Association of periodontitis and tobacco use with autoimmune diseases and its radiologic diagnostic challenges with chronic rhinosinusitis

Research output: ThesisDoctoral ThesisCollection of Articles


Chronic periodontitis is an inflammatory disease requiring treatment. Smoking is a significant risk factor for periodontal diseases and many others, including autoimmune diseases and chronic rhinosinusitis. Periodontitis can lead to periodontal-endodontic lesions and may cause chronic rhinosinusitis. To make the right treatment plan for these chronic diseases, diagnosing anatomical structures and pathological signs from radiographs is highly important. This series of investigations focused on several research questions. How does chronic periodontitis associate with autoimmune and autoimmune-related diseases? How does tobacco-product use affect periodontal health? Is tobacco-product use associated with lower education level and mortality? And what kinds of radiologic challenges can be expected when diagnosing radiological signs of periodontitis and anatomical structures in chronic rhinosinusitis patients. Altogether 1 676 randomly selected subjects in Stockholm County, Sweden, joined this study in 1985 and they were followed-up for 30 years for mortality (Studies I and II). Their tobacco use habits and the data from oral examination were recorded at baseline. The Swedish national health registers recorded their hospital and open health-care admissions (World Health Organization [WHO] International statistical classification of diseases and related health problems [ICD] 7, 9 and 10 codes). All subjects were classified into groups: “subjects with autoimmune disease” and “subjects without autoimmune diseases” (Study I); and “current tobacco product users” and “non-users” (Study II). Associations between the diagnosed autoimmune disease and the oral-health variables (Study I), periodontal health parameters, current use of tobacco products, education level and age of death were analyzed (Study II). In study III, the imaging data for 59 randomly selected patients in Helsinki University Hospital, Finland, was used. Radiographical signs of local dentoalveolar bone loss and apical radiolucency were analyzed blinded and inter-imaging accuracy was calculated from computed tomography scans (CT) and panoramic radiographic scans (PTG). Study IV employed the CT data of 57 chronic rhinosinusitis patients from Tampere University Hospital, Finland, to analyze the reproducibility of the Lund-Mackay (LM) scores and 43 other anatomical structures between three professional observers. SPSS was used for all analyses. From the data, 50 patients with diagnosed autoimmune diseases were detected. The plaque index (PI) was significantly higher in the autoimmune disease group compared to non-autoimmune group (≥ median 35 (70%) vs <median 872 (54%), P-value = .030). No statistical difference was found in other periodontal health parameters or use of tobacco products between the groups (Study I). Current tobacco users had poorer periodontal health than non-users. Use of tobacco products associated with higher plaque-, calculus- and gingival index scores compared to non-users (P<.001). They were also more likely to present with deepened periodontal pockets (5 mm) (P<.001) and missing teeth (P = .010) compared with non-users. Tobacco users had lower education level compared with non-users (P<.001), but tobacco-product use did not associate with premature death (Study II). In general, inter-observer agreement in CT and PTG scans with the three other professional observers compared to the oral radiologist was from poor (kappa -0.054) to moderate (kappa 0.455). Based oral-radiologist records, inter-imaging accuracy was moderate (kappa 0.565) to very good (kappa 0.908) (Study III). Between three observers, inter-observer agreement regarding the structures in CT scans was generally moderate by Cohen’s kappa coefficient. Poor reproducibility was observed in the certain surgically important structures, like optic nerve and anterior ethmoidal artery (Study IV). Patients with a higher PI, which characterizes poor oral hygiene, were more likely to develop autoimmune diseases in the long run. Current use of tobacco products has a negative impact on periodontal health parameters and reinforces the perception that tobacco products are risk factors for periodontal diseases. Tobacco-product users are typically less educated than non-users, although, tobacco-product use may not associate with premature death. There is a great variation between professional observers in diagnosing signs of local dentoalveolar bone loss and periapical radiolucency from PTG and CT scans, and anatomical structures in sinus CT scans, which indicates multi-professional consultation before final treatment plan. To diagnose local horizontal bone loss, PTG is as reliable as CT, but not for vertical bone loss or periapical radiolucency.
Original languageEnglish
Place of PublicationHelsinki
Print ISBNs978-951-51-6913-6
Electronic ISBNs 978-951-51-6914-3
Publication statusPublished - 2021
MoE publication typeG5 Doctoral dissertation (article)

Bibliographical note

M1 - 63 s. + liitteet

Fields of Science

  • Chronic Periodontitis
  • +diagnosis
  • +diagnostic imaging
  • +epidemiology
  • Autoimmune Diseases
  • Maxillary Sinusitis
  • +diagnostic Imaging
  • Chronic Disease
  • Periodontal Diseases
  • Mortality
  • Radiography, Panoramic
  • Tomography, X-Ray Computed
  • Educational Status
  • Dental Plaque
  • Alveolar Bone Loss
  • Oral Health
  • Periodontal Pocket
  • Referral and Consultation
  • Tobacco Smoking
  • Tobacco Use
  • Tobacco, Smokeless
  • 313 Dentistry

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