The Association Between Clinical and Radiographic Periodontitis Measurements During Periodontal Maintenance

Background: The purpose of the present study is to examine the association between clinical and radiographic periodontitis measurements during 2 years of periodontal maintenance. Methods: Secondary analyses were performed from a 2‐year, double‐masked, placebo‐controlled, randomized clinical trial evaluating the efficacy and safety of subantimicrobial dose doxycycline (SDD) in 128 postmenopausal osteopenic females with moderate‐to‐severe chronic periodontitis. Relative clinical attachment level (relative CAL) and probing depth (PD) measurements were made. Posterior vertical bitewings were taken for alveolar bone density (ABD) and alveolar bone height (ABH) measurements. Generalized estimating equations were used to model associations. Results: One‐year ABD changes and 1‐year relative CAL/PD changes did not predict 2‐year ABH changes and ABH/ABD changes, respectively. Baseline relative CAL and PD were positively associated with baseline ABH loss (P <0.0001), and baseline PDs were associated with subsequent ABD and ABH loss (P <0.05 for each). Among placebo (but not SDD) participants, relative CAL changes were associated with concurrent ABD loss (P = 0.027) when considering 1‐ and 2‐year changes combined. The odds of ABH loss were higher among sites with concurrent 1‐year ABD loss versus no change (odds ratio [OR] = 3.15, P <0.0001) or concurrent PD increases versus no change (OR = 1.88, P = 0.0025) when considering 1‐ and 2‐year changes combined. Conclusions: In postmenopausal osteopenic females undergoing periodontal maintenance, baseline PD was associated with subsequent ABD and ABH loss. Although no longitudinal change preceded another measurement change, changes in PDs and relative CALs appeared to reflect changes in the underlying alveolar bone over time.     

Association of clinical measures of periodontal disease with blood pressure and hypertension among postmenopausal women

1 Background

Hypertension and periodontal disease are common conditions among postmenopausal women. Periodontal disease has been found associated with hypertension in previous studies, but data in postmenopausal women is limited.

2 Methods

We assessed the cross‐sectional associations of clinically measured periodontal disease with prevalent hypertension and measured systolic blood pressure (SBP) among 1341 postmenopausal women enrolled in the Buffalo Osteoporosis and Periodontal Disease (OsteoPerio) study, an ancillary study of the Women's Health Initiative‐Observational Study.

3 Results

Clinical attachment level (CAL) and number of teeth missing were positively associated with SBP among those not taking antihypertensive medication in crude and multivariable adjusted linear regression models (both P < 0.05). Alveolar crestal height (ACH) and gingival bleeding on probing were associated with higher SBP in crude but not multivariable adjusted models. Neither probing pocket depth (PPD) nor severity categories of periodontitis were associated with SBP. Number of teeth missing was significantly associated with prevalent hypertension in crude and multivariable adjusted models (OR = 1.14, per 5 teeth; P = 0.04). ACH was associated with prevalent hypertension in crude but not adjusted models. CAL, PPD, gingival bleeding, and severity of periodontitis were not significantly associated with prevalent hypertension.

4 Conclusions

These results suggest that measures of oral health including CAL and number of teeth missing are associated with blood pressure in postmenopausal women. Prospective studies are needed to further investigate these associations and the potential underlying mechanisms for these relationships.     

Vitamin D Status and 5‐Year Changes in Periodontal Disease Measures Among Postmenopausal Women: The Buffalo OsteoPerio Study

Background: Vitamin D is hypothesized to prevent periodontal disease progression through its immune‐modulating properties and its role in maintaining systemic calcium concentrations. The authors investigated associations between plasma 25‐hydroxyvitamin D [25(OH)D] (collected 1997 to 2000) and the 5‐year change in periodontal disease measures from baseline (1997 to 2000) to follow‐up (2002 to 2005) among 655 postmenopausal women in a Women's Health Initiative Observational Study ancillary study. Exploratory analyses were conducted in 628 women who also had 25(OH)D measures at follow‐up. Methods: Four continuous measures of the 5‐year change in periodontal disease were assessed using alveolar crest height (ACH), clinical attachment level (CAL), probing depth (PD), and percentage of gingival sites that bled on assessment. Linear regression was used to estimate β‐coefficients, standard errors, and P values corresponding to change in periodontal disease (a 1‐mm change in ACH, CAL, or PD or a 1‐unit change in the percentage of gingival sites that bled) for a 10‐nmol/L difference in 25(OH)D. Models were adjusted for age, education, dental visit frequency, smoking, diabetes status, current medications affecting bone health, baseline measures of periodontal disease, body mass index, and recreational physical activity. Results: No statistically significant associations were observed between baseline 25(OH)D and change in periodontal disease measures, overall or in a subset (n = 442) of women with stable 25(OH)D concentrations [25(OH)D change <20 nmol/L from baseline to follow‐up]. Results also did not vary significantly in analyses that were stratified by baseline periodontal disease status. Conclusions: No association between baseline 25(OH)D and the subsequent 5‐year change in periodontal disease measures was observed. Vitamin D status may not influence periodontal disease progression. More studies are needed to confirm these results.     

Change of Periodontal Disease Status During and After Pregnancy

Background: This study explored whether there is any change of periodontal disease status during and after pregnancy. We also examined whether the change is different between females with a history of gestational diabetes mellitus (GDM) and females without GDM during pregnancy. Methods: A follow‐up study was conducted at Woman's Hospital, Baton Rouge, Louisiana. Thirty‐nine females who were previously enrolled in a case‐control study during pregnancy were followed an average of 22 months postpartum. Periodontal status was assessed through dental examinations performed both during and after pregnancy. Clinical periodontal parameters included bleeding on probing (BOP), mean probing depth (PD), and mean clinical attachment level (CAL). Periodontitis was defined as the presence of ≥1 sites exhibiting PD ≥4 mm or CAL ≥4 mm. We used generalized estimating equation analysis to examine the change of periodontal status. Results: Mean number and percentage of sites with BOP decreased from 10.7 ± 11.6 (mean ± SD) and 6.5% ± 7.0% during pregnancy to 7.1 ± 8.8 and 4.3% ± 5.3% at 22 months postpartum (P <0.05), respectively. Mean levels of PD and CAL decreased from 1.8 ± 0.4 mm and 1.9 ± 0.3 mm to 1.6 ± 0.3 mm and 1.6 ± 0.3 mm (P <0.01), respectively. The prevalence of periodontitis decreased from 66.7% to 33.3% (P <0.01, adjusted risk ratio = 2.1, 95% confidence interval = 1.3 to 3.4). There was no difference in the change of periodontal status between females with GDM and females without GDM during pregnancy. Conclusions: Pregnancy may be associated with an increased risk of periodontal disease. The association is not different between females with GDM and females without GDM during pregnancy.     

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.     

Higher prevalence of periodontitis in patients with refractory arterial hypertension: a case-control study

Oral Diseases (2011) 17 , 560–563 Objective: The aim of this study was to assess the association of periodontitis with refractory arterial hypertension. Study design: A total of 137 patients were examined. Seventy patients (mean age of 55.2 ± 9.2 years) were included in the case group, while 67 non‐hypertensive subjects (mean age of 50.0 ± 7.2) served as a control group. Periodontal clinical examination included plaque index, bleeding on probing, probing pocket depth and clinical attachment loss (CAL). Patients with at least five sites with CAL ≥6 mm were considered as severe periodontitis, and with at least 30% of the sites with CAL ≥4 mm generalized chronic periodontitis. Results: The mean (±s.d.) number and percentage of sites with CAL ≥6 mm were 11 (±14) and 16.6 (±14) in the case group, and 5.7 (±9.5) and 5.8 (±9.7) in the control group (P < 0.05). The mean (±s.d.) percentage of sites with CAL ≥4 mm was 37 (±29.6) in the case group and 21.2 (±20) in the control group (P < 0.05). The significant associations with arterial hypertension were severe chronic periodontitis (OR = 4.04, 95% CI: 1.92; 8.49) and generalized chronic periodontitis (OR = 2.18, 95% CI: 1.04; 4.56). Conclusions: Severe and generalized chronic periodontitis seem to play a role as risk indicators for hypertensive patients.     

Severe Loss of Clinical Attachment Level: An Independent Association With Low Hip Bone Mineral Density in Postmenopausal Females

Background: Bone loss is a feature of both periodontitis and osteoporosis, and several studies have analyzed whether the periodontal destruction could have been influenced by systemic bone loss. The aim of this study is to assess the association between clinical attachment level (CAL) and bone mineral density (BMD) at the lumbar spine and hip, lifestyle, smoking, sociodemographic factors, and dental clinical variables in postmenopausal women. Methods: One hundred forty‐eight women were interviewed using a structured written questionnaire and clinically examined. The periodontal examination, which was performed by calibrated investigators, included CAL, probing depth, gingival recession, bleeding on probing (BOP), visible plaque, supragingival calculus, and mean tooth loss. The sample was stratified into two groups: moderate and severe CAL. The moderate group had all sites with CAL ≤5 mm. The severe group had ≥1 site with CAL >5 mm. BMD, measured using dual‐energy x‐ray absorptiometry, was assessed at the lumbar spine, femoral neck, and total femur (grams per square centimeters). Results: Severe CAL was identified in 86 women (58.1%). The multiple linear regression analysis using CAL (dependent variable), adjusted by menopause, education, and family income, demonstrated an inverse relationship of severe CAL with the BMD of the femoral neck (P = 0.015), as well as a positive association of severe CAL with tooth loss (P = 0.000), BOP (P = 0.004), and heavy smokers (P = 0.001). Conclusions: Our study demonstrated that severe CAL was associated with low BMD of the femoral neck and deleterious clinical dental parameters and smoking. Our findings suggest that, in addition to appropriate oral care, individuals with severe CAL may also require additional attention to their systemic bone health.     

Periodontitis in Patients With Coronary Artery Disease: An 8‐Year Follow‐Up

Background: This study examines whether preceding assessment of periodontal status in patients with established coronary artery disease (CAD) can predict future CAD endpoints (myocardial infarction, new revascularization procedure, or CAD‐related death) during 8‐year follow‐up and whether the changes in periodontal status over time differ in patients with CAD compared with healthy controls. Methods: In 2003, periodontal status was examined in 161 patients with CAD who underwent percutaneous coronary intervention or coronary artery bypass graft due to significant stenosis in the coronary arteries and 162 controls without CAD. Eight years later, 126 patients with CAD (102 males and 24 females, mean age: 68 ± 8.9 years) and 121 controls (101 males and 20 females, mean age: 69 ± 9.0 years) were reexamined periodontally. A standard classification of periodontal disease in three groups (mild, moderate, and severe) was used. CAD endpoints during follow‐up were obtained by review of medical records. CAD as cause of death was confirmed from the Swedish Cause of Death Register. Results: No significant differences were found among patients with CAD, with or without CAD‐related endpoints at 8‐year follow‐up, and severity of periodontitis at baseline (P = 0.7). CAD did not influence the incidence or severity of periodontitis. Significant differences were found at the final examination in periodontitis prevalence and severity (P = 0.001), number of teeth (P = 0.006), probing depth 4 to 6 mm (P = 0.016), bleeding on probing (P = 0.001), and radiographic bone level (P = 0.042) between CAD patients and controls, all in favor of controls. Conclusions: The study results did not show a significant association during 8 years among CAD endpoints and periodontal status at baseline. The progression of periodontitis was low in both groups, although the higher proportion of individuals with severe periodontitis among patients with CAD compared with controls remained unchanged over the 8‐year follow‐up. Further long‐term prospective studies are needed to show whether periodontitis can be considered a risk or prognostic factor for CAD, in terms of endpoints including myocardial infarction, new revascularization procedure, and CAD‐related death.     

Longitudinal study of predictive factors for periodontal disease and tooth loss

Longitudinal assessment of risk factors for periodontal disease is necessary to provide evidence that a putative risk factor or risk indicator is a true risk factor. The purpose of the present study was to explore longitudinally a variety of markers as possible periodontal risk factors in subjects with little or no periodontal disease at baseline. 415 subjects with mild or little periodontal disease were examined: medical and dental history; socioeconomic profile, clinical measurements, microbial samples and radiographic assessment of bone height were performed at baseline, and at a follow-up examination 2 to 5 years later. Mean probing pocket depth (PPD) at baseline was 1.99+/-0.37 mm while mean overall change was 0.1 mm which amounts to an annual rate of 0.04 mm. Overall mean clinical attachment level (1.75+/-0.6 mm) at baseline resulted in mean attachment change of 0.28 mm (0.12 mm annually). Alveolar crestal height (ACH) at baseline (mean 2.05+/-0.85 mm) resulting in a mean net loss of 0.1 mm. Approximately 10% of all sites presented for the second visit with attachment loss exceeding the threshold (4.4% annually), while only 2.2% of all sites exhibited attachment gain (0.88% annually). Older individuals exhibited greater mean bone loss but the least amount of attachment loss. Current smokers exhibited greater disease progression compared to non-smokers. Tooth morbidity (0.17 teeth/patient/year) was associated with greater baseline CAL and ACH loss, and an assortment of systemic conditions. Subjects who harbored Bacteroides forsythus (Bf) at baseline had greater loss in ACH; likewise, these subjects experienced greater proportions of losing sites and twice as much tooth mortality compared to Bf-negative patients. Baseline clinical parameters correlated strongly with the outcome, i.e., subjects with deeper mean pocket depth at baseline exhibited greater increase in pocket depth overtime; while subjects with greater attachment loss at baseline exhibited greater attachment loss between the 1st and 2nd visits.     

Bisphosphonate therapy improves the outcome of conventional periodontal treatment: results of a 12-month, randomized, placebo-controlled study

BACKGROUND: Bone loss in periodontitis results from inflammatory reactions that stimulate osteoclastic bone resorption. Bisphosphonates inhibit bone resorption and increase bone mass. This study evaluated the effect of bisphosphonate therapy as an adjunct to non-surgical periodontal treatment in patients with moderate to severe chronic periodontitis. METHODS: Patients were randomized (2:1) to one of two bisphosphonate therapies or placebo for 1 year. All patients received non-surgical periodontal treatment (scaling, root planing) and periodontal maintenance therapy every 3 months. Clinical assessments at baseline and 6 and 12 months included clinical attachment level (CAL), probing depth (PD), and bleeding on probing (BOP). Periodontal bone mass was assessed by dental radiographs at baseline and 12 months using fractal analysis and digital subtraction radiography (DSR). RESULTS: Seventy patients were randomized, 43 to the bisphosphonate group and 27 to the placebo group. Bisphosphonate therapy significantly improved CAL, PD, and BOP relative to the placebo group during the 6- to 12-month period (CAL, P = 0.0002; PD, P = 0.0156; BOP, P = 0.0079). There was no difference in the change in periodontal bone mass between the bisphosphonate and placebo groups as measured by fractal analysis and DSR. CONCLUSION: These data suggest that bisphosphonate treatment improves the clinical outcome of non-surgical periodontal therapy and may be an appropriate adjunctive treatment to preserve periodontal bone mass.     

Efficacy of Locally Delivered 1.2% Rosuvastatin Gel To Non‐Surgical Treatment of Patients With Chronic Periodontitis: A Randomized,Placebo‐Controlled Clinical Trial

Background : Chronic periodontitis (CP) is an inflammatory condition affecting tooth‐supporting tissues and alveolar bone that surround the tooth, leading to formation of a deepened gingival sulcus that is highly prone to pathologic changes and, ultimately, bone resorption and tooth loss. In the literature, several pharmacologic agents have been administered via local delivery routes directly into diseased sites, affirming improvement in periodontal status. Therefore, this study aims to determine the clinical effectiveness of subgingivally delivered 1.2% rosuvastatin (RSV) gel incorporated into a methylcellulose vehicle for its controlled release into intrabony defect (IBD) sites as an adjunct to scaling and root planing (SRP) for treatment of patients with CP. Methods: Sixty‐five patients were categorized into two treatment groups: group 1, SRP plus 1.2 mg RSV; group 2, SRP plus placebo. Clinical parameters, including modified sulcus bleeding index (mSBI), probing depth (PD), and clinical attachment level (CAL), were recorded at baseline (before SRP) and at 1, 3, 4, and 6 months. Radiologic assessment of IBD fill was analyzed at baseline and after 6 months using software. Results: There was significant improvement in both study groups. At 6 months, there was a greater decrease in mSBI scores in group 1 (3.71 ± 0.24) compared to group 2 (1.48 ± 0.33). The mean decrease in PD from baseline to 6 months was 4.04 ± 0.34 and 1.31 ± 0.24 mm in groups 1 and 2, respectively. Mean CAL gain from baseline to 6 months was 4.2 ± 0.17 and 1.4 ± 0.15 mm in groups 1 and 2, respectively. In group 1, there was a greater decrease in mean IBD (2.23 ± 0.32 mm, 48.58%) compared to group 2 (0.46 ± 0.02 mm, 10.02%). All patients tolerated the drug without any adverse reaction. Conclusion: Rosuvastatin in situ gel (1.2%), when delivered locally into IBD/pocket sites, showed a greater reduction than placebo in PD and gingival index, along with increased gain in CAL.     

Periodontal conditions in patients requesting dental implant treatment

Periodontal disease is considered a risk factor in dental implant treatment. The purpose of this study was to investigate the periodontal conditions in patients requesting dental implant therapy. A total of 169 patients visiting Department of Oral and Maxillo-Facial Implantology at Tokyo Dental College Chiba Hospital were targeted. The following intraoral parameters were measured in each patient: Community Periodontal Index (CPI) score, probing pocket depth (PPD), clinical attachment level (CAL) and bleeding on probing (BOP). Prevalence of patients with periodontal pockets was high: 38% and 28% of patients had a CPI score of code 3 and 4, respectively. Prevalence of teeth with one or more sites with PPD≥4mm was 27%. Moreover, clinical signs suggestive of periodontitis (PPD, CAL≥4mm) were found in 10-15% of tooth sites. Prevalence rates at sites with severe periodontal breakdown (PPD, CAL≥7mm) were 2-5%. These results further emphasize the importance of thorough periodontal assessment in patients prior to dental implant treatment.     

Periodontitis and Gestational Diabetes Mellitus in Non‐Smoking Females

Background: Chronic inflammation has been implicated in the pathogenesis of gestational diabetes mellitus (GDM). Periodontal disease is associated with increased levels of inflammatory mediators and may be a risk factor for GDM. The authors aimed to examine the association between periodontitis and GDM among non‐smoking pregnant females. Methods: This case‐control study included 50 females who were diagnosed with GDM and 50 age‐ and hospital‐matched females without diabetes in Khon Kaen, Thailand. Full‐mouth periodontal examinations were performed during pregnancy by two calibrated dentists who were unaware of the case‐control status. Periodontitis was defined as ≥1 site with probing depth (PD) ≥5 mm and clinical attachment level (CAL) ≥2 mm at the same site. Serum samples were collected to measure C‐reactive protein (CRP), tumor necrosis factor‐α, and interleukin‐6 levels. Analyses were performed using conditional logistic regression. Results: Fifty percent of the case females had periodontitis compared to 26% of the controls. Females with GDM had significantly higher mean PD and CAL, more sites with bleeding on probing, and increased levels of CRP compared to the controls. Periodontitis was significantly associated with GDM (odds ratio = 3.00, 95% confidence interval = 1.19 to 7.56). The association remained significant with additional adjustment for family history of diabetes, prepregnancy body mass index, and weight gain during pregnancy. Conclusions: The results suggest that periodontitis is associated with GDM. Therefore, clinicians should assess periodontal conditions of pregnant females.     

Clinical and Radiographic Evaluation of Demineralized Freeze‐Dried Bone Allograft Versus Platelet‐Rich Fibrin for the Treatment of Periodontal Intrabony Defects in Humans

Background: A wide variety of materials have been proposed for treatment of periodontal intrabony defects (IBDs); recently, platelet‐rich fibrin (PRF) has been suggested as a grafting material. The aim of this study is to report changes in clinical attachment level (CAL) and bone fill of periodontal IBDs treated with demineralized freeze‐dried bone allograft (DFDBA) compared with PRF in humans. Methods: Thirty‐six patients completed the study protocol. Each patient contributed a single IBD, which was randomized to receive either DFDBA or PRF. Clinical and standardized radiographic data were collected at baseline and 6 months after treatment. Primary outcome measures included: 1) radiographic bone fill as measured from the cemento‐enamel junction to base of bony defect and 2) change in CAL. Results: Both treatment groups had significant gains in CAL as well as bone fill, with no significant differences in outcomes between groups. DFDBA had a mean CAL gain of 1.16 ± 1.33 mm, mean clinical bone fill of 1.53 ± 1.64 mm, and mean radiographic bone fill of 1.14 ± 0.88 mm. PRF had a mean CAL gain of 1.03 ± 0.86 mm, mean clinical bone fill of 1.35 ± 1.60 mm, and mean radiographic bone fill of 1.10 ± 1.01 mm. Conclusion: Treatment of IBDs with either DFDBA or PRF resulted in a significant gain in CAL as well as bone fill after 6 months of healing, with no significant difference between materials.     

Investigating the Association Between Obstructive Sleep Apnea and Periodontitis

Background: Obstructive sleep apnea (OSA) is a sleep disorder characterized by disruptions of normal sleep architecture. Chronic periodontitis is a chronic disease of the periodontium that elicits a general inflammatory response to local dental plaque. It has been suggested that periodontal disease may increase in severity with increasingly severe OSA because both disease entities share common inflammatory pathways, acting synergistically to alter the host response. The aim of this study is to analyze the association between severity of OSA and the prevalence/severity of periodontitis. Methods: One hundred patients from a large veterans administration sleep study center (n = 26 normal, n = 21 mild, n = 19 moderate, n = 34 severe) diagnosed with an overnight polysomnogram underwent a comprehensive periodontal examination. Periodontal parameters measured included the following: 1) mean periodontal probing depth (PD); 2) clinical attachment level (CAL); 3) gingival recession; and 4) percentage of sites with bleeding on probing, plaque, PD ≥5 mm, and CAL ≥3 mm. Results: Seventy‐three percent of the sampled population had moderate/severe periodontal disease. χ² analyses revealed no significant differences in the prevalence of periodontal disease between the apnea–hypopnea index (AHI) groups, with a negligible Spearman correlation coefficient of 0.246 between AHI severity and periodontal disease severity categories. Analysis of covariance indicated a significant association between AHI severity categories and percentage of sites with plaque, after adjusting for age. Multivariable logistic regression analysis predicting moderate/severe periodontitis with AHI score, age, and smoking status indicated a significant association with age (P = 0.028) but no significant association with the other two predictors. Conclusion: OSA was not significantly associated with the prevalence of moderate/severe periodontitis and the periodontal parameters examined, except percentage plaque.     

Periodontal disease in Hispanic Americans with type 2 diabetes

BACKGROUND: Diabetes is a major risk factor for the development of periodontal disease in certain populations. The prevalence of type 2 diabetes is increased in Hispanic Americans, but its impact on the extent and severity of periodontal disease in this population has not been determined. METHODS: Sixty-three Hispanic Americans, aged 33 to 72 years, from South Texas were grouped based on the presence or absence of type 2 diabetes. Past medical histories, including smoking, were obtained. Periodontal status was evaluated by measuring probing depth (PD), clinical attachment level (CAL), plaque, bleeding on probing, visual gingival inflammation, and calculus. RESULTS: Type 2 diabetes was associated frequently with major medical complications in this population. Diabetes was associated with significantly more calculus formation and tooth loss and an increased extent and severity of periodontitis. Subjects with diabetes had nearly three times the mean CAL and frequency of PD >6 mm than subjects without diabetes and nearly twice the frequency of moderate to advanced attachment loss (> or =3 mm). Smoking and diabetes had significant independent effects on mean CAL and the frequency of deep pockets. Diabetes and smoking combined were associated with a significantly higher frequency of sites with CAL > or =3 mm compared to healthy non-smokers, healthy smokers, and non-smokers with diabetes. CONCLUSIONS: Hispanic Americans with type 2 diabetes had more supra- and subgingival calculus, an increased extent and severity of periodontal destruction, and an increased frequency of tooth loss due to periodontitis. An additive/synergistic contribution of type 2 diabetes and smoking for increasing the extent of periodontal disease was observed.     

Accuracy of Self‐Reported Periodontal Disease in the Women's Health Initiative Observational Study

Background: This study examines the accuracy of self‐reported periodontal disease in a cohort of older females. Methods: The study comprised 972 postmenopausal females aged 53 to 83 years who completed baseline (1997 to 2001) and follow‐up (2002 to 2006) whole‐mouth oral examinations. Examinations included: 1) probing depth, 2) clinical attachment level, and 3) oral radiographs for alveolar crestal height in a study ancillary to the Women's Health Initiative Observational Study (WHI‐OS) conducted in Buffalo, New York, called the OsteoPerio study. Participants also self‐reported any history of diagnosis of periodontal/gum disease on a WHI‐OS study‐wide questionnaire administered during the time interval between the two OsteoPerio examinations. Results: Participants reporting diagnosis of periodontal/gum disease on the WHI‐OS questionnaire (n = 259; 26.6%) had worse oral hygiene habits, periodontal disease risk factors, and clinical periodontal measures compared with those not reporting periodontal/gum disease. Frequency of reported periodontal/gum disease was 13.5%, 24.7%, and 56.2% across OsteoPerio baseline examination categories of none/mild, moderate, and severe periodontal disease, respectively (trend: P <0.001), defined by criteria of the Centers for Disease Control and Prevention/American Academy of Periodontology (CDC/AAP). Sensitivity, specificity, and positive and negative predictive values for reported periodontal disease status were 56.2%, 78.8%, 32.8%, and 90.7%, respectively, when CDC/AAP‐defined severe periodontal disease at baseline was the criterion measure (prevalence of 15%) and were 76.0%, 77.4%, 22.0%, and 97.4%, respectively, when tooth loss to periodontitis (prevalence of 7%) was the criterion. Conclusion: A simple question for self‐reported periodontal disease characterizes periodontal disease prevalence with moderate accuracy in postmenopausal females who regularly visit their dentist, particularly in those with more severe disease.     

New Attempts to Modify Periodontal Risk Assessment for Generalized Aggressive Periodontitis: A Retrospective Study

Background : Periodontal risk assessment (PRA) model was designed for risk evaluation of treated patients with periodontal disease. However, its use on generalized aggressive periodontitis (GAgP) had been scarcely reported. This study aims to investigate the association of original PRA/modified PRA (MPRA) and compliance of periodontal maintenance with long‐term treatment outcomes of Chinese patients with GAgP. Methods: Eighty‐eight patients from a GAgP cohort, who completed active periodontal treatment (APT) and accepted reevaluation 3 to 11 years (mean of 5.5 years) afterward, were enrolled. PRA was modified (three strategies involving replacement of bleeding on probing with bleeding index >2, counting sites with probing depth ≥6 mm and changing method of bone loss [BL] calculation) to classify patients into different risk groups based on data at the first recall after APT. PRA and three MPRA models were investigated regarding long‐term association with tooth loss (TL) and alteration of bone level (?BL). Results: Based on original PRA, 87 patients (98.8%) had a high‐risk profile. According to three MPRA models, annual TL per patient values were greater in high‐risk groups than in low‐to‐moderate risk groups (MPRA‐1, 0.20 ± 0.33 versus 0.04 ± 0.14; MPRA‐2, 0.18 ± 0.32 versus 0.05 ± 0.14; MPRA‐3, 0.17 ± 0.32 versus 0.05 ± 0.15; P <0.05). By MPRA‐1, irregular compliers with low‐to‐moderate risk profile had greater ?BL (0.027 ± 0.031, indicating bone increment) than those with high risk (?0.012 ± 0.064, tendency for BL). For regular compliers, no significant differences of annual TL or ?BL were found between risk groups. Conclusions: MPRA models could be used for evaluating the long‐term outcomes of Chinese patients with severe GAgP, especially irregular compliers. High‐risk patients of MPRAs exhibited more TL and less bone fill than low‐to‐moderate risk ones.     

Coffee Consumption and Periodontal Disease in Males

Background: Coffee is a major dietary source of antioxidants as well as of other anti‐inflammatory factors. Given the beneficial role of such factors in periodontal disease, whether coffee intake is associated with periodontal disease in adult males was explored. Methods: Existing data collected by a prospective, closed‐panel cohort study of aging and oral health in adult males was used. Participants included the 1,152 dentate males in the Veterans Affairs (VA) Dental Longitudinal Study who presented for comprehensive medical and dental examinations from 1968 to 1998. Mean age at baseline was 48 years; males were followed for up to 30 years. Participants are not VA patients; rather, they receive their medical and dental care in the private sector. Periodontal status was assessed by probing depth (PD), bleeding on probing, and radiographic alveolar bone loss (ABL), measured on intraoral periapical radiographs with a modified Schei ruler method. Moderate‐to‐severe periodontal disease was defined as cumulative numbers of teeth exhibiting PD ≥4 mm or ABL ≥40%. Coffee intake was obtained from participant self‐reports using the Cornell Medical Index and food frequency questionnaires. Multivariate repeated‐measures generalized linear models estimated mean number of teeth with moderate‐to‐severe disease at each examination by coffee intake level. Results: It was found that higher coffee consumption was associated with a small but significant reduction in number of teeth with periodontal bone loss. No evidence was found that coffee consumption was harmful to periodontal health. Conclusion: Coffee consumption may be protective against periodontal bone loss in adult males.     

Health insurance status is associated with periodontal disease progression among Gullah African-Americans with type 2 diabetes mellitus

Objectives: Assess periodontal disease progression among Gullah African Americans with type 2 diabetes mellitus (T2DM) according to health insurance coverage. Methods: From an ongoing clinical trial among T2DM Gullah, we extracted a cohort that was previously enrolled in a cross‐sectional study (N = 93). Comparing prior exam to trial initiation, total tooth sites/person with periodontal disease progression events [evaluated separately: 2+ mm of clinical attachment loss (CAL), 2+ mm increased periodontal probing depths (PPD), bleeding on probing (BOP) emergence] were evaluated according to health insurance coverage using regression techniques appropriate for data with different counts of potential events per subject (varying tooth sites available). We used negative binomial regression techniques to account for overdispersion and fit multivariable models that also included baseline glycemic control (poor: glycated hemoglobin ≥7 percent, well: glycated hemoglobin <7 percent), history of established periodontitis, age, gender, body mass index, annual income, and oral hygiene behaviors. Final models included health insurance status, other significant predictors, and any observed confounders. Results: Privately insured were most prevalent (41.94 percent), followed by uninsured (23.66 percent), Medicare (19.35 percent), and Medicaid (15.05 percent). Those with poor glycemic control (65.59 percent) were more prevalent than well‐controlled (34.41 percent). CAL events ranged from 0 to 58.8 percent tooth sites/person (11.83 ± 12.44 percent), while PPD events ranged from 0 to 44.2 percent (8.66 ± 10.97 percent) and BOP events ranged from 0 to 95.8 percent (23.65 ± 17.21 percent). Rates of CAL events were increased among those who were uninsured [rate ratio (RR) = 1.75, P = 0.02], Medicare‐insured (RR = 1.90, P = 0.03), and Medicaid‐insured (RR = 1.89, P = 0.06). Conclusions: Increased access to health care, including dental services, may achieve reduction in chronic periodontal disease progression (as determined by CAL) for this study population. These results are very timely given the March 2010 passing of the US healthcare reform bills.