Advanced Dental Cleaning is Associated with Reduced Risk of COPD Exacerbations – A Randomized Controlled Trial

Abstract

Purpose

Infections from the oral microbiome may lead to exacerbations of chronic obstructive pulmonary disease (COPD). We investigated whether advanced dental cleaning could reduce exacerbation frequency. Secondary outcomes were disease-specific health status, lung function, and whether the bacterial load and composition of plaque microbiome at baseline were associated with a difference in outcomes.

Patients and Methods

One-hundred-one primary and secondary care patients with COPD were randomized to intervention with advanced dental cleaning or to dental examination only, repeated after six months. At baseline and at 12 months, data of exacerbations, lung function, COPD Assessment Test (CAT) score, and periodontal status were collected from questionnaires, record review, and periodontal examination. Student’s t-test and Mann–Whitney-U (MWU) test compared changes in outcomes. The primary outcome variable was also assessed using multivariable linear regression with adjustment for potential confounders. Microbiome analyses of plaque samples taken at baseline were performed using Wilcoxon signed ranks tests for calculation of alpha diversity, per mutational multivariate analysis of variance for beta diversity, and receiver operating characteristic curves for prediction of outcomes based on machine learning models.

Results

In the MWU test, the annual exacerbation frequency was significantly reduced in patients previously experiencing frequent exacerbations (p = 0.020) and in those with repeated advanced dental cleaning (p = 0.039) compared with the non-treated control group, but not in the total population including both patients with a single and repeated visits (p = 0.207). The result was confirmed in multivariable linear regression, where the risk of new exacerbations was significantly lower in patients both in the intention to treat analysis (regression coefficient 0.36 (95% CI 0.25–0.52), p < 0.0001) and in the population with repeated dental cleaning (0.16 (0.10–0.27), p < 0.0001). The composition of microbiome at baseline was moderately predictive of an increased risk of worsened health status at 12 months (AUC = 0.723).

Conclusion

Advanced dental cleaning is associated with a reduced frequency of COPD exacerbations. Regular periodontal examination and dental cleaning may be of clinical importance to prevent COPD exacerbations.

Keywords:

• alpha diversity
• periodontal disease
• beta diversity
• health status
• lung function
• plaque microbiome

Data Sharing Statement

Data cannot be made freely available as they are subject to privacy in accordance with the Swedish Public Access to Information and Secrecy Act but can be provided to researchers upon request, subject to a review of privacy. Requests for data can be sent to the corresponding author.

Acknowledgments

We thank Bodil Roth for excellent help with the logistics of the study and Susanne Rundqvist and the rest of the staff at the Public Dental Service in Skåne and Örebro for examining, randomizing, and treating the patients. We are also grateful for help with recruitment at the Departments of Respiratory Medicine in Malmö and Örebro, as well as the health centers Örestadskliniken (respiratory nurse May Bugge), Kroksbäckskliniken (respiratory nurse Hoxhaj Rama Teoreta), Viktoria Park, and Ellenbogen.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

The study was founded by grants from Oral Health Related Research by Region Skåne and the Swedish Dental Public Service of Skåne.