title: Association of environmental cadmium exposure with periodontal disease in U.S. adults.
abstract: BACKGROUND
  Periodontal disease is a complex, multifactorial, chronic inflammatory disease that involves degradation of periodontal structures, including alveolar bone. Cadmium adversely affects bone remodeling, and it is therefore possible that environmental Cd exposure may be a risk factor for periodontal-disease-related bone loss.
  
  
  OBJECTIVE
  We examined the relationship between environmental Cd exposure and periodontal disease in U.S. adults.
  
  
  METHODS
  We analyzed cross-sectional data from the third National Health and Nutrition Examination Survey (NHANES III). We defined periodontal disease as clinical attachment loss of at least 4 mm in > 10% of sites examined. We used multivariable-adjusted logistic regression analyses to estimate the association between creatinine-corrected urinary Cd levels and periodontal disease.
  
  
  RESULTS
  Of the 11,412 participants included in this study, 15.4% had periodontal disease. The age-adjusted geometric mean urine Cd concentration (micrograms per gram creatinine) was significantly higher among participants with periodontal disease [0.50; 95% confidence interval (CI), 0.45-0.56] than among those without periodontal disease (0.30; 95% CI, 0.28-0.31). Multivariable-adjusted analyses, which included extensive adjustments for tobacco exposure, showed that a 3-fold increase in creatinine-corrected urinary Cd concentrations [corresponding to an increment from the 25th (0.18 microg/g) to the 75th (0.63 microg/g) percentile] was associated with 54% greater odds of prevalent periodontal disease (odds ratio = 1.54; 95% CI, 1.26-1.87). We observed similar results among the subset of participants who had limited exposure to tobacco, but only after removing six influential observations.
  
  
  CONCLUSIONS
  Environmental Cd exposure was associated with higher odds of periodontal disease.
authors.affiliation: Population Oral Health, Faculty of Dentistry, Westmead Centre for Oral Health, University of Sydney, Sydney, New South Wales, Australia. marora@hsph.harvard.edu
authors.forename: Manish
authors.initials: M
authors.lastname: Arora
authors.forename: Jennifer
authors.initials: J
authors.lastname: Weuve
authors.forename: Joel
authors.initials: J
authors.lastname: Schwartz
authors.forename: Robert O
authors.initials: RO
authors.lastname: Wright
mesh_terms: D000293:Adolescent; D000328:Adult; D002104:Cadmium / Q000633:toxicity* / Q000652:urine; D016001:Confidence Intervals; D004781:Environmental Exposure; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010510:Periodontal Diseases / Q000139:chemically induced / Q000652:urine*; D012907:Smoking / Q000009:adverse effects; D014481:United States; D014874:Water Pollutants, Chemical / Q000633:toxicity* / Q000652:urine; D055815:Young Adult
chemical_list: D014874:Water Pollutants, Chemical; D002104:Cadmium