Dental health in smokers with and without COPD

Abstract

The association between chronic obstructive pulmonary disease (COPD) and periodontal disease is sparsely studied. The aim was to describe the co-variation of periodontitis and lung function impairment in smokers. The hypothesis was that the destructive processes in the mouth and the lungs are interdependent due to a general individual susceptibility to detrimental effects of tobacco smoke. Smokers with COPD (n = 28) stage II and III according to GOLD guidelines and smokers without COPD (n = 29) and healthy non-smokers (n = 23) participated in the study. The groups of smokers were matched for cumulative exposure to tobacco smoke. Radiographic, general and dental clinical examination, lung function measurements and quality of life (SF-36) assessment were conducted. The relationship between respiratory and dental outcomes was analyzed. Dental health, assessed by plaque, gingival bleeding, periodontal pocket depth and loss of teeth was impaired in the smokers compared with non-smokers with no major differences between smokers with and without COPD. There was, however, a weak correlation between periodontitis and emphysema/impaired diffusion capacity. Impaired quality of life was associated with smoking and impaired lung function but not influenced by dental status. In conclusion periodontitis was strongly associated with smoking, weakly associated with lung tissue destruction and very weakly or even not at all associated with chronic airflow limitation. The results indicate that, although there was a co-variation between periodontitis and pathologic lung processes in smokers, the risk of developing COPD, as defined by spirometric outcomes, is not associated with the risk of impaired dental health in smokers.

Figure 1. Dental plaque, gingival bleeding, pocket depth and remaining teeth in 28 smokers with COPD, 29 smokers who did not fulfill the criteria for COPD, matched for smoking, and 23 healthy non-smokers.

Mean values and 95% confidence intervals. There is an overall difference between the groups for all outcomes (dental plaque p<0.01, gingival bleeding p<0.001, pocket depth p<0.0001, remaining teeth p<0.001). **and ***indicate p<0.01 and p<0.001, respectively compared with non-smokers. ^# indicates p<0.05 compared with smokers without COPD.

Figure 2. Quality of life assessed by the general quality of life instrument SF-36 in 28 smokers with COPD, 29 smokers with no airflow limitation and 23 healthy non-smokers.

PCS: physical component summary, MCS: mental component summary, PF: physical functioning, RP: role-physical, BP: bodily pain, GH: general health, VT: vitality, SF: social functioning, RE: role emotional, MH: mental health. Data are presented as mean values and 95% confidence intervals. *indicates p<0.001 compared with non-smokers. ^#indicates p<0.001 compared with smokers without COPD.