Validation of self-reported periodontal disease: a systematic review

Periodontal disease and risk of psoriasis among nurses in the United States

OBJECTIVE

Periodontal disease has been associated with systemic inflammation and may be a risk factor for autoimmune diseases. This study evaluated the association between periodontal disease and the risk of incident psoriasis in a large prospective cohort study.

MATERIAL AND METHODS

Self-reported history of periodontal bone loss, from 1998-2008, was evaluated as a risk factor for incident psoriasis among 60,457 women in the Nurses' Health Study. Secondary analyses examined associations between history of tooth loss and number of natural teeth and psoriasis risk. Cox proportional hazards models were used to assess multivariate estimates, adjusting for age, cigarette smoking, body mass index, alcohol intake and physical activity.

RESULTS

An increased multivariate risk of psoriasis was observed for those with mild periodontal bone loss (RR = 1.35, 95% CI = 1.03-1.75) and moderate-to-severe periodontal bone loss (RR = 1.49, 95% CI = 1.08-2.05), as compared to those without periodontal bone loss, after adjusting for age, cigarette smoking, body mass index, alcohol intake, physical activity and tooth loss. Number of natural teeth and tooth loss were not associated with risk of psoriasis in this study.

CONCLUSION

This study shows that a history of periodontal bone loss may increase risk of subsequent psoriasis. A limitation of this study is that it is based on self-reported measures.

Application of audio computer-assisted self-interviews to collect self-reported health data: an overview

For assessment of sensitive health behaviors (e.g., sexual behavior, violent behaviors, substance use), research is typically limited to an examination of self-reports of past behavior. Audio computer-assisted self-interviews (ACASI) may enhance the validity of self-report data in research and clinical settings by reducing measurement bias. This paper provides an introduction to ACASI for collection of self-reported health data. The potential benefits and cost-effectiveness of ACASI use in research and clinical settings are reviewed. We then review the theoretical underpinnings that may underlie differential reporting of health behaviors between assessment modalities. Next, we highlight studies that have investigated differences in self-reported health behaviors between assessment modalities. Lastly, we summarize potential applications of ACASI assessments within clinical settings.

Enhancement cone beam computed tomography filters improve in vitro periimplant dehiscence detection

OBJECTIVE

To investigate whether cone beam computed tomography filters would improve periimplant dehiscence detection.

STUDY DESIGN

A hundred titanium implants were placed in bovine ribs in which defects simulating periimplant dehiscence had previously been created. After images acquisition, three oral radiologists assessed them with and without the following filters: Angio Sharpen high 5 × 5, Shadow, Sharpen 3 × 3, Sharpen Mild, and Smooth. The McNemar test verified the disagreement between all images versus the reference standard and original images versus images with filters; P < .05 was considered statistically significant.

RESULTS

Dehiscence detection using the original images and the Shadow filter disagreed from the reference standard (P < .05), as well as when using the filters instead of the original images (P < .05).

CONCLUSION

All the filters tested, with the exception of the Shadow, improved periimplant dehiscence detection. The Sharpen 3 × 3 filter was considered best for this task.

Diagnostic validity of self-reported oral health outcomes in population surveys: literature review

Population-based health surveys are increasingly including self-reported oral health measures. However, their validity is frequently questioned. This study aimed to review the diagnostic validity of self-reported oral health measures - regarding periodontal conditions, number of remaining teeth and use and need of prostheses - and to present prototypes of oral health items to assess periodontal conditions. Papers published between 1991 and 2011 were identified through PubMed database. The sample profile, the sample size and the methods used in each study were analyzed, as well as the sensitivity, specificity, positive and negative predictive values of the oral health items. Periodontists were contacted, using a standardized text, sent by e-mail, which asked them to provide self-reported items regarding periodontal conditions. We reviewed 19 studies; 13 assessed periodontal conditions; five, the number of remaining teeth and four, the use and need of prosthesis - some studies evaluated two or more conditions simultaneously. Five of the eight periodontists suggested questions to assess periodontal conditions. The maximum and the minimum sensitivity values to assess periodontal conditions, number of remaining teeth and use and need of prosthesis were 100 and 2%; 91 and 21%; 100 and 100%; respectively; the maximum and the minimum specificity values were 100 and 18%; 97 and 96%; 93 and 93%; respectively. In conclusion, there are acceptable sensitivity and specificity values for number of remaining teeth and use and need of prosthesis only. Finally, we consider there is the need for further studies in the national context, in order to assess the impact of the questions about self-reported oral health conditions in epidemiological analyses. Therefore, it will be possible to empirically verify if self-reported questions can be used in such studies.

Detection of periimplant fenestration and dehiscence with the use of two scan modes and the smallest voxel sizes of a cone-beam computed tomography device

OBJECTIVE

To assess the accuracy of cone-beam computed tomography (CBCT) in periimplant fenestration and dehiscence detection, and to determine the effects of 2 voxel sizes and scan modes.

STUDY DESIGN

One hundred titanium implants were placed in bovine ribs in which periimplant fenestration and dehiscence were simulated. CBCT images were acquired with the use of 3 protocols of the i-CAT NG unit: A) 0.2 mm voxel size half-scan (180°); B) 0.2 mm voxel size full-scan (360°); and C) 0.12 mm voxel size full scan (360°). Receiver operating characteristic curves and diagnostic values were obtained. The Az values were compared with the use of analysis of variance.

RESULTS

The Az value for dehiscence in protocol A was significantly lower than those of B or C (P < .01). They did not statistically differ for fenestration (P > .05).

CONCLUSIONS

Protocol B yielded the highest values. The voxel sizes did not affect fenestration and dehiscence detection, and for dehiscence full-scan performed better than half-scan.

Determinants of oral health: does oral health literacy matter?

Objective. To evaluate oral health literacy, independent of other oral health determinants, as a risk indicator for self-reported oral health. Methods. A cross-sectional population-based survey conducted in Tehran, Iran. Multiple logistic regression analysis served to estimate the predictive effect of oral health literacy on self-reported oral health status (good versus poor) controlling for socioeconomic and demographic factors and tooth-brushing behavior. Results. In all, among 1031 participants (mean age 36.3 (SD 12.9); 51% female), women reported brushing their teeth more frequently (P < 0.001) and scored higher for oral health literacy (mean 10.9 versus 10.2, P < 0.001). In the adjusted model, high age (OR = 1.01, 95% CI 1.003–1.034), low education (OR = 1.88, 95% CI 1.23–2.87), small living area in square meters per person (OR = 1.85, 95% CI 1.003–3.423), poor tooth brushing behavior (OR = 3.35, 95% CI 2.02–5.57), and low oral health literacy scores (OR = 1.58, 95% CI 1.02–2.45) were significant risk indicators for poor self-reported oral health. Conclusions. Low oral health literacy level, independent of education and other socioeconomic determinants, was a predictor for poor self-reported oral health and should be considered a vital determinant of oral health in countries with developing health care systems.

Porphyromonas gingivalis and disease-related autoantibodies in individuals at increased risk of rheumatoid arthritis

OBJECTIVE

To examine the relationship of Porphyromonas gingivalis to the presence of autoantibodies in individuals at risk of rheumatoid arthritis (RA).

METHODS

Study participants included the following: 1) a cohort enriched in subjects with HLA-DR4 and 2) subjects at risk of RA by virtue of having a first-degree relative with RA. None of the study subjects satisfied the American College of Rheumatology 1987 classification criteria for RA. Autoantibodies measured included anti-citrullinated protein antibody (ACPA; by second-generation anti-cyclic citrullinated peptide antibody enzyme-linked immunosorbent assay [ELISA]) and rheumatoid factor (RF; by nephelometry or ELISA for IgA, IgM, or IgG isotype). Individuals were considered autoantibody positive (n = 113) if they had ≥1 RA-related autoantibody; individuals were further categorized as high risk (n = 38) if they had ACPA or positive findings ≥2 assays for RF. Autoantibody-negative individuals (n = 171) served as a comparator group. Antibody to P gingivalis, P intermedia, and F nucleatum were measured. Associations of bacterial antibodies with group status were examined using logistic regression.

RESULTS

Anti-P gingivalis concentrations were higher in high-risk (P = 0.011) and autoantibody positive group (P = 0.010) than in the autoantibody negative group. There were no group differences in anti-P intermedia or anti-F nucleatum concentrations. After multivariable adjustment, anti-P gingivalis concentrations (but not anti-P intermedia or anti-F nucleatum) were significantly associated with autoantibody-positive and high-risk status (P < 0.05).

CONCLUSION

Immunity to P gingivalis, but not P intermedia or F nucleatum, is significantly associated with the presence of RA-related autoantibodies in individuals at risk of RA. These results support the hypothesis that infection with P gingivalis may play a central role in the early loss of tolerance to self antigens that occurs in the pathogenesis of RA.

Advances in surveillance of periodontitis: the Centers for Disease Control and Prevention periodontal disease surveillance project

The Centers for Disease Control and Prevention (CDC) has as one of its strategic goals to support and improve surveillance of periodontal disease. In 2003, the CDC initiated the CDC Periodontal Disease Surveillance Project in collaboration with the American Academy of Periodontology to address population-based surveillance of periodontal disease at the local, state, and national levels. This initiative has made significant advancements toward the goal of improved surveillance, including developing valid self-reported measures that can be obtained from interview-based surveys to predict prevalence of periodontitis in populations. This will allow surveillance of periodontitis at the state and local levels and in countries where clinical resources for surveillance are scarce. This work has produced standard case definitions for surveillance of periodontitis that are now widely recognized and applied in population studies and research. At the national level, this initiative has evaluated the validity of previous clinical examination protocols and tested new protocols on the National Health and Nutrition Examination Survey (NHANES), recommending and supporting funding for the gold-standard full-mouth periodontal examination in NHANES 2009 to 2012. These examinations will generate accurate estimates of the prevalence of periodontitis in the US adult population and provide a superior dataset for surveillance and research. Also, this data will be used to generate the necessary coefficients for our self-report questions for use in subsets of the total US population. The impact of these findings on population-based surveillance of periodontitis and future directions of the project are discussed along with plans for dissemination and translation efforts for broader public health use.

Recording and surveillance systems for periodontal diseases

This paper describes tools used to measure periodontal diseases and the integration of these tools into surveillance systems. Tools to measure periodontal diseases at the surveillance level have focussed on current manifestations of disease (e.g. gingival inflammation) or disease sequelae (e.g. periodontal pocket depth or loss of attachment). All tools reviewed in this paper were developed based on the state of the science of the pathophysiology of periodontal disease at the time of their design and the need to provide valid and reliable measurements of the presence and severity of periodontal diseases. Therefore, some of these tools are no longer valid. Others, such as loss of periodontal attachment, are the current de-facto tools but demand many resources to undertake periodical assessment of the periodontal health of populations. Less complex tools such as the Community Periodontal Index, have been used extensively to report periodontal status. Laboratory tests for detecting putative microorganisms or inflammatory agents present in periodontal diseases have been used at the clinical level, and at least one has been tested at the population level. Other approaches, such as self-report measures, are currently under validation. In this paper, we do not review indices designed to measure plaque or residual accumulation around the tooth, indices focussed only on gingival inflammation or radiographic approaches with limited applicability in surveillance systems. Finally, we review current case-definitions proposed for surveillance of periodontal disease severity.

Validity of self-reported history of endodontic treatment in the Baltimore Longitudinal Study of Aging

INTRODUCTION

Self-reported history of endodontic treatment (SRHET) has been used as a simplified method to estimate the history of endodontic disease and treatment. This study aimed to quantify the validity of SRHET, as reported in the Baltimore Longitudinal Study of Aging (BLSA), as a method to identify individuals who experienced endodontic treatment (ET) and to identify individuals who present with apical periodontitis (AP).

METHODS

SRHET was collected through the BLSA questionnaire in 247 participants. Data on ET and AP were determined from panoramic radiographs. The total number of ET, AP, and missing teeth were recorded for each individual. The validity of SRHET was determined based on ET and AP separately. Accuracy, efficiency, sensitivity, specificity, positive and negative predictive values (+PV and -PV), and positive and negative likelihood ratios (+LR and -LR) were calculated according to standard methods.

RESULTS

After exclusions, 229 participants were available for ET analysis and 129 for AP analysis. The SRHET validity values were sensitivity (ET = 0.915, AP = 0.782), specificity (ET = 0.891, AP = 0.689), +PV (ET = 0.824, AP = 0.353), -PV (ET = 0.949, AP = 0.936), +LR (ET = 8.394, AP = 2.514), and -LR (ET = 0.095, AP = 0.316).

CONCLUSIONS

SRHET was found to be a highly accurate method to predict ET but a weak predictor of the presence of AP among participants in the BLSA.

Association between periodontal disease and peptic ulcers among Japanese workers: MY health up study

OBJECTIVE

This study aimed to investigate the association between periodontal disease and peptic ulcers in a working population.

METHODS

Self-administered questionnaires were distributed to all employees of a large insurance company in Japan. The questionnaire asked about their health status and lifestyle habits. Peptic ulcer was defined as either stomach ulcer, duodenal ulcer, or both. For the evaluation of periodontal disease, three indices were used: (a) loss of five or more teeth, (b) having been told of having periodontitis, and (c) periodontal risk score.

RESULTS

Of the eligible 28 765 subjects analyzed, peptic ulcer was present in 397 (1.4%). The results of bivariate analyses showed that a significantly higher proportion of subjects with peptic ulcer reported that they lost five or more teeth (35.3 vs. 17.4%, p&lt;0.001) or that they were told they had periodontitis (33.5 vs. 20.7%, p&lt;0.001). Moreover, the periodontal risk score was higher for those with peptic ulcer than those without (mean 0.83 vs. 0.59, p&lt;0.001). In multivariate logistic regression analyses, statistical associations were found between the presence of peptic ulcer and loss of five or more teeth (odds ratio (OR): 1.41, 95% confidence interval (CI): 1.13-1.76, p&lt;0.01), having been told of having periodontitis (OR: 1.28, 95% CI: 1.03-1.59, p&lt;0.05), and a 1-point increase in the periodontal risk score (OR: 1.17, 95% CI: 1.04-1.30, p&lt;0.01), respectively.

CONCLUSION

Modest but statistically significant associations were found between the self-reported measures of periodontal disease and peptic ulcers.

Oral care practices and A1c among youth with type 1 and type 2 diabetes

BACKGROUND

Periodontal treatment is associated with lower hemoglobin A1c in individuals with diabetes, but the relationship between oral hygiene practices and A1c among youth with diabetes is understudied.

METHODS

This study evaluates the cross-sectional relationships among oral health habits, reported oral conditions, and A1c and control of diabetes among a subset of youth with diabetes enrolled in the SEARCH for Diabetes in Youth study in South Carolina. Oral hygiene practices were determined by questionnaire, and periodontal bone loss was defined as alveolar bone loss ≥3 mm on ≥1 permanent tooth site on preexisting bitewing radiographs. A1c was considered controlled if individuals were aged ≤6 years with A1c <8.5%; aged 7 to 11 years with A1c <8.0%; aged 12 to 18 years with A1c <7.5%; and aged ≥19 years with A1c <7.0%.

RESULTS

Among 155 participants, 68% brushed their teeth no less than once daily, 84% flossed, and 70% rinsed, respectively, less than once a week. Diabetes control was associated with toothbrushing (≥1 time daily [odds ratio (OR) = 3.10; 95% confidence interval (CI) = 1.26 to 7.62] and using mouthrinse at least once weekly (OR = 3.33; 95% CI = 1.30 to 8.54) after multivariate adjustment. Periodontal bone loss was three times more common among those with dry mouth (OR = 3.05; 95% CI = 1.07 to 8.70).

CONCLUSIONS

Clinicians should be aware that children with diabetes tend to have poor oral hygiene practices. Dry mouth may indicate periodontal bone loss in children with diabetes.

The association between self-reported tooth loss and cognitive function in the REasons for Geographic And Racial Differences in Stroke study: an assessment of potential pathways

BACKGROUND

Several mechanisms may associate tooth loss and related oral inflammation with cognitive impairment. The authors studied the relationship between tooth loss and cognitive function.

METHODS

The REasons for Geographic And Racial Differences in Stroke study is a national longitudinal study of more than 30,000 African American and white adults 45 years or older. Data for tooth loss, cognitive function and potential confounding variables were available for 9,853 participants at the time of analysis. The authors used incremental linear regression modeling to investigate the cross-sectional association between self-reported tooth loss and cognitive function.

RESULTS

In unadjusted analysis (mean learning followed by recall; α level of significance of .05), the loss of six to 16 teeth and the loss of more than 16 teeth were associated with poorer cognitive function compared with the loss of no teeth. Attenuated associations persisted after the authors adjusted for demographic and systemic risk factors. The full model, which was adjusted for socioeconomic status (SES), revealed no association between tooth loss and cognitive function.

CONCLUSION

Tooth loss may be associated with cognitive function; however, this association is mediated by age and SES.

CLINICAL IMPLICATIONS

Tooth loss due to periodontal disease may be a marker for low SES, and the interplay of these factors with advanced age may confer risk of having poorer cognitive function. Further studies are needed to clarify these associations.

Validade do padrão de higiene bucal de crianças aos cinco anos de idade relatado pelas mães

OBJETIVO: Determinar a validade de perguntas freqüentemente utilizadas em estudos epidemiológicos sobre higiene bucal de crianças e compará-la segundo renda familiar e escolaridade da mãe. MÉTODOS: Foram analisadas 1.122 crianças participantes do subestudo de saúde bucal de 2009 da Coorte de Nascimentos de Pelotas, RS, 2004. As crianças foram examinadas e suas mães entrevistadas no domicílio. O padrão-ouro da condição de higiene bucal foi avaliado por meio do Índice de Higiene Oral Simplificado e a partir do seu escore total o desfecho foi dicotomizado em: placa dental ausente (escore total = 0) e presente (escore total ≥ 1). As perguntas testadas sobre o padrão de higiene bucal das crianças foram formuladas às mães e incluíram: freqüência diária de escovação, escovação antes de dormir e a combinação dessas duas (higiene bucal), com suas opções de resposta dicotomizadas em regular e irregular. A validade foi determinada por meio do cálculo dos valores percentuais e respectivos intervalos de 95% de confiança de sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo. RESULTADOS: A prevalência de placa dental foi 37,0%. Os valores de sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo foram, respectivamente: 29,6%, 82,5%, 49,8% e 66,6%, para freqüência de escovação diária irregular; 41,8%, 64,6%, 40,9% e 65,5%, para escovação antes de dormir irregular; 48,8%, 60,8%, 42,2% e 67,0%, para higiene bucal irregular. A validade do padrão de higiene bucal variou conforme o nível de renda familiar e a escolaridade da mãe, e a sensibilidade e o valor preditivo positivo foram maiores entre os indivíduos com menor renda familiar e com mães menos escolarizadas e o oposto, para a especificidade e o valor preditivo negativo. CONCLUSÕES: Perguntas sobre higiene bucal respondidas pelas mães de crianças não são boas substitutas do padrão real de higiene bucal medido por meio do exame clínico bucal de placa dental.

Evaluation of self-reported measures for prediction of periodontitis in a sample of Brazilians

BACKGROUND

Questionnaires including self-reported measures have become effective as a means of accessing many diseases. The aim of the present study is to evaluate the performance of a set of self-reported periodontal measures on estimating the prevalence of periodontitis.

METHODS

The sample comprised 284 individuals, aged 18 to 60 years, from Belo Horizonte, Brazil. Full-mouth periodontal examinations were performed and periodontal parameters were recorded. Periodontitis was categorized as no or mild, moderate, and severe. Each participant answered 18 questions covering sociodemographic variables, known risk factors, and self-reported periodontal measures. Questions were globally tested through logistic regression analysis.

RESULTS

The complete final model for moderate periodontitis included age, dental flossing, and gum disease (sensitivity = 23.1%; specificity = 98%; area under the receiver operating characteristic curve = 75.4%). The complete final model for severe periodontitis included all previously cited variables in addition to the number of teeth (sensitivity = 36.4%; specificity = 96.9%; area under the receiver operating characteristic curve = 85.3%).

CONCLUSIONS

Self-reported periodontal measures showed a moderate predictive value for periodontitis prevalence. The use of these measures could be a good strategy in investigating prevalence of periodontal disease.

Association between overweight/obesity and periodontitis in adults. A systematic review

Overweight and obesity have been suggested to be associated with periodontitis as published in studies and narrative summaries. This project presents results of a systematic review investigating the association between overweight or obesity (as defined by the World Health Organization) and periodontitis. Search strategy included electronic and hand searching to December 2009. Ovid MEDLINE, EMBASE, LILACS, and SIGLE were searched. RCTs, cohort, case-control and cross-sectional study designs that included measures of periodontitis and body composition were eligible. Duplicate, independent screening and data abstraction were performed. Meta-analyses were performed when appropriate. A total of 526 titles and abstracts were screened, resulting in 61 full text articles and abstracts assessed for eligibility with 33 being included. Nineteen studies provided sufficient information for inclusion in meta-analyses. Meta-analyses indicated statistically significant associations between periodontitis and body mass index (BMI) category obese OR 1.81(1.42, 2.30), overweight OR 1.27(1.06, 1.51) and obese and overweight combined OR 2.13(1.40, 3.26). In conclusion, these results support an association between BMI overweight and obesity and periodontitis although the magnitude is unclear. Additional prospective studies to further quantify, or understand the mechanisms, of this association are merited. There is insufficient evidence to provide guidelines to clinicians on the clinical management of periodontitis in overweight and obese individuals.

Inter-generational continuity in periodontal health: findings from the Dunedin family history study

OBJECTIVE

To determine whether parental periodontal disease history is a risk factor for periodontal disease in adult offspring.

METHODS

Proband periodontal examination [combined attachment loss (CAL) at age 32, and incidence of CAL from ages 26 to 32] and interview data were collected during the age-32 assessments in the Dunedin Study. Parental data were also collected. The sample was divided into two familial-risk groups for periodontal disease (high- and low-risk) based on parents' self-reported periodontal disease.

RESULTS

Periodontal risk analysis involved 625 proband-parent(s) groups. After controlling for confounding factors, the high-familial-risk periodontal group was more likely to have 1+ sites with 4+mm CAL [relative risk (RR) 1.45; 95% confidence interval (CI) 1.11-1.88], 2+ sites with 4+mm CAL (RR 1.45; 95% CI 1.03-2.05), 1+ sites with 5+mm CAL (RR 1.60; 95% CI 1.02-2.50), and 1+ sites with 3+mm incident CAL (RR 1.64; 95% CI 1.01-2.66) than the low-familial-risk group. Predictive validity was enhanced when information was available from both parents.

CONCLUSIONS

Parents with poor periodontal health tend to have offspring with poor periodontal health. Family/parental history of oral health is a valid representation of the shared genetic and environmental factors that contribute to an individual's periodontal status, and may help to predict patient prognosis and preventive treatment need.

Correlations among inflammatory markers in plasma, saliva and oral mucosal transudate in post-menopausal women with past intimate partner violence

The relationship between psychosocial factors and an increased risk for disease has been related to a heightened pro-inflammatory status reflected in increased circulating levels of pro-inflammatory cytokines and/or C-reactive protein (CRP). Routinely, epidemiological studies rely on measurements of inflammatory markers in serum or plasma, but the use of biological fluids such as saliva or oral mucosal transudate (OMT) may offer potential advantages. This study investigated correlations among plasma CRP and levels of IL-6 and soluble IL-6 receptor (sIL-6R) in plasma, saliva and OMT in a population of middle aged women with histories of past intimate partner violence (IPV). A total of 67 women without existing chronic diseases participated in the study, which included two visits each in which psychological tests were administered, and blood, saliva and OMT samples were collected. Although significantly higher plasma CRP levels were found in past IPV sufferers compared to controls, there were no significant differences in IL-6 or sIL-6R levels in plasma, saliva or OMT between the two groups. There were only relatively modest correlations between IL-6 levels in plasma and those in saliva or OMT and between plasma IL-6 and CRP levels. A significant correlation between IL-6 and sIL-6R levels in both saliva and OMT, but not in plasma, was also detected. No significant correlations were found between levels of IL-6 in saliva or OMT and periodontal health measures. Results indicate that IL-6 and sIL-6R levels in saliva or OMT do not closely reflect those in plasma, and therefore are not a good surrogate for systemic levels.

Association of total tooth loss with socio-behavioural health indicators in Korean elderly

This study examined the association between total tooth loss, and socio-behavioural factors and general health indicators in elderly Koreans using national databases. Cross-sectional data for this study were from the third Korean National Health and Nutrition Examination Survey (KNHANES III), which was conducted among non-institutionalised civilians by the Korean Ministry of Health and Welfare in 2005. KNHANES III used a stratified, multistage probability sampling design on a representative of total South Korean population, according to geographical areas, age and sex groups. Among them, 1091 subjects aged 65 years and above were identified as potential participants in this study. The dependent variable in this study was the self-reported total tooth loss. The independent variables consisted of the following four categories: demographic information, socio-behavioural factors, psychological factors and general health indicators. The data were weighted to adjust for the sampling complexity, and SPSS version 14 for Windows software was used for data analysis. There were significant differences in total tooth loss odds according to the socio-behavioural backgrounds (education and smoking), psychological conditions (perceived oral health) and general health status (diabetes and body mass index as underweight). This suggests that the total tooth loss is associated with the socio-economic status, health-related behaviour and general health. However, more extensive longitudinal data and research will be needed to better explain the relationship between the total tooth loss and these variables.

Self-reported dental hygiene, obesity, and systemic inflammation in a pediatric rural community cohort

BACKGROUND

A growing body of epidemiologic evidence links oral health, obesity, and cardiovascular health, though few studies have reported on these relationships in children. While underlying mechanisms are unclear, adult studies have suggested sub-acute systemic inflammation, also implicated in the etiology of both obesity and cardiovascular disease. This study investigated associations between self-reported dental hygiene, obesity, and systemic inflammation in children.

METHODS

128 children < 19 years of age from rural counties in West Virginia participated in a community-based health screening that included anthropometric assessments, blood collection, and a questionnaire about dental hygiene and self-assessed oral health.

RESULTS

Participants ranged from 3.0-18.7 years. Univariate analysis demonstrated an association between parent-reported dental hygiene, including frequency of preventive dental care and parent-assessed overall dental health, and markers of systemic inflammation but not obesity. In multivariable regression, parent-assessed overall dental health and obesity were independent predictors of systemic inflammation, after adjustment for age, gender, and parent education.

CONCLUSIONS

This is the first known study of the association between dental hygiene, obesity, and systemic inflammation in children. These results highlight the importance of preventive dental care in overall, systemic health in children and are consistent with previous reports in adults.

A group of Midwestern university students needs to improve their oral hygiene and sugar/pop consumption habits

Poor oral hygiene and sugar/pop consumption practices are detrimental to one's overall health. College women were hypothesized to have better oral hygiene habits and to consume less sugar/pop than men and that the students' habits would be different from those the students had before college. These habits of students at a Midwestern university were evaluated by sex. The volunteers included 105 men and 91 women. Three quarters of the students reported brushing their teeth at least the recommended twice daily, with women brushing their teeth more often. About a third of the students flossed at least the recommended once daily. Not quite a third of the students reported brushing and flossing their teeth more often than they did before college. More than a third reported using mouth rinses 4 or more times weekly, with 13% reporting using a fluoride-containing mouth rinse. More than 60% reported using fluoride-containing toothpaste. Slightly more than a third reported drinking fluoridated water in their younger years. A larger percentage of women than men reported that diet pop was their pop of choice. More than two thirds of the students that drank pop indicated that regular pop was their favorite. Most of the students reported consuming sugary foods more than once daily, but they indicated that most of these sugars were not sticky. Few differences were observed in oral hygiene and sugar/pop consumption habits of these college students by sex. Nutritionists and other health professionals should work cooperatively in helping individuals improve their oral hygiene and sugar/pop consumption habits.

An exploration of shared genetic risk factors between periodontal disease and cancers: a prospective co-twin study

Biologic mechanisms underlying associations of periodontal disease with cancers remain unknown. The authors propose that both conditions share common genetic risk factors. They analyzed associations between baseline periodontal disease, measured by questionnaire-recorded tooth mobility, and incident cancers, identified by linkage with national registries, between 1963 and 2004 in 15,333 Swedish twins. The authors used co-twin analyses to control for familial factors and undertook analyses restricted to monozygotic twins to further control for confounding by genetic factors. They observed 4,361 cancer cases over 548,913 person-years. After adjustment for covariates, baseline periodontal disease was associated with increased risk of several cancers ranging from 15% for total cancer (proportional hazard ratio (HR) = 1.15, 95% confidence interval (CI): 1.01, 1.32) to 120% for corpus uterine cancer (HR = 2.20, 95% CI: 1.16, 4.18). Periodontal disease was also associated with increased risk of colorectal (HR = 1.62, 95% CI: 1.13, 2.33), pancreatic (HR = 2.06, 95% CI: 1.14, 3.75), and prostate (HR = 1.47, 95% CI: 1.04, 2.07) cancers. In co-twin analyses, dizygotic twins with baseline periodontal disease showed a 50% increase in total cancer risk (HR = 1.50, 95% CI: 1.04, 2.17), but in monozygotic twins this association was markedly attenuated (HR = 1.07, 95% CI: 0.63, 1.81). Similar patterns emerged for digestive tract cancers, suggesting that shared genetic risk factors may partially explain associations between periodontal disease and cancers.

Serum antibodies to periodontal bacteria as diagnostic markers of periodontitis

BACKGROUND

Assessment of periodontal conditions in epidemiologic studies usually requires a clinical examination, which is resource-intensive. We investigated the ability of serum immunoglobulin G (IgG) antibodies to periodontal bacteria to reflect clinical periodontal status.

METHODS

We used checkerboard immunoblotting to assess serum IgG levels to 19 species, including established/putative periodontal pathogens and non-pathogenic bacteria, in 5,747 dentate adults aged > or = 40 years who participated in the third National Health and Nutrition Examination Survey between 1988 and 1994. Three earlier described alternative definitions of periodontitis were used, based on specific combinations of probing depth and attachment level values. Optimized elevated titer thresholds and corresponding sensitivities and specificities were calculated for each definition. Titers significantly associated with periodontitis were identified in univariable and multivariable logistic regression models. Parsimonious models were subsequently developed using age, gender, race/ethnicity, education, smoking, and diagnosed diabetes.

RESULTS

In unadjusted models, high titers to Porphyromonas gingivalis were most strongly associated with periodontitis across all definitions (odds ratio, 2.07 to 2.74; P <0.05). In parsimonious models including demographic data, smoking, and diagnosed diabetes, high P. gingivalis titers were consistently associated with periodontitis, whereas high Eubacterium nodatum titers were associated with periodontal health in two of three definitions. Receiver operating characteristic curves for the parsimonious multivariable models showed that the area under the curve ranged between 0.72 and 0.78.

CONCLUSIONS

Serum IgG titers to selected periodontal species, combined with demographic and behavioral characteristics, resulted in a moderately accurate classification of periodontal status in epidemiologic studies. The external validity of these findings must be examined further.

Periodontitis in systemic rheumatic diseases

Periodontitis is a chronic inflammatory disease that is characterized by loss of the periodontal ligament and alveolar bone, and is a major cause of tooth loss. Results from clinical and epidemiologic studies have suggested that periodontitis and tooth loss are more prevalent in individuals with rheumatoid arthritis (RA). However, the strength and temporality of the association are uncertain. Several biologically plausible causal and noncausal mechanisms might account for this association between periodontitis and RA. There is evidence to suggest that periodontitis could indeed be a causal factor in the initiation and maintenance of the autoimmune inflammatory response that occurs in RA. If proven, chronic periodontitis might represent an important modifiable risk factor for RA. In addition, patients with RA might show an increased risk of developing periodontitis and tooth loss through various mechanisms. Moreover, exposure to common genetic, environmental or behavioral factors might contribute to a noncausal association between both conditions.

Lifetime asymptomatic for back pain: the validity of self-report measures in soldiers

STUDY DESIGN

A 5-year prospective observational study in US Army Reserve soldiers.

OBJECTIVES

The aims of this study were 2-fold: to evaluate the prevalence of soldiers reporting no previous back pain (BP) on 3 consecutive annual assessments, and to compare these findings to those obtained from a subsequent monthly detailed BP assessment.

SUMMARY OF BACKGROUND DATA

BP history is a risk factor for future BP and disability. Conversely, subjects reporting a negative history of back troubles are thought to be at low risk for future BP events. Reporting of previous BP is assumed to have high validity. Few studies have critically evaluated the validity of the self-reported "lifetime asymptomatic" status in civilian or military populations.

METHODS

Two hundred eighty-five special operations reserve soldiers were queried annually using standardized US Army Medical Questionnaires, among whom 154 (54%) reported no BP or history thereof over 3 consecutive years. Over the next 18 months these soldiers completed annual US Army Medical Questionnaires, as well as monthly numerical rating scale pain scores, Oswestry Disability Indexes, and questions regarding back injuries. At the study's conclusion, soldiers again completed the annual medical certificate, and the results of this final BP assessment were compared with those from monthly surveillance reports.

RESULTS

During monthly surveillance of purported "lifetime asymptomatic" soldiers, the 18-month cumulative percentages reporting BP scores > or = 2, > or = 4, and > or = 6 were 84%, 64%, and 14%, respectively. For Oswestry Disability Index scores, these percentages were 25% for scores > or = 10, and 12% for scores > or = 20. Yet, at the conclusion of the 5-year study, 97% soldiers still described themselves as being "asymptomatic for BP problems."

CONCLUSION

In physically active soldiers self-identified as without back problems, the report of BP using frequent surveillance tools is extremely common. The overwhelming majority of these soldiers appeared to have high resilience to common BP episodes (i.e., returned to usual duties). Episodic BP should be considered a normative rather than exceptional occurrence. Similar to other conditions, long-interval surveys of BP history may underestimate the true prevalence of BP.

Understanding measurement of dental diseases and research participation in practice set-up

A general understanding of the measurement of dental diseases can help practitioners in the process of assessing the patient's future risk of disease. More importantly, as clinical studies shift from the traditional academic setting to practice-based networks, practitioners might play a more significant role in research. An important issue in oral health disease management in the future will be the standardization of clinical criteria and the development of alternative mechanisms of data collection for epidemiologic purposes.

Maternal periodontitis and adverse pregnancy outcomes

OBJECTIVES

Maternal periodontal diseases have been associated with increased risk of preterm birth and restricted fetal growth among relatively low socioeconomic groups. Whether the association can be generalized to middle-class populations remains uncertain. We evaluated periodontitis in relation to preterm birth (<37 weeks' gestation) and small-for-gestational-age (SGA, birth weight below the 10th percentile of birth weight for gestational age) among a group of medically insured women.

METHODS

We conducted a prospective study among participants of Project Viva, a US cohort study of pregnant women and their offspring from 1999 to 2002. Pregnancy outcomes were obtained from medical records. Self-reported periodontitis was assessed during the second trimester of pregnancy, and validated against radiographs. Logistic regression analyses were employed to evaluate the association of periodontitis with pregnancy outcomes adjusted for age, race/ethnicity, smoking status, income, frequency of dental check-ups, prepregnancy body mass index, pregnancy weight gain, gravidity, prior history of preterm birth and history of genitourinary infection.

RESULTS

Of the 1635 women, 72.7% were Caucasian, 65.0% had annual household income >$70 000, 3.8% reported having periodontitis, 6.4% delivered preterm, 5.4% delivered SGA babies, and 11.0% had poor pregnancy outcome (either preterm birth or SGA). The odds ratio (OR) associated with periodontitis was 1.74 (95% CI 0.65-4.66) for preterm delivery and 2.11 (95% CI 0.76-5.86) for SGA individually. When preterm delivery and/or SGA were combined, the OR was 2.26 (95% CI 1.05-4.85) relating periodontitis with poor pregnancy outcome.

CONCLUSION

Within the limitations of the study, the results suggest that periodontitis is an independent risk factor for poor pregnancy outcome among middle-class women.

Relationship between soy and isoflavone intake and periodontal disease: the Freshmen in Dietetic Courses Study II

Background

Much research has shown that soy products inhibited various diseases. However, no published studies have examined the effects of consumption of soy and isoflavones on periodontal disease. The aim of this study was to investigate whether soy and isoflavone intake is associated with the prevalence of periodontal disease.

Methods

The subjects were 3956 Japanese female students, aged 18 to 22 years, who were taking a dietetic course. Periodontal disease was defined as present when a subject reported diagnosis of the disorder by a dentist. Information on dietary factors was collected using a validated diet history questionnaire. Logistic regression analysis was used to estimate the odds ratios and their confidence intervals of periodontal disease. Adjustment was made for cigarette smoking, toothbrushing frequency, region of residence, and body mass index.

Results

The prevalence of periodontal disease was 8.0%. Intake of total soy product and tofu was independently associated with a decreased prevalence of periodontal disease; multivariate odds ratios in comparison of the highest with the lowest quintile were 0.68 and 0.68, respectively (95% confidence intervals = 0.47–0.97 and 0.47–0.98, P for trend = 0.01 and 0.004, respectively). A significant inverse dose-response relationship between the intake of isoflavones and the prevalence of periodontal disease was observed, although the difference in the adjusted odds ratio between the extreme quintiles was of borderline significance (P for trend = 0.04). There were no measurable dose-response relationships between consumption of tofu products, fermented soybeans, boiled soybeans, miso, or miso soup and the prevalence of periodontal disease.

Conclusion

Our findings suggest that soy and isoflavone intake may decrease the likelihood of periodontal disease. Further investigations with objective measures for periodontal disease are needed to confirm our findings.

The influence of active coping and perceived stress on health disparities in a multi-ethnic low income sample

Background

Extensive research has shown that ethnic health disparities are prevalent and many psychological and social factors influence health disparities. Understanding what factors influence health disparities and how to eliminate health disparities has become a major research objective. The purpose of this study was to examine the impact of coping style, stress, socioeconomic status (SES), and discrimination on health disparities in a large urban multi-ethnic sample.

Methods

Data from 894 participants were collected via telephone interviews. Independent variables included: coping style, SES, sex, perceived stress, and perceived discrimination. Dependent variables included self-rated general and oral health status. Data analysis included multiple linear regression modeling.

Results

Coping style was related to oral health for Blacks (B = .23, p < .05) and for Whites there was a significant interaction (B = -.59, p < .05) between coping style and SES for oral health. For Blacks, active coping was associated with better self-reported health. For Whites, low active coping coupled with low SES was significantly associated with worse oral health. Coping style was not significantly related to general health. Higher perceived stress was a significant correlate of poorer general health for all ethnoracial groups and poorer oral health for Hispanics and Blacks. SES was directly related to general health for Hispanics (.B = .27, p < .05) and Whites (B = .23, p < .05) but this relationship was mediated by perceived stress.

Conclusion

Our results indicate that perceived stress is a critical component in understanding health outcomes for all ethnoracial groups. While SES related significantly to general health for Whites and Hispanics, this relationship was mediated by perceived stress. Active coping was associated only with oral health.

Self-reported periodontal disease: validation in an epidemiological survey

BACKGROUND

Evidence is accumulating to support poor oral health as a risk factor for systemic conditions, including cardiovascular diseases, diabetes control, adverse pregnancy outcomes, and pneumonia. Prohibitive costs for clinical assessment of periodontal disease limit information to assess the prevalence and trends of periodontal diseases in the United States population. However, self-report is used widely to assess economically the population-based prevalence of various medical conditions and health-related behaviors and characteristics.

METHODS

The goal of this secondary data analysis was to identify self-report items sufficiently correlated with clinical periodontal disease for use via face-to-face or telephone interviews. Data for analysis were collected for a project focused on oral health that included face-to-face interview items regarding oral health-related self-care, professional care, and barriers; knowledge, beliefs, and attitudes; risk behavior; impact on quality of life; and demographic characteristics. Also, participants had complete oral examinations.

RESULTS

Logistic regression analyses identified self-reported items contributing to two sets of models predicting moderate or severe periodontal disease (MODSEV) and severe periodontal disease (SEV). Age, gender, race/ethnicity, smoking, and periodontal health-related self-report items constituted predictive models with maximum sensitivity and specificity of 71% and 83%, respectively, with area under the receiver operating characteristic curve (AUC) of 0.85 (as a measure of accuracy) for MODSEV. For SEV, predictive models' maximum sensitivity and specificity were 92% and 53%, respectively, with a maximum AUC of 0.92.

CONCLUSION

These analyses suggest that self-report may be valid for surveillance of periodontal disease burden and trends in the American population, in lieu of more costly clinical periodontal examinations.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

CDC Periodontal Disease Surveillance Project: background, objectives, and progress report

This supplement contains papers presented at the 2006 International Association of Dental Research (IADR) symposium entitled "Development of Self-Reported Measures for Population-Based Surveillance of Periodontitis." These papers highlight activities of an independent periodontal disease surveillance workgroup convened by the Division of Oral Health (DOH), Centers for Disease Control and Prevention (CDC), in collaboration with the American Academy of Periodontology, to examine the feasibility of using self-reported measures for population-based surveillance of periodontal disease in the United States. This workgroup was convened in 2003 as part of a CDC periodontal disease surveillance project.

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).

Chewing problems and dissatisfaction with chewing ability: a survey of older Tanzanians

This study assessed the prevalence and correlates of reported chewing problems and dissatisfaction with chewing ability. Discrepancy between reported chewing problems and satisfaction/dissatisfaction with chewing ability was examined. A household survey was conducted in Tanzania in 2004/2005. A total of 1,031 adults (mean age 62.9 yr) underwent clinical examination and a personal interview. Forty per cent [95% confidence interval (CI): 37-43] reported problems with chewing at least one food item, and 25% (95% CI: 22-28) were dissatisfied with their chewing ability. Adjusted odds ratios (OR) for reporting problems with chewing any food were 1.6, 1.2, and 4.2 if having intact anterior/reduced posterior, reduced anterior/intact posterior, and reduced anterior/posterior occluding units, respectively. Subjects dissatisfied with their chewing ability were less likely to be female (OR = 0.6) and more likely to have reduced anterior/posterior occluding units (OR = 3.4), to report dental pain (OR =2.5), chewing problems (OR = 4.7), and oral impacts on daily performances (OIDP) (OR = 3.2). The OIDP scores discriminated between satisfied and dissatisfied groups, irrespective of confirmed chewing problems. Chewing problems and dissatisfaction with chewing ability was prevalent among older Tanzanians. Clinical measures of dentition status, together with reported functional and psychosocial impact scores, determined the subjects' evaluation of their chewing ability and should be taken into account when estimating treatment needs.

Public Health Perspectives on Surveillance for Periodontal Diseases

Public health surveillance has been defined as the ongoing systematic collection, analysis, interpretation, and dissemination of data regarding a health-related event for use in public health action to reduce morbidity and mortality and to improve health. Surveillance is an essential element of public health program infrastructure. The desirable attributes of public health surveillance systems are simplicity, flexibility, data quality, acceptability, sensitivity, predictive value positive, representativeness, timeliness, and stability. However, surveillance for periodontal diseases is nearly non-existent at state, county, or local levels in the United States. That void largely is the result of the current approach to monitoring periodontal diseases in populations, which generally requires resource-intensive primary collection of clinical data using relatively invasive methods. One potential alternative to that approach to periodontal disease surveillance is the use of self-reported data collected through population surveys. Seventeen identified studies have tested the validity of individual questionnaire items for their sensitivity, specificity, and predictive values positive and negative against a range of clinical operational definitions for periodontitis. No individual items seem to be robust or valid markers for clinically determined periodontitis. However, it is possible that a multivariable statistical modeling approach, which includes variables on signs, symptoms, and established risk factors, could improve the sensitivity and specificity of that approach. An example is given of a model-based approach to public health surveillance that has been effective in quantifying the impact of a public health problem, monitoring trends between and within states, and supporting advocacy and policy development by state and local governments.

Prediction of Periodontal Disease From Multiple Self-Reported Items in a German Practice-Based Sample

BACKGROUND

Ascertainment of periodontal disease using self-reported measures would be useful for large epidemiologic studies. This study evaluates whether a combination of self-reported items with established risk factors in a predictive model can assess periodontal disease accurately.

METHODS

Responses of 246 subjects to a detailed questionnaire were compared to their periodontal disease history as assessed from radiographs. Multiple regression modeling was used to construct predictive models using self-reported items and established risk factors.

RESULTS

Depending on the definition of gold-standard periodontal disease, two or three self-reported items were selected for the predictive models, in addition to age, gender, and smoking. Self-reported tooth mobility was associated strongly with periodontal disease independent of other risk factors and was selected in all models. For dichotomous definitions of periodontal disease, discrimination of predictive logistic regression models was good with areas under the receiver operating characteristic curve >0.80. Assessment of periodontal disease history based on extreme quantiles of model-predicted values yielded high sensitivity and specificity.

CONCLUSION

The combination of several self-reported items may be useful for ascertainment of periodontal disease in epidemiologic studies.