Prospective Study of Oral Health and Risk of Primary Open-Angle Glaucoma in Men

Data from the Health Professionals Follow-up Study


      Tooth loss or periodontal disease is associated with systemic endothelial dysfunction, which has been implicated in primary open-angle glaucoma (POAG). The relationship between oral health and POAG has received limited attention. Thus, we evaluated the association between oral health history and risk of POAG and POAG subtypes.


      Prospective cohort study.


      Health Professionals Follow-up Study participants (40 536 men) followed biennially from 1986 to 2012. At each 2-year risk period, eligible participants were aged 40+ years, were free of POAG, and reported eye examinations.


      By using validated questions, we updated participants' status on number of natural teeth, teeth lost, periodontal disease with bone loss, and root canal treatments.

      Main Outcome Measures

      During follow-up, 485 incident cases of POAG were confirmed with medical records and classified into subtypes defined by intraocular pressure (IOP; ≥ or <22 mmHg) or visual field (VF) loss pattern at diagnosis (peripheral loss only or early paracentral loss). Multivariable relative risks (MVRRs) and 95% confidence intervals (CIs) were estimated.


      Number of natural teeth, periodontal disease, and root canal treatment were not associated with POAG. However, compared with no report of tooth loss, a report of losing teeth within the past 2 years was associated with a 1.45-fold increased risk of POAG (95% CI, 1.06–1.97); in particular, a report within the past 2 years of both losing teeth and having a prevalent diagnosis of periodontal disease was associated with a 1.85-fold increased risk of POAG (95% CI, 1.07–3.18). The associations with recent tooth loss were not significantly different for the POAG subtypes ( P for heterogeneity ≥0.36), although associations were strongest in relation to the POAG subtypes with IOP <22 mmHg (MVRR, 1.93; 95% CI, 1.09–3.43) and early paracentral VF loss (MVRR, 2.27; 95% CI, 1.32–3.88).


      Although the number of natural teeth was not associated with risk of POAG, recent tooth loss was associated with an increased risk of POAG. Because these findings may be due to chance, they need confirmation in larger studies.

      Abbreviations and Acronyms:

      CI ( confidence interval), HPFS ( Health Professionals Follow-up Study), HTG ( high-tension glaucoma), IOP ( intraocular pressure), MVRR ( multivariable relative risk), NTG ( normal-tension glaucoma), POAG ( primary open-angle glaucoma), VF ( visual field)
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        • Scannapieco F.A.
        • Dasanayake A.P.
        • Chhun N.
        Does periodontal therapy reduce the risk for systemic diseases?.
        Dent Clin North Am. 2010; 54: 163-181
        • Borgnakke W.S.
        Does treatment of periodontal disease influence systemic disease?.
        Dent Clin North Am. 2015; 59: 885-917
        • Wyss-Coray T.
        • Rogers J.
        Inflammation in Alzheimer disease—a brief review of the basic science and clinical literature.
        Cold Spring Harb Perspect Med. 2012; 2: a006346
        • Hirsch E.C.
        • Hunot S.
        Neuroinflammation in Parkinson’s disease: a target for neuroprotection?.
        Lancet Neurol. 2009; 8: 382-397
        • Linden G.J.
        • Lyons A.
        • Scannapieco F.A.
        Periodontal systemic associations: review of the evidence.
        J Periodontol. 2013; 84: S8-S19
        • Arigbede A.O.
        • Babatope B.O.
        • Bamidele M.K.
        Periodontitis and systemic diseases: a literature review.
        J Indian Soc Periodontol. 2012; 16: 487-491
        • Orlandi M.
        • Suvan J.
        • Petrie A.
        • et al.
        Association between periodontal disease and its treatment, flow-mediated dilatation and carotid intima-media thickness: a systematic review and meta-analysis.
        Atherosclerosis. 2014; 236: 39-46
        • Seinost G.
        • Wimmer G.
        • Skerget M.
        • et al.
        Periodontal treatment improves endothelial dysfunction in patients with severe periodontitis.
        Am Heart J. 2005; 149: 1050-1054
        • Tonetti M.S.
        • D'Aiuto F.
        • Nibali L.
        • et al.
        Treatment of periodontitis and endothelial function.
        N Engl J Med. 2007; 356: 911-920
        • Bartova J.
        • Sommerova P.
        • Lyuya-Mi Y.
        • et al.
        Periodontitis as a risk factor of atherosclerosis.
        J Immunol Res. 2014; 2014: 636893
        • Astafurov K.
        • Elhawy E.
        • Ren L.
        • et al.
        Oral microbiome link to neurodegeneration in glaucoma.
        PLoS One. 2014; 9: e104416
      1. Polla D, Astafurov K, Elhawy E, et al. A pilot study to evaluate the oral microbiome and dental health in primary open angle glaucoma. J Glaucoma [in press].

        • Buys E.S.
        • Ko Y.C.
        • Alt C.
        • et al.
        Soluble guanylate cyclase alpha1-deficient mice: a novel murine model for primary open angle glaucoma.
        PLoS One. 2013; 8: e60156
        • Kang J.H.
        • Willett W.C.
        • Rosner B.A.
        • et al.
        Association of dietary nitrate intake with primary open-angle glaucoma: a prospective analysis from the Nurses' Health Study and Health Professionals Follow-up Study.
        JAMA Ophthalmol. 2016; : 1-11
        • Kang J.W.
        • Park B.
        • Cho B.J.
        Comparison of risk factors for initial central scotoma versus initial peripheral scotoma in normal-tension glaucoma.
        Korean J Ophthalmol. 2015; 29: 102-108
        • Loomis S.J.
        • Kang J.H.
        • Weinreb R.N.
        • et al.
        Association of CAV1/CAV2 genomic variants with primary open-angle glaucoma overall and by gender and pattern of visual field loss.
        Ophthalmology. 2014; 121: 508-516
        • Grobbee D.E.
        • Rimm E.B.
        • Giovannucci E.
        • et al.
        Coffee, caffeine, and cardiovascular disease in men.
        N Engl J Med. 1990; 323: 1026-1032
        • Kang J.H.
        • Loomis S.J.
        • Rosner B.A.
        • et al.
        Comparison of risk factor profiles for primary open angle glaucoma subtypes defined by pattern of visual field loss: a prospective study.
        Invest Ophthalmol Vis Sci. 2015; 56: 2439-2448
        • Douglass C.W.
        • Berlin J.
        • Tennstedt S.
        The validity of self-reported oral health status in the elderly.
        J Public Health Dent. 1991; 51: 220-222
        • Joshipura K.J.
        • Douglass C.W.
        • Garcia R.I.
        • et al.
        Validity of a self-reported periodontal disease measure.
        J Public Health Dent. 1996; 56: 205-212
        • Joshipura K.J.
        • Pitiphat W.
        • Douglass C.W.
        Validation of self-reported periodontal measures among health professionals.
        J Public Health Dent. 2002; 62: 115-121
        • Cox D.R.
        • Oakes D.
        The Analysis of Survival Data.
        Chapman and Hall, London1984
        • Lunn M.
        • McNeil D.
        Applying Cox regression to competing risks.
        Biometrics. 1995; 51: 524-532
        • Cahen P.M.
        • Frank R.M.
        • Turlot J.C.
        A survey of the reasons for dental extractions in France.
        J Dent Res. 1985; 64: 1087-1093
        • Dikbas I.
        • Tanalp J.
        • Tomruk C.O.
        • Koksal T.
        Evaluation of reasons for extraction of crowned teeth: a prospective study at a university clinic.
        Acta Odontol Scand. 2013; 71: 848-856
        • Berlove I.J.
        Chronic simple glaucoma associated with foci of infection of the teeth and right antrum; a case report.
        Oral Surg Oral Med Oral Pathol. 1957; 10: 500-503
        • Gupta A.
        Harnessing the microbiome in glaucoma and uveitis.
        Med Hypotheses. 2015; 85: 699-700
        • Wang J.W.
        • Chen S.D.
        • Zhang X.L.
        • Jonas J.B.
        Retinal microglia in glaucoma.
        J Glaucoma. 2016; 25: 459-465
        • Su W.W.
        • Cheng S.T.
        • Ho W.J.
        • et al.
        Glaucoma is associated with peripheral vascular endothelial dysfunction.
        Ophthalmology. 2008; 115: 1173-1178.e1
        • Fadini G.P.
        • Pagano C.
        • Baesso I.
        • et al.
        Reduced endothelial progenitor cells and brachial artery flow-mediated dilation as evidence of endothelial dysfunction in ocular hypertension and primary open-angle glaucoma.
        Acta Ophthalmol. 2010; 88: 135-141
        • Delaney Y.
        • Walshe T.E.
        • O'Brien C.
        Vasospasm in glaucoma: clinical and laboratory aspects.
        Optom Vis Sci. 2006; 83: 406-414
        • Moore D.
        • Harris A.
        • Wudunn D.
        • et al.
        Dysfunctional regulation of ocular blood flow: a risk factor for glaucoma?.
        Clin Ophthalmol. 2008; 2: 849-861
        • Costalonga M.
        • Herzberg M.C.
        The oral microbiome and the immunobiology of periodontal disease and caries.
        Immunol Lett. 2014; 162: 22-38
        • Segura-Egea J.J.
        • Martin-Gonzalez J.
        • Castellanos-Cosano L.
        Endodontic medicine: connections between apical periodontitis and systemic diseases.
        Int Endod J. 2015; 48: 933-951
        • Kvist T.
        • van der Sluis L.
        Report of the first ESE research meeting—17(th) October 2014, Amsterdam, the Netherlands: the relationship between endodontic infections and their treatment with systemic diseases.
        Int Endod J. 2015; 48: 913-915
      2. Rothman KJ, Greenland S. Precision and Validity in Epidemiologic Studies. In: Rothman KJ, Greenland S, eds. Modern Epidemiology. 2nd ed. Philadelphia, PA: Lippincott-Raven Publishers; 1998:130–1.

        • Susin C.
        • Haas A.N.
        • Albandar J.M.
        Epidemiology and demographics of aggressive periodontitis.
        Periodontol 2000. 2014; 65: 27-45
        • Eke P.I.
        • Dye B.A.
        • Wei L.
        • et al.
        Prevalence of periodontitis in adults in the United States: 2009 and 2010.
        J Dent Res. 2012; 91: 914-920

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