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SELECTIONS FROM THE CURRENT LITERATURE
JOURNALSCAN
SELECTIONS FROM THE CURRENT LITERATURE
Edited by Michael L. Barnett, DDS
Editor’s note: This new feature, which will appear in JADA on a bimonthly basis, offers summaries of selected relevant studies in the current dental and medical literature. PERIODONTOLOGY
Cigarette smoking and periodontal disease among 32-year-olds: a prospective study of a representative birth cohort Thomson WM, Broadbent JM, Welch D, Beck JD, Poulton R. J Clin Periodontol 2007;34(10):828-34.
moking has been identified as an important risk factor for the development of periodontitis. The authors conducted a longitudinal study to assess the impact of smoking on the development and progression of periodontitis in a birth cohort followed from ages 15 to 32 years. The investigators analyzed data from periodontal examinations of 810 people at ages 26 and 32 years along with smoking exposure determined at ages 15, 18, 21, 26 and 32 years. Subjects who smoked from their midteens onward were seven times more likely to have established periodontitis by age 32 years and were five times more likely to develop periodontitis after age 26 years than were those who never had smoked. On the other hand, subjects who gave up smoking after age 26 years were not significantly different from those who never had smoked, suggesting that smoking cessation in this age group may be associated with relatively rapid improvement of periodontal status. Significance. This epidemiologic study con-
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firms the beneficial effects of smoking cessation on oral health and reinforces the positive role that dentists can play in counseling their patients who smoke. ORAL PATHOLOGY
Oral cavity and pharynx-throat cancer in the United States, 1973-2003 Rodu B, Cole P. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104(5):653-8.
ccording to the authors, the American Cancer Society estimates that approximately 30,000 people are diagnosed with oral cancer in the United States each year. As these cases are based on anatomical criteria defined by a National Cancer Institute (NCI) surveillance program, they include lesions of the pharynx as well as of the oral cavity. The authors conducted this epidemiologic study to determine the incidence of malignancies in each of these sites from 1973 through 2003 and to estimate the number of lesions that could be detectable by a routine oral soft-tissue examination. To determine incidence estimates, the authors used data from the NCI Surveillance, Epidemiology, and End Results Program. Of the 29,132 malignant oropharyngeal neoplasms diagnosed in patients 20 years and older in 2003, 11,596 were located in the oral cavity, 12,485 were located in the pharynx or throat and 5,051 were located in major salivary glands or on the external aspect of the lips. The authors note that approximately 75 percent of these lesions are in anatomical sites included in a thorough oral soft-tissue examination and, therefore, could be detected in the dental office. A full 10,432 of these lesions were squamous cell carci-
A
http://jada.ada.org January 2008 Copyright ©2008 American Dental Association. All rights reserved.
J O U R N A L S C A N
nomas in the oral cavity, with the majority occurring on the tongue. Patients who smoke, are heavy drinkers of alcoholic beverages or both are especially at risk of developing this disease. Significance. Although, on average, dentists may only rarely, if ever, encounter an oropharyngeal malignancy in a patient, they will encounter numerous oral lesions that could be malignant, thereby requiring continued vigilance during oral soft-tissue examinations and biopsy when indicated.
Including questions about skin and soft-tissue infections in the medical history can enable dentists to provide counseling to these patients and suggest appropriate follow-up for these lesions.
INFECTIOUS DISEASES
S
Methamphetamine use and methicillinresistant Staphylococcus aureus skin infections Cohen AL, Shuler C, McAllister S, et al. Emerg Infect Dis 2007;13(11):1707-13.
ethamphetamine use has become a great concern to dentists because of its destructive effects on the dentition of users, often called “meth mouth,” and may have additional detrimental health effects. The authors conducted a prospective case-control study to determine whether methamphetamine use is a significant risk factor for methicillin-resistant Staphylococcus aureus (MRSA) skin and soft-tissue infections (SSTI). The study was conducted at six sites over a two-month period. The authors defined a “case” as a patient older than 12 years with a bacterial culture–confirmed MRSA SSTI seeking treatment during the study period, and control subjects were matched patients older than 12 years with no current skin infection. Risk estimates for MRSA SSTIs were adjusted for age, sex and race. Patients with MRSA SSTI were significantly more likely to have used methamphetamine recently than were control subjects, with an adjusted odds ratio of 5.10 (95 percent confidence interval, 1.55-16.79). Other risk factors included recent skin infection and household contact with someone with a skin infection, as well as the “skin-picking” behavior characteristic of methamphetamine users. Significance. Dentists treating methamphetamine users should be aware that these patients are at a higher risk of acquiring MRSA SSTIs.
M
EPIDEMIOLOGY
The prevalence and incidence of coronary heart disease is significantly increased in periodontitis: a meta-analysis Bahekar AA, Singh S, Saha S, Molnar J, Arora R. Am Heart J 2007;154(5):830-7.
tudies investigating an association between coronary heart disease (CHD) and periodontitis have not produced uniformly consistent results. The authors of this study sought to further elucidate the relationship through a metaanalysis of published studies. They conducted a systematic literature search and identified 15 studies that met their pre-established criteria: five prospective cohort studies with a follow-up period of more than six years; five case control studies; and five cross-sectional studies. Although, on balance, a separate meta-analysis of each of these three study groups indicated a statistically significant correlation between periodontitis and CHD, not all of the studies that were included demonstrated this. The authors note the limitations of their approach; for example, the selected studies used different study designs, the presence and severity of periodontal disease was determined in a variety of ways, and there may have been deficiencies in adjusting for certain confounding variables such as socioeconomic status. They conclude that, while the metaanalysis suggests a possible association between periodontitis and CHD, there is a need for additional well-designed prospective cohort studies with uniform definitions of periodontal disease and CHD to more definitively investigate the impact of the periodontopathogen burden on CHD incidence. Significance. This study confirms an association between periodontitis and CHD; however, the nature of the included studies is unable to provide definitive information about causation, which can be better determined by prospective intervention studies. ■
JADA, Vol. 139 http://jada.ada.org Copyright ©2008 American Dental Association. All rights reserved.
January 2008
73
SELECTIONS FROM THE CURRENT LITERATURE
Edited by Michael L. Barnett, DDS
Editor’s note: This new feature, which will appear in JADA on a bimonthly basis, offers summaries of selected relevant studies in the current dental and medical literature. PERIODONTOLOGY
Cigarette smoking and periodontal disease among 32-year-olds: a prospective study of a representative birth cohort Thomson WM, Broadbent JM, Welch D, Beck JD, Poulton R. J Clin Periodontol 2007;34(10):828-34.
moking has been identified as an important risk factor for the development of periodontitis. The authors conducted a longitudinal study to assess the impact of smoking on the development and progression of periodontitis in a birth cohort followed from ages 15 to 32 years. The investigators analyzed data from periodontal examinations of 810 people at ages 26 and 32 years along with smoking exposure determined at ages 15, 18, 21, 26 and 32 years. Subjects who smoked from their midteens onward were seven times more likely to have established periodontitis by age 32 years and were five times more likely to develop periodontitis after age 26 years than were those who never had smoked. On the other hand, subjects who gave up smoking after age 26 years were not significantly different from those who never had smoked, suggesting that smoking cessation in this age group may be associated with relatively rapid improvement of periodontal status. Significance. This epidemiologic study con-
S
72
JADA, Vol. 139
firms the beneficial effects of smoking cessation on oral health and reinforces the positive role that dentists can play in counseling their patients who smoke. ORAL PATHOLOGY
Oral cavity and pharynx-throat cancer in the United States, 1973-2003 Rodu B, Cole P. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104(5):653-8.
ccording to the authors, the American Cancer Society estimates that approximately 30,000 people are diagnosed with oral cancer in the United States each year. As these cases are based on anatomical criteria defined by a National Cancer Institute (NCI) surveillance program, they include lesions of the pharynx as well as of the oral cavity. The authors conducted this epidemiologic study to determine the incidence of malignancies in each of these sites from 1973 through 2003 and to estimate the number of lesions that could be detectable by a routine oral soft-tissue examination. To determine incidence estimates, the authors used data from the NCI Surveillance, Epidemiology, and End Results Program. Of the 29,132 malignant oropharyngeal neoplasms diagnosed in patients 20 years and older in 2003, 11,596 were located in the oral cavity, 12,485 were located in the pharynx or throat and 5,051 were located in major salivary glands or on the external aspect of the lips. The authors note that approximately 75 percent of these lesions are in anatomical sites included in a thorough oral soft-tissue examination and, therefore, could be detected in the dental office. A full 10,432 of these lesions were squamous cell carci-
A
http://jada.ada.org January 2008 Copyright ©2008 American Dental Association. All rights reserved.
J O U R N A L S C A N
nomas in the oral cavity, with the majority occurring on the tongue. Patients who smoke, are heavy drinkers of alcoholic beverages or both are especially at risk of developing this disease. Significance. Although, on average, dentists may only rarely, if ever, encounter an oropharyngeal malignancy in a patient, they will encounter numerous oral lesions that could be malignant, thereby requiring continued vigilance during oral soft-tissue examinations and biopsy when indicated.
Including questions about skin and soft-tissue infections in the medical history can enable dentists to provide counseling to these patients and suggest appropriate follow-up for these lesions.
INFECTIOUS DISEASES
S
Methamphetamine use and methicillinresistant Staphylococcus aureus skin infections Cohen AL, Shuler C, McAllister S, et al. Emerg Infect Dis 2007;13(11):1707-13.
ethamphetamine use has become a great concern to dentists because of its destructive effects on the dentition of users, often called “meth mouth,” and may have additional detrimental health effects. The authors conducted a prospective case-control study to determine whether methamphetamine use is a significant risk factor for methicillin-resistant Staphylococcus aureus (MRSA) skin and soft-tissue infections (SSTI). The study was conducted at six sites over a two-month period. The authors defined a “case” as a patient older than 12 years with a bacterial culture–confirmed MRSA SSTI seeking treatment during the study period, and control subjects were matched patients older than 12 years with no current skin infection. Risk estimates for MRSA SSTIs were adjusted for age, sex and race. Patients with MRSA SSTI were significantly more likely to have used methamphetamine recently than were control subjects, with an adjusted odds ratio of 5.10 (95 percent confidence interval, 1.55-16.79). Other risk factors included recent skin infection and household contact with someone with a skin infection, as well as the “skin-picking” behavior characteristic of methamphetamine users. Significance. Dentists treating methamphetamine users should be aware that these patients are at a higher risk of acquiring MRSA SSTIs.
M
EPIDEMIOLOGY
The prevalence and incidence of coronary heart disease is significantly increased in periodontitis: a meta-analysis Bahekar AA, Singh S, Saha S, Molnar J, Arora R. Am Heart J 2007;154(5):830-7.
tudies investigating an association between coronary heart disease (CHD) and periodontitis have not produced uniformly consistent results. The authors of this study sought to further elucidate the relationship through a metaanalysis of published studies. They conducted a systematic literature search and identified 15 studies that met their pre-established criteria: five prospective cohort studies with a follow-up period of more than six years; five case control studies; and five cross-sectional studies. Although, on balance, a separate meta-analysis of each of these three study groups indicated a statistically significant correlation between periodontitis and CHD, not all of the studies that were included demonstrated this. The authors note the limitations of their approach; for example, the selected studies used different study designs, the presence and severity of periodontal disease was determined in a variety of ways, and there may have been deficiencies in adjusting for certain confounding variables such as socioeconomic status. They conclude that, while the metaanalysis suggests a possible association between periodontitis and CHD, there is a need for additional well-designed prospective cohort studies with uniform definitions of periodontal disease and CHD to more definitively investigate the impact of the periodontopathogen burden on CHD incidence. Significance. This study confirms an association between periodontitis and CHD; however, the nature of the included studies is unable to provide definitive information about causation, which can be better determined by prospective intervention studies. ■
JADA, Vol. 139 http://jada.ada.org Copyright ©2008 American Dental Association. All rights reserved.
January 2008
73