The effect of cigarette smoking on the severity of periodontal disease among older Thai adults

BACKGROUND: The aim of this study is to determine the effect of cigarette smoking on the severity of periodontitis in a cross-sectional study of older Thai adults. METHODS: The study population consisted of 1,960 subjects (age 50 to 73 years old). All subjects received both medical and dental examinations. Periodontal examinations, including plaque score, probing depth, and clinical attachment level, were done on all teeth present in two diagonal quadrants. Sociodemographic characteristics and smoking status were obtained by questionnaires. Multinomial logistic regression was used to address the association between cigarette consumption and mean clinical attachment level. RESULTS: In this study population, 48.7% were non-smokers, 14.4% were current smokers, and 36.9% were former smokers. Current smokers had higher percentage of sites with plaque, deeper mean probing depth, and greater mean clinical attachment level than former smokers and non-smokers. The odds of having moderate and severe periodontitis for current smokers were 1.7 and 4.8 times greater than non-smokers, respectively. Former smokers were 1.8 times more likely than non-smokers to have severe periodontitis. Quitting smoking reduced the odds of having periodontitis. For light smokers (<15 packyear), the odds for severe periodontitis reverted to the level of non-smokers when they had quit smoking for > or =10 years. For moderate and heavy smokers (> or =15 packyear), the odds of having severe periodontitis did not differ from those of non-smokers when they had quit smoking for > or =20 years. CONCLUSIONS: There was a strong association between cigarette smoking and the risk of periodontitis among older Thai adults. Quitting smoking appears to be beneficial to periodontal health.     

Risk indicators for third molar caries and periodontal disease in senior adults.

PURPOSE: This study was designed to identify risk indicators for the prevalence at enrollment and incidence over 36 months of periodontal pathology and coronal caries experience affecting third molars in a community-based study of people over 65 years of age. SUBJECTS AND METHODS: Data from a subsample of 810 dentate subjects from the Piedmont 65+ Study were available for analyses. All visible teeth were examined. Periodontal probing measures were taken at 2 sites, mesiobuccal and buccal/facial. Clinical data on caries experience were collected by visual-tactile examination. At enrollment, 340 subjects had at least 1 visible third molar; all were examined for caries experience. Periodontal probing measures were available for 277 of these same subjects. The significance of the possible risk indicators for periodontal pathology and caries affecting third molars was determined by chi(2) tests. Statistical significance was set at .05. Logistic multivariable models were used to derive odds ratios and 95% confidence intervals. RESULTS: African-American subjects were more likely to have visible third molars (P < .01). Caucasian subjects were more likely to have third molar coronal caries experience (P < .01), as were subjects with greater than a high school education and those with a dental visit within 3 years (both P < .01). However, African American subjects were more likely to have periodontal pathology, CALs >/= 3 mm on third molars (P < .01), as were those who used tobacco (P < .01). None of the other risk indicators we studied were associated with progression of periodontal pathology or coronal caries experience on visible third molars. CONCLUSION: In this population study of senior adults, Caucasians and African Americans appear to have different levels of risk for caries experience and periodontal pathology affecting retained third molars.     

Risk indicators for tooth loss due to periodontal disease

BACKGROUND: Several risk indicators for periodontal disease severity have been identified. The association of these factors with tooth loss for periodontal reasons was investigated in this cross-sectional comparative study. METHODS: All extractions performed in 21 general dental practice clinics (25% of such clinics in Kuwait) over a 30-day period were recorded. Documented information included patient age and gender, medical history findings, dental maintenance history, toothbrushing frequency, types and numbers of extracted teeth, and the reason for the extraction. Reasons were divided into periodontal disease versus other reasons in univariate and binary logistic regression analyses. RESULTS: A total of 1,775 patients had 3,694 teeth extracted. More teeth per patient were lost due to periodontal disease than for other reasons (2.8 +/- 0.2 versus 1.8 +/- 0.1; P <0.001). Factors significantly associated with tooth loss due to periodontal reasons in logistic regression analysis were age >35 years (odds ratio [OR] 3.45; 95% confidence interval [CI] 2.79 to 4.26), male gender (OR 1.42; 95% CI 1.17 to 1.73), never having periodontal maintenance (OR 1.48; 95% CI 1.23 to 1.78), never using a toothbrush (OR 1.81; 95% CI 1.49 to 2.20), current or past smoking (OR 1.56; 95% CI 1.28 to 1.91), anterior tooth type (OR 3.23; 95% CI 2.57 to 4.05), and the presence of either of the following medical conditions: diabetes mellitus (OR 2.64; 95% CI 2.19 to 3.18), hypertension (OR 1.73; 95% CI 1.41 to 2.13), or rheumatoid arthritis (OR 4.19; 95% CI 2.17 to 8.11). CONCLUSION: Tooth loss due to periodontal disease is associated with the risk indicators of age, male gender, smoking, lack of professional maintenance, inadequate oral hygiene, diabetes mellitus, hypertension, rheumatoid arthritis, and anterior tooth type.     

Risk indicators for periodontal disease in a racially diverse urban population

Abstract A cross-sectional study of 117 subjects from a dental clinic serving a diverse population (i.e., Whites. African-Americans. Native-Americans, and Asians) was performed to evaluate risk indicators of periodontal disease. Gingival crevicular fluid (GCF) and subgingival plaque were taken at the same visit from 4 posterior sites of the most diseased sextant in each subject. Age, smoking packyears. β-glucuronidase (βG). neutrophil elastase (NE). myeloperoxidase (MPO). Fusobacterium nucleatum (F. nucleatum), and Porphyromonas gingivalis (P. gingivalis) were significantly (p <0.05–0.005) correlated with attachment loss. Probing depth was significantly correlated with smoking packyears, βG, NE, MPO. F. nuclealum and Prevotella intermedia (P. intermedia) (p < 0.05–0.005). Mean NE value of Whites was lower than the mean NE values of African-Americans, Native-Americans and Asians (P < 0.05). Whites had a lower mean βG value compared to African Americans, and a lower mean MPO value compared to African Americans and Native Americans. The %s of patients positive for F. nucleatum. P. intermedia and Eikenella corrodents (E. corrodents) were higher in Native Americans compared to Whites. Step-wise multiple regression analysis was performed to construct models for the estimation of probing depth and attachment loss. The most parsimonious regression models which had the best R ² values included the following variables and accounted for the indicated % of variability: models 1 and 2: βG. race, and F. nucleatum accounted for 50% of the variability in mean probing depth and 39% of the variability in a single site (first molar) for probing depth, respectively: model 3: age. βG. and F. nuclealum accounted for 53% of the variability in mean attachment loss: model 4: age. NE. and F. nuclealum explained 35% of the variability in a single site (first molar) for attachment loss. The results suggest that age. race, smoking packyears, βG, NE. MPO. F. nuclealum, P. gingivalis and P. intermedia are risk indicators for periodontal disease in this racially diverse urban population. Regression models which include multiple variables (i.e., demographic factors, GCF enzymes and periodontopathic bacteria) can be used to estimate periodontal disease status.     

The association between cumulative periodontal disease and stroke history in older adults

BACKGROUND: Since the late 1980s, several studies have been conducted to investigate the relationship between periodontal disease and ischemic stroke. The purpose of this study is to investigate the relationship of periodontal disease to the self-reported history of stroke in the elderly (60 years of age and older) by examining the data of the Third National Health and Nutrition Examination Survey (NHANES III). METHODS: Data from NHANES III, a large population-based cross-sectional survey of the United States, were used for this study. Because 1,563 of the 5,123 subjects in the study were edentulous, and periodontal disease is a major cause of tooth loss, it was necessary to account for edentulousness in the statistical analysis to avoid bias. Hence, a new index called the periodontal health status (PHS) index was developed to address this problem. Two measures of PHS were developed: PHS I, based on the median percentage of sites with >/=2 mm clinical attachment loss (CAL), and PHS II, based on the median percentage of sites with >/=3 mm CAL. Multiple logistic regression analysis was used to test for the association of PHS with stroke history. Two types of a multiple logistic regression model were fit: 1) logistic regression modeling with adjustment for age and tobacco use only; and 2) logistic regression modeling with adjustment of all statistically significant confounders. RESULTS: Based on multiple logistic regression analysis of PHS with adjustment for age and tobacco use only, completely edentulous elderly adults (PHS Class 5) and partially edentulous (teeth in one arch) elderly adults with appreciable clinical attachment loss (PHS Class 4) were significantly more likely to have a history of stroke compared to dentate adults (teeth in both arches) without appreciable clinical attachment loss (PHS Class 1). When multiple logistic regression models were fit with adjustment of all significant confounders, no statistically significant association was found between PHS and stroke. CONCLUSIONS: Based on the results of this study, there is evidence of an association between cumulative periodontal disease, based on PHS, and a history of stroke. However, it is unclear whether cumulative periodontal disease is an independent risk factor for stroke or a risk marker for the disease.     

Obesity and periodontal disease in young,middle-aged,and older adults

BACKGROUND: The growing prevalence of increased body weight and obesity in the United States has raised significant public health concerns. Obesity has been implicated as a risk factor for several chronic health conditions, as well as being associated with increased mortality. Recently, an association between obesity and periodontal disease was found in a Japanese population. The purpose of the present study is to examine the relation between body weight and periodontal disease in a representative United States sample. METHODS: Participants in the third National Health and Nutrition Examination Survey (NHANES III) who were > or =18 years and had undergone a periodontal examination were selected for the analysis (n = 13,665). Body mass index (BMI) and waist circumference (WC) were used as measures of overall and abdominal fat content, respectively. Univariable and multivariable logistic regression models were used to estimate the association between increased body weight and periodontal disease. BMI and WC were assessed independently in a multivariable logistic model containing the following variables: gender, race, education, poverty index, smoking, diabetes, and time elapsed since last dental visit. Significant interactions with age were found and analyses were then stratified by age: younger (18 to 34 years old), middle-aged (35 to 59 years old), and older (60 to 90 years old) adults. RESULTS: A significant association between the measures of body fat and periodontal disease was found among the younger adults, but not middle or older adults. The adjusted odds ratios (OR) for having periodontal disease were 0.21 (0.080 to 0.565), 1.00 (0.705 to 1.407), and 1.76 (1.187 to 2.612) for subjects with BMI < 18.5 kg/m2, 25-29.9 kg/m2, and > or = 30 kg/m2, respectively. Young subjects with high WC had an adjusted OR of 2.27 (1.480 to 3.487) for having periodontal disease. CONCLUSIONS: In a younger population, overall and abdominal obesity are associated with increased prevalence of periodontal disease, while underweight (BMI < 18.5) is associated with decreased prevalence. Obesity could be a potential risk factor for periodontal disease especially among younger individuals. Promotion of healthy nutrition and adequate physical activity may be additional factors to prevent or halt the rate of progression of periodontal disease.     

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.     

Relationship between bleeding on probing and periodontal disease progression in community-dwelling older adults

OBJECTIVE: The main objective of this study was to determine the relationship between bleeding on probing (BOP) and periodontal disease progression in community-dwelling older adults. METHODS: A 3-year longitudinal study was carried out in 229 non-smoking healthy older adults aged 70 years. Using pressure-controlled periodontal probes, BOP, pocket depth and attachment level at 13,289 sites were measured annually. Periodontal disease progression was defined as an increase in attachment loss of >or=3 mm from the baseline to the final examination. The backward stepwise logistic regression analysis was performed to assess the relationship between the total number of sites with BOP in the four examinations and periodontal progression. RESULTS: Logistic regression analysis showed that the odds ratios of BOP frequency for periodontal disease progression ranged from 1.4 to 6.2 after controlling for pocket depth >or=4 mm at baseline, number of missing teeth, jaw type and tooth site. CONCLUSION: Increasing frequencies of bleeding might increase the probability of periodontal disease progression in community-dwelling older adults.     

Risk indicators for periodontal diseases in Guatemalan adolescents

A random sample of sixty-two 11-15-year-old adolescents from 17 different locations in Guatemala were selected for this study. Pocket depth, Plaque Index, and bleeding upon probing were recorded from 6 randomly selected sites in each subject (a total of 372 sites). Subgingival plaque samples were subsequently collected from these sites and processed by several assays. For cost reasons, in each pair of sites different assays were performed as follows: sites #1, #2--BANA test for T. denticola, P. gingivalis, B. forsythus and screening of plaque samples with polyclonal antibodies (ELISA system) for A. actinomycetemcomitans; sites #3, #4--detection of yeasts by SAB agar; sites #5, #6--detection of Entamoeba gingivalis by the Heidenhain iron hematoxylin modified technique. A total of 66% of the children had at least one site that bled upon probing, 42% exhibited at least one site with pocket depth > 3 mm, and 79% exhibited a high Plaque Index, with the percent of sites affected being 30%, 12% and 41%, respectively. In sites #1, #2 (N = 124), the BANA test assay and A. actinomycetemcomitans tested positive in 77% and 47% of the children accounting for 59% and 31% of the sites, respectively. In sites #3, #4 (N = 124), yeasts were detected in 43% of the children and 29% of the sites. In sites #5, #6 (N = 124), Entamoeba gingivalis was detected in 21% of the children and in 11% of the sites. The risk for severe gingival inflammation and/or increased probing depth was 1.5 and 5.2 times higher if a positive BANA test or A. actinomycetemcomitans test was found in a particular site. No associations could be found for yeasts and Entamoeba gingivalis.     

The prevalence of periodontal disease measures in elderly adults, aged 79 and older

From 1996-98, we examined 449 adults (mean age 85 years) from the 1982 Iowa 65⁺ Rural Health Study, in the field using headlight, mirror, and periodontal probe. Ninety-six of the 342 dentate subjects were excluded from the follow-up examination due to contraindications to probing, and 10 could not be assessed due to refusals, fatigue or other reasons. For all remaining subjects (n=236), attachment loss, defined as recession plus probing depth, was determined at four sites per tooth. Ninety-one percent of the subjects had at least one site with 4⁺ mm of attachment loss, 45% had one or more sites with attachment loss of 6⁺ mm, and 15% had 8⁺ mm of attachment loss. Moderate periodontal disease is prevalent among very old dentate adults while advanced periodontal disease is much less prevalent, suggesting that most periodontal treatment needed by this age group can be provided by general dentists and dental hygienists rather than periodontists.     

FcgammaRIIIb genotypes and smoking in periodontal disease progression among community-dwelling older adults in Japan

BACKGROUND: FcgammaRIIIb genotypes and smoking are risk factors for periodontal disease. However, the interaction of FcgammaRIIIb- NA1-NA2 polymorphism with smoking remains unclear. The purpose of this study was to determine if FcgammaRIIIb-NA1-NA2 polymorphism and smoking are associated with periodontal disease progression among elderly people. METHODS: Among 70-year-old subjects, 164 with neither diabetes mellitus nor blood sugar > or =140 mg/dl, who had more than 20 teeth and who could participate in both the baseline and the follow-up examinations were included in the study. The NA1 group comprised subjects with FcgammaRIIIb-NA1NA1 genotype (N = 53), while the NA2 group included subjects with FcgammaRIIIb-NA1NA2 or NA2NA2 genotype (N = 111). We examined the progression of periodontitis by measuring attachment loss during 3 years. RESULTS: The frequency of subjects who showed > or =4 mm additional attachment loss at one or more sites was 55.6% for smokers and 37.2% for non-smokers. The odds ratio (OR) was 2.13 (confidence interval [CI]: 0.92 to 4.76). We found a better association between periodontal progression and smoking in the NA2 group. The OR for smokers was 3.03 (CI:1.12 to 8.33, P = 0.028). Additionally, the mean number of sites with > or =4 mm additional attachment loss per person between smokers and non-smokers in the NA2 group or between smokers and non-smokers in the NA1 group was 2.90 3.42 and 0.74 1.53 or 0.57 0.79 and 0.68 1.03, respectively (P <0.001; analysis of variance [ANOVA]). CONCLUSION: Our results may suggest an association between smoking and periodontal disease progression in elderly people with FcgammaRIIIb-NA2 polymorphism.     

Risk factors in periodontal disease

Some life styles and systemic pathologies represent risk factors for the periodontal disease. Cigarette smoking in particular increases the speed of progression of periodontitis. Other conditions such as diabetes mellitus, presence of genetic markers and some bacteria are significantly correlated with the periodontal disease.