Periodontal status of adult Sudanese habitual users of miswak chewing sticks or toothbrushes

Miswak chewing sticks are prepared from the roots or twigs of Salvadora persica plants. They are widely used as a traditional oral hygiene tool in several African and Middle Eastern countries. The aim of this study was to assess and compare the periodontal status of adult Sudanese habitual miswak and toothbrush users. The study population comprised male miswak users (n = 109) and toothbrush users (n = 104) with age range 20-65 years (mean 36.6 years) having 18 or more teeth present. They were recruited among employees and students at the Medical Sciences Campus in Khartoum, Sudan. One examiner used the Community Periodontal Index (CPI) to score gingival bleeding, supragingival dental calculus, and probing pocket depth of the index teeth of each sextant. In addition, the attachment level was measured, which, along with the CPI, was used to assess the periodontal status of the two test groups. Gingival bleeding and dental calculus were highly prevalent in the study population. Approximately 10% of the subjects had ≥4 mm probing depth and 51% had ≥4 mm attachment loss in one or more sextants. Subjects in the age group 40-65 years had a significantly (p < 0.05) higher number of sextants with gingival bleeding and with ≥4 mm probing depth and attachment loss than the 30-39 years group. Miswak users had significantly (p < 0.05) lower dental calculus and ≥4 mm probing depth and higher ≥4 mm attachment loss as well as a tendency (p = 0.09) to lower gingival bleeding in the posterior sextants than did toothbrush users. These differences were not significant in the anterior sextants. It is concluded that the periodontal status of miswak users in this Sudanese population is better than that of toothbrush users, suggesting that the efficacy of miswak use for oral hygiene in this group is comparable or slightly better than a toothbrush. Given the availability and low cost of miswak, it should be recommended for use in motivated persons in developing countries.

     

Application of the community periodontal index of treatment needs (CPITN) in a group of 45–54-year-old German factory workers

Abstract The purpose of the present study was to assess the periodontal status of 45–54-year-old patients and to evaluate their treatment needs. Probing depths, bleeding on probing and retentional elements (calculus and overhanging restorations) were determined according to the community periodontal index of treatment needs (CPITN). Additionally, loss of attachment was measured, Results indicated that none of the subjects had a completely healthy periodontium; only 14.7% presented with single sextants which were healthy or needed only improved oral hygiene. Slightly less than half (46.1%) of the subjects were classified as treatment need (TN) category 2 and the remainder (53.9%) as TN3. Of the subjects classed as TN category 3, 14% had the requisite code 4 in one sextant, 18.2% in 2 sextants. 21.7% in half or more of the sextants and 4.2% in all sextants. With a mean of 5.55 sextants per patient. 0.2 sextants per person were scored as code 0 or 1, 1.33 sextants as code 2, 2.79 sextants as code 3 and 1.24 sextants as code 4. The mean loss of attachment was 3.8 mm. Anterior teeth showed less loss of attachment than posterior teeth and buccal and lingual surfaces showed less loss of attachment than mesial and distal surfaces. The data indicate that although this group of 45–54-year-old subjects had high CPITN scores in total TN categories, the codes for complex Treatment Needs (TN3) were recorded only in localized areas.     

Periodontal status of adult Sudanese habitual users of miswak chewing sticks or toothbrushes

Miswak chewing sticks are prepared from the roots or twigs of Salvadora persica plants. They are widely used as a traditional oral hygiene tool in several African and Middle Eastern countries. The aim of this study was to assess and compare the periodontal status of adult Sudanese habitual miswak and toothbrush users. The study population comprised male miswak users (n = 109) and toothbrush users (n = 104) with age range 20-65 years (mean 36.6 years) having 18 or more teeth present. They were recruited among employees and students at the Medical Sciences Campus in Khartoum, Sudan. One examiner used the Community Periodontal Index (CPI) to score gingival bleeding, supragingival dental calculus, and probing pocket depth of the index teeth of each sextant. In addition, the attachment level was measured, which, along with the CPI, was used to assess the periodontal status of the two test groups. Gingival bleeding and dental calculus were highly prevalent in the study population. Approximately 10% of the subjects had > or =4 mm probing depth and 51% had > or =4 mm attachment loss in one or more sextants. Subjects in the age group 40-65 years had a significantly (p < 0.05) higher number of sextants with gingival bleeding and with > or =4 mm probing depth and attachment loss than the 30-39 years group. Miswak users had significantly (p < 0.05) lower dental calculus and > or =4 mm probing depth and higher > or =4 mm attachment loss as well as a tendency (p = 0.09) to lower gingival bleeding in the posterior sextants than did toothbrush users. These differences were not significant in the anterior sextants. It is concluded that the periodontal status of miswak users in this Sudanese population is better than that of toothbrush users, suggesting that the efficacy of miswak use for oral hygiene in this group is comparable or slightly better than a toothbrush. Given the availability and low cost of miswak, it should be recommended for use in motivated persons in developing countries.     

Periodontal health status and treatment needs among the elderly

The numbers of dentate elderly are growing rapidly in all industrialized countries, and epidemiological information about their oral health is urgently needed. Our study is part of the population-based Helsinki Ageing Study (HAS), and this paper describes the periodontal health status as well as the need for periodontal treatment among the dentate elderly born in 1904, 1909, and 1914 and living in January, 1989, in Helsinki, Finland (n = 175). The dental examinations were carried out during 1990 and 1991 at the Institute of Dentistry, University of Helsinki, Finland. The subjects' periodontal health was recorded by the CPITN (Community Periodontal Index of Treatment Needs) method. The mean number of remaining teeth was 15.1 among men and 14.0 among women, with the mean number of remaining sextants 3.7 and 3.5, respectively. Healthy periodontal tissues (CPI = 0) were found in 7% of the subjects. Bleeding on probing (CPI = 1) was recorded in 6%, and calculus and/or overhanging margins of restorations (CPI = 2) in 41% of the subjects, as the worst finding. Altogether, 46% of the subjects had deep periodontal pockets, 35% with at least one 4- to 5-mm pocket (CPI = 3), and 11% with at least one ≥ 6-mm pocket (CPI = 4). Overall, 93% of the subjects required oral hygiene instruction, 87% scaling and root planing, and 11% complex periodontal treatment. The periodontal treatment need was significantly higher in men than in women; however, no significant differences were observed among the three age cohorts. The need for complex periodontal treatment was unexpectedly low, probably explained by the fact that there were many missing teeth, especially molars, perhaps lost due to poor periodontal health.     

Degree of correlation between two periodontal indices in a rural Croatian population

AIM: To compare the periodontal status of patients measured by two indices, the Community Periodontal Index (CPI) and the Loss of Attachment Index (LA). METHOD: The CPI and LA index scores were determined for a sample of 367 adult subjects (1,535 dentate sextants) aged 15-65 years from two rural areas in Croatia and analysed according to subject, sextant and jaw. RESULTS: Partial correlation between the CPI and LA indices was found. Cumulative for all age groups, sextants with a CPI code 0, 1 and 2 most often appeared with a LA 0-3mm. Shallow pocket sextants (4-5mm) in 64.04% also correlated with the loss of attachment values 4-5mm. In deep pocket sextants (6-8 mm), a deviation from expectations was found as they appeared more often with a LA 9-11 mm designation (46.24%), rather than with an LA 6-8mm (34.41%) score. Very similar results were found between distribution per sextant, person and jaw in CPI codes 2, 3, 4 and cumulatively. CONCLUSION: CPI itself is not sufficient for periodontal status assessment, especially for the 35-44 years of age, and even more so for the 65+ group, also for the CPI code 4 in all ages.     

Periodontal conditions in patients requesting dental implant treatment

Periodontal disease is considered a risk factor in dental implant treatment. The purpose of this study was to investigate the periodontal conditions in patients requesting dental implant therapy. A total of 169 patients visiting Department of Oral and Maxillo-Facial Implantology at Tokyo Dental College Chiba Hospital were targeted. The following intraoral parameters were measured in each patient: Community Periodontal Index (CPI) score, probing pocket depth (PPD), clinical attachment level (CAL) and bleeding on probing (BOP). Prevalence of patients with periodontal pockets was high: 38% and 28% of patients had a CPI score of code 3 and 4, respectively. Prevalence of teeth with one or more sites with PPD≥4mm was 27%. Moreover, clinical signs suggestive of periodontitis (PPD, CAL≥4mm) were found in 10-15% of tooth sites. Prevalence rates at sites with severe periodontal breakdown (PPD, CAL≥7mm) were 2-5%. These results further emphasize the importance of thorough periodontal assessment in patients prior to dental implant treatment.     

Epidemiology of periodontal diseases in the study of health in Pomerania

Aim: The aim of this study was to assess the prevalence and extent of periodontal diseases among adults in a province in Eastern Germany.
Material and Methods: The Study of Health in Pomerania is a population-based study conducted during 1997–2001. The net random sample comprised 4310 20–81-year-old subjects. Periodontal status was assessed at four surfaces using a half-mouth recording protocol.
Results: The prevalence of attachment loss 3 mm was 89.7%, with 62.8% of teeth being affected. Probing depths 4 mm were prevalent in 69.7% of subjects, and 29.6% of teeth were affected. 25.3% of all subjects had severe pockets (6 mm). Periodontitis was significantly more prevalent in males. For attachment loss, the prevalence and extent increased significantly with increasing age, whereas probing depth values levelled off after the age of 40. In older subjects, increased recession and attachment loss were found, while the probing depth remained constant. According to the recent CDC classification, 17.6% and 33.3% of persons had severe and moderate periodontitis, respectively. The prevalence of periodontitis increased significantly with age and remained constant after the age of 50–59.
Conclusions: Periodontitis is more prevalent in Pomerania than in the United States or Western Europe. In older subjects, attachment loss steadily increased, while the probing depth remained constant.     

Dental and periodontal complications of lip and tongue piercing: prevalence and influencing factors

Background: The aim of this study was to compare the prevalence of lip and tongue piercing complications and explore the effect of ornament time wear period, habits, ornament morphology and periodontal biotype on the development of complications. Methods: One hundred and ten subjects with 110 lip and 51 tongue piercings were assessed for abnormal toothwear and/or tooth chipping/cracking (dental defects), gingival recession, clinical attachment loss and probing depth of teeth adjacent to the pierced site. Piercing habits (biting, rolling, stroking, sucking) were recorded. Results: Wear time and habits significantly affected the prevalence of dental defects and gingival recession. Pierced site significantly affected dental defects prevalence, with greater prevalence for tongue than lip piercing. Wear time significantly affected attachment loss and probing depth. Attachment loss and probing depth did not significantly differ between tongue and lip piercings. Gingival recession was significantly associated with ornament height closure and stem length of tongue ornaments. Periodontal biotype was not significantly associated with gingival recession, attachment loss and probing depth. Conclusions: Dental defects prevalence is greater for tongue than lip piercing. Gingival recession is similar for tongue and lip piercing. Longer wear time of tongue and lip piercing is associated with greater prevalence of dental defects and gingival recession, as well as greater attachment loss and probing depth of teeth adjacent to pierced sites. Ornament morphology affects gingival recession prevalence.     

A clinical survey of periodontal conditions in Greece

Abstract The present study used full-mouth clinical assessments of plaque, calculus, bleeding on probing, probing pocket depth and probing attachment level to evaluate the periodontal conditions in a rural (A) and an urban (B) sample of 25–64 year old Greek adults, comprising 190 and 373 subjects, respectively. 13% of the subjects in sample (A) and 8% in sample (B) were edentulous, while mean values of teeth present in the four age cohorts ranged between 19.8—12.6 and 23.3—18.3. respectively. A poor level of oral hygiene was recorded in both samples with high plaque, calculus and bleeding scores. Deep pocketing was more pronounced in the rural than in the urban sample: between 1.7 and 8.0% of all sites probed showed a PPD of ≥6 mm and between 20 and 51.2% of the subjects in each age cohort had at least one deep pocket. Corresponding figures for the urban sample was 0.6-4.7% and 15.1-49.2%. However, the prevalence of severe attachment loss was of comparable magnitude in both samples: between 2.8–25.7% of the sites in sample (A) and 2.8–20.6% in sample (B) displayed a PAL of ≥6 mm, while 32.5-72.1% and 31.8-73.8% of the subjects, respectively, had at least one severely affected site. It was further found that the distribution of advanced disease in the samples was skewed; 14.4% of the subjects in sample (A) and 9.5% in sample (B) accounted for 75%, of all deep pockets, while 21.8 and 19.4% of the subjects, respectively, accounted for 75% of all sites with PAL of ≥6 mm. Multiple regression revealed that male sex and high plaque and bleeding scores had a significant, positive influence to the amount of attachment loss on a subject level.     

Periodontal conditions in elderly people of Shanghai, People's Republic of China, in 1986

In a stratified multi-stage random sample, 1600 persons of 60 years and older in Shanghai, People's Republic of China, were investigated for periodontal conditions using the CPITN method. Periodontal conditions seemed to deteriorate steadily but rather slowly with increasing age. In the older age groups, there was a trend for an increased proportion of both subjects and sextants scoring CPITN code 4 (deep pockets). The increase in tooth loss with increasing age was more clearly visible: increasing percentages of edentulousness and decreasing mean numbers of teeth remaining in dentate subjects.     

Periodontal conditions of teeth autogenously transplanted by a two-stage technique

Inflammatory reactions of the marginal periodontal tissues and loss of attachment could partly account for the often occurring rejection of autogenously transplanted mature teeth. The periodontal conditions of transplanted teeth were investigated from 1 month up to 5 years postoperatively. The parameters plaque, bleeding on probing to the bottom of the pocket, probing pocket depth (PPD), gingival recession and probing attachment loss were analysed by multiple regression analysis. No significant difference was found between transplanted and control teeth in bleeding on probing the bottom of the pockets up to 5 years postoperatively with the exception of increased bleeding on probing of the transplanted teeth at the 1-month postsurgery examination. No significant difference of the mean probing depth between transplanted teeth and control teeth was found at the mesio- and distobuccal surfaces. The transplanted teeth at the buccal surface showed increase of the mean pocket depth during the observation period. Increased mean probing depth without progression over time was found at the transplanted teeth compared to the controls at the distolingual, lingual and mesiolingual surfaces. A small mean gingival recession at the transplants was observed. Loss of attachment was recorded at 13% of the surfaces. Totally 50% of the transplants showed loss of attachment and 5% were removed because of extensive attachment loss. On 13% of the transplanted teeth with loss of attachment, root resorption was also found.     

Probing depth, attachment loss and gingival recession

The present investigation describes probing pocket depth, probing attachment level and recession data from 319 randomly selected subjects, aged 20-79 years, from Ushiku, Japan. The findings are reported as mean values, frequency distributions and percentile plots of the 3 parameters at buccal, interproximal and lingual surfaces of single rooted (incisors, canines, premolars) and molar teeth. Inter-as well as intra-examiner errors for probing pocket depth and probing attachment levels were assessed and found to be small. The data reported revealed that practically all subjects studied had one or more sites in the dentition affected by destructive periodontal disease and that the severity of disease increased with age. It was further observed that in each age group, molars had suffered more attachment loss than single rooted teeth and that the interproximal surfaces as a rule had lost more periodontal tissue support than corresponding buccal and lingual surfaces. The attachment loss difference observed between different surfaces of a given tooth or a group of teeth, however, was comparatively small. In the age groups between 20-59 years, advanced destructive periodontal disease was found in a small subgroup of the subject sample, while after the age of 60 years, widespread destructive periodontitis was common. An attempt was made to examine the progression of destructive disease with age by comparing the frequency distributions of sites with attachment loss of greater than or equal to 3 mm in subjects of different age groups. The data suggested that in younger subject groups, progression was confined to a subset of individuals, while in older age groups, more subjects and sites became involved. A major feature of destructive periodontal disease in older individuals was the accompaniment of attachment loss with recession at the gingival margin. Deep pockets were relatively infrequently detected, while advanced loss of attachment (with recession) occurred at many sites.     

Clinical risk indicators for periodontal attachment loss

The purpose of the present investigation was to evaluate the association of baseline clinical parameters of periodontal disease with disease progression in the following year. 271 randomly selected subjects from Ushiku Japan were monitored for overt gingivitis and plaque accumulation at 4 sites per tooth and probing pocket depth, probing attachment level and bleeding on probing at 6 sites per tooth for all teeth at baseline and 1 year. A subject was considered to exhibit additional attachment loss if one or more sites increased 3 mm or more in a probing attachment level measurement in one year. The clinical variables included age, sex, number of missing teeth, mean pocket depth and attachment level. In addition, the % of sites which exhibited overt gingivitis, visible plaque, pocket depths, attachment levels or gingival recession over certain mm thresholds or bled on probing were determined. Chi 2 analysis was used to seek significant associations between the baseline clinical variables and subsequent attachment loss in a subject. Only 74 of the 271 subjects (27.3%) exhibited additional attachment loss of 3 mm or more at 1 or more sites after 1 year. Older subjects had a greater risk of disease progression than younger subjects. There were no significant differences in % of individuals exhibiting additional attachment loss when divided on the basis of sex, number of missing teeth or % of sites with overt gingivitis. However, the greater the % of sites with visible plaque or which bled on probing, the greater was the likelihood of subsequent attachment loss. Increasing mean levels of pocket depth or attachment level or increasing %s of sites exhibiting prior attachment loss were strongly related to the proportion of individuals with subsequent attachment loss. Gingival recession exhibited similar but weaker relationships. Log-linear analysis suggested that the association between bleeding on probing, age, or plaque levels with additional attachment loss may be explained by the association of these variables with baseline attachment loss. The analyses were repeated with a positive subject defined as having only 1 active site or 2 or more active sites. 37 subjects fit the 1st criterion and the remaining 37 the 2nd criterion. The associations observed were almost identical to those found when subjects were considered positive on the basis of 1 or more changing sites. Discriminant analysis was used to classify subjects as active or inactive using up to 11 predictor variables.(ABSTRACT TRUNCATED AT 400 WORDS)     

Periodontal disease and type diabetes mellitus in children and adolescents

Abstract This study compared the periodontal status of a juvenile diabetic study group with that of a non-diabetic control group similar in age and sex. The study group consisted of 26 type I diabetic patients with an average age of 13.42 years and 24 control subjects of similar age. The diabetic subjects were evaluated with glycosylated hemoglobin (GHb) to obtain a measure of diabetic control. Clinical periodontal evaluations were performed for all teeth in each subject, and consisted of the plaque index, gingival fluid flow, gingival index, probing depths, clinical attachment levels, recession, and bleeding on probing. Analysis of the data demonstrated no statistically significant differences in the overall means for the 2 groups for average attachment loss, probing depths, recession, gingival index, plaque index, gingival fluid flow, or bleeding on probing. There was no significant association between the level of control of diabetes (GHb) and clinical variables. However, comparisons based on site-specific measurements showed the gingival index to be somewhat higher among the diabetics (p=0.0002), and examination of interaction effect plots showed the diabetic group to have higher average gingival index for most teeth and higher or the same plaque index levels on all teeth relative to controls. Thus, a young study population with type 1 diabetes mellitus was found to have significantly increased severity of inflammatory gingival disease compared to controls of similar age.     

Oral health care needs among the middle-aged and the elderly in Hong Kong

Abstract A sample of 372 35–44-yr-olds and 537 noninstitutionalized 65–74-yr-olds were clinically examined in an oral health survey of Hong Kong Chinese conducted in 1991. The examination procedures and diagnostic criteria for assessing restorative and extraction treatment need followed those recommended by the World Health Organization. The Community Periodontal Index-based periodontal treatment needs involving index teeth or their replacements were computed from separate clinic scores for maximum probing depth, presence of calculus, and bleeding after probing. A set of criteria for assessing prosthodontic treatment need was specially laid down for this survey. Examiners were calibrated before the survey, and the interexaminer reliability was found to be generally good. Besides reporting the various individual normative treatment need items in the traditional way, the present analysis used some holistic treatment-need categories which may have manpower-requirement implications for the classification of subjects. All dentate subjects surveyed required some treatment. Only 6% of the elderly, all edentulous, required denture work only. Of the 35–44-yr-olds, 42% needed scaling and oral hygiene instruction only, which could be provided by dental hygienists. The treatment needs of the vast majority of the middle-aged and the elderly (mainly scaling; simple fillings; and extractions, dentures, or both) could be easily handled by general dentists. Only about one-fifth of the subjects in both age groups required some complex care such as endodontics, crowns, and advanced periodontal treatment, which could be delivered by senior dentists or dentists with specialist training.     

A cross‐sectional study of dentine hypersensitivity in China

Objective : To carry out a cross‐sectional study of the prevalence of dentine hypersensitivity and related risk factors in Chengdu City, China. Methods : A total of 1,320 subjects were distributed equally in six communities in Chengdu City and of all age groups (10 years for an age group) including the same number of male and female subjects in each community. Each subject completed a structured interview and the subjects who reported hypersensitivity were examined further using a triple syringe to administer a blast of cold air to confirm the diagnosis of dentine hypersensitivity. Periodontal attachment loss and gingival recession of all sensitive teeth were measured. Results : The prevalence of dentine hypersensitivity was 25.5% in the oral test. Only 16.6% of subjects who reported hypersensitivity symptoms had received desensitising treatment. 50–59 year age group was the cohort with the greatest number of subjects with DH and the premolar was the most commonly affected tooth. Low education level, gingival recession, and attachment loss were related to dentine hypersensitivity. Conclusions : The prevalence of dentine hypersensitivity in an urban adult population in Chengdu City was 25.5%.     

Clinical and other risk indicators for early periodontitis in adults

BACKGROUND: Periodontal diseases affect over half the adults in the U.S., disproportionately affecting minority populations. Periodontitis can be treated in early stages, but it is not clear what features indicate, or could be risk factors for, early stages of periodontal attachment loss. This study aimed to evaluate associations between clinical and other risk indicators of early periodontitis. METHODS: A cross-sectional evaluation of 225 healthy and early periodontitis adults aged 20 to 40 years was performed. Clinical measurements, demographic information, and smoking histories were recorded. Analyses evaluated demographic and clinical associations with health and early periodontitis disease categories and periodontal attachment loss. Patterns of attachment loss at interproximal and buccal/lingual sites were evaluated. RESULTS: Subject age, plaque, and measures of gingivitis exhibited associations with attachment loss and probing depth. More periodontal attachment loss was detected in African-American and Hispanic subjects compared to Asian and Caucasian subjects. Smoking history was associated with attachment loss. At interproximal sites, lower molars most frequently had attachment loss, whereas at buccal/lingual sites, higher proportions of lower bicuspid teeth demonstrated attachment loss compared with other sites. CONCLUSIONS: In this study of subjects with minimal attachment loss, gingival inflammation was associated with early periodontitis. Lower molar interproximal sites were frequently associated with interproximal attachment loss, whereas lower bicuspid teeth were at risk for gingival recession on buccal surfaces.     

Periodontal changes in patients undergoing radiotherapy

BACKGROUND: The purpose of this study was to evaluate changes in the periodontium in patients who received head and neck radiation therapy. METHODS: Periodontal clinical parameters (probing depth, clinical attachment level, gingival recession, plaque index, and bleeding on probing) were assessed on 27 patients before and 6 to 8 months following radiation therapy in the head and neck area. RESULTS: The greatest changes occurred in clinical attachment level: overall, 70.3% of the patients showed a loss, with 92% evincing loss in the mandible. Attachment loss was directly related to the field of radiation and was greater when the jaws were actually included in the irradiated area. CONCLUSION: Periodontal status should be evaluated prior to and following radiation therapy in the oral-maxillary-facial region to help ensure that periodontal health is maintained in oncology patients.     

Clinical factors and self‐perceived oral health

Self‐perceived oral health is affected not only by awareness of the clinical status but also by comparisons with people of a similar age. This study explored the relative contributions of clinical variables assessing caries, periodontal status, and prosthetic status to self‐perceived oral health within two age groups. Data of 891 adults (35–44 yr of age) and 760 older people (65–74 yr of age) from the Fourth German Oral Health Study (DMS IV, 2005) were evaluated. Self‐perceived oral health was obtained from questionnaires. Numbers of decayed, filled, and unreplaced teeth, mean attachment loss, bleeding on probing (BOP), the presence of a fixed denture, and the presence of a removable denture were assessed. Multinomial logistic regression models were developed for both age groups, separately, using stepwise methods. For adults, unreplaced teeth, filled teeth, decayed teeth, the presence of a removable denture, and mean attachment loss were added to the final model. For older people, the presence of a removable denture, unreplaced teeth, decayed teeth, mean attachment loss, filled teeth, and BOP were included in the final model. Awareness of the relative contributions of clinical variables to self‐perceived oral health is important for obtaining a clearer understanding of patients' subjective and objective self‐perceptions of oral health.     

Periodontal health in Down syndrome: Contributions of mental disability,personal, and professional dental care

Fifty‐five dentate patients with Down syndrome (DS) and 74 with mental disability non‐Down (MR) were compared to 88 control subjects. Subjects in the MR and Control groups were matched by gender and ethnicity to subjects with DS. All subjects were nonsmokers. Periodontal evaluation included plaque index (PI), gingival index (GI), bleeding on probing (BOP), and clinical periodontal attachment levels. Caries and missing teeth were recorded. Measures of personal dental hygiene and the frequency of professional dental care were also recorded. Most subjects brushed their teeth at least once per day, but did not floss. Both groups with DS and MR had significantly more missing teeth, more BOP, and higher GI and PI levels than the control group. Patients with DS had more attachment loss (AL) than the other two groups (p < .001). Increased AL in patients with DS was not associated with differences in socioeconomic status, personal/professional dental care, or mental disability.