Pekka Ylöstalo

BACKGROUND: Periodontal disease and diabetes mellitus are common, chronic diseases worldwide. Epidemiologic and biologic evidence suggest periodontal disease may affect diabetes. OBJECTIVE: To systematically review non-experimental, epidemiologic evidence for effects of periodontal disease on diabetes control, complications and incidence. DATA SOURCES: Electronic bibliographic databases, supplemented by hand searches of recent and future issues of relevant journals. STUDY ELIGIBILITY CRITERIA AND PARTICIPANTS: Longitudinal and cross-sectional epidemiologic, non-interventional studies that permit determination of directionality of observed effects were included. STUDY APPRAISAL AND SYNTHESIS METHODS: Four reviewers evaluated pair-wise each study. Review findings regarding study results and quality were summarized in tables by topic, using the PRISMA Statement for reporting and the Newcastle-Ottawa System for quality assessment, respectively. From 2246 citations identified and available abstracts screened, 114 full-text reports were assessed and 17 included in the review. RESULTS: A small body of evidence supports significant, adverse effects of periodontal disease on glycaemic control, diabetes complications, and development of type 2 (and possibly gestational) diabetes. LIMITATIONS: There were only a limited number of eligible studies, several of which included small sample sizes. Exposure and outcome parameters varied, and the generalizability of their results was limited. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Current evidence suggests that periodontal disease adversely affects diabetes outcomes, and that further longitudinal studies are warranted.

OBJECTIVE: To study the association between diagnosed dementia and oral health, focusing on the type of dementia, among an elderly population aged 75 years or older. BACKGROUND: Elderly people with dementia are at risk from oral diseases, but to date, only a few studies have analysed the association between type of dementia and oral health, and their results are inconclusive. MATERIALS AND METHODS: This cross-sectional study is based on the Geriatric multi-disciplinary strategy (Gems) study that included 76 demented and 278 non-demented subjects. The data were collected by means of an interview and an oral clinical examination. The type of dementia was diagnosed according to DSM-IV criteria. Poisson's and logistic regression models were used to determine relative risks (RR), odds ratios (OR) and 95% confidence limits (CI). RESULTS: Our results showed that patients with Alzheimer's disease and those with other types of dementia had an increased likelihood of having carious teeth, teeth with deep periodontal pockets, and poor oral and denture hygiene, compared with non-demented persons. The results showed that the type of dementia does not seem to be an essential determinant of oral health. CONCLUSIONS: Among the elderly aged 75 years or older, patients with Alzheimer's disease or other types of dementia are at increased risk of poor oral health and poor oral hygiene.

OBJECTIVES: This multicentered randomized controlled trial evaluated the effect of worksite exercise intervention on perceived work ability and sick leaves. METHODS: Women (N = 260, mean age 40 years) engaged in physically demanding laundry work were individually randomized into an intervention (N = 133) or control (N = 127) group. Perceived work ability was assessed with questionnaires at 3, 8, 12, and 15 months. Sick leave information was obtained from the personnel administration. Follow-up attendance was 100% at 3 months but declined gradually to 90% by 15 months. Both the intervention and control subjects received a 30-minute feedback on their physical capacity from a physiotherapist and individual exercise prescription and counseling. The intervention subjects also participated in worksite exercise training guided by a physiotherapist. Sixty-minute sessions (N = 26) were held once a week for 8 months. About 50% of the intervention group participated in at least two-thirds of the sessions. RESULTS: According to a dichotomized work ability index, at 12 months, workers with "good" or "excellent" work ability increased more in the intervention group than in the control group (11.0%, 95% CI 0.2-21.9), as did the health-related prognosis of work ability at 8 months (8.1%, 95% CI 0.5-16.3). There were no statistically significant differences between the two groups as regards job satisfaction, work ability index (including series of questions on 7 items), or sick leaves. CONCLUSIONS: Physical activity once a week at worksites improves the perceived work ability of women with physically demanding work only slightly. Perceived work ability and sick leaves cannot be affected very positively using single-component exercise intervention. Work ability promotion may need a more multiprofessional approach.

The purpose of this study was to investigate the dental health behavior and self-perceived dental treatment need, in relation to depressive symptoms and symptoms of anxiety, among a general population drawn from a sample of 31-yr-old-men and women born in Northern Finland in 1966 (n = 8463). The dental health behavior included toothbrushing frequency and the frequency of dental check-ups. Depressive symptoms, as well as symptoms of anxiety, were determined on the basis of the Symptom Checklist-25 (SCL-25). The participants were also asked about their education and family income. Subjects with a high number of depressive symptoms had lower toothbrushing frequency as well as a lower frequency of dental visits than subjects with no or only a few depressive symptoms. Morover, the self-perceived dental treatment need was more common among those with a high number of depressive symptoms. Symptoms of anxiety were significantly associated with lower toothbrushing frequency. The results support the view that there is an increased risk for impaired dental health among subjects with depressive symptoms or symptoms of anxiety.

OBJECTIVE: The aim of the study was to investigate the association between serum lipids and periodontal infection and the role of serum lipids in the association between body weight and periodontal infection. MATERIAL AND METHODS: The Health 2000 Health Examination Survey, which included 8028 subjects aged 30 or older living in continental Finland. This study was based on a subpopulation of dentate, non-diabetic subjects who had never smoked and were aged under 50 years (n=1297). Periodontal infection was defined as the presence of teeth with deepened periodontal pockets. Serum levels of triglycerides, high-density lipoprotein (HDL)-cholesterol and low-density lipoprotein (LDL)-cholesterol were analysed enzymatically. RESULTS: We found no consistent association between serum lipid levels and periodontal infection among normoweight subjects. There was an association of high serum triglycerides and low HDL with periodontal infection among obese subjects. The association between body mass index and periodontal infection was not essentially affected by serum lipids. CONCLUSION: In this study population serum lipid levels were not associated with periodontal infection among normoweight subjects. Obese subjects with a high serum triglyceride level and/or a low HDL-cholesterol level could be at higher risk of periodontal infection. Our results suggest that the association between body weight and periodontal infection was mainly mediated through a mechanism other than serum lipids.