Periodontal health could be a modifiable risk factor in the development of age-related macular degeneration, according to new research.
In a systematic review and meta-analysis, researchers analyzed data from 149,217 patients across 7 studies to evaluate whether a diagnosis of periodontitis is associated with prevalent or incident age-related macular degeneration (AMD). The included studies varied in design, geographic location, and diagnostic methods but consistently explored the link between oral health and retinal disease.
The odds ratio (OR) for AMD in patients with periodontitis was 1.42. “It is worthwhile to consider the impact of an OR of 1.42 on the association between periodontitis and AMD,” wrote Sophie Boberg-Ans, of Nord Specialtandlæger in Denmark, and colleagues.
The five cross-sectional and two case–control studies in the review originated from the U.S., Finland, Italy, South Korea, the UK, and Taiwan. Diagnostic assessments of periodontitis ranged from clinical exams to patient questionnaires and ICD coding. AMD diagnoses utilized optical coherence tomography, fundus photography, registry codes, or participant self-reporting. Despite methodological variation, most studies adjusted for potential confounders such as age, smoking, hypertension, cardiovascular disease, and diabetes.
Three studies evaluated the role of age in modulating the association. In one, investigators reported that the link between severe periodontitis and AMD was significant only in those aged up to 62 years of age. In a second study, investigators noted the association was significant up to 60 years of age, and the third found increased AMD risk in patients with periodontitis regardless of age group, though AMD risk increased with age generally.
Periodontitis induces systemic low-grade inflammation—characterized by elevated cytokines such as interleukin-1, interleukin-6, and tumor necrosis factor alpha. These inflammatory mediators are also elevated in patients with AMD. The meta-analysis also cited systemic C-reactive protein as a shared marker between both diseases. Previous studies have demonstrated that inflammation correlates with AMD onset and progression, particularly in neovascular cases.
“A history of smoking is [also] associated with AMD at an OR of 1.78 to 3.58, and a history of regular physical activity is associated with AMD at an OR of 0.59 to 0.92," noted Boberg-Ans and colleagues. Patients who are at risk of AMD should be advised to avoid smoking and exercise regularly. “This advice also possesses a biological plausibility, as it may modify the level of low-grade systemic inflammation."
Interventional dental care appears to be a viable option for at-risk patients; however, additional research is needed to gain more precise insight into its potential role in reducing the risk of AMD.
Limitations such as diagnostic inconsistency, potential confounding, and observational study designs were acknowledged. "However, it should be noted that our sensitivity analyses showed robustness in the conclusion of a positive association between periodontitis and AMD," noted the researchers.
Further studies should focus on modulating AMD risk by eliminating periodontitis in patients who have it.
A full list of author disclosures can be found in the published research.
Source: Journal of Personalized Medicine
