The Association of Gum Bleeding with Respiratory Health in a Population Based Study from Northern Europe

PLoS One. 2016 Jan 25;11(1):e0147518. doi: 10.1371/journal.pone.0147518. eCollection 2016.

Abstract

Background: There is little knowledge about how oral and respiratory health is interrelated even though the mucosa of the oral cavity and airways constitutes a continuum and the exposures to these are partly similar.

Aims: To investigate whether gum bleeding is related to asthma, respiratory symptoms and self-reported COPD.

Methods: A postal questionnaire including questions about respiratory and oral health was sent to general population samples in seven Northern European centres. In 13,409 responders, gum bleeding when brushing teeth was reported always/often by 4% and sometimes by 20%. Logistic regressions accounted for age, smoking, educational level, centre and gender. Effects of BMI, cardio-metabolic diseases, early life factors, gastro-oesophageal reflux, dental hygiene, nasal congestion, and asthma medication were addressed.

Results: Gum bleeding always/often was significantly associated with ≥ 3 asthma symptoms (OR 2.58, 95% CI 2.10-3.18), asthma (1.62 [1.23-2.14]) and self-reported COPD (2.02 [1.28-3.18]). There was a dose-response relationship between respiratory outcomes and gum bleeding frequency (≥ 3 symptoms: gum bleeding sometimes 1.42 [1.25-1.60], often/always 2.58 [2.10-3.18]), and there was no heterogeneity between centres (p(heterogeneity) = 0.49). None of the investigated risk factors explained the associations. The observed associations were significantly stronger among current smokers (p(interaction) = 0.004).

Conclusions: A consistent link between gum bleeding and obstructive airways disease was observed, not explained by common risk factors or metabolic factors. We speculate that oral pathogens might have unfavourable impact on the airways, and that the direct continuity of the mucosa of the oral cavity and the airways reflects a pathway that might provide novel opportunities for interventions.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Asthma / complications*
  • Europe
  • Female
  • Gingival Hemorrhage / complications
  • Gingival Hemorrhage / physiopathology*
  • Humans
  • Male
  • Middle Aged
  • Pulmonary Disease, Chronic Obstructive / complications*

Grants and funding

The RHINE III was supported financially by the Norwegian Research Council (Grant No. 214123), the Bergen Medical Research Foundation, the Western Norwegian Regional Health Authorities (Grant No. 911 892 and 911 631), the Norwegian Labour Inspection, the Norwegian Asthma and Allergy Association, the Faculty of Health of Aarhus University, (Project No. 240008), The Wood Dust Foundation (Project No. 444508795), the Danish Lung Association, the Swedish Heart and Lung Foundation, the Vårdal Foundation for Health Care Science and Allergy Research, the Swedish Council for Working Life and Social Research, the Bror Hjerpstedt Foundation, the Swedish Asthma and Allergy Association, the Icelandic Research Council, Landspitali University Hospital Research Fund, and the Estonian Science Foundation (Grant No. 4350). None of the study sponsors/funders had any role on study design, data collection, data analysis, data interpretation or writing of the report. The corresponding author had full access to all the data in the study and had full responsibility for the decision to submit for publication.