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Note to Users NOTE TO USERS This reproduction is the best copy available. ® UMI Oral Health of Patients Suffering from Chronic Obstructive Pulmonary Disease and Its Relationship with the Exacerbation Events Mareya AL-Jawder Faculty of Dentistry McGill University, Montreal October 2003 A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirement of the degree of M.Sc. in Dental Sciences © Mareya AL-Jawder 2003 Library and Bibliothèque et 1+1 Archives Canada Archives Canada Published Heritage Direction du Branch Patrimoine de l'édition 395 Wellington Street 395, rue Wellington Ottawa ON K1A ON4 Ottawa ON K1A ON4 Canada Canada Your file Votre référence ISBN: 0-612-98586-5 Our file Notre référence ISBN: 0-612-98586-5 NOTICE: AVIS: The author has granted a non­ L'auteur a accordé une licence non exclusive exclusive license allowing Library permettant à la Bibliothèque et Archives and Archives Canada to reproduce, Canada de reproduire, publier, archiver, publish, archive, preserve, conserve, sauvegarder, conserver, transmettre au public communicate to the public by par télécommunication ou par l'Internet, prêter, telecommunication or on the Internet, distribuer et vendre des thèses partout dans loan, distribute and sell th es es le monde, à des fins commerciales ou autres, worldwide, for commercial or non­ sur support microforme, papier, électronique commercial purposes, in microform, et/ou autres formats. paper, electronic and/or any other formats. The author retains copyright L'auteur conserve la propriété du droit d'auteur ownership and moral rights in et des droits moraux qui protège cette thèse. this thesis. Neither the thesis Ni la thèse ni des extraits substantiels de nor substantial extracts from it celle-ci ne doivent être imprimés ou autrement may be printed or otherwise reproduits sans son autorisation. reproduced without the author's permission. ln compliance with the Canadian Conformément à la loi canadienne Privacy Act some supporting sur la protection de la vie privée, forms may have been removed quelques formulaires secondaires from this thesis. ont été enlevés de cette thèse. While these forms may be included Bien que ces formulaires in the document page count, aient inclus dans la pagination, their removal does not represent il n'y aura aucun contenu manquant. any loss of content from the thesis. ••• Canada ABSTRACT Patients suffering from severe COPD encounter frequent episodes of exacerbations. The anatomical continuity between the oral cavity and the lung makes it a potential reservoir for respiratory pathogens that could be aspirated and cause the exacerbations. The objective of this pilot study was to determine the association between the oral health, oral hygiene in particular and the frequency of exacerbations. The study inc1uded 55 patients with severe COPD. Data were collected using various questionnaires and examinations. The results showed that poor oral hygiene was correlated significantly with the increase in number of exacerbations. There was a trend towards bad oral health in patients with high frequency of exacerbations however it was not significantly different between the two groups of low and high frequency of exacerbations. The results of bivariate and multiple logistic regression showed no statistical significant association between oral hygiene status and the frequency of exacerbations. 11 RÉSUMÉ Les patients qui souffrent de MPCO sévère éprouvent de fréquents épisodes d'aggravation. Le lien anatomique direct entre la cavité buccale et les poumons offre un réservoir éventuel aux agents pathogènes du système respiratoire qui sont aspirés et qui peuvent causer des exacerbations. L'objectif de cette étude pilote était de déceler une association éventuelle entre la santé bucco-dentaire, 1'hygiène buccale tout particulièrement et la fréquence des épisodes d'aggravation. L'étude incluait 55 patients démontrant de sévères symptômes de la MPCO. Les données ont été recueillies à l'aide de différents questionnaires et examens. Les résultats démontrent qu'une pauvre hygiène buccale est corrélée de façon significative à la fréquence élevée d'épisodes d'aggravation. On remarque que les patients sujets aux exacerbations fréquentes démontrent une tendance à souffrir de mauvaise santé bucco-dentaire, toutefois, aucune différence significative n'a été démontrée entre le groupe à faible fréquence et celui à fréquence élevée d'épisodes d'aggravation. Le résultat des analyses à deux dimensions et de régression logistique multiple ne démontre aucune association statistiquement significative entre l'hygiène buccale et la fréquence des épisodes d'aggravation. 111 AKNOWLEGMENT 1 would like to thank Dr. Jean Bourbeau for his immense assistance and guidance in evaluating my thesis in short time and 1 would like to thank Dr. Philippe Mojon for his support and guidance through out the research. Thanks to Dr. Jocelyne Feine for her attention and ensuring that every thing necessary was done for my graduation. My thanks go to the research assistances: Palmina, Chantal, and Jonathan for their help in recruiting the patients. Also 1 would like to thank aH the patients of my study who truly and anonymously donated sorne oftheir time to give me data for my research project. Special recognition goes to Christiane Trudeau and my friend Catherine Bourguinat for their help in the French translation. Thanks to Patricia Bassett for answering my question regarding administrative matters. Last but not least, my deepest thanks to my husband Fawzi for his patience and love and for the continuous support and encouragement 1 needed to complete my thesis, to my little daughter Aysha for her patience on me for being away from her most of the time during those two years, and to my family for their prayers and faith in me. IV TABLE OF CONTENT Page .. ABSTRACT n ... RESUME III . AKNOWLEGMENT IV LIST OF TABLES vnl... LIST OF FIGURES x INTRODUCTION 1 1. LITERITURE REVIEW 3 1.1. Chronic Obstructive Pulmonary Disease (COPD) 3 1.1.1. Definition of COPD 3 1.1.2. Epidemiology of COPD 4 1.1.2.1. Mortality 4 1.1.2.2. Prevalence 5 1.1.2.3. Health service and cost 5 1.1.3. Risk factors for development of COPD 6 1.1.4. Disease Manifestation and Progression 7 1.1.5. Management of COPD 10 1.2. Oral Health and Respiratory Diseases 12 1.2.1. Bacterial role in exacerbated COPD 12 1.2.2. Oral bacteria and respira tory diseases 14 1.2.3. Oral hygiene and respiratory diseases 20 1.2.4. Dental status and respiratory diseases 22 1.2.5. Oral health and COPD 24 v 1.2.6. Summary 27 1.3. Hypothesis and objectives 28 2. METRODS AND MATERIALS 29 2.1. Study Design 29 2.2. Recruitment and Patient Eligibility 29 2.2.1. Recruitment 29 2.2.2. Eligibility Criteria 30 2.3. Data collection 32 2.3.1. Questionnaires 32 2.3.2. Examinations 33 2.3.2.1. Medical examination 33 2.3.2.2.0ral examination 35 2.4. Statistical Analysis 41 2.4.1. The Variables 41 2.4.2. Statistical Methods 44 3. RESULT 46 3.1. Descriptive Analysis 46 3.2. Bivariate Analysis 56 3.2.1. :aivariate analysis using Chi-square and T -test 56 3.2.2. Bivariate analysis using logistic regression 57 3.2.3. Bivariate analysis using Correlations 59 3.3. Multiple Logistic Regressions 64 4. DISCUSSION 67 4.1. Oral hygiene status 68 4.2. Dental status 71 4.3. Strength and Limitations of the study 74 vi 6.5. Future directions 75 5. CONCLUSION 77 6. REFRENCES 78 7. APENDICES A. Other Tables and Figures 88 B. Ethic Certificate and Consent Form 92 C. Oral health questionnaire 99 D. ATS-DLD questionnaire 103 E. SGRQ questionnaire 110 VIl LIST OF TABLES Page Table No.l Chronic obstructive pulmonary disease (COPD) classification by symptoms/disability. 8 Table No.2 Chronic obstructive pulmonary disease (COPD) classification by lung function. 8 Table No.3 Denture plaque index according to Amjborsen et. al 1982. 38 Table No.4 Dental plaque index according Silness and Loe 1964. 38 Table No.5 Gingival index according to Loe and Silness 1963. 39 Table No.6 Calculus index by Ramfjord 1959. 40 Table No.7 List of the variables. 89 Table No.8 Socio-demographic information of the study population according to disease severity. 47 Table No.9 Clinical findings of the study population according to disease severity. 48 Table No.10 Number of past and present comorbid conditions of the study population. 49 Table No.lI Oral findings of the study population according to disease severity. 50 Table No.12 Prosthetic findings of the study population according to disease severity. 51 Table No.13 Oral hygiene status of the study population according to disease severity. 55 Table No.14 Oral hygiene index of the study population according to disease severity. 55 Vlll Table No.15 Odd Ratio and 95% CI from the bivariate analysis using Logistic regression analysis. 58 Table No.16 Correlations of oral findings. 63 Table No.17 Summary oflogistic regression analysis for model Nol. 66 Table No.18 Summary of logistic regression analysis for model No2. 66 ix LIST OF FIGURES Page Figure No.1 The Medical Research Council dyspnea scale. 7 Figure No.2 Location of plaque on maxillary upper denture. 37 Figure No.3 Bar Chart of upper alveolar ridge resorption. 52 Figure No.4 Bar Chart of lower alveolar ridge resorption. 52 Figure No.5 Bar Ch art of upper denture quality. 53 Figure No.6 Bar Chart of lower denture quality. 53 Figure No.7a Diagram of correlation of the outcome (dichotomous). 60 Figure No.7b Diagram of correlation of the outcome (categorical). 60 Figure No.7 Flow Chart for Data Collection Steps. 91 x INTRODUCTION Chronic obstructive pulmonary disease (COPD) represents the fourth common cause of death among the elderly [1].
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