Dental health of aboriginal pre-school children in Brisbane, Australia

Seow WK, Amaratunge A, Bennett R, Bronsch D, Lai PY: Dental health of Aboriginal pre-schools children in Brisbane, Australia.   Abstract –
This investigation studied the dental health status of a group of 184 Australian Aboriginal children with a mean age of 4.4±0.8 years, who were attending pre-schools in metropolitan Brisbane, a non-fluoridated stale capital city. The DDE (Developmental Detects of Enamel) Index was used to chart enamel hypoplasia and enamel opacities. WHO criteria was used to diagnose dental caries. The results showed that 98% of children had at least one tooth showing developmental enamel defects. Each child had a mean of 3.8 ± 1.7 teeth affected by enamel hypoplasia and another 1.1 ± 0.8 teeth affected by enamel opacity. Seventy-eight percent of the children had dental caries. The mean number of decayed, missing, filled teeth (dmft) per child was 3.8±3.7. The decayed component consituted 3.5 (95%) of the mean dmft, indicating a high unmet restorative need in this group. The mean dmft (decayed, missing, filled, surfaces) was 5.9 ± 7.3. Maxillary anterior labial decay of al least one tooth affected 43(23%) of the children. In this sub-group, the dmft and dmfs was 9.1 ± 2.8 and 15.4 ± 7.7 respectively. Oral debris was found in 98% of the children. It is hypothesized that the high levels of underlying developmental enamel defects, compounded by low fluoride exposure, poor oral hygiene and a diet high in refined sugars pose an important caries risk factor in this group of children.     

Oral health of southern Chinese children and adolescents with severe hypodontia

OBJECTIVE: The aim of this study was to assess the oral health condition of southern Chinese children and adolescents with severe hypodontia. METHODS: This was a cross-sectional clinical study in the dental teaching hospital in Hong Kong. Twenty-five children and adolescents with severe hypodontia, and a comparison group of 25 age- and gender-matched controls took part. Verified clinical examination techniques were used to assess the pattern of missing teeth, tooth spacing, dental caries, periodontal condition, enamel defects, and tooth wear. Statistical comparisons were made between groups using independent Student t-tests and chi-square tests. RESULTS: The mean number of congenitally missing permanent teeth in the severe hypodontia group was 9.1 (SD = 5.0), with the maxillary lateral incisor being the most common missing tooth (14.5%). There were significant space discrepancies in both jaws between groups (P < 0.001). Caries prevalence was low with no difference between groups. There was no difference in periodontal condition between groups, with about half of the participants having no gingival inflammation. The severe hypodontia group had more enamel defects (P = 0.043), enamel hypoplasia (P = 0.044) and tooth wear (P = 0.005) than the comparison group. Three of the severe hypodontia group had ectodermal dysplasia. CONCLUSIONS: The oral health condition of southern Chinese children and adolescents with severe hypodontia was good in terms of caries experience and periodontal health. However, the increased prevalence of developmental defects of enamel and tooth wear complicates already complex interim and definitive prosthodontic management, and may increase psychosocial impact.     

Caries experience among 45-54 year olds in Adelaide, South Australia

BACKGROUND: Middle-aged adults are an important focus of dental policy with increasing retention of teeth and use of dental services. The aims of the study were to describe the caries experience of 45-54 year olds by dental visit pattern, dental behaviour, socio-demographics and socio-economic status. METHODS: A random sample of 45-54 year olds from Adelaide, South Australia was surveyed by self-complete questionnaire during 2004-2005 with up to four follow-up mailings to non-respondents (n=879, response rate = 43.8 per cent). Oral examinations were performed by calibrated dentists on 709 persons (completion rate = 80.7 per cent). RESULTS: The mean number (95% CI) of decayed teeth was 0.39 (0.31-0.47), with 5.25 (4.92-5.58) missing teeth, 11.0 (10.62-11.32) filled teeth, and DMFT was 16.61 (16.21-17.01). Multivariate regressions of caries experience by dental visit pattern, dental behaviour, socio-demographics and socio-economic status found: time since last visit of less than 12 months was related (P < 0.05) to fewer decayed teeth (beta = -0.40), more filled teeth (beta = 1.55) and a higher DMFT (beta = 1.24); a last visit for relief of pain was related to more decayed teeth (beta = 0.56); tooth brushing 8+ times per week was related to fewer decayed (beta = -0.36), and missing teeth (beta = -1.13), and lower DMFT (beta = -1.58); not cleaning between teeth was related to more missing teeth (beta = 0.94); males had fewer missing teeth (beta = -0.76); having a diploma/degree was related to fewer missing teeth (beta = -1.07) and lower DMFT (p = -1.27); card holder status was related to more missing teeth (beta= 1.26); and household income of $80,000+ was related to fewer missing teeth (beta= -0.96) and a lower DMFT (beta= -1.35). CONCLUSIONS: Dental visit pattern, dental behaviour, socio-demographics and socio-economic status were all related to caries experience. Overall DMFT was lower for those who brushed more frequently, had higher levels of education and higher household income.     

Oral health status of New Hampshire Head Start children, 2007‐2008

Objectives: We report on the baseline prevalence and severity of dental caries of children enrolled in the New Hampshire Head Start program during the 2007‐2008 school year. Methods: We selected a random cluster sample of 607 children aged 3‐5 years attending 27 Head Start centers across the state. Four volunteer dentists provided oral examinations and determined the presence of untreated dental caries, caries experience, and treatment urgency. Results: Overall, 40 percent of the participating children had experienced dental caries, and 31 percent had at least one untreated decayed tooth. Approximately 22 percent of the children had evidence of maxillary anterior caries, 23 percent were in need of dental care, and <1 percent needed urgent care. Conclusions: The prevalence of dental caries is comparable with that reported by Head Start programs elsewhere. The prevalence of caries affecting maxillary anterior teeth is higher. Further studies should examine state‐specific barriers to dental care among this population.     

Dental caries experience and prevalence of children afraid of dental treatment

The aim of this study was to examine the clinical outcome with regard to dental caries of high self reported dental anxiety in a group of Scottish secondary schoolchildren. 1103 children participated in the study, mean age 14 yr (sd 0.35 yr), and the prevalence of high dental anxiety was 7.1% (95% CI = 5.6%, 8.6%). When these children were compared with their contemporaries their DMFT and all its components were higher but only the mean MT reached statistical significance after adjusting for gender and social class. Children with a high dental anxiety were 62% more likely to have at least 1 missing tooth due to caries. In addition this group when compared to the rest of the study population, had a significantly lower mean number of teeth fissure sealed and a lower proportion of children with sealants. No similar trend was obvious for children who had a high general fear. The dentally anxious more accurately perceived their treatment need and were more likely to defer, cancel or not turn up for dental appointments.     

Rural and urban disparities in caries prevalence in children with unmet dental needs: the New England Children's Amalgam Trial

OBJECTIVES: To compare the prevalence of caries between rural and urban children with unmet dental health needs who participated in the New England Children's Amalgam Trial. METHODS: Baseline tooth and surface caries were clinically assessed in children from rural Maine (n = 243) and urban Boston (n = 291), who were aged 6 to 10 years, with two or more posterior carious teeth and no previous amalgam restorations. Statistical analyses used negative binomial models for primary dentition caries and zero-inflated models for permanent dentition caries. RESULTS: Urban children had a higher mean number of carious primary surfaces (8.5 versus 7.4) and teeth (4.5 versus 3.9) than rural children. The difference remained statistically significant after adjusting for sociodemographic factors and toothbrushing frequency. In permanent dentition, urban children were approximately three times as likely to have any carious surfaces or teeth. However, rural/urban dwelling was not statistically significant in the linear analysis of caries prevalence among children with any permanent dentition caries. Covariates that were statistically significant in all models were age and number of teeth. Toothbrushing frequency was also important for permanent teeth. Conclusions: Within this population of New England children with unmet oral health needs, significant differences were apparent between rural and urban children in the extent of untreated dental decay. Results indicate that families who agree to participate in programs offering reduced cost or free dental care may present with varying amounts of dental need based on geographic location.     

Prevalence of early childhood caries in a population of children with history of maltreatment

OBJECTIVE: The purpose of this study was to investigate the prevalence of early childhood caries (ECC) in a population of maltreated children in Toronto, Ontario, Canada. METHODS: The sample consisted of preschool-aged children (2 to 6 years) admitted to the care of the Children's Aid Society of Toronto (CAST) between 1991 and 2004. Data were collected by reviewing the dental and social workers' records of CAST ECC was determined using the decayed, missing, and filled deciduous teeth (dmft) index. The type and severity of maltreatment were obtained from the Eligibility Spectrum. RESULTS: The study included 66 children: 37 (56 percent) boys and 29 (44 percent) girls, with an average age of 4.1 years [standard deviation (SD) = 1.2]. Four (6 percent) children had evidence of dental injury, and none had teeth filled or extracted as a result of decay ECC was observed in 58 percent of the abused children. Of these, the mean decayed teeth ("dt") value was 5.63 (SD = 4.17, n = 38) and 3.24 (SD= 4.21) for the whole sample (n = 66). The proportion of children with untreated caries was 57 percent among "neglected" children (n = 53) and 62 percent in physically/sexually abused cases (n = 13). Logistic regression revealed that children in permanent CAST care and those in its care more than once were significantly less likely to have experienced caries. CONCLUSIONS: Abused and neglected young children had higher levels of tooth decay than the general population of 5-year-olds in Toronto (30 percent prevalence, mean dt= 0.42, SD = 1.20, n = 3185). However, this study did not find any difference in ECC prevalence between children with different types of maltreatment. The study did find that CAST services had a protective effect on children's oral health, which supports the recommendation that child protection services should investigate possible dental neglect in physical/sexual abuse and neglect cases.     

Dental caries and associated factors in 12-year-old schoolchildren in Thiruvananthapuram, Kerala, India

OBJECTIVES: The aims of the present study were to describe the dental health status of 12-year-old schoolchildren in Thiruvananthapuram, Kerala, India, and to identify sociodemographic factors, oral health behaviours, attitudes and knowledge related to dental caries experience. METHODS: The study took the form of a cross-sectional survey of 838 children in upper primary schools. A two-stage cluster sampling technique was used. Dental caries was measured using World Health Organization criteria. Sociodemographic factors, oral health behaviours, attitudes and knowledge were assessed by a self-administered questionnaire. RESULTS: The prevalence of dental caries in the permanent dentition was 27%. The mean number of decayed, missing and filled teeth was 0.5 (SD=0.9). The decayed component (D) constituted 91% of the total number of decayed, missing and filled teeth (DMFT). Multiple logistic regression analysis showed that children had a higher risk of having dental caries if they lived in urban area [OR=1.5, 95% confidence interval (CI)=1.1-2.1], had visited a dentist (OR=1.6, 95% CI=1.2-2.2), did not use a toothbrush (OR=1.9, 95% CI=1.2-2.9), consumed sweets (OR=1.4, 95% CI=1.0-1.9) or performed poorly in school (OR=1.7, 95% CI=1.0-2.3). CONCLUSIONS: The prevalence of caries in this sample of 12-year-old schoolchildren was low compared to that in other developing countries. The present study indicated that urban living conditions were associated with more dental caries. Since urbanization is rapid in India, oral health promotion at the present time would be valuable to prevent increased caries prevalence.     

Prevalence and severity of dental caries in adolescents aged 12 and 15 living in communities with various fluoride concentrations

OBJECTIVES: To determine the experience, prevalence, and severity of dental caries in adolescents naturally exposed to various fluoride concentrations. METHODS: A cross-sectional census was conducted on 1,538 adolescents aged 12 and 15 years living at high altitude above sea level (> 2,000 m or > 6,560 ft) in above-optimal fluoridated communities (levels ranging from 1.38 to 3.07 ppm) of Hidalgo, Mexico. Sociodemographic and socioeconomic data were collected using questionnaires. Two previously trained and standardized examiners performed the dental exams. RESULTS: Caries prevalence was 48.6 percent and mean of decay, missing, and filling teeth (DMFT) for the whole population was 1.15 +/- 1.17. In terms of severity, 9.6 percent of the adolescents had DMFT > or = 4, and 1.7 percent had > or = 7. The significant caries index (SiC) was 2.41 in the group of 12-year-olds, and 3.46 in the 15-year-olds. Higher experience and prevalence were observed in girls, in children with dental visit in the past year, those in the wealthiest socioeconomic status (SES) (quartiles 2, 3, and 4), those whose locale of residence is in San Marcos and Tula Centro, and in fluorosis-free children and those with moderate/severe fluorosis. In an analysis of caries severity (DMFT > or = 4), both adolescents with very mild/mild and moderate/severe dental fluorosis have higher caries severity. CONCLUSIONS: The results indicated that caries experience, prevalence, and severity as well as SiC index among 12- and 15-year-old adolescents were relatively low. Sociodemographic and socioeconomic variables commonly associated with dental caries were also observed in Mexican adolescents. Unlike other studies, we found that caries increased with higher SES. Fluoride exposure (measured through fluorosis presence) does not appear to be reducing the caries prevalence (DMFT > 0) or caries severity (DMFT > or = 4) in these high-altitude communities.     

Rampant early childhood dental decay: an example from Italy

OBJECTIVES: This study sought to estimate the prevalence and related prediction factors for dental caries in 3- to 5-year-old children in Rome, Italy. METHODS: From a sample of 2,025 children, 1,494 (73.8%) were included in the analysis. Children with at least two primary maxillary incisors showing evidence of caries experience were considered affected by rampant early childhood dental decay (RECDD). Behavioral and socioeconomic variables, mutans streptococci counts, diet, and nutritional status were investigated for their association with RECDD using regression analysis. RESULTS: The prevalence of any caries was 27.3 percent, and was 7.6 percent for RECDD. Among all children, mean dft and dt scores per person were 1.1 (SD = 2.4) and 0.9 (SD = 2.3), respectively; among those classified as having RECDD, scores were 6.9 (SD = 4.2) and 6.7 (SD = 4.3), respectively. Children with RECDD had 56 percent of all the decayed teeth in the sample. Low and medium social classes, use of a baby bottle filled with sweetened beverages, high salivary mutans streptococcal levels, and malnutrition were directly associated with RECDD; milk and yogurt consumption and low Plaque Index scores were inversely associated with the condition. CONCLUSIONS: The high prevalence of RECDD suggests that the implementation of preventive programs should be a priority for dental public health. Because of its high prevalence among children as young as 3 years of age, preventive measures targeted toward pregnant women and toddlers should be developed and tested, while kindergarten students could be used for monitoring RECDD prevalence and for detection of communities at risk.     

The overtime effect of social position on dental caries experience in a group of old-aged Danes born in 1914

OBJECTIVES: The purpose of this study was to analyze the life-course effects of education, occupation, and income at ages 70, 75, 80, and 85 years, respectively, on dental caries experience of 85-year-olds. METHODS: The present study includes follow-up data from a population-based study, which comprised a sample of 176 individuals aged 85 years. Data on social position were collected at ages 70, 75, 80, and 85 years by means of structured personal interviews. Clinical oral health examinations were conducted to obtain data on dental caries at age 85. Dental caries was recorded at tooth surface level and caries experience was expressed by the DMF Index: the decayed tooth surfaces (D component), missing tooth surfaces (M component), and filled tooth surfaces (F component). RESULTS: The participants in the present study demonstrated a high level of dental caries experience; the prevalence rate for active dental caries (D-S) was 80 percent. Older adults with low education, low occupational status, and poor income tended to have more active dental caries compared to their counterparts. In contrast, individuals with high education (F-S = 35.5) and high occupational status (F-S = 36.0) had significantly more filled surfaces than persons with low education (F-S = 24.0) and low occupational status (F-S = 25.6). Individuals with high income at ages 75, 80, and 85 years had more filled surfaces (F-S = 31.9, 33.2, 34.1) compared to persons with low income (F-S = 25.5, 23.5, 22.8). CONCLUSION: The study identified social inequalities across age among the very old individuals in relation to dental caries experience.     

Prevalence and severity of dental caries in Libyan schoolchildren

Objectives: To assess prevalence and severity of dental caries, examine gender differences and assess the relationship of dental caries to socioeconomic status in a group of Libyan schoolchildren. Design and setting: A cross sectional observational study with cluster sampling within schools. Participants: A random sample of 791, 12‐year‐olds in 36 elementary public schools in Benghazi. Methods and main outcome measures: Dental caries was assessed using the DMFT and DMFS indices and WHO (1997) criteria. Information about socioeconomic status was collected through a dental health questionnaire. Results: The prevalence of dental caries was 57.8%. The mean DMFT and DMFS indices were 1.68 (SD ± 1.86) and 2.39 (SD ± 3.05) for all subjects and 2.90 (SD ± 1.56) and 4.14 (SD ± 2.97) for subjects with caries experience. Dental caries was more prevalent amongst girls (P = 0.002). There was a statistically significantly negative association between dental caries and the level of father’s education (P = 0.015). Conclusions: While dental caries prevalence in 12 year‐old Libyan children was high, the mean DMFT was low compared with other developing countries, but higher than the WHO goal for year 2020. The high level of untreated caries is a cause for concern, representing a high unmet treatment need.     

Progression of dental caries and tooth loss between the third and fourth decades of life: a birth cohort study

The majority of what is known of the experience of dental caries among adults is from cross-sectional studies, and there are surprisingly few population-level longitudinal studies of dental caries among adults. Dental examinations were conducted at age 26 and again at age 32 among participants in a longstanding prospective study of a birth cohort born in Dunedin (New Zealand) in 1972/1973. Some 901 individuals (88.8%) were dentally examined at both ages. The mean number of remaining teeth and tooth surfaces fell between 26 and 32, reflecting ongoing tooth loss. The overall prevalence of caries rose from 94.9 to 96.8%, while there were greater increases in the proportion with caries-associated tooth loss (from 10.8 to 22.8%). Caries experience was greatest in the molar teeth and upper premolars, and was lowest in the lower anterior teeth. The mean crude caries increment (CCI) was 5.0 surfaces (SD 6.6); 681 (75.5%) experienced 1+ CCI, and the mean CCI among those individuals was 6.6 surfaces (SD 6.9). Substantial dental caries and tooth loss experience occur as people move from the third into the fourth decade of life.     

Tooth loss and associated risk indicators in an adult urban population from south Brazil

The aim of the present study was to assess the prevalence, extent, and risk indicators of tooth loss in a representative adult, urban population in the Brazilian state of Rio Grande do Sul. A sample of 974 subjects (ages 30 to 103 years, mean 48.7, SD 13.4) representative of the metropolitan area of Porto Alegre, Brazil was selected by a multi-stage probability cluster sampling strategy. In all, 94% of the subjects had experienced tooth loss. The mean tooth loss was 11.2 teeth, and varied between 5.5 and 20.2 teeth in the 30-39 and 60 + years age groups, respectively. The multivariable analysis, adjusted for age, showed that subjects who had lost 7-13 or > or = 14 teeth were more likely to be females (odds ratio (OR) = 1.4, 2.4), of low (OR = 2.8, 5.1) or middle socio-economic status (OR = 2.3, 3.4), and heavy smokers (OR= 2.0, 2.3) than those with 6 or fewer missing teeth. Furthermore, loss of > or = 14 teeth was associated with presence of > 50% teeth with attachment loss > or = 5 mm (OR= 5.7), and loss of 7-13 teeth was associated with presence of > 50% teeth with attachment loss > or = 5 mm (OR = 2.4) and having 15-30% or > 30% decayed-filled teeth (OR = 2.7 and 4.1). In conclusion, tooth loss is highly prevalent in this urban Brazilian population. Gender, socio-economic status, cigarette smoking, caries experience, and attachment loss are important risk indicators. A reduction in the population's tooth loss may be achieved by the implementation of community programs for the prevention and treatment of dental caries and periodontal diseases.     

Oral health status of homeless people in Hong Kong

The authors report on an oral health survey among Hong Kong Chinese homeless people. A total of 140 homeless men underwent clinical examination and were interviewed with a structured questionnaire. More than 90% had evidence of caries experience; most (75%) were related to untreated caries. The mean DMFT score was 9.0 (DT=3.2, MT=5.2. FT=0.6). Periodontal disease was highly prevalent, with 96% having periodontal pockets. The dental problems most frequently reported by the homeless were: bleeding gums or drifting teeth (62%), dental pain (52%) and tooth trauma (38%). More than 70% of the study's participants perceived a need for dental care. The population surveyed had poorer oral health compared to the general population. High levels of dental needs, both normative and perceived, were found. There is a need to provide more accessible and affordable oral health services to this group of people.     

Dental health of Chatham Islanders: an investigation of the oral health of Chatham Islands residents

OBJECTIVES: To examine the self-reported and clinical oral health of Chatham Islanders. DESIGN: A cross-sectional oral health survey. SETTING: The Chatham Islands community. PARTICIPANTS AND METHODS: The investigation involved completion of dental self-report questionnaires by children who attended Chatham Islands schools, and adults who responded to a dental flyer. RESULTS: Eighty-seven children and 189 adults took part, all of whom had oral health examinations. Among the children, the prevalence of dental caries in the deciduous dentition was 67.8 percent, and the mean dfs, mean DFS and mean number of missing deciduous teeth due to caries were 5.9 (sd, 6.2), 0.5 (sd, 1.1) and 0.3 (sd, 0.8) respectively. Caries severity was higher in children who were episodic dental attenders, who had irregular brushing habits or whose dental experiences had had a negative impact on their lives. In adults, the prevalence of caries was 81.5 percent. The mean DFS and mean number of missing permanent teeth due to caries were 37.9 (sd, 13.1) and 4.7 (sd, 3.8) respectively. On average, caries severity was higher among infrequent and episodic dental attenders, irregular brushers and those for whom dental problems had had a negative life impact. CONCLUSIONS: While the oral health of Chatham Islands children is comparable with that of children in New Zealand, Chatham Islands adults may be dentally disadvantaged due to limited access to dental resources. The findings have important implications for the planning of dental health services for this remote area, and may provide a useful framework from which further investigations of remote community-dwellers' oral health may be developed.     

Dental Caries in Homeless Adults in Boston

Objectives : Information about the oral health status of the homeless is limited. The purpose of this study is to characterize the dental caries status among users of a dental treatment and referral program at homeless shelters in Boston, MA. Methods : Persons attending the program during a one-year period were assessed for evidence of dental caries experience by a single examiner. DMFT counts were abstracted from patient records. Results : The population examined (n=73) was 66 percent male with a mean age of 36 years. The racial composition was 51 percent African-American, 34 percent Caucasian, and 14 percent Hispanic. The 70 dentate people examined had a mean DFT of 11.1 (SD=6.1). The mean percent of DFT that was DT per person was 55.7 percent. Untreated caries was detected in 91.4 percent of those examined. Conclusions : These findings show evidence of previous dental services utilization by these homeless individuals, but demonstrate a high need for preventive and restorative dental therapy.     

Tooth loss as related to dental caries and periodontal breakdown in adult Tanzanians

A total of 170 adults aged 30-69 yr from the Zanzibar and Pemba Islands (Tanzania) were examined for tooth loss, dental caries and loss of periodontal attachment. The cause of tooth loss was recorded from information given by the examinee to a Kiswahili-English interpreter. Dental caries were recorded according to the depth of the lesion, i.e. involving enamel, dentin or pulp, respectively. Loss of attachment was measured as the distance in mm from the CEJ to the bottom of the pocket. The most severely affected surface determined the state of the tooth. The mean number of teeth present ranged from 29.5 in the youngest to 23.9 in the oldest age group. The mean number of teeth missing due to dental caries ranged between 2.1 and 7.0 teeth, and exceeded by far tooth loss due to periodontal breakdown which was only observed in the two oldest age groups. In all age groups the molars were the teeth most frequently missing and also the teeth most frequently affected by dental caries. Although a substantial number of the teeth in the older age groups demonstrated an extensive loss of attachment only a few teeth, mainly mandibular incisors, were lost due to periodontal breakdown within the age range examined.     

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.