Periodontitis and the incidence of metabolic syndrome: An 8-year longitudinal study of an adult Japanese cohort

AIM

To examine the effect of periodontitis on the development of metabolic syndrome (MetS) and MetS components.

MATERIALS AND METHODS

This study included 4761 participants aged 30-74 years who underwent health examinations at both baseline and 8-year follow-up. The Japanese MetS criteria were used for diagnosis. The Community Periodontal Index was used to assess periodontal status. The association between periodontal status and MetS incidence was examined by Poisson regression analysis.

RESULTS

Multivariate analysis revealed that individuals with a ≥6 mm periodontal pocket had a significantly higher relative risk (RR) for MetS onset, as compared to individuals without deep periodontal pockets (adjusted RR 1.30, 95% confidence interval [CI]: 1.01-1.67). Compared to individuals without a deep periodontal pocket, individuals with a ≥6 mm periodontal pocket had significantly higher RRs for developing two components of MetS; the RRs were 1.25 (95% CI: 1.01-1.56) for abdominal obesity and 1.39 (95% CI: 1.03-1.86) for hyperglycaemia.

CONCLUSIONS

Individuals with periodontitis had a significantly higher risk of MetS onset, possibly due to the influence of periodontitis on abdominal obesity and hyperglycaemia.

The frequency of periodontitis in end-stage renal disease on hemodialysis in a sample of Egyptian population: multi-center clinical cross-sectional study

BACKGROUND

There is a general assumption that periodontal disease is highly prevalent among patients with chronic renal failure undergoing hemodialysis. The aim of the study to estimate the frequency of periodontitis in patients on hemodialysis among a sample of the Egyptian population, as well as the correlation between different clinical parameters of periodontal status with serum creatinine and blood urea. This may rule out the bidirectional relationship between periodontitis and renal failure in patients on hemodialysis.

METHODS

The study was conducted on 263 hemodialysis patients (165 males and 98 females) at three dialysis centers in Benha Governorate, Egypt (Benha Hospital, Tukh hospital, Qalyub hospital). Periodontal parameters including plaque index (PI), gingival index (GI), clinical attachment level (CAL), and probing pocket depth (PPD) had been recorded in these patients. Serum urea and creatinine levels had been measured, the data had been collected and undergone statistical analysis.

RESULTS

Frequency of periodontitis was 85.6% with stage III is the most prevalent stage. There was a significant positive strong correlation between age and periodontitis stage (rs = 0.707, p < 0.001). There was a positive correlation between clinical parameters and serum creatinine level.

CONCLUSION

In the present study, a high frequency of periodontitis had been found among ESRD patients on hemodialysis in the severe form (stage III) periodontitis. There was a significant direct correlation between the severity of periodontitis and CAL with a duration of hemodialysis. There was a weak insignificant association between periodontal indices (PD, BOP, and plaque score) and duration of hemodialysis.

Periodontal Health, Nutrition and Anthropometry in Professional Footballers: A Preliminary Study

Poor oral health in elite sport is a pressing issue, however little is known about the periodontal status of professional footballers. The aim of this study was to examine the prevalence of periodontitis in a group of professional footballers and its association with nutritional parameters and self-report non-traumatic injuries. Additionally, we assessed its association with anthropometric, dietary inflammatory load and self-reported muscular and/or articular injuries. Twenty-two professional footballers were evaluated at the beginning of the 2020–2021 season via full-mouth periodontal inspection, anthropometric measurements and the application of the dietary inflammatory index through a food intake measurement of 24 h dietary recall on two different days. Self-reporting non-traumatic muscular and articular injuries for the past 6 months were recorded from each athlete. Then we compared clinical measurements according to the periodontal status and we correlated age, periodontal and nutritional parameters. Overall, the prevalence of periodontitis was 40.9% and peri-implantitis was also observed. No significant differences were found regarding age or nutritional parameters according to the periodontal status. More non-traumatic muscular events in the past 6 months were found in the periodontitis group (55.6% vs. 38.4%), although the difference was non-significant. Both clinical attachment loss, periodontal pocket depth and the periodontal epithelial surface area revealed a significant moderate correlation with the percentage of fat mass, muscle mass, muscle mass index and total adipose folds. This group of professional footballers showed an alarming prevalence of periodontitis. Further studies shall examine whether periodontitis and periodontal treatment impact the performance of this group of athletes.

Influence of Micronutrient Intake, Sociodemographic, and Behavioral Factors on Periodontal Status of Adults Assisted by a Public Health Care System in Brazil: A Cross-Sectional Multivariate Analysis

The lack of access to a balanced diet, rich in vitamins and minerals, can predispose people to inflammatory diseases such as obesity, diabetes mellitus, and periodontitis. We aimed to evaluate the relationship between micronutrient intake, sociodemographic behavioral characteristics, and periodontal health in adults assisted by a public health care system. Participants (n = 450) answered a food frequency questionnaire and were submitted to anthropometric and oral clinical examinations. Principal component analysis was used to summarize the number of components emerging from 17-micronutrient intake. Subsequently, cluster analysis was employed. The prevalence of at least one periodontal pocket ≥ 4 mm was 67.4%. Three clusters were identified according to periodontal status. Cluster 1 "poor periodontal status" was characterized by older individuals (n = 202; 85% females) with poor periodontal status, lower education level, mainly smokers with non-transmissible chronic diseases (NTCD), with lower energy, omega-3, fiber, Zn, K, Cu, and vitamin C intake. Cluster 3 "healthy periodontal status" included younger individuals (n = 54) with the healthiest periodontal status, a higher education level, without NTCD, and with higher energy, omega-3, fiber, Zn, calcium, retinol, and riboflavin intake. Cluster 2 was labeled as "intermediate periodontal status". Micronutrient ingestion was associated with periodontal status and may be considered in health promotion actions for low-income populations.

Periodontal Status of Chinese Adolescents: Findings from the 4th National Oral Health Survey

OBJECTIVE

To investigate the periodontal health status and associated factors of adolescents aged 12 to 15 years old in China.

METHODS

A cross-sectional national oral health survey was conducted in 2015-2016. The multi-stage stratified cluster sampling was used to select participants in all 31 provinces, autonomous regions and municipalities in the mainland of China. Each participant received a clinical assessment including periodontal bleeding and calculus, and 15-year-old adolescents received additional examinations including for periodontal pocket depth and attachment loss, using the latest criteria from the Oral Health Survey Basic Methods, as recommended by the World Health Organization (WHO). A self-answered structured questionnaire was designed to collect the data of background information and associated risk factors.

RESULTS

A total of 118,514 adolescents (14.0 ± 1.09 years old) completed all the oral examinations and the questionnaire. The prevalence of periodontal bleeding and calculus was 61.0% and 67.3% respectively. In the group of 15 year olds, 6.5% adolescents had periodontal pocket and 0.5% had attachment loss. Molars were often involved and, furthermore, calculus also occurred on lower incisors. The periodontal status of adolescents became worse as they grew up. The condition of girls was significantly better than boys.

CONCLUSION

This survey illustrated a brief picture of periodontal status of adolescents in China showing that gingival bleeding and calculus were very common and frequent. Further actions on oral health education were necessary, especially for those in lower socio-economic classes.

The impact of oral health on quality of life of urban and riverine populations of the Amazon: A multilevel analysis

Few studies and epidemiological surveys are carried out in populations geographically and culturally isolated, such as rural and riverine communities. Riverine populations represent one of the typical populations of the Amazon region. This study aimed to evaluate the impact of dental caries and periodontal disease on the quality of life of adolescents and young adults from an urban area and from two riverine communities of the Amazon region located at different distances from the urban area. The occurrence of dental caries and periodontal disease was examined through the Decayed, Missing, Filled (DMFT) Index and the Community Periodontal Index (CPI). The impact of oral health conditions on quality of life was examined through the Oral Health Impact Profile (OHIP-14) questionnaire. The data were collected from 564 individuals (15-25 years old): 212 residents of the urban area of Abaetetuba-Pará-Brazil, were compared to 186 inhabitants of the nearest riverine community (Maracapucu) and 166 of another riverine community (Tucumanduba River) located further from the city. The OHIP-14 was analyzed as a dependent outcome, while dental caries, bleeding, calculus, the presence of periodontal pockets, as well as sex and age were analyzed as independent variables through Poisson analysis in a multilevel model. The worst indicators of OHIP-14 and the highest DMFT scores were found in the riverine populations, especially those from the riverine community farthest from the urban area. Based on the adjusted multivariate model, variables such as the contextual variable (location, RR 1.31), and individual demographic variables (sex and age), DMFT (RR 1.53), and the presence of periodontal pockets (RR 1.15) were significantly related to the OHIP (p<0.001). Our results confirm that dental caries and periodontal disease negatively impact oral health-related quality of life; however, these diseases seem to impact the individuals from remote communities more significantly.

Variables associated with the oral impact on daily performance of adults in the state of São Paulo: A population-based study

OBJECTIVE

This study aimed to assess the oral impact on daily performance and its association with sociodemographic characteristics, tooth pain, need for prosthesis, and periodontal disease of adults in the state of São Paulo, Brazil.

METHODS

This was a cross-sectional epidemiological study with secondary data obtained from the Oral Health Conditions Project- 2015 conducted in 163 municipalities in the state of São Paulo with the participation of 17,560 individuals. This study evaluated adults in the age-range between 35-44 years (n = 5,855), selected by means of probabilistic cluster sampling in two stages. The outcome variable was the OIDP (Oral Impacts on Daily Performances), obtained by using this instrument to assess daily activities (eating, speaking, oral hygiene, relaxation, sports practice, smile, study/work, social contact, and sleep). The independent variables were collected and grouped into three blocks: Block 1 (sex, age group, and ethnic group); Block 2 (household income and education); and Block 3 (tooth pain, need for prosthesis, bleeding, calculus, and periodontal pockets). A hierarchical multiple logistic regression analysis was performed considering the complex cluster sampling plan. Each observation was assigned a specific weight, depending on the location, which resulted in weighted frequencies adjusted for the effect of outlining.

RESULTS

the female sex (p<0.0001), ethnic group black/mulatto (p<0.0001), low household income (p = 0.0112), up to 8 years of education (p<0.0001), tooth pain (p<0.0001), presence of bleeding (p<0.0001), and presence of periodontal pockets (p<0.0001) had greater oral impact on daily performance.

CONCLUSION

sociodemographic characteristics, tooth pain, and presence of periodontal disease were associated with oral impact on daily performance of the adult population in the state of São Paulo, Brazil.

The Prevalence and Associated Factors of Periodontal Disease among 35 to 44-year-old Chinese Adults in the 4th National Oral Health Survey

OBJECTIVE

To assess the current periodontal status of 35 to 44-year-olds from the Chinese population and to analyse potential influence factors on periodontal disease.

METHODS

The data of subjects were collected from both urban and rural areas of all 31 provinces, autonomous regions and municipalities of the mainland of China, as part of the 4th National Oral Health Survey. All subjects were aged 35 to 44 years old. In total, 4,410 subjects were enrolled in the present study. Each subject was asked to undergo a professional oral examination and to fill in a questionnaire. Periodontal health status was evaluated by probe bleeding, calculus, periodontal pocket depth and clinical attachment loss. The data were analysed using the chi-square test and binary logistic regression analysis.

RESULTS

The prevalence of probe bleeding and calculus was 87.4% and 96.7% respectively among the 35 to 44-year-old population. Prevalence of shallow pockets (4 mm ≤ PD < 6 mm) and deep pockets (PD ≥ 6 mm) was 45.8% and 6.9% respectively among 35 to 44-year-old people. In addition, prevalence of clinical attachment loss (CAL > 3 mm) was 33.2%. Gender, educational level, smoking, teeth brushing frequency, dental floss and toothpick use were found relevant to periodontal condition.

CONCLUSION

Periodontal disease was highly prevalent among 35 to 44-year-old Chinese adults. Gender, educational level, smoking, teeth brushing frequency, toothpick and dental floss use could be potential influence factors of periodontal health status.

Prevalence of Functional Dentition in a Group of Mexican Adult Males

OBJECTIVE

To determine the prevalence of functional dentition and associated periodontal variables in a sample of Mexican adult males.

METHODS

A cross-sectional study of 161 policemen in Campeche, Mexico, was carried out. A clinical examination using an electronic probe was used to collect variables (dental plaque, periodontal pockets, gingival recession, suppuration, and bleeding on probing) on 6 periodontal sites (a maximum of 168 sites, excluding third molars). Sociodemographic, socioeconomic, and behavioral variables were collected through a self-administered survey. Functional dentition was defined as having 21 or more natural teeth. Data were analyzed with STATA 11.0, using logistic regression models.

RESULTS

Mean age was 38.3 (±10.9) years. The prevalence of having a functional dentition was 83.8% in the sample. The odds of having a functional dentition declined with age (odds ratio [OR] = 0.93), having diabetes (OR = 0.27) and with having a high percentage of sites with plaque (OR = 0.77), with bleeding on probing (OR = 0.97), and with gingival recession (OR = 0.82).

CONCLUSION

While a large proportion of subjects had a functional dentition in this community-dwelling sample of adult Mexican males, the likelihood of their having a functional dentition decreased with age, with their having been diagnosed with diabetes, and with assorted negative indicators of periodontal/gingival status.

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.

Periodontitis in early and chronic rheumatoid arthritis: a prospective follow-up study in Finnish population

OBJECTIVES

To investigate the association between rheumatoid arthritis (RA) and periodontitis with special emphasis on the role of antirheumatic drugs in periodontal health.

DESIGN

Prospective follow-up study. Patients with early untreated RA and chronic active RA were examined at baseline and 16 months later. Controls were examined once.

SETTINGS AND PARTICIPANTS

The study was conducted in Finland from September 2005 to May 2014 at the Helsinki University Hospital. Overall, 124 participants were recruited for dental and medical examinations: 53 were patients with early disease-modifying antirheumatic drug (DMARD) naїve RA (ERA), 28 were patients with chronic RA (CRA) with insufficient response to conventional DMARDs. After baseline examination, patients with ERA started treatment with synthetic DMARDs and patients with CRA with biological DMARDs. Controls were 43 age-matched, gender-matched and community-matched participants.

OUTCOME MEASURES

Degree of periodontitis (defined according to the Center for Disease Control and Prevention and the American Academy of Periodontology). Prevalence of periodontal bacteria (analysed from plaque samples), clinical rheumatological status by Disease Activity Score, 28-joint count (DAS28), function by Health Assessment Questionnaire (HAQ) and treatment response by European League Against Rheumatism (EULAR) criteria.

RESULTS

Moderate periodontitis was present in 67.3% of patients with ERA, 64.3% of patients with CRA and 39.5% of control participants (p=0.001). Further, patients with RA had significantly more periodontal findings compared with controls, recorded with common periodontal indexes. In the re-examination, patients with RA still showed poor periodontal health in spite of treatment with DMARDs after baseline examination. The prevalence of Porphyromonas gingivalis was higher in patients with ERA with periodontal probing depth ≥4 mm compared with patients with CRA and controls. Antirheumatic medication did not seem to affect the results.

CONCLUSIONS

Moderate periodontitis was more frequent in patients with RA than in controls. Patients with ERA and CRA exhibited poorer periodontal health parameters when compared with controls. There was no association between antirheumatic treatment and periodontal parameters.

The Severity of Periodontal Disease is Associated with the Development of Glucose Intolerance in Non-diabetics: The Hisayama Study

Inflammation is hypothesized to play a significant role in the development of type 2 diabetes; however, reports on clinical inflammatory conditions are limited. Studies have suggested that periodontitis affects glucose control in diabetics. This community-based study examined the relationship between periodontitis and glucose tolerance status, including changes in status. The relationship between periodontal condition and the results of a 75-g oral glucose tolerance test was examined in 961 adults in 1998. Deep pockets (mean pocket depth > 2.0 mm) were significantly associated with impaired glucose tolerance and with diabetes as compared with shallow pockets (< 1.3 mm). In the subgroup with normal glucose tolerance 10 years previously, subjects who subsequently developed impaired glucose tolerance were significantly more likely to have deep pockets. Deep pockets were closely related to current glucose tolerance status and the development of glucose intolerance.

Prevalence of peri-implantitis in patients with implant-supported fixed prostheses

OBJECTIVE

The purpose of this study was to evaluate periimplantitis prevalence in patients using implant-supported fixed prostheses that did not have any routine maintenance care.

METHOD AND MATERIALS

A total of 161 implants (27 patients) were evaluated in patients using implant-supported fixed prostheses. Collected data included information related to patient general health and local factors such as characteristics of implants, time in function, type of loading, positioning, Modified Bleeding Index, bacterial plaque, bleeding on probing (BOP), marginal recession, probing depth (PD), keratinized mucosa, and radiographic bone loss (BL). Factors related to the prostheses were also evaluated. The exclusion criteria were patients that have had any follow-up visit for plaque control of the prosthesis and/or the implants.

RESULTS

From a total of 161 implants, 116 (72%) presented without peri-implantitis (PD > 4 mm + BOP + BL > 2 mm) while 45 (28%) had some sign of the disease. Implants placed in the maxilla were 2.98 times more likely to develop the disease (P < .05). Moreover, patients aged ≤ 60 years old were 3.24 times more likely to develop peri-implantitis (P < .05). Another analysis with statistical relevance (P < .05) was that implants with less than 3 mm interimplant distance were three times more likely to have peri-implantitis. There was no statistical relevance considering other analyses.

CONCLUSION

It can be concluded that patients aged ≤ 60 years have a greater chance of presenting periimplantitis, as well as for implants positioned in the maxilla and those placed with an interimplant distance < 3 mm.

Association Between Obstructive Sleep Apnea and Periodontitis Among Male Adults Attending a Primary Healthcare Facility in Jordan

PURPOSE

To determine the association between periodontitis and a high risk for obstructive sleep apnea (HR-OSA).

MATERIALS AND METHODS

A sample of 296 males with a mean (±SD) age 40 (8.5) years was selected. Subjects who scored positive in two or more categories of the Berlin questionnaire were considered as having HR-OSA.

RESULTS

Based on the self-reported symptoms of obstructive sleep apnea, 15% of patients were considered as HROSA. Patients with HR-OSA showed higher probing pocket depth (PPD) and clinical attachment level (CAL) compared with those with low risk for obstructive sleep apnea (LR-OSA)-2.35±0.69 vs 1.97±0.34 (p=0.000) and 2.95±0.82 vs 2.12±0.55 (p=0.000), respectively. Patients with HR-OSA were more likely to have periodontitis (OR=2.3; 95% CI: 1.03/5.10) compared to patients with LR-OSA. The prevalence of periodontitis varied significantly only among patients according to their response to category 1 (37% responded positively and 20% responded negatively, p=0.003). When the OSA variable was replaced by the individual categories (1, 2 and 3), patients with a positive category 1 (OR=2.27; 95% CI: 11.14/4.45) were more likely to have periodontitis than were patients with a negative response.

CONCLUSION

The risk of finding periodontitis in HR-OSA patients was approximately double that of LR-OSA patients. Habitual snoring was also associated with increased risk for periodontitis.

Prevalence of Peri-implant Diseases: Analyses of Associated Factors

AIM. Identify the relationship between specific factors (age, sex, smoking, time of prosthesis in function, implant location, and width of peri-implant keratinized mucosa) and peri-implant diseases in patients from the Center of Research and Continuing Education in Implant Dentistry (CEPID) at the Federal University of Santa Catarina (UFSC), Brazil.

MATERIALS AND METHODS

A cross-sectional study was conducted in 193 patients that had received 725 external-hexed cylindrical implants supporting functional prosthesis for at least 1 year (range from 1-9 years). Clinical examination included probing depths, bleeding on probing and/or suppuration. Radiographic exam was conducted to measure peri-implant bone levels.

RESULTS

There was no statistically significance in the association between prevalence of peri-implant diseases and age, sex, time with prostheses in function and implant location variables independently. There was a statistically significant association between the independent variables of smoking and the width of keratinized peri-implant mucosa less than 2mm, and the presence of peri-implant diseases. When all the categories were evaluated together in relation with the peri-implant diseases, the prostheses in function for 5 years and more had association with presence of both, peri-implant mucositis an peri-implantitis. Peri-implantitis prevalence was higher for males with the prostheses in use for 5 years or more. Peri-implant mucositis was more associated with the participants over 57 years of age, with systemic disease and with the prostheses in function for more than 5 years.

CONCLUSIONS

Smoking habits and the width of peri-implant keratinized mucosa as independent variables were associated with the prevalence of peri-implant diseases.

Efficacy of the ND:YAG laser therapy on EBV and HSV1 contamination in periodontal pockets

AIM

The aim of this retrospective multicenter study was to verify the efficacy of Nd:YAG laser in the treatment of periodontal pockets infected by Epstein-Barr Virus (EBV) and Herpes Simplex Virus 1 (HSV1).

METHODS

Subgingival plaque samples of 291 Italian periodontal patients were analyzed by Real Time PCR to evaluate the frequency of both viruses before and after Nd:YAG laser-assisted periodontal treatment.

RESULTS

Before treatment, EBV and HSV1 were observed in 29.9% and in 3.8% of periodontal patients respectively, while co-infection with both viruses was detected in 1.7% of cases. Periodontal Nd:YAG laser treatment ("Periodontal Biological Laser-Assisted Therapy", PERIOBLAST) produced statistical significant benefits, especially in EBV periodontal infection: 78.2% of EBV positive patients became EBV-negative following treatment.

CONCLUSIONS

Results of this preliminary study highlight that EBV is found in periodontal pockets more frequently than HSV1, supporting the theory of the potential role of EBV in the onset and progression of periodontal disease. Moreover, our data showed that Nd:YAG laser-assisted periodontal treatment (Perioblast) is also effective in case of viral infection, validating evidences that it represents a successful alternative approach to traditional periodontal protocols.

A cross-sectional study of the associations between periodontitis and carotid arterial calcifications in an elderly population

OBJECTIVE

To evaluate if the presence of periodontitis is associated with carotid arterial calcifications diagnosed on panoramic radiographs in an elderly population.

MATERIALS AND METHODS

Study individuals were randomly selected from the Swedish civil registration database representing the aging population (60-96 years) in Karlskrona, Sweden. Bleeding on probing (BOP) and the deepest probing measurement at each tooth were registered. The proportions of teeth with a probing depth ≥ 5 mm and the proportion of teeth with bleeding on probing were calculated. Analog panoramic radiographs were taken and the proportion of sites with a distance ≥ 5 mm between the alveolar bone level and the cement-enamel junction (CEJ) were assessed. A diagnosis of periodontitis was declared if a distance between the alveolar bone level and the CEJ ≥ 5 mm could be identified from the panoramic radiographs at > 10% of sites, probing depth of ≥ 5 mm at one tooth or more and with BOP at > 20% of teeth.

RESULTS

Readable radiographs were obtained from 499 individuals. Carotid calcification was identified in 39.1%. Individuals were diagnosed with periodontitis in 18.4%. Data analysis demonstrated that individuals with periodontitis had a higher prevalence of carotid calcifications (Pearson χ(2) = 4.05 p < 0.05) and with a likelihood of 1.5 (95% CI = 1.0, 2.3, p < 0.05).

CONCLUSIONS

Data analysis demonstrated a significant association between periodontitis and carotid calcification.

Standards for reporting chronic periodontitis prevalence and severity in epidemiologic studies: Proposed standards from the Joint EU/USA Periodontal Epidemiology Working Group

Periodontal diseases are common and their prevalence varies in different populations. However, prevalence estimates are influenced by the methodology used, including measurement techniques, case definitions, and periodontal examination protocols, as well as differences in oral health status. As a consequence, comparisons between populations are severely hampered and inferences regarding the global variation in prevalence can hardly be drawn. To overcome these limitations, the authors suggest standardized principles for the reporting of the prevalence and severity of periodontal diseases in future epidemiological studies. These principles include the comprehensive reporting of the study design, the recording protocol, and specific subject-related and oral data. Further, a range of periodontal data should be reported in the total population and within specific age groups. Periodontal data include the prevalence and extent of clinical attachment loss (CAL) and probing depth (PD) on site and tooth level according to specific thresholds, mean CAL/PD, the CDC/AAP case definition, and bleeding on probing. Consistent implementation of these standards in future studies will ensure improved reporting quality, permit meaningful comparisons of the prevalence of periodontal diseases across populations, and provide better insights into the determinants of such variation.

Update on Prevalence of Periodontitis in Adults in the United States: NHANES 2009 to 2012

BACKGROUND

This report describes prevalence, severity, and extent of periodontitis in the US adult population using combined data from the 2009 to 2010 and 2011 to 2012 cycles of the National Health and Nutrition Examination Survey (NHANES).

METHODS

Estimates were derived for dentate adults, aged ≥30 years, from the US civilian non-institutionalized population. Periodontitis was defined by combinations of clinical attachment loss (AL) and periodontal probing depth (PD) from six sites per tooth on all teeth, except third molars, using standard surveillance case definitions. For the first time in NHANES history, sufficient numbers of non-Hispanic Asians were sampled in 2011 to 2012 to provide reliable estimates of their periodontitis prevalence.

RESULTS

In 2009 to 2012, 46% of US adults, representing 64.7 million people, had periodontitis, with 8.9% having severe periodontitis. Overall, 3.8% of all periodontal sites (10.6% of all teeth) had PD ≥4 mm, and 19.3% of sites (37.4% teeth) had AL ≥3 mm. Periodontitis prevalence was positively associated with increasing age and was higher among males. Periodontitis prevalence was highest in Hispanics (63.5%) and non-Hispanic blacks (59.1%), followed by non-Hispanic Asian Americans (50.0%), and lowest in non-Hispanic whites (40.8%). Prevalence varied two-fold between the lowest and highest levels of socioeconomic status, whether defined by poverty or education.

CONCLUSIONS

This study confirms a high prevalence of periodontitis in US adults aged ≥30 years, with almost fifty-percent affected. The prevalence was greater in non-Hispanic Asians than non-Hispanic whites, although lower than other minorities. The distribution provides valuable information for population-based action to prevent or manage periodontitis in US adults.

Oral health of individuals aged 3-80 years in Jönköping, Sweden during 40 years (1973-2013). II. Review of clinical and radiographic findings

The aim of this epidemiological study performed in 2013 was to analyze various clinical and radiographic data on oral health and compare the results to those of four cross-sectional studies carried out 1973-2003. In 1973, 1983, 1993, 2003, and 2013 random samples of 1,000; 1,104; 1,078; 987; and 1,010 individuals, respectively, were studied. The individuals were evenly distributed in the age groups 3, 5, 10, 15, 20, 30, 40, 50, 60, 70, and 80o years. Eighty-year-olds were not included in 1973. All subjects were inhabitants of the city of Jönköping, Sweden. The clinical and radiographic examination assessed edentulousness, removable dentures, implants, number of teeth, caries, restorations, oral hygiene, calculus, periodontal status, and endodontic treatment. The frequency of edentulous individuals aged 40-70 years was 16, 12, 8, 1, and 0.3% in 1973, 1983, 1993, 2003, and 2013, respectively. No complete denture weareryounger than 80-years old was found in 2013. During the 40-year period, the mean number of teeth in the age groups 30-80 years increased. In 2013, the 60-year-olds had nearly complete dentitions. Implants were found in all age groups from 30 years of age. The total number of individuals with implants was 36 in 2013. This was higher than earlier surveys, 4 in 1993, and 18 in 2003. The percentage of children and adults without caries and restorations increased during the 40-year period. It was found that the percentage of caries-free 3- and 5-year-olds were 79% and 69%, respectively, of the individuals in 2013. In the age groups 10-20 years, the percentage of caries-free individuals increased between 2003 and 2013. In 2013, 43% of the 15-year-olds were completely free from caries and restorations compared to 20% in 2003. In all age groups 5-60 years, DFS was lower in 2013 compared to the earlier examinations.There was no major change in DFS between 2003 and 2013 in the age groups 70 and 80 years. The most obvious change was the decrease in number of FS over the 40-year period of time. Regarding crowned teeth the most clear changes between 1973 to 2013 were the decrease in percentage of crowned teeth in the age groups 40 and 50-year-olds. The percentage of endodontically treated teeth decreased between 1973 and 2013 in all age groups. In age groups 10-30-year-olds a major reduction from about 30% to 15% in mean plaque score was seen between 1973-2003. Only a minor change in plaque score was seen during the last decade. For the age groups 40 years and older, a decrease in the percentage of surfaces with plaque was observed between 2003-2013. The percentage of tooth sites with gingivitis was for 20 years and older about 40% in 1973. In 2013, the percentage was about 15%. The frequency of sites with gingivitis was generally lower in 2013 compared with the otheryears,1973-1993. The percentage of individuals with probing pocket depths > 4mm increased with age. Between 2003-2013 a clear reduction was seen in all age groups in frequency of individuals with probing pocket depth > 4mm. Over the 40-year period an increase in the number of individuals with no marginal bone loss and a decrease in the number of subjects with moderate alveolar bone loss were seen. The continuous improvement in oral health and the reduced need of restorative treatment will seriously affect the provision of dental helath care and dental delivery system in the near future.

[Association between periodontal pockets and health-related behaviors of workers]

OBJECTIVE

Periodontal disease is a chronic disease caused by bacterial infection, and frequently develops in adulthood. As the disease is closely related to lifestyle, it is important to clarify its relationship with health-related behaviors to provide effective health instructions targeting its prevention. In this study, we focused on periodontal pockets with advanced periodontal disease to clarify the health-related behaviors associated with the presence or absence of periodontal pockets.

METHODS

The subjects were 3,142 employees (male: N=2,429, female: N=713; 42.4 ± 10.5 years, Range 20-59 years) of one company, which had provided all employees with an oral health program in 2002. Participants with a Community Periodontal Index code of ≤2 and ≥3 were classified as those without and with periodontal pockets, respectively. To clarify the health-related behaviors associated with the presence or absence of periodontal pockets, we conducted multivariate logistic regression analysis, with presence/absence of periodontal pockets as the dependent variable, and items of health-related behavior investigated in 2002 as independent variables, and calculated the odds ratios (OR) and 95% confidence intervals (95%CI) adjusted for sex, age group and occupation.

RESULTS

The factor most strongly correlated with the presence of periodontal pockets was non-use of dental floss (OR=1.95 (95%CI: 1.57-2.41)), followed by smoking (OR=1.71 (95%CI: 1.44-2.03)), and tooth-brushing habits (≤once a day: OR=1.33 (95%CI: 1.10-1.61)).

CONCLUSIONS

Our results suggest that, to promote oral health program at the worksite, it is important to provide health education and instructions to encourage the use of dental floss, a daily tooth-brushing habit, and smoking cessation.

Accuracy of self-reported periodontal disease in the Women's Health Initiative Observational Study

BACKGROUND

This study examines the accuracy of self-reported periodontal disease in a cohort of older females.

METHODS

The study comprised 972 postmenopausal females aged 53 to 83 years who completed baseline (1997 to 2001) and follow-up (2002 to 2006) whole-mouth oral examinations. Examinations included: 1) probing depth, 2) clinical attachment level, and 3) oral radiographs for alveolar crestal height in a study ancillary to the Women's Health Initiative Observational Study (WHI-OS) conducted in Buffalo, New York, called the OsteoPerio study. Participants also self-reported any history of diagnosis of periodontal/gum disease on a WHI-OS study-wide questionnaire administered during the time interval between the two OsteoPerio examinations.

RESULTS

Participants reporting diagnosis of periodontal/gum disease on the WHI-OS questionnaire (n = 259; 26.6%) had worse oral hygiene habits, periodontal disease risk factors, and clinical periodontal measures compared with those not reporting periodontal/gum disease. Frequency of reported periodontal/gum disease was 13.5%, 24.7%, and 56.2% across OsteoPerio baseline examination categories of none/mild, moderate, and severe periodontal disease, respectively (trend: P <0.001), defined by criteria of the Centers for Disease Control and Prevention/American Academy of Periodontology (CDC/AAP). Sensitivity, specificity, and positive and negative predictive values for reported periodontal disease status were 56.2%, 78.8%, 32.8%, and 90.7%, respectively, when CDC/AAP-defined severe periodontal disease at baseline was the criterion measure (prevalence of 15%) and were 76.0%, 77.4%, 22.0%, and 97.4%, respectively, when tooth loss to periodontitis (prevalence of 7%) was the criterion.

CONCLUSION

A simple question for self-reported periodontal disease characterizes periodontal disease prevalence with moderate accuracy in postmenopausal females who regularly visit their dentist, particularly in those with more severe disease.

Detection of herpes simplex virus type 1 in gingival crevicular fluid of gingival sulcus/periodontal pocket using polymerase chain reaction

INTRODUCTION

Pathogenesis and some characteristics of periodontitis cannot be fully explained by bacterial etiology alone. Herpes viruses may bridge the gap between clinical characteristics and molecular understanding of periodontal destruction.

OBJECTIVE

The aim of this study was to investigate the prevalence of herpes simplex virus type 1 (HSV-1) in gingival crevicular fluid (GCF) of healthy and damaged periodontium in Serbian population and to explore potential correlation between the presence of this virus and the level of periodontal destruction.

METHODS

Samples were collected from gingival sulcus/periodontal pockets by sterile paper points and the presence of viral DNA in gingival crevicular fluid was assessed by PCR.

RESULTS

There was no statistically significant difference in HSV-1 in presence between periodontitis patients (PG = 38.9%) and healthy controls (HC = 32.3%), (Chi-square test, with Yates' correction p = 0.7574). However, HSV-1 positive patients showed significantly higher values of parameters of periodontal destruction (PPD = 7.11 +/- 2.52, CAL = 5.46 +/- 2.34) than periodontitis patients without HSV-1 in gingival crevicular fluid (PPD = 4.70 +/- 1.79, CAL = 3.39 +/- 2.65) (p values respectively, p = 0.002 and p = 0.023, Independent Samples T-Test). HSV-1 occurred more often in deeper (PPD > or = 6 mm) (69.2%) than in shallow pockets (3 mm < PPD < 6 mm) (18.2%) (Chi-square test, with Yates' correction, p = 0.008). Plaque index was lower in the HSV-1 positive group (0.84 +/- 0.69 vs. 1.43 +/- 0.76, p = 0.023, Independent Samples T-Test).

CONCLUSION

This study demonstrated that the presence of HSV-1 in the gingival crevicular fluid coincides with a higher degree of tissue destruction in patients with periodontitis.

Periodontal conditions, low birth weight and preterm birth among postpartum mothers in two tertiary health facilities in Uganda

BACKGROUND

Literature reports have indicated an increase in research evidence suggesting association between periodontal disease and the risk of pre-term birth (PTB) and low birth weight (LBW). Periodontal diseases in Uganda have been documented as a public health problem, but their association to adverse pregnancy outcomes is unknown. This study was conducted to assess the association between periodontital diseases in postpartum mothers and PTB and LBW of babies in Mulago and Mbarara referral hospitals.

METHODS

This was a cross sectional study using medical records, clinical examination and oral interview of mothers at the two tertiary health facilities. Mothers with singleton babies from Mulago (n = 300) and Mbarara Hospital (n = 100) were recruited for the study. The women were clinically examined for periodontal disease by 2 trained and calibrated dentists. Data on PTB and LBW were retrieved from medical records. The data were analyzed to determine the relationship between the four parameters for periodontal disease (bleeding gingiva, periodontal pockets, gingival recession and calculus with plaque deposits) and the adverse pregnancy outcomes. Frequency distribution was used to describe the data. Bivariate and multivariate analyses were used to study the association between the periodontal diseases and adverse pregnancy outcomes.

RESULTS

Approximately 26% and 29% of the postpartum mothers examined had bleeding gingiva and periodontal pockets of 4 mm or more deep, respectively. Advanced periodontitis i.e. pocket depth ≥ 6 mm was recorded in 13 (3.6%) of the mothers. Calculus with plaque deposits were recorded in 86% (n = 343) of the mothers. Gingival recession was recorded in 9.0% of the mothers and significantly and directly related to birth weight (p < 0.05).

CONCLUSION

Periodontal conditions of postpartum mothers in this study were found to be better than previously reported amongst the Ugandan population. Bivariate analysis showed a significant association only between gingival recession and low birth weight. However, this finding should be interpreted with caution as it could have occurred by chance.

Assessing periodontitis in populations: a systematic review of the validity of partial-mouth examination protocols

OBJECTIVE

To estimate bias associated with partial-mouth periodontal examination (PMPE) protocols regarding estimates of prevalence, severity and extent of clinical attachment loss (CAL), pocket depth (PD) and gingival recession (REC).

MATERIAL AND METHODS

A search was made for articles published in English, from 1946 to 2012, which compared PMPE versus full-mouth periodontal examination protocols for CAL or PD ≥ 4 mm or REC ≥3 mm thresholds. PMPE protocols were evaluated for sensitivity of estimates of periodontitis prevalence, relative biases for severity and extent estimates.

RESULTS

A review of the literature identified 12 studies which reported 32 PMPE protocols. Three PMPE protocols which had sensitivities ≥85% and relative biases ≤0.05 in absolute values for severity and extent estimates were as follows: (1) half-mouth six-sites, (2) diagonal quadrants six-sites and (3) full-mouth mesiobuccal-midbuccal-distobuccal (MB-B-DB). Two other PMPE protocols (full-mouth and half-mouth mesiobuccal-midbuccal-distolingual) performed well for prevalence and severity of periodontitis; however, their performance in estimates of extent was unknown.

CONCLUSIONS

Among the 32 PMPE protocols listed, the half-mouth six-sites and full-mouth MB-B-DB protocols had the highest sensitivities for prevalence estimates and lowest relative biases for severity and extent estimates.

Salivary cotinine concentrations and prevalence of periodontal disease in young Japanese women: the Kyushu Okinawa maternal and child health study

BACKGROUND

The authors investigated the relationship between objectively assessed tobacco smoke exposure and periodontal disease.

METHODS

This cross-sectional study included 1,103 women with a mean age of 31.5 years. Information on potential confounding factors was obtained through a self-administered questionnaire. Periodontal disease was defined as positive if a woman had at least one tooth with a probing depth of ≥ 3.5 mm. Exposure to tobacco smoke was determined based on salivary cotinine concentration. Adjustment was made for age, region of residence, household income, education, toothbrushing frequency, and use of an interdental brush.

RESULTS

The prevalence of periodontal disease was 11.3%. Salivary cotinine concentration was independently positively associated with the prevalence of periodontal disease: the adjusted odds ratio for every 1-unit (ng/mL) increase in salivary cotinine was 1.004 (95% confidence interval: 1.000 to 1.007).

CONCLUSION

Salivary cotinine concentrations were positively associated with the prevalence of periodontal disease among young women.

Social determinants of health and periodontal disease in Brazilian adults: a cross-sectional study

BACKGROUND

Recently, increasing importance has been placed on the social determinants of health and disease. The present study aimed to determine the prevalence of periodontal disease in Brazilian adults and identify possible relationships with social determinants.

METHODS

A cross-sectional study was performed using a sample of 743 adults (aged 35-49 years) living in an urban area of a large city in southeastern Brazil. The condition of the periodontium was assessed using the Community Periodontal Index (CPI) according to the diagnostic criteria established by the World Health Organization (WHO). The variables related to social determinants were collected using a structured questionnaire. A descriptive analysis of all study variables was performed. Multiple correspondence analysis was subsequently performed to identify relationships between periodontal disease and the social determinants of health.

RESULTS

The periodontal exams showed that 36.5% of adults had a healthy periodontium, 2.0% had gingival bleeding, 47.1% had calculus and 9.5% had periodontal pockets of 4-5 mm. Periodontal pockets of 6 mm or more were the worst periodontal condition found (affecting only 2.1% of the participants). The correspondence analysis enabled us to form three groups with different profiles. The first group was distinguished by the presence of bleeding (gingivitis) or a healthy periodontium. The members of this group were typically aged 35 to 39 years and had 9-12 years or more than 12 years of education. The second group consisted of subjects with calculus and periodontal pockets of 4-5 mm. The members of this group were typically white men aged 40-44 years with incomes greater than $ 300.00. The third group was distinguished by the presence of periodontal pockets of 6 mm or more. The members of this group were typically adult females, black and mixed individuals who had 8 years or less of schooling, individuals with incomes ≤ $ 300.00 and widowers.

CONCLUSION

The results suggest that periodontal health is worse in the group for which the social indicators are worse. Therefore, the social determinants of health also affect the severity of periodontal disease in adults Brazilian society.

Periodontal disease and type 1 diabetes mellitus: associations with glycemic control and complications: an Indian perspective

AIM

To evaluate the frequency of periodontal disease in a group of patients with type 1 diabetes mellitus and its relationship with diabetic metabolic control, duration and complications.

MATERIALS AND METHODS

A comparison was made of periodontal parameters (plaque index, bleeding index, pocket depth and attachment loss) in a group of diabetic patients versus a group of non-diabetics (n=20). Statistical analysis was performed to evaluate the relationship between periodontal parameters and degree of metabolic control, the duration of the disease and the appearance of complications.

RESULTS

Diabetics had greater bleeding index (p<0.001), probing pocket depth (p<0.001) and clinical attachment level (p=0.001). Patients diagnosed for diabetes for shorter duration of time (4-7 years) showed bleeding index-disease severity correlation to be 1.760 ± 0.434.

CONCLUSION

Patients with type 1 diabetes have increased periodontal disease susceptibility. Periodontal inflammation is greatly increased in subjects with longer disease course, poor metabolic control and diabetic complications.

[Digestive pathology and oral condition in the rural populations of the Ferlo in Senegal]

The aim of this work was to study the association between dental and periodontal status and digestive pathology in the Ferlo populations in Senegal.

METHOD

This was a cross sectional study involving 300 people living in the area of the Ferlo in the Centre East of Senegal. Selected individuals must be over the age of 15 years and resided in the area. Cluster sampling helped recruit individuals. Collected information related to digestive pathology (yes or no), periodontal status (plate index, inflammation, bleeding, loss of attachment, the depth of pocket and the CPITN.) Dental status was evaluated by the DMFT. The data analyzed with software R and the Student's t test used to compare the averages of the indices in both groups at the threshold of 5%. Multivariate logistic regression analysis was used to isolate the final model with a threshold of 5%.

RESULTS

Averages of dental and periodontal index were broadly equal in both groups (sick and not sick). The DMF and missing teeth were significantly associated with the digestive pathology after adjustment on gender, age, BMI, marital status, the number of cigarettes smoked and the depth of pocket.

CONCLUSION

This study revealed a significant association between dental status and digestive pathology. The comprehensive care of patients therefore raises the interest of collaboration between surgeons, dentists and gastroenterologists for effective and adequate treatment.

Oral health status and treatment need among institutionalised hearing-impaired and blind children and young adults in Udaipur, India. A comparative study

AIM

The aim of this study was to assess and compare the oral health status and the treatment needs of the institutionalised hearing-impaired and blind children and young adults in the city of Udaipur, Rajasthan, India.

METHODS

A descriptive cross-sectional study was conducted among 498 institutionalised hearing-impaired and blind people, aged 4 to 23 years, in the city of Udaipur, Rajasthan. The World Health Organization oral health assessment basic methods and form (1997) were used for data collection. Clinical examinations were carried out in the institute's medical room or classroom by single examiner with the aid of a mouth mirror, explorer and Community Periodontal Index (CPI) probe under adequate natural light (Type III examination). The resulting data were entered into statistical software and analysed by applying the chi-square test, ANOVA, t-test and stepwise multiple linear regression analysis.

RESULTS

The total mean DMFT (decayed-missing-filled teeth) and mean dft scores were 1.77 and 0.27 respectively. The largest component of DMFT was the D, with a mean of 1.49. The F component of 0.08 was very low. Mean DMFT/dft was greater among hearing-impaired than among blind subjects. Overall, 159 (32%) were periodontally healthy (CPI=0), 162 (32%) had shallow pockets (CPI=3) and 36 (7%) had deeper pockets (CPI=4). A higher percentage of the blind (87; 43%) than the hearing-impaired (72; 24%) subjects were periodontally healthy (CPI score=0). One-surface fillings were the most commonly provided form of past treatment.

CONCLUSION

The findings in this study highlight the lack of dental treatment for this group. Overall oral health status was poorer in the hearing-impaired than in the blind subjects.

Media exposure and oral health outcomes among adults

OBJECTIVE

To assess the impact of media exposure on oral health outcomes among Jewish adults in Jerusalem, Israel, by means of a conceptual hierarchical model.

METHOD AND MATERIALS

A cross-sectional study was conducted using a stratified sample of 254 adults 35 to 44 years (mean age, 38.63 years) in Jerusalem, Israel. Media exposure was operationally categorized by type and frequency. Behavioral data included toothbrushing, dental attendance, oral hygiene aids use, plaque level, sugar consumption, and smoking. Clinical outcomes were assessed according to the decayed/missing/filled teeth (DMFT) index and the community periodontal index (CPI). Results were analyzed by chi-square test, independent test, one-way ANOVA, and linear and multiple logistic regression models.

RESULTS

A total of 254 examinees consisted of 127 men and 127 mean (married couples). High type and high frequency of media exposure, as compared with other modes, revealed statistically significant higher caries experience (DMFT, 13.10), higher level of untreated decay (D, 1.67), and lower periodontal health (CPI [0], 0.39). A conceptual hierarchical regression model identified that the relationship described was mediated by sociodemographic determinants (education) and behavioral determinants (dental attendance and plaque level).

CONCLUSION

Media exposure should be observed by community health program planners and general practitioners to examine the type and frequency of the messages. They also need to react on time to balanced bad advertising and add a good message at the community. This pragmatic approach could lead to better use of the media and improve oral health behavior and outcomes.

Marginal bone loss in the adult population in the county of Skåne, Sweden

The aim of this study was to investigate the prevalence and extent of periodontal disease registered as marginal bone loss and subject characteristics in the adult population in the county of Skåne in Sweden. One thousand individuals, 20-89 years old, were randomly selected and 451 subjects agreed to participate in the study. They answered a questionnaire and in conjunction with the clinical and radiological examination the subjects answered questions about their medical history. The examiners were co-ordinated regarding the diagnostic criteria through comprehensive written instructions, practice and discussions of clinical cases. One observer estimated marginal bone loss around the teeth on digital panoramic radiographs and bitewings. The individuals were classified regarding periodontal disease experience according to the following criteria: PD- = loss of supporting bone tissue < 1/3 of the root length, PD = loss of supporting bone tissue > or = 1/3 of the root length in < 30% of the teeth and PD+ = loss of supporting bone tissue > or = 1/3 the root length in > or = 30% of the teeth. Subjects with no or minor bone loss, i.e. PD- constituted 69% of the population. Twenty percent of the study population had marginal bone loss corresponding to localised periodontal disease (PD) and 11% exhibited generalised periodontal bone loss (PD+). The periodontal treatment need, defined as probing pocket depth > or = 6 mm and bleeding on probing > or = 20%, was 53% in the PD+ group. An interesting result was that there were no differences in periodontal disease experience between the genders.

CONCLUSIONS

The prevalence and extent of periodontal disease in this study correlates well with recent other studies. Eleven percent of the population has experienced generalised periodontal disease, and 53% of them have a periodontal treatment need defined as 1 or more site with PPD > or = 6 mm and BoP > or = 20%.

Oral health status of a group of illicit drug users in Delhi, India

OBJECTIVES

To assess the oral health and related practices of a group of illicit drug users in Delhi, India; to compare with that of non-drug users; and to assess the impact of illicit drug use on oral health.

DESIGN

Cross-sectional study. Comparison was made with non-drug users to investigate any differences in oral health between illicit drug users and general population.

SETTING AND PARTICIPANTS

Illicit drug users attending a drug dependence treatment clinic in Delhi (n=126). Equal number of non-drug users attending other outpatient departments in the same setting.

OUTCOME MEASURES

Oral health practices assessed using structured questionnaire; dental caries, periodontal status and oral mucosa assessed using World Health Organization 2004 criteria; oral hygiene assessed using OHI-S.

RESULTS

Mean DMFT and OHI-S scores amongst the drug users were 3.48 and 3.80, respectively. Bleeding, shallow pockets and deep pockets were found as the highest CPI finding in 42%, 44% and 12% of drug users respectively. Premalignant states of leukoplakia and OSMF were diagnosed in 13% and 4% of drug users respectively. Significant differences were found between drug users and non-drug users with respect to oral hygiene practices; DMFT, OHI-S, CPI scores; and leukoplakia. In multivariate analysis, illicit drug use was significantly associated with CPI highest score (OR = 2.21, 95% CI 1.08-4.52).

CONCLUSION

The illicit drug users had significantly poorer oral hygiene practices, oral hygiene and periodontal health; higher caries experience; and higher prevalence of leukoplakia as compared to non-drug users. The findings of the study suggest that illicit drug use is independently associated with poor periodontal health.

Validity of partial protocols to assess the prevalence of periodontal outcomes and associated sociodemographic and behavior factors in adolescents and young adults

BACKGROUND

Most studies comparing prevalence of periodontal disease and risk factors by using partial protocols were performed in adult populations, with several studies being conducted in clinical settings. The aim of this study is to assess the accuracy of partial protocols in estimating the prevalence of periodontal outcomes in adolescents and young adults from two population-based birth cohorts from Pelotas, Brazil, and to assess differences in the estimation and strength of the effect measures when partial protocols are adopted compared to full-mouth examination.

METHODS

Gingival bleeding at probing among adolescents (n = 339) and young adults (n = 720) and dental calculus and periodontal probing depth among young adults were assessed using full-mouth examinations and four partial protocols: Ramfjord teeth (RT), community periodontal index (CPI), and two random diagonal quadrants (1 and 3, 2 and 4). Socioeconomic, demographic, and periodontal health-related variables were also collected. Sensitivity, absolute and relative bias, and inflation factors were calculated. Prevalence ratio for each periodontal outcome for the risk factors was estimated.

RESULTS

Two diagonal quadrants showed better accuracy; RT had the worst, whereas CPI presented an intermediate pattern when compared to full-mouth examination. For bleeding assessment in adolescence, RT and CPI underestimated by 18.4% and 16.2%, respectively, the true outcome prevalence, whereas among young adults, all partial protocols underestimated the prevalence. All partial protocols presented similar magnitude of association measures for all investigated periodontal potential risk factors.

CONCLUSION

Two diagonal quadrants protocol may be effective in identifying the risk factors for the most relevant periodontal outcomes in adolescence and in young adulthood.

[Periodontal health status assessed by community periodontal index and related factors in adult population of Beijing urban community]

OBJECTIVE

To investigate the periodontal health conditions by using community periodontal index (CPI) and analyze the effects of related risk factors.

METHODS

By stratified random sampling procedure, a total of 1 183 subjects aged 35-74 were recruited from 13 neighbour community and accepted structured interview and periodontal examination.

RESULTS

The percentage of edentulous jaws was 2.3% (27/1 183). For the remaining 1 156 people, the percentage of subject with a highest CPI scores of 0,1,2,3,4 were 0.3%, 0.2%, 46.3%, 31.9%, 21.3%, respectively. At the sextant and tooth level, the numbers of healthy, bleeding, calculus, shallow pocket, deep pocket and missing pocket were 0.26, 0.25, 3.56, 1.06, 0.39, 0.48, and 3.32, 2.02, 15.43, 2.60, 0.70, 3.93, respectively. By multivariable logistic regression models, many risk indicators such as age, gender, smoking, the knowledge, attitudes and practices (KAP) status, etc. were demonstrated to be related to the distribution of deeper and missing pockets.

CONCLUSION

The adult periodontal conditions of urban community were serious and affected by some demographic and behavior risk factors. More than half (53.2%) of the examined subjects require complex periodontal treatments.

[Periodontal condition and tooth loss in diabetic patients]

INTRODUCTION

Diabetes is a systemic disease which affects the metabolism of glucose,and it has been associated with the development of periodontal disease.

OBJECTIVE

The periodontal condition and tooth loss was evaluated in diabetic subjects.

MATERIALS AND METHODS

At the San Vicente de Paúl Hospital (Medellín, Colombia), 117 subjects with type 1 and 2 diabetes mellitus were examined. Patients underwent a comprehensive periodontal evaluation, glycosylated hemoglobin analysis, oral hygiene habits and history of diabetes. A descriptive and comparative analysis between the clinical parameters, tooth loss and type of diabetes was performed.

RESULTS

The prevalence of gingivitis was 27.4% and periodontitis 72.6%. The most frequent systemic complication was hypertension (51.3%). The most frequently lost teeth were molars and in general, the subjects had lost an average of 7 teeth and had a poor plaque control (55.4%). No differences were seen in clinical parameters between type 1 and 2 diabetes patients. The mean probing depth was 2.6 mm. The first and second upper and lower molars showed the highest values of PD. The mean clinical attachment loss was 3.3 mm . Maxillary teeth 17, 16, and mandibular 37, 47 showed the highest values of clinical attachment loss.

CONCLUSIONS

In conclusion, the periodontal condition in diabetic patients was poor, presenting periodontitis in most cases. This can be a major cause of tooth loss in diabetic subjects and requires special attention by clinicians.

Periodontal health status among permanent residents of low, optimum and high fluoride areas in Kolar District, India

PURPOSE

To assess and compare the periodontal health status among permanent residents of low, optimum and high fluoride areas in Kolar District, India.

MATERIALS AND METHODS

A house-to-house survey was conducted in a population consisting of 925 permanent residents aged 35 to 44 years in three villages having different levels of fluoride concentrations in the drinking water. The fluoride concentrations in selected villages were 0.48 ppm (low), 1.03 ppm (optimum) and 3.21 ppm (high). The ion selective electrode method was used to estimate the fluoride concentration in the drinking water. Periodontal status was assessed using the Community Periodontal Index (CPI) and loss of attachment (LOA). Results were analysed using the chi-square test and logistic regression. The chi-square test was used to find the group differences and logistic regression to find association between the variables.

RESULTS

The overall prevalence of periodontitis was 72.9%; specifically, prevalences were 95.4%, 76.3% and 45.7% in low, optimum and high fluoride areas, respectively. The number of sextants with shallow or deep pockets decreased (shallow pockets: 525, 438, 217; deep pockets: 183, 81, 34) from low to high fluoride areas (odds ratio: 71.3). The low fluoride area had a 7.9-fold higher risk of periodontitis than the optimum fluoride area and a 30-fold higher risk than the high fluoride area, which was highly significant (χ2 = 53.5, P < 0.0001 and χ2 = 192.8, P < 0.001, respectively).

CONCLUSIONS

The severity of periodontal disease is inversely associated with the fluoride concentrations in drinking water. This relation can provide an approach to fluoride treatments to reduce the prevalence or incidence of this disease.

Relationship between periodontal status and levels of glycated hemoglobin

The objective of this study was to assess whether there is a bi-directional relationship between periodontal status and diabetes. Study 1 included 5,856 people without periodontal pockets of ≥ 4 mm at baseline. Relative risk was estimated for the 5-year incidence of periodontal pockets of ≥ 4 mm (CPI scores 3 and 4, with the CPI probe), in individuals with glycated hemoglobin (HbA1c) levels of ≥ 6.5% at baseline. Study 2 included 6,125 people with HbA1c < 6.5% at baseline. The relative risk was assessed for elevation of HbA1c levels in 5 years, with baseline periodontal status, assessed by CPI. Relative risk of developing a periodontal pocket was 1.17 (p = 0.038) times greater in those with HbA1c of ≥ 6.5% at baseline, adjusted for body mass index (BMI), smoking status, sex, and age. Relative risks for having HbA1c ≥ 6.5% at 5-year follow-up in groups with periodontal pockets of 4 to 5 mm and ≥ 6 mm at baseline were 2.47 (p = 0.122) and 3.45 (p = 0.037), respectively, adjusted for BMI, alcohol consumption, smoking status, sex, and age. The risk of developing periodontal disease was associated with levels of HbA1c, and the risk of elevations of HbA1c was associated with developing periodontal pockets of more than 4 mm.

[An epidemiologic examination on the prevalence of the periodontal diseases and oral pigmentation in Yusho patients in 2010]

An epidemiologic examination was carried out to reveal the prevalence of the periodontal diseases and oral pigmentation in patients with Yusho in 2010. The results obtained were as follows. 1) Yusho patients complained of tooth pain and periodontal diseases such as gingival swelling, but not of oral pigmentation. 2) 104 patients out of 117 patients with Yusho, who were measured periodontal pocket depth according to Ramfjord' methods, had at least one tooth with periodontal pocket deeper than 3 mm. Similarly, 314 teeth out of a total 551 examined teeth showed a periodontal pocket with more than 3 mm in depth. However, it was determined that 57 teeth had a periodontal pocket deeper than 4 mm. 3) Oral pigmentation was observed in 63 patients out of 122 patients with Yusho. In this study, gingival pigmentation was most predominant among oral pigmentation. The prevalence of oral pigmentation in male patients seemed to be somewhat higher than that in female patients. In addition, the prevalence of oral pigmentation tended to be higher in patients under seventy years old than patients beyond the age of seventy. These results indicated that PCB-related compounds may be responsible for the higher prevalence of both periodontal diseases and oral pigmentation.

The periodontal health of adult Nepalese

PURPOSE

There exists meagre information on the prevalence of periodontal conditions among adults in Nepal. Therefore, appropriate data on periodontal conditions are needed to facilitate planning, monitoring and evaluation of oral health programmes. The objective of the present study was to determine the prevalence of periodontal conditions among adults aged between 33 and 97 years in Nepal and also to elucidate any possible risk predictors of periodontal problems.

MATERIALS AND METHODS

The total subjects included in the present study were 1210 (33 to 49 years [n = 596] and 50 to 97 years [n = 614]). Community Periodontal Index scores were used to assess the periodontal status of the selected subjects. Self-reported data were used to ascertain oral health behaviour.

RESULTS

Logistic regression analyses showed the following observations for the age group 33 to 49 years: (1) bleeding was more likely found among those subjects who resided in rural areas and upper hill terrain, and among those who used non-fluoridated dentifrice; (2) bleeding was, however, less likely to be observed among those with primary or unfinished secondary school education (PSE); (3) calculus deposits were accentuated in illiterates, whereas less calculus formation was experienced by alcohol users; (4) periodontal pocket 4 to 5 mm was predominantly seen among illiterates and those with PSE, smokers and those who used non-fluoridated dentifrice; (5) periodontal pocket v 6 mm was observed among illiterates and those with PSE and those who used non-fluoridated dentifrice. With regard to 50 years old and above, the following observations were noticed: (1) bleeding was associated with the use of non-fluoridated dentifrice; (2) chewing betel nut showed a protective effect with regard to calculus formation; (3) being illiterate increased the likelihood of having periodontal pockets 6 mm or more in depth.

CONCLUSIONS

Several findings of the present study are in concordance with empirical evidence. However, the protective effect of alcohol and betel nut against calculus formation needs to be investigated further.

Income inequality and periodontal diseases in rich countries: an ecological cross-sectional study

There are adverse effects of income inequality on morbidity and mortality. This relationship has not been adequately examined in relation to oral health.

AIMS

To examine the relationship between income inequality and periodontal disease in rich countries.

PARTICIPANTS

Adults aged 35-44 years in 17 rich countries with populations of more than 2 million.

METHODS

National level data on periodontal disease, income inequality and absolute national income were collected from 17 rich countries with populations of more than 2m. Pearson and partial correlations were used to examine the relationship between income inequality and percentage of 35-44-year-old adults with periodontal pockets > or = 4 mm and > or = 6 mm deep, adjusting for absolute national income.

RESULTS

Higher levels of income inequality were significantly associated with higher levels of periodontal disease, independently of absolute national income. Absolute income was not associated with levels of periodontal disease in these 17 rich countries.

CONCLUSION

Income inequality appears to be an important contextual determinant of periodontal disease. The results emphasise the importance of relative income rather than absoluteincome in relation to periodontal disease in rich countries.

The Second National Oral Health Survey of Vietnam--1999: variation in the prevalence of dental diseases

The 1999 National Oral Health Survey of Vietnam, a population-based survey from a developing country, provides a contrast to the findings of recent surveys in Australia and New Zealand.

OBJECTIVES

This paper aims to describe oral health status and its socio-economic distribution and to evaluate change over time in the oral health of the population of Vietnam.

METHODS

A multi-staged stratified sampling process was employed. Data on children aged 6 to 17 years were collected by an oral examination and a parental questionnaire. Adults aged 18+ years completed a questionnaire and were examined by trained and calibrated dentists.

RESULTS

Oral hygiene status of the child and adult population was poor. Caries experience was high in children but moderate in adults. Caries experience was present mostly as untreated decay. Factors related to caries were sex, hygiene practices, socio-economic status, location and dental visiting.

CONCLUSIONS

The oral health status of the younger Vietnamese generations was compromised by various factors and there are worrying trends, indicating deteriorating oral health in this population.

Periodontal condition of the elderly in Finland

OBJECTIVE

To describe the periodontal condition of the elderly in Finland and its association with sociodemographic factors.

MATERIAL AND METHODS

The study was based on a subpopulation of 1460 persons (748 dentate persons) aged > or =65 years who participated in a nationally representative Health 2000 Survey in Finland. The data for this study were collected by means of an interview and a clinical oral examination.

RESULTS

Seventy-three percent of the participants in this study had gingival bleeding in at least one sextant. The proportion of participants with no teeth with deepened periodontal pockets > or =4 mm deep was 31%. Twenty-eight percent of the participants had one to three teeth with deepened periodontal pockets > or =4 mm deep, 15% had four to six and 26% had > or =7. At the individual level, a high number of teeth with deepened periodontal pockets was associated with sociodemographic factors such as high age, intermediate or higher education, and living in a rural area.

CONCLUSION

At a national level, the greatest need for periodontal treatment presently derives from persons aged 65-74 years and/or those with low education, due to their high representation in the elderly population.

Periodontal diseases in Greek adults between 1985 and 2005--risk indicators

AIM

This study provides data on the periodontal status of Greek adults aged 35-44-years-old in relation to socio-demographic and behavioural parameters and compares these data with those of 1985.

MATERIAL AND METHODS

A stratified cluster sample was selected according to WHO guidelines for national pathfinder surveys. Periodontal and oral hygiene status were assessed using the CPI index and the OHI-S index respectively. Socio-demographic and behavioural data were collected through face-to-face interviews.

RESULTS

In 2005, 9.5% of the participants had healthy periodontium, 16.2% bleeding on probing, 46.8% calculus, 24.2% shallow pockets and 3.3% deep pockets. Half of the individuals (52.1%) had good oral hygiene status, 39.8% fair and 8.1% poor. Most of them (79%) brushed their teeth at least once a day, but only 25.4% used dental floss. Higher CPI scores were associated with living in rural areas, having a lower educational attainment and brushing and flossing teeth less frequently. Better oral hygiene status was associated with having a higher educational attainment and income, as well as brushing and flossing teeth more frequently. Comparisons with the 1985 findings indicate that severe periodontal diseases may be declining in Greece, whereas gingivitis may be increasing.

CONCLUSIONS

The prevalence of severe periodontal diseases in Greek adults is not high and their periodontal health has improved since 1985. As long as their oral hygiene status and preventive dental behaviour cannot be considered as satisfactory, there is room for further improvement.

Periodontitis in 65-74-year-old victims in Wenchuan, China post-earthquake: implications for service provision

OBJECTIVES

One year after the Wenchuan, Southwest China earthquake, a cross-sectional study was conducted as a preliminary assessment of the periodontitis of 65- to 74-year-old victims and to compare it with survey data from before the earthquake.

METHODS

A temporary housing, community-based study was conducted. A total of 1495, 65-74-year-old subjects, 740 county and 755 rural, 753 men and 742 women, were included in the study. The data were collected by means of an interviewer-administered questionnaire and an oral examination.

RESULTS

The calculus and gingival bleeding were distinctly increased, and the prevalence of Attachment Loss at 4-5 mm of 77.3%, at 6-8 mm of 44.8%, at 9-11mm of 13.6% and at > or =12 mm of 2.7%, were also much higher than the findings before the earthquake. Additionally, oral hygiene practice, stress, tobacco abuse and nutritional intake had gone into an adverse trend after the earthquake.

CONCLUSION

The changes caused by the earthquake exacerbated periodontitis in older people. Therefore, consistently superior oral prevention and treatment service programmes for elderly victims should be constituted and encouraged throughout the temporary housing community.

Relationship between periodontitis and hepatic abnormalities in young adults

OBJECTIVE

Obesity has been implicated as a risk factor for periodontitis and non-alcoholic fatty liver disease (NAFLD). In NAFLD, elevated alanine aminotransferase (ALT) is associated with obesity. Although a possible interrelationship between liver function and periodontitis has been reported among the middle-aged population, the correlation in young adults is little known. This study was designed to investigate the relationship between ALT and the presence of periodontitis in university students in Japan.

MATERIAL AND METHODS

Medical and oral health data were collected in a cross-sectional examination conducted by the Health Service Center of Okayama University. Systemically healthy, non-smoking students aged 18 and 19 years old (n = 2225) were included. The protocol of the United States National Health and Nutrition Examination Survey was applied. Subjects with probing pocket depth >or= 4 mm were defined as having periodontitis. Logistic regression analysis was used to estimate the association between ALT, body mass index and periodontitis.

RESULTS

The number of subjects with periodontitis was 104 (4.7%). In males, having periodontitis was significantly associated with an increased level of ALT (>or= 41 IU/l) in logistic regression analysis (adjusted odds ratio 2.3; 95% confidence interval 1.0-5.2; p < 0.05). However, there was no significant association between periodontitis and ALT in female students.

CONCLUSIONS

Elevated ALT could be a potential risk indicator for periodontitis among young males. Monitoring hepatic abnormalities to prevent periodontitis must be better understood, even in the young adult population.

Lifelong exposure to smoking and oral health among 35- to 44-year-old Iranians

PURPOSE

The objective of this study was to assess the periodontal treatment needs and the dental status in relation to smoking indicators with special emphasis on lifelong exposure to smoking among 35- to 44-year-old Iranian dentate subjects.

MATERIALS AND METHODS

Data (N = 8276) were collected as part of a national survey using the World Health Organization criteria for sampling and for using the data as clinical indicators. Gender, age, place of residence and level of education served as sociodemographic information, and community periodontal index (CPI) and number of teeth served as clinical measurements. The smoking indicators comprised smoking, duration of smoking (years), daily smoking (cigarettes/day) and lifelong exposure to smoking.

RESULTS

In total, 81% of the subjects were non-smokers, and 32% of the males and 5% of the females were current smokers. Maximal CPI = 2 was found among 40% of the subjects, and 53% had maximal CPI > or = 3. Higher periodontal treatment needs were associated with smoking (P < 0.01) in males; CPI = 4 was more frequent (P < 0.01) and the mean number of teeth was lower (P < 0.01) among groups with higher levels of smoking. Heavy smokers were the most likely to have maximal CPI > or = 3 (odds ratios, OR = 2.9; 95% confidence intervals, 95% CI = 1.8 to 4.7) and to have < 20 teeth (OR = 2.3; 95% CI = 1.5 to 3.6).

CONCLUSIONS

Smoking and lifelong exposure to smoking with a dose-dependent effect seem to be associated with higher periodontal treatment needs and poorer dental status among the middle-aged, particularly in males and in low socioeconomic groups in Iran.

Periodontal health status in Swedish adolescents: an epidemiological, cross-sectional study

The aim of this epidemiological survey was to analyze the periodontal conditions of 19-year old individuals in two rural county areas, i.e. Fyrbodal and Skaraborg, Västra Götaland, Sweden, with special reference to gender and socioeconomic grouping. A randomized sample of 506 individuals (Fyrbodal 250 and Skaraborg 256 individuals, respectively) was clinically examined with regard to oral hygiene, gingivitis, periodontal pockets and gingival recession. Bitewing radiographs were used for assessment of alveolar bone level (ABL) and dental calculus. A questionnaire-based interview regarding oral hygiene habits was included. A majority of the subjects (76%) claimed to brush their teeth at least twice a day, while interdental hygiene means were used daily by 4%. The subjects showed a mean plaque score of 47% and a gingivitis score of 56%. Forty-six % of the adolescents had a plaque score of > or = 50%, whereas the corresponding figure for gingivitis was 62%. The subjects had on average 5.5 teeth with facial gingival recession. The mean prevalence of sites with probing depth (PPD) of > or = 4 mm was 8, out of which 99% were located at proximal sites. A radiographic bone level of > 2 mm was observed at on average 0.4 teeth per subject. Logistic regression analyses revealed that gender (males) and county area (Fyrbodal) were significant factors for a high plaque and gingivitis score. There was no significant difference in periodontal conditions in relation to socio-economic grouping. In conclusion, the survey revealed higher prevalence of plaque and gingivitis among male than female adolescents, but no differences between socioeconomic groups.

Restoration margins in young adolescents: a clinical and radiographic study of Swiss Army recruits

PURPOSE

The aim of the present study was to report the radiographical prevalence of overhanging fillings in a group of Swiss Army recruits in 2006 and to relate the dimensions of the overhangs to clinical parameters.

MATERIALS AND METHODS

A total of 626 Swiss Army recruits were examined for their periodontal conditions, prevalence of caries, and stomatological and functional aspects of the masticatory system and halitosis. In particular, the present report deals with the presence or the absence of fillings, the presence or the absence of overhangs and their relation to clinical and radiographic parameters.

RESULTS

A total of 16,198 interdental sites were evaluated on bitewing radiographs. Of these sites, 15,516 (95.8%) were sound and 682 (4.2%) were filled. Amalgam restorations were found in 94.1% and resin composite fillings in 5.9% of the sites. Of these 682 sites, 96 (14.1%) yielded overhanging margins of various sizes. This low prevalence of fillings represents not only a substantial reduction when compared with a similar Swiss Army study (Lang et al, 1988), but also an improvement in the quality of dental care delivery to young Swiss males. Plaque Index and Gingival Index increased statistically significantly with the presence of fillings, when compared with healthy non-filled sites. Clinical parameters that were significantly associated with the presence of overhangs included clinical attachment loss. Moreover, between 1985 and 2006 the prevalence of fillings was significantly reduced from 20.0% to 4.2% of all surfaces. Furthermore, the marginal fit of the fillings improved from 33.0% with overhangs to 14.1%.

CONCLUSIONS

A significant improvement was observed in the periodontal and dental conditions of young Swiss males that was shown to have taken place within the previous two decades. From 1985 to 2006, the prevalence of fillings was reduced fourfold and that of overhanging margins twofold, documenting an improvement in the quality of restorative dentistry.