(26) Gingivitis in Children with Cystic Fibrosis

Background: The close links between the oral cavity and respiratory tract increase the potential risk of micro-aspiration of oral bacteria. Thus, it is critical to understand if children with cystic fibrosis (CF) are at risk of oral diseases. CF-related comorbidities like diabetes as well as increased systemic inflammation due to frequent lung infections and continued use of dry-mouth-inducing inhaled treatments are potential risk factors for gingivitis (i.e., gum inflammation) [1–2]. Despite these risk factors, the current literature suggests that children with CF are at lower risk for gingivitis compared to non-CF controls due to the chronic use of antibiotics to treat lung infections [3–5]. However, this literature is outdated (1977-2009) and does not account for potential confounders in the association between CF and gingivitis. Thus, the goal of this study was to compare the prevalence of gingivitis in children with and without CF.

Methods: A cross-sectional study of the risk of gingivitis in children with CF compared to non-CF children with other special health care needs ages 7-17 years. We recruited children with CF from a single pediatric CF clinic in Seattle, WA (N=69) and non-CF controls from Medicaid enrolment files in Washington State (N=89). Gingivitis was defined as bleeding in ≥10% of examined gingival sites (yes/no). We used logistic regression to compare the prevalence of gingivitis between the two groups and adjusted for age, sex, race, antibiotic use, and dental insurance type as potential confounders.

Results: Compared to non-CF controls, children with CF were slightly younger (CF 11.3±3.1 years vs non-CF 12.4±2.8, P=0.022), more likely to be white (CF 93% vs non-CF 42%, P< 0.001), and less likely to have Medicaid insurance only (CF 32% vs non-CF 84%, P< 0.001). Sixty-eight percent of children with CF had gingivitis compared to 40% for non-CF controls. Children with CF had significantly higher odds of gingivitis than non-CF controls (OR 3.1, 95% CI 1.6, 6.1; P< 0.001). This remained significant after adjusting for potential confounders (OR 4.7, 95% CI 1.9, 11.9; P=0.001).

Conclusions: In contrast to previous studies, our study showed increased gingivitis in children with CF compared to non-CF controls. Ensuring optimal oral health for children with CF is critical to maintain overall health and quality of life.

Acknowledgements: This work was supported by the University of Washington CFF Research Development Program [Grant Number SINGH19R0], the National Institute of Diabetes, Digestive and Kidney Disorders CF Research Translation Center Clinical Core [Grant Number NIH P30 DK089507], and the Dr. Douglass L. Morell Dentistry Research Fund, University of Washington.

References: [1] Kinane D, Stathopoulou P, Papapanou P. Periodontal diseases. Nat Rev Dis Primers. 2017;3:17038.
[2] Demmer R, Squillaro A, Papapanou P, et al. Periodontal infection, systemic inflammation, and insulin resistance: results from the continuous National Health and Nutrition Examination Survey (NHANES) 1999-2004. Diabetes Care. 2012;35(11):2235-2242.
[3] Ferrazzano G, Orlando S, Sangianantoni G, Cantile T, Ingenito A. Dental and periodontal health status in children affected by cystic fibrosis in a southern Italian region. Eur J Paediatr Dent.2009;10(2):65-68.
[4] Kinirons M. Dental health of patients suffering from cystic fibrosis in Northern Ireland. Community Dent Health.1989;6(2):113-120.
[5] Blacharsh C. Dental aspects of patients with cystic fibrosis: a preliminary clinical study. J Am Dent Assoc.1977;95(1):106-110.