RESEARCHARTICLE ExaminationoftheRelationshipbetween

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Relationship between Oral Health and Arterial Sclerosis. sclerosis odds ratio 0 72 95 confidence interval 0 52 0 99 per five teeth Regression. analysis showed a significant association between the IMT Cmax and the number of teeth. as an environmental factor p 0 037,Conclusions, Analysis of monozygotic twins older than 50 years of age showed that having fewer teeth. could be a significant environmental factor related to arterial sclerosis even after controlling. for genetic and familial confounding,Introduction, Although tremendous advances have been made in the field of medicine worldwide vascular. diseases are still a major concern The 2014 Japanese National Population Survey Report found. that around one fourth of all deaths in Japan were due to arteriosclerotic diseases such as cere. brovascular or cardiovascular diseases, Previous researchers have reported finding a strong association between oral health and ar. teriosclerotic diseases Using longitudinal Scottish data Watt et al found that while a biological. marker of inflammation C reactive protein CRP and an indicator of nutritional status. body mass index BMI were not significantly associated with coronary heart diseases tooth. loss was with edentate subjects having a 2 97 times higher risk for stroke related mortality 1. Joshipura et al and Paunio et al also suggested that periodontal disease and fewer teeth may be. associated with an increased risk of ischemic stroke 2 3 These studies were based on a pro. spective epidemiological aspect and were well designed to investigate which factor significantly. affected the outcome within the observed period It has also been reported that the biological. etiology of inflammation involves bacterial infection and that this is a common major factor. between tooth loss and vascular diseases 4 However no reports have clarified the association. between oral health and arteriosclerotic diseases from classical twin design even though both. diseases can be reduced by a modification of both behavior and habits Moreover despite the. fact that there may be a common genetic intervention currently no evidence suggests that ge. netic factors can affect this association Therefore further studies that specifically examine the. role oral health plays as an environmental factor in arteriosclerotic diseases in the absence of. genetic contributions need to be undertaken, The study of twins is a well known and unique method that is used to investigate genetic. contributions to physical features and diseases in human The two types of twins are monozy. gotic MZ and dizygotic DZ twins with MZ twins sharing 100 of their genes with each. other Thus by focusing only on MZ twins when comparing the phenotype between the MZ. pairs it becomes possible to match for genes identical by descent. The aim of the present study was to investigate the association between arterial sclerosis and. oral health which included factors such as the number of remaining teeth average probing. pocket depth and masticatory performance To avoid any potential genetic confounding this. study focused on older Japanese MZ twins, PLOS ONE DOI 10 1371 journal pone 0127642 May 26 2015 2 10.
Relationship between Oral Health and Arterial Sclerosis. Materials and Methods,Study Population, This cross sectional study enrolled middle aged and older Japanese twins recruited from all. over Japan The study took place at the Osaka University Center for Twin Research OUCTR. founded in 2009 5 OUCTR is a 4 year project that has been financially supported by the. Ministry of Education Culture Sports Science and Technology Japan MEXT since 2011. and MEXT KAKENHI Grant Number 24659857 Eligibility criteria required that the twins had. to be of the same sex be over 20 years of age and be able to be present at the research center at. the same time In the present study we only used data for twin pairs that were older than 50. years of age Written informed consent was obtained from all participants prior to clinical ex. aminations This study was independently approved by the Osaka University Graduate School. of Dentistry Ethics Committee H21 E2 Every clinical investigation was conducted according. to the principles expressed in the Declaration of Helsinki. Zygosity of the pairs was confirmed using 15 short tandem repeat STR markers derived. from the blood as these have previously been shown to be both accurate and reliable 6 7. Twin pairs that were completely concordant for these STR markers were designated monozy. gotic All other pairs were designated dizygotic,Measurements. We evaluated oral health by measuring the number of remaining teeth masticatory perfor. mance and periodontal status The number of teeth and masticatory performance were exam. ined by one of two trained and experienced prosthodontists who were blinded to the twin s. zygosity After being given a piece of gummy jelly UHA Mikakuto Co Osaka Japan which. is a standardized testing food participants were instructed to chew the piece 30 times on their. preferred chewing side and then expectorate the comminuted particles Masticatory perfor. mance was scored using a scale of 0 to 9 by comparing images of visual samples of the particles. 8 To evaluate periodontal status one of three experienced periodontists recorded probing. depth After assessing the probing depth in six sites mesiobuccal mid buccal distobuccal. mesiolingual mid lingual and distolingual the average pocket depth for all of the sites was. used for the study analysis, Increased carotid intima media thickness CIMT has been shown to be a predictor of sev. eral kinds of vascular disease 9 Since an ultrasonic device can be used to perform simple and. noninvasive measurements it is well suited for use in epidemiological studies 10 11 12 In. this study we also used CIMT as a surrogate end point of arterial sclerosis As CIMT is a mea. sure of the subclinical arterial sclerosis that is correlated with coronary heart disease risk fac. tors it has been shown to be predictive of subsequent myocardial infarction and stroke 13. Moreover it has been suggested that thickening of the common carotid artery might be more. representative of the total body arteriosclerotic burden. At the present time there is some controversy over whether mean or maximal measurements. should be used for the data analysis Since the maximal CIMT IMT Cmax has been reported to. have the highest reliability validity and reproducibility 14 we used IMT Cmax score as a con. tinuous variable in our current study In addition individuals with IMT Cmax 1 0 mm were. diagnosed as having arterial sclerosis This cut off point was recommended by Japanese guide. lines for cervical vessel ultrasound examination, All relevant data for this study was combined into one dataset S1 Data. PLOS ONE DOI 10 1371 journal pone 0127642 May 26 2015 3 10. Relationship between Oral Health and Arterial Sclerosis. Statistical Analysis, Age sex BMI and smoking status are considered to be major risk factors related to both oral.
health and arterial sclerosis The conventional tool of risk factor analyses in epidemiology is. the regression model but it is improper to transfer such conventional regression methods to. twin data because there is a correlation between twins the paired structure of the data needs to. be taken into account in twin study, As the first analysis we evaluated for a univariate correlation between all factors and contin. uous values of IMT Cmax using generalized estimating equations GEE analysis The design. of GEE is conceptually equivalent to a matched case control design as it controls the clustering. of twins within a pair Subsequently we evaluated single correlation between all factors and cat. egorical values of arterial sclerosis using the same method GEE. In the second step we used the multivariate GEE method to examine the association be. tween each of the three oral health related measurements and arterial sclerosis In this step we. adjusted for age sex BMI and smoking status Only the number of teeth NT was a signifi. cantly associated with arterial sclerosis within this analysis. When performing classical twin studies the assumption is that MZ twins completely share. the same genes Because of this assumption it is possible to eliminate genetic and family envi. ronmental confounding by focusing only on the MZ twins The paired structure of data from. the twins makes it possible to determine if any differences exist Thus any variations that may. have arisen between the pair can be distinguished by performing regression analysis using a. between within model 15 16 This regression analysis allows the covariate effect to differ. within and between twin pairs We formulated regression equations that consisted of the out. come IMT Cmax and the explanatory variables the twin pair average of NT and the twin. pair deviation of NT The within pair coefficient gives the expected change in IMT Cmax for a. one tooth change in the difference between the individual NT and the twin pair average NT. value The between pair coefficient gives the expected change in the IMT Cmax for a one tooth. change in the twin pair average NT A classical twin study can consider the within pair coeffi. cient as an environmental effect and can consider the between pair coefficient as a genetic ef. fect Based on this regression analysis we were able to characterize the proportion of the genetic. contribution to the association between number of teeth and IMT Cmax from the coefficient of. the twin pair average NT In the same way we were able to characterize the proportion of the. environmental contribution to the association between the number of teeth and IMT Cmax. from the coefficient of the twin pair deviation of the NT While there were no issues with regard. to controlling the age and sex of the subjects analyzed we only enrolled non smoking MZ twins. in order to ensure that we could also control smoking status of the subjects in this analysis Sta. tistical analysis was conducted using a between within model in the regression analysis with R. statistical software version 3 1 2 For each statistical analysis a p value 0 05 was considered. statistically significant, Table 1 presents the demographic distribution of all twin pairs over 50 years old Of the 169 en. rolled same sex twin pairs 106 were over 50 years of age with a mean age of 67 4 10 0 years. Out of the 106 twin pairs 91 were classified as MZ while 15 were DZ The MZ group consisted. of 42 male and 64 female twin pairs while the DZ group consisted of eight male and seven fe. male twin pairs, Table 2 shows the results of the analysis for a single correlation between all factors and. IMT Cmax using GEE Age former smoking status and all the oral health related measure. ments were significantly and independently associated with IMT Cmax Being older female a. PLOS ONE DOI 10 1371 journal pone 0127642 May 26 2015 4 10. Relationship between Oral Health and Arterial Sclerosis. Table 1 Participant characteristics,Variables Total n 212 MZ n 182 DZ n 30 P value. Mean SD Mean SD Mean SD,Age 67 4 10 0 67 0 10 1 70 1 9 4 0 68.
Number of teeth 21 1 9 3 21 1 9 2 20 1 10 0 0 46,BMI kg 22 5 3 1 22 4 3 1 22 8 3 2 0 89. Average pocket depth mm 2 8 0 6 2 8 0 6 2 8 0 6 0 31. IMT Cmax mm 0 67 0 24 0 66 0 24 0 71 0 24 0 90,n Percentage n Percentage n Percentage P value. Sex Male 84 39 6 68 32 1 16 53 3 0 10,Female 128 60 4 114 67 9 14 46 7. Smoking status Never 138 65 1 120 65 9 18 60 0 0 15. Former 44 20 8 40 22 0 4 13 3,Current 30 14 2 22 12 1 8 26 7. Masticatory performanse score 0 3 44 21 4 33 18 8 11 36 7 0 21. 4 6 101 49 0 91 51 7 10 33 3,7 9 61 29 6 52 29 5 9 30 0.
Arterial sclerosis No 201 94 8 174 96 6 27 90 0 0 20. Yes 11 5 2 8 4 4 3 10 0, Continuous variables are presented as mean and SD Standard Deviation whereas categorical variables are presented as frequency and percentages. p value was calculated by Student t test Mann Whitney s U test or chi square test to examine the difference between MZ and DZ. MZ Monozygotic twins DZ Dizygotic twins,IMT Cmax Maximum Carotid intima media thickness. doi 10 1371 journal pone 0127642 t001, smoker and having high BMI fewer teeth high score of average periodontal probing pocket. and low score of masticator performance tended to be negatively related to IMT Cmax. Table 3 shows the results of the analysis for a single correlation between all factors and arterial. sclerosis The result was the same as that for Table 2 Tooth loss deep periodontal probing. pocket and low masticatory performance were also significantly related to arterial sclerosis. Table 2 Association between all variables and IMT Cmax in GEE analysis. Variables n Estimate 95 CI,Age 212 0 31 0 17 0 45,Sex Male 84. Female 128 0 17 0 34 0 0001,Smoking status Never 138.
Former 44 0 11 0 04 0 18,Current 30 0 09 0 02 0 19. BMI kg 212 0 06 0 32 0 19,Number of teeth 212 0 032 0 061 0 004. Average pocket depth mm 194 0 20 0 02 0 39, Masticatory performance score 206 0 04 0 08 0 00002. CI Con dence Interval,Number of teeth 5 teeth for 1 unit. doi 10 1371 journal pone 0127642 t002, PLOS ONE DOI 10 1371 journal pone 0127642 May 26 2015 5 10.
Relationship between Oral Health and Arterial Sclerosis. Table 3 Association between all variables and arterial sclerosis in GEE analysis. Variables n Odds rate 95 CI,Age 212 1 09 1 02 1 17. Sex Male 84,Female 128 0 53 0 13 2 16,Smoking status Never 138. losswas with edentate subjectshavinga 2 97timeshigherriskforstroke relatedmortality 1 Joshipura etal and Paunioetal alsosuggestedthat periodontal disease and fewerteethmay be associatedwith anincreased riskofischemicstroke 2 3 Thesestudies werebased onapro

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