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Environ Health Perspect. 2009 May;117(5):739-44. doi: 10.1289/ehp.0800312. Epub 2009 Jan 22.

Association of environmental cadmium exposure with periodontal disease in U.S. adults.

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  • 1Population Oral Health, Faculty of Dentistry, Westmead Centre for Oral Health, University of Sydney, Sydney, New South Wales, Australia. marora@hsph.harvard.edu



Periodontal disease is a complex, multifactorial, chronic inflammatory disease that involves degradation of periodontal structures, including alveolar bone. Cadmium adversely affects bone remodeling, and it is therefore possible that environmental Cd exposure may be a risk factor for periodontal-disease-related bone loss.


We examined the relationship between environmental Cd exposure and periodontal disease in U.S. adults.


We analyzed cross-sectional data from the third National Health and Nutrition Examination Survey (NHANES III). We defined periodontal disease as clinical attachment loss of at least 4 mm in > 10% of sites examined. We used multivariable-adjusted logistic regression analyses to estimate the association between creatinine-corrected urinary Cd levels and periodontal disease.


Of the 11,412 participants included in this study, 15.4% had periodontal disease. The age-adjusted geometric mean urine Cd concentration (micrograms per gram creatinine) was significantly higher among participants with periodontal disease [0.50; 95% confidence interval (CI), 0.45-0.56] than among those without periodontal disease (0.30; 95% CI, 0.28-0.31). Multivariable-adjusted analyses, which included extensive adjustments for tobacco exposure, showed that a 3-fold increase in creatinine-corrected urinary Cd concentrations [corresponding to an increment from the 25th (0.18 microg/g) to the 75th (0.63 microg/g) percentile] was associated with 54% greater odds of prevalent periodontal disease (odds ratio = 1.54; 95% CI, 1.26-1.87). We observed similar results among the subset of participants who had limited exposure to tobacco, but only after removing six influential observations.


Environmental Cd exposure was associated with higher odds of periodontal disease.


NHANES III; environmental tobacco smoke; periodontal disease; smoking; urine cadmium

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