Periodontal Status and Hyperlipidemia: Statin Users Versus Non‐Users

Background: The association between serum lipids and periodontal disease has been studied predominantly in patients with chronic periodontitis with limited data available regarding periodontal status of patients with hyperlipidemia. Meanwhile, the impact of statins on the periodontal health of the population also remains largely underexplored. This study aims to assess the periodontal status among patients with hyperlipidemia and users of statins. Methods: In this cross‐sectional study, 94 patients with hyperlipidemia (50 receiving statins and 44 receiving non‐pharmacologic therapy) and 46 control individuals who were normolipidemic underwent periodontal examination (plaque index, gingival index [GI], probing depth [PD], and clinical attachment level [CAL]). Biochemical parameters measured included serum triglyceride (TG), total cholesterol (TC), low‐density lipoprotein (LDL) cholesterol, and high‐density lipoprotein cholesterol levels. Results: PD and GI were significantly higher in patients with hyperlipidemia who were non‐statin users compared with the normolipidemic individuals (P <0.001 [PD] and P <0.05 [GI]) and the statin group (P = 0.001 [PD] and P <0.05 [GI]). Periodontal parameters between statin users and the normolipidemic group did not differ significantly. After adjusting for confounders, positive and significant correlations were observed between PD and TG, and TC and LDL, whereas CAL shared correlation with TC and LDL. GI was correlated with TG and TC. Regression analyses revealed that whereas TC was associated significantly with PD (P <0.001), LDL showed significant association with CAL (P = 0.013). TG showed significant association with GI (P = 0.020). Conclusions: Our findings suggest that relative to the general population, patients with hyperlipidemia are more prone to periodontal disease. Also, within the limits of this study, statins have a positive impact on periodontal health.     

Influence of Laser‐Microtextured Surface Collar on Marginal Bone Loss and Peri‐Implant Soft Tissue Response: A Systematic Review and Meta‐Analysis

Background: A laser‐microtextured surface (LMS) dental implant collar appears to promote a more tooth‐like gingival collagen fiber attachment, which may help to stabilize peri‐implant tissues. The purpose of this systematic review is to assess the clinical effect of an LMS versus non‐LMS collar on crestal bone level and peri‐implant soft tissue response. Methods: Electronic and manual literature searches were performed by two independent reviewers for articles written in English up to December 2016. Studies were included if they were human clinical trials with the purpose of evaluating the impact of an LMS collar on peri‐implant hard and soft tissues. Cumulative marginal bone loss (MBL), probing depth (PD), and survival rate (SR) with 95% confidence intervals (CIs) were calculated to show the performance of LMS implant collars. MBL, PD, and SR data were analyzed with a random effects model to compare the influence of LMS collars with non‐LMS collars (e.g., roughened surface and machined surface). Results: Fifteen human clinical studies (three randomized controlled trials, six cohort studies, and six case series) with 772 implants met the inclusion criteria. For the overall data, the weighted mean MBL was 0.72 mm (95% CI: 0.59 to 0.85 mm), PD was 1.81 mm (95% CI: 1.13 to 2.49 mm), and SR was 0.97 (95% CI: 0.95 to 0.98). MBL around an LMS collar was significantly less than around machined‐surface collars (weighted mean difference [WMD]: ?0.77; 95% CI: ?1.01 to ?0.52; I² = 95.2%; P <0.001). PD in the LMS group was significantly shallower than in the machined‐surface group (WMD: ?1.34; 95% CI: ?1.62 to ?1.05; I² = 81.4%; P <0.001). However, no statistically significant difference was detected for MBL between the LMS and roughened‐surface groups (WMD: ?0.04; 95% CI: ?0.16 to 0.08; I² = 0.0%; P = 0.75). No statistically significant difference was found for SR between the LMS and non‐LMS groups (risk ratio: 1.01; 95% CI: 0.97 to 1.04; I² = 0.0%; P = 0.91). Conclusions: Meta‐analysis showed that an LMS collar can reduce the amount of MBL and PD compared with a machined‐surface collar. Due to high heterogeneity between the included studies, results should be interpreted cautiously.     

Vitamin D Status and Tooth Loss in Postmenopausal Females: The Buffalo Osteoporosis and Periodontal Disease (OsteoPerio) Study

Background: Vitamin D is hypothesized to reduce risk for tooth loss via its influence on bone health, inflammation, and the immune response. The association between plasma 25‐hydroxyvitamin D [25(OH)D] concentrations and prevalence and 5‐year incidence of tooth loss in a cohort of postmenopausal females was examined. Methods: Participants underwent oral examinations at study baseline (1997 to 2000) and follow‐up (2002 to 2005) to determine the number of missing teeth and 5‐year incidence of tooth loss, respectively. At both visits, females self‐reported reasons for each missing tooth. At baseline, 152 females reported no history of tooth loss, and 628 were categorized as reporting a history of tooth loss as a result of periodontal disease (n = 70) or caries (n = 558) (total n = 780). At follow‐up, 96, 376, 48, and 328 females were categorized into the aforementioned categories related to tooth loss (total n = 472). Logistic regression was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for tooth loss by category of baseline 25(OH)D (nmol/L) concentrations. Models were adjusted for age, income, smoking status, frequency of dental visits, waist circumference, and recreational physical activity. P value for trend was estimated using continuous concentrations of 25(OH)D. Results: Among females with 25(OH)D ≥50 (adequate vitamin D status) compared to <50 nmol/L (deficient/inadequate), the adjusted ORs were 1.24 (95% CI = 0.82 to 1.87), P‐trend = <0.05 for the history (prevalence) of tooth loss resulting from periodontal disease or caries and 1.07 (95% CI = 0.62 to 1.85), P‐trend = 0.11 for the incidence of tooth loss resulting from periodontal disease or caries. No statistically significant association was observed between 25(OH)D and the history or incidence of tooth loss caused by periodontal disease. An increased odds of the history of tooth loss attributable to caries was observed with increasing concentrations of 25(OH)D (P‐trend = <0.05) but was not confirmed in prospective analyses. Conclusion: In this cohort of postmenopausal females, the data do not support an association between vitamin D status and tooth loss.     

A practice‐based clinical evaluation of the survival and success of metal‐ceramic and zirconia molar crowns: 5‐year results

This practice‐based study evaluates the survival and success of conventionally luted metal‐ceramic and zirconia molar crowns fabricated by using a prolonged cooling period for the veneering porcelain. Fifty‐three patients were treated from 07/2008 to 07/2009 with either metal‐ceramic crowns (MCC) or zirconia crowns (ZC). Forty‐five patients (26 female) with 91 restorations (obser‐vational period: 64·0 ± 4·8 months) participated in a clinical follow‐up examination and were included in the study. Estimated cumulative survival (ECSv), success (ECSc) and veneering ceramic success (ECVCSc) were calculated (Kaplan–Meier) and analysed by the crown fabrication technique and the position of the restoration (Cox regression model) (P < 0·05). Five complete failures (MCC: 2, ZC: 3) were recorded (5‐year ECSv: MCC: 97·6%, (95% confidence interval (95%‐CI): [93%; 100%]/ZC: 94·0%, (95%‐CI): [87%; 100%]). Of the MCCs (n = 41), 85·0%, [95%‐CI: (77%; 96%)] remained event‐free, whereas the ECSc for the ZCs (n = 50) was 74·3% (95%‐CI): [61%; 87%]. No significant differences in ECSv (P = 0·51), ECSc (P = 0·43) and ECVCSc (P = 0·36) were detected between the two fabrication techniques. Restorations placed on terminal abutments (n = 44) demonstrated a significantly lower ECVCSc (P = 0·035), (5‐year VCF‐rate: 14·8%) than crowns placed on tooth‐neighboured abutments (n = 47), (5‐year VCF‐rate: 4·3%). In the present study, zirconia molar crowns demonstrated a 5‐year ECSv, ECSc and ECVCSc comparable to MCCs. Irrespective of the fabrication technique, crowns on terminal abutments bear a significantly increased risk for VCFs. Clinical investigations with an increased number of restorations are needed.     

Effectiveness of Periodontal Treatment to Improve Metabolic Control in Patients With Chronic Periodontitis and Type 2 Diabetes: A Meta‐Analysis of Randomized Clinical Trials

Background: It was recently suggested that scaling and root planing (SRP) may help to improve glycemic and metabolic control in patients with chronic periodontitis (CP) and type 2 diabetes mellitus (DM2); however, the effectiveness of SRP in this role remains unclear. This meta‐analysis assesses the effectiveness of SRP in improving glycemic and metabolic control in patients with CP and DM2. Methods: A literature search of electronic databases was performed for articles published through May 16, 2012, followed by a manual search of several dental journals. A meta‐analysis was conducted according to the recommendations of the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA). Weighted mean differences (MDs) and 95% confidence intervals (CIs) were calculated for glycated hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), total cholesterol (TC), triglycerides (TG), and high‐ and low‐density lipoprotein cholesterol (HDL and LDL, respectively). All outcomes were evaluated as changes from baseline to the end of follow‐up. Heterogeneity was assessed with the χ²‐based Cochran Q test and I² statistic. The level of significance was set at P < 0.05. Results: After the study selection process, five randomized clinical trials were included. Results of the meta‐analysis indicated that SRP was effective in the reduction of HbA1c (MD = 0.65; 95% CI 0.43 to 0.88; P <0.05) and FPG (MD = 9.04; 95% CI 2.17 to 15.9; P <0.05), but no significant differences were found in the reduction of TC, TG, HDL, or LDL. No evidence of heterogeneity was detected. Conclusion: The meta‐analysis results seem to support the effectiveness of SRP in the improvement of glycemic control in patients with CP and DM2; however, future studies are needed to confirm these results.     

Efficacy and safety of articaine versus lidocaine for irreversible pulpitis treatment: A systematic review and meta‐analysis of randomised controlled trials

The aim was to assess the efficacy and safety of articaine compared with lidocaine for irreversible pulpitis (IP) treatment. Databases were explored electronically and relevant journals as well as the references of the included studies were hand‐searched for randomised clinical trials comparing the efficacy and safety of articaine with lidocaine in treatment of IP. Twenty studies were included, of which eight had low risk of bias, 10 had moderate risk of bias and two had high risk of bias. In comparison with 2% lidocaine with 1:100 000 epinephrine, 4% articaine with 1:100 000 epinephrine showed a higher success rate in anaesthesia of IP at either person (risk ratio (RR) 1.15; 95% confidence intervals (CI) 1.10 1.20; P < 0.00001) or tooth unit (RR 1.10; 95% CI 1.10 1.19, P < 0.00001), lower VAS scores during injection phase (mean difference (MD) ?0.67; 95% CI ?1.26 ?0.08, P = 0.02) and treatment phase (MD ?3.35; 95% CI ?3.78 ?2.91, P < 0.00001), shorter onset time of pulpal anaesthesia (MD ?0.94; 95% CI ?1.13 ?0.74, P < 0.00001) and lower percentage of patients undergoing adverse events (RR 0.17; 95% CI 0.03 0.92, P = 0.04). Given the efficacy and safety of the two solutions, 4% articaine with 1:100 000 epinephrine was superior to 2% lidocaine with 1:100 000 epinephrine in dental treatments in IP.     

Generalized Aggressive Periodontitis as a Risk Factor for Dental Implant Failure: A Systematic Review and Meta‐Analysis

Background: Dental implant placement is a widely used treatment that provides functional and esthetic resolution for patients suffering from tooth loss. However, the incidence of peri‐implant diseases has been rising recently. Periodontal diseases and peri‐implant diseases share many similarities. Hence, it is important to find out whether patients with aggressive periodontal disease possess a higher risk of developing peri‐implant diseases. The aim of this study is to study whether generalized aggressive periodontitis (GAgP) has similar survival rates (SRs) and marginal bone loss (MBL) when compared with patients with chronic periodontitis (CP) and/or healthy patients (HPs). Methods: An electronic literature search was conducted by one reviewer (AM) in several databases from 2000 to 2013, including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Oral Health Group Trials Register databases, for articles written in English up to November 2013. Human clinical trials, either prospective or retrospective, that compared implant SR and MBL in patients with a history of GAgP versus those with CP or HPs were included. Results: A total of six non‐randomized prospective clinical trials met the inclusion criteria. The results showed SRs of 83.3% to 100% (GAgP), 96.4% to 100% (CP), and 96.9% to 100% (HP) over a mean period of 48.01 ± 71.99 months, with an overall risk ratio of 0.96 (95% confidence interval [CI] = 0.91 to 1.01, P = 0.14, GAgP versus HP) and 0.94 (95% CI = 0.87 to 1.01, P = 0.09, GAgP versus CP). However, when the “failure rate” as studied outcome was examined, meta‐analysis presented an overall risk ratio of 4.00 for the comparison between patients with AgP and HPs and an overall risk ratio of 3.97 when compared with patients with CP. The MBL weighted mean difference for each subgroup was 0.15 mm (95% CI = 0.04 to 0.26, HP versus CP), ?0.28 mm (95% CI = ?0.36 to ?0.19, HP versus GAgP), and ?0.43 mm (95% CI = ?0.53 to ?0.33, CP versus GAgP) over a mean period of 30 ± 18 months. Conclusions: Implant placement in patients with a history of GAgP might be considered a viable option to restore oral function with survival outcomes similar to those found in both patients with CP and HPs. However, the risk ratio for failure in patients with AgP is significantly higher when compared with HPs (4.0) and those with CP (3.97).     

Catecholamine Metabolites in Urine,as Chronic Stress Biomarkers,Are Associated With Higher Risk of Chronic Periodontitis in Adults

Background: The purpose of this case–control study is to investigate the association between stress and periodontitis by determining stress biomarkers in saliva and urine and to determine whether oral hygiene, gingival inflammation, and tooth loss are correlated with stress biomarkers in patients with periodontitis. Methods: A total of 77 patients (41 cases [with periodontitis] and 36 controls) participated in this study. Periodontal examination findings included probing depth, clinical attachment loss, bleeding on probing (BOP), plaque index (PI), and tooth loss. Secretory immunoglobulin (sIg)A and cortisol were determined in saliva. Cortisol, creatinine‐adjusted cortisol, metanephrine, normetanephrine, and total metanephrines were measured in urine. Results: Urinary metanephrine (P = 0.013) and total metanephrine (P = 0.023) levels were higher in the case group. In cases, salivary cortisol was correlated with PI (r = 0.464, P <0.01), BOP (r = 0.401, P <0.05), and tooth loss (r = 0.245, P <0.05). Urinary metanephrine levels above the median were associated with a 3.4‐fold higher risk of periodontitis (95% confidence interval [CI] = 1.1 to 10.2; P = 0.029), with an 82% increase in risk for each increment of 0.05 µg/24 hours. Urinary total metanephrine levels above the median were associated with a five‐fold higher risk of periodontitis (95% CI = 1.6 to 15.7; P = 0.006). Conclusions: The present results offer new evidence of the association between urinary concentrations of catecholamine metabolites (metanephrine and total metanephrines) and chronic periodontitis. Salivary IgA level showed no statistical difference between the cases and controls. Salivary cortisol levels in the patients with periodontitis were correlated with worse PI, higher gingival inflammation, and greater tooth loss.     

The Effect of Locally Delivered Statins on Treating Periodontal Intrabony Defects: A Systematic Review and Meta‐Analysis

Background: Use of statins on adult patients with chronic periodontitis shows a positive effect on their periodontal status. However, effect of locally delivered statins on periodontal treatment has not yet been systematically analyzed. Hence, the present systematic review and meta‐analysis aims to evaluate efficacy of statins on treating localized periodontal intrabony defects (IBDs). Methods: An electronic search of three databases (PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature) between January 1, 1965 and March 1, 2016, and a hand search of peer‐reviewed journals for relevant articles were performed. Controlled randomized clinical trials (RCTs) and prospective studies with data on comparison between adjunctive locally delivered statin use to mechanical scaling and root planing (SRP) and placebo in each group, with minimum 10 participants and follow‐up period of at least 6 months, were included. Results: Ten studies, eight RCTs and two prospective studies, were included. Each study included 15 to 105 patients between 25 and 55 years of age. Statistical results were recorded; weighted mean difference (WMD) and confidence interval (CI) were calculated; and meta‐analyses were performed for defect fill, probing depth (PD) reduction, and clinical attachment level (CAL) gain in both statin and placebo/no treatment groups. Overall analysis of defect fill presented WMD of 1.37 mm (95% CI = 0.96 to 1.77; P <0.0001), PD reduction presented WMD of 1.76 mm (95% CI = 1.04 to 2.47; P <0.0001), and CAL gain presented WMD of 1.58 mm (95% CI = 0.89 to 2.28; P <0.0001). However, comparison presented considerable heterogeneity among studies. Conclusions: This systematic review and meta‐analysis find that adjunctive use of locally delivered statins to mechanical SRP is beneficial to increasing bone fill percentage. Improved inflammatory and bleeding control as well as PD reduction and CAL gain are possible advantages to using these drugs in treating patients with periodontal IBDs.     

Oral health behaviors, periodontal disease, and pathogens in preeclampsia: a case-control study in Korea

Background: The aim of this study is to confirm the association among oral health behaviors, periodontitis, and preeclampsia in Korean women. Methods: This study is designed as a case‐control study. Sixteen women with preeclampsia and 48 without preeclampsia post‐delivery were included in this study from November 2007 to January 2010. Information was collected on demographics, health behaviors, and obstetric and systemic diseases that may influence the periodontal condition and preeclampsia. Full‐mouth periodontal probing was conducted by one trained examiner (KHB). Localized periodontitis was defined as periodontal clinical attachment loss (AL) ≥3.5 mm on two or three sites not on the same tooth. In addition, generalized periodontitis was defined as clinical AL ≥3.5 mm on ≥4 sites not on the same tooth. Gingival crevicular fluid was collected using a sterilized paper point for quantitative analysis of Treponema denticola, Porphyromonas gingivalis, Prevotella intermedia (Pi), and Tannerella forsythia (previously T. forsythensis). Results: After adjusting for confounders, the adjusted odds ratio (OR) was 4.79 (95% confidence interval [CI]: 1.02 to 29.72) for localized periodontitis and 6.60 (95% CI: 1.25 to 41.61) for generalized periodontitis. In addition, the proportion of floss or interdental brush users in women with preeclampsia was lower than that in women without (adjusted OR: 0.21; 95% CI: 0.02 to 0.93). Pi was significantly more prevalent in women with preeclampsia (P = 0.028). Conclusion: These results indicate that preeclampsia could be associated with the maternal periodontal condition and interdental cleaning.     

Periodontal and General Health in Long‐Term Periodontal Maintenance Patients Treated in a Norwegian Private Practice: A Descriptive Report From a Compliant and Partially Compliant Survivor Population

Background: There is weak evidence to support the benefit of periodontal maintenance therapy in preventing tooth loss. In addition, the effects of long‐term periodontal treatment on general health are unclear. Methods: Patients who were compliant and partially compliant (15 to 25 years’ follow‐up) in private practice were observed for oral and systemic health changes. Results: A total of 219 patients who were compliant (91 males and 128 females) were observed for 19.1 (range 15 to 25; SD ± 2.8) years. Age at reassessment was 64.6 (range: 39 to 84; SD ± 9.0) years. A total of 145 patients were stable (0 to 3 teeth lost), 54 were downhill (4 to 6 teeth lost), and 21 patients extreme downhill (>6 teeth lost); 16 patients developed hypertension, 13 developed type 2 diabetes, and 15 suffered myocardial infarcts (MIs). A minority developed other systemic diseases. Risk factors for MI included overweight (odds ratio [OR]: 9.04; 95% confidence interval [CI]: 2.9 to 27.8; P = 0.000), family history with cardiovascular disease (OR: 3.10; 95% CI: 1.07 to 8.94; P = 0.029), type 1 diabetes at baseline (P = 0.02), and developing type 2 diabetes (OR: 7.9; 95% CI: 2.09 to 29.65; P = 0.000). A total of 25 patients who were partially compliant (17 males and eight females) were observed for 19 years. This group had a higher proportion of downhill and extreme downhill cases and MI. Conclusions: Patients who left the maintenance program in a periodontal specialist practice in Norway had a higher rate of tooth loss than patients who were compliant. Patients who were compliant with maintenance in a specialist practice in Norway have a similar risk of developing type 2 diabetes as the general population. A rate of 0.0037 MIs per patient per year was recorded for this group. Due to the lack of external data, it is difficult to assess how this compares with patients who have periodontal disease and are untreated.     

The probability of and factors influencing tooth survival following non‐surgical root canal treatment – a prospective study

Aim To investigate the probability of and factors influencing tooth survival following primary or secondary root canal treatment. Methodology This prospective study involved annual follow‐up of up to 4 years of primary (759 teeth, 572 patients) or secondary (858 teeth, 642 patients) root canal treatment in an Eastman cohort. Informed consent was obtained from the patients. Pre‐, intra‐ and post‐operative data were collected prospectively on customised proforma. Information about extraction of the root treated tooth was reported by the patient, the referring dentist or extracted from the patient's hospital medical records. The timing and reasons for extraction were recorded. Tooth survival was estimated and prognostic factors investigated using Cox regression. Clustering effects within patients were adjusted in all models using robust standard error. Results The 4‐year tooth survival after primary root canal treatment (95.4%) or secondary root canal treatment (95.3%) were similar. Fourteen prognostic factors were identified. Significant patient factors included: History of diabetes and systemic steroid therapy. Significant pre‐operative factors included: narrow periodontal probing depth; pain; discharging sinus; cervical root resorption; and iatrogenic perforation (for retreatment cases only). Significant intra‐operative factors included: iatrogenic perforation; patency at apical terminus; and extrusion of root fillings. Significant post‐operative restorative factors included: Presence of cast restoration or temporary restoration; presence of cast post & core; proximal contacts with both mesial and distal adjacent teeth; and terminal location of the tooth. The presence of pre‐operative pain had a profound effect on tooth loss within the first 22 months after treatment (HR = 3.1; P = 0.001) with a lesser effect beyond 22 months (HR = 2.4; P = 0.01). Patency at the apical terminus reduced tooth loss (HR = 0.3; P < 0.01) within the first 22 months after treatment but had no significant effect on tooth survival beyond 22 months. Extrusion of gutta‐percha root filling did not have any effect on tooth survival (HR = 1.1; P = 0.2) within the first 22 months but significantly increased the hazard of tooth loss beyond 22 months (HR = 3.0; P = 0.003). Conclusions The 4‐year tooth survival following primary or secondary root canal treatment was 95%; with fourteen prognostic factors common to both.     

Association Between Interleukin‐4 Gene −590 C/T, −33 C/T,and 70‐Base‐Pair Polymorphisms and Periodontitis Susceptibility: A Meta‐Analysis

Background: Several studies have investigated the association between interleukin (IL)‐4 gene ?590 C/T, ?33 C/T, or 70–base pair (70‐bp) polymorphisms and periodontitis susceptibility but with conflicting results. Hence, a meta‐analysis was conducted to explore whether these polymorphisms are associated with periodontitis susceptibility. Methods: A comprehensive literature search was conducted of PubMed, Embase, Scopus, ScienceDirect, and Web of Science up to April 5, 2014. After the eligible studies were identified, data were extracted and quality‐assessed before performing the meta‐analysis. Results: The meta‐analysis included 23 eligible case‐control studies from 11 articles involving 12 studies of the ?590 C/T polymorphism (1,220 cases and 2,039 controls), five of the ?33 C/T polymorphism (715 cases and 967 controls), and four of the 70‐bp polymorphism (426 cases and 506 controls). The meta‐analysis showed that none of these IL‐4 gene polymorphisms were significantly associated with periodontitis susceptibility in all study participants. However, subgroup analysis showed that the IL‐4 ?590 T allele (odds ratio [OR] = 1.2, 95% confidence interval [CI] = 1.02 to 1.42, P = 0.03) and TT genotype (OR = 1.68, 95% CI = 1.05 to 2.67, P = 0.03) were associated with periodontitis in whites. Conclusions: Based on current evidence, the IL‐4 ?33 C/T and 70‐bp polymorphisms were not associated with an increased risk of periodontitis. However, the IL‐4 ?590 T allele and TT genotype were associated with increased risk of periodontitis in whites.     

Traumatic dental injury among 12‐year‐old South Brazilian schoolchildren: prevalence,severity, and risk indicators

Abstract – An increasing prevalence of traumatic dental injury (TDI) has been reported in the last few decades. The aim of this study was to assess the prevalence and severity of TDI and its association with socio‐demographics and physical characteristics in the anterior permanent teeth of 12‐year‐old Brazilian schoolchildren. A cross‐sectional study was carried out in a population‐based sample of 1528 subjects attending 33 public and nine private schools (response rate of 83.17%). A single calibrated examiner performed the clinical examinations at the schools and recorded the TDI index (Children’s Dental Health Survey criteria), overjet and lip coverage. Height and weight were measured to calculate the body mass index (BMI). Parents/legal guardians answered a questionnaire containing socio‐demographic questions. The relationships among TDI, socio‐demographic variables and physical characteristics were assessed by survey Poisson regression models. The prevalence of TDI was 34.79% (mild trauma = 24.37%; severe trauma = 10.43%). Male schoolchildren (RR = 1.41, 95% CI = 1.23–1.61, P = 0.002) and schoolchildren from low socioeconomic status (RR = 1.32, 95% CI = 1.07–1.64, P = 0.021) were more likely to present at least one tooth with TDI, whereas students attending 7th grade (advanced students) were less likely to experience TDI (RR = 0.59, 95% CI = 0.43–0.82, P = 0.012). Regarding the severity analysis, students of mid‐high (RR = 1.46, 95% CI = 1.09–1.94, P = 0.022), mid‐low (RR = 1.68, 95% CI = 1.01–2.77, P = 0.045) and low (RR = 1.78, 95% CI = 1.11–2.85, P = 0.027) socioeconomic status were more likely to have mild trauma when compared with schoolchildren of high socioeconomic status. No significant association between severe trauma and socioeconomic status was observed. In conclusion, this study showed a high prevalence of TDI in 12‐year‐old Brazilian schoolchildren. Socio‐demographic data and school achievement were associated with TDI.     

Clinical and community risk models of incident tooth loss in postmenopausal women from the Buffalo Osteo Perio Study

Bole C, Wactawski‐Wende J, Hovey KM, Genco RJ, Hausmann E. Clinical and community risk models of incident tooth loss in postmenopausal women from the Buffalo Osteo Perio Study. Community Dent Oral Epidemiol 2010; 38: 487–497. © 2010 John Wiley & Sons A/S Abstract – Objective: While risk factors for tooth loss in adults have been identified, limited studies describing factors associated with incident tooth loss in postmenopausal women exist. This study assessed both clinical and non‐clinical risk factors for incident tooth loss. Methods: Postmenopausal women (N = 1341) were recruited between 1997 and 2000 from 1847 eligible Observational Study participants of the Buffalo, NY center of the Women’s Health Initiative who had complete dental examinations to assess alveolar bone height, soft tissue attachment and general oral health, and completed questionnaires concerning demographics, general health, lifestyle and oral health (72.6% participation rate). Five years later (2002–2005), 1021 women (76.1%) repeated these examinations and questionnaires. Incident tooth loss was determined by oral examination. Results: After an average 5.1 years of follow‐up (SD, 0.38), a total of 323 teeth were lost in 293 women, resulting in 28.7% of women with incident loss of at least one tooth. In multivariable models, diabetes history, gum disease history, smoking, previous tooth loss, BMI and plaque index, baseline clinical measures including alveolar crestal height (ACH) (OR = 1.22 per mm loss, 95% CI 1.11, 1.35), clinical attachment loss (CAL) (OR = 1.13 per mm loss, 95% CI 1.05, 1.23), and pocket depth (PD) (OR = 1.26 per mm loss, 95% CI 1.13, 1.41) were significant risk factors of incident tooth loss. In a community model that included no clinical measures, diabetes history (OR = 2.45, 95% CI 1.26, 4.77), prior gum disease (OR = 1.97, 95% CI 1.43, 2.70), ever smoking (OR = 1.42, 95% CI 1.06, 1.89), number of teeth lost at baseline (OR = 1.05 per tooth, 95% CI 1.02, 1.08), and BMI (OR = 1.15 per 5 km/m² increase, 95% CI 1.01, 1.33) were associated with an increased risk of incident tooth loss. Conclusions: Clinical and questionnaire‐based models were found to provide similar risk estimates for incident tooth loss in postmenopausal women. These models identified high‐risk postmenopausal women where preventive strategies may be targeted.     

Meta‐Analysis of Association Between Interleukin‐1β C‐511T Polymorphism and Chronic Periodontitis Susceptibility

Background: Many studies have been conducted to explore the association between interleukin (IL)‐1β C‐511T polymorphism and risk of chronic periodontitis (CP) but with different or even contradictory results. A meta‐analysis was performed to further explore their association. Methods: PubMed, Chinese National Knowledge Infrastructure, and EMBASE were searched up to September 30, 2014 for relevant case‐control studies. Two authors (D‐YL and L‐YX) independently selected studies and extracted data from included studies. The meta‐analysis was performed using comprehensive meta‐analysis software. Results: Nineteen case‐control studies involving 2,173 patients with CP and 3,900 healthy controls were included. Using a random‐effects meta‐analysis model, a non‐significant association between IL‐1β C‐511T polymorphism and CP was identified (T versus C: odds ratio [OR] = 1.03, 95% confidence interval [CI] = 0.85 to 1.25; TT versus CC: OR = 1.03, 95% CI = 0.72 to 1.46; CT versus CC: OR = 0.96, 95% CI = 0.71 to 1.30; CT + TT versus CC: OR = 1.00, 95% CI = 0.74 to 1.34; TT versus CT + CC: OR = 1.05, 95% CI = 0.81 to 1.38), and sensitivity analysis indicated that the results were robust. Subgroup analyses also revealed a non‐significant association. No publication bias was detected. Conclusions: Based on currently available evidence, IL‐1β C‐511T polymorphism is not associated with the risk of developing CP. Additional research is warranted to further explore and confirm the association of genetic polymorphism and CP.     

Quantitative Assessment of the Associations Between Interleukin‐8 Polymorphisms and Periodontitis Susceptibility

Background: This review assesses the associations of interleukin‐8 gene (IL‐8) ?251A/T (rs4073) and ?845T/C (rs2227532) polymorphisms with susceptibility to periodontitis. Methods: Several electronic databases were searched for eligible articles. Twelve studies involving 2,233 cases and 2,655 controls were retrieved and analyzed. Odds ratios (ORs) along with 95% confidence intervals (CIs) were calculated to assess the strength of relationship between the IL‐8 polymorphisms and periodontitis risk. Results: No significant association was found for IL‐8 ?251A/T polymorphism with periodontitis in the overall analysis and stratification by periodontitis type and smoking status. Subgroup analysis by ethnicity revealed that ?251A/T T allele and TT genotype were associated with decreased risk of periodontitis in a Brazilian mixed population (T allele versus A allele: OR 0.80, 95% CI 0.68 to 0.94, P_{heterogeneity} = 0.30; TT versus AA: OR 0.65, 95% CI 0.46 to 0.93, P_{heterogeneity} = 0.39; TT versus AA/AT: OR 0.58, 95% CI 0.35 to 0.98, P_{heterogeneity} = 0.01). In addition, ?251A/T T allele was associated with increased periodontitis risk in Asians. Pooled estimates showed that the ?845T/C polymorphism was associated with periodontitis susceptibility in overall analysis and the chronic periodontitis subgroup. In addition, marginal associations were observed between ?845T/C polymorphism and periodontitis in a Brazilian mixed population. Moreover, this association was also confirmed to be significant in Brazilian non‐smokers. Conclusion: This meta‐analysis indicated that both IL‐8 ?251A/T and ?845T/C polymorphisms may be involved in the development of periodontitis in a Brazilian mixed population, whereas the ?251A/T allele T appeared to be a risk factor for periodontitis in Asians.     

Racial/ethnic variations in associations between socioeconomic factors and tooth loss

Abstract – Objectives: To compare the associations between socioeconomic factors and tooth loss among White, Black, and Mexican‐American people. Methods: Analyses were conducted on 16 821 adults, using data from the National Health and Nutrition Examination Survey‐III. Age‐ and multivariate‐adjusted negative binomial regressions were used to explore the relation of socioeconomic factors, region of residence, gender, and foreign birth with the number of missing teeth. Effect modification by race/ethnicity was assessed by the inclusion of interaction terms. Results: In multivariate‐adjusted analyses, non‐Hispanic White people with 9–12 years of education exhibited 71% higher mean number of missing teeth than those with >12 years of education [incidence rate ratio (IRR) = 1.71, 95% confidence interval (CI): 1.52–1.92]. Education was unrelated to the number of teeth among non‐Hispanic Black people (IRR = 1.16; 95% CI: 1.00–1.35) or Mexican‐Americans (IRR = 1.10, 95% CI: 0.93–1.31). The poorest White people exhibited 39% more missing teeth, on average, than the most affluent White people, but no association between poverty and number of teeth was observed among Black or Mexican‐American people. Conclusions: The associations between socioeconomic factors and tooth loss vary across race/ethnicity. This suggests that the health benefits associated with high socioeconomic status are not equally shared across racial/ethnic groups.     

Effect of Fluoxetine on Periodontal Status in Patients With Depression: A Cross‐Sectional Observational Study

Background: Fluoxetine, a selective serotonin reuptake inhibitor, has been reported to reduce periodontal disease severity in a rat ligature‐induced periodontitis model. The objective of the present study is to investigate the influence of fluoxetine intake on periodontal parameters in patients with periodontitis with clinical depression. Methods: A sample of 236 patients with chronic periodontitis and clinical depression were assessed for clinical parameters of periodontal disease. Of these, 115 patients were taking fluoxetine (20 mg/day) for ≥2 months, and 121 patients were not. Participants taking fluoxetine were further analyzed for correlation between duration of drug intake and periodontal parameters. Results: All periodontal parameters, except plaque index, were significantly lower in participants taking fluoxetine (P <0.01). Partial correlation analysis, adjusted for confounders, revealed a significant and negative correlation between duration of fluoxetine intake and attachment loss (AL) (R² = ?0.321, P <0.05). Logistic regression analysis revealed that fluoxetine intake was associated with a lower risk of having AL ≥3 (odds ratio [OR] = 0.55, 95% confidence interval [CI] = 0.31 to 0.96) and lower odds of increased bleeding on probing (BOP) percentage values (OR = 0.62, 95% CI = 0.34 to 0.97). Conclusion: In this observational study, use of fluoxetine was associated with lower BOP percentages and reduced AL.