Comparative periodontal status of caries resistant versus susceptible adults

Chronic oral diseases burden: The confluence of caries and periodontitis throughout life

AIM

To investigate the confluence of caries and periodontitis indicators from adolescence to elderhood among Americans.

MATERIALS AND METHODS

This cross-sectional study explored the grouping among a set of caries and periodontitis indicators (the proportion of sites with bleeding on probing, moderate probing pocket depth [PPD, 4-5 mm], severe PPD [≥6 mm], moderate clinical attachment level [CAL, 3-4 mm], severe CAL [≥5 mm], number of teeth with furcation involvement, number of decayed teeth, number of teeth with pulp involvement, and the number of missing teeth) in 14,421 Americans from the NHANES III study. Exploratory factorial analysis was used to determine the constructs between those indicators (factorial loading ≥0.3). These analyses were stratified by age and confirmed with a confirmatory factorial analysis. We also performed a sensitivity analysis using the NHANES 2011-2014.

RESULTS

Two constructs were extracted. The first, Chronic Oral Diseases Burden, grouped caries indicators with moderate PPD and moderate CAL for the youngest subjects (13-39 years old), while for the subjects over 50 years, the Chronic Oral Disease Burden grouped caries indicators with severe CAL and PPD and furcation involvement. The second construct, Periodontal Destruction, grouped only periodontitis indicators.

CONCLUSIONS

Caries and periodontitis indicators grouped consistently across the different age ranges in lapse times of 25 years.

Associations of decayed and filled teeth with localized stage II/III periodontitis in young adults: The CHIEF oral health study

Background/purpose

To investigate the associations between treated and untreated dental caries and periodontitis in young adults.

Materials and methods

The study enrolled 1289 participants aged 18–45 years in Taiwan. Localized periodontitis was categorized into healthy and stage II/III (n = 936 and n = 353, respectively) based on the 2017 criteria of the World Workshop. Multivariable logistic regression analysis with adjustments for sex, age, tobacco smoking status, betel nut consumption status, metabolic syndrome, and total white blood cell count was used to determine the associations.

Results

Decayed tooth numbers were positively associated with localized stage II/III periodontitis [odds ratio (OR): 1.15 (95% confidence intervals (CI): 1.06–2.25)], while filled tooth numbers were inversely associated with localized stage II/III periodontitis in young adults [OR: 0.96 (95% CI: 0.92–0.99)].

Conclusion

Our study confirms the relationship between dental caries and periodontitis by direct evidence that the more decayed teeth there are, the higher the risk of periodontitis and by indirect evidence that the more treated decayed teeth there are, the lower the risk of periodontitis in young adults.

Dental caries are positively associated with periodontal disease severity

OBJECTIVES

To examine associations between periodontal disease severity and clinical and microbiological measures of caries in adults.

MATERIALS AND METHODS

A cross-sectional study of 94 healthy adults ((mean ± SD) 55.4 ± 13.0 years) was conducted. Data were collected by means of questionnaire and a clinical examination that included the Decayed, Missing, Filled teeth Surfaces (DMFS) index, probing depth (PD), clinical attachment level (CAL), and gingival bleeding and plaque scores. Supra- and subgingival plaque samples were collected to assess the presence of Streptococcus mutans and six periodontal pathogens. Participants were subsequently categorized using Center for Disease Control and Prevention/American Academy of Periodontology (CDC-AAP) definitions and tertiles of percentage of sites with CAL ≥ 3mm.

RESULTS

Significant positive associations were found between the periodontal disease severity (CDC-AAP) and the DMFS (aOR = 1.03; 95% CI 1.01-1.05) and DS indices (aOR = 1.18; 95% CI 1.05-1.32) as well as between the tertiles of percentage of sites with CAL ≥ 3 mm and DMFS (aOR = 1.03; 95% CI 1.00-1.05) and DS indices (aOR = 1.12; 95% CI 1.00-1.25). A significant positive association was also found between oral levels of F. nucleatum and S. mutans (aOR = 6.03; 95% CI 1.55-23.45).

CONCLUSIONS

A small but positive association was found between clinical measures of caries and periodontal disease severity. Further research is warranted to examine the association between these two common oral diseases.

CLINICAL RELEVANCE

Periodontal diseases and caries are the two most common oral diseases. There was a positive association between clinical and microbiological markers of both diseases. Therefore, strategies in oral health education should involve both caries and periodontitis prevention.

Association of salivary calcium, phosphate, pH and flow rate on oral health: A study on 90 subjects

Background and Objectives:

This study was designed to compare inorganic salivary calcium, phosphate, flow rate and pH of un-stimulated saliva and oral hygiene of healthy subjects, patients with periodontitis and dental caries and to correlate salivary calcium level with the number of intact teeth.

Materials and Methods:

The present study consisted of 90 patients aged between 18 and 55 years and were divided into three groups, periodontitis, dental caries and controls. Oral hygiene index-simplified, probing pocket depth, clinical attachment level and number of teeth present, teeth with active carious lesions were recorded. Salivary flow rate and pH was recorded and subjected to biochemical investigation. Estimation of inorganic calcium and phosphate was performed by colorimetric method.

Results:

Results showed statistically significant increase in salivary inorganic calcium and phosphate levels, poor oral hygiene status, pH and salivary flow rate in patients with periodontitis when compared with dental caries group and controls.

Interpretation and Conclusion:

Individuals who have increased salivary inorganic calcium, phosphate, pH, flow rate and maintain poor oral hygiene could be at a higher risk for developing periodontitis and may have less dental caries and more number of intact teeth.

Proximal caries in juvenile periodontitis patients

BACKGROUND

Caries is recognized as the prevalent proximal dental disease in adolescents, while proximal bone loss is minimal to non-existent in this population. Adolescents demonstrating an inverse disease pattern, i.e., minimal caries and active periodontitis, could provide powerful clues with regard to both diseases. However, data are inconsistent. This study was designed to clarify this relationship by comparing proximal caries prevalence in a juvenile periodontitis (JP) group to a matched non-periodontally diseased control group.

METHODS

Two groups (cases [JPs] and control patients [CPs]) were matched for age, sex, and race and evaluated for decayed, missing, filled teeth and surfaces (DMFS) by radiographic analysis. Statistical analysis was performed by ANOVA and Student t test. The study consisted of four phases. Phase I was based on data from a previous study that failed to include race in the analysis. Thus, the original 23 JP patients (mostly African-Americans from New York City) were rematched for race as well as sex and age with CPs from Newark, NJ. The effect of water fluoridation (found in NYC) was evaluated in Phase II by matching the 23 original CPs (mostly Caucasian from NYC) with 23 CPs from NJ. Since differences were seen, we rematched our original JPs from NYC with a new set of race-matched CPs from NYC (Phase III). Finally, 13 JP patients from the University of Medicine and Dentistry of New Jersey (UMDNJ) were matched with CPs from NJ (Phase IV).

RESULTS

Phase I and III indicated that JP patients had significantly less proximal caries than their matched CPs (P < or =0.05). Phase II confirmed the role of fluoride in caries reduction. Phase IV (NJ sample) supported our previous data and suggested that JP patients had less proximal caries than CPs (P < or =0.05).

CONCLUSIONS

JP patients had significantly less proximal caries than their matched CPs when groups were balanced and radiographic evaluations were performed. In-depth studies of JP patients could provide important clues about both caries and periodontal disease etiology and pathogenesis.

Associations between salivary calcium and oral health

Recently, we have shown positive correlations between high salivary calcium content and periodontitis, and between high salivary calcium level and the number of intact teeth in selected groups of subjects. The aim of our present study was to determine whether these correlations could be seen in a randomized group of healthy adults. A thorough oral examination including orthopantomograms was carried out for a total of 137 healthy subjects, 63 men (35.4+/-5.6 years) and 74 women (33.2+/-4.7 years). Paraffin-stimulated saliva was collected from the subjects and salivary flow (ml/min), buffering capacity, calcium (mMol/l) and microbial variables including lactobacilli, yeasts, mutans streptococci, total streptococci, total number of aerobes, and anaerobes were determined. The calcium level of whole saliva had a median of 1.23 mMol/l. Subjects with calcium level below the median were categorized as 'low', while those with higher values formed the 'high' salivary calcium group. There were more men than women in the 'High' salivary calcium group (p=0.025). Subjects in the 'high' calcium group showed more bleeding on probing (p=0.026), had more intact teeth (p=0.045), and lower DMF-scores (p=0.025) than their counterparts. No other differences were found between the two groups. We found clear associations between the level of salivary calcium and factors reflecting gingival health on one hand, and dental health on the other in a randomly selected group of healthy subjects, and conclude that salivary calcium may be important with regard to both dental and gingival health.

Dental caries and tooth loss in adolescents with early-onset periodontitis

The aim of this study was to assess the caries experience and tooth loss over 6 years in subjects with early-onset periodontitis as compared to their matched controls, and to describe the characteristics of teeth lost during this period. A multi-stage probability sample representing 8th to 12th grade U.S. schoolchildren were screened during the 1986/1987 school year to identify subjects with early-onset periodontitis (cases). The examination included measuring the clinical attachment level, presence of caries and dental restorations, and tooth loss. A random sample of controls without early-onset periodontitis were selected for a follow-up examination and were matched to cases on gender, race, age, and geographic location. A total of 266 subjects, with a mean age of 16 years at baseline, were examined during the 1992/1993 school year and were classified into localized (LJP) and generalized juvenile periodontitis (GJP), incidental attachment loss (IAL), and control groups. Whites had more caries experience than Blacks and Hispanics, but there were no significant differences in tooth loss between the ethnic groups. The LJP and the IAL groups, respectively, had higher and lower overall caries experience than the control group. The LJP group had a significantly higher number of missing teeth at follow-up, and exhibited more extensive tooth mortality during 6 years than the control group. The GJP group also showed more tooth loss than the control group, but the difference was not statistically significant. In the LJP, GJP, IAL, and control groups, respectively, 43%, 32%, 26%, and 18% of the subjects lost teeth over 6 years due to disease. The findings showed differences in caries activity between the early-onset periodontitis groups and a variation by race. The findings suggest that loss of periodontal support was the principal cause for tooth loss in the LJP and GJP groups, and that dental caries was the principal cause for tooth extraction in the IAL and the control groups.

Cross-sectional assessment of caries and periodontitis risk within the same subject

Dental caries and chronic periodontitis may be synergistically associated, negatively associated, or completely independent. The present report examines this relationship by comparing the susceptibility to chronic periodontitis and caries within the same individual. From an 800-patient sample, a periodontitis risk score was derived by radiographic assessment of bone loss in quarters of optimum bone height and obtaining for each subject a mean score based on all measurable surfaces. Similarly the caries risk was determined radiographically from the total decayed and filled teeth (DFT), as a percentage of the total teeth measured. The Mantel-Haenszel technique was used for analysis of the relationship between periodontitis and caries and data was stratified on four categories of age, sex, and numbers of teeth present. This analysis revealed no systematic patterns, indicating that the risks of caries and periodontal diseases are unrelated (chi 2 = 0.00; 1 df; P greater than 0.50). In addition, a regression analysis, which was controlled for sex and age, indicated a marked lack of association between caries and periodontitis (P = 0.94). Thus, although these common diseases share putative etiologic factors such as oral hygiene practices and dental attendance pattern, the major risk factors are probably quite different.

Proximal tooth surface quality and periodontal status

The aim of this study was to determine the periodontal status in relation to the quality of the adjacent proximal tooth surface. The gingival index (GI) and probable pocket depth (PD) were measured in 144 contra-lateral pairs of sound vs. restored and 95 contra-lateral pairs of sound vs. carious surfaces in 124 patients. The restorations studied were silver amalgams and tooth-coloured filling materials, the margins of which were supragingival or level with the gingival margins. The results showed that the GI and PD were greater for both restored and carious tooth surfaces than for the contra-lateral sound surfaces. When all the teeth were grouped together, the differences in the mean values of GI and PD were statistically significant at the P less than or equal to 0.05 level. A comparison between restored and carious (non-paired) tooth surfaces revealed higher mean values of GI and PD for the latter, which were highly significant at the P less than 0.001 level. Thus the present study shows that proximal tooth surface quality influences the health status of the adjacent periodontium.

Dental status of adults with and without periodontitis

All 30- to 59-year old subjects (N = 757) from a representative sample of adult Finns (total sample = 1,105), showing advanced periodontitis (marginal bone loss more than 30%, n = 125), were compared with their age- and sex-matched pairs showing no marginal bone loss (n = 291) with respect to the number of intact teeth (no caries experience) present. Both male (n = 83) and female (n = 42) subjects with advanced periodontitis had more intact teeth and intact molars than their matched pairs (113 men and 178 women) (P less than or equal to 0.01 for intact teeth and P less than or equal to 0.05 for intact molars in both groups). The total number of teeth present did not differ significantly between the compared groups. Contrary to earlier hypotheses, our results suggest that periodontitis and dental caries do not necessarily share a common etiology.

Proximal tooth surface quality and periodontal probing depth

The proximal tooth surface integrity of 826 patients was correlated with periodontal probing depths. Results show relatively increased probing depths adjacent to restored proximal tooth surfaces, with the greatest probing depths adjacent to overhanging restorations and restorations with recurrent caries. The data confirm the significant tendency of the periodontal condition to deteriorate as a function of decreasing surface quality. Probing depth appeared to increase with the patient's age. Surface condition, however, showed a significant relationship with probing depths in all age groups.