Cystic Fibrosis-Related Diabetes, Periodontitis, and Quality of Life in Adults with Cystic Fibrosis

Abstract

There are few studies on the oral health of individuals with cystic fibrosis (CF), even though poor oral health is a potential contributor to worsening chronic health conditions. Periodontitis, the inflammation of hard tissues that support and anchor the teeth, is a source of infection that could compromise the respiratory health of individuals with CF. Periodontitis is independently associated with increased systemic inflammation and is a complication of diabetes. CF-related diabetes (CFRD) is a common comorbidity of CF impacting up to 50% of adults with CF. Other CF-related comorbidities like asthma and bone diseases as well as CF-related treatments like continued use of inhaled medications can also increase one’s risk for periodontitis. To date, there is no study that evaluated whether CFRD and other CF-related medical factors are associated with increased risk of periodontitis, nor whether the presence of periodontitis impact the quality of life of adults with CF. The main objectives of this dissertation were to: 1) identify CF-related correlates of periodontitis in adults with CF; 2) evaluate the association between CFRD and periodontitis; 3) compare the periodontal health of adults with CF to matched non-CF controls, accounting for diabetes status; and 4) evaluate the impact of periodontitis on the quality of life of adults with CF. We designed a cross-sectional study of adults with CF (age ≥ 18 years) who were recruited from the Adult CF Center at the University of Washington, Seattle, WA, U.S.A. A single study visit was scheduled for study participants at the Regional Clinical Dental Research Center at the University of Washington School of Dentistry. Study visit included a full periodontal examination and self-administered oral health and diet surveys. Periodontitis was defined using the U.S. Centers for Disease Control and Prevention and the American Academy of Periodontology case definition. We assessed the oral health-related quality of life (OHRQoL) for adults with CF using the Oral Health Impact Profile 14 and the cystic fibrosis-related quality of life (CFRQoL) using the Cystic Fibrosis Questionnaire Revised. We utilized the 2013-2014 National Health and Nutrition Examination Survey to form non-CF control groups. Non-CF controls were frequency matched to adults with CF on age, sex, diabetes status, and insulin status. We used the Fisher’s exact test, the Mann-Whitney test, the Kruskal-Wallis test, and the Spearman rank correlation for hypotheses testing. Our analyses did not identify CF-related correlates of periodontitis for adults with CF. Rather, correlates of periodontitis identified in our study are similar to previously reported correlates in the general population. Within the study population with CF, CFRD was not significantly associated with periodontitis. However, compared to healthy non-CF controls, adults with CF with and without CFRD had significantly higher prevalence of periodontitis despite having higher markers of socioeconomic status than healthy non-CF controls. In addition, both CF groups with and without CFRD had similar periodontitis prevalence to non-CF controls with diabetes, even though the non-CF controls with diabetes had significantly higher glucose levels than the two CF groups. Periodontitis was not associated with OHRQoL or CFRQoL for adults with CF. However, our analyses showed disparities in OHRQoL and in CFRQoL for adults with CF by socioeconomic status. Evaluating the impact of CF-related comorbidities and treatments on the periodontal health of adults with CF is the next step to understanding the oral health needs of this medically vulnerable population. Future studies should evaluate if an interaction between different CF-related medical factors explains the difference in periodontitis by CF status found in our study. Furthermore, it is critical to ensure adequate diversity of future study populations with CF–particularly in terms of race, socioeconomic status, dental care access, and CF phenotypes–to identify barriers¬¬ to optimal periodontal health that is general for all adults with CF.