A longitudinal study of untreated periodontal disease

Diabetes mellitus and periodontal disease in an Irish population

The prevalence of periodontitis was studied in a population of 157 insulin dependent diabetes mellitus patients aged 8-78 years attending the outpatients diabetic clinic of a large general hospital in Cork, Ireland. Every third diabetic patient attending the clinic was selected for examination. The dental parameters measured were plaque index (PI), gingivitis index (GI), periodontal pocket depth (PD) and periodontal attachment loss (PAL). Diabetic control was measured by estimating percentage haemoglobin glycolysation (% Hb Alc) known duration of diabetes (KDD) and insulin dependence. It was found that none of the diabetic measurements showed any consistent pattern in relation to any of the periodontal measurements. The findings are in agreement with other studies which suggest that no significant correlation between diabetic parameters and periodontal disease can be demonstrated. When the diabetic patient suffered periodontitis it was due to factors (such as genetic predisposition) other than impaired glucose metabolism.

Tooth loss in patients with moderate periodontitis after treatment and long-term maintenance care

Records of 63 patients diagnosed as having moderate periodontitis who had been treated and maintained by scaling and root planing for 10 years or longer (mean 13.6 years, range 10 to 34 years) in dental school clinics were reviewed for tooth loss. The patients averaged 45 years of age (range 24 to 67 years) at the initial appointment, and 41 were female. Record audit determined type of periodontal treatment, total tooth loss, periodontally related tooth loss, loss of teeth with furcation invasion, plaque scores, and maintenance interval. Results of therapy were evaluated by groups on the basis of number of teeth lost. At the completion of active periodontal therapy 1,607 teeth were present in the patients. During the maintenance period, 115 teeth (7.1%) were lost and of these 88 (5.0%) were lost due to periodontal reasons. Maxillary and mandibular molar teeth, particularly maxillary second molars, were the teeth lost most frequently to periodontal disease. Of the 164 teeth initially indicated as having furcation invasion, 23% were subsequently lost. This retrospective study confirms the low rate of tooth mortality occurring when patients with periodontal disease are treated and kept on a maintenance program. Canines were the teeth least frequently lost.

A 10-year retrospective study of periodontal disease progression

The purpose of this study was to record the rate of periodontal disease progression over a 10-year period with respect to individual subject, age and tooth type. 283 subjects, who had undergone a full-mouth radiographic examination in 1974-76 and at that time were 25-70 years old, were randomly selected from a larger patient sample for a new radiographic examination in 1985-86. 201 subjects (71%) agreed to participate. For each respondent, tooth loss over the 10-year period was calculated. The radiographic bone height at the mesial and distal aspect of all teeth was assessed by measuring the distance between the cemento-enamel junction and the bone crest. Difference in periodontal bone height between the 2 examinations was calculated for each tooth site. The results revealed that the mean number of teeth lost over the 10-year period was 3.8 (SD 4.6). Tooth mortality, expressed as a % of the no. of teeth present at the initial examination, increased with age and varied between 2.9%-28.5%. In all age groups, molars had the highest and canines the lowest rate of tooth mortality. The frequency of subjects with loss of greater than 10 teeth was highest for the initially 45-year old individuals (20%). 7 individuals (3%) had become edentulous. The mean annual reduction of alveolar bone height varied between 0.07-0.14 mm in the age groups 25-65 years. The initially 70-year old subjects showed a statistically significant higher annual rate of bone loss (0.28 mm).(ABSTRACT TRUNCATED AT 250 WORDS)

Public health implications of recent research in periodontal diseases

Knowledge of the epidemiology, natural history, and bacterial etiology of the periodontal diseases has advanced considerably as a result of research conducted through the 1980s. Prevention and control of these conditions, however, remains mechanical, cumbersome, and often impractical, based as it is on bacterially nonspecific plaque removal for an indeterminate period. This research has not yet changed the content of public health programs, but it does affect the way the programs are applied. Because sever, generalized disease seems to be less prevalent than previously thought, the need of regular, routine professional care for everybody is questioned. Professional care in a public health context is likely to be more efficient when targeted toward those with severe disease. Dental health education for personal oral hygiene is still supported by scientific studies, though a targeted approach and careful assessment of educational content is needed. Until predictive screening methods for identifying susceptible individuals are developed, selection of priority groups for education and treatment should be guided by epidemiologic data.

Tooth loss in maintenance patients in a private periodontal practice

A group of 162 maintenance patients, previously studied for compliance to suggested maintenance schedules, were surveyed for tooth loss over a 5-year period. The group was divided into those who complied to suggested maintenance schedules and those whose compliance was erratic. It was found that none of the patients who had complied to suggested maintenance schedules lost any teeth. In the erratic group, where all tooth loss occurred, it was found that the more often a patient presented for maintenance, the less likely he was to lose teeth. These findings are discussed in relation to current studies on efficacy of various therapies for periodontal diseases.

Proximal alveolar bone loss in a longitudinal radiographic investigation. III. Some predictors with a possible influence on the progress in an unselected material

The difference in proximal alveolar bone height between 1970 and 1980, the 'ABD index', has been measured longitudinally in radiographs from an unselected material. The group constitutes 406 individuals born in 1904-1952 in the county of Stockholm. Thirteen of 18 predictors determined in 1970 were significantly related to the ABD index in the simple correlation analyses. The predictor 'the alveolar bone loss 1970' ('ABL index 1970') had the strongest correlation to the ABD index. In the stepwise multiple regression analysis the predictor ABL index 1970 and three other predictors reached significant levels. These were age, number of lost teeth, and Russell's Periodontal Index.

Design of clinical trials of traditional therapies of periodontitis

The present paper on the design of clinical trials of periodontal therapy first addresses the issue of the etiology of periodontal disease. It is suggested that most if not all forms of destructive periodontal disease are caused by microorganisms and that there are different forms of disease with different microbial etiologies. The progressive nature of destructive periodontal disease is subsequently discussed and it is emphasized that, in a given patient, periodontal sites which show signs of inflammation and attachment loss may not over a period of several months and years show further sign of attachment loss. The present methods of assessing periodontal disease do not allow us to discriminate between potentially active and inactive sites in untreated patients. The significance and variability of indicators of periodontal disease such as bleeding on probing, probing pocket depth and probing attachment level measurements are discussed. The errors inherent in the various measurements are analyzed and suggestions are presented describing how alterations in any of the above parameters could be identified and presented in a clinical trial. Of concern for the statistical analysis of clinical data of periodontal disease is the definition of the "experimental unit". For a number of years, the "experimental unit" in periodontal trials was the patient. It is clear, however, that different sites within the same individual show different patterns of disease progression and lesion morphology and often respond differently to periodontal therapy. Statistical analyses must consequently be designed which recognize differences in site-to-site infection and lesion morphology within a common host. Until such analyses are available, the investigator should be wary of pooling data within the same individual, since such pooling may obscure meaningful alternatives which may take place in individual periodontal sites. Some goals of periodontal therapy are subsequently identified. 4 goals are discussed more in detail, namely: to establish conditions which will allow the patient to maintain a dentition without further breakdown of the periodontium; to reduce pocket depth to establish an anatomy in the dentogingival region which with proper maintainance care will prevent the re-establishment of the subgingival infection; to gain attachment as a result of treatment; to assess the effect of a certain chemotherapeutic agent on periodontal disease.