Contextual effects in the occurrence of periodontal attachment loss and necrotizing gingival lesions among adolescents

Endpoints of active periodontal therapy

Aim

Position paper on endpoints of active periodontal therapy for designing treatment guidelines. The question was as follows: How are, for an individual patient, commonly applied periodontal probing measures—recorded after active periodontal therapy—related to (a) stability of clinical attachment level, (b) tooth survival, (c) need for re‐treatment or (d) oral health‐related quality of life.

Methods

A literature search was conducted in Ovid MEDLINE(R) and Epub Ahead of Print, In‐Process & Other Non‐Indexed Citations and Daily <1946 to 07 June 2019>.

Results

A total of 94 papers were retrieved. From the literature search, it was found that periodontitis patients with a low proportion of deep residual pockets after active periodontal therapy are more likely to have stability of clinical attachment level over a follow‐up time of ≥1 year. Other supporting literature confirms this finding and additionally reports, at the patient level, that probing pocket depths ≥6 mm and bleeding on probing scores ≥30% are risks for tooth loss. There is lack of evidence that periodontal probing measures after completion of active periodontal treatment are tangible to the patient.

Conclusions

Based on literature and biological plausibility, it is reasonable to state that periodontitis patients with a low proportion of residual periodontal pockets and little inflammation are more likely to have stability of clinical attachment levels and less tooth loss over time. Guidelines for periodontal therapy should take into consideration (a) long‐term tangible patient outcomes, (b) that shallow pockets (≤4 mm) without bleeding on probing in patients with <30% bleeding sites are the best guarantee for the patient for stability of his/her periodontal attachment, (c) patient heterogeneity and patient changes in immune response over time, and (d) that treatment strategies include lifestyle changes of the patient. Long‐term large population‐based and practice‐based studies on the efficacy of periodontal therapies including both clinical and patient‐reported outcomes (PROs) need to be initiated, which include the understanding that periodontitis is a complex disease with variation of inflammatory responses due to environment, (epi)genetics, lifestyle and ageing. Involving people living with periodontitis as co‐researchers in the design of these studies would also help to improve their relevance.

Contextual income inequality and adolescents' oral-health-related quality of life: A multi-level analysis

OBJECTIVES

The aim of this study was to test the association of current contextual income inequality, contextual income inequality experienced during childhood, and individual factors with oral-health-related quality of life (OHRQoL) in adolescents.

METHODS

Individual data of 3,854 adolescents aged 15-19 years from the Brazilian Oral Health Survey (SB Brasil Project) nested within 27 cities and contextual income inequality were analysed. OHRQoL was assessed using the Oral Impacts on Daily Performance (OIDP) questionnaire. The individual variables were demographic characteristics, socio-economic factors, and oral clinical measures. The Gini Index was used to evaluate city-level income inequality in 2003 (during childhood) and in 2010 (current) according to the tertiles of distribution. Multi-level Poisson regression was used to test the association of contextual income inequality and individual characteristics with OIDP extent according to the WHO framework on social determinants of health.

RESULTS

The prevalence of OIDP was 34.5%. In the adjusted analysis, adolescents living in the cities with high-level income inequality during childhood were 1.75 times more likely (95% confidence interval 1.23-2.48) to have a higher mean of OIDP extent. Current income inequality was not associated with OIDP extent in adolescents.

CONCLUSIONS

Contextual income inequality during childhood was a structural determinant of OHRQoL among Brazilian adolescents after adjustment for individual demographic characteristics, socio-economic factors and oral clinical measures. Reducing social inequalities through inter-sectoral actions should be on the political agenda to improve adolescents' oral health.

Individual and contextual factors influencing dental health care utilization by preschool children: a multilevel analysis

The effect of contextual factors on dental care utilization was evaluated after adjustment for individual characteristics of Brazilian preschool children. This cross-sectional study assessed 639 preschool children aged 1 to 5 years from Santa Maria, a town in Rio Grande do Sul State, located in southern Brazil. Participants were randomly selected from children attending the National Children's Vaccination Day and 15 health centers were selected for this research. Visual examinations followed the ICDAS criteria. Parents answered a questionnaire about demographic and socioeconomic characteristics. Contextual influences on children's dental care utilization were obtained from two community-related variables: presence of dentists and presence of workers' associations in the neighborhood. Unadjusted and adjusted multilevel logistic regression models were used to describe the association between outcome and predictor variables. A prevalence of 21.6% was found for regular use of dental services. The unadjusted assessment of the associations of dental health care utilization with individual and contextual factors included children's ages, family income, parents' schooling, mothers' participation in their children's school activities, dental caries, and presence of workers' associations in the neighborhood as the main outcome covariates. Individual variables remained associated with the outcome after adding contextual variables in the model. In conclusion, individual and contextual variables were associated with dental health care utilization by preschool children.

[Socioeconomic status, toothbrushing frequency, and health-related behaviors in adolescents: an analysis using the PeNSE database]

This study investigated the association between oral and general health-related behaviors and socioeconomic status, and the relationship between health-related behaviors and toothbrushing among adolescents. The database used here was the National School-Based Health Survey (PeNSE), a cross-sectional population-based study in 2009 with students from 27 Brazilian State capitals. Socio-demographic and health-related behavior data were collected. The survey included 49,189 adolescents (47.5% males), the majority of whom were 14 years of age and enrolled in public schools. The associations between toothbrushing frequency and other health-related behaviors and socioeconomic status varied between boys and girls. Associations were observed between health-related habits and toothbrushing frequency in both sexes, but with variations according to socioeconomic status. Planning health promotion interventions for adolescents should take their individual characteristics and family and social context into account.

Subgingival microbial consortia and the clinical features of periodontitis in adolescents

This study aimed to investigate the association between microbial consortia and the clinical features of periodontitis using a multilevel modeling approach. A total of 958 sites in 87 adolescents with periodontitis (cases) and 73 controls were microbiologically sampled and clinically examined. Associations between each of the clinical parameters clinical attachment, probing depth, supragingival plaque, calculus, bleeding on probing, and each of 18 bacterial species; and between the same clinical parameters and each of two microbial consortia identified, were investigated using mixed-effects regression modeling. Higher counts of Tannerella forsythia, Campylobacter rectus, and Porphyromonas gingivalis were all statistically significantly associated with higher values of clinical attachment level, probing depth, and bleeding on probing in the sampled site, when both case status and between-subject variance were accounted for. Higher counts for the consortium comprising the putative periodontopathogens were statistically significantly associated in a dose-response manner with both higher clinical attachment levels and with increased pocket depth. The counts for the consortium predominantly comprising the early-colonizer species were statistically significantly negatively associated with the presence of supragingival calculus, but positively associated with the presence of supragingival plaque. The study demonstrates a relationship between the counts of putative periodontopathogens and clinical attachment levels and probing pocket depths, even for low levels of these clinical parameters.

Impact of periodontitis definition in epidemiological research. Results from the EPIPAP study in postpartum women

The purpose of this investigation was to study the impact of using various definitions of periodontitis on the frequency of periodontitis and on the associations with some known risk factors for periodontitis in a population of postpartum women in France. A clinical examination was performed within 2-4 d postpartum in 932 at-term women at five maternity units. We studied six definitions of periodontitis; five were applicable if at least two teeth were found to have the following: (i) a proximal clinical attachment level (CAL) of ≥ 3 mm; (ii) a probing depth (PD) of ≥ 4 mm; (iii) a PD of ≥ 4 mm and a CAL of ≥ 3 mm at the same site; (iv) a proximal PD of ≥ 5 mm or a proximal CAL of ≥ 4 mm; or (v) a PD of ≥ 4 mm and a CAL ≥ 3 mm and bleeding on probing at the same site. The sixth definition required the involvement of four teeth with a PD of ≥ 4 mm and a CAL of ≥ 3 mm at the same site. Associations between case status according to each definition and maternal characteristics (age, educational level, smoking before pregnancy, and time since last dental visit) were analyzed using generalized estimating equation models. The definition of periodontitis had an impact on the frequency of periodontitis, which ranged from 12.1% to 37.7%, and produced different ORs for the associations with risk factors for periodontitis.