Self-reported periodontal disease: validation in an epidemiological survey

Gastric adenocarcinoma and periodontal disease: A systematic review and meta-analysis

BACKGROUND

The oral cavity is a link between of external environment with gastrointestinal tract. Studies are controversial on the presence of Periodontal Disease (PD) and its association with Gastric Adenocarcinoma (GAC).

METHODS

The authors performed a systematic review and meta-analysis to verify the association between PD and GAC. Six electronic databases were evaluated between 1961 and 2022. Titles and abstracts were reviewed independently according to the eligibility criteria, assessing full texts of selected studies. The quality of the included research was verified using the Newcastle-Ottawa Scale for case-control and cohort studies. Statistical analyses were performed based on fixed and/or random effects models to calculate the summarized Relative Risk (RR) and its 95 % Confidence Interval (95 % CI).

RESULTS

There were 639 studies, of which nine articles were included (3 case-controls and 6 cohorts). Overall, the authors identified 1,253 cases of GAC 2,501 controls in case-control studies, and 1,631 patients with GAC enrolled in cohort studies. Patients presenting PD increased the risk of developing GAC by 17 % (RR=1.17; 95 % CI 1.03‒1.32), which remained regardless of the diagnostic method for PD, i.e., clinical examination (RR = 1.19; 95 % CI 1.14‒1.24) and self-report (RR = 1.34; 95 % CI 1.06‒1.69). Moreover, Asian patients (RR=1.17; 95 % CI 1.00‒1.36) with PD had a higher risk of having GAC than American and European patients (RR = 1.18; 95 % CI 0.84‒1.66).

CONCLUSIONS

The presence of PD the risk of GAC suggesting that its infectious-inflammatory process of PD may be related to GAC development. Further investigations on the oral-gastric microbiota and its role in the carcinogenesis of gastric cancer should be carried out, and the screening of patients with potential risk for GAC should be considered in the clinical practice of dentists.

Putative Bidirectionality of Chronic Obstructive Pulmonary Disease and Periodontal Disease: A Review of the Literature

The prevalence of chronic obstructive pulmonary disease (COPD) is increasing worldwide and is currently the third leading cause of death globally. The long-term inhalation of toxic substances, mainly cigarette smoke, deteriorates pulmonary function over time, resulting in the development of COPD in adulthood. Periodontal disease is an inflammatory condition that affects most adults and is caused by the bacteria within dental plaque. These bacteria dissolve the gums around the teeth and the bone that supports them, ultimately leading to tooth loss. Periodontal disease and COPD share common risk factors, such as aging and smoking. Other similarities include local chronic inflammation and links with the onset and progression of systemic diseases such as ischemic heart disease and diabetes mellitus. Understanding whether interventions for periodontal disease improve the disease trajectory of COPD (and vice versa) is important, given our rapidly aging society. This review focuses on the putative relationship between COPD and periodontal disease while exploring current evidence and future research directions.

Validity of Simple Self-Reported Periodontal Status Questions

OBJECTIVE

The aim of this research was to evaluate the validity of the questions developed by Thai periodontists on self-reported periodontal status and symptoms in identifying severe periodontitis amongst adults in Thailand.

METHODS

Registered Electricity Generating Authority of Thailand (EGAT) employees completed medical examinations and full-mouth periodontal examinations. They also were interviewed using a self-reported questionnaire that was developed by Thai periodontists. The questions pertained to their periodontal status and symptoms comprising swollen gums, bad breath, loose teeth, bleeding on brushing, painful gums, and pus or abscesses. The participants were categorised as having nonsevere and severe periodontitis according to the Centers for Disease Control and Prevention in partnership with the American Academy of Periodontology (CDC/AAP) case definitions. Self-reported periodontal status and symptom results were compared with actual periodontal status. The area under the receiver operating characteristic curve (AUROCC), sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated.

RESULTS

A total of 1393 EGAT employees participated in this study. The questions on self-reported periodontal status and all symptoms poorly identified patients with severe periodontitis, with an AUROCC of 0.52 to 0.60. The sensitivity was 5.0% to 40.2%; however, the specificity was good, at 73.2% to 99.1%. The validity of the self-reported questions was comparable amongst the sex, education, and income subgroups.

CONCLUSIONS

This study demonstrated that self-reported periodontal status and symptoms were inadequate in identifying patients with severe periodontal disease.

Who to Be Treated: Nomogram Using Self-Reported Periodontal Screening Instrument among English-Speaking Adults in Multi-Ethnic Singapore

Periodontal disease is a major public health problem. This study aimed to develop a nomogram using a self-reported periodontitis screening instrument in predicting severe periodontitis (SP), defined by the World Workshop on Classification of Periodontal and Peri-Implant Diseases and Conditions, and evaluate its utility in clinical setting. An Akaike information criterion selected multivariable model was developed to predict SP using a self-reported questionnaire, with a nomogram developed based on its regression coefficients. Discriminatory capability was evaluated by Receiver-operating characteristic curve. Ability to predict SP of individual patients was evaluated with bootstrapping. Decision curve analysis (DCA) was performed to evaluate its potential clinical utility by evaluating clinical net benefit at different thresholds. 58.1% of 155 participants were classified with SP. Older males without tertiary education, with ‘loose teeth’, ‘bone loss’ and ‘mouth rinse use’ had higher SP risk. The nomogram showed excellent discriminatory capability with Area under Curve of 0.83 (95% CI = (0.76, 0.89)), good calibration (intercept = 0.026) and slight overestimation of high risk and underestimation of low risk (slope = 0.834). DCA showed consistent clinical net benefit across the range of thresholds relative to assumption of ‘no patient’ or ‘all patient’ with SP. Our nomogram using a self-reported periodontitis instrument is useful in SP screening in English-speaking Singaporean adults.

Self-reported questionnaire on periodontal condition validated for use in Brazil

There is a current expectation of instruments for periodontal condition surveillance worldwide. The present study aimed to validate the Oral Health Questions Set B (OHQB) for the Brazilian Portuguese and evaluate its temporal stability. This is a sequential mixed-method investigation. After the forward-backward translation process to the Brazilian Portuguese, the OHQB Brazil (OHQB-Br) was applied to 156 participants (39.5 ± 14.14 years; 51.9% males). In sequence, through a full-mouth six-sites/teeth examination and in accordance with the original instrument, the periodontal diagnosis was obtained (March 2020). In January 2021, the OHB-BR was reapplied (n = 71). Ordinal alpha and McDonald's omega tested the internal consistency of the OHQB-Br. Temporal stability was investigated [Spearman correlation, intraclass correlation coefficient (ICC), and the Bland-Altman]. The concurrent validity was also verified, considering the periodontal clinical diagnosis (Kruskal Wallis). The ordinal alpha (0.69) and McDonald's omega (0.73) coefficients showed an adequate internal consistency of the OHQB-Br. The OHQB-Br temporal stability was high, as demonstrated by the Spearman coefficient (0.80) and ICC (0.79) and by the Bland-Altman plot. A concurrent validity showed a direct relationship between the OHQB-Br and the clinical condition of no periodontitis, mild, moderate, and severe periodontitis (p < 0.05). Because the OHQB-Br shows internal validity, temporal stability, and adequately identifies periodontal health and moderate/severe periodontitis, the instrument might represent an important tool, at the public level or other settings, for periodontal surveillance in Brazil.

Microbiome differences in periodontal, peri-implant, and healthy sites: a cross-sectional pilot study

OBJECTIVES

To explore microbial communities associated with health and disease status around teeth and dental implants.

MATERIALS AND METHODS

A total of 10 healthy, 24 periodontitis, and 24 peri-implant sites from 24 patients were sequenced by next-generation sequencing. Microbial DNA was extracted and 16S rRNA gene was amplified. Bioinformatic analyses were performed using quantitative insights into microbial ecology (QIIME), linear discriminant analysis effect size (LEfSE), and STAMP.

RESULTS

Differences in microbial diversity across three types of sites were not statistically significant. Several genera and species were more prevalent in healthy compared with diseased sites, including Lautropia, Rothia and Capnocytophaga and Kingella. Among diseased sites, Peptostreptococcaceae, Dialister, Mongibacterium, Atopobium, and Filifactor were over-represented in peri-implantitis sites, while Bacteroidales was more abundant in periodontitis sites.

CONCLUSIONS

Diseased periodontal and peri-implant sites and corresponding healthy sites have distinct microbiological profiles. These findings suggest that microbial analyses could identify biomarkers for periodontal health and disease and lead to the development of new strategies to improve periodontal health and treat peri-implant and periodontal diseases.

CLINICAL RELEVANCE

The study contributes to improving our understanding of healthy, periodontally affected, and peri-implantitis sites which can improve our ability to diagnose, monitor, and manage these oral conditions.

Self-perception of periodontal health status among individuals with Fanconi anemia

INTRODUCTION

Fanconi anemia (FA) is a rare genetic disease characterized by congenital malformations and bone marrow failure. One of the most common oral diseases in individuals with FA is periodontitis and adequate self-perception of periodontal status could contribute to its prevention and early detection.

AIM

To compare oral health self-perception, measured by a questionnaire, with the clinical oral condition of patients with FA.

METHODS AND RESULTS

Fifty-six patients with FA, over 11 years of age, answered a questionnaire about dental history and self-reported oral health. Decayed, missing, and filled teeth (DMFT), Visible Plaque Index (VPI) and Gingival Bleeding Index (GBI) were measured. The median age of participants was 21 years (min 11, max 44), 31 (55%) were females and 25 (45%) males. Thirty-five (62.5%) participants rated their oral condition as satisfactory and 7 (12.5%) participants reported tooth mobility, 10 (17.9%) exposed roots and 21 (37.5%) gingival bleeding. Clinical examination detected average DMFT = 5.23, VPI = 31.36% and GBI = 33.77%. The gingival bleeding report was more frequent among individuals with higher GBI (p =  0.014). The DMFT was higher in those who had already undergone dental treatments (p =  0.031). There was an association between participants who presented dental caries and who rated their oral health as poor (p =  0.03). The question "Do your gums bleed easily?" had good accuracy in the evaluation of periodontal disease (p =  0.68).

CONCLUSION

Oral health self-perception of individuals with FA about gingival inflammation was associated with their gingival bleeding index.

Modelling the Validity of Periodontal Disease Screening Questions in a Nondental Clinical Setting

OBJECTIVE

Periodontal examinations are time-consuming and potentially uncomfortable for recipients. We modelled if self-reported questions alone, or combined with objective evidence of periodontal bone loss observable from radiographs, are accurate predictors of periodontitis.

METHODS

Self-reported data from the Australian National Survey of Adult Oral Heath 2004-06 were compared with clinical periodontal examinations to assess the validity of 8 periodontitis screening questions in predicting moderate/severe periodontitis. To model alveolar bone loss, a proxy variable simulating radiographic clinical attachment level (rCAL) was created. Three multivariable binary logistic regression models were constructed: responses to 8 screening questions alone (Model 1), screening questions combined with 5 classic periodontitis risk indicators (age, sex, smoking status, country of birth, and diabetes status) (Model 2), and the addition of rCAL (Model 3). Predictive validity was determined via sensitivity (Se) and specificity (Sp) scores and graphically represented using area under the receiver operator characteristic curves (AUROC).

RESULTS

Data from 3630 participants periodontally examined determined that 32.4% exhibited periodontitis. Periodontitis risk indicators were all significantly associated with periodontitis case status. Six of 8 screening questions (Model 1) were weak periodontitis predictors (Se = 0.28; Sp = 0.89; AUROC = 0.61). Combining 13 variables for (Model 2) improved prediction (Se = 0.55; Sp = 0.81; AUROC = 0.77). The addition of rCAL (Model 3) improved diagnostic capacity considerably (AUROC = 0.86).

CONCLUSIONS

Self-reported questions combined with classic risk indicators are "useful" for periodontitis screening. Addition of radiographs markedly improved diagnostic validity. Based on modelling, nondental health care professionals may provisionally screen for periodontitis with minimal training.

Diagnostic accuracy of self-reported measures of periodontal disease: A clinical validation study using the 2017 case definitions

AIM

To clinically validate a self-reported questionnaire for periodontal disease and assess its accuracy for differentiating periodontal health and different stages of periodontitis.

METHODS

A Chinese (Cantonese) version of a self-reported questionnaire was prepared by translating and validating the original English questions proposed by the Centers for Disease Control and Prevention/American Academy of Periodontology (CDC/AAP). The utility of the CDC/AAP questionnaire and its individual questions was assessed against a full-mouth periodontal examination. Periodontal case definition was based on the 2017 World Workshop classification of periodontal diseases. Multivariable logistic regression and the area under the receiver operating characteristic curve (AUROC) analysis were performed to assess the accuracy of the questionnaire.

RESULTS

408 subjects enrolled in this study, including those with periodontal health (16.2%), gingivitis (15.2%), Stages I/II periodontitis (31.8%) and Stages III/IV periodontitis (36.8%). Overall, the questionnaire had poor accuracy in detecting the presence of Stages I/II periodontitis with an AUROC 0.608. While it showed moderate to high accuracy for identifying periodontal disease (gingivitis and periodontitis), periodontitis and Stages III/IV periodontitis with an AUROC of 0.837, 0.803 and 0.870, respectively. Self-reported measures in combination with age and tobacco smoking showed excellent performance for identifying Stages III/IV periodontitis with a high AUROC of 0.953, a sensitivity of 95.7%, and a specificity of 89.0%. Specific questions and combinations provided greater utility to discriminate the various periodontal case definitions.

CONCLUSIONS

The self-reported CDC/AAP questionnaire may be a feasible tool for detecting periodontitis, and its combination with demographic and lifestyle factors is useful for the identification of individuals with Stages III/IV periodontitis. This questionnaire seems less helpful in screening of Stages I/II periodontitis. Further studies are needed to test the validity in larger community-based populations.

Public Health Aspects of Periodontitis: Recent Advances and Contributions by Dr. Robert J. Genco

Purpose of review

This review provides an overview of the objectives, activities and accomplishments of the CDC-AAP collaboration on public health aspects of periodontitis focusing mostly on surveillance. Dr. Robert Genco was co-chair of this effort.

Recent findings

This initiative developed new standard periodontitis case definitions for surveillance and implemented for the first time a full-mouth periodontal examination protocol for NHANES 2009 -2014. Measurements from this survey resulted in significantly greater estimate for the national prevalence of periodontitis in US adults and our understanding of population risk factors associations with periodontitis. Notably, this initiative also developed, and validated field-testing a battery of eight questions for multivariable modeling of self-report measures for predicting periodontitis in populations.

Summary

This Initiative resulted in significant improvements of surveillance of periodontitis and produced unique findings with important implications for advancing our understanding of population aspects of periodontitis in US adults at the national, state, and local levels.

Validation of maternal report of early childhood caries status in Ile-Ife, Nigeria

Background

To determine the validity of maternal reports of the presence of early childhood caries (ECC), and to identify maternal variables that increase the accuracy of the reports.

Methods

This secondary data analysis included 1155 mother–child dyads, recruited through a multi-stage sampling household approach in Ile-Ife Nigeria. Survey data included maternal characteristics (age, monthly income, decision-making ability) and maternal perception about whether or not her child (age 6 months to 5 years old) had ECC. Presence of ECC was clinically determined using the dmft index. Maternally reported and clinically determined ECC presence were compared using a chi-squared test. McNemar's test was used to assess the similarity of maternal and clinical reports of ECC. Sensitivity, specificity, positive and negative predictive values, absolute bias, relative bias and inflation factor were calculated. Statistical significance was determined at p < 0.05.

Results

The clinically-determined ECC prevalence was 4.6% (95% Confidence interval [CI]: 3.5–5.0) while the maternal-reported ECC prevalence was 3.4% (CI 2.4–4.6). Maternal reports underestimated the prevalence of ECC by 26.1% in comparison to the clinical evaluation. The results indicate low sensitivity (9.43%; CI 3.13–20.70) but high specificity (96.9%; CI 95.7–97.9). The positive predictive value was 12.8% (CI 4.3–27.4) while the negative predictive value was 95.7% (CI 94.3–96.8). The inflation factor for maternally reported ECC was 1.4. Sensitivity (50.0%; CI 6.8–93.2) and positive predictive value were highest (33.3%; CI 4.3–77.7) when the child had a history of visiting the dental clinic.

Conclusions

Mothers under-reported the presence of ECC in their children in this study population. The low sensitivity and positive predictive values of maternal report of ECC indicates that maternal reporting of presence of ECC may not be used as a valid tool to measure ECC in public health surveys. The high specificity and negative predictive values indicate that their report is a good measure of the absence of ECC in the study population. Child’s history of dental service utilization may be a proxy measure of presence of ECC.

Prevalence and Associated Factors of Self-Reported Gingival Bleeding: A Multicenter Study in France

Gingival bleeding (GB) is a common sign of gingival inflammation which indicates the presence of periodontal diseases. This cross-sectional multicenter survey aimed to assess the prevalence of self-reported gingival bleeding (SRGB) in French adults and identify the main associated factors. A questionnaire-based interview was randomly proposed to 794 individuals in four French cities (Nancy, Montpellier, Paris, and Rennes). Subjects were recruited in preventive medicine centers (50%), railway stations, and malls (50%). The questionnaire comprised 25 items: SRGB characteristics, socioeconomic variables, oral hygiene habits, use of drugs, and anxiety level. The overall prevalence of SRGB was 63.2% [59.8%; 66.6%], with 58.7% bleeding after toothbrushing and 4.5% spontaneous bleeding. Males reported significantly lower SRGB prevalence than females (p = 0.04). The distribution of SRGB frequency was inversely proportional to age (p < 0.0001). No association between drug use and SRGB was found. The people interviewed in the preventive medicine centers reported the highest frequency of SRGB (p < 0.0001). In the multivariate logistic model, SRGB was significantly related to occupation, smoking status, brushing frequency, and anxiety level. In conclusion, SRGB was prevalent in more than half of the sample and was mainly associated with age, toothbrushing frequency, and anxiety level. Thus, providing information to patients about the importance of this oral manifestation may play an important role in preventing periodontal diseases.

Cross-sectional study of age-specific differences in salivary occult blood test results in older adults

This study aimed to identify factors associated with poor oral health status, as indicated by salivary occult blood (SOB) level, in community-dwelling older adults. A total of 592 community-dwelling participants aged 70 to 84 years with 20 to 28 teeth participated in the survey and SOB evaluation. Survey items included behaviors during dental visits, systemic diseases, smoking habit, cognitive function, and findings of intraoral examination. To identify factors associated with high SOB levels, binomial logistic regression analysis was performed after classifying participants as having high and low SOB on the basis of 75th-percentile SOB measurements. Presence of dental plaque (odds ratio [OR]: 2.26), poor subjective oral health (OR: 2.99) (for the age group 70 to 74 years), fewer remaining teeth (OR: 0.80), no dental visits during the previous year (OR: 2.80) (for the age group 75 to 79 years), and no dental visits during the previous year (OR: 3.93) (for the age group 80 to 84 years) were significantly associated with high SOB levels. The factors associated with high SOB, which indicates poor oral health status, differed by age group in community-dwelling older adults. Therefore, oral health management may improve oral health by providing different age groups with care that accounts for their physical and social functional abilities.

Self-reported and clinical periodontal conditions in a group of Eastern European postpartum women

Periodontitis is a highly prevalent condition leading to a continuous destruction of tooth-supporting tissues. It increases the risk for various systemic diseases and adverse pregnancy outcomes. Therefore, screening for periodontitis is important. Screening measures can range from self-reported symptoms to clinical full-mouth periodontal examination. The hypothesis of our study was that self-reported parameters and clinical definition perform equally well in identifying periodontitis patients. The aim of this study was to develop, validate its internal consistency, and evaluate a self-reported instrument against periodontal clinical evaluation for diagnosis of periodontitis in a group of postpartum women, as well as to describe their periodontal status and the risk factors associated with periodontal disease. A cross-sectional study on postpartum women was conducted in a tertiary university hospital, from April 2018 to March 2019. Sociodemographic and behavioral data, periodontal clinical parameters, and self-reported periodontal perception were collected. A 16-item questionnaire was developed to obtain information about perceived periodontal alterations and oral hygiene habits. The utility of the questionnaire was tested against a periodontal diagnosis based on a full-mouth periodontal examination. The questionnaire was applied in 215 postpartum women aged 29.16±5.54 years (mean age (y) ± standard deviation) having the following periodontal status: 16 individuals without periodontal disease (7.44%), 32 individuals with gingivitis (14.88%), 19 individuals with mild periodontitis (8.84%), 132 individuals with moderate periodontitis (61.39%), and 16 individuals with severe periodontitis (7.44%). A significant association was observed between oral hygiene score, smoking status, and periodontal conditions (p<0.05). A significant association between the self-reported items related to “gum swelling”, “halitosis”, “previous periodontal diagnosis” and “previous periodontal treatment” with clinical periodontitis have been identified (p<0.05). Using self-reported questionnaires for detection of periodontal disease was ineffective in our studied population, since self-reported parameters and clinical definition do not appear to perform equally in identifying periodontitis cases. Clinical periodontal examination remains the gold standard for screening. Periodontitis was frequent in our group and the severity was significantly associated with the oral hygiene score and smoking. These results underline the necessity for periodontal clinical examination during pregnancy.

Validity of Self-Reported Periodontitis in Japanese Adults: The Japan Public Health Center-Based Prospective Study for the Next-Generation Oral Health Study

This study evaluated the validity of self-reported periodontitis measures among 2404 Japanese adults aged 40 to 75 years. A self-administered questionnaire survey and a clinical periodontal examination were conducted from 2013 through 2016. The self-reported periodontitis questions included 3 sociodemographic, 3 health, and 5 periodontal health-related items. Based on the clinical case definition of periodontitis, 26.5% of participants were found to be periodontally healthy, 2.7% had mild periodontitis, 55.2% moderate periodontitis, and 15.6% severe periodontitis. No single self-reported question demonstrated satisfactory validity in predicting the presence or absence of periodontitis. The predictive ability in mild and/or moderate periodontitis was poor even after combining multiple sociodemographic, health, and periodontal health-related questions. In severe periodontitis, the model including age, sex, education level, smoking status, diabetes history, body mass index, informed by a dentist, gingival bleeding, calculus deposit, and tooth mobility, presented moderate predictive performance (C-statistic: 0.676, sensitivity: 65.2%, and specificity: 61.1%). An age-stratified analysis on severe periodontitis showed that sensitivity was higher, and specificity was lower in older age group (60-75 years) than younger age group (40-59 years). Further refinement of questions in the self-report is required to increase the accuracy of the prediction of clinical periodontitis.

Recent epidemiologic trends in periodontitis in the USA

The most important development in the epidemiology of periodontitis in the USA during the last decade is the result of improvements in survey methodologies and statistical modeling of periodontitis in adults. Most of these advancements have occurred as the direct outcome of work by the joint initiative known as the Periodontal Disease Surveillance Project by the Centers for Disease Control and Prevention and the American Academy of Periodontology that was established in 2006. This report summarizes some of the key findings of this important initiative and its impact on our knowledge of the epidemiology of periodontitis in US adults. This initiative first suggested new periodontitis case definitions for surveillance in 2007 and revised them slightly in 2012. This classification is now regarded as the global standard for periodontitis surveillance and is used worldwide. First, application of such a standard in reporting finally enables results from different researchers in different countries to be meaningfully compared. Second, this initiative tackled the concern that prior national surveys, which used partial-mouth periodontal examination protocols, grossly underestimated the prevalence of periodontitis of potentially more than 50%. Consequently, because previous national surveys significantly underestimated the true prevalence of periodontitis, it is not possible to extrapolate any trend in periodontitis prevalence in the USA over time. Any difference calculated may not represent any actual change in periodontitis prevalence, but rather is a consequence of using different periodontal examination protocols. Finally, the initiative addressed the gap in the need for state and local data on periodontitis prevalence. Through the direct efforts of the Centers for Disease Control and Prevention and the American Academy of Periodontology initiative, full-mouth periodontal probing at six sites around all nonthird molar teeth was included in the 6 years of National Health and Nutrition Examination Surveys from 2009-2014, yielding complete data for 10 683 dentate community-dwelling US adults aged 30 to 79 years. Applying the 2012 periodontitis case definitions to the 2009-2014 National Health and Nutrition Examination Surveys data, the periodontitis prevalence turned out to be much greater than previously estimated, namely affecting 42.2% of the population with 7.8% of people experiencing severe periodontitis. It was also discovered that only the moderate type of periodontitis is driving the increase in periodontitis prevalence with age, not the mild or the severe types whose prevalence do not increase consistently with age, but remain ~ 10%-15% in all age groups of 40 years and older. The greatest risk for having periodontitis of any type was seen in older people, in males, in minority race/ethnic groups, in poorer and less educated groups, and especially in cigarette smokers. The Centers for Disease Control and Prevention and the American Academy of Periodontology initiative reported, for the first time, the periodontitis prevalence estimated at both local and state levels, in addition to the national level. Also, this initiative developed and validated in field studies a set of eight items for self-reported periodontitis for use in direct survey estimates of periodontitis prevalence in existing state-based surveys. These items were also included in the 2009-2014 National Health and Nutrition Examination Surveys for validation against clinically determined cases of periodontitis. Another novel result of this initiative is that, for the first time, the geographic distribution of practicing periodontists in relation to the geographic distribution of people with severe periodontitis is illustrated. In summary, the precise periodontitis prevalence and distribution among subgroups in the dentate US noninstitutionalized population aged 30-79 years is better understood because of application of valid periodontitis case definitions to full-mouth periodontal examination, in combination with reliable information on demographic and health-related measures. We now can monitor the trend of periodontitis prevalence over time as well as guide public health preventive and intervention initiatives for the betterment of the health of the adult US population.

Influence of smoking on periodontal healing one year after active treatment

OBJECTIVE

To investigate the impact of smoking on the reduction of pockets >4 mm deep and a composite variable of residual pockets >4 mm and bleeding on probing (BoP) after treatment.

METHODS

Eligible after exclusion due to missing records were 3,535 individuals, referred for periodontal treatment between 1980 and 2015. The number of teeth (NT), probing pocket depth (PPD), proportion of plaque (PLI) and BoP were registered before treatment and 1 year after treatment. To analyse the impact of smoking on PPD reduction, a mixed model adjusted for age, sex, type of therapy, baseline PPD, reduction of PLI, BoP and NT was used. Depending on residual PPD and BoP, two categories were created: good and poor responders.

RESULTS

PLI was reduced by 20% in non-smokers and by 18% in smokers, and BoP by 46% and 37%, respectively. In the adjusted mixed model, the mean reduction of PPD > 4 mm among smokers undergoing surgery was 14.4 versus 9.7 in non-smokers (p < .001). The odds ratio for being a poor responder was 2.40 (95% CI 1.99-2.91, p < .001) for smokers.

CONCLUSION

Although surgical treatment reduced PPD >4 mm in smokers more effectively than in non-smokers, significantly more non-smokers were good responders after periodontal therapy.

Validity of self-reported periodontal measures, demographic characteristics, and systemic medical conditions

BACKGROUND

The objective of the present study was to assess self-reported periodontal screening questions, demographic characteristics, systemic medical conditions, and tobacco use for predicting periodontal disease among individuals seeking dental therapy in a university dental clinic.

METHODS

In this retrospective study, a total of 4,890 randomly selected dental charts were evaluated from among patients who had attended the University of Minnesota School of Dentistry clinics for treatment. Radiographic bone loss measurements were used to assess the severity of periodontal disease. Demographic characteristics as well as medical history of the patients were also recorded. Five self-reported periodontal screening questions were included, with answers limited to Yes/No. Generalized logit models were used to assess the association between bone loss and the predictors.

RESULTS

The sample's mean age was 54.1 years and included 52.6% males and 14.9% smokers, with a mean of 3.5 missing teeth. Self-reported tooth mobility, history of "gum treatment," and the importance of retaining teeth as well as age, tobacco use, and cancer were statistically significant predictors (P < 0.05) of a radiographic diagnosis of moderate and severe periodontal disease. With respect to severe periodontal disease, significant associations (P < 0.05) were also found with "bleeding while brushing," gender, diabetes, anxiety, and arthritis.

CONCLUSIONS

Self-reported periodontal screening questions as well as demographic characteristics, smoking, and systemic medical conditions were significant predictors of periodontal disease, and they could be used as valid, economic, and practical measures.

A patient-reported questionnaire developed in a German early arthritis cohort to assess periodontitis in patients with rheumatoid arthritis

Background

The aim of this study was to develop a patient-reported questionnaire that is suitable to detect periodontitis (PD) in patients with rheumatoid arthritis (RA).

Methods

A self-reported questionnaire containing 12 items potentially relevant to PD and dentists’ semiquantitative assessment of PD (no/mild/moderate/severe) was obtained from 353 patients from an early arthritis cohort. Available radiographs (n = 253) and blinded assessment of 3 independent dentists were used for validation. By defining the dentists’ assessment as the reference standard, relevant questionnaire items were identified with factor analysis methods. Receiver operator characteristic (ROC) plots were used to determine sensitivities and specificities to detect PD in varying severity. Ordinal regression models were used to determine the coefficients for the final score.

Results

Seventy percent had at least mild PD. The items from the questionnaire correlating best with the dentists’ assessment were selected for a final 6-item score (number of teeth, gum pockets, receding gums, loose teeth, receding jaw bone and tooth extractions and age). For the detection of any/moderate/severe PD, the bias-corrected areas under the curve (AUC) were 0.81/0.83/0.90. Sensitivity to detect mild PD was 85% and specificity 57%. Very high specificity was achieved for the detection of severe PD with 99% at the cost of low sensitivity (28%).

Conclusions

This patient-reported six-item score has moderate diagnostic properties to study PD in RA patients in epidemiological settings. We propose to use the score as a measure of periodontitis without applying cut-off values.

Dental Cleaning, Community Water Fluoridation and Preterm Birth, Massachusetts: 2009-2016

Objectives Data on the potential effect of dental cleaning and community water fluoridation (CWF) on pregnancy outcomes are scarce. While numerous studies confirm the cost-effectiveness of fluoride in preventing dental caries, the benefit of CWF during pregnancy has not been well established. Methods This cross-sectional study used data from 2009 to 2016 Massachusetts Pregnancy Risk Assessment Monitoring System and restricted to singleton live births (n = 9234, weighted response rate = 64.3%). Our exposures were: (1) dental cleaning alone during pregnancy; (2) CWF alone; and (3) dental cleaning and CWF combined (DC-CWF). Women without dental cleaning during pregnancy and CWF comprised our reference group. The outcome was preterm birth, (birth < 37 weeks gestation). This study used multivariate logistic regression modeling, controlling for maternal sociodemographic characteristics, previous medical risk and behavioral factors, and calculated adjusted risk ratios (aRRs) and 95% confidence intervals (CIs). Results During 2009-2016, the prevalence of preterm birth among women with a singleton live birth was 8.5% in Massachusetts. Overall, 58.7% of women had dental cleaning during pregnancy, and 63.6% lived in CWF. After adjusting for potential confounders, the associations between dental cleaning alone and preterm birth (aRR = 0.74 [95% CI 0.55-0.98]), and DC-CWF and preterm birth (aRR = 0.74 [95% CI 0.57-0.95]) were significant, while the association between CWF alone and preterm birth was not significant (aRR = 0.81 [95% CI 0.63-1.05]), compared to women without dental cleaning and CWF. Conclusions for Practice This study shows that the prevalence of preterm birth was lower among women with DC only and DC-CWF.

Development of a self-report questionnaire designed for population-based surveillance of gingivitis in adolescents: assessment of content validity and reliability

The major infectious diseases in Chile encompass the periodontal diseases, with a combined prevalence that rises up to 90% of the population. Thus, the population-based surveillance of periodontal diseases plays a central role for assessing their prevalence and for planning, implementing, and evaluating preventive and control programs. Self-report questionnaires have been proposed for the surveillance of periodontal diseases in adult populations world-wide.

A Clinical Validation of Self-Reported Periodontitis Among Participants in the Black Women's Health Study

BACKGROUND

There is a paucity of data on the validity of self-report of periodontal disease in African Americans. The Black Women's Health Study (BWHS), a United States national cohort study of 59,000 black women followed via mailed questionnaires since 1995, offered the opportunity to clinically validate self-reported periodontitis among a sample of participants.

METHODS

Oral health questionnaires were sent to study participants residing in Massachusetts. Respondents living in the Boston metro area were invited for clinical examination. Self-reports were compared with clinical data obtained from the 77 women (mean age: 59 years) who were examined. The authors examined the predictive ability of individual and combined questionnaire items with respect to clinical periodontal disease severity. Validation parameters were calculated for each question, and receiver operating characteristic statistics were generated to compare questionnaire items.

RESULTS

Periodontitis prevalence in the validation sample was 24% for severe periodontitis and 61% for moderate disease. Performance of individual questionnaire items with respect to predicting periodontitis was better for severe compared with moderate disease. Combinations of questionnaire items improved the predictive ability with respect to severe disease beyond that of individual questionnaire items.

CONCLUSIONS

Prevalence of severe periodontitis was similar to other age-comparable populations, without regard for race or sex, whereas prevalence of total periodontitis (moderate and severe) among women of similar age and/or race was much higher. Predictive ability of questionnaire items assessed in the BWHS was similar to that in other studies.

Oral health status in adult patients with newly diagnosed acute leukemia

BACKGROUND

The aim of this cross-sectional study was to evaluate the oral health of adult patients with newly diagnosed acute leukemia.

METHODS

Patients with initially diagnosed acute myeloid (AML) or lymphocytic (ALL) leukemia and a matched healthy control (HC) group were included. The oral investigation comprised inspection of the oral mucosa; the decayed (D), missing (M), and filled (F) teeth (DMF-T) index; and a detailed periodontal status. Subgingival biofilm samples were analyzed (polymerase chain reaction) for the presence of selected potentially periodontal pathogenic bacteria. Statistical analysis was performed using Fisher's exact test, chi-squared test, and Mann-Whitney U test (significance level α = 5%).

RESULTS

Thirty-nine patients with leukemia (AML 26, ALL 13) and 38 HCs were included. Oral mucosal findings were present in 62% of L compared to 0% of HC patients, whereby gingival hyperplasia was the most detected finding. Furthermore, a higher caries prevalence in leukemia patients was shown (D value 3.64 ± 3.98 vs. 0.72 ± 1.72, p < 0.01). The periodontal parameters were poorer in leukemia patients. No substantial differences in microbiological findings of selected bacteria were detected within L group and between L and HC patients.

CONCLUSION

The high prevalence of oral diseases supports the demand of an early and consequent dental treatment of leukemia patients, especially considering subsequent therapy.

Predicting Periodontitis at State and Local Levels in the United States

The objective of the study was to estimate the prevalence of periodontitis at state and local levels across the United States by using a novel, small area estimation (SAE) method. Extended multilevel regression and poststratification analyses were used to estimate the prevalence of periodontitis among adults aged 30 to 79 y at state, county, congressional district, and census tract levels by using periodontal data from the National Health and Nutrition Examination Survey (NHANES) 2009-2012, population counts from the 2010 US census, and smoking status estimates from the Behavioral Risk Factor Surveillance System in 2012. The SAE method used age, race, gender, smoking, and poverty variables to estimate the prevalence of periodontitis as defined by the Centers for Disease Control and Prevention/American Academy of Periodontology case definitions at the census block levels and aggregated to larger administrative and geographic areas of interest. Model-based SAEs were validated against national estimates directly from NHANES 2009-2012. Estimated prevalence of periodontitis ranged from 37.7% in Utah to 52.8% in New Mexico among the states (mean, 45.1%; median, 44.9%) and from 33.7% to 68% among counties (mean, 46.6%; median, 45.9%). Severe periodontitis ranged from 7.27% in New Hampshire to 10.26% in Louisiana among the states (mean, 8.9%; median, 8.8%) and from 5.2% to 17.9% among counties (mean, 9.2%; median, 8.8%). Overall, the predicted prevalence of periodontitis was highest for southeastern and southwestern states and for geographic areas in the Southeast along the Mississippi Delta, as well as along the US and Mexico border. Aggregated model-based SAEs were consistent with national prevalence estimates from NHANES 2009-2012. This study is the first-ever estimation of periodontitis prevalence at state and local levels in the United States, and this modeling approach complements public health surveillance efforts to identify areas with a high burden of periodontitis.

Diagnostic accuracy of a combination of salivary hemoglobin levels, self-report questionnaires, and age in periodontitis screening

PURPOSE

This study evaluated the predictive performance of a combination of self-report questionnaires, salivary hemoglobin levels, and age as a non-invasive screening method for periodontitis.

METHODS

The periodontitis status of 202 adults was examined using salivary hemoglobin levels, responses to 10 questions on a self-report questionnaire, and the Community Periodontal Index (CPI). The ability of those two variables and the combination thereof with age to predict the presence of CPI scores of 3-4 and 4 was assessed using logistic regression and receiver operating characteristic (ROC) curve analysis.

RESULTS

CPI scores of 3-4 and 4 were present among 79.7% and 46.5% of the sample, respectively. The area under the ROC curves (AUROCs) of salivary hemoglobin levels for predicting prevalence of CPI scores of 3-4 and 4 were 0.63 and 0.67, respectively (with sensitivity values of 71% and 60% and specificity values of 56% and 72%, respectively). Two distinct sets of five questions were associated with CPI scores of 3-4 and 4, with AUROCs of 0.73 and 0.71, sensitivity values of 76% and 66%, and specificity values of 63% and 69%. The combined model incorporating both variables and age showed the best predictive performance, with AUROCs of 0.78 and 0.76, sensitivity values of 71% and 65%, and specificity values of 68% and 77% for CPI scores of 3-4 and 4, respectively.

CONCLUSIONS

The combination of salivary hemoglobin levels and self-report questionnaires was shown to be a valuable screening method for detecting periodontitis.

Self-report of gingival problems and periodontitis in indigenous and non-indigenous populations in Chiapas, Mexico

OBJECTIVE

To estimate the prevalence of self-reported gingival and periodontal conditions and their association with smoking, oral hygiene, indigenous origin, diabetes and location (urban or rural) in indigenous and non-indigenous adults in Chiapas, Mexico.

METHODS

A cross-sectional study of 1,749 persons, ≥20 years of age, living in four rural and four urban marginal localities in Comitán (Chiapas, México). The variables investigated were: age; sex; indigenous origin; oral hygiene; halitosis; chewing ability; gingival conditions; periodontitis; smoking; alcoholism; diabetes; and location. Bivariate analysis and a logistic regression model were used to identify the association of periodontitis with the independent variables.

RESULTS

In total, 762 (43.6%) indigenous and 987 (56.4%) non-indigenous persons were interviewed. Their mean age was 41 ± 14 years, 66.7% were women and 43.8% lived in rural locations. Gingival problems were reported by 68.5% and periodontitis by 8.7%. In total, 17.9% had used dental services during the previous year, 28.7% wore a removable partial or a complete dental prosthesis, 63.7% had lost at least one tooth, the prevalence of diabetes was 9.2% and the prevalence of smoking was 12.2%. The logistic regression model showed that age, diabetes and the interaction between rural location and indigenous origin were associated with the presence of periodontitis.

CONCLUSIONS

Indigenous people living in rural areas are more likely to have periodontitis. It is necessary to promote oral health practices in indigenous and marginalised populations with a focus on community-oriented primary care.

Validation of periodontitis screening model using sociodemographic, systemic, and molecular information in a Korean population

BACKGROUND

This study aims to evaluate and validate a periodontitis screening model that includes sociodemographic, metabolic syndrome (MetS), and molecular information, including gingival crevicular fluid (GCF), matrix metalloproteinase (MMP), and blood cytokines.

METHODS

The authors selected 506 participants from the Shiwha-Banwol cohort: 322 participants from the 2005 cohort for deriving the screening model and 184 participants from the 2007 cohort for its validation. Periodontitis was assessed by dentists using the community periodontal index. Interleukin (IL)-6, IL-8, and tumor necrosis factor-α in blood and MMP-8, -9, and -13 in GCF were assayed using enzyme-linked immunosorbent assay. MetS was assessed by physicians using physical examination and blood laboratory data. Information about age, sex, income, smoking, and drinking was obtained by interview. Logistic regression analysis was applied to finalize the best-fitting model and validate the model using sensitivity, specificity, and c-statistics.

RESULTS

The derived model for periodontitis screening had a sensitivity of 0.73, specificity of 0.85, and c-statistic of 0.86 (P <0.001); those of the validated model were 0.64, 0.91, and 0.83 (P <0.001), respectively.

CONCLUSIONS

The model that included age, sex, income, smoking, drinking, and blood and GCF biomarkers could be useful in screening for periodontitis. A future prospective study is indicated for evaluating this model's ability to predict the occurrence of periodontitis.

Development and validation of a self-reported periodontal disease measure among Jordanians

BACKGROUND

The development of self-reported measures of periodontal disease would be of great benefit to facilitate epidemiological studies of periodontal disease on a larger scale, and to allow for surveillance of the periodontal condition of populations over time.

OBJECTIVES

To develop a culturally adapted self-reported measure of periodontal disease, test its predictive and discriminative validity and establish a cut-off value for this measure to diagnose periodontal disease.

METHODS

A total of 288 Jordanian adults completed the questionnaire assessing self-reported periodontal health (18 questions) and underwent periodontal examination. Of the 18 questions, six were significantly associated with at least one clinical definition of periodontitis and were used to constitute the self-reported periodontal disease measure. Receiver-operating characteristics (ROC) curve analyses were used to examine the overall discriminatory power, sensitivity and specificity, and corresponding cut-off points of the self-reported periodontal disease measure.

RESULTS

ROC analysis showed that the self-reported periodontal disease measure had an excellent performance to discriminate between those with and without periodontal disease, regardless of the clinical definition used. A score of 2, on a scale of 0 to 6, had the highest sensitivity and specificity to detect periodontal disease when defined by all study criteria. Significant associations were observed between self-reported periodontal disease measures and all clinical definitions in the regression analysis (the odds ratio ranged from 8.31 to 18.96), according to the clinical definition to be predicted.

CONCLUSION

Self-reported periodontal disease measures have excellent predictive and discriminative validity when tested against clinical definitions, and severity and extent of periodontal disease.

Validation of self-reported information on dental caries in a birth cohort at 18 years of age

Objective

Estimate the prevalence of dental caries based on clinical examinations and self-reports and compare differences in the prevalence and effect measures between the two methods among 18-year-olds belonging to a 1993 birth cohort in the city of Pelotas, Brazil.

Method

Data on self-reported caries, socio-demographic aspects and oral health behaviour were collected using a questionnaire administered to adolescents aged 18 years (n = 4041). Clinical caries was evaluated (n = 1014) by a dentist who had undergone training and calibration exercises. Prevalence rates of clinical and self-reported caries, sensitivity, specificity, positive and negative predictive values, absolute and relative bias, and inflation factors were calculated. Prevalence ratios of dental caries were estimated for each risk factor.

Results

The prevalence of clinical and self-reported caries (DMFT>1) was 66.5% (95%CI: 63.6%–69.3%) and 60.3% (95%CI: 58.8%–61.8%), respectively. Self-reports underestimated the prevalence of dental caries by 9.3% in comparison to clinical evaluations. The analysis of the validity of self-reports regarding the DMFT index indicated high sensitivity (81.8%; 95%CI: 78.7%–84.7%) and specificity (78.1%; 95%CI: 73.3%–82.4%) in relation to the gold standard (clinical evaluation). Both the clinical and self-reported evaluations were associated with gender, schooling and self-rated oral health. Clinical dental caries was associated with visits to the dentist in the previous year. Self-reported dental caries was associated with daily tooth brushing frequency.

Conclusions

Based on the present findings, self-reported information on dental caries using the DMFT index requires further studies prior to its use in the analysis of risk factors, but is valid for population-based health surveys with the aim of planning and monitoring oral health actions directed at adolescents.

Self-reported measures for surveillance of periodontitis

The purpose of this study was to evaluate the performance of self-reported measures in predicting periodontitis in a representative US adult population, based on 2009-2010 National Health and Nutrition Examination Survey (NHANES) data. Self-reported gum health and treatment history, loose teeth, bone loss around teeth, tooth not looking right, and use of dental floss and mouthwash were obtained during in-home interviews and validated against full-mouth clinically assessed periodontitis in 3,743 US adults 30 years and older. All self-reported measures (> 95% item response rates) were associated with periodontitis, and bivariate correlations between responses to these questions were weak, indicating low redundancy. In multivariable logistic regression modeling, the combined effects of demographic measures and responses to 5 self-reported questions in predicting periodontitis of mild or greater severity were 85% sensitive and 58% specific and produced an 'area under the receiver operator characteristic curve' (AUROCC) of 0.81. Four questions were 95% sensitive and 30% specific, with an AUROCC of 0.82 in predicting prevalence of clinical attachment loss ≥ 3 mm at one or more sites. In conclusion, self-reported measures performed well in predicting periodontitis in US adults. Where preferred clinically based surveillance is unattainable, locally adapted variations of these self-reported measures may be a promising alternative for surveillance of periodontitis.

Advances in surveillance of periodontitis: the Centers for Disease Control and Prevention periodontal disease surveillance project

The Centers for Disease Control and Prevention (CDC) has as one of its strategic goals to support and improve surveillance of periodontal disease. In 2003, the CDC initiated the CDC Periodontal Disease Surveillance Project in collaboration with the American Academy of Periodontology to address population-based surveillance of periodontal disease at the local, state, and national levels. This initiative has made significant advancements toward the goal of improved surveillance, including developing valid self-reported measures that can be obtained from interview-based surveys to predict prevalence of periodontitis in populations. This will allow surveillance of periodontitis at the state and local levels and in countries where clinical resources for surveillance are scarce. This work has produced standard case definitions for surveillance of periodontitis that are now widely recognized and applied in population studies and research. At the national level, this initiative has evaluated the validity of previous clinical examination protocols and tested new protocols on the National Health and Nutrition Examination Survey (NHANES), recommending and supporting funding for the gold-standard full-mouth periodontal examination in NHANES 2009 to 2012. These examinations will generate accurate estimates of the prevalence of periodontitis in the US adult population and provide a superior dataset for surveillance and research. Also, this data will be used to generate the necessary coefficients for our self-report questions for use in subsets of the total US population. The impact of these findings on population-based surveillance of periodontitis and future directions of the project are discussed along with plans for dissemination and translation efforts for broader public health use.

The association between maternal oral health experiences and risk of preterm birth in 10 states, Pregnancy Risk Assessment Monitoring System, 2004-2006

The aim of this study is to investigate the association between oral health experiences of women in the peripartum period and the risk of preterm delivery (<37 weeks). We analyzed 2004-2006 data from the CDC Pregnancy Risk Assessment Monitoring System (PRAMS), a population-based surveillance system that collects data on pregnancy and postpartum experiences of mothers who have recently delivered a live infant. Ten states included in the analysis had a ≥70% weighted response rate and three standard questions pertaining to oral health. White non-Hispanic (WNH), Black non-Hispanic (BNH), and Hispanic women were selected for analysis. Chi-squared analysis was performed for our bivariate analysis and multivariate logistic regression models were created to calculate adjusted odds ratios, controlling for socio-demographic characteristics and peripartum morbidities. Weighted percentages and standard errors were used for all analyses. Among the 35,267 women studied, in the multivariate analysis, mothers who did not receive dental care during pregnancy and did not have a teeth cleaning during pregnancy were at higher risk for delivering a preterm infant (OR 1.15, CI 1.02-1.30; OR 1.23, CI 1.08-1.41). In this population-based study, women who did not receive dental care or have a teeth cleaning during pregnancy were at slightly higher risk for preterm delivery after adjustment for pertinent confounders.

Validity of self-reported history of endodontic treatment in the Baltimore Longitudinal Study of Aging

INTRODUCTION

Self-reported history of endodontic treatment (SRHET) has been used as a simplified method to estimate the history of endodontic disease and treatment. This study aimed to quantify the validity of SRHET, as reported in the Baltimore Longitudinal Study of Aging (BLSA), as a method to identify individuals who experienced endodontic treatment (ET) and to identify individuals who present with apical periodontitis (AP).

METHODS

SRHET was collected through the BLSA questionnaire in 247 participants. Data on ET and AP were determined from panoramic radiographs. The total number of ET, AP, and missing teeth were recorded for each individual. The validity of SRHET was determined based on ET and AP separately. Accuracy, efficiency, sensitivity, specificity, positive and negative predictive values (+PV and -PV), and positive and negative likelihood ratios (+LR and -LR) were calculated according to standard methods.

RESULTS

After exclusions, 229 participants were available for ET analysis and 129 for AP analysis. The SRHET validity values were sensitivity (ET = 0.915, AP = 0.782), specificity (ET = 0.891, AP = 0.689), +PV (ET = 0.824, AP = 0.353), -PV (ET = 0.949, AP = 0.936), +LR (ET = 8.394, AP = 2.514), and -LR (ET = 0.095, AP = 0.316).

CONCLUSIONS

SRHET was found to be a highly accurate method to predict ET but a weak predictor of the presence of AP among participants in the BLSA.

Comparison of oral impacts experienced by patients treated with labial or customized lingual fixed orthodontic appliances

INTRODUCTION

Our objective was to compare the oral impacts experienced by patients treated with labial or customized lingual fixed orthodontic appliances.

METHODS

This was an age- and sex-matched prospective longitudinal study of 60 adult patients treated with either labial or customized lingual fixed orthodontic appliances over a 3-month period. Ratings of oral impacts experienced and satisfaction were made on visual analog scales at 3 time points after appliance fixation. Variations in oral impacts and satisfaction over the trajectory of treatment were assessed. Area-under-the-curve analyses were conducted to assess variations in oral impacts and satisfaction between the groups.

RESULTS

All patients experienced oral impact disturbances, although these disturbances decreased over time (P < 0.001). Patients treated with customized lingual appliances reported more oral discomfort (P < 0.001), dietary changes (P < 0.001), swallowing difficulty (P < 0.001), speech disturbances (P < 0.001), and social problems (P < 0.001) than did those in the other group. There was no significant difference between the groups regarding ratings of oral self-care, mastication, and satisfaction level of treatment (P > 0.05).

CONCLUSIONS

The findings indicate that oral impacts are commonly experienced during both labial and customized lingual fixed orthodontic therapies. However, the oral impacts decreased over the observational period. Patients treated with customized lingual appliances experienced more oral impacts. Both groups had similar levels of treatment satisfaction.

MR-Imaging of teeth and periodontal apparatus: an experimental study comparing high-resolution MRI with MDCT and CBCT

OBJECTIVES

The aim of this study was (1) to assess the ability of magnetic resonance imaging (MRI) to visualize dental and periodontal structures and (2) to compare findings with multidetector computed tomography (MDCT) and cone beam CT (CBCT).

MATERIALS AND METHODS

Four porcine mandibles were examined with (1) 3T-MRI, (2) MDCT and (3) CBCT. Two observers independently reviewed MR, MDCT and CBCT images and assessed image quality of different dental and periodontal structures. To assess quantitatively the accuracy of the different imaging technique, both observers measured burr holes, previously drilled in the mandibles.

RESULTS

Dental structures, e.g. teeth roots, pulpa chamber and dentin, were imaged accurately with all imaging sources. Periodontal space and cortical/trabecular bone were better visualized by MRI (p < 0.001). MRI could excellently display the lamina dura, not detectable with MDCT and only inconstant visible with CBCT (p < 0.001). Burr hole measurements were highly precise with all imaging techniques.

CONCLUSIONS

This experimental study shows the diagnostic feasibility of MRI in visualization of teeth and periodontal anatomy. Detection of periodontal structures was significantly better with MRI than with MDCT or CBCT. Prospective trials have to evaluate further the potential benefit of MRI in a clinical setting.

Evaluation of self-reported measures for prediction of periodontitis in a sample of Brazilians

BACKGROUND

Questionnaires including self-reported measures have become effective as a means of accessing many diseases. The aim of the present study is to evaluate the performance of a set of self-reported periodontal measures on estimating the prevalence of periodontitis.

METHODS

The sample comprised 284 individuals, aged 18 to 60 years, from Belo Horizonte, Brazil. Full-mouth periodontal examinations were performed and periodontal parameters were recorded. Periodontitis was categorized as no or mild, moderate, and severe. Each participant answered 18 questions covering sociodemographic variables, known risk factors, and self-reported periodontal measures. Questions were globally tested through logistic regression analysis.

RESULTS

The complete final model for moderate periodontitis included age, dental flossing, and gum disease (sensitivity = 23.1%; specificity = 98%; area under the receiver operating characteristic curve = 75.4%). The complete final model for severe periodontitis included all previously cited variables in addition to the number of teeth (sensitivity = 36.4%; specificity = 96.9%; area under the receiver operating characteristic curve = 85.3%).

CONCLUSIONS

Self-reported periodontal measures showed a moderate predictive value for periodontitis prevalence. The use of these measures could be a good strategy in investigating prevalence of periodontal disease.

Periodontal status, tooth loss and self-reported periodontal problems effects on oral impacts on daily performances, OIDP, in pregnant women in Uganda: a cross-sectional study

BACKGROUND

An important aim of antenatal care is to improve maternal health- and well being of which oral health is an important part. This study aimed to estimate the prevalence of oral impacts on daily performances (OIDP) during pregnancy, using a locally adapted OIDP inventory, and to document how periodontal status, tooth-loss and reported periodontal problems are related to oral impacts.

METHODS

Pregnant women at about 7 months gestational age who were members of a community based multi-center cluster randomized community trial: PROMISE EBF: Safety and Efficacy of Exclusive Breast feeding in the Era of HIV in Sub-Saharan Africa, were recruited in the district of Mbale, Eastern Uganda between January 2006 and June 2008. A total of 877 women (participation rate 877/886, 98%, mean age 25.6, sd 6.4) completed an interview and 713 (participation rate 713/886, 80.6%, mean age 25.5 sd 6.6) were examined clinically with respect to tooth-loss and according to the Community Periodontal Index, CPI.

RESULTS

Seven of the original 8 OIDP items were translated into the local language. Cronbach's alpha was 0.85 and 0.80 in urban and rural areas, respectively. The prevalence of oral impacts was 25% in the urban and 30% in the rural area. Corresponding estimates for CPI>0 were 63% and 68%. Adjusted ORs for having any oral impact were 1.1 (95% CI 0.7-1.7), 1.9 (95% CI 1.2-3.1), 1.7 (1.1-2.7) and 2.0 (0.9-4.4) if having respectively, CPI>0, at least one tooth lost, tooth loss in molars and tooth loss in molar-and anterior regions. The Adjusted ORs for any oral impact if reporting periodontal problems ranged from 2.7(95% CI 1.8-4.2) (bad breath) through 8.6(95% CI 5.6-12.9) (chewing problem) to 22.3 (95% CI 13.3-35.9) (toothache).

CONCLUSION

A substantial proportion of pregnant women experienced oral impacts. The OIDP impacts were most and least substantial regarding functional- and social concerns, respectively. The OIDP varied systematically with tooth loss in the molar region, reported chewing-and periodontal problems. Pregnant women's oral health should be addressed through antenatal care programs in societies with limited access to regular dental care facilities.