The evidence that lead may adversely affect bone metabolism and depress the immune system make lead a potential risk factor for periodontitis. Objective: to test the hypothesis of association between lead blood levels (PbB) and periodontitis. Methods: Study population- individuals from 20 to 55 years-old (n=8801) from the Third Health and Nutrition Examination Survey (1988-1994) (NHANES-III). The associations between PbB and extent and severity of periodontitis (based on attachment loss -AL) were investigated using logistic regression considering the sampling design. Results:

	Extent (% of mesial sites ³ 4mm of AL)	Severity (average AL ³ 1.5mm)
PbB (m g/dL)	³ 20 % OR* (95% CI)	³ 1.5mm OR (95% CI)
<3	1.00	1.00
3-7	1.72 (1.02–2.91)	1.63 (0.93– .78)
>7	2.57 ( 1.32–5.01)	2.56 (1.35–2.48)

Odds Ratios* were adjusted for age, race, sex, poverty, phase of NHANES, examiners, smoking status, pack-year, age of house, frequency of dental visits, US region, serum calcium, bone mineral density, dental caries, missing teeth. The trend test was significant for the association between PbB and severity of periodontitis only (p=0.0375). Interpretation of these findings should consider that: (1) this is a cross-sectional study, therefore, causality cannot be inferred; (2) PbB is strongly associated with socioeconomic factors (SES); the constant decline of lead exposure in the US might be turning PbB into a good marker of individuals with low SES, living in a compromised environment (I don't know the last statement I just don't like); (4) it cannot be concluded from this study that periodontitis was associated with low levels of PbB since, in 1976, 82% of the US population had > 10m g/dL of PbB. Conclusion: this study showed an association between PbB and periodontitis. However, further studies are necessary to confirm our results and to elucidate the role of SES factors and living in poor neighborhood in this association.

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