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Periodontal disease, tooth loss and incident rheumatoid arthritis: results from the First National Health and Nutrition Examination Survey and its epidemiological follow‐up study
Author(s) -
Demmer Ryan T.,
Molitor Jerry A.,
Jacobs David R.,
Michalowicz Bryan S.
Publication year - 2011
Publication title -
journal of clinical periodontology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.456
H-Index - 151
eISSN - 1600-051X
pISSN - 0303-6979
DOI - 10.1111/j.1600-051x.2011.01776.x
Subject(s) - medicine , gingivitis , national health and nutrition examination survey , periodontitis , rheumatoid arthritis , tooth loss , epidemiology , odds ratio , rheumatoid factor , clinical attachment loss , arthritis , risk factor , dentistry , population , oral health , environmental health
Aims Infection may be a rheumatoid arthritis ( RA ) risk factor. We examined whether signs of periodontal infection were associated with RA development in the First National Health and Nutrition Examination Survey and its epidemiological follow‐up study. Material and Methods In 1971–1974, 9702 men and women aged 25–74 were enrolled and surveyed longitudinally (1982, 1986, 1987, 1992). Periodontal infection was defined by baseline tooth loss or clinical evidence of periodontal disease. Baseline ( n = 138) and incident ( n = 433) RA cases were defined via self‐report physician diagnosis, joint pain/swelling, ICD ‐9 codes (714.0–714.9), death certificates and/or RA hospitalization. Results Adjusted odds ratios ( OR s) (95% CI ) for prevalent RA in gingivitis and periodontitis ( versus healthy) were 1.09 (0.57, 2.10) and 1.85 (0.95, 3.63); incident RA OR s were 1.32 (0.85, 2.06) and 1.00 (0.68, 1.48). The OR s for prevalent RA among participants missing 5–8, 9–14, 15–31 or 32 teeth ( versus 0–4 teeth) were 1.74 (1.03, 2.95), 1.82 (0.81, 4.10), 1.45 (0.62, 3.41) and 1.30 (0.48, 3.53); OR s for incident RA were 1.12 (0.77, 1.64), 1.67 (1.12, 2.48), 1.40 (0.85, 2.33) and 1.22 (0.75, 2.00). Dose‐responsiveness was enhanced among never smokers. The rate of death or loss‐to‐follow‐up after 1982 was two‐ to fourfold higher among participants with periodontitis or missing ≥9 teeth ( versus healthy participants). Conclusions Although participants with periodontal disease or ≥5 missing teeth experienced higher odds of prevalent/incident RA , most OR s were non‐statistically significant and lacked dose‐responsiveness. Differential RA ascertainment bias complicated the interpretation of these data.