Periodontal conditions among the old elderly: five-year longitudinal study

Estimation of Oral Disease Burden among Older Adults in LTC: A Scoping Review

Oral health is an essential part of healthy aging and very little data exists around the disease burden for older adults in a long-term care setting. The aim of this scoping review was to estimate the disease burden of dental caries, periodontal disease, and tooth loss among older adults in Long-Term Care (LTC). This scoping review was conducted in accordance with the Joanna Briggs Institute methodology. A detailed strategy was used to conduct a comprehensive search of electronic databases: PubMed, Embase, and Dentistry and Oral Sciences Source (DOSS). The Rayyan AI platform was used to screen abstracts for assessment by one of five co-investigators. Results indicate that only one in three might have a functional dentition upon entry into LTC, and among those who are dentate, most might expect to develop at least one new coronal and one new root caries lesion each year. There is a need to better document the disease experiences of this group to tailor approaches to care that might reduce the avoidable suffering as a result of dental caries and periodontal disease.

Diagnostic accuracy of severe periodontitis case definitions: Comparison of the CDC/AAP, EFP/AAP, and CPI criteria

BACKGROUND

This cross-sectional study aimed to evaluate the diagnostic accuracy of severe periodontitis by three different case definitions.

METHODS

Patients aged >35 years (n = 243, mean age = 47.8 ± 9.3 years) were evaluated by periodontal examinations and classified in patients with severe periodontitis according to the case definition proposed by the Centers for Disease Control and Prevention (CDC) in collaboration with the American Academy of Periodontology (AAP)-CDC/AAP, the new periodontal disease classification proposed jointly by the AAP and the European Federation of Periodontology (EFP/AAP), and the Community Periodontal Index (CPI). The primary outcome was to compare the diagnostic accuracy of severe periodontitis between the three case definitions. Sensitivity (SS), specificity (SP), and area under the receiver operating characteristic (ROC) curve were used to analyze the accuracy.

RESULTS

The proportion of subjects presenting the most severe definitions of each classification was: severe periodontitis (CDC/AAP) = 47.3%, type III and IV periodontitis (EFP/AAP) = 43.2% and CPI code 4 = 44.4%. When comparing the CDC/AAP case definitions with the EFP/AAP classification, SS, SP, and ROC of 81.7%, 91.4%, and 0.866 (CI, 95%: 0.816 to 0.916), respectively, were obtained. Similarly, when comparing CDC/AAP to CPI code 4, SS, SP, and ROC of 81.7%, 89.1%, and 0.854 (CI, 95%: 0.802 to 0.906), respectively, were obtained. When type III and IV periodontitis (EFP/AAP) was compared with CPI code 4, the values were 92.4%, 92%, and 0.922 (CI, 95%: 0.883 to 0.961), respectively.

CONCLUSIONS

The EFP/AAP classification and the CPI demonstrated high diagnostic accuracy with the CDC/AAP case definition to diagnose severe periodontitis.

Influence of oral health behavior and sociodemographic factors on remaining teeth in Korean adults: 2010-2012 Korea national health and nutrition examination survey

In this study, the number and location of remaining teeth were analyzed according to sociodemographic variables, anthropometric measurements, and oral health behavior patterns. The hypothesis was that the number and location of remaining teeth would be affected by oral health behavior and by sociodemographic factors, such as education levels, household income, and urban/rural residency.This nationwide cross-sectional study was performed with a total of 36,026 representative Korean adults aged 19 and older. The data were taken from the 2012-2012 Korea National Health and Nutrition Examination Survey.Men had, on average, significantly more remaining teeth than women did. Women brushed their teeth more often than men per day and were more likely to brush their teeth after meals. The participants with higher education levels or household income had significantly more remaining teeth; the number of daily tooth brushing was positively associated with the number of remaining teeth; urban residents had significantly more remaining teeth than rural residents; and elderly adults had fewer remaining teeth than younger adults had (all with P < 0.05). The participants were more likely to retain their incisors (especially their canines) for their entire lifetimes than do so for their molars. From the incisors to the second premolars, they had more mandibular teeth than maxillary teeth, but among molars, they had more maxillary teeth than mandibular teeth. Elementary graduates with low household income had fewer remaining teeth than did university graduates with high household income (P < 0.0001). Finally, participants with high socioeconomic status were more likely to lose their molar teeth than anterior teeth compared to those with low socioeconomic status.The participants who brushed their teeth fewer times per day, those with low household incomes and/or education levels, and those who lived in rural districts had significantly higher prevalence of tooth loss than did other groups in Korean adults. Participants had more anterior and premolar teeth on mandible, but they had more molars on maxilla. In addition, participants with high socioeconomic status were more likely to lose their molar teeth than anterior teeth compared to those with low socioeconomic status.

Prevalence and risk factors of periodontitis among adults with or without diabetes mellitus

BACKGROUND/AIMS

This study examined prevalence and risk factors of periodontitis in representative samples of Korean adults, with and without diabetes mellitus (DM).

METHODS

Data from the 2012 Korean National Health and Nutritional Examination Survey were analyzed. A total of 4,477 adults (≥ 30 years old) were selected from 8,057 individuals who completed a nutrition survey, a self-reported general health behavior questionnaire, an oral examination, an oral hygiene behaviors survey, and laboratory tests. DM was defined as a fasting plasma glucose ≥ 126 mg/dL, or self-reported diagnosed diabetes, or current use of oral hypoglycemic agents and/or insulin. The community periodontal index was used to assess periodontitis status and comparisons between the periodontitis and the non-periodontitis group, were performed, according to the presence of DM. Risk factors for periodontitis in adults with DM and without DM were evaluated by multiple logistic regression analysis.

RESULTS

The prevalence of periodontitis was significantly higher in adults with DM (43.7%) than in those without DM (25%, p < 0.001). In adults without DM, risk factors for periodontitis were older age, male, urban habitation, waist circumference, smoking, oral pain, and less frequent tooth brushing. Significant risk factors for periodontitis in adults with DM were the smoking, oral pain, and not-using an oral hygiene product.

CONCLUSIONS

Adults with DM have an increased risk of periodontitis than those without DM. Current smoking and oral pain increase this risk. Using an oral hygiene product can reduce risk of periodontal disease in adults with DM.

Periodontal health status in the elderly with different levels of education: a 5-year follow-up study

OBJECTIVE

To assess the association between the periodontal health status and level of education over a 5-year period among the elderly aged 75 years and older.

BACKGROUND

Oral health among the higher educated is known to be better than among the less-well educated. On the other hand, the prevalence and severity of periodontal disease has been found to grow with increasing age.

METHODS

The participants were derived from a population-based Helsinki Aging Study, a random sample of 76-, 81- and 86-year-old elderly. The 170 dentate elderly who underwent clinical oral examinations at baseline and 71 who participated in the follow-up were included in this study. The data was collected from intraoral and radiological examinations and from a structured questionnaire.

RESULTS

Subjects with a higher level of education had more retained teeth than subjects with a lower level of education. According to CPITN index, better-educated participants had more healthy sextants, but they also had more sextants with periodontal pockets. Radiographic examination showed similar results.

CONCLUSION

Level of education has a clear effect on the periodontal health status in the elderly. More treatment need seems to polarise into those elderly who are better educated as they retain more teeth into old age.

Periodontal disease and mortality in an aged population

We investigated the relationship between periodontitis and mortality in home-dwelling individuals aged (75+ years), considering potential confounders including C-reactive protein levels. This study involved 364 individuals, originally part of the Helsinki Ageing Study cohort, who underwent medical and dental examinations in 1990 and were followed for five years. After five years, 52 of the 175 dentate subjects had died. Using univariate analysis, the association between baseline periodontitis and mortality was of borderline significance. After controlling for the common risk factors, periodontitis more than doubled the risk of cardiovascular disease-related mortality (HR 2.28, CI 1.03-5.05). The increase in total mortality was, however, not statistically significant (HR 1.43, CI 0.81-2.50). Subjects who were edentulous had higher mortality than those who were dentate without periodontitis, but the difference was not statistically significant. A baseline CRP level above 3 mg/l was associated with high mortality; but this effect was significant only among individuals with periodontitis. These results suggest that periodontitis influences the pathogenesis and outcome of cardiovascular disease, especially in individuals who also have evidence of a systemic inflammatory reaction.

Oral health status, C-reactive protein and mortality--a 10 year follow-up study

BACKGROUND

Epidemiological studies have reported a strong association between C-reactive protein (CRP) and cardiovascular diseases (CVD). Elevated CRP levels have been observed both in dentate individuals with chronic dental infections like periodontal disease and in those edentulous. The mechanisms behind these observations, especially the reasons for the elevation of CRP in the edentulous, are poorly understood. The comparative data on the importance of these inflammatory conditions in the oral cavity as causes of elevated CRP levels and CVD risk factors are also limited.

OBJECTIVE

To determine if edentulism is associated with increased levels of CRP and investigate the possible mechanism for this association; and to study the influence of periodontal disease and edentulism on 10-year mortality.

SUBJECTS

Of the 364 subjects aged 76, 81, and 86 years in 1990, 196 were dentate and 168 edentulous. By December 1999, 179 had died, almost half (n = 87) of them due to cardiovascular disease.

RESULTS

Significantly more of the edentulous subjects had elevated (> or = 3 mg/L) CRP levels as compared to those with at least 20 teeth (p < 0.01). They also had high salivary microbial counts (p < 0.05), and more mucosal lesions (p < 0.0001) than those with at least 20 teeth. In multivariate analysis, high microbial counts (OR 2.3, CI 1.06-5.05) and mucosal lesions (OR 2.18, CI 1.03-4.61) were significantly associated with elevated CRP levels. The risk for all-cause mortality was non-significantly elevated among the edentulous (RR 1.48, CI 0.95-2.31) and dentate with periodontal disease (RR 1.58, CI 0.96-2.61). CVD mortality was significantly higher among the dentate with periodontal disease (RR 1.97, CI 1.01-3.85) when compared with dentate without periodontal disease.

CONCLUSION

Among the edentulous, chronic infections like denture-related mucosal lesions are important determinants of elevated CRP, comparable to periodontal disease in the dentate. Elevated CRP per se and edentulism were not significantly associated with increased mortality. Periodontal disease was, however, still associated with a two-fold CVD mortality in this very old population.