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Preference: Respiratory Medicine

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Is oral health the unspoken determinant?

BY AMA PRESIDENT DR TONY BARTONE

According to the Australian Institute of Health and Welfare’s (AIHW) report Australia’s Health 2012, most people will experience oral health issues at some point in their life. In fact, oral diseases are recurrently among the most frequently reported health problems by Australians.

Considered a disease of affluence up until the late 20th century, poor oral health outcomes have now become an indicator of disadvantage, highlighting a lack of access to preventative services. Insufficient access to, high cost of, or long waiting periods for dental services; and low oral care education, have all been associated with patients not seeking dental care when it is needed. Of course, non-fluoridised water supplies also has a role in explaining the prevalence.

However, more recently, it is the modifiable risk factors like poor nutrition, smoking, substance use, stress, and poor oral hygiene that are considered to have the greatest impacts on periodontal diseases. 

Dental conditions frequently rank in the top 10 potentially preventable acute condition hospital admissions for Aboriginal and Torres Strait Islander people and were the third leading cause of all preventable hospitalisations in 2013-14, with 63,000 admissions.

Like most other health conditions, Aboriginal and Torres Strait Islander people have poorer oral health outcomes. While Indigenous people currently have most of the same oral health risk factors as non-Indigenous people, they are less likely to have the same access to preventative measures, leading to marked disparities in oral health between Indigenous people and other Australians.

While the majority of oral health concerns are often considered inconsequential, such as avoiding certain foods, or cosmetic with people embarrassed about their physical appearance, there is a significant body of evidence which suggests that oral health may be the undiscussed determinant of health.

More than two decades ago, population-based studies identified possible links between oral health status and chronic diseases such as cardiovascular disease (CVD), diabetes, respiratory diseases, stroke, and kidney diseases, as well as pre-term low birthweight. And the relationship appears to lie with inflammation.

It is clear more research is needed to determine the exact links (if any), between periodontal disease and chronic disease condition, however, the growing body of evidence links poor oral health to major chronic illnesses.

The Government has made numerous financial commitments to improving access to dental services, however, oral health data will continue to demonstrate that without equitable access to dental services, Australians, and particularly Aboriginal and Torres Strait Islander people, will continue to suffer poorer oral health outcomes, and potentially poorer health outcomes, as a result. 

The AMA supports improved Doctor/Dentist collaborations if such partnerships could lead to increased early identification of both chronic disease and oral health conditions, particularly for Aboriginal and Torres Strait Islander peoples, for whom oral health services are less frequently accessed.

Dental Health Week is 6-12 August 2018.

[Perspectives] Chen Wang: new President of CAMS and PUMC

Professor Chen Wang, Director of the Centre for Respiratory Medicine at Beijing’s China–Japan Friendship Hospital, is the new President of the Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC). Of the several reasons for welcoming the appointment, the most obvious is Wang’s expertise in the respiratory diseases that are a leading cause of morbidity and mortality in his country and impose a great socioeconomic burden. Moreover, he makes no secret of his enthusiasm for curbing tobacco use, which, while now recognised by the Chinese Government as a key public health issue, remains high.

[Perspectives] Catherine Karr: improving paediatric respiratory health

Catherine Karr, Professor of Pediatrics and Environmental and Occupational Health Sciences at the University of Washington (UW) in Seattle, WA, USA, aims to improve child respiratory health, including among remote communities in Washington state. As a paediatric environmental medicine specialist and environmental epidemiologist, her work has centred on the environmental disparities that impact on child health. “Exposure to environmental pollutants, indoor or outdoor, can really affect children’s health”, says Karr.

Surprise finding in sex and sleep apnoea trial

 

Sexual function in sleep apnoea is a relatively well-researched field. Many studies have shown that the sleep disorder is associated with erectile dysfunction, ejaculation disorder and decreased frequency in sexual relations in men. Fewer studies have been carried out in women, but those that have been done show an association with pain during sex, insufficient vaginal lubrication and lower libido. The question, therefore, is no longer whether sleep apnoea affects people’s sex lives, but whether treatment improves the situation.

A prospective study from Washington University in the US offers some answers. The researchers looked at 182 people diagnosed with sleep apnoea who answered a quality of life survey at diagnosis, and a year after. The questionnaire included two items about sex: “Because of medical problem unable to have sexual relations” and “lack of desire for sexual relations”. Respondents had to score those items from 0 to 5, with 0 indicating no problem and 5 indicating the problem is as bad as it can be.

Among the participants, 72 used a CPAP machine after diagnosis, while 110 didn’t or weren’t able to. The researchers found a substantial difference between the two cohorts, with the patients on CPAP therapy reporting greater sexual satisfaction than those who weren’t. But when they adjusted for a range of socioeconomic and other confounders, they found the gains were all skewed to one gender. Women’s libido bounced back, but men’s didn’t.

“We were surprised to see a pretty big effect on women, but minimal effect on men, especially given previous literature,” says lead author Dr Sebastian Jara.

He says the findings go against previous studies which have found a positive effect of CPAP on men’s sex lives. But he says the reason for the discrepancy between his team’s study and previous ones might be to do with differences in the cohorts studied. Previous studies tended to look at men who already had a sexual problem such as erectile dysfunction, and measured whether CPAP helped with the problem.

“Those subjects might have been starting from a relatively worse-off place, which may have resulted in higher self-reported improvement,” he speculates.

Men with sleep apnoea have been more intensively studied than women, because of a perception that it is more of a man’s disorder. But Dr Jara says there is a growing recognition that women can be affected as well, and can benefit from CPAP therapy.

He says that even if his study did not demonstrate a benefit in sexual satisfaction in men, there are many other reasons why a man with sleep apnoea would want to start therapy.

“A myriad of other long-term health benefits and improvements in well-being have been demonstrated with CPAP,” he points out.

The study was published in JAMA Otolaryngology & Head and Neck Surgery. You can access it here.

[Series] Action to address the household economic burden of non-communicable diseases

The economic burden on households of non-communicable diseases (NCDs), including cardiovascular diseases, cancer, respiratory diseases, and diabetes, poses major challenges to global poverty alleviation efforts. For patients with NCDs, being uninsured is associated with 2–7-fold higher odds of catastrophic levels of out-of-pocket costs; however, the protection offered by health insurance is often incomplete. To enable coverage of the predictable and long-term costs of treatment, national programmes to extend financial protection should be based on schemes that entail compulsory enrolment or be financed through taxation.

[Articles] Prevalence and risk factors of chronic obstructive pulmonary disease in China (the China Pulmonary Health [CPH] study): a national cross-sectional study

Spirometry-defined COPD is highly prevalent in the Chinese adult population. Cigarette smoking, ambient air pollution, underweight, childhood chronic cough, parental history of respiratory diseases, and low education are major risk factors for COPD. Prevention and early detection of COPD using spirometry should be a public health priority in China to reduce COPD-related morbidity and mortality.

[Comment] The emerging Chinese COPD epidemic

Few people today question the global burden of chronic respiratory diseases, of which chronic obstructive pulmonary disease (COPD) is the most prominent cause of disability-adjusted life-years.1 Tobacco smoking, poverty, and exposure to biomass fuel are the most important risk factors for COPD globally, and which are unevenly spread.2

[Articles] Dysfunction of NaV1.4, a skeletal muscle voltage-gated sodium channel, in sudden infant death syndrome: a case-control study

Rare SCN4A variants that directly alter NaV1.4 function occur in infants who had died from SIDS. These variants are predicted to significantly alter muscle membrane excitability and compromise respiratory and laryngeal function. These findings indicate that dysfunction of muscle sodium channels is a potentially modifiable risk factor in a subset of infant sudden deaths.

[Department of Error] Department of Error

Iuliano AD, Roguski KM, Chang HH, et al. Estimates of global seasonal influenza-associated respiratory mortality: a modelling study. Lancet 2017; 391: 1285–300—In the Research in Context panel of this Article (published Online First on Dec 13, 2017), the first sentence of the Evidence before this study section should read “Previous estimates commonly attributed to WHO indicate that 250 000–500 000 deaths occur annually worldwide due to seasonal influenza viruses.” The last sentence of the second paragraph in the Methods section should read “Of the 15 remaining countries contacted, eight did not respond to collaboration requests, five were unable to share data by September, 2017, and two had insufficient quality vital records data.” These corrections have been made to the online version as of Jan 19, 2018, and the printed Article is correct.