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Advanced dental cleaning is associated with reduced risk of copd exacerbations – a randomized controlled trial

Sundh, Josefin ; Tanash, Hanan LU ; Arian, Rahi ; Neves-Guimaraes, Alessandra ; Broberg, Katrin ; Lindved, Gustav ; Kern, Timo ; Zych, Konrad ; Nielsen, Henrik Bjørn and Halling, Anders LU , et al. (2021) In International Journal of COPD 16. p.3203-3215
Abstract

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... (More)

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 con-founders. 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.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Alpha diversity, Beta diversity, Health status, Lung function, Periodontal disease, Plaque microbiome
in
International Journal of COPD
volume
16
pages
13 pages
publisher
Dove Medical Press Ltd.
external identifiers
  • scopus:85120165811
  • pmid:34858021
ISSN
1176-9106
DOI
10.2147/COPD.S327036
language
English
LU publication?
yes
id
10eef151-cebb-4beb-b656-024091de7114
date added to LUP
2021-12-14 12:16:11
date last changed
2024-04-20 17:43:05
@article{10eef151-cebb-4beb-b656-024091de7114,
  abstract     = {{<p>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 con-founders. 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 &lt; 0.0001) and in the population with repeated dental cleaning (0.16 (0.10–0.27), p &lt; 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.</p>}},
  author       = {{Sundh, Josefin and Tanash, Hanan and Arian, Rahi and Neves-Guimaraes, Alessandra and Broberg, Katrin and Lindved, Gustav and Kern, Timo and Zych, Konrad and Nielsen, Henrik Bjørn and Halling, Anders and Ohlsson, Bodil and Jönsson, Daniel}},
  issn         = {{1176-9106}},
  keywords     = {{Alpha diversity; Beta diversity; Health status; Lung function; Periodontal disease; Plaque microbiome}},
  language     = {{eng}},
  pages        = {{3203--3215}},
  publisher    = {{Dove Medical Press Ltd.}},
  series       = {{International Journal of COPD}},
  title        = {{Advanced dental cleaning is associated with reduced risk of copd exacerbations – a randomized controlled trial}},
  url          = {{http://dx.doi.org/10.2147/COPD.S327036}},
  doi          = {{10.2147/COPD.S327036}},
  volume       = {{16}},
  year         = {{2021}},
}