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Daniel Polla, Konstantin Astafurov, Eman Elhawy, Leslie Hyman, John Danias; Dental Health in Glaucoma. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3715.
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To evaluate a possible association between dental health and primary open angle glaucoma (POAG), as recent results suggest that the oral microbiome contributes to glaucoma pathophysiology (Astafurov et al., 2014).
POAG cases (n=120) and controls without glaucoma (n=87) were recruited at SUNY Downstate between 2011 and 2013. Inclusion criteria for the POAG group were open angles, characteristic visual field (VF) defects, and typical optic nerve head (ONH) appearance (cup-to-disc ratio (CDR)>0.8) in at least one eye as determined by a glaucoma specialist. Controls had no current or past intraocular pressure elevation, no significant ONH asymmetry, and CDR<0.5 in both eyes. Data collection included a full ophthalmic examination (including dilated stereoscopic ONH evaluation) and information regarding medical history, dental health, and alcohol and tobacco consumption. POAG severity of each case was assessed by the VF mean deviation of the worse eye.
Cases and controls were similar in frequency of systemic disease (diabetes, hypertension, hypercholesterolemia) as well as alcohol and tobacco consumption (p>0.05, Fisher's exact test), but cases were older than controls by ~6 years (p<.01, t-test) and had a higher proportion of males (47% vs 31%, p<.04, Fisher’s exact test). POAG cases had fewer teeth than controls (18 vs 22, p<.01, t-test) and a higher frequency of edentulism (p<.03, Fisher’s exact test). The relationship between group status and number of teeth persisted in multivariate regression analysis (p<.03), adjusting for sex and age. The number of teeth did not correlate with disease severity. Gingivitis, periodontal disease, or both were similarly prevalent among cases and controls. Within the POAG group, signs of gingivitis and periodontal disease were more prevalent in patients with "mild-moderate” glaucoma than patients with severe disease (35% vs 12%, p<0.01 for gingivitis and 58% vs 36%, p<0.02 for periodontal disease, Fisher's exact test).
Decreased number of teeth (a marker for periodontal disease and dental health) may be associated with POAG. The lack of association between disease severity and number of teeth as well as the negative correlation between periodontal disease and glaucoma severity argues against POAG causing poorer dental health. Dental health may affect glaucoma by leading to chronic inflammation in the oral cavity. Further investigation of the association between dental health and glaucoma is warranted.
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