title: Prospective Study of Oral Health and Risk of Primary Open-Angle Glaucoma in Men: Data from the Health Professionals Follow-up Study.
abstract: Tooth loss or periodontal disease is associated with systemic endothelial dysfunction, which has been implicated in primary open-angle glaucoma (POAG). The relationship between oral health and POAG has received limited attention. Thus, we evaluated the association between oral health history and risk of POAG and POAG subtypes.
  
  
  
  Prospective cohort study.
  
  
  
  Health Professionals Follow-up Study participants (40 536 men) followed biennially from 1986 to 2012. At each 2-year risk period, eligible participants were aged 40+ years, were free of POAG, and reported eye examinations.
  
  
  
  By using validated questions, we updated participants' status on number of natural teeth, teeth lost, periodontal disease with bone loss, and root canal treatments.
  
  
  
  During follow-up, 485 incident cases of POAG were confirmed with medical records and classified into subtypes defined by intraocular pressure (IOP; ≥ or <22 mmHg) or visual field (VF) loss pattern at diagnosis (peripheral loss only or early paracentral loss). Multivariable relative risks (MVRRs) and 95% confidence intervals (CIs) were estimated.
  
  
  
  Number of natural teeth, periodontal disease, and root canal treatment were not associated with POAG. However, compared with no report of tooth loss, a report of losing teeth within the past 2 years was associated with a 1.45-fold increased risk of POAG (95% CI, 1.06-1.97); in particular, a report within the past 2 years of both losing teeth and having a prevalent diagnosis of periodontal disease was associated with a 1.85-fold increased risk of POAG (95% CI, 1.07-3.18). The associations with recent tooth loss were not significantly different for the POAG subtypes (P for heterogeneity ≥0.36), although associations were strongest in relation to the POAG subtypes with IOP <22 mmHg (MVRR, 1.93; 95% CI, 1.09-3.43) and early paracentral VF loss (MVRR, 2.27; 95% CI, 1.32-3.88).
  
  
  
  Although the number of natural teeth was not associated with risk of POAG, recent tooth loss was associated with an increased risk of POAG. Because these findings may be due to chance, they need confirmation in larger studies.
authors.affiliation: Glaucoma Service, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Louis R
authors.initials: LR
authors.lastname: Pasquale
authors.affiliation: Division of Epidemiology, Department of Preventive Medicine, Stony Brook University, Stony Brook, New York.
authors.forename: Leslie
authors.initials: L
authors.lastname: Hyman
authors.affiliation: Glaucoma Service, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts.
authors.forename: Janey L
authors.initials: JL
authors.lastname: Wiggs
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Bernard A
authors.initials: BA
authors.lastname: Rosner
authors.affiliation: Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts; Center for Clinical Research and Health Promotion, University of Puerto Rico-MSC, San Juan, Puerto Rico.
authors.forename: Kaumudi
authors.initials: K
authors.lastname: Joshipura
authors.affiliation: The School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: McEvoy
authors.affiliation: The School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.
authors.forename: Zachary E
authors.initials: ZE
authors.lastname: McPherson
authors.affiliation: Glaucoma Service, Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, New York.
authors.forename: John
authors.initials: J
authors.lastname: Danias
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts. Electronic address: nhjhk@channing.harvard.edu.
authors.forename: Jae H
authors.initials: JH
authors.lastname: Kang
mesh_terms: D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D006282:Health Personnel; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009909:Oral Health; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013997:Time Factors; D014065:Tonometry, Ocular; D014481:United States / Q000453:epidemiology; D014794:Visual Fields / Q000502:physiology*