Predictors and systemic effects of periodontal disease progression

Thesis (Ph.D.)--Boston University PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would...

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Main Author: Heaton, Brenda
Language:en_US
Published: Boston University 2015
Online Access:https://hdl.handle.net/2144/12418
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spelling ndltd-bu.edu-oai-open.bu.edu-2144-124182020-11-10T17:01:16Z Predictors and systemic effects of periodontal disease progression Heaton, Brenda Thesis (Ph.D.)--Boston University PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. Periodontal disease is a chronic and inflammatory oral condition, common among adults, with important outcomes such as tooth loss and systemic inflammatory-related events such as coronary heart disease [CHD]. Studies of periodontal disease occurrence permeate the literature; however, longitudinal studies of disease progression are rare. Using data from the Veterans Administration Dental Longitudinal Study and Normative Aging Study we compiled a population of adult men suffering from periodontal disease. Within this population we conducted three prospective cohort studies; two examined the impact of exposures on the progression of disease and one that examined the impact of disease progression on the incidence of CHD events. In the first study, we estimated the effect of smoking on progression of disease. After restricting the population according to age and periodontal disease status at entry, smokers displayed greater progression of periodontal disease over time than nonsmokers (Difference in slopes: 0.14; 95% CI: 0.05, 0.23) after controlling for heavy alcohol use, body mass index [BMI] and diabetic diagnoses. The second study estimated the effect of uric acid on progression of periodontal disease. After implementing marginal structural modeling to address the influence of time-varying covariates and adjusting for heavy alcohol use and smoking, we did not observe any effect of high uric acid levels (Difference in slopes: 0.01; 95% CI: -0.003, 0.02). In the third study, we evaluated the continuous effect of periodontal disease progression on incident CHD events. After restricting the population according to periodontal disease status at entry, incremental increases in periodontal disease were found to be associated with a two-fold increase in risk of CHD events (HR: 1.99; 95% CI: 0.45, 8.83), adjusting for age, SES, BMI, diabetic diagnoses, heavy alcohol use and smoking. This association also appeared to depend on smoking status and heavy alcohol use with smokers and heavy alcohol users observed to have a higher risk of CHD. The results of the current studies provide initial insight into the possible predictors and effects of periodontal disease progression. Most importantly, they highlight the influence of prevalent cohort biases studies of progression and the unique intricacies of studying periodontal health over time. 2015-08-04T20:24:03Z 2015-08-04T20:24:03Z 2012 2012 Thesis/Dissertation (ALMA)contemp https://hdl.handle.net/2144/12418 en_US 12732 12889 Boston University
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language en_US
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description Thesis (Ph.D.)--Boston University PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. === Periodontal disease is a chronic and inflammatory oral condition, common among adults, with important outcomes such as tooth loss and systemic inflammatory-related events such as coronary heart disease [CHD]. Studies of periodontal disease occurrence permeate the literature; however, longitudinal studies of disease progression are rare. Using data from the Veterans Administration Dental Longitudinal Study and Normative Aging Study we compiled a population of adult men suffering from periodontal disease. Within this population we conducted three prospective cohort studies; two examined the impact of exposures on the progression of disease and one that examined the impact of disease progression on the incidence of CHD events. In the first study, we estimated the effect of smoking on progression of disease. After restricting the population according to age and periodontal disease status at entry, smokers displayed greater progression of periodontal disease over time than nonsmokers (Difference in slopes: 0.14; 95% CI: 0.05, 0.23) after controlling for heavy alcohol use, body mass index [BMI] and diabetic diagnoses. The second study estimated the effect of uric acid on progression of periodontal disease. After implementing marginal structural modeling to address the influence of time-varying covariates and adjusting for heavy alcohol use and smoking, we did not observe any effect of high uric acid levels (Difference in slopes: 0.01; 95% CI: -0.003, 0.02). In the third study, we evaluated the continuous effect of periodontal disease progression on incident CHD events. After restricting the population according to periodontal disease status at entry, incremental increases in periodontal disease were found to be associated with a two-fold increase in risk of CHD events (HR: 1.99; 95% CI: 0.45, 8.83), adjusting for age, SES, BMI, diabetic diagnoses, heavy alcohol use and smoking. This association also appeared to depend on smoking status and heavy alcohol use with smokers and heavy alcohol users observed to have a higher risk of CHD. The results of the current studies provide initial insight into the possible predictors and effects of periodontal disease progression. Most importantly, they highlight the influence of prevalent cohort biases studies of progression and the unique intricacies of studying periodontal health over time.
author Heaton, Brenda
spellingShingle Heaton, Brenda
Predictors and systemic effects of periodontal disease progression
author_facet Heaton, Brenda
author_sort Heaton, Brenda
title Predictors and systemic effects of periodontal disease progression
title_short Predictors and systemic effects of periodontal disease progression
title_full Predictors and systemic effects of periodontal disease progression
title_fullStr Predictors and systemic effects of periodontal disease progression
title_full_unstemmed Predictors and systemic effects of periodontal disease progression
title_sort predictors and systemic effects of periodontal disease progression
publisher Boston University
publishDate 2015
url https://hdl.handle.net/2144/12418
work_keys_str_mv AT heatonbrenda predictorsandsystemiceffectsofperiodontaldiseaseprogression
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