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Periodontal disease and respiratory disease: A systematic review of the evidence

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ABSTRACT Objective: The purpose of this systematic review (SR) was to answer the focused research question: Is there an association between periodontal disease and pneumonia or chronic obstructive pulmonary disease (COPD)? Method: Databases and keywords searched included: Medline, PubMed, and the Cochrane Database of Systematic Reviews on combinations of lung disease, obstructive pneumonia, and periodontal disease. The literature searches were limited to 1997 to 2011; humans; and in English. Inclusion criteria were RCTs/clinical trials, SRs/meta analysis, and longitudinal, cohort, case control, multicenter and epidemiological studies for links between COPD or pneumonia and periodontal disease. Results and Discussion: 114 articles from databases, and 22 from hand searching were scrutinized for predetermined inclusion and exclusion criteria. Of these, 17 and 4 (n=21) respectively met the criteria, were analyzed and scored independently by each reviewer to extract evidence: 1) seven well designed studies and 3 systematic reviews provided fair evidence of an association between periodontal disease and pneumonia; 2) two small scale studies, at lower levels of quality of evidence, indicated conflicting results; 3) five well designed longitudinal or matched case control studies provided fair evidence of an association between periodontal disease and COPD; 4) four large scale, retrospective studies also supported this association. Conclusion: A causal association between respiratory diseases (pneumonia or COPD) and periodontal diseases remains conjectural. The conclusions reached based on this SR indicate there is fair evidence—Grade B, Level II-2—supporting: 1) an association of pneumonia and periodontal disease concurring with previous reviews; 2) an association between COPD and periodontal disease.
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... Examples of these issues are impacts on people's eating and swallowing abilities, diet type and speech. 1 Association between poor oral health and adverse medical outcomes such as aspiration pneumonia and cardiovascular disease have also been suggested. [2][3][4][5] Despite the recognition of oral hygiene as an important part of nursing care, 6,7 dependent frail elderly in hospitals and long-term care facilities are at risk of having poor oral health. [8][9][10] Reasons include limited access to dentists/ oral hygienists and variability in oral care knowledge and practice among nurses and care staff. ...
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... Host defense capabilities are destroyed by hydrolytic enzymes associated with oral disease and cytokines. 11 Recent research also suggests that poor dental health may have an association with Alzheimer's disease. 10 Lipopolysaccharide, a component of P gingivalis, was found in 4 of 10 brain samples with Alzheimer's disease. ...
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