The relationship between oral health and COPD exacerbations

Abstract

Introduction: Poor oral health has been implicated as an independent risk factor for the development of COPD, but few studies have evaluated the association between oral health and COPD exacerbations. We aimed to determine if poor oral health is associated with COPD exacerbations and/or worse respiratory health.

Methods: We performed a case-control study of oral health among COPD exacerbators and non-exacerbators. Cases (exacerbators) had experienced ≥1 exacerbation in the previous 12 months, while controls (non-exacerbators) had no exacerbations in the previous 24 months. We excluded those with <4 teeth. We evaluated the global oral health assessment, Oral Health Impact Profile (OHIP-5), dental symptoms/habits, and St. George’s Respiratory Questionnaire (SGRQ). In a subset, we performed blinded dental exams to measure bleeding on probing, probing depth, clinical attachment loss, periodontitis severity, plaque index, gingival index, and carries risk. We evaluated associations between oral health and COPD exacerbations using logistic regression. Linear regression was used to assess relationships between oral health and SGRQ scores.

Results: Screened non-exacerbators (n=118) were significantly more likely to have <4 teeth, compared to screened exacerbators (n=100) (44% vs 30%, respectively; p=0.046). After excluding those with <4 teeth, there were 70 cases and 66 controls. Self-reported oral health and objective dental exam measures did not vary significantly between cases vs controls. However, the odds of severe COPD exacerbations requiring hospitalizations and/or emergency department visits trended higher in those with worse dental exam compared to those with better dental exam. Worse OHIP-5 was strongly associated with worse SGRQ scores.

Conclusions: Oral health status was not related to COPD exacerbations, but was associated with self-reported respiratory health. Non-exacerbators were more likely to be edentate or have ≤4 teeth compared to exacerbators. Larger studies are needed to address oral health as a potential method to improve respiratory health in patients with COPD.

Keywords:

• pulmonary disease
• chronic obstructive
• oral health
• periodontitis

Acknowledgments

Disclaimer: the views expressed in this article are those of the authors and do not reflect the views of the United States Government, the Department of Veterans Affairs, the funders, the sponsors, or any of the author’s affiliated academic institutions. 

This research was supported by the National Heart, Lung and Blood Institute (NHLBI) grant T32 HL007741-23 (AKB), Flight Attendant Medical Research Institute (CHW), and Veterans Affairs Career Development Award 1IK2CX001095 (AAP). This material is also the result of work supported with resources of the Minneapolis VA Health Care System.

A version of this manuscript’s abstract was published and presented as a poster discussion at the American Thoracic Society in San Diego, CA, USA, in May 2018, and the Aspen Lung Conference in Aspen, CO, USA, in June 2018 (https://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2018.197.1_MeetingAbstracts.A2754).

Disclosure

KMK has received consulting fees from GlaxoSmithKline outside of this submitted work and reports no conflicts of interest in this work. All of the other authors report that they have no affiliations with or involvement in any organization or entity with any financial or non-financial interest in the subject matter or materials discussed in this manuscript, and have no conflicts of interest in this work.

Supplementary materials

Table S1 Oral health questionnaire

Table S2 Periodontitis severity based on probing depth (PD) and clinical attachment loss (CAL)