Effects of risk factors on periodontal disease defined by calibrated community periodontal index and loss of attachment scores

Association between periodontal health and trait anxiety in Egyptian women: A cross-sectional study

OBJECTIVES

This study explored the relationship between periodontal problems and trait anxiety in a sample of Egyptian women.

MATERIALS AND METHODS

The Egyptian validated Arabic version of the State-Trait Anxiety Inventory-Trait subscale was used to measure levels of trait anxiety, and the periodontal health status of 451 Egyptian women was assessed using the Community Periodontal Index. Data were also collected on potential covariates such as age, educational level, marital status, parity, smoking, and oral healthcare-seeking behavior. Multivariate logistic regression analysis was done to evaluate the association between periodontal diseases and trait anxiety.

RESULTS

Among study participants, and after adjusting for some of the potential confounders, trait anxiety exhibited weak association with periodontal diseases (OR: 1.11; 95% CI= 1.07, 1.14; p <0.001). Also, old age (OR: 1.12; 95% CI = 1.07, 1.17; p < 0.001) as well as parity (OR: 7.26; 95% CI = 2.89, 18.27; p <0.001) were significantly associated with periodontal problems in the adjusted model.

CONCLUSION

While the study findings may implicate that personality traits, such as trait anxiety, could be linked to periodontal diseases more research is warranted to confirm or reject this association.

Poor oral health conditions and cognitive decline: Studies in humans and rats

Background

The relationship between poor oral health conditions and cognitive decline is unclear.

Objective

To examine the association between oral health and cognition in humans and rats.

Methods

In humans: a cross-sectional study was conducted. Cognitive levels were evaluated by the Mini Mental State Examination (MMSE); oral conditions were reflected by the number of missing index teeth, bleeding on probing, and probing pocket depth (PD). In rats: a ligature-induced (Lig) periodontitis model and Aβ_25-35-induced model of Alzheimer’s disease (AD) were established; tumor necrosis factor-α (TNF-α), interleukin 1 (IL-1), interleukin 6 (IL-6), and C-reactive protein levels in the hippocampus and cerebral cortex were detected.

Results

MMSE scores for the number of missing index teeth ≥ 7 group were significantly lower than those in the ≤ 6 group. A negative relationship (correlation coefficient ρ = −0.310, P = 0.002) was observed between MMSE scores and number of missing index teeth. More missing index teeth and lower education levels were independent risk factors for cognitive decline. A negative relationship (correlation coefficient ρ = −0.214, P = 0.031) was observed between MMSE scores and average PD. TNF-α and IL-6 levels in the hippocampus of the Lig+AD group were significantly higher than those of the AD group. IL-1 and IL-6 levels in the cerebral cortex of the Lig+AD group were significantly higher than those of the AD group.

Conclusion

Poor oral health conditions including more missing index teeth and higher average PD may be risk factors for cognitive decline. Periodontitis may increase inflammatory cytokines in rat models of AD.

How to correct the odds ratio for lack of sensitivity and specificity

This commentary explains and exemplifies a method to estimate the Odds Ratio-OR with a correction for possible errors in diagnosis. This procedure allows reassessing hypotheses of association between health outcomes and exposures when the database entails lack of accuracy, and the estimates of sensitivity and specificity of the diagnostic tool are available. Misclassification is not uncommon in dental public health research. Classification errors should not be ignored; they should instead be subject of measurement and adjustment. However, the lack of diagnostic validity is an elusive error, which cannot be entirely controlled. The method described here is solely an attempt to explore further the assessment of factors impacting on health outcomes.

The Relationship between Vitamin C and Periodontal Diseases: A Systematic Review

Vitamin C is important for preventing and slowing the progression of many diseases. There is significant evidence linking periodontal disease and vitamin C. We aimed to systematically review the studies addressing the relationship between vitamin C and periodontal disease, and the preventive ability of vitamin C against periodontal disease. Electric searches were performed using PubMed, EMBASE, Cochrane Library, and Web of Science. Studies addressing the relationships between periodontal disease and vitamin C in adults aged over 18 years were included. Quality assessment was done using the Critical Appraisal Skills Program guideline and GRADE-CERQual. There were 716 articles that were retrieved and 14 articles (seven cross-sectional studies, two case-control studies, two cohort studies, and three randomized controlled trials (RCT)) were selected after reviewing all of the articles. The vitamin C intake and blood levels were negatively related to periodontal disease in all seven cross-sectional studies. The subjects who suffer from periodontitis presented a lower vitamin C intake and lower blood-vitamin C levels than the subjects without periodontal disease in the two case-control studies. The patients with a lower dietary intake or lower blood level of vitamin C showed a greater progression of periodontal disease than the controls. The intervention using vitamin C administration improved gingival bleeding in gingivitis, but not in periodontitis. Alveolar bone absorption was also not improved. The present systematic review suggested that vitamin C contributes to a reduced risk of periodontal disease.

A composite score to assess the burden of periodontal diseases and tooth loss

BACKGROUND

Population studies of the prevalence of oral disease rely upon indices that summarize disease status. There is no universally accepted index that summarizes the burden of periodontal diseases, considering the number of teeth remaining in the mouth.

METHODS

A new conceptual index was developed that includes consideration of the extent and severity of the periodontal diseases, the distribution of affected teeth, and tooth loss as a function of age. The index is referred to as the burden of periodontal diseases and tooth loss (BPT).

RESULTS

A cohort of 1,097 individuals originally seen as new patients in a dental school clinic, and evaluated for undiagnosed dysglycemia, were studied. The BPT index was applied to this data set. A modifying effect of considering the number of lost teeth was observed. The distribution of scores w skewed to the left, which gradually shifted to the right when the most involved teeth (periodontal pathology, tooth loss) were weighted more heavily. This shift was not observed when missing teeth were not considered.

CONCLUSIONS

This conceptual study illustrates that the extent and severity of periodontal pathology, and number and distribution of missing teeth, are important considerations when summarizing the condition of the mouth. The BPT provides a measure of the oral disease burden, as both periodontal pathology and tooth loss are associated with both functional impairment and reduced quality of life. The dental profession and dental research community must continually seek to develop new approaches to defining and summarizing the oral disease burden.

Effects of risk factors on periodontal disease defined by calibrated community periodontal index and loss of attachment scores

OBJECTIVES

We evaluated whether and how the effects of risk factors on periodontal disease (PD) were modified by measurement errors using community periodontal index (CPI) and loss attachment (LA) in the community-based survey.

METHODS

A pilot validation study was performed to estimate the rates of false negative and false positive for both CPI and LA in 31 subjects from different regions using measurements from 12 well-trained dentists and a senior periodontist as a gold standard. Afterward, a Taiwanese nationwide survey was conducted by enrolling 3,860 participants to estimate the effect of each risk factor on PD calibrated with both sensitivity and specificity of two indices.

RESULTS

The values obtained for the sensitivity to false-positive ratio for CPI ranged widely from 1.12 to 7.71, indicating regional variation in both errors. The calibrated adjusted odds ratio for smoking vs non-smoking was higher than the uncalibrated odds ratio for PD defined by CPI (2.75 (2.01, 3.77) vs 2.02 (1.63, 2.52)) and LA (3.85 (2.44, 6.13) vs 1.93 (1.47, 2.54)) scores. Similar underestimation was noted for other risk factors.

CONCLUSION

The effects of risk factors on PD measured using CPI and LA in a large population-based survey were underestimated without correcting for measurement errors.