Behavioral risk indicators of attachment loss in adult Floridians

Behavioural and socioeconomic factors associated with the simultaneous occurrence of periodontal disease and dental caries

Objective: The aim was to evaluate the association of behavioural and socioeconomic factors with the occurrence of periodontal disease and dental caries, paying special attention to the simultaneous occurrence of these diseases.Materials and methods: The study population consisted of 5255 dentate persons aged ≥30 years from a nationally representative survey. Caries and probing pocket depth were recorded by tooth and calculated in relation to the number of existing teeth. The groups were: non-affected (A), the two most affected quintiles for periodontal disease with little or no dental caries (B), the two most affected quintiles for dental caries with little or no periodontal disease (C) and the two most affected quintiles for both periodontal disease and dental caries (D). Presence of dental plaque was determined, and behavioural and socioeconomic factors were established.Results: Dental plaque, smoking, lack of regular dental check-ups, older age and a basic level of education were strongly associated with the simultaneous occurrence of periodontal disease and dental caries.Conclusions: There are many behavioural and socioeconomic factors that associate with the occurrence of both periodontal disease and dental caries. These factors also increase the risk of individuals having these diseases simultaneously.

New insights in the link between malocclusion and periodontal disease

AIM

We aimed to investigate associations between malocclusions and periodontal disease by comparing it to that of smoking in subjects recruited from the population-based cross-sectional study "Study of Health in Pomerania."

MATERIALS AND METHODS

Sagittal intermaxillary relationship, variables of malocclusion and socio-demographic parameters of 1,202 dentate subjects, 20-39 years of age, were selected. Probing depth (PD) and attachment loss (AL) were assessed at four sites by tooth in a half-mouth design. Analyses were performed with multilevel models on subject, jaw and tooth level.

RESULTS

Distal occlusion determined in the canine region, ectopic position of canines, anterior spacing, deep anterior overbite and increased sagittal overjet were associated with AL (p-value <0.05). Associations between malocclusions and PD: deep anterior overbite with gingival contact (odds ratio [OR] = 1.40, 95% CI: 1.08-1.82; p-value = 0.0101) and anterior crossbite (OR = 1.75, 95% CI: 1.29-2.38; p-value = 0.0003). Regarding crowding, only severe anterior crowding was compatible with a moderate to large association with PD (OR = 1.93, 95% CI: 0.89-4.20). Compared to smoking, the overall effect of malocclusions was about one half for AL and one-third for PD.

CONCLUSION

Malocclusions or morphologic parameters were associated with periodontal disease.

Risk indicators for prevalence, extent and severity of periodontitis among rural Indian population aged 35-54 years

AIMS

This study aimed to identify risk indicators associated with periodontitis and the contribution of each of the indicators towards the prevalence, extent and severity of periodontitis in a rural Indian population.

METHODS

A cross-sectional study design was used to collect data according to National Survey of Adult Oral Health Australia guidelines. A multistage stratified random sampling was followed to select 1401 participants, who were in the age group of 35-54 years. The participants were selected from 50 villages belonging to the 5 sub-provinces of 2 Indian districts. Data were collected through face-to-face interviews and oral examination. Statistical analysis was performed using SAS version 9.3. The univariate, bivariate and multivariate analyses were performed to determine the risk indicators of prevalence, extent and severity of periodontitis. Population attributable fraction was estimated for each of the significant risk indicators of prevalence and extent.

RESULTS

In this study, factors such as age, education, tobacco chewing and plaque accumulation were significantly associated with the prevalence of periodontitis. Age, socioeconomic status, method of tooth cleaning, alcohol consumption and plaque accumulation were significant risk indicators for generalized periodontitis. Age, tobacco chewing and plaque were associated with severity of periodontitis in the population.

CONCLUSION

The rural population had a high prevalence of periodontitis. Sociodemographic factors, poor oral hygiene, tobacco and alcohol were the main risk indicators attributable to periodontitis.

Development of a self-report questionnaire designed for population-based surveillance of gingivitis in adolescents: assessment of content validity and reliability

The major infectious diseases in Chile encompass the periodontal diseases, with a combined prevalence that rises up to 90% of the population. Thus, the population-based surveillance of periodontal diseases plays a central role for assessing their prevalence and for planning, implementing, and evaluating preventive and control programs. Self-report questionnaires have been proposed for the surveillance of periodontal diseases in adult populations world-wide.

Influence of oral health behavior and sociodemographic factors on remaining teeth in Korean adults: 2010-2012 Korea national health and nutrition examination survey

In this study, the number and location of remaining teeth were analyzed according to sociodemographic variables, anthropometric measurements, and oral health behavior patterns. The hypothesis was that the number and location of remaining teeth would be affected by oral health behavior and by sociodemographic factors, such as education levels, household income, and urban/rural residency.This nationwide cross-sectional study was performed with a total of 36,026 representative Korean adults aged 19 and older. The data were taken from the 2012-2012 Korea National Health and Nutrition Examination Survey.Men had, on average, significantly more remaining teeth than women did. Women brushed their teeth more often than men per day and were more likely to brush their teeth after meals. The participants with higher education levels or household income had significantly more remaining teeth; the number of daily tooth brushing was positively associated with the number of remaining teeth; urban residents had significantly more remaining teeth than rural residents; and elderly adults had fewer remaining teeth than younger adults had (all with P < 0.05). The participants were more likely to retain their incisors (especially their canines) for their entire lifetimes than do so for their molars. From the incisors to the second premolars, they had more mandibular teeth than maxillary teeth, but among molars, they had more maxillary teeth than mandibular teeth. Elementary graduates with low household income had fewer remaining teeth than did university graduates with high household income (P < 0.0001). Finally, participants with high socioeconomic status were more likely to lose their molar teeth than anterior teeth compared to those with low socioeconomic status.The participants who brushed their teeth fewer times per day, those with low household incomes and/or education levels, and those who lived in rural districts had significantly higher prevalence of tooth loss than did other groups in Korean adults. Participants had more anterior and premolar teeth on mandible, but they had more molars on maxilla. In addition, participants with high socioeconomic status were more likely to lose their molar teeth than anterior teeth compared to those with low socioeconomic status.

Risk factors for the progression of periodontal disease in a Greek adult population

AIM

The purpose of the present study was to investigate the progression risk factors of periodontal disease by individual characteristics at baseline in a Greek adult population.

METHODS

The study sample consisted of 854 individuals. All participants were clinically examined and answered questions regarding sex, smoking status, socioeconomic status, low educational level, frequency of dental follow up, and oral hygiene habits. Serum levels of disease markers were investigated, and attachment levels were clinically recorded. For the assessment of periodontal disease progression, additional clinical attachment loss (CAL) was used if one or more sites showed a 3 mm or more increase in probing attachment level over a 2-year period. Statistical analysis was performed by using a modified multiple Poisson's analysis model.

RESULTS

A total of 74% of the participants exhibited additional CAL over a 2-year period. Significant associations were observed between additional CAL and smoking (relative risk [RR] = 0.78, 95% confidence level [CI] = 0.65-0.92), attachment level of 5 mm or more at baseline (RR = 0.89, 95% CI = 0.75-1.05), educational level (RR = 0.90, 95% CI = 0.76-1.07), socioeconomic status (RR = 0.86, 95% CI = 0.59-1.14), and irregular dental follow up (RR = 1.23, 95% CI = 1.04-1.45).

CONCLUSIONS

Smoking, baseline attachment level of 5 mm or more, low educational level, low socioeconomic status, and irregular dental follow up could be considered risk factors for further CAL.

Risk factors and socioeconomic condition effects on periodontal and dental health: A pilot study among adults over fifty years of age

OBJECTIVE

Observational studies on the association among systemic/general and oral cavity indices, tooth loss, periodontal conditions, and socioeconomic inequalities are to be still performed in the population of Southern Europe. This study aims to determine the extent of this relationship among Italian healthy adults 50 years of age and above.

MATERIALS AND METHODS

Socioeconomic and lifestyle characteristics, cardiovascular indicators, and systemic indices were examined by contrasting the dental indices among adult people of Northern Italy. Data were processed through correlation analysis, and multivariate analysis was carried out using seemingly unrelated regressions.

RESULTS

A total of 118 adults 50 years of age and above, after anamnesis, underwent systemic and dental examination. Their socioeconomic status was found to be inversely associated only with smoking and dental parameters. Unexpected outcomes between lifestyle and risk factors were detected. The statistical analysis showed an uneven correlation among dental indices and between those indices and the socioeconomic status, such as, a periodontal condition, apparently free from influences, unusually became worse as the socioeconomic status enhanced.

CONCLUSIONS

The study outcomes indicate a relationship between tooth loss and conservative endodontic therapy, but they result in alternative choices. Nevertheless, the socioeconomic status has an inverse relationship with tooth loss and conservative endodontic therapy, but a direct relation with worsening of the periodontal condition. This pilot study highlights a need for the public health administration to adopt a socioeconomic assessment not only based on the household income, but also to accordingly improve its therapeutic course.

Education as a predictor of chronic periodontitis: a systematic review with meta-analysis population-based studies

BACKGROUND

The impact of socioeconomic inequalities on health is well-documented. Despite the links of periodontal disease with cardiovascular diseases, adverse pregnancy outcomes and diabetes, no meta-analysis of socioeconomic variations in periodontal disease exists. This meta-analytic review was conducted to determine the extent to which education attainment influences risk of periodontitis in adults aged 35+ years in the general population.

METHODS

The authors searched studies published until November 2010 using EMBASE and MEDLINE databases. References listed were then scrutinised, our own files were checked, and, finally, we contacted experts in the field. The authors included only general population-based studies conducted in adults aged 35 years and more. All articles were blind reviewed by two investigators. In the case of disagreement, a third investigator arbitrated. Using PRISMA statement, two reviewers independently extracted papers of interest.

RESULTS

Relative to the higher education group, people with low education attainment experience a greater risk of periodontitis (OR: 1.86 [1.66-2.10]; p<0.00001). The association was partially attenuated after adjustment for covariates (OR: 1.55 [1.30-1.86]; p<0.00001). Sensitivity analyses showed that methods used to assess periodontitis, definition of cases, study country and categorization of education are largely responsible for the heterogeneity between studies. No significant bias of publication was shown using both the Egger (p = 0.16) and rank correlation tests (p = 0.35).

CONCLUSIONS

In the studies reviewed, low educational attainment was associated with an increased risk of periodontitis. Although this evidence should be cautiously interpreted due to methodological problems in selected studies, efforts to eliminate educational inequalities in periodontitis should focus on early life interventions.

Sex differences in destructive periodontal disease: a systematic review

BACKGROUND

Sexual dimorphisms exist in the prevalence and severity of many human conditions and diseases. Models of risk assessment for periodontitis, however, are inconsistent with respect to the inclusion of sex as a risk factor. A systematic review of the literature and meta-analyses estimates sex-related differences in the prevalence of periodontitis.

METHODS

MEDLINE, EMBASE, and SCOPUS databases were searched for population surveys (sample size >500, half-mouth minimum, clinical attachment level) containing prevalence data on destructive periodontal disease in males and females.

RESULTS

Data were stratified by disease thresholds (3, 4, 5, and 7 mm) representing 50,604 subjects from 12 population surveys meeting selection criteria. Using a ≥ 5-mm clinical attachment loss threshold, seven studies provided data, permitting computation of mean-weighted sex differences in prevalence. Four studies provided data enabling a meta-analysis of prevalence rates. Sex exhibited a significant association with prevalence, reflecting a 9% difference between males and females (37.4% versus 28.1%, respectively), although the overall effect of sex in the meta-analysis was comparatively small (d = 0.19; 95% confidence interval, 0.16 and 0.22). This mean difference in prevalence between males and females was similar regardless of severity of disease threshold and after adjustment for other risk factors.

CONCLUSIONS

Men appear at greater risk for destructive periodontal disease than women; however, men do not appear at higher risk for more rapid periodontal destruction than women.

Diabetes modulates gene expression in the gingival tissues of patients with chronic periodontitis

AIM

This study evaluated whether diabetes modulates gene expression [interleukin (IL)-1beta, IL-1ra, IL-6, IL-8, IL-10; tumor necrosis factor (TNF)-alpha; interferon (IFN)-gamma, receptor activator of NF-kappaB ligand (RANKL) and osteoprotegerin (OPG)] in sites with periodontitis.

MATERIALS AND METHODS

Gingival biopsies were harvested and divided into three groups--Control group: systemically and periodontally healthy subjects (n = 10); Periodontitis group: systemically healthy subjects diagnosed with chronic periodontitis (n = 20); Diabetes group: type 1 diabetic subjects, diagnosed with chronic periodontitis (n = 20). Total RNA was obtained and analyzed by quantitative polymerase chain reaction.

RESULTS

Data analysis demonstrated that, except for OPG, mRNA levels for all factors were increased by inflammation (P < 0.001). Interleukin-1beta, IL-1ra, IL-6, IL-8, IFN-gamma, and RANKL mRNA levels were higher in the diabetic group when compared with the control non-periodontitis group (P < 0.05), whereas IL-10 and OPG were lower (P < 0.05). No difference was observed for TNF-alpha between diabetic and control groups (P > 0.05). Diabetes lowered IL-1beta, IL-8, IL-10, TNF-alpha, RANKL, and OPG mRNA levels in sites with comparable type of periodontitis (P < 0.001). Moreover, increased RANKL:OPG and IL-6:IL-10 ratios were found.

CONCLUSION AND CLINICAL RELEVANCE

Taken together, these data suggest that decreased levels of IL-10 and OPG may play an important role in the periodontal breakdown in diabetic patients.

Associations between periodontal diseases and systemic diseases: a review of the inter-relationships and interactions with diabetes, respiratory diseases, cardiovascular diseases and osteoporosis

The aim of this review article is to examine the associations between periodontal diseases and common systemic diseases, namely diabetes, respiratory diseases, cardiovascular diseases and osteoporosis. A substantial number of review articles have been published to elucidate the relationships between these diseases; however, none provide a complete overview on this topic from the aspects of definition, classification, clinical characteristics and manifestations, inter-relationships and interactions, proposed schematic mechanisms, clinical implications and management of periodontal patients with these systemic diseases. The aim of this article is to provide an overall understanding and general concepts of these issues in a concise and inter-related manner.

Validity of self-reported periodontal status in the Florida dental care study

BACKGROUND

Our objectives were to assess the validity of self-reported periodontal status by quantifying the 1) concordance between self-reported and clinical status at baseline; and 2) validity using a multivariable regression of self-reported periodontal status and sociodemographic status.

METHODS

The Florida Dental Care Study was a prospective study that used a population-based, stratified random sample of 873 persons in four counties of north Florida who were > or = 45 years of age at baseline. Analyses used baseline data derived from in-person interviews and clinical periodontal examinations. Multivariable logistic regressions were done to quantify the relationships between the outcome (clinically determined periodontal attachment level) and predictors (self-reported dental symptoms, self-reported dental behaviors, sociodemographic circumstances, and clinically determined number of remaining teeth).

RESULTS

Self-rated "gum" health and presence of a loose tooth were the only periodontal measures that were associated significantly with clinically determined periodontal status in multivariable regressions. The validity of self-reported periodontal status improved when the threshold of severity was increased. Significant racial differences in the validity of self-reports were evident.

CONCLUSION

Self-reported measures of periodontal status were related to clinically measured periodontal attachment loss and warranted classifying their validity as "moderate" and useful for some circumstances.

Racial differences in treatment preferences: oral health as an example

RATIONALE, AIMS AND OBJECTIVES

Recent analyses from the Florida Dental Care Study found that response to a hypothetical scenario at baseline strongly predicted: (a) tooth loss during follow-up; and (b) subsequent receipt of either a dental extraction or Root Canal Therapy (RCT). The scenario ('CHOICE') required choosing either to: (1) extract the tooth before even knowing the cost of treatments; (2) extract, but after knowing the cost of all treatments; or (3) have RCT despite knowing costs.

OBJECTIVE

The purpose of this study was to identify factors associated with CHOICE and quantify their effects.

METHODS

As part of the baseline phase of the study, 873 subjects with at least one tooth and who were 45 years or older participated for an interview and dental examination. A multinomial multivariable regression of CHOICE quantified effects due to hypothesized predictors.

RESULTS

CHOICE was strongly associated with race (African-Americans were significantly less likely to choose RCT). Results from the multivariable regression suggest that the race effect could be explained by racial differences in patient preference, treatment acceptability and ability to afford treatment.

CONCLUSIONS

There were substantial racial differences in treatment preference even in this hypothetical scenario where racial differences in patient-provider interaction and clinical factors were not relevant. Certain predisposing and enabling variables explained these racial differences in treatment preference.

Effects of smoking and drinking habits on the incidence of periodontal disease and tooth loss among Japanese males: a 4-yr longitudinal study

OBJECTIVE

We investigated the risk of periodontal disease and tooth loss, associated with habits of smoking and alcohol consumption, in a longitudinal study.

SUBJECTS AND METHODS

The subjects were 1332 Japanese males, 30-59 yr of age, who were free from periodontal disease at the baseline check-up, and who underwent a second check-up 4 yr later. Periodontal disease was diagnosed using the community periodontal index score, based on the clinical probing of pocket depth (> or = 4 mm). Smoking and alcohol consumption patterns were evaluated using a self-administered questionnaire.

RESULTS

A dose-response relationship was observed between the amount of smoking and the incidence of periodontal disease in each age group. The overall odds ratios (95% confidence intervals), adjusted for age and alcohol, were 1.51 (0.95-2.22), 1.58 (1.13-2.22) and 2.81 (1.96-4.03), among smokers consuming 1-19, 20 or 21 or more cigarettes per day, respectively, with a significant linear trend (p < 0.0001). A similar association was found between smoking and tooth loss, except for the 50-59-yr-old age group. The adjusted odds ratios were 1.26 (0.60-2.64), 2.01 (1.21-2.32) and 2.06 (1.23-3.48), respectively. A significant linear trend between smoking and tooth loss was also observed (p = 0.01). Ex-smokers showed no significant difference compared with nonsmokers. We also found a significant linear trend between alcohol consumption and tooth loss among 30-39-yr-old subjects, while no relationship was observed between alcohol consumption and periodontal disease.

CONCLUSION

Cigarette smoking was found to be an independent risk factor for periodontal disease and tooth loss. Alcohol consumption was a limited risk factor for tooth loss in the younger age group, but was unrelated to periodontal disease. To prevent periodontal disease and tooth loss, health practitioners need to encourage people to stop smoking or not to start.

Dental attitudes: proximal basis for oral health disparities in adults

OBJECTIVES

Behavioral science postulates that underlying characteristics of populations, rather than sociodemographic groupings, are more proximal causes of oral health disparities through differing oral health behaviors. To our knowledge this is the first report in the literature that examines longitudinal correlates of oral health and dental care using groups of persons holding similar attitudes and beliefs.

METHODS

The subjects were 873 participants in the Florida Dental Care Study, a longitudinal study of oral health among dentate adults. Hierarchical cluster analysis identified four groups with similar dental attitudes that were labeled 'favorable attitudes about dental care', 'frustrated believers in dental care', 'negative attitudes and cost concerns', 'pessimistic about personal and professional oral care'.

RESULTS

The attitudinal groups cut across race, sex, and age with race and educational status the best discriminators among sociodemographic and economic variables. The negative attitude group reported the least preventive care and the largest oral health decrements on clinical examination at baseline and 24 months. The group with favorable attitudes about dental care reported the highest number of preventive and restorative visits and the lowest point-prevalence of toothache pain, temperature sensitivity, and painful gums. The frustrated believers have access to dental care equivalent to the favorable attitude group, but may delay seeking dental care until oral disease becomes more severe, based on their pattern of preventive, restorative, and dental extraction visits. Additional group differences on oral health and dental care are reported.

CONCLUSION

This study takes a novel approach to examining oral healthy disparities. Differences in oral health behaviors support the validity of the groups.

Periodontal disease in the oldest-old living in Kungsholmen, Sweden: findings from the KEOHS project

AIMS

The Kungsholmen Elders Oral Health Study evaluated the oral health status of generally healthy, community-dwelling persons aged 80 years and over living in Stockholm, Sweden. This paper reports periodontal disease findings and evaluates the distribution by sociodemographic factors.

METHODS

Eligible persons were identified through the Kungsholmen Project, an ongoing, longitudinal, population-based study of older adults. A total of 121 study subjects received a periodontal examination.

RESULTS

The mean pocket probing depth was 2.6 mm and the mean clinical attachment loss was 3.7 mm. Gingival bleeding was common. Over half of all study participants met the criteria used for "serious periodontitis" (SP). In the best fit adjusted odds ratio (OR) model, males were 3.1 times more likely than females to have "SP" (OR=3.1, 95% CI 1.2, 8.0), a statistically significant observation. A sub-analysis of the differences in proportion of participants with SP revealed that the difference by sex also increased by age.

CONCLUSIONS

These findings document the substantial and ongoing impact of periodontal disease in a sample of generally healthy, community dwelling older adults and underscore the importance of continued periodontal disease prevention and treatment in the oldest-old.

Risk Assessment for Severe Clinical Attachment Loss in an Adult Population

BACKGROUND

This study was carried out to identify variables related to severe clinical attachment loss (CAL) in an adult French population.

METHODS

This cross-sectional survey employed 2,132 subjects of the First National Periodontal and Systemic Examination Survey (NPASES I) aged 35 to 64 years, each with at least six teeth. A nationally representative sample was obtained from September 2002 to June 2003 by a quota method stratified on age, gender, socioeconomic status, and geographic areas. The subjects had a complete full-mouth periodontal examination of four sites per tooth, assessment of missing teeth, and a number of laboratory tests and questionnaires. The periodontal status of each subject was assessed by criteria based on the severity and extent of CAL. The data were analyzed by univariable and multivariable models using logistic regression analyses.

RESULTS

Nineteen and seven-tenths percent (19.7%) of the subjects had CAL>5 mm. When dental variables were not included in the analysis (model 1), age (odds ratio [OR]=1.8), male gender (OR=1.7), body mass index (OR=1.2), and white blood cell count (OR=2.2) showed significant association with severe CAL. A significantly higher risk was also present in non-drinkers and regular drinkers compared to occasional drinkers (OR=1.6). Model 2, including dental variables in addition to model 1 variables, showed that a significantly higher risk for severe CAL was also present with age (OR=1.6) and in males (OR=1.7). The number of teeth (OR=1.1), and the mean gingival bleeding index (OR=1.7) were the dental variables significantly associated with severe CAL.

CONCLUSIONS

The results indicated that age and gender are powerful independent predictors of clinical attachment loss, as is the mean gingival bleeding index. To a lesser extent, the number of missing teeth was a good predictive variable. The patient profile for severe clinical attachment loss also included body mass index and white blood cell count. Occasional drinking may be associated with decreased severity of CAL.

Risk factors and prevalence of periodontitis in community-dwelling elders in Mexico

AIM

The objective of this study was to determine whether an association existed between chronic systemic diseases/conditions, risk factors common in old age, and the extent and severity of chronic periodontal disease.

MATERIALS AND METHODS

Sociodemographic and lifestyle characteristics were examined by contrasting rural, urban-marginal, and urban social environments in Central Mexico. Data were analysed with Analysis of Variance, chi2 tests, and multivariable logistic regression.

RESULTS

A total of 473 adults 60 years old and over were interviewed; 315 were also examined and underwent laboratory assays (participation rate, 66%); women, 62%; mean age 73+/-8 years; 23% edentulous. The distribution of periodontitis by sociodemographic variables showed differences across locales (73% low-urban, 57% middle-urban, 29% rural). The regression model indicated that periodontitis was more frequently associated with low-urban locale, higher systolic blood pressure, higher body mass index, and worse calculus readings, with an interaction whereby being obese and having a high calculus index was associated with a high probability of having periodontitis.

CONCLUSIONS

Overall periodontal conditions were fair. While we identified oral, systemic, and social variables that modulated the experience of periodontitis, it would appear that urban, low social class elders appeared to have worse periodontal conditions.

The Influence of Dynamic Occlusal Interferences on Probing Depth and Attachment Level: Results of the Study of Health in Pomerania (SHIP)

BACKGROUND

The purpose of this study was to investigate potential associations between dynamic occlusal interferences and signs of periodontal disease in posterior teeth based on dental and medical measurements obtained from a population-based sample in the cross-sectional epidemiological study entitled, "Study of Health in Pomerania" (SHIP).

METHODS

Medical history and dental and sociodemographic parameters of 2,980 representatively selected dentate subjects, 20 to 79 years of age, were collected. The analysis was performed on posterior teeth only using a mixed linear model that considers the clustered structure of the data. The model also was adjusted with respect to known risk factors for periodontal disease.

RESULTS

The presence of non-working side contacts only was significantly related to probing depth (P<0.0001) and attachment loss (P=0.001). The presence of non-working side contacts and working side contacts on the same tooth was significantly related to increased probing depth (P=0.004) but not attachment level. The effect magnitude was a mean increase of 0.13 mm for probing depth and 0.14 mm in attachment loss. Known risk factors for periodontal disease that also showed significant associations with probing depth and attachment loss included male gender, age, smoking, education, and plaque score. Other factors significantly related to probing depth and/or attachment loss were tilted teeth, restored occlusal surfaces versus sound surfaces, elongated teeth, and tooth type (molar versus premolar).

CONCLUSION

The effect of non-working contacts on periodontal disease status was discernible, but weak in terms of magnitude and specificity.

Overweight and obesity as risk indicators for periodontitis in adults

BACKGROUND

Developed and developing countries are facing an obesity epidemic with various health consequences. Few studies have addressed the relationship between obesity and periodontal health. The present study assessed the association of overweight and obesity with periodontitis in Brazilian adults.

METHODS

A representative probability sample comprising 706 subjects aged 30 to 65 years from south Brazil was examined clinically and using a structured interview. Overweight and obesity were assessed by body mass index (BMI) using the World Health Organization (WHO) criteria. Individuals with > or =30% teeth with attachment loss > or =5 mm were classified as having periodontitis. Statistical analysis accounted for survey design, and separate analyses were performed for non-smokers.

RESULTS

In this population, 60% and 65% of males and females, respectively, were overweight or obese. Periodontitis was observed in 50.7% and 35.3% of males and females, respectively. The percentage of males with periodontitis was similar in the overweight/obese individuals compared to those with normal weight. In females, there was a positive correlation between the BMI index and the occurrence of periodontitis, with a significantly (P < 0.05) higher prevalence of periodontitis in obese than in normal weight females. The multivariable analysis showed that obese females were significantly more likely (odds ratio = 2.1) to have periodontitis than normal weight females. A separate analysis for non-smokers showed that obese females were approximately 3.4 times more likely to have periodontitis than the normal BMI group. There were no significant differences in the prevalence of periodontitis between BMI groups among smokers of both genders and in male non-smokers.

CONCLUSIONS

Obesity was significantly associated with periodontitis in adult, non-smoker women. Overweight was not significantly associated with periodontitis. Smoking may attenuate the association of periodontitis with obesity.

Smoking, periodontal disease and the role of the dental profession

Epidemiological investigations support a firm relationship between smoking and periodontal disease. The likely benefits of smoking cessation programmes are considerable for periodontal disease, cancers and nearly all chronic systemic diseases. The mechanisms by which smoking may influence the development and progression of periodontal disease are as yet unclear, but may include changes in the vasculature, the immune and inflammatory systems, tissue oxygenation and the healing processes. Unfortunately, although dental professionals have more opportunities to encourage smokers to quit (most people visit their dentist more frequently than their doctor), dentists claim that they are not well informed on this subject. The purpose of this review is to describe the evidence for a link between smoking and periodontal disease, the possible pathology induced by smoking on the periodontal tissues and its impact on therapy, and to outline the smoking cessation techniques that are currently available.

A socio-economic perspective on periodontal diseases: a systematic review

OBJECTIVE

The aim of this systematic review was to ascertain whether socio-economic conditions increase the risk of periodontal diseases.

METHODS

A MEDLINE search was conducted for the period 1965-April 2004. Only original articles were included; 47 studies remained for the final assessment. The studies were analysed regarding the outcome of the association between socio-economic variables and periodontal disease, depending on the study design (cross-sectional survey or longitudinal case-control) and whether smoking was included or not.

RESULTS

Twenty-nine out of 36 studies with a cross-sectional design were in favour of the association between socio-economic factors and periodontal diseases. In the studies with a longitudinal or case-control design, there were five in favour of the association, and also six against. When smoking was included in the analysis of cross-sectional studies, a significant association between socio-economic variables and periodontal disease was found in 11 studies and no significance in another five studies. The corresponding figures for case-control studies showed four studies being significant, but also four studies showing no significance.

CONCLUSION

Based on relevant study designs and including smoking in the analysis, the socio-economic variables associated with periodontal diseases appear to be of less importance than smoking.

Epidemiology and risk factors of periodontal diseases

Periodontal diseases are chronic inflammatory disorders encompassing destructive and nondestructive diseases of the periodontal supporting tissues of teeth. Gingivitis is a nondestructive disease ubiquitous in populations of children and adults globally. Aggressive periodontitis is characterized by severe and rapid loss of periodontal attachment often commencing at or after the circumpubertal age and is more prevalent among Latin Americans and subjects of African descent, and least common among Caucasians. Chronic periodontitis is a common disease and may occur in most age groups, but is most prevalent among adults and seniors world-wide. Approximately 48% of United States adults have chronic periodontitis, and similar or higher rates have been reported in other populations. Moderate and advanced periodontitis is more prevalent among the older age groups, and rates of 70% or more have been reported in certain populations. Chronic and aggressive periodontitis are multifactorial diseases caused primarily by dental plaque microorganisms, and with important modifying effects from other local and systemic factors. The study of the significance of demographic, environmental, and biologic variables is important for risk assessment and the control of periodontal diseases.

Periodontal antimicrobials — finding the right solutions

Strengthened by promising research data and commercial backing, interest in the field of anti-infective periodontal therapy is rapidly expanding. Management of the periodontal microbiota with antibiotic drugs and antiseptic agents in conjunction with mechanical debridement seems to be more effective than mechanical therapy alone, at least in the treatment of advanced periodontal disease. The choice of a periodontal chemotherapeutic regimen requires an understanding of the usual infecting flora, available antimicrobial agents, and pathogen susceptibility patterns. Systemic administration of combinations of metronidazole and either amoxicillin or ciprofloxacin has been widely used with great success; however the presence of subgingival yeasts and resistant bacteria can be a problem in some periodontitis patients. Valuable antiseptic agents for subgingival application include 10% povidone-iodine for professional use and 0.1-0.5% sodium hypochlorite for patient self-care. These antiseptics have significantly broader spectra of antimicrobial action, are less likely to induce development of resistant bacteria and adverse host reactions, and are considerably less expensive than commercially available antibiotics in controlled release devices. In practice, mechanical debridement combined with subgingival povidone-iodine application in the dental office and sodium hypochlorite irrigation for patient self-care are valuable antimicrobial remedies in the treatment of virtually all types of periodontal disease. Management of moderate to severe periodontitis may require additional systemic antibiotic and/or surgical treatment.

Childhood dental history and adult dental attitudes and beliefs

OBJECTIVE

To examine associations between childhood dental visits and attitudes and beliefs about dental care, and oral health as measured during adulthood.

METHODS

The data were taken from the Florida Dental Care Study (FDCS), a prospective longitudinal study of oral health and dental care, among 683 adults 45 years of age and older who answered questions about early dental history at the 54-month follow-up interview.

RESULTS

Fifty-nine per cent (n = 400) reported having had a dental visit before 18 years of age. Of those with a childhood visit, 72% reported that the first dental visit was a negative experience. Having a childhood dental visit was associated with several positive attitudes and beliefs about dental care. In addition, having early experiences with a dentist was associated with preventive and restorative dental visits and several objective and subjective measures of oral health. Having a negative childhood experience was associated with only one of the adult dental attitude and beliefs subscales, and none of the oral health behaviours.

CONCLUSIONS

Our data suggest that the socialisation associated with early dental visits may occur even though the experience may have been painful or frightening. Although this study design precluded direct inference about causation, these findings do support the utility of further investigations into possible causative linkages between childhood dental experiences and adult attitudinal and dental health outcomes.

Forty-Eight–Month Periodontal Attachment Loss Incidence in a Population-Based Cohort Study: Role of Baseline Status, Incident Tooth Loss, and Specific Behavioral Factors

BACKGROUND

The objectives of this study were to: 1) test hypotheses that behavioral factors, baseline clinical status, and incident tooth loss are significantly associated with attachment loss incidence (ALI) and 2) quantify the effect of incident tooth loss on conclusions made about ALI.

METHODS

The Florida Dental Care Study was a prospective study of persons > or =45 years old. In-person interviews and examinations were conducted at baseline and 48 months, with telephone interviews in between.

RESULTS

Of 560 persons with baseline and 48-month examinations, 22% of persons and 1.8% of teeth had ALI. This was highest among persons with no dental visit during follow-up (person-level incidence of 46%; 5.0% tooth-level incidence). Statistically significant covariates in a multivariable regression of ALI were: losing a tooth due to periodontal reasons after baseline, but before the 48-month examination; not receiving a dental cleaning; and baseline factors (worst attachment level of > or =7 mm, not flossing, a molar tooth, current smoker).

CONCLUSIONS

A substantial percentage of persons experienced ALI. Baseline attachment level and behavioral factors were significantly associated with ALI. Persons with incident tooth loss were also at increased risk for ALI, and teeth lost during follow-up had worse baseline attachment level. Had these teeth not been lost before the final examination, the ALI estimate could only have been higher. These findings demonstrate that those at greatest risk for ALI are least likely to enter the dental care system, and among those who do, one health outcome (tooth loss) can affect conclusions made about the incidence of another (ALI).

Risk indicators of periodontal disease in older Thai adults

BACKGROUND

The aim of this study was to identify risk indicators for periodontitis using cross-sectional data from a group of older Thai adults.

METHODS

The study group consisted of 2,005 individuals, aged 50 to 73 years old. They received detailed medical examinations and periodontal examinations including plaque score, probing depth, and clinical attachment level. These individuals were categorized into mild, moderate, or severe periodontitis if mean clinical attachment level was <2.5 mm, 2.5 to 3.9 mm, or > or = 4.0 mm, respectively. The degree of association between the severity of periodontitis and various independent variables was investigated using multinomial logistic regression analysis.

RESULTS

The percentage of subjects classified as mild, moderate, and severe periodontitis was 30.5, 53.6, and 15.9, respectively. The prevalence of severe periodontitis was higher in males and increased with age. In univariate analysis, older subjects, males, less educated persons, persons with lower income, persons with higher plaque score, smokers, drinkers, and diabetics were more likely to have both moderate and severe periodontitis. In multivariate analysis, males, less educated persons, persons with higher plaque score, and current smokers were more likely to have moderate periodontitis. Three additional factors including older age, former smokers, and diabetes significantly increased the odds for having severe periodontitis. Income, alcohol consumption, body mass index, and waist circumference had no significant effects on periodontal disease severity in the multivariate model.

CONCLUSIONS

Our data suggest that age, gender, education, oral hygiene status, smoking, and diabetes are significantly associated with periodontal disease severity in this study group. Longitudinal studies will establish whether these variables are true risk factors.

Clinical and other risk indicators for early periodontitis in adults

BACKGROUND

Periodontal diseases affect over half the adults in the U.S., disproportionately affecting minority populations. Periodontitis can be treated in early stages, but it is not clear what features indicate, or could be risk factors for, early stages of periodontal attachment loss. This study aimed to evaluate associations between clinical and other risk indicators of early periodontitis.

METHODS

A cross-sectional evaluation of 225 healthy and early periodontitis adults aged 20 to 40 years was performed. Clinical measurements, demographic information, and smoking histories were recorded. Analyses evaluated demographic and clinical associations with health and early periodontitis disease categories and periodontal attachment loss. Patterns of attachment loss at interproximal and buccal/lingual sites were evaluated.

RESULTS

Subject age, plaque, and measures of gingivitis exhibited associations with attachment loss and probing depth. More periodontal attachment loss was detected in African-American and Hispanic subjects compared to Asian and Caucasian subjects. Smoking history was associated with attachment loss. At interproximal sites, lower molars most frequently had attachment loss, whereas at buccal/lingual sites, higher proportions of lower bicuspid teeth demonstrated attachment loss compared with other sites.

CONCLUSIONS

In this study of subjects with minimal attachment loss, gingival inflammation was associated with early periodontitis. Lower molar interproximal sites were frequently associated with interproximal attachment loss, whereas lower bicuspid teeth were at risk for gingival recession on buccal surfaces.

Risk determinants of periodontal disease - an analysis of the Study of Health in Pomerania (SHIP 0)

BACKGROUND

In this study, risk determinants were determined for periodontal disease in the representative population sample (n=3146) of the Study of Health in Pomerania.

METHODS

After examining the net random sample (response 69%) and exclusion of edentulous cases and those with missing values, 2595 subjects remained. Using a multivariate, fully adjusted logistic regression, different definitions of "periodontally diseased/healthy" were examined as the dependent variable (extent of attachment loss (AL> or =4 mm, combined AL and tooth loss). The independent variables used were sociodemographic factors (age, gender, income, education), medical factors (systemic diseases, drugs), behavioral factors (regular dental checkup, smoking), and oral factors (presence of supragingival calculus and plaque).

RESULTS

The following risk determinants were found for AL: male gender, presence of supragingival plaque and calculus, smoking, low educational level. For the combination of AL and tooth loss, risk determinants were female gender, supragingival plaque, smoking, and low educational level. Consumption of antiallergic medications and regular dental checkups proved to be protective. Smoking was the most influential risk determinant. These parameters explained approximately 43-55% of the variation.

CONCLUSION

These results concur with those of the literature. In order to explain disease status further, host-response and microbiological factors must also be examined.

Periodontal epidemiology: towards social science or molecular biology?

Terms such as 'molecular epidemiology' and 'genetic epidemiology' have been coined to depict the change from 'traditional epidemiology', concerned with disease determinants at the community or society level, over to 'modern epidemiology', which is concerned with determinants operating at the individual level or even below, i.e. at the organ, tissue, cell, or molecular level. In this commentary, we point out to the limitations of this development and suggest that more emphasis is placed on making the presumed causal disease models explicit, when investigating the relationship between putative determinants and disease. Understanding the disease processes at the micro-level is insufficient for understanding disease at the individual level; and disease patterns at the population level cannot be understood unless it is realized that individuals exist in a variety of contexts that cannot be reduced to individual attributes.

Subgingival microbiota of chilean patients with chronic periodontitis

BACKGROUND

An association between race/ethnicity and the composition of the subgingival microbiota has been found in chronic periodontitis. A study was undertaken to determine the characteristics of the subgingival microbiota of chronic periodontitis in Chileans residing in Santiago.

METHODS

Twenty-six subjects (mean age 45 +/- 7 years) with chronic periodontitis, mean probing depth (PD) 2.63 +/- 0.5 mm, mean attachment level (AL) 3.70 +/- 0.77 mm, and without a history of periodontal therapy were selected. Measurements of PD, AL, bleeding on probing, and plaque accumulation were recorded at six sites per tooth. Subgingival plaque samples were taken from the mesial aspect of every tooth and evaluated for the presence, levels, and proportions of 40 bacterial taxa using whole genomic DNA probes and checkerboard DNA-DNA hybridization. The microbial data of the Chileans were compared with data from 115 chronic periodontitis patients from Boston, Massachusetts. Since several clinical and demographic parameters differed between the two populations, significance of differences for each species was determined using analysis of covariance, adjusting for age, plaque level, mean PD, gender, and smoking status.

RESULTS

Each of the individual test species was present in at least 25 of the 26 subjects, and 12 subjects (46.1%) harbored all 40 test species. With the exception of Prevotella intermedia, all test species colonized more than 75% of sites, and 25 species colonized > or = 90% of sites including the co-colonizing species of advanced periodontal lesions, termed the red complex, composed of the three species Porphyromonas gingivalis, Tannerella forsythensis (formerly Bacteroides forsythus), and Treponema denticola as well as Fusobacterium nucleatum subspecies, Campylobacter rectus, Peptostreptococcus micros, and Treponerma socranskii. Sixteen of the 40 species differed significantly between Chilean and U.S. subjects. Red, yellow, and other complexes were significantly higher in the Chileans, while the Actinomyces were higher in the U.S. subjects.

CONCLUSIONS

The composition of the subgingival plaque differs among different subject populations. Thus, care should be taken when extrapolating the findings of one study to different ethnic groups.

Some characteristics of 50/55-year-old individuals with various experience of destructive periodontal disease: a cross-sectional study

OBJECTIVE

To analyze the association between subject characteristics and degree of destructive periodontal disease in a randomly selected sample of 50/55-year-old individuals.

METHODS

A randomized and geographically stratified (urban/rural districts) subject sample composed of dentate 50-year-old (n = 190) and 55-year-old individuals (n = 359) from the county of Varmland, Sweden were examined. Data were collected through full mouth clinical and radiographic examinations and by the use of questionnaires. Based on the cumulative distribution of the individuals with respect to mean probing attachment loss (PAL), subgroups of subjects with the lowest (L20%) and highest (H20%) experience of PAL were identified. Similar classifications were made for never-smokers and current smokers. Correlation analyses and forward stepwise logistic regression models were performed.

RESULTS

The subgroup with the most extensive PAL loss (H20%) included a significantly higher proportion of (i) males (60 vs 33%), (ii) subjects with low educational level (65 vs 41%), (iii) smokers (49 vs 15%), and had (iv) less favorable lifestyle characteristics than the subgroup with minimal experience of PAL loss (L20%). The same pattern of differences was observed when the analysis was restricted to never-smokers, with the addition of a significantly lower proportion of subjects living in urban areas (40 vs 69%) in the H20% compared to the L20% subgroup. The stepwise logistic regression analysis revealed that number of teeth and smoking habits were significant factors in the identification of individuals in the L20% subgroup. For the H20% subgroup, number of teeth, gender, number of cigarettes/day and lifestyle index were significant explanatory variables.

CONCLUSION

Number of remaining teeth and smoking habits were identified as the main discriminating factors for classification of subjects with regard to degree of destructive periodontal disease.

Intra-oral pattern of tooth and periodontal bone loss between the age of 50 and 60 years. A longitudinal prospective study

OBJECTIVE

In a 10-year prospective study we analyzed (i) the intra-oral pattern of and (ii) potential risk factors for tooth and periodontal bone loss in 50-year-old individuals.

METHODS

A randomized subject sample of 50-year-old inhabitants in the County of Varmland, Sweden, was examined at baseline and after 10 years. Data from full-mouth clinical and radiographic examinations and questionnaire surveys of 309 (72%) of the individuals who were dentate at baseline were available for analysis. Non-parametric tests and binary logistic multiple regression models were used for statistical analysis of the data.

RESULTS

4.1% of the 7,101 teeth present at baseline, distributed among 39% of the subjects, were lost during the 10-year interval. The incidence of tooth loss was highest among mandibular molars (7.5%) and lowest among canines (1.8%). The relative risk (RR) for tooth loss for endodontically compromised teeth was 4.1 and for furcation-involved molars 2.4-6.5, depending on tooth position. Logistic regression analysis identified baseline alveolar bone level (ABL), endodontic conditions, CPITN score (Community Periodontal Index of Treatment Needs), tooth position, caries, and educational level as risk factors for tooth loss. The overall mean 10-year ABL change was -0.54 mm (S.E. 0.01). On a tooth level the ABL change varied between -0.35 mm (mandibular molars) and -0.79 mm (mandibular incisors). Smokers experienced a greater (20-131% depending on tooth type) mean bone loss than non-smokers. The logistic regression model revealed that tooth position, smoking, and probing pocket depth > or =4 mm were risk factors for bone loss of >1 mm. No pertinent differences were observed with respect to risk factors for ABL change in the subgroup of non-smokers compared to the results of the analysis based on the entire subject sample.

CONCLUSION

Tooth loss was more common in the molar than in the anterior tooth regions, while periodontal bone loss had a random distribution in the dentition. The predominant risk factors identified with regard to further radiographic bone loss were "probing pocket depth > or =6 mm" and "smoking".

Root Canal Treatment in a Population-Based Adult Sample: Status of Teeth After Endodontic Treatment

The purpose of this study was to quantify treatment outcomes of endodontically treated teeth, in a representative, population-based adult sample. The "Florida Dental Care Study" was a prospective, longitudinal, cohort study of 873 subjects who had at least one tooth at baseline and who were 45 yr or older. An in-person interview and clinical examination were conducted at baseline, 24 months, and 48 months after baseline, with 6-monthly telephone interviews between those times. Dental record information was abstracted afterward. Seventy-five teeth had conventional root-canal therapy (RCT) performed and met the inclusion criteria of 1-yr of follow-up or extraction. The mean duration of follow-up after RCT was 24.8 months. The mean (SD) attachment loss (AL) on teeth receiving RCT was only 3.3 (1.4) mm. Permanent restorations were placed in 79% of teeth a mean of 4.4 months after the RCT. However, 12% of teeth did not have any restorative treatment after RCT. After RCT had been completed, 81% of teeth were retained and 19% were ultimately extracted. Taken as a whole, this community-based study of a representative sample of adults suggests a higher failure rate than reported from studies in highly controlled environments or insured populations. It also suggests that the length of time to initial restoration of RCT-treated teeth is less than optimal. RCT was almost never performed on teeth with advanced periodontal attachment loss.

Some risk factors for periodontal bone loss in 50-year-old individuals. A 10-year cohort study

OBJECTIVE

The aim of this 10-year prospective study of 50-year-old individuals was to analyze the incidence of periodontal bone loss and potential risk factors for periodontal bone loss.

METHODS

The subject sample was generated from an epidemiological survey performed in 1988 of subjects living in the County of Värmland, Sweden. A randomized sample of 15% of the 50-year-old inhabitants in the county was drawn. At the 10-year follow-up in 1998, 320 (75%) of the 449 individuals examined at baseline were available for re-examination, out of which 4 had become edentulous. Full-mouth clinical and radiographic examinations and questionnaire surveys were performed in 1988 and 1998. Two hundred and ninety-five individuals (69%) had complete data for inclusion in the analysis of radiographic bone changes over 10 years. Non-parametric tests, correlations and stepwise multiple regression models were used for statistical analysis of the data.

RESULTS

The mean alveolar bone level (ABL) in 1988 was 2.2 mm (0.05) and a further 0.4 mm (0.57) (p=0.000) was lost over the 10 years. Eight percent of the subject sample showed no loss, while 5% experienced a mean bone loss of >/=1 mm. Smoking was found to be the strongest individual risk predictor (RR=3.2; 95% CI 2.03-5.15). When including as smokers only those individuals who had continued with the habit during the entire 10-year follow-up period, the relative risk was slightly increased (3.6; 95% CI 2.32-5.57). Subjects who had quit smoking before the baseline examination did not demonstrate a significantly increased risk for disease progression (RR=1.3; 95% CI 0.57-2.96). Stepwise multiple regression analysis revealed that smoking, % approximal sites with probing pocket depth >/=4 mm, number of teeth and systemic disease were significant explanatory factors for 10-year ABL loss (R(2)=0.12). For never smokers, statistically significant predictors were number of teeth, mean ABL, % periodontally healthy approximal sites and educational level (R(2)=0.20).

CONCLUSION

The inclusion of smokers in risk analysis for periodontal diseases may obstruct the possibility to detect other true risk factors and risk indicators.

Edentulism and nutritional status in a biracial sample of well-functioning, community-dwelling elderly: the health, aging, and body composition study

BACKGROUND

Edentulism may affect dietary intake in older adults, but the relation between edentulism and nutritional status is not completely understood.

OBJECTIVE

The present study examined whether edentulism is associated with nutritional status and whether there is an interaction between race and edentulism on nutritional status among well-functioning, community-dwelling elderly.

DESIGN

The study cohort included 3075 elderly aged 70-79 y (52% women, 42% black) in the Health, Aging, and Body Composition Study. Dietary intake, anthropometric variables, weight change, and serum albumin and lipid concentrations were compared between edentate and dentate participants by the use of multiple linear and logistic regressions.

RESULTS

Edentulism was not associated with total energy or food intake but was associated with the food groups consumed, particularly fat, micronutrients, and hard-to-chew foods. Edentulism was more strongly linked to dietary intake in whites than in blacks. Unlike black edentate elderly, white edentate elderly consumed significantly lower energy-adjusted amounts of vitamin A and beta-carotene, higher amounts of energy-adjusted total and saturated fat and cholesterol, and higher percentages of energy from fat than did white dentate elderly. Anthropometry and biochemical indexes were not significantly different by edentulism status in both races. Edentulism was associated with weight gains of >5% in 1 y in both races.

CONCLUSIONS

Edentulism was associated with differences in the nutritional status of well-functioning, community-dwelling elderly, more so in whites than blacks. Edentate elders may benefit from dental, medical, and nutrition interventions targeted to addressing these findings.

Progression of destructive periodontal diseases in three urban minority populations: role of clinical and demographic factors

BACKGROUND, AIMS

Differences in prevalence, severity and risk factors for destructive periodontal diseases have been reported for ethnic/racial groups. However, it is not certain whether this disparity is due to ethnicity/race or factors associated with ethnicity/race. Therefore, the present study addressed whether the rates of disease progression and clinical and demographic factors associated with disease progression varied among three ethnic/racial groups.

METHODS

The study population consisted of 53 Asian-, 69 African- and 62 Hispanic-Americans. Clinical measurements included probing depth, attachment level, gingival erythema, bleeding upon probing, suppuration and plaque. Disease progression was defined as a > 2 mm loss of attachment 2 months post baseline. The demographic variables examined included occupational status, report of a private dentist, years resident in the United States and smoking history.

RESULTS

The rate of attachment loss for the entire population was 0.04 mm or 0.24 mm/year. No significant differences were found among the three ethnic/racial groups. Variables associated with subsequent attachment loss for the entire population were age, male gender, mean whole-mouth plaque, erythema, bleeding upon probing, suppuration, attachment loss and probing depth, and belonging to the "unskilled" occupational group. No differences in risk profiles were found among the 3 ethnic/racial groups. Using stepwise logistic regression analysis, a model was developed to relate the clinical and demographic variables examined with subsequent attachment loss. The model indicated that prior attachment loss, gingival erythema, suppuration, being a current smoker and belonging to the "unskilled" occupational group conferred high risk of > 1 site of attachment loss of > 2 mm.

CONCLUSIONS

The results of this study suggest that variables associated with ethnicity/race, such as occupational status, are largely responsible for the observed disparity in destructive periodontal disease progression in these populations.

Lifestyle and Psychosocial Factors Associated with Chronic Periodontitis in Taiwanese Adults

BACKGROUND

The development of chronic periodontitis (CP) is a multifactorial process and variation in severity cannot be explained by just a few risk factors. The aims of this study were: 1) to explore the lifestyle and psychosocial factors of CP patients and 2) to estimate the proportion of total CP cases attributable to one or more risk factors considered.

METHODS

A case-control study of 250 cases of CP patients and 250 controls were matched by age (within 3 years) and gender. Complete dental examinations were performed based on the clinical criteria for CP for both groups. Structured questionnaires were conducted to collect lifestyle and psychosocial factors. Multivariate logistic regression was applied to assess the association between risk factors and chronic periodontitis.

RESULTS

Conditional multivariable logistic regression analysis showed that toothbrushing frequency (odds ratio [OR]: 5.77, if rarely; OR: 3.50, if once a day), mental illness (OR: 5.32, if Chinese Health Questionnaire scores were > or = 6), and smoking (OR: 3.93, if pack years smoked was > 21) are significantly and independently associated with chronic periodontitis. In addition, all these variables reflected a dose-response effect (P trend = <0.001, 0.004, and 0.005, respectively).

CONCLUSIONS

For Taiwanese adults, 36.10% of CP cases were presumably attributable to toothbrushing frequency, mental illness, and smoking. These three factors should be the first priorities in establishing a preventive program to improve the periodontal health status.

Predictors of chewing difficulty onset among dentate adults: 24-month incidence

OBJECTIVES

Chewing ability is an important measure of health-related quality of life, yet few studies have examined predictors of chewing difficulty in community-based samples. This study describes longitudinal patterns of chewing difficulty and identifies predictors of chewing difficulty onset.

METHODS

The Florida Dental Care Study (FDCS) was a longitudinal study of oral health and related behaviors. Interviews and a clinical exam were conducted with a sample that included persons who had at least one tooth and were aged 45 years or older (n = 873). The five-item chewing index of Leake (1990), with minor revision, was the outcome of interest.

RESULTS

Approximately 21 percent of baseline participants reported chewing difficulty and about 34 percent reported difficulty during the study. Having infected or sore gums, loose tooth, loose crown or bridge, toothache pain, lower numbers of opposing pairs of teeth, dry mouth, and being female were significant predictors of incident chewing difficulty.

CONCLUSIONS

Self-reported oral disease and tissue damage and toothache pain were strong predictors of decline in chewing ability. Additionally, women were identified as a high-risk group for incident chewing difficulty. Future research should elaborate further the pathways through which these factors affect oral function.

Tobacco smoking and risk for periodontal disease

OBJECTIVE

The magnitude of risk for periodontal disease associated with smoking was investigated by exploring the interrelationships between definition of disease, prevalence and relative risk in a population of dentally aware individuals.

MATERIALS AND METHODS

A total of 133 smokers and 242 non-smokers in the age range 20-69 years served as the database. Criteria based on clinical probing of pocket depth and radiographic measurement of bone height were used for the purpose of disease definition. Various pocket frequency cutoff points for two probing depth levels, > or =5 and > or =6 mm, and, in addition, the 30th, 25th, and 20th percentiles of the bone height distribution were alternately selected as criteria.

RESULTS

Disease definition had an impact on the prevalence, and the relative risk varied as a function of the prevalence. For a broad definition of disease such as 1% of pockets > or =5 mm, the prevalence for smokers was approximately twice the prevalence for non-smokers and the odds ratio (OR) was 3.0. A narrower definition such as 15% of pockets > or =5 mm resulted in decreased prevalences for both smokers and non-smokers and an OR of 12.1. Increasing exposures correlated with greater magnitudes of risk. Heavy exposure was associated with greater risk than light exposure. For the combination of a narrow disease definition and heavy exposure, the relative risk was considerable (OR 9.8-20.3).

CONCLUSION

Smoking-associated relative risk is dependent on definition of disease and prevalence. Given other factors, a narrow definition will result in a low prevalence and a high risk and, vice versa, for a broader definition, prevalence will be high and the risk moderate.

Destructive periodontal diseases in minority populations

Disparities in the prevalence and severity of destructive periodontal diseases have been reported for American minority populations and have raised the following questions. Are differences in destructive periodontal disease prevalence and severity due to genetic or other confounding variables associated with ethnicity race? Do risk factors for destructive periodontal diseases differ among American minority populations or differ from the population at large? Answers to these questions will have profound impact on the direction of future research and the allocation of resources to address disparities in destructive periodontal diseases in American minority populations. Risk assessment studies that examined a set of clinical, demographic, immunologic, and microbiologic parameters of Asian Americans, African Americans, and Hispanic Americans resident in the greater New York City region suggest that occupational status, monitored as a surrogate variable for socioeconomic status, may be a more robust risk factor than ethnicity/race for destructive periodontal diseases in these populations.

Predicting tooth loss during a population-based study: role of attachment level in the presence of other dental conditions

BACKGROUND

Our objectives were to quantify: 1) the association between incident tooth loss and prior periodontal attachment level; and 2) the contribution to tooth loss made by non-periodontal conditions in increasingly periodontally involved teeth.

METHODS

The Florida Dental Care Study was a prospective cohort study of persons who at baseline had at least 1 tooth and were 45 years or older. In-person interviews and clinical examinations were conducted at baseline, and at 24 and 48 months, with telephone interviews at 6-month intervals in between. A regression model was used to simultaneously quantify tooth-specific predictors of tooth loss, with person-level factors taken into account.

RESULTS

Of the 687 persons who participated for a 48-month clinical examination, 36% lost 1 or more teeth during follow-up, and 5.0% of all teeth were lost. Attachment level up to 2 years before tooth loss was strongly predictive of incident tooth loss, with increases in risk for each millimeter in attachment loss. Certain other tooth-specific conditions (tooth mobility, bulk restoration fracture, decayed surfaces, filled surfaces, tooth type and arch location, root fragment) were strongly and independently associated with increased risk for tooth loss, while others were not (prosthetic crown coverage, cusp fracture, root surface defect). Propensity to choose extraction over other treatment alternatives, as reported by participants at baseline, was also strongly predictive of tooth loss.

CONCLUSIONS

Increasingly severe attachment level was consistently associated with an increased risk for tooth loss in this sociodemographically diverse sample, with or without other tooth-specific conditions taken into account.

Longitudinal study on periodontal conditions in healthy elderly people in Japan

OBJECTIVES

A strategy for the control of periodontal disease progression is required to prevent tooth loss in older people. However, detailed epidemiological data on periodontal conditions in elderly people is limited. The purpose of the present study is to describe the natural history of periodontal disease and to evaluate the intraoral factors relating to the disease progression in systemically healthy elderly people.

METHODS

In the cross-sectional study, 599 and 162 subjects aged 70 and 80 years, respectively, were examined. Of those subjects aged 70 years, 436 (73%) participated in the 2-year longitudinal study. Pocket depth (PD) and attachment level (AL) were measured for all functioning teeth at six sites per tooth. In the cross-sectional study, AL of 4 mm or greater and 7 mm or greater were defined as moderate and severe disease, respectively. In the longitudinal study, a change in AL of 3 mm or greater at each site was defined as periodontal disease progression.

RESULTS

In the cross-sectional study, 97.1% of the subjects had at least one site of AL of 4 mm or greater (4+ mm). The prevalence of AL of 7 mm or greater (7+ mm) was 47.9%, with 2.8 affected teeth per person in those with AL 7+ mm. These findings reveal that periodontal disease is extremely widespread in the elderly population. However, very few had many teeth with severe periodontal conditions. In the longitudinal study, 75.1% experienced attachment loss of 3 mm or greater (3+ mm) during the 2-year study period. Of those subjects who experienced attachment loss, a mean of 4.7 teeth exhibited attachment loss. Multivariate logistic regression showed that both the highest AL in each tooth at baseline and abutment teeth for removable partial dentures were significantly related to periodontal disease progression as well as tooth loss incidence.

CONCLUSIONS

These results suggest that teeth with poor periodontal conditions as well as abutment teeth for removable partial dentures were significant intraoral factors relating to periodontal disease progression as well as tooth loss.

A prospective study of the validity of data on self-reported dental visits

OBJECTIVE

To measure the validity of self-reported dental visits from a diverse sample of adults.

METHODS

The Florida Dental Care Study was a longitudinal cohort study of a diverse sample of residents of north Florida, USA. In-person interviews and dental examinations were conducted at baseline, 24 and 48 months after baseline, with half-yearly telephone interviews in between. Dental record information was abstracted afterward.

RESULTS

Agreement between self-report and dental record at each half-yearly interview ranged from 84 to 91%. Validity did not differ between persons of key sociodemographic groups (sex, race, age group, rural/urban residence, poverty status, level of formal education, or problem-oriented/regular approach to dental care). In a single bivariate multiple logistic regression (two outcomes: (i) self-reported use; and (ii) use measured from the dental chart), odds ratio estimates over-lapped for each of the 20 predictors.

CONCLUSIONS

Validity of self-reported dental care use was good. There would have been few differences in conclusions made about predictors of dental care use had chart data been available earlier.