Smoking in adolescence as a predictor of early loss of periodontal attachment

OBJECTIVES: On the basis of information from studies of older adults, smoking is considered to be an important risk factor for periodontal disease. Examining periodontal loss of attachment among younger adults means a lower contribution from cumulative exposure to other environmental risk factors. The aim of this study was to examine the role of chronic exposure to cigarette smoking as a risk factor for greater prevalence and extent of periodontal loss of attachment among 26-year-old participants in a longstanding prospective cohort study. METHODS: Loss of attachment (LOA) was measured at three sites per tooth in two randomly selected contralateral quadrants (one upper, one lower). Cigarette smoking history was obtained at ages 15, 18, 21 and 26, and used to categorise participants as "never-smokers", "ever-smokers", "long-term smokers" or "very longterm smokers". RESULTS: Periodontal data were available for 914 Study members, among whom the prevalence of LOA of 4+mm was 19.4%. Among those who smoked at ages 15, 18, 21 and 26, it was 33.6%, and, after controlling for sex, selfcare and dental visiting, they were nearly three times as likely to have one or more sites with 4+mm LOA. CONCLUSIONS: Chronic exposure to smoking is a strong predictor of periodontal disease prevalence in young adults.     

Risk indicators for periodontal disease in a remote Canadian community--a dental practice-based study

OBJECTIVES: The purpose of this cross-sectional study was to identify risk markers and risk indicators for periodontal attachment loss in a remote Canadian community. Of special interest was the association between smoking and periodontal disease experience. METHODS: Data were collected from a convenience sample of 187 adult patients attending a dental office in a rural community located in Northern Ontario. Information was obtained via a questionnaire and a periodontal examination. The questionnaire included the use of dental services, self-care behaviors, general health status, smoking, and personal characteristics. Periodontal health was assessed using the mean periodontal attachment loss (MPAL), measured at two sites on all remaining teeth and the proportions of sites examined with loss of 2 mm or more and 5 mm or more. Plaque scores and measures of the number of missing teeth also were obtained. The relationships between mean periodontal attachment loss, the proportion of sites with 5 mm or more of loss and independent variables such as age, sex, current smoking status, mean tooth plaque scores, flossing frequency, and regularity of preventive dental visits were examined in bivariate and multivariate analyses. RESULTS: The data revealed a mean periodontal attachment loss of 3.9 mm (SD=1.5). The mean proportion of sites examined with loss of 2 mm or more was 0.89 and the mean proportion with loss of 5 mm or more was 0.35. In linear regression analysis, plaque scores, the number of missing teeth, age, current smoking status, regularity of dental visits, and flossing frequency had statistically significant independent effects and explained 60.0 percent of the variance in mean periodontal attachment loss. Just over 30 percent of subjects had severe periodontal disease, defined as 50 percent or more of sites examined with loss of 5 mm or more. In logistic regression analysis, missing teeth, dental visiting, smoking status, age, and flossing frequency had significant independent effects. The strongest association observed was with smoking, which had an odds ratio of 6.3. The logistic regression model correctly predicted 64.3 percent of cases with severe disease. CONCLUSIONS: The data indicate that the periodontal health of these patients is poor. Risk indicators or markers of poor periodontal health in the population studied included missing teeth, plaque scores, age, current smoking status, regularity of dental visits, and flossing frequency. This supports previous findings that behavioral factors play an important role in periodontal disease.     

Stress and the progression of periodontal disease

Abstract This study examined the association between occupational stress and the progression of periodontitis in employed adults. 23 regular dental attenders, enrolled in a longitudinal study of periodontal disease, were examined on 2 occasions at an interval of 5.5 (SD 0.6) years. The mean age at the 2nd examination was 41.1 (SD 7.3) years. Clinical measurements of periodontal status including clinical attachment level were made at four proximal sites on all teeth. A questionnaire, the occupational stress indicator, was used at the second examination to assess stress retrospectively. The mean change in clinical attachment level was 0.63 (SD 0.42) mm and 9.6 (SD 8.6) % of sites measured at both examination lost ≥3 mm of periodontal attachment. Multiple regression analysis was used to explore the relationship between mean loss of periodontal attachment and measures of occupational stress and sociodemographic data. In the final regression model, an increase in loss of periodontal attachment was significantly predicted by increasing age, lower socio-economic status, lower job satisfaction and type A personality. In addition, locus of control was included in the regression model which explained 65% of the variance in the loss of periodontal attachment. The results suggest that occupational stress may have a relationship to the progression of periodontitis.     

Smoking influences salivary histamine levels in periodontal disease

Oral Diseases (2012) 18 , 410–416 Objectives: Histamine, a potent vasoactive amine, is increased in saliva of periodontitis patients. The present study aimed to further investigate the diagnostic potential of histamine for periodontal disease and assessed smoking, a major risk factor of periodontitis, as a possible influencing factor. Methods: Salivary and serum samples of 106 participants (60 periodontitis patients, 46 controls) were collected. Salivary histamine was determined by a commercially available ELISA kit, and serum C‐reactive protein was measured by a routine laboratory test. Cigarettes per day and packyears were assessed as smoking exposure parameters. Results: Statistically significantly increased levels of salivary histamine and serum C‐reactive protein were detected between the patient and control group (P = 0.022 and P = 0.001). Salivary histamine levels were significantly higher in smoking compared with non‐smoking patients (P < 0.001), and salivary histamine as well as serum C‐reactive protein correlated significantly positively with smoking exposure parameters (P < 0.05). Conclusions: Smoking, an established and common risk factor of periodontitis, was assessed as a possible influencing factor for salivary histamine. Most interestingly, salivary histamine differed highly significantly between smoking and non‐smoking periodontitis patients. Our results suggest a possible involvement of histamine in tobacco‐exacerbated periodontal disease, but do not suggest salivary histamine as a reliable diagnostic marker for periodontitis.     

Low-dose aspirin therapy and periodontal attachment loss in ex- and non-smokers

BACKGROUND, AIMS: This study investigated the periodontal status of non-smokers and ex-smokers in relation to their intake of low-dose aspirin. METHODS: A self-selected sample of 392 males aged 50 years and over was recruited from the general population. Subjects were included in the study if they had a minimum of 6 or more natural teeth, took aspirin (300 mg or less per day) for at least 2 years and were either ex- or non-smokers. Controls were subjects who did not take aspirin regularly. A questionnaire was used to record demographic data, medical and dental histories. Individuals who had diabetes or other systemic diseases were excluded from the study. Periodontal attachment loss (PAL) was calculated by adding measurements of gingival recession and periodontal pocket depth made by a single examiner at 6 sites around each tooth using non-pressure sensitive periodontal probes. Plaque and gingival bleeding indices were also scored. Subjects were divided into 4 groups: aspirin non-smokers, aspirin ex-smokers, no aspirin non-smokers and no aspirin ex-smokers. Data were analysed using two-way ANOVA with age as the covariate. Severity and extent of mean PAL and the cumulative distribution of the mean of the most severe sites (MSS) of PAL were analysed. RESULTS: Controlling for age, mean PAL in aspirin takers was significantly less 2.6+/-0.08 (se) mm than non-aspirin takers 2.9+/-0.06 (se) mm; this association was independent of smoking history. Ex-smokers had significantly more mean PAL 3.9+/-0.07 (se) mm than non-smokers 2.6+/-0.08 (se) mm, irrespective of aspirin status. When MSS-PAL was analysed, these differences became more pronounced; MSS-PAL in aspirin takers was significantly less 3.9+/-0.1 (se) mm than non-aspirin takers 4.2+/-0.08 (se) mm. Ex-smokers had significantly more MSS-PAL 4.3+/-0.08 (se) mm than non-smokers 3.8+/-0.08 (se) mm. Aspirin apparently had a protective association on PAL and it is hypothesised that low-dose aspirin may have reduced the rate of attachment loss. CONCLUSIONS: This hypothesis needs to be confirmed by a prospective study. The results of this study suggest that individuals aged over 50 years, particularly ex-smokers, may benefit by taking low-doses of aspirin daily to reduce their risk of periodontal attachment loss.     

Smoking and periodontal disease

Periodontal disease is considered to be an opportunistic infection as a result of interactions between the causative agents (dental plaque) and the host responses which may be modulated by genetic, environmental and acquired risk factors. Besides being a well-confirmed risk factor in a number of systemic diseases, tobacco smoking has also been associated with periodontal disease. Over the past 10–15 years, more and more scientific data on the impact of smoking on various aspects of periodontal disease and the underlying mechanisms has been published. The purpose of this review was to provide an overview of the available data in order to give practitioners a better understanding of the relationship between smoking and periodontal disease. Subsequently, they can use some of the information in treatment decisions and give advice to patients who are smokers suffering from periodontal disease.     

The validity of periodontal probing as a method of measuring loss of attachment

Linear probe measurements are used to assess the severity and extent of attachment loss in chronic periodontitis and to identify, retrospectively, sites of disease activity. The use of the probe for these purposes is based on the implicit assumption that there is a direct and predictable relationship between linear probe measurements of attachment loss and the area of cemental surface which has been denuded of periodontal ligament. The aim of this study was to test this assumption by determining the correlation between loss of attachment as expressed by probe readings, and that expressed as the area of denuded root surface. The areas of denuded root surface of 236 teeth of different morphotype in 41 human dried skulls were determined by a rubber base impression technique and compared with their corresponding probe measurements, made at 10 sites per tooth. Although the majority of correlations between linear and area measurements were statistically significant for some individual morphotypes and categories of bone loss, there was overall, no consistent pattern of correlation between the two parameters. Furthermore, many correlations which were statistically significant had low values of the correlation coefficient: Kendall's T. It was concluded that probe readings are not a very precise measure of attachment loss, particularly with increasing severity destruction. These results cast doubt on the ability of individual linear measurements to represent the true severity of attachment loss, and thus on the precision of loss of attachment charts for retrospectively identifying sites of periodontal disease activity.     

Cigarette smoking as risk factor in chronic periodontal disease

Patients admitted to the School of Dentistry, Stockholm, for treatment of chronic periodontal disease during the years 1980-82 were retrospectively investigated with respect to their smoking habits. The investigation was designed as a case control study and covered all patients 30, 40, or 50 yr of age upon admission, in all 155. As control served a random sample of the Stockholm population. The periodontal variables under scrutiny were frequency of periodontally diseased teeth, frequency of periodontally diseased sites (probing depth greater than 4 mm), gingival index, and plaque index. The overall occurrence rate of smokers in the sample of cases was 56%, which is significantly greater than the population at large. This held true for all three age cohorts and for men as well as women. The risk ratio was 2.5, indicating more prevalent disease among smokers. Further, significantly greater frequencies of periodontally involved teeth and diseased sites were found in smokers, indicating more severe disease among smokers. Gingival index and plaque index did not notably differ between smoking groups. The results suggest increased prevalence as well as severity in smokers. Smoking, therefore, should be considered a risk factor for chronic periodontal disease.     

Natural history of periodontal disease in man

Abstract This paper describes the initiation, rate of progress of periodontal disease and consequent tooth loss in a population never exposed to any programs or incidents relative to prevention and treatment of dental diseases. The group consisted of 480 male laborers at two tea plantations in Sri Lanka. The study design and baseline data have been published. At the initial examination in 1970, the age of the participants ranged between 14 and 31 years. Subsequent examinations occurred in 1971, 1973, 1977, 1982 and 1985. Thus, the study covers the age range 14–46 years. Throughout the study, the clinical indices were scored by the same two examiners, both well-trained and experienced periodontitis. Intra-examiner reproducibility for each index was tested at baseline and repeated periodically during the study. The data for each examination were computerized and updated on an ongoing basis. At the last examination in 1985, there were 161 individuals who had participated in the first survey. This population did not perform any conventional oral hygiene measures and consequently displayed quite uniformly large aggregates of plaque, calculus and stain on their teeth. Virtually all gingival units exhibited inflammation. Based on interproximal loss of attachment and tooth mortality rates, three subpopulations were identified: (1) individuals (～8%) with rapid progression of periodontal disease (RP), those (～81%) with moderate progression (MP), and a group (～11 %) who exhibited no progression (NP) of periodontal disease beyond gingivitis. At 35 years of age, the mean loss of attachment in the RP group was ～9 mm, the MP group had ～4 mm and the NP group had less than 1 mm loss of attachment. At the age of 45 years, the mean loss of attachment in the RP group was ～13 mm and the MP group ～7 mm. The annual rate of destruction in the RP group varied between 0.1 and 1.0 mm, in the MP group between 0.05 and 0.5 mm, and in the NP group between 0.05 and 0.09 mm. Since this population was virtually caries free, essentially all missing teeth were lost due to periodontal disease. In the RP group, tooth loss already occurred at 20 years of age and increased throughout the next 25 years. At 35 years of age, 12 teeth had been lost, at 40 years of age 20 teeth were missing and at 45 all teeth were lost. In the MP groups, tooth mortality started after 30 years of age and increased throughout the decade. At 45 years of age, the mean loss of teeth in this group was 7 teeth. The NP group essentially showed no tooth loss.     

A community study of periodontal attachment loss in smokers

Objective : This study compared per‐sextant periodontal attachment levels of smokers and non‐smokers attending private dental practices. Method : One thousand adults (51.5% female) aged 25 to 64 years underwent an oral clinical examination and questionnaire survey covering demographic characteristics, personal traits, coping and history of tobacco consumption. Medical history was also recorded. Results : Of the subjects, 9.0% had a healthy periodontal status, whereas 52.5%, 23.3%, 10.1% and 5.1% showed low, moderate, high and severe attachment loss, respectively. Most participants (86.0%) were never‐smokers, and 1.1%, 3.9%, 3.5% and 5.5% were very light, light, moderate and heavy smokers, respectively. Corresponding full‐mouth mean clinical attachment levels (CALs) were 2.0mm, 1.5mm, 1.4mm, 1.8mm and 2.9mm (p < 0.001, ANOVA). After adjustment for factors known to be associated with an increase in CAL, the mean per‐sextant CAL in never‐smokers was 2.0–2. 1mm (p = 0.11); in heavy smokers, the mean CAL for the anterior sextants was significantly higher than that for the posterior sextants (3.2mm vs. 2.8mm; p = 0.04). Conclusion : In Hong Kong, heavy smokers are more likely to experience attachment loss than are other smokers and never‐smokers, and their anterior sextants are affected more than their posterior sextants.     

Epidemiologic risk factors for periodontal attachment loss among adults in the United States

OBJECTIVES: The objective of this study was to identify variables related to periodontal loss of attachment (LOA). MATERIALS AND METHODS: The study population consisted of a nationally representative sample of 12,325 US adults who participated in the National Health and Nutrition Examination Survey III. The analyses used survey multinomial logistic regression to account for the complex survey design. RESULTS: The adjusted odds ratio for a mean LOA of 3 mm or more associated with current smoking was 18.55 (95% CI 9.44-36.45) among 20-49-year olds. Among those aged 50 years or more, the odds ratio for a mean LOA of 4 mm or more was 25.64 (13.04-50.40). Prior smoking, untreated decayed surfaces (on both person and site levels), and male gender were also associated with LOA. There was no excess risk observed among non-Hispanic blacks or Mexican-Americans. The adjusted population attributable fractions due to current smoking were 60% for persons aged 20-49 with the worst 10% of LOA (1.58 mm or more), and 47% for those aged 50 plus (LOA of 3.39 mm or more). CONCLUSION: These results support earlier findings regarding the central role of cigarette smoking in the etiology of periodontal loss of attachment, a role due in large part to the substantial relationship between smoking and severe periodontal disease.     

青海省人群牙周健康状况流行病学调查报告

目的了解青海省人群牙周健康的状况,为牙周疾病的防治提供基线资料。方法根据第三次全国口腔健康流行病学调查牙周状况的检查标准,采用多阶段、分层、等容量、随机抽样的方法,对青海省12、35～44和65～74岁3个年龄组的牙龈出血、牙结石、牙周袋及附着丧失等进行流行病学抽样调查。结果1）青海省12、35～44、65～74岁年龄组牙龈出血检出率分别为98.74%、97.84%和92.23%,牙结石检出率分别为89.76%、99.87%和92.87%。2）35～44岁年龄组浅牙周袋检出率为34.64%,深牙周袋检出率为5.58%;65～74岁年龄组浅牙周袋检出率为50.45%,深牙周袋检出率为13.12%。3）35～44岁年龄组附着丧失4～5、6～8、9～11、12 mm或以上的检出率分别为40.74%、18.78%、4.82%、1.78%;65～74岁年龄组附着丧失4～5、6～8、9～11、12 mm或以上的检出率分别为71.21%、51.34%、20.51%、7.01%。结论青海省人群口腔卫生状况很差,中老年人牙周袋及附着丧失的程度比较严重,必须加强对牙周疾病的预防。     

The effect of a triclosan-containing dentifrice on the progression of periodontal disease in an adult population

OBJECTIVES: The aim of the present study was to determine the effect of unsupervised, long-term use of a 0.3% triclosan/2% copolymer dentifrice on the progression of periodontal disease in a general adult population. METHODS: Five hundred and four volunteers were enrolled in a double-blind, controlled clinical trial. Participants were matched for disease status, plaque index, age and gender. At the baseline examination, probing pocket depths and relative attachment levels were recorded and participants were assigned to either the test or control group. Re-examinations took place after 6, 12, 24, 36, 48 and 60 months. Subgingival plaque samples were collected at each examination and assayed for Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans and Prevotella intermedia. A generalised linear model was used to analyse the data, with a number of covariates thought to influence the responses included as the possible confounding effects. RESULTS: The triclosan/copolymer dentifrice had a significant effect in subjects with interproximal probing depths > or =3.5 mm, where it significantly reduced the number of sites with probing depths > or =3.5 mm at the following examination, when compared with the control group (p<0.001). Furthermore, this effect increased with increasing numbers of affected sites. There was no effect of the triclosan/copolymer dentifrice in individuals without probing depths > or =3.5 mm at the previous examination. Other factors significantly affecting probing pocket depths (PPD) included increasing age, smoking and presence of P. gingivalis. PPD > or =3.5 mm were positively associated with loss of attachment some 2 years later. CONCLUSION: This study showed that in a normal adult population, unsupervised use of a triclosan/copolymer dentifrice is effective in slowing the progression of periodontal disease.     

A longitudinal study of interleukin-1 gene polymorphisms and periodontal disease in a general adult population

BACKGROUND: Cross-sectional studies have demonstrated that a specific polymorphism (allele 2 of both IL-1A +4845 and IL-1B +3954) in the IL-1 gene cluster has been associated with an increased susceptibility to severe periodontal disease and to an increased bleeding tendency during periodontal maintenance. The aim of the present study was to investigate the relationship between IL-1 genotype and periodontitis in a prospective longitudinal study in an adult population of essentially European heritage. METHODS: From an ongoing study of the Oral Care Research Programme of The University of Queensland, 295 subjects consented to genotyping for IL-1 allele 2 polymorphisms. Probing depths and relative attachment levels were recorded at baseline, 6, 12, 24, 36, 48 and 60 months using the Florida probe. Periodontitis progression at a given site was defined as attachment loss > or =2 mm at any observation period during the 5 years of the study and the extent of disease progression determined by the number of sites showing attachment loss. Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans and Prevotella intermedia were detected using ELISA. RESULTS: 38.9% of the subjects were positive for the composite IL-1 genotype. A relationship between the IL-1 positive genotype and increased mean probing pocket depth in non-smokers greater than 50 years of age was found. Further, IL-1 genotype positive smokers and genotype positive subjects with P. gingivalis in their plaque had an increase in the number of probing depths > or =3.5 mm. There was a consistent trend for IL-1 genotype positive subjects to experience attachment loss when compared with IL-1 genotype negative subjects. CONCLUSION: The results of this study have shown an interaction of the IL-1 positive genotype with age, smoking and P. gingivalis which suggests that IL-1 genotype is a contributory but non-essential risk factor for periodontal disease progression in this population.     

The relative effects of therapy and periodontal disease on loss of probing attachment after root debridement

This study investigated the immediate effects, and the effects during 12 months, of a single episode of root debridement in 1248 sites in 9 periodontitis patients. Single recordings for probing depths and probing attachment levels were made at baseline, and at 3, 6, 9 and 12 months. In addition, triplicate recordings of attachment levels were made for all sites by 3 independent examiners immediately prior to debridement, immediately post debridement, and at 3 and 12 months. It was found that a mean loss of probing attachment of 0.5 to 0.6 mm occurred as a result of instrumentation, irrespective of initial probing depth. Individual sites were identified as having lost probing attachment using a site-specific standard deviation for measurement variability and a greater than or equal to 1.0 mm change. 5% of all sites lost probing attachment from pre-instrumentation to 12 months. Approximately half of these had probing attachment loss inflicted during instrumentation. 23 sites (2% of all sites) were identified as having lost probing attachment from the post-instrumentation time point to 12 months. The majority of these sites seemed to undergo this probing attachment loss as a result of a remodelling process during the healing phase. Over the observation period used in this study, the majority of the attachment loss identified seems to be either directly attributable to instrumentation or to a remodelling process as a result of the therapy rather than to progressive periodontitis.     

Bleeding on probing. A predictor for the progression of periodontal disease?

Bleeding on probing (BOP) is a widely used criterion to diagnose gingival inflammation. The purpose of the present retrospective study was to evaluate its prognostic value in identifying sites at risk for periodontal breakdown during the maintenance phase of periodontal therapy. 55 patients who had been treated for advanced periodontitis participated in a recall system for at least 4 years, at regular intervals of 3-5 months. At the start of every appointment, BOP to the bottom of the pocket was registered at 4 sites of every tooth. A random selection of 1054 pockets was made and subdivided into 5 categories according to the incidence of BOP during the last 4 recall appointments. All pockets with a BOP incidence of 4/4 and 3/4 were selected, while only interproximal sites with a BOP incidence of 2/4, 1/4 and 0/4 were chosen. Subsequently, these categories were grouped according to whether or not the attachment level had been maintained from the time prior to the last 4 recall visits. Greater than or equal to 2 mm was defined as loss of clinical attachment. The results indicated that pockets with a probing depth of greater than or equal to 5 mm had a significantly higher incidence of BOP. Patients with 16% or more BOP sites had a higher chance of loosing attachment. Pockets with an incidence of BOP of 4/4 had a 30% chance of loosing attachment. This chance decreased to 14% with BOP of 3/4, 6% with BOP of 2/4, 3% with BOP of 1/4 and 1.5% with BOP of 0/4.(ABSTRACT TRUNCATED AT 250 WORDS)     

Progression of periodontal disease in patients with mild to moderate adult periodontitis

Abstract The aim of the present study was to determine the progression rate of periodontal disease in patients treated for localized or generalized mild to moderate adult periodontitis. 52 patients with a mean age of 53.7 years (S.D. 12. 6 years) were instructed in optimal home care procedures and exposed to initial periodontal therapy, before reconstructive therapy was initiated. Following completion of the prosthetic procedures, supportive therapy was offered to a limited extent and maintenance visits were irregularly scheduled corresponding to traditional dental care. Clinical periodontal parameters from 4 sites per tooth were assessed at the initial examination, at the time of reevaluation after initial therapy and at the re-examination after 8-years. Full sets of intraoral radiographs from the initial and the 8-year re-examination were analyzed with respect to changes in the radiographic alveolar bone height as a % of the total tooth length. As the result of the home care instructions, the mean plaque index (plaque control record) amounted to 21% at the end of initial periodontal therapy. 8 years later, the re-examination revealed a mean plaque index of 49% and a mean gingival bleeding index of 24%. At the initial examination, the 52 patients presented with an average of 18.7 teeth. During treatment. 26 teeth were sacrificed and 19 teeth were lost over the 8 years of supportive therapy. Bicuspids were the most frequent teeth to be lost over the observation period. As a result of initial therapy, the mean pocket probing depths decreased significantly. However, after 8 years, only minor differences were found when compared to the initial examination. At all examinations, the buccal and the oral aspects presented with shallower pockets compared to the interproximal sites. The comparison of the changes in the mean probing attachment levels over the observation period at mesial, buccal, distal and oral sites revealed a gain in clinical attachment after initial therapy and a mean loss of attachment ranging from 0.48 mm to 0.79 mm from the initial to the re-examination after 8 years. The buccal aspects demonstrated the highest mean clinical attachment loss followed by the oral sites. The radio-graphic assessment of the changes in the mean alveolar bone height revealed a statistically significant, but a clinically insignificant, loss of alveolar bone height of less than 2% of the tooth length. The patient population was grouped into 21 patients seeking supportive therapy less than once per year over 8 years. 14 patients having had one maintenance visit per year and 17 patients who were recalled more than once per year. With respect to the distribution of the number of sites with different changes in probing attachment level, no statistically significant difference between the groups was observed. When frequency analyses of the radiographically assessed changes in the alveolar bone height were performed, similar results were obtained. With the parameters and the statistical methods applied in this study, no significant influence of the age nor the recall frequency on the progression rate of periodontal disease could be detected in this group of patients presenting initially with mild to moderate adult periodontitis. Recall visits corresponding to conventional dental care did not prevent further loss of attachment, resulting in a deterioriation of the periodontal conditions compared to the results achieved after initial therapy and in 45 out of 52 patients compared to the baseline examination.     

Absence of bleeding on probing An indicator of periodontal stability

Following active periodontal therapy, 41 patients were incorporated in a maintenance program for 2 1/2 years with recall intervals varying between 2-6 months. At the beginning of each maintenance visit, the periodontal tissues were evaluated using "bleeding on probing" (BOP). Reinstrumentation was only performed at sites which bled on probing. However, supragingival plaque and calculus was always removed. Pocket probing depths and probing attachment levels were recorded after active treatment and at the conclusion of the study. Progression of periodontal disease was defined by an observed loss of probing attachment of greater than or equal to 2 mm. The reliability of the BOP test as a predictor was evaluated by calculating sensitivity, specificity, accuracy, and positive and negative predictive values. While only a 29% sensitivity was calculated for frequent bleeding, the specificity was 88%. The fact that the positive predictive value for disease progression was only 6% and the negative predictive value was 98% renders continuous absence of BOP a reliable predictor for the maintenance of periodontal health.     

Longitudinal validation of a risk calculator for periodontal disease

BACKGROUND: Risk assessment and utilization of the results are important components of prevention, diagnosis and treatment of periodontal diseases. Risk assessment is relatively new to dentistry. Currently risk is assessed by subjective evaluation and results vary widely among clinicians. We have developed a computer-based risk assessment tool, the Periodontal Risk Calculator (PRC), for objective, quantitative assessment of risk. The purpose of the study reported here was to evaluate the accuracy and validity of this tool. METHODS: Clinical records and radiographs of 523 subjects enrolled in the VA Dental Longitudinal Study of Oral Health and Disease, covering a period of 15 years, were used. Information from baseline examinations was entered into the risk calculator and a risk score on a scale of l-5 for periodontal deterioration was calculated for each subject. Actual periodontal status in terms of alveolar bone loss determined using digitized radiographs, and tooth loss determined from the clinical records, was assessed at years 3, 9 and 15. The strength of the association between risk prediction and actual outcome was determined statistically. RESULTS: The risk scores were strong predictors of future periodontal status measured as worsening severity and extent of alveolar bone loss and tooth loss, especially loss of periodontally affected teeth. Over the entire 15-year period, risk scores consistently ranked groups from least to most bone loss and tooth loss. Risk groups differed greatly from one another. By year 3, the incidence rate of bone loss of group 5 was 3.7-fold greater than for group 2, and by year 15, the loss of periodontally affected teeth was 22.7-fold greater than for group 2 (p<0.001). By year 15, 83.7% of subjects in risk group 5 had lost one or more periodontally affected teeth compared to 20.2% of subjects in group 2. CONCLUSIONS: Risk scores calculated using the PRC and information gathered during a standard periodontal examination predict future periodontal status with a high level of accuracy and validity. Use of the risk assessment tool over time may be expected to result in more uniform and accurate periodontal clinical decision-making, improved oral health, reduction in the need for complex therapy and reduction in health-care cost.