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Association of Periodontal Disease and Tooth Loss with Rheumatoid Arthritis in the US Population
PAOLA de PABLO, THOMAS DIETRICH, and TIMOTHY E. McALINDON
ABSTRACT. Methods. The third National Health and Nutrition Examination Survey (NHANES III) is a nationally representative cross-sectional survey of noninstitutionalized civilians. We included participants aged ≥ 60 years who had undergone both musculoskeletal and dental examinations. RA was defined based on American College of Rheumatology criteria. Dental examinations quantified decayed and filled surfaces, missing teeth, and periodontitis. Periodontitis was defined as at least 1 site exhibiting both attachment loss and a probing depth of ≥ 4 mm. We classified dental health status as (1) no periodontitis, (2) periodontitis, or (3) edentulous (i.e., complete tooth loss). We performed multivariate multinomial logistic regression models with dental health status as the dependent and RA as the independent variables. Results. The sample consisted of 4461 participants, of whom 103 were classified as having RA. Participants with RA had more missing teeth (20 vs 16 teeth; p < 0.001), but less decay (2% vs 4%; p < 0.001) than participants without RA. After adjusting for age, sex, race/ethnicity, and smoking, subjects with RA were more likely to be edentulous [odds ratio (OR) 2.27, 95% confidence interval (CI) 1.56–3.31] and have periodontitis (OR 1.82, 95% CI 1.04–3.20) compared with non-RA subjects. In participants with seropositive RA there was a stronger association with dental health status, in particular with edentulism (OR 4.5, 95% CI 1.2–17). Conclusion. RA may be associated with tooth loss and periodontitis. (First Release Nov 15 2007; J Rheumatol 2008;35:70-6) Key Indexing Terms:
RHEUMATOID ARTHRITIS From the Division of Rheumatology, Department of Medicine, Tufts–New England Medical Center, Tufts University School of Medicine; and the Department of Health Policy and Health Services Research and the Department of Periodontology and Oral Biology, Boston University Goldman School of Dental Medicine, Boston, Massachusetts, USA. Dr. de Pablo was supported by a Post-Doctoral Fellowship from the Arthritis Foundation. P. de Pablo, MD, MPH, Assistant Professor of Medicine, Division of Rheumatology; T.E. McAlindon, MD, MPH, Associate Professor of Medicine, Chief, Division of Rheumatology, Department of Medicine, Tufts-New England Medical Center; T. Dietrich, MD, DMD, MPH, Assistant Professor, Department of Health Policy and Health Services Research, and Department of Periodontology and Oral Biology, Boston University Goldman School of Dental Medicine. Address reprint requests to Dr. P. de Pablo, Division of Rheumatology, Tufts-New England Medical Center, 750 Washington Street, Box 406, Boston, MA 02111. E-mail: pdepablo@tufts-nemc.org Accepted for publication September 20, 2007. |