Airway resistance improves after periodontal treatment
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Key takeaways:
- Oral bacteria may spread to the lungs, impacting respiratory health.
- Periodontal treatment included a cleaning and 2 weeks of chlorhexidine therapy.
- There were no improvements in spirometry measurements.
The next time you have patients who struggle with airway resistance, you may want to refer them to your local periodontist for a deep cleaning, according to a poster presented at the European Respiratory Society International Congress.
“The concept of the ‘oral-lung axis’ has gained more attention in recent decades, linking oral health to respiratory health,” Anders Røsland, a PhD candidate in the department of clinical dentistry at the University of Bergen in Norway, told Healio.
The oral-lung axis
Oral bacteria can migrate from the mouth to the lungs, potentially triggering or worsening respiratory conditions, Røsland said.
“In diseases like periodontitis, we know that the abundance of pathogens is significantly higher compared to healthy individuals,” he said.
The current evidence linking periodontitis to respiratory disorders is largely epidemiological, although a few interventional studies primarily focus on patients with COPD, he continued.
“These intervention studies have demonstrated beneficial effects, including improved lung function and reduced exacerbation rates following periodontal interventions,” Røsland said.
In the current trial, the researchers investigated the effect of improved oral health through periodontal therapy in otherwise healthy individuals.
“This would help us understand the potentially causal and preventative role of proper oral care in respiratory health, as no previous studies have explored this relationship in nonsmoking subjects without pre-existing respiratory conditions,” Røsland said.
Time for a cleaning
The study included 62 patients (mean age, 35.8 years; 63% female) with periodontitis (stage 1, 21%; stage 2, 79%) who did not smoke and who were otherwise healthy.
“Periodontitis is a chronic inflammatory disease of infectious origin that affects the tissues surrounding the teeth,” Røsland said.
Periodontitis is characterized by the progressive loss of connective tissue and bone that primarily is caused by chronic inflammation that is triggered by the persistent presence of pathogenic bacteria in dental biofilms.
“These bacteria accumulate in periodontal pockets, leading to the activation of the body’s immune response, which leads to breakdown of the supporting structures of the teeth —and in the final stage, tooth loss,” Røsland said.
The researchers conducted a periodontal examination on each patient, which included a thorough medical history to assess whether any comorbidities may affect the patient’s periodontal health.
“The clinical examination includes evaluating the depth of periodontal pockets, the level of inflammation in the gums (bleeding upon probing) and the level of the oral hygiene measured by a plaque score,” Røsland said. “Additionally, radiographic imaging is taken to assess the extent of bone loss.”
Periodontal therapy, which each patient also received, included education about oral hygiene practices and a full-mouth disinfection protocol to reduce gingival inflammation and bacterial load in the mouth to control periodontitis progression. The stepwise approach followed European Federation of Periodontology guidelines.
“The process begins with informing the patient about their diagnosis and creating an individualized treatment plan,” Røsland said.
Education about proper oral hygiene techniques then follows, including brushing, flossing and the use of interdental brushes to maintain plaque control at home.
“This helps manage plaque buildup, a major contributor to periodontal disease,” Røsland said. “Patients are provided with a comprehensive kit of oral hygiene agents to help them maintain oral hygiene.”
Immediately, patients then received a deep cleaning, which involved the mechanical removal of biofilm from the teeth both above and below the gumline.
“This includes eliminating plaque, calculus and bacterial toxins from tooth surfaces and periodontal pockets,” Røsland said. “Additionally, root planing smooths the root surfaces to prevent bacteria from accumulating, promoting gum reattachment to the teeth and reducing pocket depth.”
Patients then followed a 2-week regimen of 0.2% chlorhexidine mouthwash and a 1% chlorhexidine gel.
Study results
The researchers measured lung function via spirometry and oscillometry at baseline and at 3 and 6 weeks. Periodontal health was assessed again at 6 weeks as well, and the researchers reported improvements in all periodontal parameters.
There were no improvements in spirometric measurements, including FEV1, forced vital capacity (FVC) or the FEV1/FVC ratio.
However, airway resistance fell by 4.7% from 3 cm H2O/L/s to 2.86 H2O/L/s (P = .003) at 11 Hz and by 5.4% from 2.78 H2O/L/s to 2.63 H2O/L/s (P = .002) at 19 Hz. Airway resistance also fell 3.4% from 3.22 H2O/L/s to 3.11 H2O/L/s at 5 Hz, but the researchers did not consider it to be statistically significant.
“Almost half of the patients showed improved airway resistance,” Røsland said. “A reduction in airway resistance suggests that patients experienced less obstruction in their small airways, leading to easier breathing.”
Noting that these improvements were observed within just 6 weeks, Røsland said that it will be important to assess airway resistance over a longer period.
Next steps
Lung diseases such as asthma and COPD can be managed but not cured, Røsland said, which makes prevention crucial.
“By establishing a connection between periodontal disease and lung health, we believe there is a strong rationale for implementing an oral hygiene program that improves both oral and respiratory health,” Røsland said.
Existing evidence indicates that physicians should refer patients with lung disorders, or those at risk, for oral and periodontal health examinations, he continued.
“We believe that this approach, with collaborative efforts among health care providers, could contribute to preventing respiratory diseases and other conditions associated with poor oral health,” Røsland said.
Next, he continued, researchers should conduct large-scale, long-term randomized clinical trials to strengthen the existing evidence.
“Furthermore, detailed characterization of the oral microbiome, focusing on specific bacterial compositions and functional genes that potentially could predict respiratory outcomes, would be of importance in developing patient-tailored treatment plans,” he said.
“Additionally, assessing systemic inflammatory markers in these patients would be of interest, as both periodontitis and respiratory disorders are associated with systemic inflammation,” he said.
For more information:
Anders Røsland can be reached at anders.rosland@uib.no.
Perspective
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Bruce V. Freeman, DDS, DOrtho, MSc
Anything inflammatory creates a systemic or bodily reaction, so reducing inflammation is critical, as is reducing oral bacteria. COVID-19 and similar diseases hit people with respiratory issues more severely. Also, there is already documentation that reducing oral bacteria is beneficial for patients with cardiac issues and diabetes, and it has a significantly positive impact on patients with cognitive decline as well. Before major surgeries and cancer treatments, patients additionally must have dental cleanings and be cleared of oral disease. So, dentistry truly is a sub-specialty of medicine, and management of respiratory patients should emphasize good oral hygiene. Of course, more randomized controlled trials are necessary to further our understanding of the connection.
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Røsland A, et al. Poster 734. Presented at: European Respiratory Society International Congress; Sept. 7-11, 2024; Vienna.
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