Gum bleeding raises odds for asthma symptoms, COPD 10 years later

Key takeaways:

• Self-reported gum bleeding is related to respiratory diseases/symptoms later in life.
• Researchers found heightened odds for self-reported COPD and asthma symptoms with periodontitis.

Odds for asthma symptoms, COPD and chronic bronchitis went up if individuals reported earlier “often/always” vs. “never” gum bleeding, according to a poster presented at the European Respiratory Society International Congress.

“With our study we show that a relatively simple question to the patients regarding whether they experienced bleeding gums or have periodontitis might inform the clinician that these patients may be of particular risk of developing respiratory disease or having more severe symptoms,” Randi Bertelsen, PhD, researcher at University of Bergen, told Healio. “We need to become better at informing the patients that good oral hygiene doesn’t only give you a white smile and good breath but may also help reduce the risk of more serious overall health issues.

“It is known that improving periodontal health status in patients with severe COPD leads to fewer exacerbations and better lung function, and this is something the clinicians should be aware of, and thus, prevention with keeping up good oral health is key in preventing future respiratory disease or improving existing respiratory conditions,” Bertelsen continued.

Using data from two surveys of the Respiratory Health in Northern Europe (RHINE) study collected 10 years apart, Bertelsen and colleagues assessed 8,345 individuals (average age, 62 years; n = 3,882 men; n = 4,463 women) to determine the link between gum bleeding during tooth brushing in the 2010 to 2012 RHINE III study and respiratory diseases in the 2020 to 2023 RHINE IV study.

Individuals self-reported four respiratory outcomes in RHINE IV, including current asthma, chronic bronchitis, COPD and at least three asthma symptoms defined by researchers as:

• “wheezing or whistling from the chest;
• breathless when wheezing;
• wheezing or whistling when not having a cold;
• waking up with feeling of tightness in the chest;
• having been woken by attack of shortness of breath;
• having been woken by attack of cough;
• attack of asthma; [and]
• currently taking asthma medication.”

Of the four respiratory outcomes, having at least three asthma symptoms was reported by the highest proportion of patients in RHINE IV at 14.8%. Current asthma (defined as “use of asthma medication and/or asthma attack the last 12 months”) was reported by 11.9% of the total study population, chronic bronchitis (defined as “bringing up phlegm almost every day for at least 3 months in 2 consecutive years”) was reported by 6.1% and COPD was reported by 2.1%, according to researchers.

Further, periodontitis was found in 44% of those who reported the occurrence of gum bleeding as “often/always” in RHINE III (n = 322). This disease was also observed in 31% of individuals who reported gum bleeding as “sometimes” happening in RHINE III (n = 1,601).

“The question ‘Do you bleed from your gums when you brush your teeth?’ appears to be a very good marker of gum inflammation, with almost 50% of those with high gum bleeding frequency reporting periodontitis at follow-up,” Bertelsen told Healio.

Following adjustment for sex, age, smoking, BMI and study center, researchers found heightened odds for self-reported COPD in RHINE IV with periodontitis (adjusted OR = 1.46; 95% CI, 1.07-1.98). The presence of periodontitis also raised the odds for at least three asthma symptoms (aOR = 1.3; 95% CI, 1.09-1.56).

“We know that for bacteria, the mouth is the gateway to the respiratory tract and to the rest of the body. Therefore, it is not so unexpected to find this association,” Bertelsen told Healio.

Periodontitis was not linked to self-reported current asthma or chronic bronchitis in RHINE IV, according to researchers.

Switching to gum bleeding, researchers found that individuals reporting “often/always” vs. “never” gum bleeding in RHINE III had a greater likelihood for at least three asthma symptoms, COPD and bronchitis in RHINE IV. Bertelsen told Healio this was a surprising finding.

“It is important that we start to consider the mouth as part of the rest of the body,” Bertelsen said. “There is a strong connection between oral health and overall health and all health care providers should keep this in mind when seeing patients.

“The advantage of the current study is that it allows us to follow-up a large general population with questionnaires designed to see how health status and behavior changes over time and that we have several study centers from different countries, which also gives valuable information and more strength to our findings,” Bertelsen added.

Looking ahead, lung function measures and dental records should be incorporated into research on this topic, Bertelsen told Healio.

“Future studies with thorough or objectively measured periodontal health status and respiratory status, including lung function, will be important,” Bertelsen said. “We have studies ongoing where we are doing this, both an oral health intervention study for exploring the effect on lung function and studies where we have thorough dental examinations and oral bacteria samples that are linked to lung function and respiratory health status.”