Academic journal article Scandinavian Journal of Work, Environment & Health

Association between Shift Work and Periodontal Health in a Representative Sample of an Asian Population

Academic journal article Scandinavian Journal of Work, Environment & Health

Association between Shift Work and Periodontal Health in a Representative Sample of an Asian Population

Article excerpt

Han D-H, Khang Y-H, Jung-Choi K, Lim S. Association between shift work and periodontal health in a representative sample of an Asian population. Scand J Work Environ Health. 2013;39(6):559-567. doi:10.5271/sjweh.3370

Objective The association of shift work with periodontal disease is not well known. We studied the relationship between shift work and periodontitis in a representative sample of an Asian population.

Methods Participants were 4597 full-time employees from the Fourth Korean National Health and Nutrition Examination Survey (KNHANES IV). Shifting patterns were categorized into five shifts: daytime (N=3768), evening (N=121), night (N=59), rotating (N=206), and irregular (N=443). Periodontitis was measured with the Community Periodontal Index (CPI). Confounders included age, gender, income, and education. Mediators were frequency of daily tooth brushing, regular dental check-up, smoking, alcohol consumption, diabetes, obesity, and white blood cell count. Multiple logistic regression analyses were performed to evaluate the relationship.

Results The prevalence of periodontitis in the study population was 32.3%. Shift workers had an elevated odds ratio (OR) of periodontitis [OR 1.22, 95% confidence interval (95% Cl) 1.01-1.48] after controlling for confounders. The magnitude of the association between shift work and periodontitis attenuated with adjustment of mediators (smoking and a marker of inflammation). In subgroup analyses, the association was significant (OR 1.42, 95% Cl 1.03-1.95) among those >45 years. Irregular shift among those >45 years showed a significant association (OR 1.79, 95% Cl 1.15-2.78).

Conclusion Findings of this cross-sectional study suggest that shift work may be associated with periodontitis. Shift workers aged >45 years and irregular shift workers aged >45 years were risk groups for periodontitis.

Key terms Asia; epidemiology; inflammation; Korea; periodontitis.

The management of work schedules (shift work) has become common in our 24/7 society and increases night work and the diversity of flexible work-hour patterns in industrialized nations (1,2). Approximately 15% of the fulltime workforce in the United States are shift workers (3). In the European Union (EU), 17% of the workforce are shift workers, while in the EU 27 countries, 19% are night workers (4). In Asia, 22.7% and 15.5% are shiftworkers in Japan (5) and Taiwan (6), respectively. In Korea, shift workers represent 10.9% of the total workforce, and the shift patterns are regular 2 shifts (38.6%), regular 3 shifts (23.9%), 24-hour shift (14.0%), irregular 2 shifts (5.7%), fixed shifts (5.5%), split shifts (3.6%), irregular 3 shifts (2.9%), and ?other? (5.8%) (7).

It is well known that several physiological functions follow a circadian rhythm, and long-term disturbance of the circadian rhythm reportedly has clinical conse- quences. Higher incidences of somatic diseases such as coronary heart disease (8) and metabolic syndrome (9), including obesity and diabetes (10), have been reported among shift workers. Circadian variations in immune defense and inflammation may also be affected by shift effects of occupational exposure. An increase in white blood cell (WBC) count among rotating shift compared to daytime workers has been reported (11, 12). Elevated C-reactive protein was associated with 3-shift work, and 2- and 3-shift work were related with increased WBC count (13).

Periodontal diseases are a group of bacterial inflam- matory diseases of the supporting tissues of the teeth. Periodontal disease is one of the most common chronic inflammatory diseases in the world and occurs in at least 35% of the American population (14), 42.5% among Japanese (15), and 33% among Koreans (16). Moreover, periodontitis could be an early sign of severe inflamma- tory systemic disorder (17).

This study hypothesizes that shift work could be associated with periodontitis, and this association might be mediated by several potential mechanisms including health behaviors (oral health behaviors and other general health behaviors), somatic health problems (obesity and diabetes), and inflammation (measured by WBC count). …

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