Academic journal article Environmental Health Perspectives

Cumulative Lead Exposure and Tooth Loss in Men: The Normative Aging Study

Academic journal article Environmental Health Perspectives

Cumulative Lead Exposure and Tooth Loss in Men: The Normative Aging Study

Article excerpt

BACKGROUND: Individuals previously exposed to lead remain at risk because of endogenous release of lead stored in their skeletal compartments. However, it is not known if long-term cumulative lead exposure is a risk factor for tooth loss.

OBJECTIVES: We examined the association of bone lead concentrations with loss of natural teeth. METHODS: We examined 333 men enrolled in the Veterans Affairs Normative Aging Study. We used a validated K-shell X-ray fluorescence (KXRF) method to measure lead concentrations in the tibial midshaft and patella. A dentist recorded the number of teeth remaining, and tooth loss was categorized as 0, 1-8 or [greater than or equal to] 9 missing teeth. We used proportional odds models to estimate the association of bone lead biomarkers with tooth loss, adjusting for age, smoking, diabetes, and other putative confounders.

RESULTS: Participants with [greater than or equal to] 9 missing teeth had significantly higher bone lead concentrations than those who had not experienced tooth loss. In multivariable-adjusted analyses, men in the highest tertile of tibia lead (> 23 [micro]g/g) and patella lead (> 36 [micro]g/g) had approximately three times the odds of having experienced an elevated degree of tooth loss ([greater than or equal to] 9 vs. 0-8 missing teeth or [greater than or equal to] l vs. 0 missing teeth) as those in the lowest tertile [prevalence odds ratio (OR) = 3.03; 95% confidence interval (CI), 1.60-5.76 and OR = 2.41; 95% CI, 1.30-4.49, respectively]. Associations between bone lead biomarkers and tooth loss were similar in magnitude to the increased odds observed in participants who were current smokers.

CONCLUSION: Long-term cumulative lead exposure is associated with increased odds of tooth loss.

KEY WORDS: aging, blood lead, bone lead, KXRF, tooth loss. Environ Health Perspect 117:1531-1534 (2009). doi:10.1289/ehp.0900739 available via http://dx.doi.org/ [Online 15 June 2009]

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Although the successful implementation of public health policies has lowered environmental lead exposure in the United States, individuals previously exposed to this toxicant remain at risk because of endogenous release of lead stored in their skeletal compartments (Hu et al. 1998; Vig and Hu 2000). The majority of lead absorbed into the body is incorporated into bones from which it may interchange with other tissues. Bone lead biomarkers have been successfully applied to estimate long-term cumulative environmental lead exposure and have been linked with a number of adverse health effects, including neurologic impairment, hypertension, and renal dysfunction (Glenn et al. 2003; Navas-Acien et al. 2007; Shih et al. 2007; Tsaih et al. 2004; Weaver et al. 2005; Weisskopf et al. 2007). Although emerging evidence suggests that lead exposure may increase the risk of some oral diseases, no study has previously investigated whether bone lead levels are associated with tooth loss.

Lead is known to disrupt several cellular and molecular pathways that are relevant to the health of oral tissues. Lead can alter both humoral and cell-mediated immunity, and recent evidence suggests that lead exposure may affect regulation of inflammatory cytokines in occupationally exposed workers (Singh et al. 2003; Valentino et al. 2007). Furthermore, lead may induce oxidative stress in a number of tissues and organs, including salivary glands (Abdollahi et al. 2003; Ahamed and Siddiqui 2007). These effects of lead are pertinent to common oral diseases including dental caries and periodontitis, which have previously been associated with tooth loss (Eklund and Burt 1994; Locker et al. 1996).

Loss of natural teeth is an important public health issue, with approximately 25% of American adults [greater than or equal to] 60 years of age experiencing complete tooth loss (Beltran-Aguilar et al. 2005). Poor oral health, while in itself associated with a decline in quality of life (Brennan et al. …

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