Periodontal disease estimates in NHANES III: clinical measurement and complex sample design issues

Association between the quality of plant-based diets and periodontitis in the U.S. general population

AIM

To investigate the relationship between plant-based diet indices (PDIs) and periodontitis and serum IgG antibodies against periodontopathogens in the U.S.

POPULATION

MATERIALS AND METHODS

We analysed cross-sectional data on 5651 participants ≥40 years of age from the Third National Health and Nutrition Examination Survey. Food frequency questionnaire data were used to calculate the overall PDI, healthy plant-based diet index (hPDI), and unhealthy plant-based diet index (uPDI). Periodontitis was defined using a half-reduced Centers for Disease Control and Prevention and American Academy of Periodontology case definition. Serum antibodies against 19 periodontopathogens were used to classify the population into two subgroups using hierarchical clustering. Survey-weighted multivariable logistic regressions were applied to assess the associations of PDI/hPDI/uPDI z-scores with periodontitis and hierarchical clusters after adjusting for potential confounders.

RESULTS

A total of 2841 (50.3%) participants were defined as having moderate/severe periodontitis. The overall PDI z-score was not significantly associated with the clinical and bacterial markers of periodontitis. By considering the healthiness of plant foods, we observed an inverse association between hPDI z-score and periodontitis (odds ratio [OR] = 0.925, 95% confidence interval [CI]: 0.860-0.995). In contrast, higher uPDI z-score (adherence to unhealthful plant foods) might increase the risk of periodontitis (OR = 1.100; 95% CI: 1.043-1.161). Regarding antibodies against periodontopathogens, the participants in cluster 2 had higher periodontal antibodies than those in cluster 1. The hPDI z-score was positively associated with cluster 2 (OR = 1.192; 95% CI: 1.112-1.278). In contrast, an inverse association between uPDI z-score and cluster 2 was found (OR = 0.834; 95% CI: 0.775-0.896).

CONCLUSIONS

Plant-based diets were associated with periodontitis, depending on their quality. A healthy plant-based diet was inversely related to an increased risk of periodontitis but positively related to elevated antibody levels against periodontopathogens. For an unhealthy plant-based diet, the opposite trends were observed.

Serum antibodies to periodontal pathogens are related to allergic symptoms

BACKGROUND

The association between periodontitis and allergic symptoms has been investigated. However, the difference in immune signatures between them remains poorly understood. This cross-sectional study assessed the relationship between serum immunoglobulin G (IgG) antibodies to periodontal pathogens and allergic symptoms in a nationwide population cohort.

METHODS

Two phases of the Third National Health and Nutrition Examination Survey (NHANES III) were used as discovery dataset (n = 3700) and validation dataset (n = 4453), respectively. Based on the antibodies against 19 periodontal pathogens, we performed an unsupervised hierarchical clustering to categorize the population into three clusters. In the discovery dataset, cluster 1 (n = 2847) had the highest level of IgG antibodies, followed by clusters 2 (n = 588) and 3 (n = 265). Data on allergic symptoms (asthma, hay fever, and wheezing) were obtained using a self-reported questionnaire. Survey-weighted multivariable logistic regression evaluated the association between these clusters and allergic symptoms.

RESULTS

In the discovery dataset, the participants with lower levels of antibodies to periodontal pathogens exhibited a higher risk of asthma (odds ratio [OR]_{cluster 3 vs. cluster 1} = 1.820, 95% confidence interval [CI]: 1.153-2.873) and wheezing (OR_{cluster 3 vs. cluster 1} = 1.550, 95% CI: 1.095-2.194) compared to those with higher periodontal antibodies, but the non-significant association with hay fever. Consistent results were found in the validation dataset.

CONCLUSIONS

Serum IgG titers to periodontal pathogens were inversely associated with the risk of asthma and wheezing, suggesting the potentially protective role against allergic conditions.

Serum Antioxidant Vitamins Mediate the Association between Periodontitis and Metabolically Unhealthy Overweight/Obesity

BACKGROUND

Periodontal disease is associated with metabolic syndrome and obesity. This cross-sectional study aimed to investigate whether serum antioxidant vitamins could mediate the association between periodontitis and a metabolically unhealthy phenotype in the overweight and obese population; Methods: We included 6158 Americans (body mass index (BMI) ≥ 25 kg/m²) from the Third National Health and Nutrition Examination Survey (NHANES III). Periodontitis was defined using a half-reduced CDC/AAP (Centers for Disease Control and Prevention/American Academy of Periodontology) definition. Having two or more metabolic abnormalities was defined as a metabolically unhealthy overweight and obese (MUO) phenotype. Mediation analysis of four oxidative stress biomarkers (serum antioxidant vitamins A, C, D, and E) was conducted; Results: Of participants with overweight and obesity, 2052 (33.3%) Americans were categorized as having periodontitis. Periodontitis increased dyslipidemia risk and systemic inflammation in the overweight and obese population. In the multivariable logistic regression model, periodontitis was positively associated with MUO (adjusted odds ratio = 1.238; 95% confidence interval: 1.091 to 1.406). These findings were validated in an independent cohort. Serum vitamins C and D were estimated to mediate 19.3% and 8.4% of the periodontitis-MUO association.

CONCLUSIONS

Periodontitis might decrease serum vitamins C and D and induce a metabolically unhealthy state among adults with overweight and obesity.

Type 1 diabetes and periodontitis: prevalence and periodontal destruction-a systematic review

AIMS

Data about the association between periodontal disease or periodontitis (PD), diabetes and hyperglycemia have been reported mostly in patients with type 2 diabetes. Conversely, information about PD in type 1 diabetes (T1DM) is relatively scarce. The aim of this meta-analysis is therefore: (1) to assess the prevalence and severity of PD in patients affected by T1DM in comparison with the general population and (2) to verify the association between severity of PD and glycemic control in type 1 diabetics.

METHODS

An electronic search was performed on MEDLINE, Cochrane Central Register of Trials and EMBASE, up to October 31, 2019. Estimates of prevalence of PD in T1DM were calculated together with Mantel-Haenszel odds ratios (MH-OR) of the risk of PD associated with T1DM; weighed mean difference in CAL between T1DM and control and weighed mean difference in CAL in patients with T1DM and unsatisfactory glycemic control as compared with those in good glycemic control were also evaluated..

RESULTS

The prevalence of PD in type 1 diabetes was 18.5 [8.0; 37.1] %; the MH-OR for PD is 2.51 (1.32;4.76) in T1DM patients versus general population (p = 0.005). The weighed mean difference in CAL depth between T1DM patients and controls is 0.506 [0.181; 0.832] mm (p < 0.005), and in T1DM patients with good glycemic control CAL depth is - 0.71 [- 1.00; - 0.42] mm less deep than in subjects with HbA1c > 7%.

CONCLUSIONS

The present data confirm that T1DM is a relevant risk factor for the development of PD. The proportion of patients affected by PD is more than doubled in subjects with T1DM in comparison with non-diabetic individual, and among patients with T1DM, PD seems to be more severe and the differences appear very wide between subjects in optimal and suboptimal glycemic control.

Stress, salivary cortisol and periodontitis: A systematic review and meta-analysis of observational studies

OBJECTIVE

This meta-analysis aims to systematically assess whether periodontitis has a meaningful effect on salivary cortisol, reflecting changes on free blood cortisol levels.

DESIGN

The Cochrane Handbook and the PRISMA statement were used as reporting guidelines. The MEDLINE-PubMed, Google Scholar, EMBASE, and CENTRAL databases were searched until September 2017 to identify eligible studies, screened by seven independent authors and verified by an eighth. Studies comparing salivary cortisol level of periodontitis cases to controls were included. Data were extracted using a predefined table and since all papers were non-randomized clinical trials they were appraised using Downs and Black tool. DerSimonian random effects meta-analysis was performed using OpenMetaAnalyst.

RESULTS

Six cross-sectional studies were included, with 258 participants with chronic periodontitis and 72 with aggressive periodontitis, in a total of 573 participants. Overall results showed that aggressive periodontitis patients have, on average, 53% higher salivary cortisol levels than healthy controls 1.53 (1.11-2.12). Meta-regression exploring the relationship among salivary cortisol levels and periodontal measures, i.e., periodontitis severity, showed a global neutral effect, although this result requires future confirmation due to the low power of the model.

CONCLUSION

Observational studies results suggest that subjects with aggressive periodontitis have higher salivary cortisol levels than healthy ones or patients with chronic periodontitis. Such salivary cortisol response difference may have a negative impact on the periodontium, contributing to worse the burden of aggressive periodontitis disease. In the future, wide and well-designed longitudinal studies should be carried out in order to extensively confirm this possible effect, considering the complex nature of periodontitis and its many confounders factors that may contribute to this outcome.

A comparative study of Dashana Samskara Choorna Pratisarana and Dashana Samskara paste application in the management of Sheetada (Gingivitis)

Sheetada is the early stage of periodontal diseases. This occurs due to negligence of oral hygiene, changing life-style, habits, and addictions. It is Kapha Rakta Pradhana Vyadhi. In modern dentistry papillary or marginal gingivitis can be correlated with Sheetada, on the basis of similarities in symptoms, involvement of anatomical structure, etiology and prognosis. The epidemiological studies conducted by American Academy of Periodontology shows that gingivitis of varying severities is nearly universal. It is estimated that over 80% of the world's population suffers from gingivitis. In this clinical study, 106 patients were registered among them 103 completed the treatment and were randomly divided by lottery method into two groups. In Group-A, Dashana Samskara paste local application on gums and in Group-B, Dashana Samskara Choorna Pratisarana on gums was given. After enrollment of the patients in the study cardinal symptoms of Sheetada (gingivitis) such as, Raktasrava, Krishnata, Prakledata, Mriduta, Mukhadaurgandhya, and also the objective criteria such as oral hygiene index, Gingival Index (GI-S), and Gingival Bleeding Index (GBI-S) were studied before and after the treatment. While considering comparative effect on subjective parameters such as Raktasrava, Dantamamsa Shiryamanata, Shotha and Chalata statistically significant results were obtained in Group-A than Group-B. In objective parameters such as, GI-S and GBI-S also showed statistically significant results in Group-A. Observations in follow-up study confirmed that the recurrence rate in the Group-Awas significantly lesser than the Group-B.

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.

Examining periodontal disease disparities among U.S. adults 20 years of age and older: NHANES III (1988-1994) and NHANES 1999-2004

OBJECTIVE

We examined disparities in periodontal disease in U.S. adults according to age, sex, race/ethnicity, country of birth, education, income, and poverty-income ratio within and between the third National Health and Nutrition Examination Survey (NHANES III, 1988-1994) and NHANES 1999-2004.

METHODS

We assessed disparities and changes therein using prevalence differences and ratios, as well as the Symmetrized Theil Index (STI). While these measures document disparities between pairs of population subgroups, and changes in relative disparities between surveys, the STI is a summary measure of health disparities that also tracks between-group disparities relative to the total population.

RESULTS

Prevalence differences and ratios for the prevalence of periodontitis, the mean pocket depth (PD), and the mean clinical attachment loss (CAL) suggest that periodontal disease significantly decreased between NHANES III and NHANES 1999-2004 (p<0.01). However, the STI for the prevalence of periodontitis suggests that disparities significantly increased within categories of race/ethnicity, country of birth, and education in NHANES 1999-2004 compared with NHANES III. These findings were corroborated for mean PD and mean CAL (p<0.001): the overall STI significantly increased for mean PD from 4.53% in NHANES III to 11.02% in NHANES 1999-2004 and for mean CAL for teeth with CAL >0 from 31.73% in NHANES III to 43.36% in NHANES 1999-2004.

CONCLUSIONS

Our findings suggest that inequalities in periodontal disease significantly decreased between NHANES III and NHANES 1999-2004 in the total population and across selected characteristics of the population. However, these inequalities increased within groups of the population in NHANES 1999-2004 compared with NHANES III. These findings call attention to the absolute and relative differences not only between population groups across surveys, but also within population groups within and between surveys.

Overview and quality assurance for the oral health component of the National Health and Nutrition Examination Survey (NHANES), 2005-08

The oral health component for the National Health and Nutrition Examination Survey (NHANES) was changed in 2005 from an examination conducted by dentists to an oral health screening conducted by health technologists rather than dental professionals. The oral health screening included a person-based assessment for dental caries, restorations, and sealants. This report provides oral health content information and presents results of data quality analyses that include dental examiner reliability statistics for data collected during NHANES 2005-08. Oral health data are available on 15,342 persons aged 5 years and older representing the civilian, noninstitutionalized population of the United States who participated in NHANES 2005-08. Overall, interrater reliability findings indicate that health technologist performance was excellent with concordance between examination teams and the survey reference examiner being almost perfect for a number of assessments. Concordance for dental caries and sealants (kappa statistics) between health technologists and the survey reference examiner ranged from 0.82 to 0.90 for the combined 4-year period. These findings support the use of health technologists in the assessment of person-based estimators of dental caries and sealant prevalence as part of an oral health surveillance system.

Determinants of serum IgG responses to periodontal bacteria in a nationally representative sample of US adults

AIM

To assess the distribution of elevated antibody titres to multiple periodontal bacteria, including established/putative pathogens and health-related species, by selected demographic, behavioural, and oral- and general health-related characteristics.

METHODS

Data from 8153 >or=40-year-old participants from the third National Health and Nutrition Examination Survey were used, including 1588 edentulous individuals. We used checkerboard immunoblotting to assess serum IgG levels to 19 periodontal species. Thresholds for elevated antibody responses were defined for each species using the 90th percentile titre in periodontal healthy participants, using two alternative definitions of periodontitis.

RESULTS

Edentulous individuals showed lower antibody responses than dentate participants, notably for titres to "red complex" species and Actinobacillus actinomycetemcomitans. Elevated titres to Porphyromonas gingivalis were twice as prevalent in participants with periodontitis than in periodontal healthy individuals. Non-Hispanic blacks and Mexican-Americans were more likely to display elevated titres for P. gingivalis compared with non-Hispanic whites (22.9%versus 19.4%versus 9.5%). Current smokers were significantly less likely to exhibit high titres to multiple bacteria than never smokers.

CONCLUSION

Demographic, behavioural, and oral- and general health-related characteristics were strong determinants of systemic antibody responses to periodontal bacteria in a nationally representative sample of US adults.

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.

Exploring potential pathways between parity and tooth loss among American women

OBJECTIVES

We assessed the impact of parity on tooth loss among American women and examined mediators of this relationship.

METHODS

The study sample comprised 2635 White and Black non-Hispanic women who had taken part in the third National Health and Nutrition Examination Survey. We examined the relationship between parity and tooth loss, by age and by socioeconomic position, and tested a theoretical model focusing on direct and indirect influences of parity on dental disease. Robust regression techniques were used to generate path coefficients.

RESULTS

Although parity was associated with tooth loss, the relationship was not moderated through dental care, psychosocial factors, or dental health-damaging behaviors.

CONCLUSIONS

Parity is related to tooth loss among American women, but the mechanisms of the association remain undefined. Further investigation is warranted to determine whether disparities in dental health among women who have been pregnant are caused by differences in parity or to physiological and societal changes (e.g., factors related to pregnant women's access to care) paralleling reproductive choices.

A brief history of national surveillance efforts for periodontal disease in the United States

National efforts directed toward improving our understanding of the epidemiology of periodontal disease began nearly a half century ago following the development of Russell's periodontal index (PI). United States Public Health Service agencies began national surveillance activities for periodontal disease with the first National Health Examination Survey in 1960 to 1962, and this continued periodically through 2004 in the National Health and Nutrition Examination Survey (NHANES). Periodontal disease status was assessed by using the PI in the earlier national health surveys, but beginning in the 1980s, direct measures for clinical attachment loss were made in national health surveys and continued through 2004 in NHANES. This article provides a general history of the development and implementation of national surveillance efforts for periodontal disease from the mid-1950s to 2005. It also provides brief background information on the factors that have influenced these national surveillance efforts.

Overview and quality assurance for the National Health and Nutrition Examination Survey (NHANES) oral health component, 1999-2002

The Oral Health Component of the 1999-2002 National Health and Nutrition Examination Survey (NHANES) is a collaborative effort between the National Institute of Dental and Craniofacial Research (NIDCR), the National Center for Chronic Disease Prevention and Health Promotion, Division of Oral Health (NCCDPHP/DOH), and the National Center for Health Statistics (NCHS). The current NHANES is designed as a continuous survey with data released on a 2-year cycle to represent the civilian, non-institutionalized population of the US. Oral health data are currently available for 8082 and 9010 persons aged > or =2 years who participated in the 1999-2000 and 2001-2002 NHANES, respectively. This article provides background information on previous national examination surveys with oral health content. It also provides general analytical considerations, oral health content information, and evaluations of data quality in terms of examiner reliability statistics (percent agreements, kappa, and correlation coefficients) for the 1999-2002 NHANES Oral Health Component.

The relationship between cigarette smoking and perceived dental treatment needs in the United States, 1988–1994

BACKGROUND

Although factors affecting perceived dental treatment needs have been investigated, the effect of smoking status on perceptions of dental needs has not been examined.

METHODS

The authors examined data on 13,227 dentate people aged 20 to 79 years from the Third National Health and Nutrition Examination Survey (NHANES III). Information was collected information on sociodemographic characteristics, cigarette smoking, perceived dental treatment needs and other factors during a home interview, and clinical oral health information was collected at a mobile examination center.

RESULTS

In univariate analyses, current smokers were more likely than nonsmokers to perceive dental needs in all categories, except for the need for a dental cleaning. Multivariate regression results indicate that current smokers were more likely to report a need for periodontal treatment and dental extractions compared with nonsmokers (odds ratio [OR] = 1.40; 95 percent confidence interval [CI] = 1.05-1.87 and OR = 1.61; 95 percent CI = 1.22-2.14, respectively). The authors found an interaction between smoking and race/ethnicity in models describing the need for teeth to be filled/replaced and for orthodontic/cosmetic work.

CONCLUSIONS

Current smokers were more likely to have more perceived dental needs compared with nonsmokers. Practice Implications. These results may be important for the advancement of efforts directed toward tobacco-use cessation programs and to understand factors that could affect dental care utilization.

Serum antibodies to periodontal pathogens and markers of systemic inflammation

AIM

We examined the relationship between serum antibodies against Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans, and plasma fibrinogen and serum C-reactive protein (CRP) in a nationally representative sample.

METHODS

Data on 2,973 participants aged 40 years and older from the third National Health and Nutrition Examination Survey, second phase (1991-1994) were used. Three logistic regression models adjusted for gender, race, educational attainment, diabetes, cigarette smoking, body mass index (BMI), and other inflammatory conditions were constructed, based on three different assumptions: (A) no access to dental/periodontal data; (B) knowledge of number of teeth present but not of clinical periodontal status; and (C) knowledge of both dental and clinical periodontal status.

RESULTS

High fibrinogen (>400 mg/dl) was unrelated to P. gingivalis and A. actinomycetemcomitans antibodies in all models. High CRP (>0.4 mg/dl) was related to high antibody levels to P. gingivalis in models A [odds ratios (OR) 1.63, 95% confidence intervals (CI) 1.15-2.32], B (OR 1.69, 95% CI 1.18-2.41), and C (OR 1.58, 95% CI 1.12-2.23). In model C, high CRP was related to >30% extent of attachment loss of >or=3 mm (OR 1.58, 95% CI 1.19-2.08). Antibodies to A. actinomycetemcomitans were not associated with high CRP levels in any model.

CONCLUSIONS

High serum titre to P. gingivalis and the presence of periodontal disease are independently related to high CRP levels.

The relationship between selected measures of periodontal status and demographic and behavioural risk factors

OBJECTIVE

To assess differences between selected periodontal measures by demographic and behavioural factors in a nationally representative sample of the United States.

METHODS

Data for 11,347 person's ages 20-79 years from the third National Health and Nutrition Examination Survey (NHANES III) were used. Indices and measures constructed from NHANES III data used for this study were: derived community periodontal index (dCPI), attachment loss extent index (ALEI), attachment loss (AL) scores, and a Periodontal Status Measure (PSM) developed for this study.

RESULTS

The influence of demographic and behavioural factors varied across the four indices examined in multivariate cumulative logistic models. Moreover, there was significant effect modification by cigarette smoking with age in the ALEI and AL models. The odds ratio (OR) of increasing periodontal disease status among 20-39 year olds as measured by AL or ALEI for current smokers compared with non-smokers were OR=6.2 (95% confidence interval (CI)=4.1, 8.7) and OR=5.6 (95% CI=3.7, 8.7), respectively. In a similar comparison, the OR for dCPI was 2.6 (95% CI=1.7, 3.8). Furthermore, Mexican American ethnicity was generally not significant in any models using dCPI, PSM, AL, or ALEI and prior dental visit was more likely to be significant only in the dCPI and PSM models.

DISCUSSION

Among the well-known demographic and behavioural influences on periodontal health status, some, such as race/ethnicity and prior dental visit status have different relationships with differing periodontal measures employed to assess periodontal status. Moreover, potential interactions among cofactors also are dependent upon the measure selected. Periodontal research findings may be influenced significantly by periodontal measure selection and its affect on measurement validity. This may have particular relevance to issues concerning disease surveillance and assessing reduction of disparities in oral health. Consequently, a renewed approach to developing appropriate measures for periodontal epidemiology is needed.

Influence of cigarette smoking on the overall perception of dental health among adults aged 20-79 years, United States, 1988-1994

OBJECTIVE

Investigation into the relationship between lifestyle factors (particularly cigarette smoking) and perceived oral health has been limited. Data from the third National Health and Nutrition Examination Survey (NHANES II), 1988-1994, were used to explore this relationship in a large sample of U.S. adults.

METHODS

This study used data on 13,357 dentate participants in NHANES III aged 20-79 years. In NHANES III, information on perceived dental health, sociodemographic attributes, smoking status, frequency of dental visits, dental insurance, and general health perception were collected during a home interview, and oral health status was assessed at a mobile examination center.

RESULTS

Overall, 34.4% of individuals in the study sample reported having an unfavorable perception of their dental health by qualifying it as "fair" or "poor." Furthermore, 46.6% of smokers had an unfavorable dental health perception, compared to 28.3% of non-smokers. An interaction between smoking and race/ethnicity was found in logistic regression modeling. Stratified results show that cigarette smoking was not a significant predictor for an unfavorable dental health perception among individuals who self-identified as Mexican American, but smoking was a significant predictor for an unfavorable dental health perception among those who identified as non-Hispanic black or non-Hispanic white.

CONCLUSIONS

This is the first study to describe the effects of smoking on dental health perception while controlling for examined oral health status. Because perceived dental health is a potential indicator for dental care utilization, a better knowledge of the factors that influence dental health perception is not only important for dental services planning, but also for understanding oral health-related quality of life issues. Additionally, given that smoking may negatively affect dental health perception, these findings have potential implications for smoking cessation activities conducted by dental care providers.

Longitudinal study of periodontal disease and edentulism with rates of bone loss in older women

BACKGROUND

Previous cross-sectional studies have suggested a link between periodontal disease and osteoporosis. The purpose of the present study is to evaluate the association between changes in bone mineral density (BMD) and clinical signs of periodontal tissue destruction and tooth loss over a 2-year period.

METHODS

A total of 398 women (mean age 75.5 years) were randomly selected for an ancillary study of periodontal disease; osteoporosis in association with the presence or absence of teeth was evaluated. Osteoporosis in association with periodontal disease was also evaluated. All subjects were participants at the Pittsburgh Clinical Center for the Study of Osteoporotic Fractures (SOF), a prospective cohort study of women 65 years of age or older designed to determine risk factors for fractures. Oral health examinations, including periodontal probing and attachment loss, were performed at the fourth clinical visit, an average of 6 years after baseline. BMD of the total hip and its subregions was measured using dual energy x-ray absorptiometry at the time of dental examination and 2 years later. Results are expressed as annual percentage change.

RESULTS

A total of 145 (36.4%) women were edentulous and 163 (80.7%) of the dentate women (N = 253) had periodontal disease. Dentate women reported higher education (P <0.001) and a higher calcium intake (P= 0.002). Absolute BMD and percentage change in BMD were similar in dentate and edentulous women. We found no difference in BMD or in absolute or percentage change in BMD between women with or without periodontal disease.

CONCLUSION

Little evidence exists for an association between edentulousness, periodontal disease, and longitudinal changes in BMD.

Can nonstandardized bitewing radiographs be used to assess the presence of alveolar bone loss in epidemiologic studies?

OBJECTIVE

To compare periodontitis-associated alveolar bone loss assessment by standardized and nonstandardized radiographs in clinical and epidemiologic studies.

METHODS

Participants included 37 patients aged 21-66 years with prior nonstandardized bitewing radiographs scheduled to receive bitewing radiographs as part of their next routine dental care visit. Standardized bitewing radiographs were taken with a Rinn film holder to position the film in the mouth and align the X-rays so that they were at 90 degrees to the film. Before taking the radiograph the bite was registered in centric relation using a polyether impression material. One registered dental hygienist took and processed all the standardized radiographs. One dentist read all radiographs using a viewing box, magnifying lens, and periodontal probe with William's markings. Radiographic bone loss was measured to the closest millimeter at mesial and distal sites of the posterior teeth excluding third molars. The examining dentist was blinded to the participant's name, age, gender, or if the radiograph was standardized or nonstandardized.

RESULTS

Mean bone loss (+/- SD) was similar in the standardized and nonstandardized groups (1.60 +/- 0.72 mm versus 1.64 +/- 0.85 mm), and the correlation was high (r = 0.95). Periodontitis was defined as present if the participant had at least one site with 3, 4 and 5 mm bone loss. The Kappa statistics for concordance using these three cutoffs were good and ranged from 0.60 to 0.65. The sensitivity ranged from 72.7 to 80.8% and specificity from 88.5 to 90.9%.

CONCLUSIONS

Periodontitis assessed as mean alveolar bone loss or the prevalence of disease based on alveolar bone loss can be accurately and reliably evaluated from nonstandardized radiographs.

Periodontitis in the United States: beyond black and white

OBJECTIVES

This paper examines whether historical disparities in periodontal status between African Americans and whites in the United States have increased, decreased, or remained the same over the 15-year period between the First National Health and Nutrition Examination Survey (NHANES I, 1971-74) and the Third National Health and Nutrition Examination Survey (NHANES III, 1988-94).

METHODS

This study compared the magnitude of the relative and absolute differences in the periodontal status of African-American and white adults in NHANES I and again in NHANES III.

RESULTS

The prevalence of periodontitis in the US adult population in NHANES I was 31.6 percent, with African Americans exhibiting higher prevalence than whites. In NHANES III, using a different case-definition for periodontitis, the overall prevalence was 11.9 percent, with African Americans again exhibiting higher prevalence than whites. The magnitude of the intrasurvey relative and absolute differences between African Americans and whites increased between NHANES I and NHANES III. This finding remained after adjustment in the logistic regression analyses. After adjustment for all covariates in the model, African Americans were more likely to exhibit periodontitis than whites in both NHANES I (odds ratio [OR] = 1.31; 95% confidence intervals [CI] = .78, 2.19) and NHANES III (OR = 2.09; 95% CI = 1.68, 2.60). However, the CI included 1.00 in NHANES I.

CONCLUSIONS

Disparities in periodontitis between African Americans and whites are pervasive and have increased over time. This increase appears to be driven by social, cultural, and behavioral factors.