Periodontitis and the subsequent risk of glaucoma: results from the real-world practice.

Periodontitis is a multifactorial inflammatory disease that can cause tooth loss and contribute to systemic inflammation. It is suggested that periodontitis may be associated with the development of glaucoma. Based on data from Taiwan's National Health Insurance Research Database, a retrospective cohort study was conducted to investigate the risk of developing glaucoma in patients with periodontitis. The periodontitis cohort consisted of newly diagnosed adult patients (n = 194,090, minimum age = 20 years) between 2000 and 2012. The comparison group included age-, gender-, and diagnosis date-matched people without periodontitis (n = 194,090, minimum age = 20 years). Incident glaucoma was monitored until the end of 2013. Hazard ratios (HRs) with confidence intervals (CIs) were established based on the Cox proportional hazard models. The risk of developing glaucoma was higher in patients with periodontitis than those without periodontitis (31.2 vs. 23.3 patients per 10,000 person-years, with an adjusted HR of 1.26 [95% CI 1.21-1.32]). A high risk was evident even after stratifying by age (adjusted HRs = 1.34 [1.26-1.44] for ages 20-49, 1.24 [1.13-1.36] for ages ≥ 65, and 1.20 [1.12-1.29] for ages 50-64 years), sex (adjusted HRs = 1.33 [1.24-1.41] and 1.21 [1.14-1.28] for men and women, respectively), presence of comorbidity (adjusted HRs = 1.38 [1.29-1.47] and 1.18 [1.12-1.25] for without and with comorbidity, respectively), and corticosteroid use (adjusted HRs = 1.27 [1.21-1.33] and 1.21 [1.08-1.35] for without and with corticosteroid use, respectively). Specifically, patients with periodontitis exhibited a significantly high risk of primary open-angle glaucoma (adjusted HR = 1.31 [1.21-1.32]) but not for primary closed-angle glaucoma (adjusted HR = 1.05 [0.94-1.17]). People with periodontitis are at a greater risk of glaucoma than individuals without periodontitis. Ocular health should be emphasized for such patients, and the underlying mechanisms need further investigation.

RISK OF AGE-RELATED MACULAR DEGENERATION IN PATIENTS WITH PERIODONTITIS: A Nationwide Population-Based Cohort Study.

PURPOSE: Periodontitis is an inflammatory disease that results in loss of connective tissue and bone support. Evidence shows a possible relationship between periodontitis and age-related macular degeneration (AMD). METHODS: This population-based cohort study was conducted using data from the National Health Insurance Research Database in Taiwan, with a 13-year follow-up, to investigate the risk of AMD in patients with periodontitis. The periodontitis cohort included patients with newly diagnosed periodontitis between 2000 and 2012. The nonperiodontitis cohort was frequency-matched with the periodontitis cohort by age and sex, with a sample size of 41,661 in each cohort. RESULTS: Patients with periodontitis had an increased risk of developing AMD compared with individuals without periodontitis (5.95 vs. 3.41 per 1,000 person-years, adjusted hazard ratio = 1.58 [95% confidence interval, 1.46-1.70]). The risk of developing AMD remained significant after stratification by age (adjusted hazard ratio = 1.48 [1.34-1.64] for age <65 years and 1.76 [1.57-1.97] for age ≥65 years), sex (adjusted hazard ratio = 1.40 [1.26-1.55] for women and 1.82 [1.63-2.04] for men), and presence of comorbidity (adjusted hazard ratio = 1.52 [1.40-1.66] for with comorbidity and 1.92 [1.63-2.26] for without comorbidity). In addition, patients with periodontitis showed an increased incidence for both nonexudative type AMD (5.43 vs. 3.13 per 1,000 person-years) and exudative type AMD (0.52 vs. 0.28 per 1,000 person-years). CONCLUSION: People with periodontitis could be at a greater risk of developing AMD than those without periodontitis. However, we need more evidence to support this association.

The association between Type 1 diabetes mellitus and periodontal diseases.

BACKGROUND/PURPOSE: Type 1 diabetes mellitus (T1DM) is a chronic autoimmune disease affecting oral health. Evidence shows possible association between T1DM and periodontal diseases (PDs). We conducted a nationwide population-based study in Taiwan, with a 14-year follow-up to investigate the risk of PDs in T1DM patients. METHODS: We used data from the National Health Insurance Research Database in Taiwan. The T1DM cohort was identified with newly diagnosed T1DM from 1998 to 2011. The non-T1DM cohort was frequency matched with the T1DM cohort. Participants comprised 4248 patients in the T1DM cohort and 16992 persons in the non-T1DM cohort. RESULTS: The T1DM patients showed an increased risk of PDs compared to non-T1DM individuals [adjusted hazard ratio (aHR) = 1.45]. T1DM patients who visited the emergency room more than twice per year had a higher aHR of 13.0 for developing PDs. The aHR for PDs was 13.2 in the T1DM patients who had been hospitalized more than twice per year. CONCLUSION: T1DM patients are at higher risk of developing PDs than non-T1DM individuals. Our results further showed that the number of T1DM interventions; that is, annual emergency visits and hospitalizations were associated with increased the risk of developing PDs.

Bite-force difference among obese adolescents in central Taiwan.

BACKGROUND/PURPOSE: Maximal bite force of the jaw can cause thorough food chewing and result in good digestion. Bite force is related to the health of the masticatory muscles. Muscle force is frequently affected by obesity in adolescence, however, little is known about how obesity influences the maximum bite force and the difference between genders. METHODS: Five hundred and seventy-seven adolescent students (292 girls and 285 boys), aged 13-16 years, from central Taiwan were recruited for a cross-sectional study in 2009. The maximum bite force, hand strength, triceps skin-fold fat thickness, serum level of testosterone, and body mass index (BMI) were measured. Dental health was evaluated based on malocclusion and dental caries. RESULTS: Bite force in girls was highest in the obese group (32.49 ± 19.13 kg, mean ± standard deviation), whereas in boys it was higher in the overweight group (41.89 ± 19.3 kg) than in the obese group (33.21 ± 17.12 kg). The prevalence of obesity was twofold higher in boys (14.39%) than in girls (7.88%). The mean serum level of testosterone increased with BMI in girls (p = 0.0172), whereas it decreased with BMI in boys (p = 0.0014). The relationships of serum testosterone level and bite force with BMI were similar in the two gender groups. CONCLUSION: The maximum bite force decreased in obese boys but increased in obese girls, which may be due to the sensitivity to testosterone being modulated by the fat level.

Effect of t'ai chi exercise on biochemical profiles and oxidative stress indicators in obese patients with type 2 diabetes.

OBJECTIVE: This study aimed to validate the effects of a simplified, gentle form of t'ai chi chuan in patients with type 2 diabetes and who are also obese. DESIGN: The study was designed to be a randomized controlled trial. SETTING: This study was conducted in the department of metabolism and endocrinology at Cheng Ching Hospital, in Taichung, Taiwan. SUBJECTS: The study subjects were hospital-based patients with type 2 diabetes and who were also obese (ages 40-70, with a body-mass index [BMI] range of 30-35). The patients were randomly selected and grouped into t'ai chi exercise (TCE) and conventional exercise (CE) groups. INTERVENTIONS: After receiving instruction in t'ai chi, the TCE group and the CE group practiced three times per week, including one practice session lasting up to 1 hour, for 12 weeks. OUTCOME MEASURES: Hemoglobin A1C, serum lipid profile, serum malondialdehyde, and C-reactive protein were measured. Physical parameters of body weight and BMI were also measured. Diet and medications of participants were monitored carefully while biochemical and physical conditions were analyzed. RESULTS: After 12 weeks, hemoglobin A1C values of the TCE group did not decrease (8.9 ± 2.7% : 8.3 ± 2.2%; p = 0.064). BMI (33.5 ± 4.8 : 31.3 ± 4.2; p = 0.038) and serum lipids, including triglyceride (214 ± 47 mg/dL : 171 ± 34 mg/dL; p = 0.012) and high density lipoprotein cholesterol (38 ± 16 mg/dL : 45 ± 18 mg/dL; p = 0.023) had significant improvements. Serum malondialdehyde tended to decrease from baseline (2.66 ± 0.78 µmol/L : 2.31 ± 0.55 µmol/L; p = 0.035), and C-reactive protein also decreased (0.39 ± 0.19 mg/dL : 0.22 ± 0.15 mg/dL; p = 0.014). No improvements occurred in BMI, lipids, and oxidative stress profiles in the CE group. CONCLUSIONS: T'ai chi exercise practiced by patients who are obese and have type 2 diabetes is efficient and safe when supervised by professionals and helps improve parameters, such as BMI, lipid profile, C-reactive protein, and malondialdehyde. Periodic monitoring of blood glucose, blood pressure, heart rate, breathing, physical fitness, and symptoms of discomfort of patients who exercise helps prevent injury. Simple, gentle TCE can be applied as regular daily exercise for patients with type 2 diabetes even when such patients are obese.