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Advanced Dental Cleaning is Associated with Reduced Risk of COPD Exacerbations – A Randomized Controlled Trial
PURPOSE: Infections from the oral microbiome may lead to exacerbations of chronic obstructive pulmonary disease (COPD). We investigated whether advanced dental cleaning could reduce exacerbation frequency. Secondary outcomes were disease-specific health status, lung function, and whether the bacteri...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Dove
2021
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8629912/ https://www.ncbi.nlm.nih.gov/pubmed/34858021 http://dx.doi.org/10.2147/COPD.S327036 |
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author | Sundh, Josefin Tanash, Hanan Arian, Rahi Neves-Guimaraes, Alessandra Broberg, Katrin Lindved, Gustav Kern, Timo Zych, Konrad Nielsen, Henrik Bjørn Halling, Anders Ohlsson, Bodil Jönsson, Daniel |
author_facet | Sundh, Josefin Tanash, Hanan Arian, Rahi Neves-Guimaraes, Alessandra Broberg, Katrin Lindved, Gustav Kern, Timo Zych, Konrad Nielsen, Henrik Bjørn Halling, Anders Ohlsson, Bodil Jönsson, Daniel |
author_sort | Sundh, Josefin |
collection | PubMed |
description | PURPOSE: Infections from the oral microbiome may lead to exacerbations of chronic obstructive pulmonary disease (COPD). We investigated whether advanced dental cleaning could reduce exacerbation frequency. Secondary outcomes were disease-specific health status, lung function, and whether the bacterial load and composition of plaque microbiome at baseline were associated with a difference in outcomes. PATIENTS AND METHODS: One-hundred-one primary and secondary care patients with COPD were randomized to intervention with advanced dental cleaning or to dental examination only, repeated after six months. At baseline and at 12 months, data of exacerbations, lung function, COPD Assessment Test (CAT) score, and periodontal status were collected from questionnaires, record review, and periodontal examination. Student’s t-test and Mann–Whitney-U (MWU) test compared changes in outcomes. The primary outcome variable was also assessed using multivariable linear regression with adjustment for potential confounders. Microbiome analyses of plaque samples taken at baseline were performed using Wilcoxon signed ranks tests for calculation of alpha diversity, per mutational multivariate analysis of variance for beta diversity, and receiver operating characteristic curves for prediction of outcomes based on machine learning models. RESULTS: In the MWU test, the annual exacerbation frequency was significantly reduced in patients previously experiencing frequent exacerbations (p = 0.020) and in those with repeated advanced dental cleaning (p = 0.039) compared with the non-treated control group, but not in the total population including both patients with a single and repeated visits (p = 0.207). The result was confirmed in multivariable linear regression, where the risk of new exacerbations was significantly lower in patients both in the intention to treat analysis (regression coefficient 0.36 (95% CI 0.25–0.52), p < 0.0001) and in the population with repeated dental cleaning (0.16 (0.10–0.27), p < 0.0001). The composition of microbiome at baseline was moderately predictive of an increased risk of worsened health status at 12 months (AUC = 0.723). CONCLUSION: Advanced dental cleaning is associated with a reduced frequency of COPD exacerbations. Regular periodontal examination and dental cleaning may be of clinical importance to prevent COPD exacerbations. |
format | Online Article Text |
id | pubmed-8629912 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Dove |
record_format | MEDLINE/PubMed |
spelling | pubmed-86299122021-12-01 Advanced Dental Cleaning is Associated with Reduced Risk of COPD Exacerbations – A Randomized Controlled Trial Sundh, Josefin Tanash, Hanan Arian, Rahi Neves-Guimaraes, Alessandra Broberg, Katrin Lindved, Gustav Kern, Timo Zych, Konrad Nielsen, Henrik Bjørn Halling, Anders Ohlsson, Bodil Jönsson, Daniel Int J Chron Obstruct Pulmon Dis Original Research PURPOSE: Infections from the oral microbiome may lead to exacerbations of chronic obstructive pulmonary disease (COPD). We investigated whether advanced dental cleaning could reduce exacerbation frequency. Secondary outcomes were disease-specific health status, lung function, and whether the bacterial load and composition of plaque microbiome at baseline were associated with a difference in outcomes. PATIENTS AND METHODS: One-hundred-one primary and secondary care patients with COPD were randomized to intervention with advanced dental cleaning or to dental examination only, repeated after six months. At baseline and at 12 months, data of exacerbations, lung function, COPD Assessment Test (CAT) score, and periodontal status were collected from questionnaires, record review, and periodontal examination. Student’s t-test and Mann–Whitney-U (MWU) test compared changes in outcomes. The primary outcome variable was also assessed using multivariable linear regression with adjustment for potential confounders. Microbiome analyses of plaque samples taken at baseline were performed using Wilcoxon signed ranks tests for calculation of alpha diversity, per mutational multivariate analysis of variance for beta diversity, and receiver operating characteristic curves for prediction of outcomes based on machine learning models. RESULTS: In the MWU test, the annual exacerbation frequency was significantly reduced in patients previously experiencing frequent exacerbations (p = 0.020) and in those with repeated advanced dental cleaning (p = 0.039) compared with the non-treated control group, but not in the total population including both patients with a single and repeated visits (p = 0.207). The result was confirmed in multivariable linear regression, where the risk of new exacerbations was significantly lower in patients both in the intention to treat analysis (regression coefficient 0.36 (95% CI 0.25–0.52), p < 0.0001) and in the population with repeated dental cleaning (0.16 (0.10–0.27), p < 0.0001). The composition of microbiome at baseline was moderately predictive of an increased risk of worsened health status at 12 months (AUC = 0.723). CONCLUSION: Advanced dental cleaning is associated with a reduced frequency of COPD exacerbations. Regular periodontal examination and dental cleaning may be of clinical importance to prevent COPD exacerbations. Dove 2021-11-25 /pmc/articles/PMC8629912/ /pubmed/34858021 http://dx.doi.org/10.2147/COPD.S327036 Text en © 2021 Sundh et al. https://creativecommons.org/licenses/by-nc/3.0/This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/ (https://creativecommons.org/licenses/by-nc/3.0/) ). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). |
spellingShingle | Original Research Sundh, Josefin Tanash, Hanan Arian, Rahi Neves-Guimaraes, Alessandra Broberg, Katrin Lindved, Gustav Kern, Timo Zych, Konrad Nielsen, Henrik Bjørn Halling, Anders Ohlsson, Bodil Jönsson, Daniel Advanced Dental Cleaning is Associated with Reduced Risk of COPD Exacerbations – A Randomized Controlled Trial |
title | Advanced Dental Cleaning is Associated with Reduced Risk of COPD Exacerbations – A Randomized Controlled Trial |
title_full | Advanced Dental Cleaning is Associated with Reduced Risk of COPD Exacerbations – A Randomized Controlled Trial |
title_fullStr | Advanced Dental Cleaning is Associated with Reduced Risk of COPD Exacerbations – A Randomized Controlled Trial |
title_full_unstemmed | Advanced Dental Cleaning is Associated with Reduced Risk of COPD Exacerbations – A Randomized Controlled Trial |
title_short | Advanced Dental Cleaning is Associated with Reduced Risk of COPD Exacerbations – A Randomized Controlled Trial |
title_sort | advanced dental cleaning is associated with reduced risk of copd exacerbations – a randomized controlled trial |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8629912/ https://www.ncbi.nlm.nih.gov/pubmed/34858021 http://dx.doi.org/10.2147/COPD.S327036 |
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