In the JournalsPerspective

Periodontal disease may be risk factor for AMD

Periodontal diseases are a possible additional risk factor for age-related macular degeneration; however, the link between the two remains unclear, according to a literature review published in The Permanente Journal.

Recent studies have shown that AMD and periodontal diseases (PDs) have been associated with similar biomarkers, said the authors.

A study by Hong and colleagues found that people with high C-reactive protein levels have double the risk of developing advanced AMD. Kauppinen and colleagues found that proinflammatory cytokines interleukin (IL)-1, IL-6, and tumor necrosis factor can promote the development of AMD.

PDs are known to induce chronic inflammation, and also have been associated with elevated biomarkers such as C-reactive protein, IL-1, IL-6 and tumor necrosis factor, said the authors.

Brzozowska and Puchalska-Niedba were the first to report about periodontal status and AMD in a 2012 study of 56 patients between the ages of 45 and 90 years with AMD. They found many lesions in the patients’ oral cavities that were mainly located in the periodontal tissue.

In a 2013 study of 1,751 individuals 30 years old and older, Karesvuo and colleagues found that people with AMD had fewer teeth and more alveolar bone loss than participants without AMD.

A 2015 study by Wagley and colleagues, using data from the U.S. Third National Health and Nutritional Examination Survey (NHANES III), found that PD was independently associated with AMD only in the “youngest group” (40-60 years), but not the “oldest group” (older than 60 years).

A similar study was published in 2017 by Shin and colleagues where they enrolled 13,702 adults who were at least 40 years old from the Korean NHANES. The researchers found a significant link between severe PD and AMD in the youngest group (younger than 62 years). They found no significant association between PD and AMD in the oldest age group (62 years and older).

According to the authors, the significant association between PDs and AMD only in the youngest individuals can be explained either by PDs having a role in the earlier stages of AMD or by covariates increasing with age diluting the effect of PDs on individuals 60 years and older.

Although the link between the two is still unclear, PD and AMD share similar risk factors such as inflammation disorders, advanced age, smoking habits and diabetes, said the authors. More studies are needed for better understanding of the relationship between PD and AMD. – by Kaitlin McGee

References:

Brzozowska A, et al. Klin Oczna. 2012;114(1):29-32.

Hong T, et al. Surv Ophthalmol. 2011;doi:10.1016/j.survophthal.2010.08.007.

Karesvuo P, et al. J Periodontal. 2012;doi:10.1902/jop.2012.110643.

Kauppinen A, et al. Cell Mol Life Sci. 2016;doi:10.1007/s00018-016-2147-8.

Shin YU, et al. Medicine (Baltimore). 2017;doi:10.1097/MD.0000000000006418.

Wagley S, et al. Retina. 2015;doi:10.1097/IAE.0000000000000427.

Disclosures: The authors report no relevant financial disclosures.

Periodontal diseases are a possible additional risk factor for age-related macular degeneration; however, the link between the two remains unclear, according to a literature review published in The Permanente Journal.

Recent studies have shown that AMD and periodontal diseases (PDs) have been associated with similar biomarkers, said the authors.

A study by Hong and colleagues found that people with high C-reactive protein levels have double the risk of developing advanced AMD. Kauppinen and colleagues found that proinflammatory cytokines interleukin (IL)-1, IL-6, and tumor necrosis factor can promote the development of AMD.

PDs are known to induce chronic inflammation, and also have been associated with elevated biomarkers such as C-reactive protein, IL-1, IL-6 and tumor necrosis factor, said the authors.

Brzozowska and Puchalska-Niedba were the first to report about periodontal status and AMD in a 2012 study of 56 patients between the ages of 45 and 90 years with AMD. They found many lesions in the patients’ oral cavities that were mainly located in the periodontal tissue.

In a 2013 study of 1,751 individuals 30 years old and older, Karesvuo and colleagues found that people with AMD had fewer teeth and more alveolar bone loss than participants without AMD.

A 2015 study by Wagley and colleagues, using data from the U.S. Third National Health and Nutritional Examination Survey (NHANES III), found that PD was independently associated with AMD only in the “youngest group” (40-60 years), but not the “oldest group” (older than 60 years).

A similar study was published in 2017 by Shin and colleagues where they enrolled 13,702 adults who were at least 40 years old from the Korean NHANES. The researchers found a significant link between severe PD and AMD in the youngest group (younger than 62 years). They found no significant association between PD and AMD in the oldest age group (62 years and older).

According to the authors, the significant association between PDs and AMD only in the youngest individuals can be explained either by PDs having a role in the earlier stages of AMD or by covariates increasing with age diluting the effect of PDs on individuals 60 years and older.

Although the link between the two is still unclear, PD and AMD share similar risk factors such as inflammation disorders, advanced age, smoking habits and diabetes, said the authors. More studies are needed for better understanding of the relationship between PD and AMD. – by Kaitlin McGee

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References:

Brzozowska A, et al. Klin Oczna. 2012;114(1):29-32.

Hong T, et al. Surv Ophthalmol. 2011;doi:10.1016/j.survophthal.2010.08.007.

Karesvuo P, et al. J Periodontal. 2012;doi:10.1902/jop.2012.110643.

Kauppinen A, et al. Cell Mol Life Sci. 2016;doi:10.1007/s00018-016-2147-8.

Shin YU, et al. Medicine (Baltimore). 2017;doi:10.1097/MD.0000000000006418.

Wagley S, et al. Retina. 2015;doi:10.1097/IAE.0000000000000427.

Disclosures: The authors report no relevant financial disclosures.

    Perspective
    Richard Trevino

    Richard Trevino

    While there is little here that is directly applicable in clinical practice, it is fascinating to learn that these two very different conditions share so much in common. For example, both are age-related, both share smoking as a major risk factor and both are believed to be inflammatory in nature. Given these similarities, it’s not surprising that several epidemiological studies have found significant associations between PD and AMD, but association does not indicate causation. Because the prevalence of PD is so high (60% to 70% of those older than 65 years) compared with AMD (less than 20% of those older than 60 years), PD is not clinically useful as a risk factor for AMD, and referral of AMD patients for dental evaluation does not seem justified.

    • Richard Trevino, OD, FAAO
    • Associate professor
      Director, Residency Programs
      Chief, Ocular Health Service
      Rosenberg School of Optometry

    Disclosures: Trevino reports no relevant financial disclosures.