Smoking and periodontal disease: clinical evidence for an association

PURPOSE

The aim of the present study was to assess the periodontal condition and smoking status, according to dose and duration information, and to estimate the percentage of subjects with periodontitis attributable to cigarette smoking in a representative adult rural population in southern Brazil.

MATERIALS AND METHODS

Bivariate statistical analysis was used to evaluate the association of smoking status with periodontitis in a cross-sectional study comprising 165 dentate individuals, aged 35 to 66 years, subjected to oral clinical examination of six sites per tooth in all sextants.

RESULTS

The prevalence of periodontitis (having > or = 1 pocket of > or = 4 mm around the index teeth) in the population was 35.2%. Overall, 13.9% had a cumulative loss of attachment > 4 mm; 35.7% of subjects were current smokers, classified as heavy (average 25.3 pack years), moderate (average 14.6 pack years) and light smokers (average 3.1 pack years). Statistical analysis showed that current smokers had an 11 times (95% confidence interval [CI] = 4.69 to 26.62) and former smokers had a nine times (95% CI = 3.29 to 25.96) greater probability of having established periodontitis compared with non-smokers. The number of pack years (P = 0.0004) and years of smoking exposure (P = 0.0013) were associated with an increased prevalence of periodontitis. The number of current smokers with periodontitis might be reduced by 80%, had they not smoked cigarettes. Of the subjects with periodontitis, 64% could be prevented among current smokers by eliminating tobacco consumption.

CONCLUSIONS

Cigarette smoking was strongly associated with periodontitis, and there was a relationship with dose and duration of smoking. These findings contributed to the evidence of smoking as a risk factor for periodontal disease and support the importance of dose-response analysis on determining the strength of this association.

Oral health and its impact on the life quality of homeless people in Hong Kong

OBJECTIVES

To report on the oral health status and its impact on the life quality of homeless people in Hong Kong.

DESIGN

A cross sectional epidemiological survey involving clinical oral examinations and face-to-face interviews with 147 homeless participants. Clinical examinations were carried out following WHO criteria. The impact of oral health on quality of life was assessed with the short form of Oral Health Impact Profile, OHIP-14.

RESULTS

Over 90% had caries experience and most related to untreated decay. The mean DMFT score for dentate subjects was 8.1 (DT = 3.4, MT = 4.0, FT = 0.7). Periodontal disease was highly prevalent, 96% having periodontal pockets. The burden of oral health on their daily lives was common, 88% reporting an oral health impact within the past year. A multiple regression analysis indicated that the OHIP-14 score had significant associations with self-rated oral health, dental pain, employment status and length of time being homeless (p < 0.05). Those who assessed rated oral health as 'poor/very poor', reported dental pain in the past year, were unemployed, and homeless for more than one year had poorer oral health related quality of life (significantly higher OHIP scores) than their counterparts.

CONCLUSION

Among the homeless population studied, oral health status was poor and its impact on their life quality was substantial. The oral health impact was associated with socio-demographics and perceived dental problems.

Prediction of periodontal pathology around third molars using linear mixed effects modeling

OBJECTIVE

To compare the random intercept multilevel model with other linear mixed effects models in an assessment of the effect of quadrant-, jaw-, and person level covariates on probing depth of asymptomatic third molars.

BASIC RESEARCH DESIGN

Five different covariance models were considered: 1) the random intercept multilevel 2) multi-level with unequal jaw variance 3) multi-level with unequal tooth variance 4) multi-level with unequal jaw and side variance and 5) the general linear model for correlated data with unstructured covariance matrix.

PARTICIPANTS

235 subjects with all four third molars erupted were included. Fifty-one percent were female and 75% Caucasian. The average age was 29.1 years (sd = 7.0).

RESULTS

The extended multi-level with unequal residual variance was the best fit to the data. Likelihood ratio tests in a stepdown selection approach resulted in a final model for mean probing depth that included one statistically significant three-way interaction (age x gingival inflammation x gender), two statistically significant two-way interactions (jaw x gingival inflammation and jaw x gender) and one significant main effect (ethnicity).

CONCLUSIONS

Linear mixed effects modeling is a powerful tool for the analysis of correlated dental data. However, no one covariance structure is appropriate for all purposes.

The periodontal treatment needs of Libyan school children in Kufra and Tobruk

OBJECTIVE

This study was designed to examine the oral hygiene and periodontal status in a large sample of Libyan school children and to establish baseline data for further studies.

MATERIALS AND METHODS

The study was carried out in 2015 Libyan school children aged 7 to 16 years. The clinical examinations included measurement of oral hygiene status, gingivitis, periodontal pocket depth, and evaluation of periodontal treatment need. The correlation between these variables was analyzed.

RESULTS

There was a statistically significant difference between the boys and girls in oral hygiene status. The overall mean gingival score for the total study sample was 0.05. In children (15 and 16 years old) from rural areas, 4.9% had signs of periodontal pocketing; the comparable figure for both urban and rural areas was 4.1%. Only 4% of 15 and 16 year old children were found to require complex periodontal treatment.

CONCLUSION

Though the oral hygiene index was generally good, some of the children had mild gingival inflammation and periodontal pocketing.

[Evaluation of stomatognathic system in BRCA1 gene mutation carriers before and after prophylactic adnexectomy--part II: evaluation of stomatognathic system in BRCA1 gene mutation carriers after prophylactic adnexectomy]

INTRODUCTION

Prophylactic adnexectomy is widely used for cancer risk reduction in women with BRCA1 gene mutations. Adnexectomy significantly reduces ovarian/ salpinx/peritoneum cancer risk to 5% and breast cancer risk to 30-40%. The aim of the study was evaluation of influence of prophylactic adnexectomy in BRCAI gene female mutation carriers on stomatognathic system.

MATERIAL AND METHODS

Thirty BRCA1 gene female mutation carriers aged 43-56 years, patients of the Hereditary Cancer Center in Szczecin, one year after prophylactic adnexectomy have been studied. The control group consisted the same patients, but had been studied before adnexectomy. Females with BRCA1 gene mutations have not received any hormone replacement therapy since the adnexectomy. They were divided into 2 subgroups: Y--women before menopause and Z--women aftermenopause. The complete dental exam was performed in all patients. Additionally, panoramic radiograms were performed.

RESULTS

Patients after prophylactic oophorectomy revealed higher rates of periodontal pockets 4-5 mm deep and increase of complaints such as: gingival bleeding following brushing, oral dryness and burning.

CONCLUSIONS

In conclusion, especially premenopausal women with BRCA1 gene mutations after surgical menopause should use short-term hormone replacement therapy to alleviate oral discomfort. Short-term hormone replacement therapy use does not negate the protective effect of prophylactic adnexectomy on breast cancer risk reduction in BRCA1 gene mutation carriers.

Profile of periodontal conditions in a Brazilian adult population

PURPOSE

To evaluate the periodontal condition of adult patients attending public health centres in the city of Recife, Brazil, and to investigate whether periodontal conditions are associated with socioeconomic and demographic variables.

MATERIALS AND METHODS

This cross-sectional study included 13 randomly selected public health centres. Sample size was calculated using 5.0% standard error and a confidence interval of 95%. The minimum sample size was 461 subjects, and a total of 505 subjects participated in this study. Each participant completed a questionnaire and underwent periodontal examination. Periodontal conditions were based on the Community Periodontal Index (CPI). Bivariate analysis of frequencies and means was performed with SPSS, version 11.0. The chi-square and likelihood ratio statistical tests were used to calculate the level of statistical significance of the associations tested. The level of statistical significance was set at P < 0.05.

RESULTS

Calculus was the highest CPI score in 61.8% of the subjects, and shallow pockets (4-5 mm) were the highest score in 15.2% of them. A healthy periodontium was observed in 10.7%, while gingival bleeding and deep pockets (> or = 6 mm) were found as the highest CPI score in 10.3% and 2.0% of the sample, respectively. Periodontal conditions showed significant association with the socioeconomic and demographic variables analysed (P < 0.05).

CONCLUSIONS

Findings indicate a high prevalence of periodontal alterations in the sample. Periodontal conditions were worse in men, married individuals, older subjects and individuals with low socioeconomic class and poor education.

A community-based epidemiological study of periodontal disease in Keelung, Taiwan: a model from Keelung community-based integrated screening programme (KCIS No. 18)

AIMS

To estimate the prevalence and severity of periodontal disease (PD) in the Taiwanese population aged 35-44 years and to investigate the association between demographic factors and PD.

MATERIALS AND METHODS

Between 2003 and 2005, residents of Keelung of the appropriate age were invited to screening. The community periodontal index (CPI) and loss of attachment (LA) index were used to measure the periodontal status at subject (prevalence) and sextant levels (severity). Basic demographic information was also collected by a questionnaire.

RESULTS

Of 8462 enrollees, 94.8% had some signs of PD, of whom 29.7% had periodontal pockets >3 mm and 35% LA >3 mm. Calculus was the most common problem in terms of both prevalence (49.6%) and severity (affecting an average of 3.0 sextants per person). Risk factors for poor periodontal status (as measured by CPI) were older age (odds ratio, OR: 1.44), male gender (OR: 2.70), low education level (OR: 1.40), and being a manual worker (OR: 1.51). Similar findings were observed for LA.

CONCLUSION

The prevalence of PD in 35-44-year-olds was found to be high in this large community-based study of screening for PD with CPI and LA. Poorer periodontal health was observed in males, the less educated, and manual workers.

Interim analysis of validity of periodontitis screening questions in the Australian population

BACKGROUND

The purpose of this study was to provide interim results regarding the validity of six periodontal screening questions in predicting the prevalence of clinically assessed periodontitis among Australian adults.

METHODS

The Australian National Survey of Adult Oral Health is a cross-sectional survey of Australians aged 15 years or older. Subjects were selected using a multistage probability sampling design. The interview included six questions to screen for periodontal disease and five demographic/health history questions that represented traditional risk indicators for the disease. Oral examinations were conducted by trained, calibrated dentists who measured periodontal recession and probing depth at mesio-buccal, mid-buccal, and disto-buccal sites on all erupted teeth. A computer algorithm determined three categories of periodontal case status: none/mild, moderate, or severe. Multivariable binary logistic regression models were constructed using six screening questions, five traditional risk indicators, and all 11 variables.

RESULTS

This interim analysis used data from 2,999 subjects who resided in the first five states/territories that completed the survey. Based on clinical findings, 4.0% of subjects were classified with "severe" periodontitis and 25.2% were classified with "moderate" periodontitis. Five screening questions had non-response rates of <2%, whereas bivariate correlations among screening questions were weak, indicating little redundancy among items. The combined set of 11 questions achieved "useful" overall levels of prediction based on area under receiver operating characteristic curves. Values of combined sensitivity and specificity were modest when considered at a threshold needed for predicting prevalence. Larger values of combined sensitivity and specificity were achieved when higher prevalence was predicted.

CONCLUSION

Six screening questions and five conventional risk indicators can be used readily in large population surveys, yielding useful levels of validity in predicting the prevalence of periodontitis.

Epidemiology of periodontal status in dentate adults in France, 2002-2003

BACKGROUND AND OBJECTIVE

Few recent nationwide studies of the periodontal landscape in European countries have been developed from the point of view of attachment loss and pocket depth. Decision makers are not always in a position to estimate the burden of periodontal disease. The purpose of this study was to investigate the prevalence and the oral distribution of periodontal status among dentate adults in the general population of France.

MATERIAL AND METHODS

In 2002-2003, a National Periodontal and Systemic Examination Survey was organized to a stratified quota sample of 2144 adults, aged 35-64 years, nationwide. Participants with six or more teeth were selected from the Health Examination Centers of the National Health Insurance. Measurement of periodontal health was assessed by clinical attachment level and probing depth.

RESULTS

A total of 95.40% and 82.23% of adults were found to have clinical attachment loss and periodontal pockets, respectively. Population prevalence estimates indicated that loss of attachment > or = 5 mm is 46.68% and probing depth (> 5 mm) is 10.21%. However, clinical attachment loss of > or = 5 mm occurred in only 0.88 sites in an individual. Periodontal depth pocket generalized forms were as follows: 78% slight, 18% moderate and 4% severe. Multiple logistic regression analyses showed significant differences of attachment loss values between types of tooth (molar, incisors, canines, or premolars).

CONCLUSION

Based on the International Classification of Periodontal Diseases, approximately 50% of adults in France may suffer from a severe attachment loss problem. Periodontal pockets are an uncommon condition in France. Significant differences in the prevalence of loss of attachment and probing depth with respect to location of attack have implications in the purchase and development of screening and treatment services.

Predictive Values of Self-Reported Periodontal Need: National Health and Nutrition Examination Survey III

BACKGROUND

This study assessed predictive values of self-reported periodontal need to identify periodontal conditions using clinical examinations as the gold standard.

METHODS

We identified 12,370 adults > or = 18 years of age in the third National Health and Nutrition Examination Survey. Self-reported periodontal need was based on participants responding that gum treatment and/or cleaning was needed when asked: "What type of dental care do you need now?" Two periodontal conditions were at least two sites with pockets (pockets > or = 3 mm or pockets > or = 4 mm) and at least two sites with calculus. Main outcomes were: 1) positive predictive value (PPV(Clean)): proportion of those who self-reported the need for cleaning who had calculus; and PPV(Gum): proportion who self-reported the need for gum treatment who had pockets; 2) negative predictive value (NPV(Clean)): proportion of those who self-reported no need for cleaning who did not have calculus; and NPV(Gum): proportion who self-reported no need for gum treatment who did not have pockets; 3) association between predictive values and sociodemographic and behavioral characteristics; and 4) proportion of individuals with specific sociodemographic and behavioral characteristics whose self-reported periodontal need predicted periodontal conditions.

RESULTS

The prevalence of periodontal conditions influenced predictive values. Calculus prevalence = 85%: corresponding PPV(Clean) = 88% and NPV(Clean) = 16%. Prevalence of pockets > or = 3 mm = 47%: corresponding PPV(Gum) = 62% and NPV(Gum) = 54%. Prevalence of pockets > or = 4 mm = 11%: corresponding PPV(Gum) = 25% and NPV(Gum) = 90%. Ninety percent of 30- to 44-year-old minority female smokers who did not visit the dentist in the past year and reported the need for gum treatment had pockets > or = 3 mm (PPV(Gum) = 90%).

CONCLUSIONS

Self-reported periodontal need (cleaning/gum treatment) predicted the presence of the prevalent conditions (calculus/pockets > or = 3 mm). Not reporting a need for periodontal treatment predicted the absence of the less common condition (pockets > or = 4 mm) but not the more prevalent condition (calculus).

Periodontal disease and coronary heart disease: an epidemiological and microbiological study

AIMS

This is an investigation on the association between periodontal disease and an increased risk of coronary heart disease; the main hypothesis is that periodontal infections may increase the systemic inflammatory burden of the host above a threshold that may favour the atherogenic processes.

MATERIALS AND METHODS

Case-control study with 27 cases, cardiologically affected, and 15 healthy controls. Patients underwent a complete periodontal probing. Periodontal conditions were compared between cases and controls to assess the mentioned association and to search for periodontal conditions related to the increased coronary risk. The presence and prevalence of periodontal pathogens was assessed in crevicular fluid samples.

RESULTS

The overall periodontal conditions resulted worse in the test group. In particular periodontal conditions such as the presence of deep pockets (probing depth >6 mm) and the loss of more than 12 teeth might represent indicators of a strongly increased risk of cardiological disease and microbiological investigations confirmed these findings; Prevotella gingivalis was the most common bacteria.

CONCLUSION

This study supports the existence of an epidemiologic association between periodontal disease and coronary heart disease and confirms previous data present in the literature. Two periodontal parameters, deep pockets and number of missing teeth, seem to be important risk factors for cardiovascular diseases.

[Epidemiologic examination on the prevalence of the periodontal diseases and oral pigmentation in Yusho patients in 2006]

An epidemiologic examination was carried out to reveal the prevalence of the periodontal diseases and oral pigmentation in patients with Yusho in 2006. The results obtained were as follows. (1) 98 patients out of 106 patients with Yusho, who were measured periodontal pocket depth according to Ramfjord' methods, had at least one tooth with periodontal pocket deeper than 3 mm. Similarly, 343 teeth out of a total 494 examined teeth showed periodontal pocket with more than 3 mm depth. (2) Oral pigmentation was observed in 61 patients out of 116 patients with Yusho. In this study, gingival pigmentation was most predominant among oral pigmentation. The prevalence of oral pigmentation in male patients seemed to be somewhat higher than that in female patients. In addition, this examination revealed that the patients below the age of sixty had a high prevalence of oral pigmentation. These results indicated that PCB-related compounds may be responsible for the higher prevalence of both periodontal diseases and oral pigmentation.

Area deprivation and oral health in Scottish adults: a multilevel study

OBJECTIVES

To explore the association between area deprivation and adult oral health.

METHODS

Multilevel regression analysis of data taken from the 1998 Adult Dental Health Survey in the UK comprising 632 participants living in 346 households located in 31 postcode sectors in Scotland. Three oral health outcomes were investigated: number of sound (including restored) teeth; has one or more unsound teeth; has periodontal pocketing 4 mm or more in one or more teeth.

RESULTS

In the most deprived areas, individuals had a mean of 4.6 fewer sound teeth than those in the least deprived areas. The difference in normalised number of sound teeth between least and most deprived areas was -0.707 (95% CI -1.164, -0.250), P = 0.024. After adjusting for age, sex, qualification status, head of household social class and household income, the estimated difference was -0.238 (-0.591 to 0.115) (P = 0.164). Area deprivation was not associated with having one or more unsound teeth or periodontal pocketing 4 mm or more in one or more teeth.

CONCLUSIONS

There is a univariate association of area deprivation with the number of sound teeth. This association is largely explained by household and individual level socioeconomic variables. A small area deprivation effect cannot be excluded in these data. The findings challenge current understanding of the relationship between area deprivation and oral health. Further multilevel research exploring the relationship between area deprivation and oral health is required using a larger sample and a prospective longitudinal design.

Periodontal pathogens in periodontal pockets and in carotid atheromatous plaques

AIM

In the last years the relationship between periodontitis and cardiovascular diseases has been a subject of increasing research. The identification of periodontopathic bacteria in atheromas can contribute to our knowledge of such an association. The aim of our study was to assess the concomitant presence of 5 periodontal pathogens (Actinobacillus actinomycetemcomitans, Prevotella intermedia, Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia) in periodontal pockets and in carotid atheromas recovered from the same individuals.

METHODS

Twenty-one patients with chronic periodontitis scheduled for endarterectomy for carotid stenosis were enrolled in the study. Subgingival plaque samples and carotid atheromas were examined using the polymerase chain reaction and reverse hybridization techniques by means of specific probes for periodontal bacteria. Human beta-globin amplification was used as internal polymerase chain reaction efficiency control.

RESULTS

Three patients were excluded because the endarterectomy specimens were negative to DNA amplification. All subgingival plaque samples were positive for at least one target micro-organism. The prevalence of Tannerella forsythia, Porphyromonas gingivalis, Prevotella intermedia, Treponema denticola, and Actinobacillus actinomycetemcomitans was 72.22%, 61.11%, 55.56%, 50%, and 33.33%, respectively. No periodontal bacteria DNA was detected in any endarterectomy specimen.

CONCLUSIONS

The presence of periodontal bacteria in atheromatous plaques was not confirmed by this investigation and, thus, no correlation between periodontitis bacteria and micro-organisms involved in the atherosclerotic lesions could be drawn.

Skin colour is associated with periodontal disease in Brazilian adults: a population-based oral health survey

AIM

To estimate the prevalence of periodontal disease in Brazilian adults and to test its association with skin colour after controlling for socio-demographic variables.

METHODS

The periodontal status of 11,342 Brazilian adults was informed by a nationwide oral health survey. Socio-demographic variables included skin colour, gender, schooling, per capita income, age and geographical region. The association between periodontal disease and skin colour was tested by a logistic regression model, adjusting for covariates. Interactions between skin colour and socio-demographic variables were tested.

RESULTS

The prevalence of periodontal diseases was 9.0% [95% confidence interval (CI) 7.6-10.3]. Lighter-skinned black people (pardos) and dark-skinned black people (pretos) presented higher levels of periodontal disease when compared with white people [odds ratio (OR)=1.5; 95% CI 1.2; 1.8; OR=1.6; 95% CI 1.2; 2.1, respectively] even after controlling for age, gender, schooling, per capita income and geographic region. No interactions were statistically significant.

CONCLUSION

Skin colour was significantly associated with periodontal disease among Brazilian adults after adjustment for socio-economic and demographic covariates.

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.

Partial recording protocols for periodontal disease assessment in epidemiological surveys

The objective of the present study was to compare the reliability of four partial-mouth protocols for assessing shallow, moderate, and deep sites for periodontal pocket depth and clinical attachment levels. Periodontal pocket depth and clinical attachment level measurements were recorded for 156 subjects (age > 30). The four models of partial-mouth protocols compared were: Model I: all sites per tooth in the random half-mouth protocol randomly selecting one maxillary and mandibular quadrant, Model II: buccal sites in a full-mouth protocol, Model III: buccal sites in the random half-mouth protocol randomly selecting one maxillary and mandibular quadrant, Model IV: all sites per tooth using Community Periodontal Index teeth. In comparison with full mouth examination, Model I did not show significant differences for periodontal pocket depth and clinical attachment level parameters. Models II and III were different for some periodontal pocket depth means, and Model IV significantly overestimated all clinical parameters related to periodontal disease. Model I appears to be adequate to substitute for the full-mouth examination to assess the prevalence and severity of chronic periodontal disease in adults.

Third Molar Periodontal Pathology and Caries in Senior Adults

PURPOSE

This study was designed to assess the prevalence at enrollment and incidence over 36 months of periodontal pathology and caries affecting third molars in a community-based study of people over the age of 65 years in North Carolina.

SUBJECTS AND METHODS

A sub-sample of 818 subjects with dental examinations taken from the Piedmont 65+ Study was available for analysis. All visible teeth were examined. Periodontal probing (PD) measures were taken at 2 sites, mesiobuccal and buccal/facial. Clinical data on caries experience were collected by visual-tactile examination. At enrollment, 342 subjects had at least 1 visible third molar that could be examined. PD measures were available for 276 of these same subjects. The significance of comparisons between third molars and nonthird molars were determined by chi(2) tests and the statistical significance was set at .05.

RESULTS

Most of the 342 subjects with at least 1 visible third molar were female (57%) or African American (63%). Mean age was 73 years (SD 5.5 years). Of the 197 subjects with caries experience, third molars were affected in 49% of subjects, less than the 87% in nonthird molars. Third molar caries experience was associated with caries experience on nonthird molar teeth (P < .01). Clinical attachment level (CAL) greater than 3 mm was detected at enrollment in third molars in 68% of subjects, and in nonthird molars in 96%. With one exception, CAL greater than 3 mm in third molars was associated with CAL greater than 3 mm elsewhere in the mouth. Few subjects (17%) had clinical evidence of both caries and periodontal pathology affecting third molars. In this older population of individuals with third molars, 21% were free of periodontal pathology or caries experience.

CONCLUSIONS

Data on the prevalence of third molar periodontal pathology and third molar caries experience in an elderly population should be useful to both clinicians and their younger patients when considering the merits of retaining or removing third molars with no evidence of pathology.

Prevalence and risk variables for peri-implant disease in Brazilian subjects

OBJECTIVES

The aim of this study was to verify the prevalence of peri-implant disease and analyse possible risk variables associated with peri-implant mucositis and peri-implantitis. The study group consisted of 212 partially edentulous subjects rehabilitated with osseointegrated implants.

MATERIAL AND METHODS

The implants placed were examined clinically and radiographically to assess the peri-implant status. The degree of association between peri-implant disease and various independent variables was investigated using a multinomial regression analysis.

RESULTS

The prevalence of peri-implant mucositis and peri-implantitis were 64.6% and 8.9%, respectively. In univariate modelling, healthy peri-implant subjects presented lower plaque scores, less periodontal bleeding on probing, and less time elapsed since placement of supra-structures. In multivariate analyses, the risk variables associated with increased odds for having peri-implant disease included: gender, plaque scores, and periodontal bleeding on probing. Presence of periodontitis and diabetes were statistically associated with increased risk of peri-implantitis. The only two factors, which did not contribute to the presence of the disease, were the time elapsed since placement of supra-structures and the frequency of visits for maintenance care.

CONCLUSION

Our data suggest that subjects with periodontitis, diabetes, and poor oral hygiene were more prone to develop peri-implantitis.

Oral hygiene practices, periodontal conditions, dentition status and self-reported bad mouth breath among young mothers, Tanzania

OBJECTIVES

To determine the oral hygiene practices, periodontal conditions, dentition status and self-reported bad mouth breath (S-BMB) among young mothers.

STUDY PARTICIPANTS AND METHODS

This was a cross-sectional descriptive study conducted at Muhimbili National Hospital, Dar es Salaam, Tanzania. A total of 302 postpartum mothers, aged 14-44 years, were interviewed on oral hygiene practices and S-BMB using structured questionnaire. Oral hygiene, dentition and periodontal status were assessed using the Community Periodontal Index probe and gingival recessions (GR) using Williams Periodontal probe.

RESULTS

Tooth brushing practice was 99%; tongue brushing (95%), plastic toothbrush users (96%), chewing stick (1%), wooden toothpicks (76%), dental floss (<1%); and toothpaste (93%). The prevalence of plaque and gingival bleeding on probing was 100%, gum bleeding during tooth brushing (33%), calculus (99%), probing periodontal pocket depth (PPD) 4-5 mm (27%), PPD 6+ mm (3%), GR 1+ mm (27%) and tooth decay (55%). The prevalence of S-BMB was 14%; the S-BMB had higher mean number of sites with plaque compared to the no S-BMB group (P=0.04). Factors associated with S-BMB were gum bleeding on tooth brushing (OR=2.4) and PPD 6+ mm (OR=5.4).

CONCLUSION

Self-reported bad mouth breath is a cause of concern among young mothers, and associated significant factors were gum bleeding on tooth brushing and deep periodontal pockets of 6+ mm. Further research involving clinical diagnosis of bad mouth breath and intervention through oral health promotion and periodontal therapy are recommended.

CLINICAL RELEVANCE

This study provides baseline information on oral health status and the complaint on bad mouth breath which necessitates in the future need for objective assessment, diagnosis and management of bad mouth breath for enhanced social and professional interaction without embarrassment.

Java project on periodontal diseases. The natural development of periodontitis: risk factors, risk predictors and risk determinants

OBJECTIVE

To identify risk factors, risk predictors and risk determinants for onset and progression of periodontitis.

MATERIAL AND METHODS

For this longitudinal, prospective study all subjects in the age range 15-25 years living in a village of approximately 2000 inhabitants at a tea estate on Western Java, Indonesia, were selected. Baseline examination was carried out in 1987 and follow-up examinations in 1994 and 2002. In 2002, 128 subjects could be retrieved from the original group of 255. Baseline examination included evaluation of plaque, bleeding on probing, calculus, pocket depth, attachment loss and presence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, spirochetes and motile microorganisms.

RESULTS

The mean attachment loss increased from 0.33 mm in 1987 to 0.72 mm in 1994 and 1.97 mm in 2002. Analysis identified the amount of subgingival calculus and subgingival presence of A. actinomycetemcomitans as risk factors, and age as a risk determinant, for the onset of disease. Regarding disease progression, the number of sites with a probing depth > or = 5 mm and the number of sites with recession were identified as risk predictors and male gender as a risk determinant.

CONCLUSION

Screening of these parameters early in life could be helpful in the prevention of onset and progression of periodontal diseases.

Oral health status of homeless people in Hong Kong

The authors report on an oral health survey among Hong Kong Chinese homeless people. A total of 140 homeless men underwent clinical examination and were interviewed with a structured questionnaire. More than 90% had evidence of caries experience; most (75%) were related to untreated caries. The mean DMFT score was 9.0 (DT = 3.2, MT = 5.2, FT = 0.6). Periodontal disease was highly prevalent, with 96% having periodontal pockets. The dental problems most frequently reported by the homeless were: bleeding gums or drifting teeth (62%), dental pain (52%) and tooth trauma (38%). More than 70% of the study's participants perceived a need for dental care. The population surveyed had poorer oral health compared to the general population. High levels of dental needs, both normative and perceived, were found. There is a need to provide more accessible and affordable oral health services to this group of people.

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.

Increased intake of dairy products is related to lower periodontitis prevalence

BACKGROUND

An inverse association between calcium intake and periodontitis prevalence was recently reported. Dairy products are rich sources of calcium and other important nutrients. To date, it appears that the relationship between the intake of dairy products and periodontitis has not been investigated. The purpose of the present study was to examine whether or not there is an association between the intake of dairy products and periodontitis prevalence.

METHODS

A total of 12,764 individuals who participated in the Third National Health and Nutrition Examination Survey were included in this study. Individuals who had at least one site with an attachment loss>or=3 mm and a probing depth>or=4 mm were considered to have periodontitis. The intake of dairy products was categorized into quintiles. Descriptive statistics and logistic regression models were used for data analyses.

RESULTS

Prevalence of periodontitis was 41% lower for individuals in the highest quintile of intake of dairy products than those in the lowest quintile (P<0.001 for trend). After adjusting for known and suspected periodontitis risk factors (age, gender, race\ethnicity, cigarette smoking, education, diabetes, poverty index, vitamin use, body mass index, physical activity, time since the last dental visit, dental calculus, and gingival bleeding), individuals in the highest quintile of intake of dairy products were 20% less likely to have periodontitis than those in the lowest quintile (P=0.024 for trend).

CONCLUSIONS

The results of this study showed an inverse association between the intake of dairy products and prevalence of periodontitis. Longitudinal and/or intervention studies are required to confirm these findings and to further examine the impact of a higher intake of dairy products on the prevention and treatment of periodontitis.

Periodontal conditions in 35-44 and 65-74-year-old adults in Denmark

OBJECTIVES

To assess the periodontal health status in the Danish adult population and to analyze how the level of periodontal health is associated with age, gender, urbanization, socio-economic factors, and dental visiting habits; furthermore, to compare the periodontal health status of Danish adults with that of adults in other industrialized countries.

MATERIAL AND METHODS

A cross-sectional study of a random sample of 1,115 Danish adults aged 35-44 years and 65-74 years. Data were collected by means of personal interviews and by clinical examinations in accordance with the World Health Organization Basic Methods Criteria.

RESULTS

The clinical examination revealed a low prevalence of healthy periodontal conditions in both age groups: at age 35-44 years 7.7% and at age 65-74 years 2.4% had healthy periodontal conditions. A high proportion of the elderly had scores of severe periodontal health; more than 82% of older participants had pockets of 4-5 mm or deeper against 42% in younger adults. In both age groups, the mean number of teeth with periodontal pockets deeper than 4-5 mm was high in individuals with low education. Only a weak association between periodontal health and income was found. High Community Periodontal Index scores were seen for irregular dental visitors, but in the 35-44-year-olds deep periodontal pockets were more often seen among young regular dental visitors. The multivariate analysis showed that participants with low or medium levels of education had significantly more teeth with shallow and deep pockets than those with high education. Persons with regular dental visiting habits had fewer teeth with gingival bleeding, shallow and deep pockets than individuals with irregular dental visiting habits.

CONCLUSION

Reorientation of the Danish dental health-care services is needed with further emphasis on preventive care, and public health programs should focus on risk factors shared by chronic diseases in order to improve the periodontal health of Danish adults.

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.

[Caries and periodontal state of pregnant women. Part II. Periodontal state]

A great number of clinical studies focused on the periodontal health of the pregnant women in the last decades, since an association has been presumed between the pregnant women's periodontal disease and the adverse pregnancy outcome. Altogether 161 healthy women were examined soon after delivery in Szeged/Hungary. The periodontal status of the patients was recorded by the Silness-Löe Plaque index (0.67), frequency of calculus (21.07%), mean probing pocket depth (1.67 mm) and the frequency of bleeding on probing (37.8%). A significant correlation was found between the state of the periodontium and the educational level and the pregnant women's profession. The periodontal state of women with higher education and the intellectuals was much better, than of the less educated patients and the manual workers.

Occurrence and risk indicators of increased probing depth in an adult Brazilian population

BACKGROUND/AIMS

There is little information about the occurrence and risk indicators for periodontal diseases in Latin America. The present study describes the prevalence, extent and severity of periodontal probing depth (PPD) and assesses the association between demographic, behavioural and environmental risk indicators and the extent and severity of PPD in this population.

MATERIALS AND METHODS

The target population was urban adults aged > or =30 years in Rio Grande do Sul state in South Brazil. A representative sample was selected using a multi-stage, probability, cluster sampling strategy and included 853 dentate subjects 30-103 years of age. A full-mouth clinical examination was carried out at six sites per tooth on all permanent teeth, excluding third molars, and was conducted in a mobile examination centre.

RESULTS

Approximately 65% and 25% of the subjects and 19% and 5% teeth per subject had PPD > or =5 and > or =7 mm, respectively. 31.6%, 33.7% and 34.7% subjects had generalized, localized or no PPD > or =5 mm, respectively. Probing depth increased in prevalence with increasing age, and leveled off at around 50 years of age and beyond. PPD > or =5 mm was significantly higher in males than in females, and in non-Whites than in Whites. Cigarette smokers had a significantly higher occurrence of PPD > or =5 mm than non-smokers, and this relationship was dose dependent. A multivariate model showed that generalized PPD > or =5 mm was associated with subjects aged > or =40 years, males, non-Whites and moderate or heavy cigarette smokers (relative risk ratios: 2.0, 2.0, 2.2, 2.4 and 6.8, respectively).

CONCLUSION

Moderate and deep probing depth was a common finding in this urban adult Brazilian population. Older age, male gender, non-White race and moderate and heavy cigarette smoking were significant risk indicators of increased PPD, and these may be useful indicators of periodontal disease high-risk groups.

Socio-economic influence on caries experience and CPITN values among a group of Italian call-up soldiers and cadets

PURPOSE

Dental care in Italy is carried out mainly by private professionals and therefore the collection of epidemiological data on dental health is not often possible. Thus, the aim of this study was to collect the DMFT and CPITN values in a population of young Italian male subjects, namely call-up soldiers and cadets, and relate them to the socio-economic status of the subjects.

MATERIAL AND METHODS

The sample was made up of two groups from different Italian academies: call-up soldiers: 1184 male call-up soldiers aged from 19 to 25; cadets: 2477 cadets aged from 19 to 25. The level of education was evaluated by means of a questionnaire which the soldiers had to fill in before being examined. Two trained dentists carried out the epidemiological survey following WHO guidelines. Data elaboration was carried out at the 'WHO Collaboration Centre of Milan for Epidemiologist and Community Dentistry'. Data on DMFT were compared by ANOVA. A p value < 0.01 was considered as statistically significant.

RESULTS

The mean DMFT value observed was 3.69 +/- 3.31. The differences between the two groups were statistically significant for D e F components (p < 0.05). The caries-free rate is lower in the call-up soldiers group (12.57%) than that reported for the cadets group (25.26%) and the difference was statistically significant (p < 0.01). Statistically significant differences were observed in DMFT values between the two groups stratified by educational level. A healthy periodontium was observed in more than 50% of the sample. In the call-up soldiers group, 40.95% had healthy periodontal conditions; 40.25% of the subjects showed bleeding on probing; 19.03% presented with calculus; and 2.77% presented periodontal pockets 4-5 mm deep. In the cadets group, 57.95% had healthy periodontal conditions; 38.18% of the subjects showed bleeding on probing; 3.52% presented with calculus; and 0.35% presented periodontal pockets 4-5 mm deep. The differences in proportion between the two groups were always statistically significant except for the bleeding score where an almost similar percentage for both groups was recorded.

CONCLUSION

The results showed that call-up soldiers have a higher DMFT index and the D value is higher in less educated subjects. Bleeding on probing did not vary either between call-up soldiers and cadets or among socio-economic subgroups. Such results have underlined the need of a systematical information campaign on oral hygiene in Italian schools.

Further evidence of the association between periodontal conditions and coronary artery disease

BACKGROUND

There is increasing evidence that chronic infections, such as periodontal diseases, could play a role in the initiation and development of coronary artery disease (CAD). The present study was intended to test for a possible association between presence and severity of periodontitis and coronary artery disease in a Belgian population.

METHODS

A total of 108 CAD patients (mean age 59.2 +/- 11 years) and 62 presumably healthy controls (mean age 57.7 +/- 9 years) were enrolled in the study. Probing depth, periodontal pocket bleeding index (PPBI), plaque index, furcation involvements, and tooth mobility were evaluated to compare periodontal health in both groups. The subjects were also ranked according to a novel index of periodontitis severity, the periodontal index for risk of infectiousness (PIRI), aimed at quantifying the risk of release of proinflammatory mediators from the periodontal sites.

RESULTS

Periodontitis was significantly more frequent in CAD patients than in controls (CAD patients: 91%; controls: 66%). The mean number of pockets was 18 +/- 17.1 in cardiac patients versus 7.6 +/- 12.7 in controls (P < 0.0001), despite the fact that the mean number of missing teeth was significantly greater in cases than in controls (14 +/- 7.1 versus 9 +/- 5.2; P < 0.0001). Furthermore, proportions of mobile teeth, bleeding sites, periodontal pockets, and involved furcations were significantly higher in CAD patients than in controls. In addition, the extent of the periodontal disease present was also greater in cases than in controls. A logistic model, adjusted for known cardiovascular risk factors, showed a strong association between CAD and periodontitis (odds ratio [OR] = 6.5). Moreover, there was a significant dose-response relationship between increasing scores of the periodontal risk of infectiousness and the presence of CAD (adjusted OR = 1.3 per PIRI unit).

CONCLUSION

In the present study, periodontitis was revealed to be a significant risk factor for CAD after adjusting for other confounding factors, with the level of association increasing with the individual extent of the periodontal lesions.

Oral health in Jordan

This paper reviews the overall picture for oral hygiene, gingival/periodontal disease, dental caries and oral lesions/conditions in Jordanian subjects and its relationship to socioeconomic status. Furthermore, the trends of certain conditions are described. Only approximately one-third of children brushed their teeth regularly, so the amount of plaque was high and gingivitis was pronounced irrespective of socioeconomic status. Public school children had higher overall scores for decayed, missing, or filled teeth and surfaces than the children in the private schools. In general, boys had higher plaque and gingival scores than girls. The occurrences of shallow and deep pockets in these children were low (0.3-5.3%). Although an improvement in oral hygiene, gingival conditions and dental caries has been reported recently in children, the prevalence of these conditions is still high compared to that found in the developed countries. More than one half of the adults brushed their teeth regularly and high proportions of subjects with shallow and deep pockets were found in the 50-60-year-old age group with about 19% and 11% respectively. Fordyce's granules and tori were the most common lesions among the thirty different oral lesions or conditions diagnosed. It may be concluded that motivation and proper oral hygiene should be emphasised. Secondly, implementation of school-based oral health promotion and prevention programmes is urgently needed.

Degree of correlation between two periodontal indices in a rural Croatian population

AIM

To compare the periodontal status of patients measured by two indices, the Community Periodontal Index (CPI) and the Loss of Attachment Index (LA).

METHOD

The CPI and LA index scores were determined for a sample of 367 adult subjects (1,535 dentate sextants) aged 15-65 years from two rural areas in Croatia and analysed according to subject, sextant and jaw.

RESULTS

Partial correlation between the CPI and LA indices was found. Cumulative for all age groups, sextants with a CPI code 0, 1 and 2 most often appeared with a LA 0-3mm. Shallow pocket sextants (4-5mm) in 64.04% also correlated with the loss of attachment values 4-5mm. In deep pocket sextants (6-8 mm), a deviation from expectations was found as they appeared more often with a LA 9-11 mm designation (46.24%), rather than with an LA 6-8mm (34.41%) score. Very similar results were found between distribution per sextant, person and jaw in CPI codes 2, 3, 4 and cumulatively.

CONCLUSION

CPI itself is not sufficient for periodontal status assessment, especially for the 35-44 years of age, and even more so for the 65+ group, also for the CPI code 4 in all ages.

Oral health status of institutionalised elderly in Hong Kong

OBJECTIVES

To describe the oral health status of institutionalized elderly in Hong Kong.

METHODS

Older adults in 56 elderly homes were clinically examined in the institution by one of two calibrated dentists using standard methods recommended by the World Health Organization. Information on their perceived oral health status and behaviour was obtained from an interview.

RESULTS

A total of 3153 elderly aged 65 years or above (mean = 79.8) were examined. Around 20% of them were edentulous. The mean DMFT score was 23.0 (DT = 2.6; MT = 20.1; FT = 0.3). The percentage of dentate subjects with healthy gingivae, bleeding on probing, calculus, shallow pockets, and deep pockets (according to the highest CPI score) were 1, 2, 41, 37 and 20 respectively. Two-thirds of the elderly reported having difficulties chewing, and over half had not visited a dentist for over 5 years.

CONCLUSION

The oral health status of institutionalised elderly in Hong Kong is poor and needs to be improved.

Caries and periodontal disease of the elderly in Pomerania, Germany: results of the Study of Health in Pomerania

OBJECTIVE

The aim of this study was to describe the oral health status of older adults living in northeastern Germany.

MATERIALS AND METHODS

Representative samples of adults aged 60 years or older were examined as part of Study of the Health in Pomerania, a cross-sectional, population-based study. Data on 1446 subjects aged 60-79 years were evaluated for coronal caries using the decayed/missing/filled teeth (DMFT) index, root caries using the root caries index (RCI), calculus, plaque, bleeding on probing, pocket depth and attachment loss.

RESULTS

The prevalence of edentulousness varied from 16% in the 60-65-year-old group to 30% in the 75-79-year-old group, whereas the median number of remaining natural teeth per subject varied from 14 in the youngest age group (60-65 years) to one in the oldest (75-79 years). Among subjects aged 60-69 years, a quarter (26%) of the teeth examined had coronal restoration against 17% in the oldest age group (70-79 years). Coronal caries was found in 2% of the teeth in both age groups. Among teeth with gingival recession, 6% had fillings on root surfaces and 2% had root caries, irrespective of age. In all, 11% of the subjects had at least one untreated coronal lesion and 27% had at least one untreated root caries lesion. Plaque score, calculus score and bleeding on probing were higher in the oldest age group (70-79 years). The prevalence of periodontal disease expressed as the presence of at least one periodontal pocket of 4 mm and more, was higher in men and among the younger subjects (men aged 60-69 years: 85% vs. 71% in 70-79-year-old men; women aged 60-69 years: 71% vs. 62% in 70-79-year-olds). The prevalence of attachment loss of 3 mm or more followed a similar pattern.

CONCLUSIONS

It seems therefore that in this population, the major oral health concern is related to caries and the small number of teeth retained among the dentate subjects.

Self-reporting of periodontal diseases and clinical assessment outcome in a Swedish urban population of smokers and non-smokers

The aim of this study was to determine whether there is an association between self-reporting of periodontal diseases and outcome in a clinical examination, and whether any difference is present in awareness of periodontal status between smokers and non-smokers. Participants comprised 1676 adults (838 M and 838 F aged between 31 and 40 years), 564 of whom reported being smokers. Subjects were asked via questionnaire whether they thought they had periodontal disease and why. A total of 1655 subjects answered the questionnaire and were subsequently divided into those who suspected having periodontal disease (Yes-group) and those who did not (No-group). A full-mouth clinical examination was carried out in all subjects. Female smokers in the Yes-group had a significantly higher number of teeth with pockets > or = 5 mm (P < 0.001) and a higher calculus index (CI-S, P < 0.01) than female smokers in the No-group. Male smokers in the Yes-group had significantly less remaining teeth (P < 0.01), more teeth with pockets > or = 5 mm (P < 0.001), and a higher CI-S (P < 0.05) than their counterparts in the No-group. For smokers, multivariate logistic regression analysis yielded an odds ratio (OR 3.21 [95% CI 1.73 5.74]) of self-reported periodontal disease to periodontitis outcome which was significant (P < 0.001). This association remained significant (P < 0.01) after adjustment for confounding factors. Subjects who reported having periodontal disease, especially those who also reported having movable teeth, were confirmed to have the disease. Smokers were more aware of their periodontal status than non-smokers.

Periodontal treatment needs in a native island community in Colombia determined with CPITN

AIMS

To identify the prevalence and different degrees of periodontal disease in an isolated community (Isla Grande, Colombia) with no dental services and low educational level with the use of CPITN, and to establish periodontal treatment needs in different age groups.

RESULTS

Of 116 people examined, 0.9% were in periodontal health (CPITN value 0), 18.1% had gingival bleeding (CPITN value 1), 51.7% had supra or subgingival calculus (CPITN value 2), 18.1% presented pockets 3.5-5.0 mm deep (CPITN value 3), and 11.2% had pathological pockets of 5.5mm or deeper (CPITN value 4). No clear differences were observed between sexes.

CONCLUSIONS

This study shows that 81% of the sample has some type of periodontal treatment need, with 69.8% of them requiring periodontal treatment that may be supplied by a hygienist and 11.2% requiring specialised treatment. Implementation of oral health education and oral prevention programmes was recommended to the authorities for this community.

Predictors of Tooth Loss in Two US Adult Populations

OBJECTIVES

This study determines tooth loss rate over a 10-year period and identifies predictors of tooth loss in two separate US adult longitudinal study populations.

METHODS

Subjects from the Baltimore Longitudinal Study of Aging (BLSA), consisting of 47 men and 47 women, ages ranging from 30 to 69 years, were compared to subjects from the VA Dental Longitudinal Study (VADLS) in Boston, MA, consisting of 481 men in the same age range. Baseline and follow-up examinations were performed on each cohort over a 10-year period. Using multivariate regression models, significant predictors of tooth loss were identified.

RESULTS

A mean rate of tooth loss of 1.5 teeth lost per 10 years was noted in the VADLS cohort compared to 0.6 teeth lost per 10 years in the BLSA (P < .001). Combining subjects from both populations, significant predictors of tooth loss were baseline values of: percent of teeth with restorations, mean probing pocket depth score, age, tobacco use, alcohol consumption, number of teeth present, and male sex. However, the set of significant predictor variables differed between the two populations and sexes. In BLSA men, number of teeth present, percent of teeth with restorations, mean probing pocket depth score, and alcohol consumption, but not age, were significant, while in BLSA women, only age was a significant predictor.

CONCLUSIONS

Over a 10-year period, the incidence of tooth loss, the rates of tooth loss, and the predictors of tooth loss were found to vary by population and by sex. These results illustrate the limits of generalizing tooth loss findings across different study cohorts and indicate that there may exist important differences in risk factors for tooth loss among US adult populations.

Incidence of periodontal attachment loss over 5 years among older South Australians

OBJECTIVES

This study described the 5-year incidence of periodontal attachment loss (ALOSS) among older Australians.

MATERIAL AND METHOD

Clinical examination data were obtained at baseline and 5 years from participants in a cohort study of South Australians aged 60+. Periodontal measurements (gingival recession, GR; probing depth, PD) were made for each tooth at 3 sites. An incident case of ALOSS was identified as an individual having 2+ sites with 3+ mm ALOSS.

RESULTS

Some 342 (42.7%) of the 801 individuals examined at baseline were re-examined after 5 years, contributing longitudinal data from a total of 15,522 sites (6102 in the maxilla and 9420 in the mandible). Most sites showed no change in either GR or PD. Using a threshold of 3+ mm for change, ALOSS occurred at 2.3% of mesiobuccal sites, 2.5% of buccal sites, and 3.4% of distolingual sites. Distolingual sites on molars showed the highest progression rates. The major component of ALOSS was increased GR. Overall, only 10.1% of the observed ALOSS was contributed by increases in PD. Nearly two-thirds of the sites that experienced ALOSS had <3 mm of ALOSS at baseline. The weighted 5-year incidence estimate for ALOSS was 43.2% (N=145), and was higher among diabetics or those who had lost 1+ teeth since baseline. Smoking was not a significant predictor.

CONCLUSION

The rates and patterns of ALOSS among older South Australians are largely similar to those recently reported for North Carolinians. Most ALOSS in older people manifests as increases in GR, rather than PD. Diabetics should be targeted for intensive primary and secondary prevention of periodontal disease.

Cross-sectional evaluation of clinical parameters to select high prevalence populations for periodontal disease: the site comparative severity methodology

Epidemiological studies have shown strong evidence that periodontal disease does not affect all subjects in the same manner. There are subjects and sites with higher risk for disease progression. This study tested parameters to select "a priori" sites and subjects potentially at risk. The data from periodontal clinical examinations of 2273 subjects was used. The clinical loss of attachment was measured in 6 sites per tooth. Using computer software, the patients were distributed into 14 age groups, with intervals of 5 years, from 11 years to greater than 75 years of age. The measure of each site was compared with the average and the median values of the subject age group, with the results indicating site comparative severity (SCS). Three global parameters were calculated: parameter 1 (P1) - percentage of sites with clinical attachment loss > 4 mm; parameter 2 (P2) - percentage of sites with clinical attachment loss > 7 mm; parameter 3 (P3) - percentage of sites with clinical attachment loss surpassing the median value for the age group by 100% or more. There were 1466 (65%) females and 807 (35%) males. Most subjects had P1, P2 and P3 values less than 30%. Parameter 3 allowed a division of the sample similar to that of Parameters 1 and 2, with the advantage of analyzing the subject in relation to his/her age group. It was suggested that the methodology of SCS is useful for selecting a population with a high disease prevalence, and that cut-off lines between 10% and 20% would be appropriate for using Parameter 3.

A case of prepubertal periodontitis and prevalence of gingivitis in a population attending a university clinic in Rosario, Argentina

The present study was based on the finding of a case of prepubertal periodontitis, a low prevalence pathology. One hundred and fifty-two infant patients attending the Department of Odontopediatrics of the Faculty of Dentistry of the National University of Rosario over the period April 1995-September 1996 were included in the present study. The reason for consultation was dental caries. However, the high general prevalence of gingivitis (50%) was remarkable. This may be due to deficient oral health care awareness at home and at school. The prevalence of prepubertal periodontitis (PPP) in the population under study (one case of localized PPP) was 0.66%. These data are in agreement with international reports that account for a prevalence value of less than 1%. A relevant difference with other reported cases could be that this patient complained of upper respiratory tract disorders and, occasionally, ear infections. These symptoms appear in the generalized but not the localized forms of the disease.

Periodontal disease among the middle-aged Vietnamese population

Information about periodontal disease patterns among the populations of developing countries is limited. These populations may illustrate the natural history of the disease owing to low or virtually no access to dental care, contributing to a more complete understanding of the disease process. The present study aimed to describe the patterns of periodontal loss of attachment (LOA) among representative middle-aged Vietnamese adults. A multi-stage, stratified random sampling technique was employed in two randomly selected provinces. The US NIDR protocol with two sites per tooth for the whole mouth, excluding third molars, was used to assess LOA. A total of 575 subjects aged 35-44 years were interviewed and periodontally examined (response 84.6%). Data were re-weighted to reflect the population of the two provinces. Oral hygiene status was poor with high accumulation of plaque and calculus. The prevalence, extent of sites with pockets (PD), recession (GR) and LOA exceeding various thresholds and the severity of LOA were calculated. Almost all subjects presented with at least one site with LOA > or = 2 mm but the higher levels of the disease were skewed. The extent of sites with GR, PD and LOA > or = 4mm was 1.35, 5.04 and 11.81 per cent respectively. More buccal sites had GR, while more mesial sites had PD and LOA. Severity score of LOA was 2.5 (SD: 0.7). LOA of 4+mm were observed more at maxillary molar buccal sites, followed by mandibular incisor mesial sites. LOA was prevalent among middle-aged Vietnamese adults. The loss of periodontal support was positively skewed and varied between teeth and sites.

[Periodontal disease in Belgian adults]

BACKGROUND

To date, no epidemiological study has been published on the periodontal health of the Belgian population. The aim of this study was to rectify this situation and determine the extent of the problem in Belgium.

METHODS

A prevalence survey was carried out in a representative sample of employees of the Catholic University of Louvain. A total of 402 people aged between 35 and 65 were examined. Periodontal suffering was estimated using the CPITN index (WHO), which determines the most affected sextant of a mouth in order to assign a code to the mouth as a whole. At the same time, treatment needs were evaluated.

RESULTS

Only one subject was considered healthy, i.e. there was no bleeding of the gums in any part of the mouth. At the same time, 41.4% of the subjects examined exhibited a deep periodontal pocket in at least one sextant of the mouth likely to progress to the loss of the teeth. Many mouths (28.5%), which were free from moderate or deep pockets, had to be scaled and polished or to be treated in order to eliminate other factors which could lead to a build-up of tartar.

CONCLUSION

In this study population representative of a socio-economically favored stratum of the Belgian population, we observed a high prevalence of periodontal diseases, grading from mild chronic gingivitis to the deep cavities which are observed when the bone supporting the tooth has been lost. At the same time, we uncovered many needs for periodontal care, ranging from instruction on how to control the dental plaque to specialized periodontal care via careful scaling and polishing.

Dental indices and their impact on targeting of dental prevention, periodontal and filling therapy in young adults undergoing subsidised public dental care

OBJECTIVE

To describe the dental health of young adults undergoing subsidised public dental care and evaluate the amount and targeting of actual dental prevention, filling and periodontal therapy, and the length of proposed check-up intervals in relation to dental health indices.

BASIC RESEARCH DESIGN

Data on dental prevention, periodontal and filling therapy for the age groups 19- to 36-years in 1999 were analysed in relation to dental indices.

SETTING

Public dental clinics of the Helsinki City Health Department.

PARTICIPANTS

In total, 25,657 patients whose check-ups were conducted by 139 dentists.

MAIN OUTCOME MEASURES

Length of proposed check-up intervals, actual number of visits, actual time used for repeated dental prevention, periodontal and filling therapy and their relation to caries and periodontal indices.

RESULTS

The mean DMFT for all patients was 11.8 and DT 1.6; 6% had deep (> or = 4 mm) periodontal pockets and 70% had calculus with no pockets. Repeated dental prevention was not given to 77% of patients with calculus and DM > or = 3, but given to 19% of those with calculus and DT = 0. Dental indices reflected proposed individual check-up intervalsand repeated dental prevention actually given. The average length of proposed check-up intervals was 17.8 months. Of all fillings,13% were done for DT = 0 patients.

CONCLUSIONS

Dentists' dental prevention practices for young adults showed under use of preventive actions. The value of the DT and CPITN indices as a measure of treatment needs of caries and periodontal disease in young adults seemed to be minor.

Periodontal conditions among adults in Southern Thailand

OBJECTIVE

To describe the periodontal conditions among 30-39- and 50-59-year-old rural Thais from the Province of Songkhla, Southern Thailand.

METHODS

A total of 359 dentate persons were given a clinical examination comprising recordings of plaque and calculus in six teeth, and bleeding on probing, attachment level and pocket depth in six sites of all teeth present, except third molars. The same examiner carried out all examinations. Information on religious faith, smoking habits and use of betel was obtained by interview. A subset consisting of 60 persons was reexamined for attachment level 6 months later by another examiner.

RESULTS

The oral hygiene conditions were poor with abundant amounts of both plaque and calculus. Gingival bleeding was essentially ubiquitous. The prevalence of attachment loss > or = 4 mm was 92% among 30-39-year-olds and 100% among 50-59-year-olds. The average percentage of sites affected in the two age groups was 23.9% and 63.9%. Pockets > or = 4 mm were seen in 84% of the 30-39-year-olds and in 93% of the 50-59-year-olds. Older age, Thai Buddhist faith and a high percentage of sites with calculus were significant positive predictors of a high percentage of sites with attachment loss > or = 4 mm, whereas older age and Thai Buddhist faith were the only statistically significant predictors of a high percentage of sites with attachment loss > or = 7 mm.

CONCLUSION

The results indicate that this Thai population may have more widespread and severe periodontal destruction than other Asian populations, but failed to confirm the contention that Muslim faith is associated with more severe periodontal destruction.

[Periodontal health and care needs in a sample of the Belgian population]

An epidemiological survey was carried out of among staff members of the Catholic University of Louvain. A total of 402 subjects, age 35 to 65, were examined. Periodontal lesions were estimated using the CPITN index (WHO). Only one subject presented no signs of gingival bleeding in any part of the mouth. 41.4% of the subjects presented a deep periodontal pocket in at least one sextant. Many subjects, although not presenting deep or moderately deep periodontal pockets (28.5%) needed scaling and rootplanning or other treatments to eliminate plaque retentive factors. In this sample, representing a socio-economically favoured segment of the population, we revealed a significant prevalence of periodontal disease from mild chronic gingivitis to deep pockets. Requirements in terms of care are considerable, ranging from oral hygiene instruction to control plaque to specialised care.

The prevalence of periodontal disease measures in elderly adults, aged 79 and older

From 1996-98, we examined 449 adults (mean age 85 years) from the 1982 Iowa 65+ Rural Health Study, in the field using headlight, mirror, and periodontal probe. Ninety-six of the 342 dentate subjects were excluded from the follow-up examination due to contraindications to probing, and 10 could not be assessed due to refusals, fatigue or other reasons. For all remaining subjects (n=236), attachment loss, defined as recession plus probing depth, was determined at four sites per tooth. Ninety-one percent of the subjects had at least one site with 4+ mm of attachment loss, 45% had one or more sites with attachment loss of 6+ mm, and 15% had 8+ mm of attachment loss. Moderate periodontal disease is prevalent among very old dentate adults while advanced periodontal disease is much less prevalent, suggesting that most periodontal treatment needed by this age group can be provided by general dentists and dental hygienists rather than periodontists.

[Oral hygiene habits and the state of periodontal health among a population of 1228 students in Abidjan]

The purpose of our study was to determine the customs of oral hygiene and the health periodontal of a population of pupils in Abidjan. We led a transverse inquiry on a sample of 1228 pupils. Our results showed that the pupils had bad habits of bucco-dental hygiene which is translated by a bad periodontal health. More than 80% of them presents deposits of tartar and 9.6% of the population have periodontal pockets.

Oral health status and treatment needs of institutionalized elderly and disadvantaged population in Fiji (1997)

Information on the oral health of institutionalized elderly populations in a number of countries is available but, no data is available nor published on the elderly population of Fiji. A pilot survey was carried out at the nursing homes in the Suva area. The aim of this study was to investigate the dental status and treatment needs of institutionalized elderly people. Examiner was calibrated and consent approved from the relevant institutions. This study found that residents were institutionalized, because family members could not care for them; did not receive any form of financial assistance and therefore totally relied on the institution; generally had medical problems such as neurological disorders, cardiovascular disease and diabetes. Generally had poor oral health status such as root stumps, many missing teeth, calculus and shallow pockets were common, oral hygiene practices were poor, high demand for dentures/or the dentures were not clean, some cases of leukoplakia were found and there was an urgent need for the dental profession to deliver dental care. Recommendations include issues in developing a supporting environment, provision of adequate and appropriate access, community education and skill development, workforce development and research in geriatric dentistry in Fiji.