvement of glycemic control in 165 veterans with poorly controlled diabetes over 4 months.
Outcomes were change in Haemoglobin A1c (HbA1c) in the Early Treatment versus untreated (Usual Care) groups and percent of participants with decreases in HbA1c. Analyses included simple/multiple variable linear/logistic regressions, adjusted for baseline HbA1c, age, and duration of diabetes.
Unadjusted analyses showed no differences between groups. After adjustment for baseline HbA1c, age, and diabetes duration, the mean absolute HbA1c change in the Early Treatment group was -0.65% versus -0.51% in the Usual Care group (p=0.47). Adjusted odds for improvement by 0.5% in the Early Treatment group was 1.67 (95% confidence interval: 0.84, 3.34, p=0.14). Usual Care subjects were twice as likely to increase insulin from baseline to 4 months (20% versus 11%, p=0.12) and less likely to decrease insulin (1% versus 6%, p=0.21) than Early Treatment subjects. Among insulin users at baseline, more increased insulin in the Usual Care group (40% versus 21%, p=0.06).
No significant benefit was found for periodontal therapy after 4 months in this study; trends in some results were in favour of periodontal treatment.
Journal Of Clinical Periodontology 02/2007; 34(1):46-52. · 3.00 Impact Factor
