Juvenile periodontitis: skeletal bone mineral content

Low bone mineral density is associated with severe periodontitis at the end of the second decade of life: A population-based study

AIM

To evaluate the association between low bone mineral density (BMD) and severe periodontitis at the end of the second decade of life.

MATERIALS AND METHODS

This population-based study analysed 2032 youngers (18-19 years old) of the RPS cohort. BMD of lumbar spine (BMD-LS) and of the whole body (BMD-WB) were assessed by dual x-ray emission densitometry. Low BMD-LS (Z-score ≤ -2) and low BMD-WB (Z-score ≤ -1.5) were correlated with severe periodontitis. The extent of periodontal disease was also evaluated as the following outcomes: proportions of teeth affected by clinical attachment loss ≥5 mm and probing depth ≥5 mm. Multivariate models by sex, education, family income, risk of alcohol dependence, smoking, plaque, bleeding index, and body mass index were estimated through logistic regression (binary outcomes) and Poisson regression (continuous outcomes).

RESULTS

The prevalence of severe periodontitis was 10.97%. Low BMD-LS (odds ratio [OR] = 2.08, confidence interval [CI] = 1.12-3.85, p = .01) and low BMD-WB (OR = 1.34, CI = 1.001-1.81, p = .04) were associated with severe periodontitis in the final multivariate models. Low BMD-LS and BMD-WB were also associated with a greater extent of periodontitis (p < .05).

CONCLUSIONS

Low BMD was found to be associated with the severity and extent of periodontitis in adolescents. Adolescents at peak bone mass age presenting low BMD are more likely to be affected by severe periodontitis.

Association of bone mineral density with periodontal status in postmenopausal women

AIM

Menopausal changes expose an individual towards risk of various pathologies during midlife transition. This study aimed to investigate the possible association of bone mineral density (BMD) with periodontal parameters in early postmenopausal Indian women.

METHODS

In 78 dentate postmenopausal female patients periodontal examination was performed including clinical attachment loss, pocket depth, plaque index and sulcular bleeding index. Alveolar crestal height was measured on proximal surfaces of all posterior teeth except third molars with the help of bitewing radiographs. Patient's BMD was assessed with dual energy X-ray absorptiometry. Statistical analysis was performed to assess the correlation between BMD and periodontal parameters.

RESULTS

Pocket depth, clinical attachment loss and alveolar crestal height were found to have negative and statistically significant (P = -0.000 each) correlation with T-score, with the value of Pearson's correlation coefficient being -0.474, -0.426, and -0.419 respectively. Number of teeth lost due to periodontitis was not significantly correlated with T-score (P > 0.05). Results of anova and the post-hoc Tukey test revealed a statistically significant difference of mean clinical attachment loss, pocket depth and alveolar crestal height for the osteoporotic versus osteopenic group and the osteoporotic versus normal group. However, between the osteopenic and normal group, the differences of mean were statistically nonsignificant (P > 0.05). Body mass index was found to have a weakly positive (r = 0.376) and statistically significant (P = 0.001) correlation with T-score.

CONCLUSIONS

Bone mineral density is an important risk indicator for periodontitis in postmenopausal women. Number of teeth lost due to periodontitis is not significantly affected by the BMD of the early postmenopausal phase.

Association between periodontitis and systemic bone mineral density in Japanese community-dwelling postmenopausal women

OBJECTIVE

The purpose of this cross-sectional study was to evaluate the association between loss of attachment (LA) which is clinical index of periodontitis and bone mineral density (BMD) of the lumbar vertebrae and femur measured with dual energy X-ray absorptiometry (DXA) in Japanese community-dwelling postmenopausal women.

SUBJECTS AND METHODS

Subjects were 374 [corrected] women aged 55-74. The oral cavity was divided into 6 areas according to the WHO's method for the determination of the clinical attachment level score (CALscore); the LA was measured at 6 sites using a WHO probe in 17, 16, 11, 26, 27, 37, 36, 31, 46, and 47, and the values were recorded in mm. Then, we assessed BMD of the lumbar vertebrae (L2-L4) and femur (femoral neck, proximal part) by DXA. Based on these data, analysis of covariance was used to estimate relation between periodontitis and systemic BMD status excluding effect of age. Multiple linear regression analysis was used to estimate relation between periodontitis and BMD adjusted for 17 variables.

RESULTS

Significant differences were observed in the mean value between the mean CALscore=0 and CALscore≥1 groups in the Z value in lumbar vertebrate (106.9±18.7 vs. 102.3±1.0, p<0.05, t-test). Multiple regression analysis was conducted using the mean LA as dependent variable. Lumbar vertebral BMD (regression coefficient: B=-1.039±0.379, p=0.007), femoral neck BMD (B=-1.332±0.627, p=0.034), and proximal femoral BMD (B=-1.329±0.536, p=0.014) all exhibited a significant negative correlation with the mean LA.

CONCLUSION

A significant negative correlation was observed between periodontal disease and truncal bone BMD in this study.

Bone mineral content and bone metabolism in young adults with severe periodontitis

OBJECTIVES

To clarify in young adults with severe periodontitis (1) whether the bone mineral content (BMC) or density (BMD) in the mandible/other skeletal sites and the systemic bone metabolism differed from normal and (2) whether mandibular/forearm BMC did change during the 5 to 10-year follow-up.

MATERIAL AND METHODS

24 young otherwise normal patients with verified severe periodontitis were included, of which 20 attended the follow-up visit. Mandibular/forearm BMC was measured at both visits by dual-photon absorptiometry, supplemented with femoral neck/lumbar spine BMD measurements at follow-up visit by dual-energy X-ray absorptiometry. Serum alkaline phosphatase/ionized calcium, urinary excretion of pyridinoline/deoxy-pyridinoline were analysed at the follow-up visit. A conventional periodontal examination was performed at both visits.

RESULTS

Mandibular BMC was significantly below normal mean BMC at both visits. The mandibular Z-scores were < or = -2.00 in 33.3% (8/24). BMC/BMD in the remaining sites and the values for bone markers did not differ from normal. Mandibular/forearm BMC was stable while a significant aggravation of alveolar bone loss occurred during the trial without change of probing depth.

CONCLUSIONS

Severe periodontitis in young adults seems to be a local disorder associated with relatively low BMC in the jaws without systemic alterations of BMC/BMD and bone metabolism.

Analysis of vitamin D and Fcgamma receptor polymorphisms in Japanese patients with generalized early-onset periodontitis

Early-onset periodontitis (EOP) is considered to have a genetic basis which has not been clearly defined. Genetic polymorphisms of the vitamin D receptor (VDR-B-b) and the immunoglobulin-Fc-gamma receptor IIIb (FcgammaRIIIb-NA1-NA2) are associated with bone metabolism and infectious diseases, respectively. The purpose of this study was to investigate the associations of EOP with VDR and FcgammaRIIIb polymorphisms. Subjects were comprised of those with generalized EOP (G-EOP, n = 42), adult periodontitis (AP, n = 52), and healthy control (HC, n = 55). VDR and FcgammaRIIIb genotypes were determined by allele-specific polymerase chain-reactions. Our results indicated that frequencies of the VDR-B non-carrier and the FcgammaRIIIb-NA2 carrier were lower in the G-EOP compared with the AP and HC groups. Furthermore, we found a strong association between G-EOP and the VDR-Fc-gammaRIIIb composite genotype (G-EOP vs. AP - OR = 5.09, p = 0.009; G-EOP vs. HC - OR = 5.93, p = 0.004). In conclusion, no correlation was found between the VDR genotype and G-EOP. However, the VDR and Fc-gammaRIIIb genotype combination may be associated with susceptibility to G-EOP.

The relationship between bone mineral density and periodontitis in postmenopausal women

BACKGROUND

Systemic bone loss has been proposed as a risk factor for periodontal disease; however, the relationship between these two diseases is still not clear. The objective of this study was to assess the relationship between systemic bone mineral density and periodontal disease, controlling for known confounders.

METHODS

The study population included 70 postmenopausal Caucasian women aged 51 to 78 (mean +/- SD: 62.10 +/- 7.1 years). Skeletal bone mineral density (BMD) was assessed by dual energy x-ray absorptiometry (DXA) at the neck, trochanter, intertrochanter, Ward's triangle, and total regions of the femur, and from the anterior-posterior view of the lumbar spine. Periodontal disease severity was represented by clinical attachment loss (CAL) and interproximal alveolar bone loss (ABL). Other measures of periodontal status included probing depth (PD), supragingival plaque, gingival bleeding on probing, and calculus. DXA and oral examinations were performed by calibrated examiners. Partial correlation coefficients (r) were obtained from multiple linear regression analysis adjusting for age, age at menopause, estrogen supplementation, cigarette smoking, body mass index, and supragingival plaque.

RESULTS

Mean ABL was significantly correlated with BMD of the trochanter (r =- 0.27), Ward's triangle (r = -0.26), and total regions of the femur (r = -0.25). Mean CAL appeared to be related to BMD consistently at all regions of the skeleton, although the association did not reach statistical significance.

CONCLUSIONS

We can conclude that skeletal BMD is related to interproximal alveolar bone loss and, to a lesser extent, to clinical attachment loss, implicating postmenopausal osteopenia as a risk indicator for periodontal disease in postmenopausal Caucasian women.

Association of a vitamin D receptor gene polymorphism with localized early-onset periodontal diseases

BACKGROUND

Early-onset periodontal diseases (EOP) are caused by interactions between host factors, specific microbial pathogens, and environmental factors. It is, therefore, of interest to investigate the nature of host factors as they may provide useful risk markers and reveal important information regarding the disease pathogenesis. Genetic polymorphisms in the vitamin D receptor (VDR) gene are associated with parameters of bone homeostasis and with diseases in which bone loss is a cardinal sign, in particular osteoporosis. Rapidly progressive bone loss is one feature of EOP. We, therefore, sought to determine whether EOP is associated with a polymorphism in the VDR gene.

METHODS

A restriction fragment length polymorphism (RFLP) for Taq I in exon nine of the VDR gene was analyzed by PCR, followed by restriction digestion with Taq I and gel electrophoresis. We analyzed the genotypes of 69 EOP patients, including 20 patients with unequivocal evidence of localized disease (L-EOP), and 72 controls with no history of EOP.

RESULTS

The genotype distribution in the L-EOP patient group was 7 (35%), 5 (25%) and 8 (40%) and in the control group 31 (43.1%), 36 (50.0%) and 5 (6.9%) for TT, Tt and tt respectively (where t and T represent the alleles with and without the Taq I RFLP respectively). Chi2 analysis indicated that the distribution of the genotypes between these two groups was highly significantly different (P = 0.001). Allele frequencies were 47.5% and 52.5% for T and t in the L-EOP group; 68.1% and 31.9% in the control group, showing a significant association between the prevalence of the less frequent allele (t) and L-EOP (P = 0.017). There was no significant difference in the genotype distribution or the allele frequencies between the control samples and the larger EOP patient group (n = 69) which included patients with generalized and localized disease.

CONCLUSIONS

These data indicate that carriage of the less frequent allele of the Taq I RFLP (t) in the VDR gene significantly increases the risk of developing L-EOP. However, VDR genotype may not affect the incidence of all cases of EOP. These findings contribute to our understanding of the genetic basis for periodontal disease and may help define sub-groups of this disease which share common pathogenic factors.

Osteoporosis and oral bone loss

This paper is a review of the literature on the possible association between osteoporosis and oral bone loss, with an emphasis on radiological studies. Such an association was first suggested in 1960. Subsequent histomorphometric and microradiographic studies showed that after the age of 50 there was a marked increase in the cortical porosity of the mandible, with this increase being greater in the alveolar bone than the mandibular body; and that with this increase in porosity, there was a concomitant decrease in bone mass, which appeared to be more pronounced in females than in males, with the loss in bone mineral content estimated to be 1.5% per year in females and 0.9% in males. These studies also demonstrated a considerable amount of variation in the amounts of cortical and trabecular bone within and among individuals. Subsequent clinical studies reported associations between the bone densities of jaws and (1) metacarpals, (2) forearm bones, (3) vertebrae and (4) femurs. These studies indicated that women had lower mandibular bone mineral content (BMC) than men and that age-related loss of bone was more pronounced in women after the age of 50 years than in men of the same age, as was the case for the rest of the body. It was suggested that systemic factors responsible for osteoporotic bone loss may combine with local factors (periodontal diseases) to increase rates of periodontal alveolar bone loss. Although not all studies found associations between osteoporosis and oral bone loss, the conclusion of this review is that such an association exists; yet additional longitudinal investigations are needed to confirm this, and before the implications of this association could be fully utilized in clinical dentistry, inexpensive methods must be developed for sensitive and specific measures of oral bone loss.

Mineral status of skeleton and advanced periodontal disease

Studies of the effect of general bone loss on periodontal condition and on development of periodontal pockets suggest that there is no clear correlation between periodontal health or number of teeth and the general mineral status of the skeleton. In some reports, however, deep periodontal pockets have been correlated with good mineral status in the jawbones and skeleton. The purpose of this study of 227 healthy postmenopausal women aged 48 to 56 years was to determine whether advanced alveolar bone loss, diagnosed by panoramic radiographs, and periodontal probing depths or number of remaining teeth were correlated with the bone mineral status of the skeleton and cortical bone in the mandible. The results suggest that individuals with high mineral values in the skeleton seem to retain their teeth with deep periodontal pockets more easily than those with osteoporosis. This finding may especially motivate treatment of persons suffering from advanced periodontal disease but having good mineral status.

In vivo measurement of bone mineral content of mandibles by dual-photon absorptiometry

The purpose of this study was 1) to reveal the short- and long-term precision of noninvasive in vivo measurements of bone mineral content (BMC) in larger and smaller parts of mandibles and in forearm bones by a new two-dimensional dual-photon attenuation system GT45; 2) to develop normal reference values and ranges for mandibular BMC in individuals between 20-40 yr of age without known systemic diseases and with normal oral state, (n = 56, F:M = 1:1), and 3) to relate mandibular BMC with forearm bone BMC, sex and age, by comparing BMC values of a well-defined normal old test group (n = 24, F:M = 1:1, 70-81 yr of age) with the normal reference values. The analyses indicated: 1) the in vivo short- and long-term precision of the methods is high. 2) BMC of mandibles and forearm bones is significantly related to sex and age (P less than 0.01, and in mandibles of young females/males: P = 0.02). 3) BMC in mandibles and forearm bones is significantly correlated in both age groups (P less than 0.01) with relatively weak coefficients of correlation. GT45 may be used to follow BMC changes in mandibles in groups or single individuals after surgical treatment and to evaluate sex and age dependent BMC changes in mandibles and forearm bones.

Juvenile periodontitis: an historical review

A review of the literature on juvenile periodontitis has been undertaken. This paper traces the historical development of the appreciation of the condition. Some of the numerous early attempts to define a systemic background are noted, and the concept of 'periodontosis' and its subsequent influence, e.g. on epidemiological and clinical studies are discussed. The refining over the last 20 years of the concept of aggressive periodontal disease in the young is recorded. The patterns of bone loss in juvenile periodontitis and some forms of treatment are presented, together with evidence on its histopathology. Recent research has tended to concentrate on the microbiology and immunological background of juvenile periodontitis and a number of these studies are discussed.

Juvenile periodontitis

Our knowledge of juvenile periodontitis is still fragmentary. In 50 years we have advanced from the concept of diffuse atrophy of the alveolar bone (Gottlieb 1923) through the theory of non-inflammatory, degenerative disease of the periodontium (Orban & Weinmann 1942) to the present conception of juvenile periodontitis (Manson & Lehner 1974, Waerhaug 1977a) as a periodontal disease appearing in young individuals with inflammation always present. Only the clinical picture of the disease is quite clear as Baer described it (1971): rapid destruction of the alveolar bone, not commensurate with the local irritants, around more than one permanent tooth in otherwise healthy adolescents. The etiology and etiopathogenesis of juvenile periodontitis have remained unknown. The bacteriological findings of Scransky et al. (1970) and Newman et al. (1974), suggesting some Gram-negative rods as an etiological factor, are still controversial. Neither is the theory of Lehner and his coworkers (1974), that juvenile periodontitis is a selective, cell-mediated immunodeficiency condition, fully accepted. Heredity is an etiologic factor for which there is more evidence. Several authors have found a familial pattern of the disease and it might be either an autosomal, recessive trait (Fourel 1972, Jorgenson et al. 1975) or an X-linked dominant disease (Melnick et al. 1976). These two statements are, however, also controversial. The prevalence rates vary from 0.1% to 17.6%. Although there could be racial variations, the estimated prevalence rates also vary within racial groups, suggesting that there must be great variations in methods and diagnostics. Juvenile periodontitis seems to exist in all racial groups throughout the world and although comparable prevalence figures are difficult to obtain, it seems that the disease is less common in Caucasoid populations and more frequent in India and Africa. The claim of female preponderence requires further investigation.