Periodontal therapy and glycaemic control among individuals with type 2 diabetes: reflections from the PerioCardio study.

OBJECTIVES: Diabetes mellitus and periodontal disease are highly prevalent among Indigenous Australian adults. Untreated periodontitis impacts glycaemic control in people with diabetes. The aim of this study was to report on the effect of periodontal therapy on glycaemic control among people with obesity. METHODS: This subgroup analysis is limited to 62 participants with diabetes from the original 273 Aboriginal Australian adults enrolled into the PerioCardio study. Intervention participants received full-mouth non-surgical periodontal scaling during a single, untimed session while controls were untreated. Endpoints of interest included change in glycated haemoglobin (HbA1c), C-reactive protein (CRP) and periodontal status at 3 months post-intervention. RESULTS: There were more females randomized to the treatment group (n = 17) than control (n = 10) while the control group had a higher overall body mass index (BMI) [mean (SD)] 33.1 (9.7 kg m-2 ) versus 29.9 (6.0 kg m-2 ). A greater proportion of males were followed up at 3 months compared to females, P = 0.05. Periodontal therapy did not significantly reduce HbA1c: ancova difference in means 0.22 mmol mol-1 (95% CI -6.25 to 6.69), CRP: ancova difference in means 0.64 (95% CI -1.08, 2.37) or periodontal status at 3 months. CONCLUSIONS: Non-surgical periodontal therapy did not significantly reduce glycated haemoglobin in participants with type 2 diabetes. Reasons are likely to be multifactorial and may be influenced by persistent periodontal inflammation at the follow-up appointments. Alternatively, the BMI of study participants may impact glycaemic control via alternative mechanisms involving the interplay between inflammation and adiposity meaning HbA1c may not be amenable to periodontal therapy in these individuals.

Multi-ancestry Genome-Wide Association Study of Early Childhood Caries.

Early childhood caries (ECC) is the most common non-communicable childhood disease. It is an important health problem with known environmental and social/behavioral influences that lacks evidence for specific associated genetic risk loci. To address this knowledge gap, we conducted a genome-wide association study of ECC in a multi-ancestry population of U.S. preschool-age children (n=6,103) participating in a community-based epidemiologic study of early childhood oral health. Calibrated examiners used ICDAS criteria to measure ECC with the primary trait using the dmfs index with decay classified as macroscopic enamel loss (ICDAS ≥3). We estimated heritability, concordance rates, and conducted genome-wide association analyses to estimate overall genetic effects; the effects stratified by sex, household water fluoride, and dietary sugar; and leveraged the combined gene/gene-environment effects using the 2-degree-of-freedom (2df) joint test. The common genetic variants explained 24% of the phenotypic variance (heritability) of the primary ECC trait and the concordance rate was higher with a higher degree of relatedness. We identified 21 novel non-overlapping genome-wide significant loci for ECC. Two loci, namely RP11-856F16 . 2 (rs74606067) and SLC41A3 (rs71327750) showed evidence of association with dental caries in external cohorts, namely the GLIDE consortium adult cohort (n=∼487,000) and the GLIDE pediatric cohort (n=19,000), respectively. The gene-based tests identified TAAR6 as a genome-wide significant gene. Implicated genes have relevant biological functions including roles in tooth development and taste. These novel associations expand the genomics knowledge base for this common childhood disease and underscore the importance of accounting for sex and pertinent environmental exposures in genetic investigations of oral health.

Surface-specific efficacy of fluoride varnish in caries prevention in the primary dentition: results of a community randomized clinical trial.

OBJECTIVES: Fluoride varnish (FV) is efficacious in caries prevention although its effects among different tooth surfaces are poorly understood. This study sought to determine the extent to which caries-preventive effects of a community intervention that included FV application among preschool-aged children varied according to primary tooth anatomy and baseline tooth pathology. METHODS: Secondary analysis was undertaken of data from a community-randomized controlled trial among 543 3- to 5-year-old Aboriginal children in 30 Northern Territory Australian communities. Children in intervention communities received community health promotion and FV application once every 6 months. Net caries (d(3)mfs) risk and 95% confidence limits (CL) were estimated for the control and intervention arms, and stratified according to tooth anatomy/location and baseline pathology (sound, enamel opacity, hypoplastic defect or precavitated carious lesion). The intervention's efficacy was quantified using generalized estimating equation modeling accounting for study design and clustering. The assumption of efficacy homogeneity was tested using a Wald χ(2) test with a p < 0.2 criterion and post hoc pairwise comparisons. RESULTS: The intervention resulted in a 25% reduction (relative risk, RR = 0.75; 95% CL = 0.71, 0.80) in the 2-year surface-level caries risk. There was substantial heterogeneity in FV efficacy by baseline surface pathology: RRs were 0.73 for sound, 0.77 for opaque, 0.90 for precavitated, and 0.92 for hypoplastic surfaces. Among sound surfaces, maxillary anterior facials received significantly more benefit (RR = 0.62) compared to pits and fissures (RR = 0.78). CONCLUSION: The intervention had greatest efficacy on surfaces that were sound at baseline. Among those sound surfaces, maxillary anterior facials received most caries-preventive benefit.

Is self interdental cleaning associated with dental plaque levels, dental calculus, gingivitis and periodontal disease?

BACKGROUND AND OBJECTIVE: To ascertain whether interdental cleaning behaviours of Australian adults were associated with lower levels of plaque, gingivitis and periodontal disease. MATERIAL AND METHODS: Data were obtained from the National Survey of Adult Oral Health 2004-06. Outcome variables were three indicators of oral hygiene outcomes (the presence or not of dental plaque, dental calculus and gingivitis) and two of periodontal disease (the presence or not of at least one tooth with a periodontal pocket or clinical attachment loss of ≥ 4 mm). The independent variable was classified into the following three groups: regularly clean interproximally 'at least daily' (daily+); 'less than daily' (< daily); and 'do not regularly clean interproximally' (reference group). Poisson regression with robust variance estimation was used to calculate prevalence ratios (PRs) and 95% confidence intervals (95% CIs) relative to the reference group, adjusted for covariates. RESULTS: Regular self interdental cleaning was associated with less dental plaque (< daily, PR = 0.89, 95% CI = 0.84, 0.95; and daily+, PR = 0.89, 95% CI = 0.82, 0.96), less dental calculus (< daily, PR = 0.88, 95% CI = 0.80, 0.97; and daily+, PR = 0.79, 95% CI = 0.70, 0.89) and lower levels of moderate/severe gingivitis (daily+, PR = 0.85, 95% CI = 0.77, 0.94). Periodontal pocketing was less likely for the < daily group (PR = 0.61, 95% CI = 0.46, 0.82), but was not associated with daily+ cleaning (PR = 0.99, 95% CI = 0.663, 1.49). There was not a significant association between interdental cleaning and clinical attachment loss (< daily, PR = 0.90, 95% CI = 0.77, 1.05; and daily+, PR = 1.17, 95% CI = 0.95, 1.44). CONCLUSION: Regular interdental cleaning was associated with better oral hygiene outcomes, such as dental plaque and gingivitis, although there was no significant association between regular interdental cleaning and clinical attachment loss.

National prevalence of oral HPV infection and related risk factors in the U.S. adult population.

This article reviews the rapidly growing evidence that oral human papilloma viruses (HPV) infection contributes to the risk of oral squamous cell carcinoma. It also reports the first nationally representative estimates of oral HPV prevalence in the United States adult population. An estimated 7.3% (95% CI: 6.0, 8.9) of the U.S. population had one or more oral HPV types detected in oral rinse; 3.1% (95%CI: 2.4, 3.9) of the U.S. population had one or more oncogenic HPV types. A substantial excess risk of HPV infection in men is not explained by education, smoking, age of sexual debut, or number of lifetime sex partners. Based on the published finding from a case-control study, where there was an odds ratio of 2.6 (95% CI: 1.5, 4.2) for the association of head and neck cancer oncogenic oral HPV infection, the estimated population attributable risk for head and neck cancer in the U.S. population was 4.7%. In other words, there would be a 4.7% reduction in incidence rate of head and neck cancer in the United States if oncogenic HPV infection could be prevented. The results also provide population data that help evaluate the likely public health benefits of prophylactic vaccination against oral HPV acquisition.

The relationship between dental care and perceived oral health impacts.

BACKGROUND: Knowledge of the effect of dental care and dental visiting behavior on oral health impacts is important for effective resource allocation. OBJECTIVE: To determine the association between dental care, including the reason for dental attendance and time since last dental visit, with perceived oral health impacts among Australian adults. METHODS: Data were obtained from the Australian National Survey of Adult Oral Health 2004/06. Analysis was limited to 4,170 dentate adults who answered the Oral Health Impact Profile (OHIP-14) questions. Prevalence of frequent impacts was defined as the percentage of people reporting 'fairly often' or 'very often' to one or more of the OHIP-14 questions. RESULTS: Over half the dentate Australians (63.0%) visited a dentist in the past year. Unadjusted analysis showed a statistically significant association between the prevalence of frequent impacts and receipt of: extractions (prevalence ratio = 1.7, 95% CI = 1.2-2.2), scale/clean (0.7, 0.5-0.8), and denture care (1.6, 1.1-2.4). After adjustment for the usual reason for dental attendance there was no effect of any of the three treatments or the time since last visit on the prevalence of frequent impacts. CONCLUSION: The usual reason for dental attendance, and not the time since last visit or the type of dental care supplied, accounted for differences in perceived oral health impacts.

COMT Genotype and Efficacy of Propranolol for TMD Pain: A Randomized Trial.

Propranolol is a nonselective ß-adrenergic receptor antagonist that is efficacious in reducing facial pain. There is evidence that its analgesic efficacy might be modified by variants of the catechol-O-methyltransferase (COMT) gene. We tested the hypothesis in a subset of 143 non-Hispanic Whites from a randomized controlled trial of patients with painful temporomandibular disorder (TMD). Patients were genotyped for rs4680, a single nucleotide polymorphism of COMT, and randomly allocated to either propranolol 60 mg twice daily or placebo. During the 9-wk follow-up period, patients recorded daily ratings of facial pain intensity and duration; the product was computed as an index of facial pain. Postbaseline change in the index at week 9 (the primary endpoint) was analyzed as a continuous variable and dichotomized at thresholds of ≥30% and ≥50% reduction. Mixed models for repeated measures tested for the genotype × treatment group interaction and estimated means, odds ratios (ORs), and 95% confidence limits (95% CLs) of efficacy within COMT genotypes assuming an additive genetic model. In secondary analysis, the cumulative response curves were plotted for dichotomized reductions ranging from ≥20% to ≥70%, and genotype differences in area under the curve percentages (%AUC) were calculated to signify efficacy. Mean index reduction did not differ significantly (P = 0.277) according to genotype, whereas the dichotomized ≥30% reduction revealed greater efficacy among G:G homozygotes (OR = 10.9, 95%CL = 2.4, 50.7) than among A:A homozygotes (OR = 0.8, 95%CL = 0.2, 3.2) with statistically significant interaction (P = 0.035). Cumulative response curves confirmed greater (P = 0.003) efficacy for G:G homozygotes (%AUC difference = 43.7, 95%CL = 15.4, 72.1) than for A:A homozygotes (%AUC difference = 6.5, 95%CL = -30.2, 43.2). The observed antagonistic effect of the A allele on propranolol's efficacy was opposite the synergistic effect hypothesized a priori. This unexpected result highlights the need for better knowledge of COMT's role in pain pathogenesis if the gene is to be used for precision-medicine treatment of TMD (ClinicalTrials.gov NCT02437383).

A comprehensive approach to health promotion for the reduction of dental caries in remote Indigenous Australian children: a clustered randomised controlled trial.

AIM: To evaluate the effect of a community-oriented primary health care (CPHC) intervention on oral health behaviours of Indigenous preschool children living in remote communities of Australia's Northern Territory. METHODS: The study was a community-clustered randomised controlled trial over two years, set in 30 remote Indigenous communities in the Northern Territory of Australia. Children aged 18-47 months at baseline were enrolled in the study. The intervention included fluoride varnish applications, training of primary care workers, and health promotion for oral health at an individual, family and community level. Intervention communities received six-monthly visits over two years and control communities were visited at baseline and two years later with no contact in the intervening period. The outcome measures reported in this paper are the impact of the intervention on two secondary endpoints: oral health promotion activities in the community and personal oral health practice of children. RESULTS: The intervention did not produce any significant change in oral health behaviours, clinical measures of oral hygiene, or community programmes promoting oral health. Dental caries can be reduced but will continue to be a problem among young remote Indigenous children while they experience major social disadvantage.

Emulation of Community Water Fluoridation Coverage Across US Counties.

INTRODUCTION: Expansion of community water fluoridation has stalled in the United States, leaving 115 million Americans without fluoridated drinking water. OBJECTIVE: This study used spatial regression methods to assess contributions of supply-side factors (neighboring counties' fluoridation coverage) and demand-side factors (health literacy, education, and population density of the local county) in predicting the extent of fluoridation in US counties. METHODS: For this cross-sectional ecological analysis, data from the 2014 Water Fluoridation Reporting System for all 3,135 US counties were merged with sociodemographic data from the 2014 American Community Survey and county-level estimates of health literacy based on the National Association of Adult Literacy Survey. We employed multilevel geographically weighted autoregressive models to predict fluoridation coverage of each county as a function of fluoridation coverage of neighboring counties and local-county covariates: either health literacy or sociodemographic characteristics. Akaike's Information Criterion was used to distinguish the better model in terms of explanatory power and parsimony. RESULTS: In the best-fit model, an increase from the first to third quartile of neighboring counties' fluoridation coverage was associated with an increase of 27.76 percentage points (95% confidence limits [CI] = 27.71, 27.81) in a local county's fluoridation coverage, while an increase from the first to third quartile of local county's health literacy was associated with an increase of 2.8 percentage points (95% CL = 2.68, 2.89). The results are consistent with a process of emulation, in which counties implement fluoridation based upon their population's health literacy and the extent of fluoridation practiced in neighboring counties. CONCLUSION: These results suggest that demand for community water fluoridation will increase as health literacy increases within a county. Furthermore, when considering expansion of fluoridation, non-fluoridated communities can benefit from precedents from nearby communities that are fluoridated. KNOWLEDGE TRANSFER STATEMENT: Expanded coverage of community water fluoridation has stalled in the United States. The economic theory of diffusion describes how, over time and space, policy enacted in one community can influence public opinion in a neighboring community. This study applies geospatial analysis of county-level data and the theory of policy diffusion to demonstrate that fluoridated counties can promote the implementation of community water fluoridation in their neighboring, non-fluoridated communities.

Professional charges not reimbursed to dentists in the U.S.: evidence from Medical Expenditure Panel Survey, 1996.

OBJECTIVES: This cross-sectional study examined professional charges not paid to dentists. METHODS: This analysis used logistic regression in SUDAAN examining the 1996 MEPS data from 12,931 adults. RESULTS: Among people incurring dental care charges, 13.6% had more than $50 of unpaid charge (UC). The percapita UC was $53.30. Total UC was higher for highest income group [45.4% of total] compared to lowest income group [26.0%]. The percapita UC of $76.70 for low income group was significantly greater than for high income group ($47.80, P < 0.01). More Medicaid recipients (52% vs. non-recipients: 12%) incurred at least $50 in UC (P < 0.01). Adjusted odds of incurring UC were greater for those employed (OR = 1.3, 95% CI: 1.0-1.7), and for those with private insurance (OR: 1.5, CI: 1.3-1.9). Number of dental procedure types modified the association between Medicaid recipient and UC (OR = 13.6 for Medicaid recipients undergoing multiple procedure types; OR: 2.3 for Medicaid non-recipients with multiple procedure types; OR: 1.9 for Medicaid recipients receiving single dental procedure. CONCLUSIONS: Having private insurance, being unemployed and being Medicaid insured undergoing multiple procedure were strongest predictors of UC.

Biomarkers of periodontal inflammation in the Australian adult population.

BACKGROUND: Several inflammatory biomarkers are implicated in the pathogenesis of periodontitis including interleukin-1beta (IL-1beta) and C-reactive protein (CRP). This study investigated the presence of these factors in gingival crevicular fluid (GCF) and their relationship to clinical and social determinants of periodontitis in the Australian population. METHODS: Equal numbers of periodontitis cases and non-cases were sampled during oral epidemiologic examination in the National Survey of Adult Oral Health. GCF was sampled from four sites where probing pocket depth (PPD) and recession were recorded. From these, IL-1beta and CRP were quantified by ELISA and the log amount of GCF IL-1beta (pg) per person and the proportion of adults with detectable CRP was computed. RESULTS: Periodontitis cases (n = 511) had significantly higher levels of IL-1beta and CRP than non-cases (n = 562). PPD, clinical attachment loss, plaque and gingivitis indices were positively associated with elevated levels of both biomarkers. Levels of both were positively associated with age, low socio-economic position and non-Australian birth. CONCLUSIONS: The presence of IL-1beta and CRP in GCF are associated with periodontal disease parameters within the Australian population. The levels of both biomarkers are influenced by age, education and eligibility for public dental care.

Comparison of adult oral health in Australia, the USA, Germany and the UK.

BACKGROUND: Australian adults reportedly have poor oral health when compared to 28 other OECD countries. The Australian ranking was based on edentulism and caries experience data from selected age groups that apparently were collected in 1987-88. The objective of this study was to compare the oral health of Australian adults with that of three other western countries that have comprehensive oral health survey data. METHODS: Published data were obtained from the NHANES 2003-2004, the Fourth German Oral Health Study 2005 and the UK Adult Dental Health Survey 1998. Data from the Australian NSAOH 2004-06 were analysed to generate comparable age-specific estimates using nine dental clinical indicators, two measures of oral hygiene behaviour and two of dental attendance. RESULTS: Australia had the best oral health based on two clinical indicators, was equal first on three indicators and ranked second in the remaining clinical indicators. Australia ranked first or second based on dental flossing, use of mouthwash and frequency of dental attendance. CONCLUSIONS: The oral health of the Australian adult population was among the best of the four nations studied.

Exposure to water fluoridation and caries increment.

OBJECTIVE: The objective of this cohort study was to examine the association between exposure to water fluoridation and the increment of dental caries in two Australian states: Queensland (Qld)--5 per cent fluoridation coverage; and South Australia (SA)--70 per cent fluoridation coverage. METHOD: Stratified random samples were drawn from fluoridated Adelaide and the largely non-fluoridated rest-of-state in SA, and fluoridated Townsville and non-fluoridated Brisbane in Qld. PARTICIPANTS: Children were enrolled between 1991 and 1992 (SA: 5-15 yrs old, n = 9,980; Qld: 5-12 yrs old, n = 10,695). Follow-up caries status data for 3 years (+/- 1/2 year) were available on 8,183 children in SA and 6,711 children in Qld. MAIN OUTCOME MEASURES: Baseline data on lifetime exposure to fluoridated water, use of other fluorides and socio-economic status (SES) were collected by questionnaire, and tooth surface caries status by dental examinations in school dental service clinics. RESULTS: Higher per cent lifetime exposure to fluoridated water (6 categories: 0;1-24; 25-49; 50-74; 75-99; 100 per cent) was a significant predictor (ANOVA, p < 0.01) of lower annualised Net Caries Increment (NCI) for the deciduous dentition in SA and Qld, but only for Qld in the permanent dentition. These associations persisted in multiple linear regression analyses controlling for age, gender, exposure to other fluorides and SES (p < 0.05). CONCLUSIONS: Water fluoridation was effective in reducing caries increment, even in the presence of a dilution effect from other fluorides. The effect of fluoridated water consumption was strongest in the deciduous dentition and where diffusion of food and beverages from fluoridated to non-fluoridated areas was less likely.

Impact of dental care on oral health-related quality of life and treatment goals among elderly adults.

BACKGROUND: General dental care can effectively control disease and restore damaged tissue, yet little is known about its impact on patients' subjective oral health, namely treatment goals and oral health-related quality of life (OHRQoL). This study aimed to evaluate change in both aspects of subjective oral health among elderly adults receiving publicly-funded, general dental care. METHODS: We conducted a prospective, single-group intervention study of adults aged 75+ years receiving care through the South Australian Dental Service (SADS). Before receiving dental care, subjects completed the Oral Health Impact Profile (OHIP-14) questionnaire which evaluates OHRQoL. In this questionnaire, subjects rated the extent to which they had attained a self-nominated oral health goal. Dentists provided standard-of-care treatment and six months later the OHIP-14 and goal attainment questions were re-administered. RESULTS: Among the 253 adults studied, overall improvements in OHRQoL were observed (p < 0.05), although the effect was dependent on pre-treatment goal: mean OHIP-14 scores did not change significantly for subjects whose goal was less pain/discomfort while significant improvements were observed for subjects with other treatment goals. In contrast, mean goal attainment ratings improved significantly (P < 0.05), regardless of treatment goal categories. CONCLUSIONS: Dental care was associated with improvements in subjective oral health, although different patterns of improvement were observed for OHRQoL compared with goal attainment ratings.

Long-chain omega-3 fatty acids and headache in the U.S. population.

The objective of this study was to assess whether dietary intake of long-chain omega-3 polyunsaturated fatty acids (PUFAs) is associated with lower prevalence of headache in the U.S. POPULATION: This cross-sectional study used data for a nationally representative sample of 12,317 men and women aged ≥ 20 years participating in the National Health and Nutrition Examination Surveys of 1999-2004. Interviewers recorded self-report of severe headache or migraine in the past three months. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) were quantified from 24-hour dietary recall using the U.S. Department of Agriculture National Nutrient Database. Serum concentration of C-reactive protein, a marker of inflammation and potential mediator of PUFA's analgesic properties, was quantified by latex-enhanced nephelometry. Multivariable generalized linear models estimated prevalence ratios (PR) with 95% confidence limits (CL) for severe headache or migraine adjusting for NHANES cycle, sociodemographic characteristics, body mass index and total energy intake. The unadjusted prevalence of severe headache or migraine was 22.0% (females 28.2%, males 15.5%). In multivariable analysis, greater intake of omega-3 PUFAs was associated with lower prevalence of severe headache or migraine: PR 0.94 (95% CL: 0.88, 0.99, p = 0.035) per log unit increase in EPA, and PR 0.94 (95% CL: 0.90, 0.99, p = 0.023) per log unit increase in DHA. The strength of association was greater for non-Mexican Hispanics than for other racial/ethnic groups but was not attenuated after adjustment for C-reactive protein. In conclusion, higher dietary intakes of EPA and DHA were associated with lower prevalence of headache supporting the hypothesis that omega-3 PUFAs may prevent or reduce headache.

Water Fluoridation and Dental Caries in U.S. Children and Adolescents.

Fluoridation of America's drinking water was among the great public health achievements of the 20th century. Yet there is a paucity of studies from the past 3 decades investigating its dental health benefits in the U.S. POPULATION: This cross-sectional study sought to evaluate associations between availability of community water fluoridation (CWF) and dental caries experience in the U.S. child and adolescent population. County-level estimates of the percentage of population served by CWF (% CWF) from the Centers for Disease Control and Prevention's Water Fluoridation Reporting System were merged with dental examination data from 10 y of National Health and Nutrition Examination Surveys (1999 to 2004 and 2011 to 2014). Dental caries experience in the primary dentition (decayed and filled tooth surfaces [dfs]) was calculated for 7,000 children aged 2 to 8 y and in the permanent dentition (decayed, missing, and filled tooth surfaces [DMFS]) for 12,604 children and adolescents aged 6 to 17 y. Linear regression models estimated associations between % CWF and dental caries experience with adjustment for sociodemographic characteristics: age, sex, race/ethnicity, rural-urban location, head-of-household education, and period since last dental visit. Sensitivity analysis excluded counties fluoridated after 1998. In unadjusted analysis, caries experience in the primary dentition was lower in counties with ≥75% CWF (mean dfs = 3.3; 95% confidence limit [CL] = 2.8, 3.7) than in counties with <75% CWF (mean dfs = 4.6; 95% CL = 3.9, 5.4), a prevented fraction of 30% (95% CL = 11, 48). The difference was also statistically significant, although less pronounced, in the permanent dentition: mean DMFS (95% CL) was 2.2 (2.0, 2.4) and 1.9 (1.8, 2.1), respectively, representing a prevented fraction of 12% (95% CL = 1, 23). Statistically significant associations likewise were seen when % CWF was modeled as a continuum, and differences tended to increase in covariate-adjusted analysis and in sensitivity analysis. These findings confirm a substantial caries-preventive benefit of CWF for U.S. children and that the benefit is most pronounced in primary teeth.

Does psychological stress mediate social deprivation in tooth loss?

It is unclear which theoretical dimension of psychological stress affects health status. We hypothesized that both distress and coping mediate the relationship between socio-economic position and tooth loss. Cross-sectional data from 2915 middle-aged adults evaluated retention of < 20 teeth, behaviors, psychological stress, and sociodemographic characteristics. Principal components analysis of the Perceived Stress Scale (PSS) extracted 'distress' (a = 0.85) and 'coping' (a =0.83) factors, consistent with theory. Hierarchical entry of explanatory variables into age- and sex-adjusted logistic regression models estimated odds ratios (OR) and 95% confidence intervals [95% CI] for retention of < 20 teeth. Analysis of the separate contributions of distress and coping revealed a significant main effect of coping (OR = 0.7 [95% CI = 0.7-0.8]), but no effect for distress (OR = 1.0 [95% CI = 0.9-1.1]) or for the interaction of coping and distress. Behavior and psychological stress only modestly attenuated socio-economic inequality in retention of < 20 teeth, providing evidence to support a mediating role of coping.

Influence of psychological factors on risk of temporomandibular disorders.

Psychological characteristics potentially may be a cause or consequence of temporomandibular disorder (TMD). We hypothesized that psychological characteristics associated with pain sensitivity would influence risk of first-onset TMD, but the effect could be attributed to variation in the gene encoding catechol-O-methyltransferase (COMT). We undertook a prospective cohort study of healthy female volunteers aged 18-34 yrs. At baseline, participants were genotyped, they completed psychological questionnaires, and underwent quantitative sensory testing to determine pain sensitivity. We followed 171 participants for up to three years, and 8.8% of them were diagnosed with first-onset TMD. Depression, perceived stress, and mood were associated with pain sensitivity and were predictive of 2- to 3-fold increases in risk of TMD (P < 0.05). However, the magnitude of increased TMD risk due to psychological factors remained unchanged after adjustment for the COMT haplotype. Psychological factors linked to pain sensitivity influenced TMD risk independently of the effects of the COMT haplotype on TMD risk.

Racial differences in periodontal disease and 10-year self-reported tooth loss among late middle-aged and older adults: the dental ARIC study.

OBJECTIVE: To investigate racial differences in the associations between periodontitis and 10-year self-reported incident tooth loss in a biracial, community-based cohort of US late middle-aged and older adults. METHODS: Subjects were 3,466 dentate men and women aged 53-74 who underwent dental examinations from 1996 to1998. In 2012-2013, telephone interviewers asked participants about tooth loss in the preceding 10 years. Separate multivariable ordinal logistic regression models were used to calculate proportional odds ratios (OR) and 95% confidence intervals (CI) as estimates of association between periodontitis and tooth loss for Whites and African-Americans (AAs). RESULTS: The majority of participants were White (85 percent) and female (57 percent) with 23 teeth on average at enrollment. Approximately half the Whites (56 percent) and AAs (49 percent) had periodontitis. At follow-up, approximately 44 percent of AAs and 38 percent of Whites reported having lost ≥1 tooth. In multivariable models, severe periodontitis (OR = 3.03; 95% CI = 2.42-3.80) and moderate periodontitis (OR = 1.64; 95% CI= 1.39-1.94) were significant risk factors of incident tooth loss among Whites. For AAs, severe but not moderate periodontitis increased the odds of incident tooth loss (OR = 2.22; 95% CI = 1.37-3.59). In the final model, education was inversely associated with incident tooth loss among AAs, while lower income was associated with greater odds of tooth loss among Whites. CONCLUSIONS: In this population-based cohort, there is racial heterogeneity in the association between periodontitis and tooth loss. Interventions to reduce the impact of periodontitis on tooth loss need to consider these differences.