Some risk factors for periodontal bone loss in 50-year-old individuals. A 10-year cohort study

Objective: The aim of this 10-year prospective study of 50-year-old individuals was to analyze the incidence of periodontal bone loss and potential risk factors for periodontal bone loss. Methods: The subject sample was generated from an epidemiological survey performed in 1988 of subjects living in the County of Värmland, Sweden. A randomized sample of 15% of the 50-year-old inhabitants in the county was drawn. At the 10-year follow-up in 1998, 320 (75%) of the 449 individuals examined at baseline were available for re-examination, out of which 4 had become edentulous. Full-mouth clinical and radiographic examinations and questionnaire surveys were performed in 1988 and 1998. Two hundred and ninety-five individuals (69%) had complete data for inclusion in the analysis of radiographic bone changes over 10 years. Non-parametric tests, correlations and stepwise multiple regression models were used for statistical analysis of the data. Results: The mean alveolar bone level (ABL) in 1988 was 2.2 mm (0.05) and a further 0.4 mm (0.57) (p=0.000) was lost over the 10 years. Eight percent of the subject sample showed no loss, while 5% experienced a mean bone loss of 1 mm. Smoking was found to be the strongest individual risk predictor (RR=3.2; 95% CI 2.03–5.15). When including as smokers only those individuals who had continued with the habit during the entire 10-year follow-up period, the relative risk was slightly increased (3.6; 95% CI 2.32–5.57). Subjects who had quit smoking before the baseline examination did not demonstrate a significantly increased risk for disease progression (RR=1.3; 95% CI 0.57–2.96). Stepwise multiple regression analysis revealed that smoking, % approximal sites with probing pocket depth 4 mm, number of teeth and systemic disease were significant explanatory factors for 10-year ABL loss (R²=0.12). For never smokers, statistically significant predictors were number of teeth, mean ABL, % periodontally healthy approximal sites and educational level (R²=0.20). Conclusion: The inclusion of smokers in risk analysis for periodontal diseases may obstruct the possibility to detect other true risk factors and risk indicators.     

Patient-based assessments of clinical periodontal conditions in relation to alveolar bone loss

BACKGROUND: Limited subject-based information exists on the relationship between clinical and radiographic periodontal data. AIMS: To use subject-based data to assess the extent of concurrence between clinical and radiographic information, and to study what clinical information best predicts alveolar bone loss (ABL). Material and Methods: Subject-based data on smoking habits, bleeding on probing, plaque scores, pocket probing depth (PD), and evidence of alveolar BL were obtained, and functional periodontal pentagon risk diagrams (PPRDs) were studied from 168 consecutive subjects attending a medical clinic. RESULTS: The mean age of the subjects was 62.7 years (SD+/-9.0). The average number of teeth was 21.3 (SD+/-8.0) with on average 5.6 molars remaining (SD+/- 3.9). In this subject cohort, 33.1% had never smoked, 44.2% had quit smoking, and 22.7% were currently smokers. Mean plaque and bleeding scores were high or 60.2% (SD+/-24.0) and 53.1% (SD+/-23.6), respectively. PDs >or=6.0 mm were found in 55.9% of the subjects. Binary logistic regression analysis demonstrated that tooth loss and proportional plaque scores were the predominant factors included in the equations associated with ABL. Wald coefficients varied between 3.99 and 9.15, and with p-values between 0.05 and 0.01. When included, the PPRD score became the exclusive factor at several cut-off levels (Wald's coefficients between 19.8 and 15.6, p<0.001). Consequently, the best receiver operator curve was identified for the PPRD at the >40% cut-off ABL level (area under the curve: 0.81; 95% CI: 0.74-0.89; p<0.001). CONCLUSIONS: The number of teeth lost and the proportion of plaque scores provided significant predictive factors for ABL. The functional PPRD demonstrated an exclusive and highly predictable association with ABL. Subject-based proportional data for PDs >4.0 mm provided poor substitute measures for the extent of ABL.     

Association between alveolar bone loss and elevated serum C-reactive protein in Japanese men

BACKGROUND: Moderate elevation of C-reactive protein (CRP) is thought to predict type 2 diabetes and cardiovascular disease (CVD), both of which are associated with periodontitis. Recent studies indicate that periodontal disease is associated with moderate elevation of CRP; however, the relationship between alveolar bone loss (ABL) and CRP elevation is unclear. METHODS: A total of 179 Japanese men aged 50 to 54 years old, with at least 10 teeth, were examined as part of a comprehensive health examination before retirement from the Japan Self-Defense Force. ABL was measured at proximal sites of posterior teeth on a panoramic x-ray film. The relationship between the mean ratio of ABL to root length and serum CRP level and other variables was analyzed. RESULTS: ABL was significantly correlated with serum CRP level (P = 0.008), alkaline phosphatase (P = 0.008), high-density lipoprotein (HDL) cholesterol (P = 0.04, inversely), white blood cell count (P < 0.001), erythrocyte sedimentation rate (P = 0.002), age (P = 0.03), and smoking history (P < 0.001). In a multiple logistic regression model adjusted for age, smoking history, systolic blood pressure, body-mass index, triglyceride, and HDL cholesterol, subjects in the highest tertile of ABL had an increased risk for CRP elevation > or = 1.3 mg/l (odds ratio [OR] = 8.20; 95% confidence interval [CI], 1.6 to 40.7; P = 0.01) when compared to the lowest tertile of ABL. CONCLUSION: ABL around posterior teeth was associated with elevated CRP in Japanese men, suggesting an association between periodontal disease and increased risk of type 2 diabetes and CVD.     

The association between tooth loss and coronary heart disease in men and women

OBJECTIVES: This paper evaluates the relation of tooth loss to incidence of coronary heart disease in two large cohort studies. METHODS: Participants included 41,407 men and 58,974 women free of any cardiovascular diseases at baseline. We recorded 1,654 incident coronary heart disease events (562 fatal events) among men during 12 years of follow-up and 544 events (158 fatal events) among women during 6 years of follow-up. RESULTS: After controlling for important cardiovascular risk factors, compared to men with 25-32 teeth at baseline, men with 0-10 teeth had a significantly higher risk of coronary heart disease (relative risk [RR]= 1.36; 95 percent confidence interval [CI]=1.11, 1.67). The relative risk increased to 1.79 (95% CI=1.34, 2.40) when limited to fatal events. Women with 0-10 teeth were also at increased risk of coronary heart disease compared to women with 25-32 teeth (RR=1.64; 95% CI=1.31, 2.05). The association was similar for fatal events (RR= 1.65; 95% CI=1.11, 2.46). The association between number of teeth and incidence of coronary heart disease was similar between men with and without a history of periodontal disease, and there was no significant association between tooth loss during follow-up and coronary heart disease. CONCLUSIONS: This study showed a significant association between number of teeth at baseline and risk of coronary heart disease and the mechanisms to explain this association should be further clarified.     

Periodontal disease and coronary heart disease

BACKGROUND: Several epidemiological studies have demonstrated an association between periodontal disease and coronary heart disease (CHD). The association could be a result of confounding by mutual risk factors. The present study was undertaken in a Danish population to reveal the significance of common risk factors. METHODS: The investigation was conducted as a case-control study comprising 250 individuals: 110 individuals with verified CHD from a Department of Cardiovascular Medicine and 140 control individuals without CHD from the Copenhagen City Heart Study. Information on diabetic status, smoking habits, alcohol consumption, physical activity, school attendance, household income, body weight and height, triglyceride, and serum cholesterol was obtained. Full-mouth probing depth (PD), clinical attachment loss (CAL), bleeding on probing (BOP), and alveolar bone level (ABL) on radiographs were registered. ABL was stratified into ABL1=ABL2 to 4 mm. Multiple logistic regression models with stepwise backward elimination were used allowing variables with P<0.15 to enter the multivariate analysis. RESULTS: The CHD group had a significantly lower outcome with respect to PD, BOP, CAL, and ABL. For participants<60 years old, only risk factors such as smoking and diabetic status entered the multivariate analysis. For the ABL3 group, there was a significant association with CHD for participants<60 years old, the odds ratio being 6.6 (1.69 to 25.6). For participants>or=60 years old, there was no association. CONCLUSIONS: The present study showed a positive association between periodontal disease and CHD in agreement with several other studies. The association was highly age dependent and could only be attributed to diabetes and smoking to some extent.     

Intra-oral pattern of tooth and periodontal bone loss between the age of 50 and 60 years. A longitudinal prospective study

OBJECTIVE: In a 10-year prospective study we analyzed (i) the intra-oral pattern of and (ii) potential risk factors for tooth and periodontal bone loss in 50-year-old individuals. METHODS: A randomized subject sample of 50-year-old inhabitants in the County of Varmland, Sweden, was examined at baseline and after 10 years. Data from full-mouth clinical and radiographic examinations and questionnaire surveys of 309 (72%) of the individuals who were dentate at baseline were available for analysis. Non-parametric tests and binary logistic multiple regression models were used for statistical analysis of the data. RESULTS: 4.1% of the 7,101 teeth present at baseline, distributed among 39% of the subjects, were lost during the 10-year interval. The incidence of tooth loss was highest among mandibular molars (7.5%) and lowest among canines (1.8%). The relative risk (RR) for tooth loss for endodontically compromised teeth was 4.1 and for furcation-involved molars 2.4-6.5, depending on tooth position. Logistic regression analysis identified baseline alveolar bone level (ABL), endodontic conditions, CPITN score (Community Periodontal Index of Treatment Needs), tooth position, caries, and educational level as risk factors for tooth loss. The overall mean 10-year ABL change was -0.54 mm (S.E. 0.01). On a tooth level the ABL change varied between -0.35 mm (mandibular molars) and -0.79 mm (mandibular incisors). Smokers experienced a greater (20-131% depending on tooth type) mean bone loss than non-smokers. The logistic regression model revealed that tooth position, smoking, and probing pocket depth > or =4 mm were risk factors for bone loss of >1 mm. No pertinent differences were observed with respect to risk factors for ABL change in the subgroup of non-smokers compared to the results of the analysis based on the entire subject sample. CONCLUSION: Tooth loss was more common in the molar than in the anterior tooth regions, while periodontal bone loss had a random distribution in the dentition. The predominant risk factors identified with regard to further radiographic bone loss were "probing pocket depth > or =6 mm" and "smoking".     

Assessment of periodontal conditions and systemic disease in older subjects

BACKGROUND: An increased risk for periodontitis has been associated both with type-1 or insulin dependent diabetes (IDDM) and with type-2 or non-insulin dependent diabetes (NIDDM). AIMS: 1) To describe and analyze periodontal conditions in older low-income ethnic diverse subjects with or without a diagnosis of diabetes. 2) To assess to what extent diabetes mellitus is associated with periodontal status, and 3) how periodontitis ranks as a coexisting disease among other diseases in subjects with diabetes mellitus. MATERIAL AND METHODS: Radiographic signs of alveolar bone loss were studied in 1101 older subjects 60-75 years old (mean age 67.6, SD+/-4.7). The number of periodontal sites and the proportions of teeth with probing depth (PD) > or =5 mm, clinical attachment levels (CAL) > or =4 mm were studied in a subset of 701 of the subjects. RESULTS: IDDM was reported by 2.9% and NIDDM by 9.2% of the subjects. The number of remaining teeth did not differ by diabetic status. The number of sites with PD > or =5 mm and the proportion of PD with > or =5 mm was significantly smaller in the non-diabetic group (chi2=46.8, p<0.01, and chi2=171.1, p<0.001, respectively). Statistical analysis failed to demonstrate group differences for the number and proportions of sites with CAL > or =4 mm and for radiographic findings of alveolar bone loss. Combining all periodontal parameters revealed that the Mantel-Haenszel common odds of having IDDM/NIDDM and periodontitis was 1.8 : 1 (95% CI: 1.1-3.1, p<0.03). The common odds ratio estimate of an association between heart disease and diabetes was 3.6 : 1 (95% CI: 2.1-2.6, p<0.001). CONCLUSIONS: Probing depth differences between IDDM/NIDDM vs. non-diabetic subjects may reflect the presences of pseudo-pockets and not progressive periodontitis in many subjects with diabetes mellitus. Periodontitis is not a predominant coexisting disease in older subjects with diabetes mellitus.     

Periodontal disease and the incidence of tooth loss in postmenopausal women

BACKGROUND: The role of periodontal disease as a predictor of incident tooth loss in postmenopausal women has not been determined. The aim of this cohort study was to determine the extent of the association between baseline periodontal status and incident tooth loss in a population of postmenopausal women. METHODS: The study population included 106 dentate white postmenopausal women who participated in a cross-sectional study between 1989 and 1991 who were willing and eligible to have a repeat examination after 10 to 13 years. At baseline, full-mouth assessment of periodontal status was performed clinically and radiographically. Assessment of tooth loss during follow- up was assessed clinically by a periodontist. Odds ratio (OR) and its 95% confidence interval (CI) for each periodontal variable was obtained from separate multiple logistic regression analyses adjusting for the effect of age, household income, smoking, hormone therapy, snack consumption, and number of decayed teeth. RESULTS: Sixty-one (57.5%) subjects lost at least one tooth during follow-up. Mean tooth loss per person was 1.81 +/- 2.77. After adjusting for confounders, each millimeter of alveolar bone loss at baseline increased the risk of tooth loss 3-fold (OR = 3.26; 95% CI: 1.60 to 6.64). The risk of tooth loss also increased 2.5 times for each millimeter of clinical attachment loss (OR = 2.50; 95% CI: 1.24 to 5.07). Probing depth (OR = 2.53; 95% CI: 0.98 to 6.53), gingival bleeding (OR = 1.99; 95% CI: 0.21 to 18.94), calculus (OR = 2.05; 95% CI: 0.91 to 4.61), and plaque (OR = 0.70; 95% CI: 0.13 to 3.34) were not significantly associated with incident tooth loss. CONCLUSION: Periodontal disease, especially measured by alveolar bone loss, is a strong and independent predictor for incident tooth loss in postmenopausal women.     

Analysis of periodontal risk profiles in adults with or without a history of myocardial infarction

BACKGROUND: An association between periodontitis and cardiovascular diseases has been suggested. AIMS: To study whether a combination of clinical variables in a functional risk diagram enhanced the ability to differentiate between subjects with or without an immediate history of acute myocardial infarction (AMI). MATERIAL AND METHODS: A functional periodontal pentagon risk diagram (PPRD) with five periodontal risk vectors was created. The surface of individual PPRDs was calculated using data from 88 subjects with recent AMI and 80 matched control subjects with no history of AMI. RESULTS: Age, gender, number of remaining teeth (mean value: 21.1 versus 21.6 teeth), smoking status, and pocket probing depth (PPD) distribution did not differ by group. Gingival recession was greater in control subjects (mean difference: 5.7, SD: +/- 1.9, p<0.01, 95% CI: 1.8-9.6). Bone loss > or = 4.0 mm was at all levels studied was significantly greater in subjects with AMI and bone loss > or = 50% (> or = 4 mm) was the best individual predictor of AMI (beta = 2.99, p < 0.000, 95% CI: 7.5-53.4). Only PPRD scores were associated with AMI status when factors not included in the PPRD were studied (beta = 22.1, SE: 5.9, p < 0.0001, 95% CI: 10.3-33.7). The best association between AMI status and study variables was the combination of > or = 4 mm of bone loss > or = 50%, proportion of bleeding on probing (%BOP), %PPDs > or = 6 mm, and tooth loss (Nagelkirke r2 = 0.46). CONCLUSIONS: The combination of five periodontal parameters in a PPRD added predictive value, suggesting that comprehensive data should be used in studies of associations between periodontitis and heart diseases. Radiographic evidence of bone loss was the best individual parameter.     

Effect of lifestyle on periodontal disease status in diabetic patients

Lifestyle and socioeconomic status have been associated with the disease status of diabetic patients. However, there have been few reports on the relationship between these factors and the periodontal condition of diabetics. We assessed the association between disease status and lifestyle of diabetic patients and clinical features of advanced periodontitis such as deep probing depths and severe alveolar bone loss. Fifty-seven diabetic patients were examined in this study. Clinical assessment of probing pocket depth and radiographic alveolar bone loss was performed. Data regarding diabetic status and lifestyle of the diabetic patients were also recorded and statistically analysed by logistic regression. Drinking habits and high values of hemoglobin A1c (HbA1c) (>9.0%) were significantly associated with deep probing depth. The odds ratios (OR) of these factors were 7.72 (95% confidence interval (CI), 1.80 to 33.19), and 6.10 (95% CI = 1.23 to 30.25), respectively. Presence of complications such as retinopathy (OR = 8.86, 95% CI, 1.99 to 39.40), irascible behaviour (OR = 8.40, 95% CI = 1.33 to 53.17) and high value of HbA1c (OR = 4.94, 95% CI = 1.14 to 21.46) were significantly related to mean advanced alveolar bone loss. Only the high value of HbA1c (OR = 3.53, 95% CI = 1.06 to 11.73) was detected as a significant factor related to advanced periodontitis, characterised by more than 50% mean alveolar bone loss, or two or more teeth with probing depth greater than 6 mm. In conclusion, drinking habit and irascible behaviour are correlated with the periodontal disease condition of diabetic patients, in addition to a high value of HbA1c (>9.0%). Lifestyle and psychosocial stress may affect the periodontal disease status of diabetic patients.     

Alveolar bone loss and aging: a model for the study in mice

BACKGROUND: Several animal studies have shown a positive correlation between aging and alveolar bone loss (ABL). The purpose of this study was to develop a model for the study of ABL in mice and aging. METHODS: Mucoperiosteal flap surgery (MFS) was performed on the buccal aspect of the left side of the mandible (BL) in 72 CF(1) Mus domesticus mice and divided into three groups as follows: males, breeding (non-virgin) females, and virgin females. The MFS was performed in 3-, 6-, 9-, and 12-month-old animals under anesthesia. The buccal aspects of right hemimandibles were used as controls (BR). Animals were sacrificed under anesthesia 21 days after surgery. Mandibles were removed, defleshed, stained with toluidine blue, and photographed in a microscope. The photographs were digitized, and ABL was measured as the exposed root surface area (mm(2)). Blinded measurements were performed using a computer-assisted image analysis system. RESULTS: In terms of alveolar bone loss, the BL (operated) area showed a significant difference (paired Student t test; P <0.001) when compared to the BR area in all three groups. Sex and breeding differences were not observed in this experiment. ABL in the left hemimandibles was significantly larger in 3- (mean: 0.70; 95% confidence interval [CI]: 0.59 to 0.80) and 12-month-old animals (mean: 0.58; 95% CI: 0.46 to 0.71) than in 6- (mean: 0.39; 95% CI: 0.33 to 0.46) and 9-month-old animals (mean: 0.42; 95% CI: 0.35 to 0.48); P <0.001. CONCLUSION: The results suggest that 3-month-old CF(1) mice, in a sex and breeding independent process, could be a useful model for provoked alveolar bone loss studies in aging.     

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.     

Signs of carotid calcification from dental panoramic radiographs are in agreement with Doppler sonography results

BACKGROUND: Duplex ultrasonography (DS) is a frequently used noninvasive method for assessing carotid artery stenosis. The level of agreement between panoramic radiographs (PMX) findings of radiopacities in the area of C3-C4 and DS results has not been established. AIMS: (1) to examine the level of agreement between DS results and PMX signs of carotid calcification and (2) to evaluate the association between periodontitis and DS results. MATERIAL AND METHODS: Eighty-three subjects who had received a DS assessment at the University of Washington Medical Center within 36 months volunteered for a periodontal examination, including assessments of probing pocket depth (PPD), attachment level (PAL), evidence of bleeding on probing and bone loss from PMX. Two examiners independently analyzed the radiographs for evidence of carotid calcifications. The distance between the cemento-enamel junction (CEJ) to bone level (BL) CEJ-BL was used to assess alveolar bone loss as a criteria for periodontitis. RESULTS: Twenty-nine subjects (34.9%) presented with positive DS readings. The Mantel-Haentszel common odds ratio estimate for a positive DS score and periodontitis (> 30% of teeth with distance CEJ-BL > or = 4.0 mm) was 38.4 (95% CI: 10.6-138.7, p < 0.0001). For nonsmokers only (n = 72) the odds ratio was 43.0 (95% CI: 16.7-1178.0, p < 0.0001). Evidence of bleeding on probing was 16% of sites both in the DS-positive and -negative subjects. Subjects with a positive DS result had significantly more teeth with clinical evidence of attachment loss > or = 5.0 mm (p < 0.001). The odds ratio of having periodontitis (CEJ-BL > or = 4.0 mm at > or = 30% of the teeth) and medical records confirmed diagnosis of either a stroke or an infarct or both was 7.8 (95% CI: 2.6-23.8, p < 0.001). CONCLUSIONS: Subjects with positive DS readings of the carotid arteries due to calcified arterial plaque are accurately detected by means of conventional PMX. The likelihood of being DS positive and having radiographic evidence of periodontitis is high. A dose-response relationship between the extent of carotid calcification and severity of periodontitis was demonstrated, supporting the hypothesis of an association between periodontitis and cardiovascular diseases.     

Association Between Metabolic Syndrome and Periodontal Disease Measures in Postmenopausal Women: The Buffalo OsteoPerio Study

Background: The objective of this study is to characterize the association between metabolic syndrome (MetS) and periodontitis in women, for which there is limited evidence. Methods: Cross‐sectional associations between MetS and periodontitis were examined in 657 postmenopausal women aged 50 to 79 years enrolled in a periodontal disease study ancillary to the Women's Health Initiative Observational Study. Whole‐mouth measures of alveolar crest height (ACH), clinical attachment level (CAL), probing depth (PD), gingival bleeding, and supragingival plaque and measures to define MetS using National Cholesterol Education Program criteria were from a clinical examination. Study outcomes were defined as: 1) mean ACH ≥3 mm, two sites ≥5 mm, or tooth loss to periodontitis; 2) ≥2 sites with CAL ≥6 mm and ≥1 site with PD ≥5 mm; 3) gingival bleeding at ≥50% of sites; and 4) supragingival plaque at ≥50% of sites. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results: In unadjusted analyses, MetS (prevalence: 25.6%) was significantly associated with supragingival plaque (OR = 1.74; 95% CI: 1.22 to 2.50) and non‐significantly associated with periodontitis defined by ACH (OR = 1.23; 95% CI: 0.81 to 1.85) and gingival bleeding (OR = 1.20; 95% CI: 0.81 to 1.77). Adjustment for age, smoking, and other confounders attenuated observed associations, though supragingival plaque remained significant (OR = 1.47; 95% CI: 1.00 to 2.16; P = 0.049). MetS was not associated with periodontitis defined by CAL and PD. Conclusions: A consistent association between MetS and measures of periodontitis was not seen in this cohort of postmenopausal women. An association between MetS and supragingival plaque requires further investigation.     

Relationship of stress, distress and inadequate coping behaviors to periodontal disease.

BACKGROUND: The association of stress, distress, and coping behaviors with periodontal disease was assessed. METHODS: A cross-sectional study of 1,426 subjects between the ages of 25 and 74 years in Erie County, New York, was carried out to assess these relationships. Subjects were asked to complete a set of 5 psychosocial questionnaires which measure psychological traits and attitudes including discrete life events and their impact; chronic stress or daily strains; distress; coping styles and strategies; and hassles and uplifts. Clinical assessment of supragingival plaque, gingival bleeding, subgingival calculus, probing depth, clinical attachment level (CAL) and radiographic alveolar crestal height (ACH) was performed, and 8 putative bacterial pathogens from the subgingival flora measured. RESULTS: Reliability of subjects' responses and internal consistencies of all the subscales on the instruments used were high, with Cronbach's alpha ranging from 0.88 for financial strain to 0.99 for job strain, uplifts, and hassles. Logistic regression analysis indicated that, of all the daily strains investigated, only financial strain was significantly associated with greater attachment and alveolar bone loss (odds ratio, OR = 1.70, 95% CI = 1.09 to 2.65 and OR = 1.68, 95% CI = 1.20 to 2.37, respectively) after adjusting for age, gender, and cigarette smoking. When coping behaviors were evaluated, it was found that those with more financial strain who were high emotion-focused copers (a form of inadequate coping) had a higher risk of having more severe attachment loss (OR = 2.24, 95% CI = 1.15 to 4.38) and alveolar bone loss (OR = 1.91, 95% CI = 1.15 to 3.17) than those with low levels of financial strain within the same coping group, after adjustment for age, gender, and cigarette smoking. Similar results were found among the low problem-focused copers for AL (OR = 2.21, 95% CI = 1.11 to 4.38) and ACH (OR = 2.12, 95% CI = 1.28 to 3.51). However, subjects with high levels of financial strain who reported high levels of problem-based coping (considered adequate or good coping) had no more periodontal disease than those with low levels of financial strain, suggesting that the effects of stress on periodontal disease can be moderated by adequate coping behaviors. CONCLUSIONS: We find that psychosocial measures of stress associated with financial strain and distress manifest as depression, are significant risk indicators for more severe periodontal disease in adults in an age-adjusted model in which gender (male), smoking, diabetes mellitus, B. forsythus, and P. gingivalis are also significant risk indicators. Of considerable interest is the fact that adequate coping behaviors as evidenced by high levels of problem-based coping, may reduce the stress-associated risk. Further studies also are needed to help establish the time course of stress, distress, and inadequate coping with respect to the onset and progression of periodontal disease, and the mechanisms that explain this association.     

EFFECT OF LOCALLY DELIVERED BISPHOSPHONATES ON ALVEOLAR BONE: A SYSTEMATIC REVIEW AND META-ANALYSIS

ObjectiveTo assess the effect of locally applied bisphosphonate drugs on alveolar bone defects caused by periodontitis and marginal bone level after placement of dental implants.Materials and MethodsThree electronic databases (PubMed/MEDLINE, Web of Science, and Scopus) were searched from January 2010 until May 2020 for randomized controlled clinical trials reporting the effect of locally delivered bisphosphonates on alveolar bone. The risk of bias was assessed and quantitative synthesis was conducted with both fixed and random-effects meta-analyses by using RevMan version 5.3. Subgroup and sensitivity analyses were performed whenever required.ResultsAmong the included studies, the effect of locally delivered bisphosphonates on alveolar bone regeneration in periodontitis was measured by 15 studies and on marginal bone level after installation of dental implants by three studies. Bisphosphonates showed significantly higher intrabony defect depth reduction than placebo/control in vertical bone defects treated with non-surgical approach (MD = 1.69mm; 95% CI, 1.32-2.05; P < 0.00001; I²=93%) or surgical approach (MD = 0.70mm; 95% CI, 0.23-1.16; P = 0.003; I² = 78%) and in class II furcation defects treated with non-surgical approach (MD = 1.61mm; 95% CI, 1.15-2.07; P < 0.00001; I² = 99%) or surgical approach (MD = 0.24mm; 95% CI, 0.05-0.42; P = 0.01; I² = 62%). Clinical attachment loss increased by 1.39mm (95% CI, 0.92-1.85; P < 0.01; I²=93%) and 1mm (95% CI, 0.75-1.26; P < 0.001; I² = 0%) in vertical bone defects after non-surgical and surgical treatments, respectively, and by 1.95mm (95% CI, 1.37-2.53; P < 0.00001; I² = 96%) and 0.84mm (95% CI, 0.58-1.10; P < 0.01, I² = 47%) after non-surgical and surgical treatment in class II furcation defects, respectively. Lesser marginal bone loss during pre-loading (MD = -0.18 mm; 95% CI, -0.24- -0.12; P<0.00001; I²=0%) and 1-year post-loading (MD = -0.33 mm; 95% CI, -0.59–0.07; P = 0.01; I² = 0%) periods was observed when bisphosphonate coated dental implants were used.ConclusionLocally delivered bisphosphonates induce bone regeneration in periodontal defects and decrease the rate of marginal bone loss after dental implant therapy.     

Smoking, a weak predictor of periodontitis in older adults

BACKGROUND: The impact of smoking habits on periodontal conditions in older subjects is poorly studied. AIMS: To assess if a history of smoking is associated with chronic periodontitis and medical history in older subjects. MATERIAL AND METHODS: The medical and dental history was collected from 1084 subjects 60-75 years of age. Smoking history information was obtained from self-reports. Periodontal variables [clinical probing depth (PD)>/=5.0 mm, clinical attachment levels (CALs) >/=4.0 mm], and radiographic evidence of alveolar bone loss were assessed. RESULTS: 60.5% had never smoked (NS), 32.0% were former smokers (FS) (mean smoke years: 26.1 years, SD+/-13.1), and 7.5% were current smokers (CS) (mean smoke years 38.0 years, (SD+/-12.1). The proportional distribution of CAL >/=4.0 mm differed significantly by smoking status (NS and CS groups) (mean difference: 12.1%, 95% confidence interval (CI): 1.5-22.6, p<0.02). The Mantel-Haenszel common odds ratio between smoking status (CS+FS) and periodontitis (>20% bone loss) was 1.3 (p<0.09, 95% CI: 0.9-2.0) and changed to 1.8 (p<0.02, 95% CI: 1.3-2.7) with 30 years of smoking as cutoff. A weak correlation between number of years of smoking and CAL>/=4.0 mm was demonstrated (r(2) values 0.05 and 0.07) for FS and CS, respectively. Binary logistic forward (Wald) regression analysis demonstrated that the evidence of carotid calcification, current smoking status, gender (male), and the number of remaining teeth were explanatory to alveolar bone loss. CONCLUSIONS: A clinically significant impact on periodontal conditions may require 30 years of smoking or more. Tooth loss, radiographic evidence of carotid calcification, current smoking status, and male gender can predictably be associated with alveolar bone loss in older subjects.     

Intra‐oral pattern of tooth and periodontal bone loss between the age of 50 and 60 years. A longitudinal prospective study

Objective: In a 10‐year prospective study we analyzed (i) the intra‐oral pattern of and (ii) potential risk factors for tooth and periodontal bone loss in 50‐year‐old individuals. Methods: A randomized subject sample of 50‐year‐old inhabitants in the County of Värmland, Sweden, was examined at baseline and after 10 years. Data from full‐mouth clinical and radiographic examinations and questionnaire surveys of 309 (72%) of the individuals who were dentate at baseline were available for analysis. Non‐parametric tests and binary logistic multiple regression models were used for statistical analysis of the data. Results: 4.1% of the 7,101 teeth present at baseline, distributed among 39% of the subjects, were lost during the 10‐year interval. The incidence of tooth loss was highest among mandibular molars (7.5%) and lowest among canines (1.8%). The relative risk (RR) for tooth loss for endodontically compromised teeth was 4.1 and for furcation‐involved molars 2.4–6.5, depending on tooth position. Logistic regression analysis identified baseline alveolar bone level (ABL), endodontic conditions, CPITN score (Community Periodontal Index of Treatment Needs), tooth position, caries, and educational level as risk factors for tooth loss. The overall mean 10‐year ABL change was ?0.54?mm (S.E. 0.01). On a tooth level the ABL change varied between ?0.35?mm (mandibular molars) and ?0.79?mm (mandibular incisors). Smokers experienced a greater (20–131% depending on tooth type) mean bone loss than non‐smokers. The logistic regression model revealed that tooth position, smoking, and probing pocket depth ≥4?mm were risk factors for bone loss of >1?mm. No pertinent differences were observed with respect to risk factors for ABL change in the subgroup of non‐smokers compared to the results of the analysis based on the entire subject sample. Conclusion: Tooth loss was more common in the molar than in the anterior tooth regions, while periodontal bone loss had a random distribution in the dentition. The predominant risk factors identified with regard to further radiographic bone loss were ‘probing pocket depth ≥6?mm’ and ‘smoking’.     

Third molars and progression of periodontal pathology during pregnancy.

PURPOSE: This study was conducted to evaluate the association between third molar periodontal pathology at enrollment and periodontal disease progression during pregnancy. PATIENTS AND METHODS: The data were derived from patients in an institutional review board-approved prospective study known as the Oral Conditions and Pregnancy (OCAP) study. Demographic, health behavior, and medical history data were obtained from medical records. Full-mouth periodontal examinations of 6 periodontal probing sites for each visible tooth, including third molars, were conducted at less than 26 weeks of pregnancy and within 72 hours postpartum. The primary outcome variable was periodontal progression (4 or more probing sites with at least a 2 mm increase in probing depth (PD), all at least 4 mm deep), between the enrollment and postpartum examinations. The primary predictor variables at enrollment were at least 1 PD >or=4 mm around the third molars, and the upper tertile of the number of third molar probing sites recorded as bleeding on probing (BOP). Bivariate analyses were performed for baseline characteristics. The chi2 test was used to determine statistical significance (P = .05). Significant variables were included in unconditional logistic multivariable models to derive relative risk ratios (RRs) and 95% confidence intervals (CIs). RESULTS: Data from enrollment and term were available for 360 subjects with visible third molars (mean age, 27.3 years; standard deviation, 5.5 years). At the postpartum examination, 122 subjects (34%) demonstrated periodontal progression. These subjects included 74 of the 176 subjects (42%) in whom a third molar PD >or=4 mm was detected at baseline and 48 of the 184 (26%) without third molar PD >or=4 mm (P = .001). Periodontal progression was found in 40 of the 77 subjects (52%) who were in the upper tertile of the number of third molar probing sites exhibiting BOP at enrollment versus 82 of the 203 (29%) in the lower tertiles (P = .0002). In multivariable models, either third molar PD >or=4 mm at enrollment (RR = 1.4; 95% CI = 1.1 to 2.0) or third molar bleeding on probing (RR = 1.7; 95% CI = 1.3 to 2.3) was associated with periodontal disease progression. CONCLUSION: Third molar periodontal pathology appears to be a significant risk indicator for periodontal disease progression during pregnancy.     

Association between periodontitis and low birth weight: a case-control study

OBJECTIVE: To verify a possible association between periodontitis and low-birth-weight babies. MATERIAL AND METHODS: One hundred and fifty-one mothers were examined. The case group included 76 mothers (mean age 25.6 years), whose babies at birth weighed <2500 g and had a gestational age (GA) <37 weeks, while 75 mothers (mean age 24.4 years), whose babies were born with a weight of >2500 g and with a GA>37 weeks, were the control group. Data from the mothers and the babies were collected from the Hospital registration records and during an interview with the mother. The periodontal examination included measurements of probing pocket depth (PPD) and clinical attachment loss (CAL) in six sites from all existing teeth, except for third molars. Mothers with periodontitis had at least four sites with PPD> or =4 and CAL> or =3 mm, while healthy mothers had PPD< or =3 mm and CAL< or =1 mm. RESULTS: The median number of sites with PPD> or =4 and CAL> or =3 mm was eight in the case group, and four in the control group. The significant associations with low birth weight (LBW) babies were periodontitis (odds ratio (OR)=3.48, 95% confidence interval (CI): 1.17; 10.36), arterial hypertension (OR=9.65, 95% CI: 2.22; 41.91), haemorrhage during pregnancy (OR=10.88, 95% CI: 1.95; 60.53), number of pre-natal examinations (OR=0.10, 95% CI: 0.02; 0.43) and genitourinary infection (OR=3.21, 95% CI: 1.25; 8.20). CONCLUSION: Periodontitis was considered a risk indicator for LBW in this sample, similar to other risk factors already recognized by obstetricians.