2010年06月14日

table & figure

Table1.

1.
Bleeding gums, gum recession, unsteady teeth, and tooth loss are signs and symptoms of periodontal disease.

2.
Periodontal disease affects as many as 75% of the U.S. population.

3.
Periodontal disease has been associated with suppressed levels of serum inflammatory markers.

4.
Poor oral health may increase the risk of cardiovascular disease.

5.
Periodontal disease is less prevalent/severe in patients with diabetes.

Figure 1.

Percentage of subjects achieving two, three, four, or five correct answers on the five true/false knowledge items of the questionnaire (N = 112).

Figure 2.

Questions exploring clinical practice behaviors/orientations.

Percentage of trainees responding never, sometimes, or always/often to these items are shown (N = 115).

1.
Do you ask your patients if they have ever been diagnosed with periodontal disease ?

2.
Do you screen your patients for periodontal disease?

3.
Do you refer patients to a dentist for evaluation/care ?

Figure 3.

Questions exploring perceived knowledge and training.

Responses of trainees with percentages are shown (N = 115).

1.
How comfortable are you in performing a simple periodontal exam ?

2.
How would you rate your knowledge about periodontal disease and its association with...

3.
Did you receive training in periodontal disease in medical school?

Figure 4.

Questions exploring attitudes toward periodontal disease and perceptions that may influence clinical practices.

Responses of trainees with percentages are shown (N = 115).

Agree or disagree ?

1.
Patients expect me to discuss/screen for periodontal disease.

2.
Discussing/evaluating periodontal status is periodontal to my role...

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2010年06月12日

その2

J Periodontol
Mar-10
Knowledge and orientations of internal medicine trainees toward periodontal disease

Aimee Quijano,* Amit J. Shah,* Aron I. Schwarcz,* Evanthia Lalla, and Robert J. Ostfeld
=============
Background:

There is growing evidence that periodontal disease may be a source of systemic inflammation that impacts overall health.

As such, periodontal disease is associated with an increased risk of systemic illnesses such as cardiovascular disease and adverse outcomes in diabetes mellitus and pregnancy.

With the aim of assessing oral health knowledge and orientations of physicians in training, we surveyed incoming internal medicine trainees about their general knowledge, attitudes, and behaviors/practices about periodontal health and disease.

Methods:

A 16-question survey was distributed during orientation to incoming internal medicine trainees at a single urban teaching hospital in New York City in 2007 and 2008.

Questions aimed to assess the knowledge levels of the subjects about periodontal disease and their attitudes toward discussing/evaluating the periodontal status of their patients.

The study was approved by the Montefiore Institutional Review Board.

Results:

Of 125 incoming medical trainees queried, 115 responded (92% response rate).

Of the 115 responders, 96% were medical interns.

The median age of the trainees was 27 years (interquartile range: 26 to 29 years), and 61% were female.

Overall, 34% of the trainees answered all five true/false general knowledge questions correctly,

82% reported that they never asked patients if they were diagnosed with periodontal disease,

90% reported not receiving any training about periodontal disease during medical school,

69% reported that they were not comfortable at all performing a simple periodontal examination,

17% agreed that patients expect physicians to discuss/screen for periodontal disease,

46% felt that discussing/evaluating the periodontal status of their patients was peripheral to their role as physicians,

76% reported never screening patients for periodontal disease,

and 23% stated that they never referred patients to dentists.

Conclusions:

In this study, incoming internal medicine trainees had inadequate knowledge regarding periodontal disease.

They were also generally uncomfortable with performing a simple periodontal examination.

Oral health training in medical school and the medical postgraduate setting is recommended.

J Periodontol 2010; 81:359-363.

KEY WORDS
Dental health education;knowledge;orientation;periodontal diseases;physicians;preventive medicine.

=======
* Department of Internal Medicine, Montefiore Medical
Center, Albert Einstein University, Bronx, NY.
*1 Division of Periodontics, College of Dental Medicine,
Columbia University, New York, NY.
*2 Department of Cardiology, Montefiore Medical Center,
Albert Einstein University.

========
Periodontal disease is a bacterially induced chronic inflammatory process that affects tooth-supporting connective tissue and alveolar bone in the oral cavity, potentially leading to tooth loss.
1
In the United States (U.S.), periodontal disease occurs in ;
8% of adults, with a disproportionately higher prevalence in blacks (13%) and Hispanics (8%) than whites (7%).
2
There is growing evidence that periodontal disease may be a source of systemic inflammation that impacts overall health.
1
As such, periodontal disease is associated with an increased risk of systemic illnesses such as cardiovascular disease, stroke, peripheral vascular disease, and adverse diabetes mellitus and pregnancy outcomes.
3月8日
These associations pose a compelling reason for physicians to increase their role in inquiring about oral health care and screening for oral problems and led to a call for greater collaboration between dentists and physicians.
9
As such, a recent consensus statement 10 recommended that patientswith therosclerotic cardiovascular disease should receive a periodontal evaluation, and patients with moderate to severe periodontitis should be informed about their potential increased risk of atherosclerosis.

Nevertheless, few studies 11,12 examined a physician's role in identifying, discussing, or preventing oral disease and only focused on children.

With the aim of assessing oral health knowledge and orientations of physicians in training, we surveyed internal medicine trainees about their general knowledge, attitudes, and behaviors/practices about periodontal health and disease.
=========
material and methods

A short questionnaire was distributed to incoming internal medicine trainees at Montefiore Medical Center, Albert Einstein University, during their orientation in June 2007 and June 2008.

It was developed to assess the knowledge, attitudes, and behaviors about periodontal disease of incoming internal medicine trainees.

Participation was voluntary and anonymous, and the questionnaire, including five true/false knowledge items, and eight Likert-scale questions, was completed in ; 15 minutes.

Respondents were instructed to circle the single best answer.

The participants were also queried regarding gender, age, and training level.

Trainees who were beginning their first year were asked to respond to questions related to clinical practices based on their clinical experiences during medical school outpatient rotations or to reflect what they would do in future clinical practices.

Analyses were performed using commercially available statistical software.
§

Medians and interquartile ranges are reported.

Residents were given a total quiz score ranging from 0 to 5, earning a point for each true/false question answered correctly.

Chi-square analyses were conducted to compare male and female subgroups.

The Spearman correlation coefficient was used to correlate the self-assessed knowledge and quiz scores of trainees.

The study was approved by the Montefiore Medical Center Institutional Review Board and informed consent waived because of the minimal risk nature of this study.


===========
RESULTS

The survey was given to a total of 125 incoming medical trainees; 115responded, foraresponserateof92%.

The 115 responders had graduated from 57 different medical schools (70% in the U.S. and 30% internationally).

Their median age was 27 years (interquartile range: 26 to 29 years): 70 (61%) were female, and 45 (39%) were male.

Of the responders,96%were incoming medical interns (first-year trainees).

The rest were incoming medical residents (second- and third-year trainees).

Table 1 shows the true/false knowledge items with the correct answer and the percentage of subjects who answered each question correctly.

The percentage of trainees that answered any one question correctly ranged from 56% to 98%.

Although most trainees demonstrated knowledge regarding the signs of periodontal disease and its association with diabetes and cardiovascular disease, nearly half did not know about the association of periodontal disease with increased levels of systemic inflammatory markers.

Figure 1 summarizes the overall results of the responders’ scores on the five-question quiz.

The median quiz score was 4 (interquartile range: 3 to 5), and a perfect quiz score was achieved by 34% of the residents.

Three subjects did not complete all five quiz questions and were excluded from the analysis.

No subject answered fewer than two questions correctly.

Figures 2 through 4 summarize the responses to questions exploring attitudes, orientations, and behaviors.

Questions regarding clinical practices (Fig. 2) were interpreted to reflect practices in medical school and/or future behaviors for those entering their first year of internal medicine training: 82% of the responders never asked their patients whether they were diagnosed with periodontal disease, 76% never screened their patients for periodontal disease, and 23% never referred patients to a dentist for evaluation and care.

As shown in Figure 3, 69% of the responders did not feel comfortable doing a simple periodontal examination, 81% reported limited understanding of the association between periodontal health and general health, and 90% did not receive any training in periodontal disease during medical school.

Finally, as shown in Figure 4, 83% of responders disagreed/ strongly disagreed that patients expected them to discuss/ screen for periodontal disease, and 46% agreed/ strongly agreed that discussing or evaluating periodontal status of their patients was peripheral to their role as physicians.

For the subgroup analysis by gender, no significant difference was found between genders for the total quiz score or for each question in Figures 2 through 4.

There was a trend toward a positive correlation between self-rated knowledge and the total quiz score, with a Spearman correlation coefficient of 0.19 (P = 0.055).


===========
DISCUSSION
We found that knowledge of internal medicine trainees about periodontal disease is limited.

The trainees rarely asked about periodontal diseasewhen taking a patient ’s medical history, and they were not comfortable performing a simple periodontal examination; most trainees received no training in periodontal health in medical school (Fig. 3), and many somewhat or strongly agreed that discussing/ evaluating the periodontal status of their patients is peripheral to their role as a physician (Fig. 4).

To the best of our knowledge, this is the first study to assess the knowledge levels, attitudes, and behaviors of physician trainees about issues related to periodontal health.

Our findings raise concerns.

Given the high prevalence of periodontal disease, its deleterious impact on oral health and its association with systemic disease, patients seeing internal medicine physicians may not be receiving the education and guidance needed.
1,2
An increased awareness of certain aspects of periodontal disease and its link to systemic conditions are important, and patients should be counseled about this at each health care contact they have, whether it is with a dentist, a physician, or any other health care provider.

Furthermore,; 31 million people in the U.S. live in‘‘dental shortage areas,’’ where there is less than one full-time equivalent dentist per 5,000 people, highlighting the need for physicians to be competent in advising about the importance of periodontal health.
13
At a minimum, our findings suggest that medical schools should provide more comprehensive training in oral/periodontal health.

And, given that the cohort surveyed in this study came from 57 different national and international medical schools, it appears that suboptimal oral health training in medical schools may be widespread.

Future efforts to improve physicians’ability to contribute to oral health should include at least a rudimentary curriculum in medical school that would be supplemented by postgraduate training.

Although medical schools in different countries may vary in their curricula, many medical schools in the U.S. allot 2 years for preclinical basic sciences, which would allow for some education on oral disease and the systemic effects of periodontal infections.

Furthermore, many medical schools offer an introduction to clinical medicine during the first and/ or second year, during which an examination of the oral cavity could be incorporated into teaching the physical exam.

This could be coupled with instructions on prevention counseling, especially during outpatient encounters.

These sessions could be reinforced during the clinical rotations in the third and fourth years.

This way, oral/periodontal health may both be taught theoretically and reinforced into practice during early training.

Our study has certain limitations.

Although it was anonymous, the self-reported attitudes and practices may be biased by what responders believed was ideal or socially desired.

It was performed at a single medical center, and findings may not be generalizable.

Finally, most of the cohort was entering internal medicine training.

Although their answers reflected current opinions and may provide an estimate for future practices, their attitudes and orientations may change at the completion of their training.
==========
CONCLUSIONS

In this study, internal medicine trainees were not equipped to screen for or discuss issues related to periodontal health.

Oral health education in medical school and the postgraduate setting is recommended.
===========
ACKNOWLEDGMENT

The authors report no conflicts of interest related to this study.
============

Table 1.
true/ false knowledge items with correct answers and ercentages of subjects who answered correctly (N = 112)

Item
Correct answer
Answering correctly
(%)

1
Bleeding gums, gum recession, unsteady teeth, and tooth loss are signs and symptoms of periodontal disease.
TRUE 98

2
Periodontal disease affects as many as 75% of the U.S. population.
True 69

3
Periodontal disease has been associated with suppressed levels of serum inflammatory markers.
False 56

4
Poor oral health may increase the risk of cardiovascular disease.
True 89

5
Periodontal disease is less prevalent/severe in patients with diabetes.
False 97
====
Figure 1.
Percentage of subjects achieving two, three, four, or five orrect answers on the five true/false knowledge items of the questionnaire (N = 112).
Number of questions answered correctly
Subjects (%)
====
Figure 2.
Questions exploring clinical practice behaviors/orientations.
Percentage of trainees responding never, sometimes, or always/often to these items are shown (N = 115).
2-1) Do you ask your patients if they have ever been diagnosed with periodontal disease ?
2-2) Do you screen your patients for periodontal disease?
2-3) Do you refer patients to a dentist for evaluation / care ?
Never / sometimes / always
====
Figure 3.
Questions exploring perceived knowledge and training.
Responses of trainees with percentages are shown (N = 115).
3-1) How comfortable are you in performing a simple periodontal exam ?
Not at all / Somewhat / Very
3-2) How would you rate your knowledge about periodontal disease and its association with...
Limited / Moderate / Good / Excellent
3-3) Did you receive training in periodontal disease in medical school?
Yes / No
=====
Figure 4.
Questions exploring attitudes toward periodontal disease and perceptions that may influence clinical practices.
Responses of trainees with percentages are shown (N = 115).

4-1) Agree or disagree ? “Patients expect me to discuss / screen for periodontal disease”

Strongly Disagree / Disagree / Agree / Strongly agree
Agree or disagree ? “ Discussing / evaluating periodontal
status is periodontal to my role...
Strongly Disagree / Disagree / Agree / Strongly agree
=======
==========
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その1

A Cohort Study on the Association Between Periodontal Disease and the Development of Metabolic Syndrome

Toyoko Morita,*† Yoji Yamazaki,† Ayae Mita,† Koji Takada,† Misae Seto,‡ Norihide Nishinoue,‡Yoshiyuki Sasaki,§ Masafumi Motohashi,* and Masao Maeno*

Background:

An association between periodontal disease and metabolic syndrome based on cross-sectional and casecontrol studieswas recently reported, but their causal relationship has not been fully clarified. The objective of this cohort study is to investigate the association between periodontal disease and changes in metabolic-syndrome components to accumulate evidence of the causal relationship between the two conditions.

Methods:

The study subjects consisted of 1,023 adult employees (727 males and 296 females; mean age: 37.3 years) who underwent medical and dental checkups between 2002 and 2006 and in whom all metabolic-syndrome components were within the standard values in 2002.

The association between the presence of periodontal pockets and the positive conversion of metabolic-syndrome components was investigated using multiple logistic-regression analysis, odds ratios (ORs), and 95% confidence intervals (CIs).

Results:

The presence of periodontal pockets was associated with a positive conversion of one or more metabolic components during the 4-year observation period (OR: 1.6; 95% CI: 1.1 to 2.2).

The ORs for a positive conversion of one component and two or more components were 1.4 (95% CI: 1.0 to 2.1) and 2.2 (95% CI: 1.1 to 4.1), respectively, and the difference was significant for two or more positive components.

Of the metabolic-syndrome components, positive conversions of blood pressure and the blood-lipid index were significantly associated with the presence of periodontal pockets.

Conclusion:

The presence of periodontal pockets was associated with a positive conversion of metabolic-ndromecomponents, suggesting that preventing periodontal disease may prevent metabolic syndrome.

J Periodontol 2010;81:512-519.

Kew words

Cohort study; hyperglycemia; hypertension; lipid metabolism; obesity; periodontal disease.

===============

* Department of Oral Health Sciences, Nihon university School of Dentistry, Tokyo, Japan.

† The Lion Foundation for Dental Health, Tokyo, Japan.

‡ Health Care Center, Lion Corporation, Tokyo, Japan.

§ Center for Education and Research in Oral Health Care, Faculty of Dentistry, Tokyo Medical and Dental University, Tokyo, Japan.

===============

Metabolic syndrome is a complex collection of components that are thought to arise from a visceral fat-type obesity involving hypertension and abnormal glucose and lipid metabolism.

Preventing metabolic syndrome is of great medical importance because the presence of multiple components increases the risk of developing cardiovascular disease.

1,2 Numerous studies3-13 linked periodontal disease with several serious risk factors for metabolic syndrome, including type 2 diabetes,3,4 obesity among community residents,5,6 lipid abnormalities in patients with periodontal disease7-11 and community residents, 12 and elevated blood-pressure levels.

13 Studies on the association between periodontal disease and metabolic syndrome in Japanese-community residents and adults in Northern Jordan and China14-16 and analysis of results from the United States National Health and Nutrition Examination Survey III17 were reported, and Morita et al.

18 described the association in industrial workers.

Previous studies14-18 of the association of periodontal disease and metabolic syndrome were cross-sectional or case-control studies.

The results provided by these study designs is relatively weaker than in cohort studies.

Elevated blood levels of inflammatory markers, such as C-reactive protein (CRP) and interleukin (IL)-6 were reported in patients with periodontal disease,19,20 suggesting that periodontal disease is amild chronic inflammatory disease affecting the systemic condition.

21,22 Aggravation of glucose tolerance in people with deep periodontal pockets was also shown epidemiologically, suggesting that infection with periodontal disease pathogens enhances tumor necrosis factor-alpha (TNF-a) production, induces the prediabetic condition, and leads to abnormal glucose tolerance.

23 Furthermore, negative influences by lipopolysaccharide (LPS) and cytokines produced by inflammation, such as TNF-a and IL-1, on lipid metabolism were reported,24 suggesting that Gram-negative anaerobe- induced periodontal disease has some influence on lipid metabolism.

Considering these findings, it is possible that periodontal disease increases the risk of developing metabolic syndrome as a Gram-negative anaerobeinduced mild chronic inflammatory disease.

The aim of this cohort study is to evaluate the influence of periodontal disease on the development of metabolic syndrome in industrial workers. In this study, exposure was the presence of a periodontal pocket ‡4 mm, and the outcome was a positive conversion of metabolic-syndrome components.

========
Materials and methods

The subjects were industrial employees of a company that manufacturers household products in Tokyo, Japan.

The subjects underwent periodic health and dental checkups that were independently performed by a health-insurance association in 2002 and 2006.

In 2002, 99.9% of the employees underwent systemic medical checkups, 88.4% of them had dental examinations, and 2,796 received both checkups.

There were 2,078 employees who had checkups in 2002 and 2006 and gave written informed consent to participate in the present study.

The study subjects included 1,023 industrial workers in whom all components of metabolic syndrome were within the standard values at baseline in 2002 (727 males and 296 females; age range: 20 to 56 years; mean age: 37.3 years).

The remaining 1,055 workers were excluded from the study because one or more metabolic syndrome components were not within standard values in 2002.

The presence of periodontal disease at the initiation of follow-up was assessed according to the criteria of the World Health Organization (WHO) Community Periodontal Index (CPI) criteria.

25 Dental hygienists (AM et al.) examined 10 representative teeth in six sextants under the supervision of dentists (Yoko Ogawa et al.).

Oral examinations were carried out using standardWHOprobes after calibration of the pressure (<20 g) of the probe using a sensor probe.

The subjects were divided into two groups: individualswith CPI codes £2 (without a periodontal pocket) and the other individuals with at least one sextant with a CPI code ‡3 (periodontal pocket ‡4 mm), and their relationships with the positive conversion of each metabolic-syndrome component were analyzed.

Additionally, oral examination was carried out by dentists to assess dental caries experience and periodontal disease excluding third molars.

Blood pressure was measured with an automatic hemomanometer while the patients were in a sitting position.

Blood pressure was measured twice for only those subjects with an abnormal value at the first measurement.

The data of blood pressure used in the present study were based upon the first measurement only for consistency in data collection across subjects.

After fasting from 9:00 pm to the following morning, blood samples were collected from an arm vein.

Triglyceride, high-density lipoprotein (HDL) cholesterol, total cholesterol, and fasting blood glucose levels were measured from these samples.

The body mass index (BMI) was calculated from the heights and body weights of each participant.

The test values of hypertension, lipid abnormality, and hyperglycemia were based on the definition and diagnostic criteria for metabolic syndrome in Japan;26,27 a ‡130-mm/Hg systolic or ‡85-mm/Hg diastolic blood pressure was equated with hypertension, ‡150 mg/dl triglycerides or <40 mg/dl HDL cholesterol was considered an abnormal lipid profile, and ‡110 mg/dl fasting blood glucose was deemed positive for hyperglycemia.

A BMI ‡25 kg/m2 was regarded as positive for a metabolic disorder.

The health habits described by Belloc and Breslow28 were surveyed using a self-completed questionnaire.

The items on the questionnaire were: ‘‘Do you have a smoking habit?,’’ ‘‘Are you doing physical exercise regularly?,’’ and ‘‘Are you controlling consumption of food between meals?’’ Subjects answered the questions by selecting ‘‘yes’’ or ‘‘no.’’ Periodontal pockets, age, gender, and smoking habit were determined at the baseline of the observational period.

This study was approved by the ethics committee of the Nihon University School of Dentistry.

======
Statistical Methods

Multiple logistic regression analysis was used to evaluate the association between the presence of periodontal pocket and the number of positively changed components during 4 years (positive components) and between the presence of periodontal pocket and positive components.

Dependent variable was the positivity of each component and explanatory variables were the presence of periodontal pockets, carious teeth, and missing teeth representing the oral condition in 2002.

Odds ratios (ORs) and confidence intervals (CIs) were calculated with adjustments for age, gender, cigarette smoking, exercise, eating between meals, and the maintenance of a healthy body weight J Periodontol • April 2010 Morita, Yamazaki, Mita, et al. 513 in 2002.

Statistical analysis softwarei was used, and the significance level was set at £5%.

However, >3,000 employeeswork for the company, indicating that the data may be generalized in terms of industrial workers.

Metabolic syndrome was defined as an obesity (waist circumference)-based condition with three or more of the following conditions: obesity, hypertension, lipid abnormality, and hyperglycemia in Japan by the Japanese Society of Internal Medicine in 2005;26,27 whereas the American Heart Association and United States National Heart, Lung, and Blood Institute regard persons with three or more of the following conditions: obesity (waist circumference) and abnormal levels of triglycerides, HDL cholesterol, blood pressure, and fasting blood glucose as those with metabolic syndrome.

29 This definition is not obesity based because the presence of nonobese cases with insulin resistance and other metabolic risk factors was recognized, and placing special emphasis on a single pathology, visceral obesity, was considered inadequate.

We considered obesity as an index to investigate whether the presence of periodontal pockets was associated with the development of metabolic syndrome and surveyed positive conversions of obesity, hypertension, lipid abnormality, and hyperglycemia to investigate their associations with periodontal disease.

The BMI was adopted as the obesity index because the waistcircumference measurement specified for metabolic syndrome was not performed on health checkups in 2002 and 2006.

The metabolic-syndrome criteria26,27 regard conditions with three or more positive components as metabolic syndrome, but subjects with two or more positive components were collectively handled in the analysis because only 0.8% of subjects became positive for three or more components, whereas 18.2% and 4.0% became positive for one and two components, respectively.

The positive rate for any one of the metabolicsyndrome components was significantly higher in subjects with periodontal pockets than in subjects without periodontal pockets in 2002(OR: 1.6),even after adjustments for age, gender, and habits (cigarette smoking, exercise, eating between meals, and the maintenance of a healthy body weight).

18,30-32 These findings indicate that the maintenance of a healthy oral cavity to prevent periodontal pocket formation is effective for maintaining metabolic-syndrome components within standard values.

After 4 years, the OR rose as the number of positive components increased, and the difference was significant for two or more positive components (OR: 2.2), thus clarifying that the risk of becoming positive for metabolic-syndrome components is higher in subjects with periodontal pockets.

Previous cross-sectional14,17,18 and case-control15,16 studies showed the presence of a close association between periodontal disease and metabolic syndrome, and that patients with metabolic syndrome may be at a higher risk for periodontal disease.

Furthermore, the present cohort study suggests that people with periodontal pockets are at a higher risk for developing metabolic syndrome even when all metabolic-syndrome components are within standard values.

Periodontal disease is considered a mild chronic inflammatory condition caused by Gram-negative anaerobes inhabiting periodontal pockets,21,22 and the elevation of the blood levels of cytokines, such as CRP and IL-6, has been reported.

19,20 These inflammatory substances induced by periodontal disease may influence the whole body and act toward the positive conversion of metabolic-syndrome components.

In contrast, a report33 found that the level of CRP increases in the person with the metabolic syndrome.

Therefore, an increase of CRP due to periodontitis is related to the progression of the metabolic syndrome.

Positive conversions of hypertension and lipid abnormality were significantly associated with the presence of periodontal pockets.

Negative influences of a Gram-negative bacterial cell component, LPS, and cytokines, such as TNF-a and IL-1, on lipid metabolism were reported, 24 suggesting that the OR for the development of lipid abnormality increases through these substances in subjects with periodontal pockets.

Although an association between hypertension and periodontal disease was reported,34 the reason for this association has not been clarified.

However, thrombus formation caused by Porphyromonas gingivalis from aggregating platelets,35 the elevation of risks of hypertension and coronary arterial heart disease because of an elevated CRP level,36-38 and elevated CRP levels in patients with periodontal disease19,21 were reported.

It is quite possible that periodontal disease influences the development of hypertension through inflammatory substances, such as CRP, which supports our finding that the presence of periodontal pockets increases the risk of developing hypertension.

In contrast, there was no significant association between the presence of periodontal pockets and a positive conversion of obesity or hyperglycemia, but obesity showed a tendency toward an association (P = 0.056); P value was approximated to P = 0.05.

It was reported that LPS stimulated fat deposition in the liver and adipose tissue in mice, which led to a weight increase.

39 This result and our findings suggest that periodontal disease affects obesity.

A reduction in blood glucose levels after periodontal treatment in patients with diabetes was reported in studies40,41 on periodontal disease and diabetes intervention.

The OR for subjects with periodontal pockets becoming hyperglycemic was 1.4, but the association was not significant.

In the 2006 National Nutrition Survey, 42 the rate of people between 20 and 69 years of age strongly suspected of having diabetes and in whom the possibility of diabetes could not be ruled out increased with advancing age, and the difference between age groups classified as patients with and suspected of having diabetes for 10 years was 3.0% to 9.5%.

However, the rate of subjects who became positive for hyperglycemia within the next 4 years was only 1% of all subjects, and this may have been the reason for the absence of a significant difference.

The present study shows that adult employees, ranging in age from 20 to 56 years, with periodontal pockets were at a higher risk for the positive conversion of metabolic-syndrome components.

Accordingly, the prevention of periodontal disease may consequently prevent metabolic syndrome, and the maintenance of a healthy oral cavity from a young age may be important to maintain the health of the entire body.

However, there is a limitation for the findings of this study.

Periodontal disease and metabolic syndrome are considered to be related to a complex lifestyle.

To exclude confounding factors, habits (cigarette smoking, exercise, eating between meals, and the maintenance of a healthy body weight) that are assumed to affect periodontal disease and metabolic syndrome18,30-32 were adopted for adjustment, in addition to age and gender.

However, it cannot be ruled out that habits not investigated in this study may affect metabolic syndrome.

Interventional studies on periodontal treatment-induced changes in the condition of metabolic syndrome in patients with periodontal disease and metabolic syndrome may be necessary to further clarify the causal relationship between periodontal disease and metabolic syndrome.

============
Conclusion

The presence of periodontal pockets was associated with positive conversions of metabolic-syndrome components, suggesting that the prevention of periodontal disease consequently prevents metabolic syndrome.

=============
Acknowledgments

This work was supported by the Promotion and Mutual Aid Corporation for Private Schools of Japan,Tokyo, Japan. The authors report no conflicts of interest related to this study.

===========
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19.
Saito T, Murakami M, Shimazaki Y, Oobayashi K,Matsumoto S, Koga T.
Association between alveolar bone loss and elevated serum C-reactive protein in Japanese men.
J Periodontol 2003;74:1741-1746.

20.
Loos BG, Craandijk J, Hoek FJ, Wertheim-van Dillen PM, Van der Velden U.
Elevation of systemic markers related to cardiovascular diseases in the peripheral blood of periodontitis patients.
J Periodontol 2000;71:1528-1534.

21.
Nishimura F, Soga Y, Iwamoto Y, Kudo C, Murayama Y.
Periodontal disease as part of the insulin resistance syndrome in diabetic patients.
J Int Acad Periodontol 2005;7:16-20.

22.
Slade GD, Ghezzi EM, Heiss G, Beck JD, Riche E, Offenbacher S.
Relationship between periodontal disease and C-reactive protein among adults in the Atherosclerosis Risk in Communities study.
Arch Intern Med 2003;163:1172-1179.

23.
Saito T, Shimazaki Y, Kiyohara Y, et al.
The severity of periodontal disease is associated with the development of glucose intolerance in non-diabetics: The Hisayama study.
J Dent Res 2004;83:485-490.

24.
Hardardo´ ttir I, Gru¨nfeld C, Feingold KR.
Effects of endotoxin and cytokines on lipid metabolism.
Curr Opin Lipidol 1994;5:207-215.

25.
Ainamo J, Barmes D, Beagrie G, Cutress T, Martin J, Sardo-Infirri J.
Development of the World Health Organization (WHO) Community Periodontal Index of Treatment Needs (CPITN).
Int Dent J 1982;32:281-291.

26.
Matsuzawa Y.
Metabolic syndrome – Definition and diagnostic criteria in Japan.
J Atheroscler Thromb 2005;12:301.

27.
Aizawa Y, Kamimura N, Watanabe H, et al.
Cardiovascular risk factors are really linked in the metabolic syndrome:
This phenomenon suggests clustering rather than coincidence.
Int J Cardiol 2006;109:213-218.

28.
Belloc NB, Breslow L. Relationship of physical health status and health practices.
Prev Med 1972;1:409-421.

29.
Grundy SM, Cleeman JI, Daniels SR, et al.
Diagnosis and management of the metabolic syndrome:
An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement.
Circulation 2005;112:2735-2752.

30.
Ntandou G, Delisle H, Agueh V, Fayomi B.
Abdominal obesity explains the positive rural-urban gradient in the prevalence of the metabolic syndrome in Benin, West Africa.
Nutr Res 2009;29:180-189.

31.
Toornvliet AC, Pijl H, Tuinenburg JC, et al.
Psychological and metabolic responses of carbohydrate craving obese patients to carbohydrate, fat and protein-rich meals.
Int J Obes Relat Metab Disord 1997;21:860-864.

32.
Horne J.
Short sleep is a questionable risk factor for obesity and related disorders: Statistical versus clinical significance.
Biol Psychol 2008;77:266-276.

33.
Ford ES.
The metabolic syndrome and C-reactive protein, fibrinogen, and leukocyte count:
Findings from the Third National Health and Nutrition Examination Survey.
Atherosclerosis 2003;168:351-358.

34.
Engstro¨m S, Gahnberg L, Ho¨gberg H, Sva¨rdsudd K.
Association between high blood pressure and deep periodontal pockets:
A nested case-referent study.
Ups J Med Sci 2007;112:95-103.

35.
Imamura T, Travis J, Potempa J.
The biphasic virulence activities of gingipains:
Activation and inactivation of host proteins.
Curr Protein Pept Sci 2003; 4:443-450.

36.
Vidal F, Figueredo CM, Cordovil I, Fischer RG.
Periodontal therapy reduces plasma levels of interleukin-6, C-reactive protein, and fibrinogen in patients with severe periodontitis and refractory arterial hypertension.
J Periodontol 2009;80:786-791.

37.
Lakoski SG, Cushman M, Palmas W, Blumenthal R, D’Agostino RB Jr., Herrington DM.
The relationship between blood pressure and C-reactive protein in the Multi-Ethnic Study of Atherosclerosis (MESA).
J Am Coll Cardiol 2005;46:1869-1874.

38.
Sesso HD, Wang L, Buring JE, Ridker PM, Gaziano JM.
Comparison of interleukin-6 and C-reactive protein for the risk of developing hypertension in women.
Hypertension 2007;49:304-310.

39.
Cani PD, Amar J, Iglesias MA, et al.
Metabolic endotoxemia initiates obesity and insulin resistance.
Diabetes 2007;56:1761-1772.

40.
Janket SJ, Wightman A, Baird AE, Van Dyke TE, Jones JA.
Does periodontal treatment improve glycemic control in diabetic patients?
A meta-analysis of intervention studies.
J Dent Res 2005;84:1154-1159.

41.
Grossi SG, Skrepcinski FB, DeCaro T, et al.
Treatment of periodontal disease in diabetics reduces glycated hemoglobin.
J Periodontol 1997;68:713-719.

42.
The National Health and Nutrition Survey in Japan.Tokyo:
Office for Life-Style Related Diseases Control General Affairs Division Health Service Bureau Ministry of Health, Labour, and Welfare; 2006:72-73.
Correspondence:
Dr. Masafumi Motohashi,
Department of Oral Health Sciences, Nihon University School of Dentistry,
1-8-13 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8310,
Japan. Fax: 81-3-3219-8138;
e-mail: motohashi@dent.nihon-u.ac.jp.
Submitted October 23, 2009;
accepted for publication December 11, 2009.

==========
Table 1.
Association Between One or More Positivity of Metabolic-Syndrome Components in 2006 and Oral Condition in 2002

====
Subjects in 2006 (n [%])
Oral Condition
in 2002
No Positive
Components
(n = 788 [77.0%])
One or More
Positive Components
(n = 235 [23.0%]) OR (95% CI)*
Periodontal pockets
Without pockets 656 (80.2) 162 (19.8) 1
With pockets 132 (64.4) 73 (35.6) 1.6 (1.1 to 2.2)†
Missing teeth
None 656 (78.2) 183 (21.8) 1
One or more 132 (71.7) 52 (28.3) 1.0 (0.6 to 2.0)
Carious teeth
None 739 (77.1) 219 (22.9) 1
One or more 49 (75.4) 16 (24.6) 1.1 (0.7 to 1.6)
* Adjusted for age, gender, smoking habit, exercise, eating between meals, and healthy body weight.
† P <0.05

===========
Table 2.
Association Between Each Number of Positive Components of Metabolic Syndrome in 2006 and Oral Condition in 2002

========
Subjects in 2006 (n [%]) OR (95% CI)*
Oral Condition
in 2002
No Positive
Components
(n = 788 [ 77.0%])
One Positive
Component
(n = 186 [18.2%])
Two Positive
Components
(n = 41 [4.0%])
Three Positive
Components
(n = 8 [0.8%])
One
Positive
Component
Two or More
Positive
Components
Periodontal pockets
Without pockets 656 (80.2) 132 (16.1) 27 (3.3) 3 (0.4) 1 1
With pockets 132 (64.4) 54 (26.3) 14 (6.8) 5 (2.5) 1.4 (1.0 to 2.1) 2.2 (1.1 to 4.1)†
Missing teeth
None 656 (78.2) 146 (17.4) 30 (3.6) 7 (0.8) 1 1
One or more 132 (71.7) 40 (21.7) 11 (6.0) 1 (0.6) 1.0 (0.6 to 1.5) 1.2 (0.4 to 3.6)
Carious teeth
None 739 (77.1) 174 (18.2) 37 (3.9) 8 (0.8) 1 1
One or more 49 (75.4) 12 (18.5) 4 (6.1) 0 (0) 1.3 (0.4 to 3.6) 1.1 (0.5 to 2.1)
* Adjusted

=========
Table 3.
Association Between Obesity in 2006 and Oral Condition in 2002

========

Subjects in 2006 (n [%])
Oral Condition
in 2002
Non-Obese
(n = 950 [92.9%])
Obese
(n = 73 [ 7.1%])
OR
(95% CI)*
Periodontal pockets
Without pockets 767 (93.8) 51 (6.2) 1
With pockets 183 (89.3) 22 (10.7) 1.7 (1.0 to 3.0)
Missing teeth
None 779 (92.9) 60 (7.1) 1
One or more 171 (92.9) 13 (7.1) 1.2 (0.6 to 2.3)
Carious teeth
None 891 (93.0) 67 (7.0) 1
One or more 59 (90.8) 6 (9.2) 1.3 (0.5 to 3.0)
* Adjusted for age, gender, smoking habit, exercise, eating between meals, and healthy body
weight

============
Table 4.
Association Between Hypertension in 2006 and Oral Condition in 2002

======
Subjects in 2006 (n [%])
Oral Condition
in 2002
Non-Hypertensive
(n = 883 [86.3%])
Hypertensive
(n = 140 [13.7%])
OR
(95% CI)*
Periodontal pockets
Without pockets 726 (88.8) 92 (11.3) 1
With pockets 157 (76.6) 48 (23.4) 1.5 (1.0 to 2.3)†
Missing teeth
None 736 (87.7) 103 (12.3) 1
One or more 147 (79.9) 37 (20.1) 1.3 (0.8 to 2.0)
Carious teeth
None 826 (86.2) 132 (13.8) 1
One or more 57 (87.7) 8 (12.3) 1.1 (0.5 to 2.7)
* Adjusted for age, gender, smoking habit, exercise, eating between meals, and healthy body
weight.
† P <0.05.

========

Table 5.
Association Between Lipid Abnormality in 2006 and Oral Condition in 2002

===
Subjects in 2006 (n [%])
Oral Condition
in 2002


No Lipid
Abnormality
(n = 954 [93.3%])
With Lipid
Abnormality
(n = 69 [6.7%]) OR (95% CI)*
Periodontal pockets
Without pockets 774 (94.6) 44 (5.4) 1
With pockets 180 (87.8) 25 (12.2) 1.9 (1.1 to 3.2)†
Missing teeth
None 782 (93.2) 57 (6.8) 1
One or more 172 (93.5) 12 (6.5) 1.4 (0.7 to 2.9)
Carious teeth
None 893 (93.2) 65 (6.8) 1
One or more 61 (93.9) 4 (6.2) 1.3 (0.5 to 4.3)
* Adjusted for age, gender, smoking habit, exercise, eating between meals, and healthy body weight.
† P <0.05.

=========

Table 6.
Association Between Hyperglycemia in 2006 and Oral Condition in 2002

=======
Subjects in 2006 (n[%])
Oral Condition
in 2002
Non-Hyperglycemic
(n = 1,013 [99.0%])
Hyperglycemic
(n = 10 [1.0%]) OR (95% CI)*
Periodontal pockets
Without pockets 810 (99.0) 8 (1.0) 1
With pockets 203 (99.0) 2 (1.0) 1.4 (1.0 to 2.1)
Missing teeth
None 832 (99.2) 7 (0.8) 1
One or more 181 (98.4) 3 (1.6) 1.0 (0.6 to 1.5)
Carious teeth
None 950 (99.2) 8 (0.8) 1
One or more 63 (96.9) 2 (3.1) 4.6 (0.7 to 20.6)
* Adjusted for
=========
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2007年05月12日

1年以上放置してました

なんとなく再開しました。
seesaaの画面が一新していて、
いかに放置していたかを痛感。

最近はmixiばかりしてましたが、
こちらも時々更新しようと思います。

posted by 繭玉 at 12:15| 新潟 ☁| Comment(26) | TrackBack(0) | 日記 | このブログの読者になる | 更新情報をチェックする

2006年03月06日

昨日の写真です。

以下、劇団電脳部への私信です。
続きを読む
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2006年01月25日

カンガルーポンプのモニター。

今日から1週間程、デモ機を借りて試用してみることになりました。
写真は後ほどアップします。
続きを読む
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2006年01月01日

今年のおみくじ。

新年明けましておめでとうございます。
で、近所の神社で御参りと御神籤を引きに行きました。
引く前から気になっていた項目は、
病気・家庭・願望
結果が気になった項目は、
恋愛・旅行・失物

色々な意味で身につまされる結果となりました。




御神籤を読む
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2005年12月30日

忘年会でした。

個人的に思い入れのある今年の劇団の忘年会。
そういえば、術後3回目になりますが、
自分なりの食べられる範囲が段々広がってきています。

続きを読む
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2005年12月22日

新潟県内大停電。

すごかったですね、停電。

(メール投稿情報)
http://www.niigata-nippo.co.jp/teiden/teiden.html

(新潟大停電動画ニュース)
http://www.niigata-nippo.co.jp/movie/teiden.wmv

(新潟日報top)
http://www.niigata-nippo.co.jp/index.html



続きを読む
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2005年09月11日

病院にもとめるもの。

久々のサインイン。
ブログって面倒で。
これじゃダメダメですねぇ。

今日は某掲示板から拾ってきたネタ。
続きを読む
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2005年08月27日

再燃したかもという時

久しぶりのブログです。
書きたいことは色々あるのに、そんな時ほど忙しい。。。

再燃するかも・・・と思うときのポイントの私の現在のランキング。



続きを読む
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2005年08月02日

お昼は頂き物で。

同僚の富山土産と先生の頂き物のおすそ分けのおせんべい。
どちらもオミヤにしようと思いつつ、一人お昼だったのでつい、食べてしまう。
続きを読む
posted by 繭玉 at 23:45| Comment(0) | TrackBack(0) | 日記 | このブログの読者になる | 更新情報をチェックする

2005年08月01日

今日からブログスタート。

昨日、散々悩んだ挙句に白羽の矢を立てたseesaaでのブログ立ち上げ。
ブログの面倒なところは、その日のうちに書かないといけない所。
さるさるなら、平気で前の週の分とか書いてたんだけど、そうはいかないらしい。

写真のアップとか色々出来るみたいだけど、それはそのうち。

まぁ、いつまで持つか。試してみてます。
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