Are Hill's criteria for causality satisfied for vitamin D and periodontal disease?

Figures & data

Table 1 Regression results for tooth loss for data in Dunning (1953)71

Number of states	UVB (β, p)	Urban (β, p)	T July (β, p)	Adj. R^2, F, p
48	−0.72*	0.39*		0.64, 42*
47	−0.55*		−0.25, 0.08	0.52, 26*
47		0.37, 0.001	−0.60	0.48, 22*

* p < 0.001.

Table 2 Associations of periodontal disease with chronic and infectious diseases themselves known to be associated with hypovitaminosis D

Disease or health outcome	Study parameters	Findings:- Risk/Odds/Hazard Ratio [95% confidence interval]	Reference
Cardiovascular disease	215 epidemiological studies, 47 were observational 29 of these suitable for meta-analysis. 16,720 subjects in cross-sectional studies, 1,464 cases, 1,726 controls and 147,821 in cohort studies.	Pooled OR calculated from 22 case-control & cross-sectional studies 2.35 [1.87; 2.96; p < 0.0001]. RR for incident cardiovascular disease in the 7 cohort studies = 1.34 [1.27; 1.42; p < 0.0001].	96
Coronary heart disease	Meta-analysis of risk of PD with elevated markers of systemic bacterial exposure Total N of subjects = 12,074	OR = 1.75 [1.32; 2.34; p < 0.001]	114
Cognitive function	NHANES 2001 to 2002. 803 dentate participants aged 60 or older, completing periodontal and cognitive examination.	OR = 0.69 [0.51; 0.94] per/standard deviation (SD) increase in the DSST score	115
Pneumonia	Cohort study of 277 men and 420 women aged 80 years old examined in Japan in 1997.	OR for death from pneumonia (adjusted) = 3.9 in those with 10 or more teeth and with pockets >4 mm deep vs. those with 10 or more teeth but without pockets.	100
Cancers	Cohort study with 48,375 men and 18 years of follow-up were available (1986 to January 31, 2004; median follow-up 17.7 yrs), during which time 5,720 incident cancer cases were documented (excluding nonmelanoma skin cancer and nonaggressive prostate cancer).	By cancer site, significant associations for those with periodontal disease were found for lung (1.36 [1.15–1.60]), kidney (1.49 [1.12–1.97]), pancreas (1.54 [1.16–2.04]) and haematological cancers (1.30 [1.11–1.53]). Fewer teeth at baseline (0–16) marked OR for lung cancer of 1.70 [1.37–2.11], for those with 0–16 teeth vs. those with 25–32 teeth. In never-smokers, periodontal disease was associated with increases in total (1.21 [1.06–1.39]) and haematological cancers (1.35 [1.01–1.81]). But not for lung cancer (0.96 [0.46–1.98]).	93
	Review of approximately 40 studies	The most consistent risk increases were seen for oral and esophageal cancers in periodontal disease. Gastric and pancreatic cancers were associated in some but not all studies. Lung, prostate, hematologic and other cancers were not consistently associated or there were too few studies for analysis.	94

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