Assessment of partial-mouth periodontal examination protocols for periodontitis surveillance

The association between periodontitis and sleep duration

AIM

Due to its potential to influence systemic inflammation and oxidative stress, and to predispose to bacterial infections, sleep duration could potentially be a risk factor for periodontitis. The aim of this cross-sectional study was to evaluate if there was in 2012 an association between periodontitis and sleep duration in a representative sample of the South Korean population.

MATERIALS AND METHODS

A total of 5812 subjects representative of 39.4 million of adults were examined. Multivariate logistic regressions were applied controlling for age, gender, education, smoking status, alcoholism and consumption frequency of coffee, tea, chocolate and red wine.

RESULTS

Compared to the group sleeping ≤5 h/day, the adjusted odds ratios for periodontitis prevalence defined as Community Periodontal Index (CPI) = 4 were OR = 2.46 (95% CI: 1.20-5.06) in the 6 h/day sleepers group, OR = 2.66 (95% CI: 1.35-5.25) in the 7 h/day sleepers group, OR = 2.29 (95% CI: 1.13-4.63) in the 8 h/day sleepers group and OR = 4.27 (95% CI: 1.83-9.97) in the ≥9 h/day sleepers group. The association has shown to be highlighted in middle-aged people, females, non-smokers, lower educated, with lower lead and higher cadmium blood levels and with higher carotene dietary intake ones and to be partially mediated by lipid profile alterations, diabetes, serum Vitamin D levels and WBC count.

CONCLUSIONS

A novel, direct and independent association between sleep duration and the prevalence of periodontitis was found. However, it needs to be investigated how the factors influencing the sleep duration affect this association.

A new way to estimate disease prevalence from random partial-mouth samples

AIM

Standard partial-mouth estimators of chronic periodontitis (CP) that define an individual's disease status solely in terms of selected sites underestimate prevalence. This study proposes an improved prevalence estimator based on randomly sampled sites and evaluates its accuracy in a well-characterized population cohort.

METHODS

Importantly, this method does not require determination of disease status at the individual level. Instead, it uses a statistical distributional approach to derive a prevalence formula from randomly selected periodontal sites. The approach applies the conditional linear family of distributions for correlated binary data (i.e. the presence or absence of disease at sites within a mouth) with two simple working assumptions: (i) the probability of having disease is the same across all sites; and (ii) the correlation of disease status is the same for all pairs of sites within the mouth.

RESULTS

Using oral examination data from 6793 participants in the Arteriolosclerosis Risk in Communities study, the new formula yields CP prevalence estimates that are much closer than standard partial mouth estimates to full mouth estimates.

CONCLUSIONS

Resampling of the cohort shows that the proposed estimators give good precision and accuracy for as few as six tooth sites sampled per individual.

Partial-mouth periodontal examination protocol for estimating periodontitis extent and severity in a US population

We have previously demonstrated that half-mouth four-site periodontal examination protocol performed well in estimating periodontitis prevalence. This study aimed to assess biases associated with this same protocol in estimating periodontitis extent and severity in a United States population. Periodontitis extent as determined by percentage of sites with clinical attachment loss (CAL) ≥3, and ≥5 mm and severity as determined by mean CAL were calculated for full-mouth examination and half-mouth four-site protocol based on 3734 adults sampled from the National Health and Nutrition Examination Survey 2009-2010. Probing depth was excluded because of low data reliability. The comparison between full-mouth and half-mouth assessments was based on bias, relative bias, Wilcoxon signed-rank test, and intra-class correlation coefficient (ICC). For full-mouth examination, periodontitis extent was 21.2% for CAL ≥3 mm and 6.9% for CAL ≥5 mm; periodontitis severity (mean CAL) was 1.73 mm. Half-mouth four-site protocol provided bias -1.2% and relative bias -5.7% for extent (CAL ≥3 mm). Corresponding numbers were -0.3% and 4.3% for extent (CAL ≥5 mm), -0.05 mm and -2.9% for severity. Although the difference between full-mouth and half-mouth assessments was statistically significant, ICCs between them were ≥0.96 for extent (CAL ≥3, 5 mm), and severity (mean CAL). Half-mouth four-site protocol performed well in estimating periodontitis extent and severity based on CAL. Therefore, this protocol should be considered for periodontitis surveillance.