# The Effect of Inhaled Corticosteroid Therapy on Periodontal Status in Patients with Asthma
## 4 Discussion
From the literature collected by me, the most similar results to ours were obtained by [PERSON] et al. [54], who studied 170 subjects with type 1 diabetes and assessed the relationship between periodontitis and respiratory allergies. For subjects with allergies, including asthma, the mean CAL was 1.56 mm, and the proportion of sites with CAL > 3 mm was 18.8%; in the group without allergies, the mean CAL was 2.31 mm, and the ratio of sites with CAL > 3 mm was 36%. According to the authors, these data are a strong argument supporting the inverse relationship between periodontal disease and respiratory allergies: the so-called hygiene hypothesis. [PERSON] et al. [41] conducted a study within the Study of Health in Pomerania (SHIP) project on a subpopulation of 2837 subjects, 438 of whom suffered from respiratory allergies (lay fever, house dust mite allergy, asthma). They examined the relationship to periodontal disease by assessing clinical loss of connective tissue attachment > 3 mm (4 surfaces on up to 14 teeth were concerned). The authors found it in 37% of the tested sites in control subjects, 24% in the hay fever group, 22% in the house dust mite allergy group, and 33% in the asthma group. Compared to the papers describing patients with periodontitis, the results from our group of patients with periodontitis and asthma were significantly lower. [PERSON] et al. [52] evaluated the effect of non-surgical treatment in 57 adults with chronic periodontitis. The initial mean level of clinical assessed parameters was: percentage of sites with plaque present 66%; BOP 57%; PD 3.3; CAL 2.9; the proportion of shallow pockets 63%, medium 34%, and deep 3%. [PERSON] et al. [51], in 41 patients with periodontitis, conducted an analysis of the effectiveness of scaling and root planning and surgical treatment (OP), taking into account patient- or tooth-related risk factors. After initial periodontal management--supragingival scaling and OHI--PDs were measured at four sites at each tooth. For areas less than 3 mm, no additional periodontal measures were performed. Subgingival scaling was performed for pockets 3-6 mm. For pockets greater than 6 mm, surgical treatment was performed. Considering the division into anterior and premolar teeth, which corresponds to our division into central and lateral sextants, they showed significant differences in the initial mean PD for anterior teeth and premolars in clinical attachment and the plaque index. For the change in PD, there was a positive effect of baseline and a negative effect of cigarette smoking, interproximal site, premolar teeth, and baseline value of clinical attachment level. It is noteworthy that the final regression models did not include other patient-dependent factors such as age and gender. [PERSON] et al. [44], in a population-based cross-sectional study involving 238 asthmatic children aged 13-17 and 1250 healthy controls, found no statistically significant differences in the number of bleeding sites, the presence of supragingival and subgingival calculus, the number of sites with PDs greater than 3 mm, and the loss of clinical connective tissue at an attachment level greater than 2 mm. Nowadays, the association between asthma and oral status is emphasized in the literature [55]. [PERSON] et al. conducted a systematic literature review with meta-analysis. The authors stated that asthma may be a risk factor for periodontal disease in study populations. A meta-analysis showed that asthma patients had higher BoP and CAL than healthy controls [56]. Limitations of our study included the small study group. The study included only 120 participants, 40 in each study and control group. Unfortunately, the power of the study was also not calculated because all patients available at the time were included in the study. In a later stage of the study, we plan to increase the study group. The small size of the study groups may bias the results and inaccurately reflect the prevalence of the problem in the community.