A Two‐Domain Self‐Report Measure of Periodontal Disease Has Good Accuracy for Periodontitis Screening in Dental School Outpatients

Background: The assessment of periodontitis and treatment needs is primarily based on clinical and radiographic examinations. Albeit effective in predicting treatment needs, these examinations are costly, time‐consuming, and impractical for assessing population‐level needs. The purpose of the present study is to evaluate a two‐domain self‐report questionnaire for rapid periodontitis screening. Methods: Six hundred white adult individuals, dentate or partially dentate and seeking dental therapy at a university clinic, underwent oral examination utilizing the full‐mouth Community Periodontal Index of Treatment Needs (CPITN). To assess predictive value of self‐reported periodontal measures (SRPMs) for periodontitis screening, four questions were formulated. Two questions aimed to assess “dentist‐diagnosed periodontal disease” and two inquired about “self‐assessed periodontitis.” Multiple logistic regression models were used to construct receiver‐operating characteristic curves, and predictor selection was performed via a forward stepwise selection process. Results: Five hundred thirty‐five volunteers with a mean age of 50.1 years elected to respond to SRPMs via telephone interview. After oral examination, 17.8% of participants were assessed as having CPITN = 4, representing compromised periodontal status. Sensitivity and specificity for correctly classifying compromised periodontal status ranged from 5.3% to 72.6%, and 87.8% to 99.5% for individual SRPMs. Sensitivity and specificity were increased when combining a measure of self‐assessed periodontal disease and a measure of dentist‐diagnosed disease as predictors. Addition of age and sex maximized sensitivity/specificity at 82.1%/82.2%. Diabetic status, smoking, and body mass index did not enhance the prediction. Conclusions: A two‐domain self‐report measure combining two self‐report items with age and sex has good sensitivity and specificity for periodontitis screening in a white, university‐based population. The proposed self‐report measure can be valuable for periodontitis screening in resource‐limited settings where gold standard clinical examination may not be pragmatic. Further validation studies are required to assess whether findings from this study are context‐specific.     

Oral Hygiene Instruction and Health Risk Assessment in Dental Practice

We studied oral hygiene instruction given to 109 patients in 19 Washington State dental practices to investigate the extent to which therapists targeted their efforts toward patients with high disease risk. Patients were examined prior to instruction and prophylaxes. Therapists' instructions were tape-recorded and their content analyzed: therapists' expectations were scored. There were no statistically significant associations between patients' initial plaque levels and the process/content of the oral hygiene instructions delivered. On average, therapists spent 9.4 minutes of each prophylaxis session discussing oral hygiene. Therapists were judged more genuine with those patients for whom they had higher expectations of compliance, i.e., those with less plaque and low disease risk. We conclude that dental practitioners were not employing effective risk assessment strategies in selection of patients most in need of intensive instructional efforts.     

Evidence Linking the Role of Placental Expressions of Peroxisome Proliferator‐Activated Receptor‐γ and Nuclear Factor‐Kappa B in the Pathogenesis of Preeclampsia Associated With Periodontitis

Background: Peroxisome proliferator‐activated receptor (PPAR)‐γ activation leads to suppression of production of a broad range of proinflammatory molecules. It plays a role in differentiation of trophoblasts and helps in normal placentation and formation of vascular exchange interface. Activation of nuclear factor‐kappa (NF‐κ) B triggers proinflammatory molecules inducing abnormal placentation and premature labor. This study aims to explore expression of PPAR‐γ and NF‐κB in placentas of women with periodontitis‐associated preeclampsia compared with that in normotensive pregnant women. Methods: Fifty pregnant women were included. Twenty‐five were controls (normotensive pregnant women) and 25 were pregnant women with preeclampsia, including those with gestational hypertension. Demographic data, pregnancy characteristics, and periodontal parameters were recorded, including: 1) plaque index; 2) gingival index; 3) bleeding on probing (BOP); 4) probing depth; and 5) attachment loss (AL). Placental tissue samples were collected from both groups and analyzed to quantify expression of PPAR‐γ and NF‐κB using real‐time polymerase chain reaction. Results: BOP and AL were significantly higher in pregnant women with preeclampsia compared with normotensive pregnant women (P <0.05). Expression of PPAR‐γ was downregulated in patients with preeclampsia compared with that of healthy normotensive patients, which was statistically significant (P <0.05), whereas NF‐κB was significantly activated (P <0.05) in pregnant women with preeclampsia compared with normotensive pregnant women. Conclusions: Higher periodontal disease prevalence is found among pregnant women with preeclampsia, with increased percentage of sites with BOP and greater AL. This study provides novel information on host response to systemic inflammation induced by periodontal pathogens through mechanisms involving downregulation of PPAR‐γ and increased activation of NF‐κB.     

Oral health behaviors, periodontal disease, and pathogens in preeclampsia: a case-control study in Korea

Background: The aim of this study is to confirm the association among oral health behaviors, periodontitis, and preeclampsia in Korean women. Methods: This study is designed as a case‐control study. Sixteen women with preeclampsia and 48 without preeclampsia post‐delivery were included in this study from November 2007 to January 2010. Information was collected on demographics, health behaviors, and obstetric and systemic diseases that may influence the periodontal condition and preeclampsia. Full‐mouth periodontal probing was conducted by one trained examiner (KHB). Localized periodontitis was defined as periodontal clinical attachment loss (AL) ≥3.5 mm on two or three sites not on the same tooth. In addition, generalized periodontitis was defined as clinical AL ≥3.5 mm on ≥4 sites not on the same tooth. Gingival crevicular fluid was collected using a sterilized paper point for quantitative analysis of Treponema denticola, Porphyromonas gingivalis, Prevotella intermedia (Pi), and Tannerella forsythia (previously T. forsythensis). Results: After adjusting for confounders, the adjusted odds ratio (OR) was 4.79 (95% confidence interval [CI]: 1.02 to 29.72) for localized periodontitis and 6.60 (95% CI: 1.25 to 41.61) for generalized periodontitis. In addition, the proportion of floss or interdental brush users in women with preeclampsia was lower than that in women without (adjusted OR: 0.21; 95% CI: 0.02 to 0.93). Pi was significantly more prevalent in women with preeclampsia (P = 0.028). Conclusion: These results indicate that preeclampsia could be associated with the maternal periodontal condition and interdental cleaning.     

A Clinical Validation of Self‐Reported Periodontitis Among Participants in the Black Women’s Health Study

Background: There is a paucity of data on the validity of self‐report of periodontal disease in African Americans. The Black Women’s Health Study (BWHS), a United States national cohort study of 59,000 black women followed via mailed questionnaires since 1995, offered the opportunity to clinically validate self‐reported periodontitis among a sample of participants. Methods: Oral health questionnaires were sent to study participants residing in Massachusetts. Respondents living in the Boston metro area were invited for clinical examination. Self‐reports were compared with clinical data obtained from the 77 women (mean age: 59 years) who were examined. The authors examined the predictive ability of individual and combined questionnaire items with respect to clinical periodontal disease severity. Validation parameters were calculated for each question, and receiver operating characteristic statistics were generated to compare questionnaire items. Results: Periodontitis prevalence in the validation sample was 24% for severe periodontitis and 61% for moderate disease. Performance of individual questionnaire items with respect to predicting periodontitis was better for severe compared with moderate disease. Combinations of questionnaire items improved the predictive ability with respect to severe disease beyond that of individual questionnaire items. Conclusions: Prevalence of severe periodontitis was similar to other age‐comparable populations, without regard for race or sex, whereas prevalence of total periodontitis (moderate and severe) among women of similar age and/or race was much higher. Predictive ability of questionnaire items assessed in the BWHS was similar to that in other studies.     

Dental Implants in Patients with Oral Lichen Planus: A Cross‐Sectional Study

Purpose: The main aim of this study was to evaluate the patients with oral lichen planus (OLP) and dental implants. Material and Methods: Three groups of 16 patients took part in the study. Group I patients had received dental implants and been diagnosed with OLP; Group II had not received implants but were diagnosed with OLP; Group III had implants but not OLP. Clinical observations and OLP symptoms were registered in each case. Periodontal pocket depth, implant mobility, bleeding upon probing, erythema, pain, and radiolucency around implants were measured. Patient quality of life was evaluated using OHIP 14. Results: Peri‐implant mucositis and peri‐implantitis were detected in 17.86% and 25% of the OLP‐implant group, while the control group with implants showed 18% and 16%. The implant survival rate in patients treated for OLP did not appear to differ from the survival rate among the general population. Quality of life was better among patients with implants and without OLP (p = .001). Conclusions: The results of the present study suggest that implants do not influence manifestations of OLP. OLP is not a risk factor for peri‐implantitis.     

Evaluation of periodontal pathogens in amniotic fluid and the role of periodontal disease in pre-term birth and low birth weight

Abstract

Background. Pre-term birth and/or low birth weight (PTLBW) is a serious problem in developing countries. The absence of known risk factors in ～ 50% of PTLBW cases has resulted in a continued search for other causes. The aim of this study was to examine the effect of periodontitis on pregnancy outcomes. Methods. Samples were taken from 50 pregnant women who underwent amniocentesis. Polymerase chain reaction was performed on amniotic fluid samples obtained during amniocentesis and on subgingival plaque samples to determine the presence of Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Treponema denticola, Tannerella forsythia, Fusobacterium nucleatum, Prevotella intermedia, Campylobacter rectus and Eikenella corrodens. Plaque index, gingival index, bleeding on probing, probing depth and clinical attachment level were evaluated. Medical records were obtained after birth. Results. Social and demographic variables were similar among the Gingivitis (G), Localized Periodontitis (LP) and Generalized Periodontitis (GP) groups. Four subjects gave birth to PTLBW neonates. Campylobacter rectus, T. forsythia, P. gingivalis and F. nucleatum were detected in the amniotic fluid and subgingival plaque samples of three patients who gave birth to PTLBW neonates. The amniotic fluid sample from the fourth patient was not positive for any of the tested pathogens. Conclusion. These findings suggest that the transmission of some periodontal pathogens from the oral cavity of the mother may cause adverse pregnancy outcomes. The results contribute to an understanding of the association between periodontal disease and PTLBW, but further studies are required to better clarify the possible relationship.     

Associations Among Oral Hygiene Behavior and Hypertension Prevalence and Control: The 2008 to 2010 Korea National Health and Nutrition Examination Survey

Background: Recently, a positive association has been reported between hypertension and periodontitis. The authors hypothesized that oral hygiene promotion activities could have an effect on hypertension prevention or the degree of hypertension control. Therefore, this study examines the relationship between oral hygiene behaviors and hypertension using data from a nationally representative survey, the Korea National Health and Nutrition Examination Survey (KNHANES). Methods: Using data from the KNHANES (2008 to 2010), 19,560 adults with complete data sets were included. The authors analyzed the relationship of the prevalence and control rate of hypertension and numerous variables, including oral hygiene behavior. Results: As the frequency of toothbrushing increased, the prevalence of hypertension decreased in multivariate analysis after adjusting for various factors, including the presence of periodontitis. In a subgroup analysis, this relationship was also observed in individuals without periodontitis. In particular, systolic blood pressure levels progressively decreased as the frequency of toothbrushing and the number of secondary oral products used increased. The adjusted odds ratio of hypertension prevalence was 1.195 (95% confidence interval 1.033 to 1.383) for individuals who brushed their teeth hardly ever or once daily compared with those who brushed after every meal. Conclusions: Individuals with poor oral hygiene behavior are more likely to have a higher prevalence of hypertension, even before periodontitis is shown. Oral hygiene behavior may be considered an independent risk indicator for hypertension, and maintaining good oral hygiene may help to prevent and control hypertension.     

Oral Health,Diabetes, and Inflammation: Effects of Oral Hygiene Behaviour

IntroductionThe aim of this research was to assess the association between inflammation and oral health and diabetes, as well as the mediating role of oral hygiene practice in this association.MethodsData were from the 2009–2010 National Health and Nutrition Examination Survey. The analytical sample consisted of 2,191 respondents aged 50 and older. Poor oral health was clinically defined by significant tooth loss (STL) and periodontal disease (PD). Diabetes mellitus (DM) was determined by glycemic levels. The outcome variable was serum C-reactive protein (CRP) level, dichotomised as ≥1 mg/dL (elevated CRP) vs <1 mg/dL (not elevated CRP). Two path models, one using STL and DM as the independent variable, the other using PD and DM as the independent variable, were estimated to assess the direct effects of having poor oral health and DM on elevated CRP and the mediating effects of dental flossing.ResultsIn path model 1, individuals having both STL and DM (adjusted odds ratio [AOR], 1.92; 95% confidence interval [CI], 1.30–2.82) or having STL alone (AOR, 2.30; 95% CI, 1.68–3.15) were more likely to have elevated CRP than those with neither STL nor DM; dental flossing (AOR, 0.92, 95% CI, 0.88–0.96) was associated with lower risk of elevated CRP. In path model 2, no significant association was found between having both PD and DM and elevated CRP; dental flossing (AOR, 0.91; 95% CI:, 0.86–0.94) was associated with lower risk of elevated CRP.ConclusionsFindings from this study highlight the importance of improving oral health and oral hygiene practice to mitigate inflammation. Further research is needed to assess the longer-term effects of reducing inflammation.Key words: Tooth loss, Periodontal disease, Diabetes, Inflammation     

What Frames of Reference Underlie Self‐Ratings of Oral Health?*

Objectives: This study aimed to investigate the referents and meanings that underlie self‐ratings of oral health and to determine whether they vary by participants' characteristics. Methods: Semistructured interviews were conducted with a convenience sample of 80 adults who were asked to rate their oral health and explain the reasons for their ratings. The interviews were tape‐recorded, transcribed in full, and subject to a content analysis that involved identification and coding of their frames of reference. These codes were collapsed to create a smaller number of categories to allow for comparisons of the proportions invoking each frame of reference. Results: There was considerable variation in the accounts offered to support the self‐ratings of oral health. The most common referents used were biomedical, involving current oral problems, treatment needs and treatment histories, and behavioral, which included oral self‐care practices, other health behaviors, and dental visiting patterns. Pain and tooth loss were also common. Most notable was the absence of functional and psychosocial referents that are prominent in contemporary definitions and measures of “oral‐health‐related quality of life.” There was some variation in the referents used according to sociodemographic characteristics, with age being the main source of variation. There was also variation according to the category of the self‐rating used; those with favorable ratings tended to use different frames of reference than those with unfavorable ratings. Conclusions: The biomedical model and professional ideologies and values provide the main frames of reference that give meaning to self‐ratings of oral health. Variations in the meanings of the self‐ratings have some implications for the use of this item in quantitative studies, which warrants further investigation.     

Relationship Among Mothers’ Glycemic Level,Periodontitis, and Birth Weight

Background: The aim of this study is to determine the influence of glycemic level on the relationship between periodontitis and low birth weight (LBW). Methods: A case‐control study was conducted with 372 females divided into cases (109 mothers of newborns with birth weight <2,500 g) and controls (263 mothers of newborns with birth weight ≥2,500 g). The birth weight of children was obtained from medical records, whereas information on sociodemographic, lifestyle, and health characteristics of the participants was obtained through an interview. Glycated hemoglobin (HbA1c) levels were measured, and probing depth, clinical attachment levels, and bleeding on probing were used to determine the periodontal status. Results were analyzed using logistic regression. Results: The likelihood of having children with LBW among the mothers with periodontitis was six times greater than that observed among mothers without periodontitis (adjusted odds ratio [OR_adjusted] = 6.02, 95% confidence interval [CI] = 2.47 to 15.17), even after adjustment. There was also a strong, statistically significant relationship between periodontitis and LBW in both the normal glycemic–level group (HbA1c levels <5.6%, unadjusted odds ratio [OR_unadjusted] = 8.30, 95% CI = 3.56 to 19.35) and the high glycemic–level group (HbA1c levels ≥5.6% and <6.5%, OR_unadjusted = 5.73, 95% CI = 1.75 to 18.70). After adjustment for confounders, the magnitude of the association continued to be strong in the normal glycemic–level group (OR_adjusted = 7.59, 95% CI = 2.7 to 24.28), an increase of 25% when compared to the main association measurement. In those with high glycemic levels (OR_adjusted = 4.03, 95% CI = 0.81 to 19.96), the OR decreased almost 50%, and the association lost statistical significance. Conclusion: Periodontitis and glycemic levels appeared to have opposing influences on birth weight, with periodontitis being associated with LBW and the magnitude of the association being altered depending on maternal blood glucose level.     

An Interprofessional Approach to Oral Hygiene for Elderly Inpatients and the Perception of Caregivers Towards Oral Health Care

ObjectiveThe objective of this study was to investigate the effect of an interprofessional oral hygiene support program for elderly inpatients and the perception of caregivers of the elderly towards oral health care.Materials and methodsParticipants comprised 37 elderly inpatients requiring nursing care (17 males, 20 females; mean age, 83.3 ± 4.9 years) and 29 registered nurses who participated in the interprofessional oral health care support program as a caregiver (4 males, 25 females; mean age, 45.2 ± 10.3 years). In this program, inpatients received daily oral cleaning by registered nurses based on each patient's oral health care plan. The number of microbes on the tongue surface of the inpatients was measured once a week for 12 weeks. Additionally, as an investigation of the perception of the caregivers towards oral health care, a questionnaire about the required frequency and duration for oral cleaning was conducted with registered nurses before and after the program to investigate the perception of the caregivers towards oral health care.ResultsSignificant differences were observed in the number of microbes on the tongue surface between baseline and at every measurement after the beginning of this program, except for the first week. The mean required frequency and duration for oral cleaning by registered nurses at baseline were 1.5 ± 0.8 times and 3.8 ± 2.2 minutes, whereas those after the program were 2.7 ± 0.7 times and 5.8 ± 2.9 minutes, respectively.ConclusionImplementation of the program decreased the number of microbes on the tongue surface of the elderly inpatients and improved the perception of their caregivers towards oral health care.     

Effect of Intensive Oral Hygiene Regimen During Pregnancy on Periodontal Health,Cytokine Levels,and Pregnancy Outcomes: A Pilot Study

Background: Data are limited on the potential effect of intensive oral hygiene regimens and periodontal therapy during pregnancy on periodontal health, gingival crevicular fluid (GCF) and serum cytokines, and pregnancy outcomes. Methods: A clinical trial was conducted on 120 community‐dwelling, 16‐ to 35‐year‐old pregnant women at 16 to 24 weeks of gestation. Each participant presented with clinical evidence of generalized, moderate‐to‐severe gingivitis. Oral hygiene products were provided, together with instructions for an intensive daily regimen of hygiene practices. Non‐surgical therapy was provided at baseline. Oral examinations were completed at baseline and again at 4 and 8 weeks. In addition, samples of blood and GCF were collected at baseline and week 8. Mean changes in clinical variables and GCF and serum cytokine levels (interleukin [IL]‐1β, IL‐6, tumor necrosis factor [TNF]‐α) between baseline and week 8 were calculated using paired t test. Pregnancy outcomes were recorded at parturition. Results: Results indicated a statistically significant reduction in all clinical variables (P <0.0001) and decreased levels of TNF‐α (P = 0.0076) and IL‐1β (P = 0.0098) in GCF during the study period. The rate of preterm births (<37 weeks of gestation) was 6.7% (P = 0.113) and low birth weight (<2,500 g) was 10.2% (P = 1.00). Conclusions: Among the population studied, intensive instructions and non‐surgical periodontal therapy provided during 8 weeks at early pregnancy resulted in decreased gingival inflammation and a generalized improvement in periodontal health. Large‐scale, randomized, controlled studies are needed to substantiate these findings.     

Periodontitis and obesity: a study of the Fourth Korean National Health and Nutrition Examination Survey

Background: The present study aims to determine whether there is an association between periodontitis and obesity among Korean adults who participated in the Fourth Korean National Health and Nutrition Examination Survey (KNHANES). Methods: In 2007, 4,246 subjects, >19 years of age, who participated in the KNHANES (a cross‐sectional survey conducted by the Korea Centers for Disease Control and Prevention) were selected for analysis. Participants underwent a periodontal examination and anthropometric measurements, and were asked to complete a questionnaire about their socioeconomic status and overall health status. Body mass index (BMI) and waist circumference (WC) were used as measures of overall body fat and upper body fat. Standard BMI and WC cutoff points were used, as established by the World Health Organization and the Korean Society for the Study of Obesity. Periodontal status was assessed by Community Periodontal Index and periodontitis was defined as ≥ “code 3.” Multivariate logistic regression analyses were carried out, adjusting for the following variables: sex; age; household income; bedtime toothbrushing habits; use of dental floss; use of an interproximal toothbrush; presence of active tooth decay; the number of decayed, missing, or filled permanent teeth; diabetes mellitus; and present smoking status. Results: In multivariate logistic regression analysis, there was no association between BMI and periodontitis. Obese people with BMI ≥25 had an adjusted odds ratio of 0.991 (0.806 to 1.220) for having periodontitis. But we found a significant association between abdominal obesity and periodontitis. After adjusting for all covariates, the adjusted odds ratio for periodontitis was 1.358 (confidence interval 1.003 to 1.839) for obese subjects. Conclusions: A high WC seems to be associated with periodontitis, whereas BMI does not. This finding shows that abdominal obesity is significantly correlated with periodontitis.     

Association of Serum 17β‐Estradiol Concentration,Hormone Therapy,and Alveolar Crest Height in Postmenopausal Women

Background: Declines in endogenous estrogen levels after menopause can lead to systemic bone loss, including loss of oral bone and alveolar crest height (ACH). However, few studies have assessed both serum 17β‐estradiol (E₂) and exogenous hormone therapy (HT) use in relation to oral bone loss. Methods: This study examines the associations among serum E₂, HT use, and ACH in 613 postmenopausal women from the Buffalo OsteoPerio study. Baseline ACH levels and 5‐year ACH were assessed for groups according to E₂ level (undetectable, >5.00 to ≤18.00, >18.00 to ≤46.07, and >46.07 pg/mL) and among HT use (never, ever) using analysis of variance and analysis of covariance. Logistic regression was used to analyze the association of ACH loss with serum E₂ and HT use. Results: In cross‐sectional analyses, no association was found of serum E₂ with whole‐mouth mean or worst‐site ACH. However, history of HT use was associated with ACH. Women who had never used HT had more ACH loss assessed as a whole‐mouth mean ACH (P = 0.01) and as worst‐site ACH loss (P = 0.03). In logistic regression analyses of baseline ACH loss severity, HT never‐users had two‐fold higher odds of being in the severe ACH loss category compared to ever‐users (odds ratio, 2.00; 95% confidence interval, 1.11 to 3.62). No association was observed of 5‐year change in ACH with baseline serum E₂ or HT use. Conclusion: Although this study did not detect an association with current serum E₂ level and ACH, HT use was found to be associated with less ACH loss in postmenopausal women.     

Intrapregnancy Non‐Surgical Periodontal Treatment and Pregnancy Outcome: A Randomized Controlled Trial

Background: The purpose of the present study is to investigate the potential link between maternal periodontitis and pregnancy outcomes, including preterm birth (<37 weeks) and low birth weight (<2,500 g). Methods: Ninety nine pregnant females with mild/moderate periodontitis were randomly allocated to a control (n = 50) or test (n = 49) group. Test group participants received intrapregnancy non‐surgical periodontal treatment, whereas this was deferred until after delivery for controls. Demographic and baseline clinical data were obtained for all participants at initial assessment pretreatment. Clinical data were rerecorded for test participants at review 8 weeks after treatment. Birth outcomes were completed at delivery by midwives who also collected cord blood samples when possible; the latter were analyzed to determine the presence/levels of cytokines interleukin (IL)‐1β, IL‐6, and IL‐8. All data were analyzed on an intention‐to‐treat basis using appropriate statistical tests. Results: Random allocation of participants resulted in well‐balanced control and test groups. All test group participants and all but one control participant gave birth to a live infant. No significant differences were detected between control and test groups with regard to birth outcome measures of birth weight and gestational age or in relation to cytokine prevalence/levels. Conclusion: Intrapregnancy non‐surgical periodontal treatment, completed at 20 to 24 weeks, did not reduce the risk of preterm, low‐birth‐weight delivery in this population.