title: Smoking induced heavy metals and periodontitis: findings from the Korea National Health and Nutrition Examination Surveys 2008-2010.
abstract: OBJECTIVE
  Exposure to hazardous heavy metals such as cadmium and lead may contribute to increased oxidative stress and inflammation in the periodontal tissue. We aimed to evaluate the association between serum cadmium and lead levels and periodontitis.
  
  
  METHODS
  Pooled cross-sectional data from the Korea National Health and Nutrition Examination Surveys 2008-2010 were used. Periodontitis was defined as WHO community periodontal index. Active smokers were defined as self-reported current smokers or those with measured urine cotinine ≥164 ng/ml measurements. Serum cadmium and lead levels were measured using graphite furnace atomic absorption spectrometry. Multiple logistic regression analysis was used to estimate the odds ratios (OR) for periodontitis.
  
  
  RESULTS
  The mean cadmium and lead levels were significantly higher in the periodontitis group compared with control population. A progressive increase in serum heavy metals were found as the number of sextants with periodontitis. The ORs for periodontitis were significantly associated with serum cadmium (OR = 1.37; 95% CI 1.00-1.87) and lead levels (OR = 1.60; 95% CI 1.15-2.21). The association between periodontitis and smoking was attenuated after adjusting for serum cadmium concentration.
  
  
  CONCLUSIONS
  We demonstrated a significant association between periodontitis and serum cadmium and lead concentrations. Cadmium appeared to partially mediate the association between smoking and periodontitis.
authors.affiliation: Department of Preventive and Social Dentistry, School of Dentistry, Seoul National University, 110-749 Seoul, Korea. dhhan73@snu.ac.kr
authors.forename: Dong-Hun
authors.initials: DH
authors.lastname: Han
authors.forename: Hye-Ju
authors.initials: HJ
authors.lastname: Lee
authors.forename: Sinye
authors.initials: S
authors.lastname: Lim
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D002104:Cadmium / Q000097:blood*; D015986:Confounding Factors, Epidemiologic; D003367:Cotinine / Q000652:urine; D003430:Cross-Sectional Studies; D003729:Dental Care / Q000706:statistics & numerical data; D004522:Educational Status; D005260:Female; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007854:Lead / Q000097:blood*; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D009749:Nutrition Surveys; D010512:Periodontal Index; D010518:Periodontitis / Q000097:blood / Q000453:epidemiology*; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D012907:Smoking / Q000097:blood / Q000453:epidemiology*; D013054:Spectrophotometry, Atomic / Q000379:methods; D014099:Toothbrushing / Q000706:statistics & numerical data
chemical_list: D001786:Blood Glucose; D002104:Cadmium; D007854:Lead; D003367:Cotinine
keywords: cadmium; lead; periodontitis; smoking