Logo of envhperEnvironmental Health PerspectivesBrowse ArticlesAbout EHPGeneral InformationAuthorsMediaProgramsPartnerships
Environ Health Perspect. 2002 Oct; 110(10): 997–1002.
PMCID: PMC1241025
Research Article

The relationship between blood lead levels and periodontal bone loss in the United States, 1988-1994.


An association between bone disease and bone lead has been reported. Studies have suggested that lead stored in bone may adversely affect bone mineral metabolism and blood lead (PbB) levels. However, the relationship between PbB levels and bone loss attributed to periodontal disease has never been reported. In this study we examined the relationship between clinical parameters that characterize bone loss due to periodontal disease and PbB levels in the U.S. population. We used data from the Third National Health and Nutritional Examination Survey (NHANES III), 1988-1994, for the analyses. A total of 10,033 participants 20-69 years of age who completed a periodontal examination and had whole blood tested for lead were examined. Four types of periodontal disease measures were used to indicate oral bone loss: periodontal pocket depth, attachment loss extent, attachment loss severity, and the presence of dental furcations. We found that dental furcations were the best periodontal bone loss indicator for PbB levels (p = 0.005) in a multivariate linear regression model adjusting for sex, age, race/ethnicity, educational attainment, poverty status, smoking, and age of home. Furthermore, after additional modeling, we found a smoking and dental furcation interaction (p = 0.034). Subsequent stratified analyses indicated that current and past smoking is an effect modifier for dental furcations on PbB levels. These findings indicate that increased PbB levels may be associated with advanced periodontal bone loss, particularly among people with a history of smoking.

Full Text

The Full Text of this article is available as a PDF (581K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Adachi JD, Arlen D, Webber CE, Chettle DR, Beaumont LF, Gordon CL. Is there any association between the presence of bone disease and cumulative exposure to lead? Calcif Tissue Int. 1998 Nov;63(5):429–432. [PubMed]
  • Albandar JM, Brunelle JA, Kingman A. Destructive periodontal disease in adults 30 years of age and older in the United States, 1988-1994. J Periodontol. 1999 Jan;70(1):13–29. [PubMed]
  • Ainamo J, Ainamo A. Partial indices as indicators of the severity and prevalence of periodontal disease. Int Dent J. 1985 Dec;35(4):322–326. [PubMed]
  • Anderson C, Danylchuk KD. The effect of chronic low level lead intoxication on the Haversian remodeling system in dogs. Lab Invest. 1977 Nov;37(5):466–469. [PubMed]
  • Arbes SJ, Jr, Slade GD, Beck JD. Association between extent of periodontal attachment loss and self-reported history of heart attack: an analysis of NHANES III data. J Dent Res. 1999 Dec;78(12):1777–1782. [PubMed]
  • Barry PS. A comparison of concentrations of lead in human tissues. Br J Ind Med. 1975 May;32(2):119–139. [PMC free article] [PubMed]
  • Beck J, Garcia R, Heiss G, Vokonas PS, Offenbacher S. Periodontal disease and cardiovascular disease. J Periodontol. 1996 Oct;67(10 Suppl):1123–1137. [PubMed]
  • Carlos JP, Wolfe MD, Kingman A. The extent and severity index: a simple method for use in epidemiologic studies of periodontal disease. J Clin Periodontol. 1986 May;13(5):500–505. [PubMed]
  • Update: blood lead levels--United States, 1991-1994. MMWR Morb Mortal Wkly Rep. 1997 Feb 21;46(7):141–146. [PubMed]
  • Drury TF, Winn DM, Snowden CB, Kingman A, Kleinman DV, Lewis B. An overview of the oral health component of the 1988-1991 National Health and Nutrition Examination Survey (NHANES III-Phase 1). J Dent Res. 1996 Feb;75(Spec No):620–630. [PubMed]
  • Gruber HE, Gonick HC, Khalil-Manesh F, Sanchez TV, Motsinger S, Meyer M, Sharp CF. Osteopenia induced by long-term, low- and high-level exposure of the adult rat to lead. Miner Electrolyte Metab. 1997;23(2):65–73. [PubMed]
  • Gulson BL, Mahaffey KR, Mizon KJ, Korsch MJ, Cameron MA, Vimpani G. Contribution of tissue lead to blood lead in adult female subjects based on stable lead isotope methods. J Lab Clin Med. 1995 Jun;125(6):703–712. [PubMed]
  • Hu H, Payton M, Korrick S, Aro A, Sparrow D, Weiss ST, Rotnitzky A. Determinants of bone and blood lead levels among community-exposed middle-aged to elderly men. The normative aging study. Am J Epidemiol. 1996 Oct 15;144(8):749–759. [PubMed]
  • Hu H, Rabinowitz M, Smith D. Bone lead as a biological marker in epidemiologic studies of chronic toxicity: conceptual paradigms. Environ Health Perspect. 1998 Jan;106(1):1–8. [PMC free article] [PubMed]
  • Hujoel PP, Drangsholt M, Spiekerman C, DeRouen TA. Periodontal disease and coronary heart disease risk. JAMA. 2000 Sep 20;284(11):1406–1410. [PubMed]
  • Hunt RJ, Fann SJ. Effect of examining half the teeth in a partial periodontal recording of older adults. J Dent Res. 1991 Oct;70(10):1380–1385. [PubMed]
  • Kiechl S, Egger G, Mayr M, Wiedermann CJ, Bonora E, Oberhollenzer F, Muggeo M, Xu Q, Wick G, Poewe W, et al. Chronic infections and the risk of carotid atherosclerosis: prospective results from a large population study. Circulation. 2001 Feb 27;103(8):1064–1070. [PubMed]
  • Kingman A, Morrison E, Löe H, Smith J. Systematic errors in estimating prevalence and severity of periodontal disease. J Periodontol. 1988 Nov;59(11):707–713. [PubMed]
  • Klein RF, Wiren KM. Regulation of osteoblastic gene expression by lead. Endocrinology. 1993 Jun;132(6):2531–2537. [PubMed]
  • Lippmann M. 1989 Alice Hamilton lecture. Lead and human health: background and recent findings. Environ Res. 1990 Feb;51(1):1–24. [PubMed]
  • Moss ME, Lanphear BP, Auinger P. Association of dental caries and blood lead levels. JAMA. 1999 Jun 23;281(24):2294–2298. [PubMed]
  • Pirkle JL, Kaufmann RB, Brody DJ, Hickman T, Gunter EW, Paschal DC. Exposure of the U.S. population to lead, 1991-1994. Environ Health Perspect. 1998 Nov;106(11):745–750. [PMC free article] [PubMed]
  • Rabinowitz MB, Wetherill GW, Kopple JD. Kinetic analysis of lead metabolism in healthy humans. J Clin Invest. 1976 Aug;58(2):260–270. [PMC free article] [PubMed]
  • Rabinowitz MB. Toxicokinetics of bone lead. Environ Health Perspect. 1991 Feb;91:33–37. [PMC free article] [PubMed]
  • Rabinowitz M. Historical perspective on lead biokinetic models. Environ Health Perspect. 1998 Dec;106 (Suppl 6):1461–1465. [PMC free article] [PubMed]
  • Schroeder HA, Tipton IH. The human body burden of lead. Arch Environ Health. 1968 Dec;17(6):965–978. [PubMed]
  • Silbergeld EK. Lead in bone: implications for toxicology during pregnancy and lactation. Environ Health Perspect. 1991 Feb;91:63–70. [PMC free article] [PubMed]
  • Smith DR, Osterloh JD, Flegal AR. Use of endogenous, stable lead isotopes to determine release of lead from the skeleton. Environ Health Perspect. 1996 Jan;104(1):60–66. [PMC free article] [PubMed]
  • Steenhout A. Kinetics of lead storage in teeth and bones: an epidemiologic approach. Arch Environ Health. 1982 Jul-Aug;37(4):224–231. [PubMed]
  • Tomar SL, Asma S. Smoking-attributable periodontitis in the United States: findings from NHANES III. National Health and Nutrition Examination Survey. J Periodontol. 2000 May;71(5):743–751. [PubMed]
  • Tsaih SW, Korrick S, Schwartz J, Lee ML, Amarasiriwardena C, Aro A, Sparrow D, Hu H. Influence of bone resorption on the mobilization of lead from bone among middle-aged and elderly men: the Normative Aging Study. Environ Health Perspect. 2001 Oct;109(10):995–999. [PMC free article] [PubMed]
  • Winn DM, Johnson CL, Kingman A. Periodontal disease estimates in NHANES III: clinical measurement and complex sample design issues. J Public Health Dent. 1999 Spring;59(2):73–78. [PubMed]
  • Wu T, Trevisan M, Genco RJ, Dorn JP, Falkner KL, Sempos CT. Periodontal disease and risk of cerebrovascular disease: the first national health and nutrition examination survey and its follow-up study. Arch Intern Med. 2000 Oct 9;160(18):2749–2755. [PubMed]

Articles from Environmental Health Perspectives are provided here courtesy of National Institute of Environmental Health Science


Save items

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • Cited in Books
    Cited in Books
    NCBI Bookshelf books that cite the current articles.
  • Compound
    PubChem chemical compound records that cite the current articles. These references are taken from those provided on submitted PubChem chemical substance records. Multiple substance records may contribute to the PubChem compound record.
  • MedGen
    Related information in MedGen
  • PubMed
    PubMed citations for these articles
  • Substance
    PubChem chemical substance records that cite the current articles. These references are taken from those provided on submitted PubChem chemical substance records.

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...