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Advanced Dental Cleaning is Associated with Reduced Risk of COPD Exacerbations: A Randomized Controlled Trial
Örebro University, School of Medical Sciences. Department of Respiratory Medicine.ORCID iD: 0000-0003-1926-8464
Department of Respiratory Medicine, Skåne University Hospital, Lund University, Malmö, Sweden.
Department of Periodontology and Implantology, Public Dental Service, Örebro, Sweden.
Department of Periodontology and Implantology, Public Dental Service, Örebro, Sweden.ORCID iD: 0000-0002-1291-6492
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2021 (English)In: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 16, p. 3203-3215Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Dove Medical Press Ltd. , 2021. Vol. 16, p. 3203-3215
Keywords [en]
Alpha diversity, beta diversity, health status, lung function, periodontal disease, plaque microbiome
National Category
Respiratory Medicine and Allergy
Identifiers
URN: urn:nbn:se:oru:diva-95770DOI: 10.2147/COPD.S327036ISI: 000723247500001PubMedID: 34858021Scopus ID: 2-s2.0-85120165811OAI: oai:DiVA.org:oru-95770DiVA, id: diva2:1617522
Note

Funding agencies:

Oral Health Related Research by Region Skåne

Swedish Dental Public Service of Skåne

Available from: 2021-12-07 Created: 2021-12-07 Last updated: 2025-01-30Bibliographically approved

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Sundh, JosefinNeves Guimaraes, Alessandra

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