LOW-GRADE SYSTEMIC INFLAMMATION MAY INCREASE THE RISK OF PERIODONITIS

Subjects The study participants for this analysis belonged to a prospective cohort from northeast Germany, the Study of Health in Pomerainia. Data were collected from 1997 to 2001 for baseline measures and from 2008 to 2012 for follow-up. All participants were Caucasian, and 47% were male. The final sample size varied by the completeness of exposure and outcome information. The sample sizes for evaluating white blood cell (WBC) counts as the exposure in relation to probing depth (PD), clinical attachment loss (CAL), and the CDC/American Academy of Periodontology (AAP) case definition were 1784, 1697, and 1638, respectively. Likewise for fibrinogen level as the exposure, the sample sizes were 1764, 1680, and 1621, respectively. Key Risk/Study Factor The key risk factors in this study were systemic inflammatory markers, which were measured as WBC counts and fibrinogen. Both WBC and fibrinogen were collected from the nonfasting blood samples of the participants. Main Outcome Measure The main outcome measure was severity of periodontitis, which was assessed by PD, CAL, and the CDC/AAP case definition. PD and CAL were assessed at 4 sites pertooth. PD represents the distances from the gingival margin, and CAL represents the cementoenamel junction to the bottom of the periodontal pocket. Only teeth remaining atfollow-up were used during analysis. In the analysis, the variables were the mean values or PD and CAL and percentage of sites (extent) with PD or CAL 3 mm. The CDC/AAP case definition of periodontitis was a dichotomous measure: having at least 2 sites with PD 5 mm or CAL mm. An alternative measure for the CDC/AAP case definition was the number of missing teeth, excluding third molars, and the percentage of decayed and filled surfaces based on half-mouth assessments. Main Results In this study, inflammatory markers at baseline were positively related to measures of periodontitis over the 11-year follow-up period. In the fully adjusted models, a 1 g/L-higher fibrinogen level was associated with an increase of 0.08 mm (0.05-0.11 mm) in mean PD and 0.10 mm (0.05-0.15 mm) in mean CAL. Fora 1 Gpt/L higher WBC level, there was a mean increase of 0.01 mm (0.02-0.04 mm) in mean PD and 0.05 mm (0.03-0.08 mm) in CAL. Similarly, for the extent measure, a 1-unit higher fibrinogen level corresponded to an increase of approximately 3% in PD and CAL and 1% increase in PD and CAL for 1 unit higher in the WBC level. Fibrinogen and WBC were also positively associated with the CDC/AAP case definition but not with the number of missing teeth or percentage of decayed and filled surfaces. Conclusions The authors concluded that systemic inflammation at baseline predicted periodontal destruction and clinical periodontitis at follow-up in a prospective study.