Associations of nonsteroidal anti-inflammatory drug use with periodontal disease in postmenopausal women: The OsteoPerio study

Background: Periodontal disease is characterized in part by a host immune-inflammatory response that releases proteolytic enzymes, which damage periodontal tissue. Nonsteroidal anti-inflammatory drugs (NSAIDs) modulate host immune-inflammatory responses. We investigated cross-sectional and prospective relationships between NSAID use and indicators of periodontal disease, for which there is limited epidemiologic evidence. Methods: Data were from the Buffalo OsteoPerio Study of 1342 postmenopausal women ages 53–81 years. Periodontal assessments included measurements of alveolar crestal height (ACH), probing pocket depth (PPD), clinical attachment level (CAL), and gingival bleeding, taken at baseline (1997–2001) and 5 years later. Prospective outcomes included measures of periodontal disease progression defined by ACH loss, incident tooth loss, and gingival bleeding. NSAID use was assessed via medication inventory at baseline. Demographic, lifestyle, dental hygiene, and medical history information were collected. Multivariable linear and logistic regression modeling was used to examine associations between NSAID use and periodontal health outcomes. Results: At baseline, 45.8% of participants used NSAIDs, half of whom exclusively used aspirin. No significant cross-sectional differences in periodontal measures were found between NSAID users and nonusers. Prospectively, NSAID users had 37% lower odds of periodontal disease progression defined by ACH loss (odds ratio [OR] 0.63, 95% confidence interval; [CI]: 0.45–0.88), after controlling for demographic variables, lifestyle factors, comorbidities, and dental hygiene behaviors. Prospective associations with PPD, CAL, gingival bleeding, and tooth loss were of variable magnitude and did not achieve statistical significance. Conclusions: In a cohort of postmenopausal women with well-characterized clinical periodontal measurements, use of NSAIDs at baseline was associated with lower odds of periodontal disease progression defined by ACH loss over 5 years of follow-up. NSAID use was not associated with changes to PPD, CAL, gingival bleeding, or tooth loss. Plain Language Summary: Periodontal disease, a common condition characterizing poor oral health, can worsen over time due to the body's inflammatory response, which damages the tissues supporting teeth. Nonsteroidal anti-inflammatory drugs (NSAIDs), like aspirin, can reduce inflammation, but whether they have any role in preventing periodontal disease has not been well-studied. We explored this connection in more than 1,300 postmenopausal women from the Buffalo OsteoPerio Study, tracking their oral health over 5 years. At the start, nearly half of the women reported using NSAIDs, mostly aspirin. While NSAID users and nonusers had similar gum health at the beginning, we found that women who used NSAIDs had a 37% lower odds of losing the bone that supports their teeth over the next 5 years. This protective association remained even after accounting for age, lifestyle, medical conditions, and dental care habits. However, NSAID use was not associated with other measures of oral health, like gum bleeding, pocket depth around teeth, or tooth loss. These findings suggest that NSAIDs may help slow some aspects of periodontal disease progression, but their overall effects on oral health remain unclear. Understanding how common medications like NSAIDs affect oral health could guide strategies to protect against gum disease in older adults.