General health risk of periodontal disease

The possibility that periodontal disease might influence the morbidity and mortality of systemic diseases constitutes a research topic of great current interest. Human periodontal disease is associated with a complex microbiota containing approximately 500 microbial taxa and various human viruses, many of which possess significant virulence potential. Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis and other periodontopathic bacteria that are unique to the oral cavity and may disseminate to other body sites comprise the best‐documented form of dental focal infection. However, systemically healthy individuals seem to be at low risk of acquiring acute non‐oral diseases from direct infections by periodontal pathogens. Research data from various laboratories point to periodontal infections as a risk factor for chronic medical disorders, including cardiovascular disease, cerebrovascular accidents and low‐birth‐weight infants. However, recent epidemiological studies have failed to show a significant relationship between periodontal disease and cardiovascular disease. This review paper evaluates the current status of knowledge on dental focal infection and suggests avenues for further research into the topic of general health risks of periodontal disease.     

Changes in health complaints after removal of amalgam fillings

The aim of the present study was to investigate whether removal of all amalgam fillings was associated with long-term changes in health complaints in a group of patients who attributed subjective health complaints to amalgam fillings. Patients previously examined at the Norwegian Dental Biomaterials Adverse Reaction Unit were included in the study and assigned to a treatment group (n = 20) and a reference group (n = 20). Participants in the treatment group had all amalgam fillings replaced with other restorative materials. Follow-ups took place 3 months, 1 and 3 years after removal of all amalgam fillings. There was no intervention in the reference group. Subjective health complaints were measured by numeric rating scales in both groups. Analysis of covariance was used to compare changes in health complaints over time in the two groups. In the treatment group, there were significant reductions in intra-oral and general health complaints from inclusion into study to the 3-year follow-up. In the reference group, changes in the same period were not significant. Comparisons between the groups showed that reductions in intra-oral and general health complaints in the treatment group were significantly different from the changes in the reference group. The mechanisms behind this remain to be identified. Reduced exposure to dental amalgam, patient-centred treatment and follow-ups, and elimination of worry are factors that may have influenced the results.     

Oral health, related behaviors and oral health impacts among homeless adults

OBJECTIVE: To assess the oral health needs, related behavior and oral health impact among homeless persons in Newark, New Jersey. METHODS: Participants represented a convenience sample of adults (n=46) participating in Homeless Services Day, an annual event sponsored by the Homeless Services Division of the Newark, NJ Department of Health and Human Services. Their mean age was 40.4 yr (SD=10.0), and 51.1% were female. The majority (76%) reported African-American ethnicity; remaining participants self-identified as Hispanic, White or Asian. Participants reported being homeless for a median of 11 months, with a range of 1 to 108 months. RESULTS: The 46 participants had 745 teeth (averaged 16.2 per person) that were either missing, had fillings or had untreated decay. Diseased teeth averaged 3.8 per person; missing teeth averaged 8.6 per person; and filled teeth averaged 3.7 per person. Only 28.3% had a dental visit in the past year. Approximately 87% reported negative oral health impacts impact: over half (55.6%) had current oral facial pain and two-thirds of our participants reported having dental-related face pain during the past year. Additional oral health impacts included: eating (42%), smiling (33%), concentrating (18%) and talking (16%). CONCLUSIONS: Consistent with other studies, this homeless sample presented with considerable oral health needs. Newark's homeless, like other homeless cohorts, face access to care and negative oral health impacts. This study informs the need for future research that can provide substantive evidence for care providers and policy makers.     

Late-life depression: its oral health significance

Late-life depression (LLD) initially occurs after age 65 and is a major public health concern because elderly people who are at high risk constitute an ever-expanding segment of the population. LLD is a mental illness in which mood, thought content, and behavioural patterns are impaired, causing individual distress, compromising social function and impairing self-maintenance skills (e.g. bathing, dressing, hygiene). It is characterised by marked sadness, or a loss of interest or pleasure in daily activities and may be accompanied by weight change, sleep disturbance, fatigue, difficulty concentrating, and high suicide rate. Individuals under treatment for LLD and those whose illness has not been diagnosed or treated often present to the dentist with significant oral disease. LLD is frequently associated with a disinterest in performing oral hygiene, a cariogenic diet, diminished salivary flow, rampant dental decay, advanced periodontal disease, and oral dysesthesias. Many medications used to treat the disease magnify the xerostomia and increase the incidence of dental disease. Appropriate dental management necessitates a vigorous preventive dental education programme, the use of artificial salivary products, antiseptic mouthwash, daily fluoride mouthrinse and special precautions when administering local anaesthetics with vasoconstrictors and prescribing analgesics.     

Association between subjective oral health and regularity of service use

The aim was to evaluate the predictive power of two different measures of subjective oral health in relation to regularity of use of oral health-care services. The nationally representative data were collected as part of the Health 2000 Survey on Finnish adults, 30+ yr of age (n=4926). Subjective oral health and regularity of using of oral health-care services were measured using single questions and oral health-related quality of life was measured using the 14-item Oral Health Impact Profile (OHIP-14) questionnaire. Those reporting poor oral health or higher impacts in the OHIP-14 were more likely to be irregular users of oral health-care services. Further research is needed to investigate more precisely the applicability of these measures in different settings of oral health-care provision.     

Deficits in perceptions of oral health relative to general health in populations

OBJECTIVE: To compare perceptions of general health versus oral health within two populations. METHODS: Secondary analysis of cross-sectional survey data obtained from representative samples of dentate adults in Australia and the United States. Australian data were collected in the 2002 National Dental Telephone Interview Survey and United States data were from the NHANES, 1988-1994. A stratified analysis compared self-ratings of general and oral health among groups classified by age, socioeconomic status and access to dental care. RESULTS: In Australia, 43.6% rated their dental health 'very good' or 'excellent' whereas 58.6% rated their general health 'very good' or 'excellent'--a deficit of 15.0%. In the US, there was a comparable deficit of 24.2%. The deficit could be explained as a 'generation gap' where oral health ratings of the youngest cohort resembled the general health ratings of middle-aged adults in Australia and retirees in the US. An 'affluence gap' was evident where the oral health ratings of wealthier adults resembled the general health ratings of disadvantaged adults. Among Australians with private dental insurance who had visited a dentist in the past year the oral health deficit was negligible. Similar stratification in the US sample considerably attenuated the deficit. CONCLUSION: There is a deficit in perceived oral health compared with general health at all stages of adulthood and spanning the socioeconomic spectrum. The deficit was diminished among insured adults who had made a dental visit within the preceding year, suggesting that improved access to dental services may help redress the discrepancy.     

Network science and oral health research

The present overview of research methods describes a scientific enquiry paradigm that is well established in other disciplines, including health research, but that is fairly new to oral health research. Social networks analysis (SNA) or network science research is a set of relational methods purporting to identify and characterize the connections between members of a system or network, as well as the structure of the network. Persons and communities making up the members of networks have commonly been the focus of SNA studies but corporations or living organisms might just as well be organized in networks. SNA is grounded in both graphic imagery and computational models. SNA is based on the assumptions that features and structure of networks are amenable to characterization, that such information sheds light on the ways members of the network relate to each other (sharing information, diseases, norms, and so on), and that through these connections between members the overall network structure and characteristics are shaped. The overview resorts to examples specific to oral health themes and proposes a few general avenues for population‐based research.     

General health and oral health self-ratings, and impact of oral problems among older adults

The aim was to assess associations of general and oral health perceptions, and the impact of general and oral health functional problems on general health perceptions. Data were collected from adults, 60-71 yr of age in 2008, and included global self-ratings of general and oral health, Oral Health Impact Profile (OHIP-14) scores, and health problem scores [using the five items from the EuroQol instrument (EQ-5D)]. Responses were collected from 444 subjects (response rate = 68.8%). Self-rated general and oral health showed fair to good agreement (kappa = 0.47). Adjusted estimates of self-rated general health showed that worse ratings were associated with lower social status [prevalence ratio (PR) = 0.42] and with more health problems (PR = 0.64). Adjusted estimates of self-rated oral health also showed that worse ratings were associated with lower social status (PR = 0.48) and with more health problems (PR = 0.63), as well as with higher OHIP scores (PR = 0.21). The interaction of health problems and OHIP scores was significant for self-rated general health, with self-rated general health being worse when both health problems and OHIP score were higher. For older adults, general health and oral health were associated, although oral health impact was only associated with general health for those with more health problems, indicating that those in worse health suffer more impact from oral health problems.     

Longitudinal radiological study of the oral health parameters in an elderly Finnish population

In the oldest elderly, an increase in the number of remaining teeth may increase oral infection foci. The aim of this follow-up study was to examine the radiologically detected oral health condition of a group of home-living elderly in Helsinki at 5-year intervals. The population of this study comprised 103 home-living elderly people, all participants of the population-based Helsinki Aging Study. Panoramic radiography supplemented by intraoral radiographs was performed on all these participants at the Institute of Dentistry, University of Helsinki, in 1990-1991. Follow-up radiographic examination was completed in 1995-1996. Mean number of teeth decreased during the follow-up period from 13.2±9.0 to 12.5±9.2 (P = 0.0001). Mean number of teeth with periapical lesions decreased in men from 1.3±1.4 to 0.6±0.9 (P = 0.007), but no differences in number of teeth with periapical findings were observed in women. There were relatively few changes in the subjects' radiographic periodontal findings. However, fewer teeth with vertical bone pockets >1-3 mm deep were found in the follow-up study than 5 years earlier (0.6±1.2 vs 1.1±1.8; P = 0.0008). In both the baseline and the follow-up studies the radiographic findings occurred in the subjects who had retained more natural teeth. In the follow-up study, 68% of the subjects had radiographically detected signs of chronic oral infection foci. It may be concluded that radiographically detected oral health parameters remain relatively unchanged, but treatment need is higher among those who have successfully retained their natural dentition into old age.

Keywords: Endodontics; gerodontology; radiography; periodontitis     

Oral health status and oral health behaviour of urban and rural schoolchildren in Southern Thailand

AIM: To describe the level of oral disease in urban and rural schoolchildren in Southern Thailand; to analyse self-care practices and dental visiting habits of 12-year-olds, and to assess the effect of socio-behavioural factors on dental caries experience. DESIGN: A cross sectional study of 6- and 12-year-old children, urban and rural schools chosen at random from 19 districts of one province. SETTING: Suratthani Province, Southern Thailand. PARTICIPANTS: A total of 1,156 children of grade 1 (6 yrs) and 1,116 children of grade 6 (12yrs). METHODS: Clinical recordings of dental caries and periodontal CPI scores 0, 1 or 2 according to WHO; structured interviews of 12-year-olds (n=1,084) concerning oral health behaviour and attitudes. RESULTS: At age 6, 96.3% of children had caries and mean dmft was 8.1. In 12-year-olds, 70% had caries in permanent teeth and the level of DMFT was 2.4. Experience of pain during the previous 12 months was reported by 53% of 12-year-olds, 66% saw a dentist within the previous year and 24% reported that visits were due to troubles in teeth. Toothbrushing at least once a day was claimed by 88%. Significant numbers of the children reported having hidden sugar every day: soft drinks (24%), milk with sugar (34%), and tea with sugar (26%). Important predictors of high caries experience were dental visits, consumption of sweets, ethnic group (Muslim) and sex (girls) whereas lower risk was observed in children with positive oral health attitudes. CONCLUSIONS: Systematic health education may further improve the oral health of Thai children and the primary school provides a unique setting for such programmes.     

Influences of adult‐onset diabetes on orofacial pain and related health behaviors

Objectives: This study tested the hypothesis that persons with orofacial pain and comorbid adult‐onset diabetes will experience greater functional and emotional impact than persons experiencing orofacial pain without diabetes. Methods: A random‐digit dialing sampling procedure was used for a disproportionate probability sample of 10,341 persons who were screened for orofacial pain in the past 6 months and diabetes. This paper reports on 1,767 individuals reporting toothache pain and 877 reporting painful oral sores. A structured telephone interview assessed diabetes history, orofacial pain characteristics, oral health‐care behaviors, and emotional and functional impacts of orofacial pain. Results: The 6‐month point prevalence was 16.8 percent for toothache pain, 8.9 percent for painful oral sores, and 9.6 percent for adult‐onset diabetes. Individuals with comorbid orofacial pain and adult‐onset diabetes differed significantly on many of the pain characteristics and health behaviors compared with nondiabetic sufferers of orofacial pain. Diabetics were more likely than nondiabetics to have pain every day, to suffer negative emotions associated with pain, to experience disruption of daily activities and sleep, to make an emergency room visit for orofacial pain, and to report the current need for a pain‐related health‐care visit. Conclusions: Although diabetes is well known to be associated with neuropathic pain, these results indicate that the experience of nociceptive pain is exacerbated by diabetes. Findings have significance for the subjective experience of oral pain, dental‐care outcomes, and health‐related quality of life associated with oral‐health outcomes among individuals with diabetes.     

Levels of pentraxin-3 in gingival crevicular fluid and plasma in periodontal health and disease

Background: Pentraxins are classic mediators of inflammation and markers of acute‐phase reactions. Pentraxin‐3 (PTX3) is the first‐identified long pentraxin and is believed to be a true independent indicator of disease activity. Although a classic pentraxin, C‐reactive protein, and its association with various systemic diseases is well documented in the periodontal literature, there is no data on PTX3 to our knowledge. Methods: Forty participants (20 males and 20 females; age range: 23 to 50 years) were involved in the study. Participants were divided into three groups based on gingival index, probing depth, and clinical attachment level: the healthy group (group 1; n = 10), gingivitis group (group 2; n = 15), and periodontitis group (group 3; n = 15). Gingival crevicular fluid (GCF) and plasma samples collected from each subject were quantified for PTX3 levels using an enzyme‐linked immunosorbent assay. Results: In tandem with the disease progression from healthy to gingivitis to periodontitis, the mean PTX3 concentrations increased in GCF and plasma. However, GCF values were higher than plasma values. It was found that PTX3 concentration was highest in group 3 and lowest in group 1. PTX3 concentrations also correlated positively with periodontal parameters. Conclusions: GCF and plasma PTX3 concentrations correlated positively in all groups. However, within the limits of the present study, the differences in plasma PTX3 levels were not found to be statistically significant. Hence, GCF PTX3 values were considered a marker of inflammatory activity in periodontal disease. However, PTX3 deserves further consideration as a therapeutic target. Additional large‐scale studies should be carried out to confirm positive correlations.