Comparison of initial dental treatment decisions between in-person and asynchronous teledentistry examinations for people with special health care needs.

BACKGROUND: People with special health care needs in long-term care settings have difficulty accessing a traditional dental office. The goal of the authors was to assess initial treatment decision concordance between dentists conducting traditional in-person examinations using mobile equipment and additional dentists conducting examinations using asynchronous teledentistry technology. METHODS: Six dentists from Access Dental Care, a North Carolina mobile dentistry nonprofit, saw new patients on-site at 12 participating facilities or asynchronously off-site with electronic dental records, radiographs, and intraoral images, all captured by an on-site dental hygienist. Off-site dentists were masked to other dentists' treatment need decisions; 3 through 5 off-site examinations were conducted for each on-site examination. Demographic and binary treatment need category data were collected. For the 3 most prevalent treatment types needed (surgery, restorative, and new removable denture), the authors calculated the percentage agreement and κ statistics with bootstrapped CIs (1,000 replicates). RESULTS: The 100 enrolled patients included 47 from nursing homes, 45 from Programs of All-Inclusive Care for the Elderly, and 8 from group homes for those with intellectual and developmental disabilities. Mean (SD) age was 73.9 (16.5) years. Among dentate participants, the percentage agreement and bootstrapped κ (95% CI) were 87% and 0.74 (0.70 to 0.78) for surgery and 78% and 0.54 (0.50 to 0.58) for restorative needs, respectively, and among dentate and edentulous participants, they were 94% and 0.78 (0.74 to 0.83), respectively, for new removable dentures. CONCLUSIONS: The authors assessed the initial dental treatment decision concordance between on-site dentists conducting in-person examinations with a mobile oral health care delivery model and off-site dentists conducting examinations with asynchronous dentistry. Concordance was substantial for surgery and removable denture treatment decisions and moderate for restorative needs. Patient characteristics and facility type were not significant factors in the levels of examiner agreement. PRACTICAL IMPLICATIONS: This evidence supports teledentistry use for patients with special health care needs and could help improve their access to oral health care.

Periodontal and Other Oral Bacteria and Risk of Lung Cancer in the Atherosclerosis Risk in Communities (ARIC) Study.

BACKGROUND: Evidence suggests that periodontal disease is associated with increased lung cancer risk, but whether periodontal pathogens are explanatory is unknown. We prospectively studied associations of prediagnostic circulating antibodies with oral bacteria and of periodontal bacteria in subgingival plaque with lung cancer. METHODS: We included 4,263 cancer-free participants in the Atherosclerosis Risk in Communities study with previously measured serum IgG antibodies to 18 oral bacteria. In 1,287 participants for whom subgingival plaque was collected, counts for 8 periodontal bacteria were previously measured. Incident lung cancers (N = 118) were ascertained through 2015 (median follow-up = 17.5 years). We used Cox regression to estimate multivariable-adjusted associations, including for sums of antibodies to orange (C. rectus, F. nucleatum, P. intermedia, P. micra, and P. nigrescens) and red (P. gingivalis, T. forsythensis, and T. denticola) complex bacteria. RESULTS: Orange complex bacteria antibodies were positively associated with lung cancer [per IQR hazard ratios (HR) = 1.15; 95% confidence intervals (CI), 1.02-1.29], which was stronger in men (HR = 1.27, 95% CI 1.08-1.49), and explained by P. intermedia and P. nigrescens (HR = 1.15; 95% CI, 1.04-1.26). Suggestive positive associations with lung cancer (N = 40) were observed for F. nucleatum, A. actinomycetemcomitans, and P. gingivalis counts. Significant positive associations were found for the count to antibody ratio for P. intermedia and P. gingivalis. CONCLUSIONS: We identified positive associations with lung cancer for oral bacteria, especially orange complex that are moderately pathogenic for periodontal disease. IMPACT: This prospective study supports the need for more research on periodontal bacteria in lung cancer etiology. If associations are supported, this may inform novel lung cancer prevention strategies.

Association between asthma and periodontitis in the US adult population: A population-based observational epidemiological study.

AIM: To examine the association between asthma and periodontitis in a nationally representative sample of adults in the United States. MATERIALS AND METHODS: Data obtained from 10,710 adult men and women who participated in National Health and Nutritional Examination Survey from 2009 to 2014 were analysed. Asthma was measured based on self-reported physician diagnosis. Periodontitis was the outcome of interest. It was classified into mild, moderate, and severe periodontitis according to the updated CDC/AAP case definitions. Multivariable models were developed to examine the association of asthma with periodontitis while controlling for age, race/ethnicity, gender, education, income, body mass index, diabetes, and smoking. Odds ratio (OR) and respective 95% confidence interval (CI) were calculated. Replication was performed by differently classifying the outcome using another system called periodontal profile class (PPC). RESULTS: Current asthmatics, in reference to never asthmatics, had lower odds of severe periodontitis [(adjusted OR = 0.51, 95% CI = 0.30-0.87) and (adjusted OR = 0.58, 95% CI = 0.35-0.97) as classified using CDC/AAP case definitions and PPC system, respectively]. However, there was no statistically significant association between asthma and any other forms of periodontitis (p value >.05). CONCLUSIONS: In the United States, current-asthmatic adults were less likely to have severe periodontitis as compared with never-asthmatic adults. Further research is required to fully understand this association.

Association between asthma and dental caries in US (United States) adult population.

OBJECTIVE: To investigate the associations of asthma with dental-caries-experience (DFT: decayed and filled teeth) and untreated-dental-caries (DT: decayed teeth) in the US adult population. METHODS: Data from the National Health and Nutritional Examination Survey, 2009-2014 were analyzed. Study-participants were classified into current, former and never asthmatics based on their asthma-status. Former-asthmatics were excluded. Both the outcomes, dental-caries-experience and untreated-dental-caries were dichotomized as being either present or absent, and were also categorized into tertiles based on their distributions in our study-sample. Logistic regression analyses were performed to determine the associations of asthma with dichotomized outcomes. The generalized logit model was applied for multilevel categorical outcomes. Multivariable models were developed to control for common demographic, clinical, and lifestyle factors. RESULTS: Total study-participants were 13,135, representing 175.26 million US adults. In the adjusted models, current-asthmatics, when compared to the reference group of never-asthmatics, were more likely to have dental-caries-experience (odds ratio [OR], 1.37; 95% confidence interval [CI], 1.13-1.66) and untreated-dental-caries (OR, 1.38; 95% CI, 1.10-1.73) in ≥1 tooth. Asthma was associated with all three categories of dental-caries-experience in our study-sample. We observed a positive gradient in the OR with an increasing extent of untreated-dental-caries. Relative to never-asthmatics, asthma doubled the odds of having untreated dental caries in the subgroup of current-smokers. CONCLUSION: Current-asthmatic adults had higher odds of dental-caries-experience and untreated-dental-caries as compared to never-asthmatic adults in the US. Based on the observations from this study, interprofessional collaboration should be recommended to institute caries control and health promotion in current-asthmatic adult population.

Periodontal profile classes predict periodontal disease progression and tooth loss.

BACKGROUND: Current periodontal disease taxonomies have limited utility for predicting disease progression and tooth loss; in fact, tooth loss itself can undermine precise person-level periodontal disease classifications. To overcome this limitation, the current group recently introduced a novel patient stratification system using latent class analyses of clinical parameters, including patterns of missing teeth. This investigation sought to determine the clinical utility of the Periodontal Profile Classes and Tooth Profile Classes (PPC/TPC) taxonomy for risk assessment, specifically for predicting periodontal disease progression and incident tooth loss. METHODS: The analytic sample comprised 4,682 adult participants of two prospective cohort studies (Dental Atherosclerosis Risk in Communities Study and Piedmont Dental Study) with information on periodontal disease progression and incident tooth loss. The PPC/TPC taxonomy includes seven distinct PPCs (person-level disease pattern and severity) and seven TPCs (tooth-level disease). Logistic regression modeling was used to estimate relative risks (RR) and 95% confidence intervals (CI) for the association of these latent classes with disease progression and incident tooth loss, adjusting for examination center, race, sex, age, diabetes, and smoking. To obtain personalized outcome propensities, risk estimates associated with each participant's PPC and TPC were combined into person-level composite risk scores (Index of Periodontal Risk [IPR]). RESULTS: Individuals in two PPCs (PPC-G: Severe Disease and PPC-D: Tooth Loss) had the highest tooth loss risk (RR = 3.6; 95% CI = 2.6 to 5.0 and RR = 3.8; 95% CI = 2.9 to 5.1, respectively). PPC-G also had the highest risk for periodontitis progression (RR = 5.7; 95% CI = 2.2 to 14.7). Personalized IPR scores were positively associated with both periodontitis progression and tooth loss. CONCLUSIONS: These findings, upon additional validation, suggest that the periodontal/tooth profile classes and the derived personalized propensity scores provide clinical periodontal definitions that reflect disease patterns in the population and offer a useful system for patient stratification that is predictive for disease progression and tooth loss.

Periodontal profile class is associated with prevalent diabetes, coronary heart disease, stroke, and systemic markers of C-reactive protein and interleukin-6.

BACKGROUND: This paper focuses on the Periodontal Profile Class (PPC) System that may be more informative and representative of periodontitis phenotypes than current case definitions of periodontitis. This study illustrates the unique aspects of the PPC compared with other periodontal indices for studying associations between periodontal disease and prevalent systemic conditions. METHODS: We computed odds ratios and 95% confidence intervals to compare associations between periodontal disease and prevalent systemic conditions using our new PPC and two traditional indices. We used the Bayesian Information Criterion (BIC) to determine the fit of the model and the magnitude of the contribution attributable to periodontal disease beyond traditional risk factors. The Atherosclerosis Risk in Communities (ARIC) Study (1996-1998) results were compared with results from the combined National Health and Nutrition Examination Survey 2009-2014 datasets. RESULTS: In the ARIC Study, high gingival inflammation, tooth loss, severe tooth loss, and severe disease PPC components were significantly associated with diabetes, coronary heart disease (CHD), high-sensitivity C-reactive protein, and interleukin (IL)-6, while only severe disease was associated with stroke. Severe disease was associated with CHD using the Centers for Disease Control/American Academy of Periodontology index, and the European Periodontal index was associated with CHD and IL-6. CONCLUSIONS: The addition of the PPC to traditional variables associated with prevalent diabetes, stroke, CHD, and systemic measures of inflammation resulted in very strong improvement of the overall models, while the traditional indices were less likely to be associated and, if present, the associations were weaker. The PPC system provides specific insight into the individuals and periodontal characteristics of the phenotype that are associated with systemic conditions that may be useful in designing treatment interventions.

Contrasting Patterns for Missing Third Molars in the United States and Sweden.

PURPOSE: The purpose of this study was to compare the prevalence of third molars from the US National Health and Nutrition Examination Survey (NHANES) and the Swedish survey. MATERIALS AND METHODS: This cross-sectional study involved the comparison of the only published data on third molar prevalence. The number of visible third molars in the NHANES of 2011 through 2012 were assessed in nonclinical settings by trained, calibrated dental hygienists and reported by age decade (approximately 5,000 patients). Similar data were reported for the Swedish population with data collected in clinical settings (approximately 700 patients). The primary outcome variable was the number of third molars (0 to 4); the predictor variables were age cohorts (20 to 29 through 70 to 79 yr). Outcome data were reported with descriptive statistics. RESULTS: In the youngest cohort (20 to 29 yr), having no visible third molars was more likely in the US population than in the Swedish population (47 vs 2%, respectively). By 50 to 59 years, outcomes for no third molars were similar in the United States and Sweden (53 and 57%, respectively). CONCLUSION: The presence or absence of third molars reported from the US and Swedish populations presented contrasting patterns, particularly in the younger cohorts. More comprehensive and detailed data are required in future surveys as population studies on third molars become more important for clinicians and other stakeholders.

Prevalence of Visible Third Molars in the United States Population: How Many Individuals Have Third Molars?

PURPOSE: To determine the prevalence of third molars in the US population and to report the differences in prevalence of visible third molars in the most recent National Health and Nutrition Examination Survey (NHANES) population of 2011 through 2012 by participant, jaw, and demographics. MATERIALS AND METHODS: The number of visible third molars in the NHANES data was assessed in nonclinical settings by trained, calibrated dental hygienists by decade of age beginning in the 20- to 29-year-old cohort through the 70- to 79-year-old cohort. Cross-sectional analyses of third molar data were conducted by the authors from the NHANES databases of 2001 through 2002, 2009 through 2010, and 2011 through 2012 to compare data for similarity of outcomes on third molar prevalence in the US population. Outcomes on third molar prevalence also were assessed from the NHANES of 2011 through 2012 by participant, jaw, and demographics: gender, race or ethnicity (Caucasian, African American, other), and education (less than high school, high school graduate, some college, college graduate). RESULTS: Data on the mean number of third molars from NHANES of 2001 through 2002, 2009 through 2010, and 2011 through 2012 were similar. The number of visible third molars in the NHANES of 2011 through 2012 decreased progressively from a mean of 1.48 in the 20- to 29-year-old cohort to 0.81 in the 60- to 69-year-old cohort, No visible third molars were observed in 47% of the 20- to 29-year-old cohort compared with 53% in the 50- to 59-year-old cohort. Participants who were male, non-Caucasian, and had less than a high school education were more likely to have a visible third molar in all age cohorts. No data were collected by NHANES examiners to determine why third molars were absent. CONCLUSION: Third molar prevalence did not appear to differ in the US population during the first decade of the 21st century. Numbers of visible third molars, prevalent in young adults, decreased progressively through each successive age cohort. Demographic differences exist for prevalence of third molars in the US population.

Salivary biomarkers in a biofilm overgrowth model.

BACKGROUND: The purpose of this study is to determine whether baseline salivary inflammatory biomarkers could discriminate between different clinical levels of disease and/or detect clinical changes over a 3-week stent-induced biofilm overgrowth (SIBO) period. METHODS: A total of 168 participants were enrolled in a 21-day experimental gingivitis investigation and grouped according to clinical measures of periodontal status of health and diseased individuals representing each of five biofilm gingival interface (BGI) periodontal groups: 1) health, all probing depth (PD) <3 mm and bleeding on probing (BOP) <10%; 2) gingivitis, all PD <3 mm and BOP ≥10%; 3) periodontitis (P)1, ≥1 site with PD >3 mm and BOP ≤10%; 4) P2, ≥1 site with PD >3 mm and BOP >10% but ≤50%; and 5) P3, ≥1 site with PD >3 mm and BOP >50%. Stents were used to prevent plaque removal during brushing over one maxillary and one mandibular posterior dental sextant for 21 days. Clinical periodontal parameters and unstimulated saliva were collected at screening, baseline, and each week during SIBO. Saliva samples were assessed for levels of 13 different biomarkers by multiplex immunoassay. RESULTS: Higher salivary levels of interleukin (IL)-1ß, matrix metalloproteinase (MMP)-3, MMP-8, MMP-9, and neutrophil gelatinase-associated lipocalin (NGAL) were found in diseased groups compared with the healthy group at baseline. Conversely, higher IL-1 receptor antagonist (ra) levels were found in healthy patients at baseline. In addition, during SIBO, MMP-1, tissue inhibitor of metalloproteinase (TIMP)-1, and TIMP-2 levels increased across all participant groups. A stepwise linear regression model using all salivary biomarkers demonstrated that, at baseline, increased IL-1ra (P = 0.004) and IL-6 (P = 0.009) were significantly associated with change in PDs during SIBO. CONCLUSIONS: In summary, this investigation supports salivary levels of IL-1ra and IL-6 as potential indicators for PD changes during induced gingival inflammation. In addition, participants from the BGI-P3 group (severe periodontitis) demonstrated elevated baseline levels of IL-1ß, MMP-3, MMP-8, MMP-9, and NGAL compared with the other study groups, strengthening the relevance of participants' biologic phenotype on expression of salivary biomarkers.

Clinical and subclinical effects of power brushing following experimental induction of biofilm overgrowth in subjects representing a spectrum of periodontal disease.

AIM: Investigate short-term effects of power brushing following experimental induction of biofilm overgrowth in periodontal disease states. MATERIALS AND METHODS: Overall, 175 subjects representing each of five biofilm-gingival interface (BGI) periodontal groups were enrolled in a single-blind, randomized study. After stent-induced biofilm overgrowth for 21 days subjects received either a manual or a power toothbrush to use during a 4 weeks resolution phase. At baseline and during induction and resolution, standard clinical parameters were measured. Subclinical parameters included multikine analysis of 13 salivary biomarkers and 16s Human Oral Microbe Identification Microarray (HOMIM) probe analysis of subgingival plaque samples. RESULTS: All groups exhibited significantly greater reductions in bleeding on probing (BOP) (p = 0.002), gingival index (GI) (p = 0.0007), pocket depth (PD) (p = 0.04) and plaque index (p = 0.001) with power brushing compared to manual. When BGI groups were combined to form a shallow PD (PD ≤ 3 mm) and a deep PD group (PD > 4 mm) power brushing reduced BOP and GI in subjects with both pocket depths. Power brushing significantly reduced IL-1ß levels at resolution while changes in bacterial levels showed non-significant trends between both brushing modalities. CONCLUSIONS: Short-term changes in select clinical parameters and subclinical salivary biomarkers may be useful in assessing efficacy of power brushing interventions in a spectrum of periodontal disease states.

The presence of visible third molars negatively influences periodontal outcomes in the Maternal Oral Therapy to Reduce Obstetric Risk study.

PURPOSE: To assess the relationship between the presence or absence of visible third molars and outcomes for periodontal inflammatory disease. METHODS: Obstetric subjects, at enrollment in an institutional review board-approved, multisite study, Maternal Oral Therapy to Reduce Obstetric Risk (N = 1,798), were divided into 2 groups, those with no visible third molars (n = 692) and those with at least 1 visible third molar (n = 1,106), the predictor variables for this study. The principal outcome variables were the patient-level periodontal status of the first/second molars: mean periodontal probing depths, mean attachment levels, and mean extent scores. Periodontal disease severity also was assessed by criteria from the Oral Conditions and Pregnancy trial and the Centers for Disease Control and Prevention/American Academy of Periodontology. Outcomes according to the presence or absence of third molars were compared with χ(2) statistics and multivariable analyses. Significance was set at P < .05. RESULTS: Significantly more subjects had at least 1 third molar (62%) as compared with subjects with no visible third molar (38%) (P < .01). Ethnic characteristics of the 2 groups were similar. Overall, more subjects were white (61%), with most identifying their ethnicity as Latino. African-American subjects were well represented (37%). Subjects with a visible third molar were more likely to be significantly older, to be receiving medical assistance, and to have used tobacco before pregnancy. If subjects had at least 1 visible third molar, the mean first/second molar probing depths, attachment levels, and scores for bleeding on probing were significantly greater even after adjustment for covariates. On the basis of either Oral Conditions and Pregnancy criteria or Centers for Disease Control and Prevention/American Academy of Periodontology criteria, subjects were significantly more likely to have moderate or severe periodontal disease if a third molar was detected. CONCLUSION: If at least 1 visible third molar was detected in subjects in the Maternal Oral Therapy to Reduce Obstetric Risk study at enrollment as compared with no detected third molars, periodontal outcomes were significantly worse.

A randomized controlled trial of intensive periodontal therapy on metabolic and inflammatory markers in patients With ESRD: results of an exploratory study.

BACKGROUND: Periodontitis is a novel risk factor for inflammation and cardiovascular disease in the dialysis population. Limited information exists about the impact of periodontal therapy in patients receiving dialysis. STUDY DESIGN: Randomized controlled trial to assess feasibility and gather preliminary data. SETTING & PARTICIPANTS: Dialysis patients with moderate/severe chronic periodontitis. INTERVENTION: Intensive treatment, consisting of scaling and root planing, extraction of hopeless teeth, and placement of local-delivery antibiotics, was performed at the baseline visit for treatment-group patients and after study completion for control-group patients. OUTCOMES: Outcomes were feasibility (screening, recruitment, enrollment, adverse events, and study withdrawal/completion), clinical periodontal parameters (probing depth, clinical attachment level, bleeding on probing, gingival index, and plaque index), and serum albumin and interleukin 6 levels at 3 and 6 months postintervention. RESULTS: 342 dialysis patients were approached for participation: 53 were randomly assigned, with 26 participants assigned to immediate treatment and 27 assigned to a control arm for treatment after 6 months. 51 patients completed baseline appointments; 46 were available for 3-month follow-up, 45 were available for 6-month follow-up examinations, and 43 completed all visits. At 3 months, there was a statistically significant improvement for the treatment group compared to the control group for 3 periodontal parameters: mean probing depth (P = 0.008), extent of probing depth ≥4 mm (P = 0.02), and extent of gingival index ≥1 (P = 0.01). However, by 6 months, the difference between groups was no longer present for any variable except probing depth ≥4 mm (P = 0.04). There was no significant difference between groups for serum albumin or high-sensitivity interleukin 6 level at any time when adjusted for body mass index, diabetic status, and plaque index. LIMITATIONS: Small sample size and relatively healthy population, imbalance in diabetes. CONCLUSIONS: This small trial demonstrates successful cooperation between dentists and nephrologists and successful recruitment, treatment, and retention of dialysis patients with periodontitis. Larger studies with longer follow-up are needed to determine whether treatment can improve markers of inflammation and morbidity.

What are the local and systemic implications of third molar retention?

PURPOSE: To establish a relationship between visible third molars (M3s) and increased periodontal probing depths on teeth other than M3s and to examine the hypothesis that the presence of M3s and/or increased probing depths and local inflammation associated with M3s was associated with increased levels of serum inflammatory markers. PATIENTS AND METHODS: The data from three previous population studies (Dental Atherosclerosis Risk In Communities [DARIC], Oral Conditions and Pregnancy [OCAP], and National Health and Nutrition Estimates Study [NHANES III]) and the third molar clinical trials of young adults (White et al) are summarized. A secondary analysis determined whether the presence or absence of visible M3s was associated with an increased prevalence of clinical signs of periodontal disease using adjusted logistic regression models. In addition, serum samples collected from the OCAP, DARIC, and White studies were used to measure the markers of systemic inflammation, C-reactive protein, interleukin-6, and soluble intracellular adhesion molecule-1. RESULTS: In young adults, asymptomatic M3s were associated with an increase in periodontal probing depths of at least 4 mm on second molars and an increase in probing depth of at least 2 mm in 24% of subjects after 2 years. Retention of asymptomatic M3s for 6 years led to a significant increase in the number of subjects with a probing depth of 4 mm or more in non-M3 regions of the mouth. Findings from the DARIC, OCAP, and NHANES III further confirmed the association between the M3 probing depth and periodontal inflammation on non-M3s. Retention of M3s in the presence of periodontal inflammation was associated with significant increases in the serum interleukin-6, soluble intracellular adhesion molecule-1, and C-reactive protein levels. CONCLUSION: Patients deciding to retain M3s should consider the potential long-term effects on their periodontal status and the potential for the retained M3s to serve as a chronic source of inflammation that stresses their systemic health.

Prevalence of visible third molars with caries experience or periodontal pathology in middle-aged and older Americans.

PURPOSE: To assess the prevalence of periodontal pathology and caries experience in visible third molars, as well as the relationship of these findings to periodontal pathology and caries experience in teeth more anterior in the mouth. PATIENTS AND METHODS: Data were from 6,793 Dental Atherosclerosis Risk in Communities participants who underwent a clinical examination for periodontal disease and coronal caries experience and who retained at least 1 visible third molar. Outcome variables were the detection of periodontal pathology or coronal caries experience on visible third molars and on teeth more anterior in the mouth (non-third molars). Periodontal probing depths at least 4 mm (PD4+) and clinical attachment levels at least 3 mm (CAL3+) were indicator variables for periodontal pathology. At least 1 carious/decayed coronal surface or filled coronal surface was an indicator variable for caries experience. Outcomes for third molar and non-third molar teeth were compared by descriptive statistics and χ(2) tests with statistical significance set at P < .05. RESULTS: A third of the 6,793 Dental Atherosclerosis Risk in Communities subjects, who averaged 62 years of age, had at least 1 visible third molar. Subjects were more likely to have at least 1 third molar CAL3+ as compared with at least 1 third molar PD4+: 78% versus 61%. PD4+ and CAL3+ were significantly more prevalent among non-third molars as compared with third molars (P < .01). Most subjects, 73%, had restorations on visible third molars and non-third molars, and over two-thirds of subjects had a visible third molar with caries experience and periodontal pathology. Fewer than 2% of subjects had third molars free of caries experience or periodontal pathology. CONCLUSIONS: Most subjects had clinical evidence of caries experience or periodontal pathology on visible third molars; few subjects had visible third molars that were disease free. Subjects with periodontal pathology or caries experience on third molars were significantly more likely to have these findings detected on teeth more anterior in the mouth.

Visible third molars as risk indicator for increased periodontal probing depth.

PURPOSE: To assess the relationship between visible third molars and the periodontal status of teeth more anterior in the mouth from reports that included periodontal probing data for all teeth. MATERIALS AND METHODS: Each of 4 reports that included periodontal probing data, 6 probing sites for all teeth, including third molars collected by trained, clinician examiners, were briefly summarized. The design, strengths, and weaknesses of each of the 4 studies were compared and summarized. A Forest plot was used to combine the findings from the 4 studies comparing the mean second molar probing depth differences in mm by the presence of at least 1 visible third molar or no visible third molar. RESULTS: A review of the data from 4 reports, 1 from middle-age adults and 3 from young adults, suggested an association between the visible presence of a third molar and increased periodontal probing depths on teeth more anterior in the mouth, predominately the first and second molars. Coupled with the probing depth around the third molars, the result was an expanded surface area at the biofilm-gingival interface. CONCLUSIONS: Although all those with retained third molars are not at increased risk, the summary data we have reported suggest that those with a visible third molar are more likely to have greater periodontal probing depths overall, particularly on second molars, and a greater surface area of the biofilm-gingival interface compared with those with no visible third molar.

Third molar caries experience in middle-aged and older Americans: a prevalence study.

PURPOSE: To assess the prevalence of third molar caries experience in a middle-aged and older population and the relationship of these findings to caries experience in teeth more anterior in the mouth. PATIENTS AND METHODS: Data from 6,550 Dental Atherosclerosis Risk in Communities study participants aged 52 to 74 years who underwent a clinical examination for coronal caries experience were available for these analyses. Subjects with visible third molars (N = 2,003) were divided based on third molar coronal caries experience on at least 1 third molar: no carious/decayed coronal surface (DS) or at least 1 coronal DS and no filled coronal surface (FS) or at least 1 coronal FS. Coronal DS and FS were also calculated for more anterior teeth. Covariates included ethnicity, gender, age, body mass index, education, income, smoking status, and diabetes diagnosis. Subject level outcomes for third molar and more anterior teeth were compared by descriptive statistics and chi(2) or t tests with statistical significance set at P less than .05. Multivariate modeling was performed to adjust outcome variables for covariates. RESULTS: Third molar caries experience was detected in 77% of subjects and was significantly associated with caries experience in more anterior teeth and white race (P < .01). Caries experience was detected in only third molars in 1% of subjects, and 1% of subjects were caries free. Subjects with less education (20%) and lower income (19%) were significantly more likely to have DS detected compared with subjects with more education (6%) and higher income (5%) (P < .01). Conversely, subjects with more education (75%) and higher income (77%) were significantly more likely to have FS detected compared with subjects with less education (55%) and lower income (60%) (P < .01). CONCLUSIONS: Third molar coronal caries experience was significantly associated with caries experience in teeth more anterior in the mouth in this middle-aged and older population.

Third molars and periodontal pathologic findings in middle-age and older Americans.

PURPOSE: To assess the association between the visible presence of third molars and the severity of periodontal pathologic findings on teeth more anterior in the mouth. PATIENTS AND METHODS: The present analysis included dentate participants, 52 to 74 years old, from the Dental Atherosclerosis Risk in Communities study who had undergone an oral examination that included periodontal probing depths (PDs) on all visible teeth, including any third molars. A PD of 4 mm or more and a clinical attachment level of 3 mm or greater were indicator variables for periodontal pathologic features. Explanatory variables were the presence or absence of visible third molars. The covariates included gender, ethnicity, age, income level, education, and smoking status. The outcome variables for periodontal pathologic features were the mean PD, extent (percentage of probing sites) of PDs of 4 mm or more, and the extent (percentage of probing sites) of a clinical attachment level of 3 mm or more. The outcomes between those with and without visible third molars were compared using descriptive statistics and chi-square tests, with significance set at P = .05. Multivariate modeling was performed using Statistical Analysis Systems SAS Proc GLM (SAS Institute, Cary, NC) to calculate the least squared means, adjusting for the study outcome variables and covariates. RESULTS: The Dental Atherosclerosis Risk in Communities study sample included 6,793 subjects; 80% were white and 19% were black. Most (53%) were 62 to 74 years old and female (54%). Of the 6,793 participants, 2,035 (30%) had at least 1 visible third molar. The presence of a visible third molar was significantly associated with male gender, black race, age younger than the mean of 62.4 years, greater income, and never smoking (all P < .01). A greater mean PD for the first and second molars, the extent of PD of 4 mm or more at the first and second molars, and the extent of a clinical attachment level of 3 mm or more at the first and second molars were all significantly associated with the presence of a visible third molar in the unadjusted and adjusted models. CONCLUSIONS: In these middle-age and older Americans, the presence of a visible third molar was significantly associated with more severe periodontal disease on teeth more anterior in the mouth compared with those subjects with no visible third molars.

Maternal periodontal disease and soluble fms-like tyrosine kinase-1 expression.

BACKGROUND: This study was conducted to examine the relationship between maternal periodontal disease and plasma angiogenic factor expression of soluble fms-like tyrosine kinase (sFlt)-1. METHODS: This was a nested case-control study of 220 women, including 45 healthy women with evidence of active periodontal disease, 98 women without evidence of active periodontal disease, 13 women with fetal exposure to oral pathogens, and 64 women without fetal exposure to oral pathogens. Active periodontal disease was defined as the presence of moderate/severe periodontal disease and evidence of periodontal disease progression. Fetal exposure to oral pathogens was determined by fetal immunoglobulin M (IgM) umbilical cord seropositivity. Maternal plasma was collected at <26 weeks of gestation; umbilical cord blood was collected at delivery. sFlt-1 was measured with an immunoradiometric assay. Demographic and medical data were chart abstracted. Maternal variables and sFlt-1 concentrations were compared between cases and controls using the Student t and chi(2) tests and analysis of variance. RESULTS: The median sFlt-1 concentration at the time of enrollment for all women was 2,374 pg/ml (interquartile range [IQR]: 1,504 to 3,194 pg/ml). Women with evidence of fetal exposure to oral pathogens had significantly higher sFlt-1 concentrations compared to IgM-negative fetuses (3,383 pg/ml [IQR: 2,610 to 4,244 pg/ml] versus 2,123 pg/ml [IQR: 1,456 to 3,011 pg/ml]; P = 0.03). CONCLUSION: Fetal exposure to oral pathogens was associated with increased plasma concentrations of sFlt-1 early in pregnancy.

Periodontal disease adversely affects the survival of patients with end-stage renal disease.

Periodontal disease is associated with cardiovascular disease and is thought to accelerate systemic atherosclerosis. Here we examined the relationship between periodontitis and cardiovascular disease mortality in outpatients on hemodialysis using a retrospective analysis of 168 adult patients in New York City and North Carolina. During 18 months of follow-up, cardiovascular disease and all-cause mortality were determined from a centralized dialysis registry. One hundred patients had mild or no periodontal disease but the remaining 68 had moderate-to-severe disease defined as 2 or more teeth with at least 6 mm of inter-proximal attachment loss. At baseline, the proportion of males was significantly lower in the moderate-to-severe group. Compared with mild or no periodontal disease, moderate-to-severe disease was significantly associated with death from cardiovascular causes. Adjustment for age, gender, center and dialysis vintage, smoking status, and history of diabetes mellitus or hypertension did not diminish the strength of this association. Our findings suggest a need for larger studies to confirm this connection, along with intervention trials to determine if treating periodontitis reduces cardiovascular disease mortality in dialysis patients.

Periodontal disease early in pregnancy is associated with maternal systemic inflammation among African American women.

BACKGROUND: Maternal periodontal disease is a chronic oral infection with local and systemic inflammatory responses and may be associated with adverse pregnancy outcomes. This study determined whether maternal periodontal disease in early pregnancy is associated with elevated serum C-reactive protein (CRP) levels and whether maternal race influences the relationship between maternal periodontal disease and systemic inflammatory responses. METHODS: A secondary analysis of prospectively collected data from the Oral Conditions and Pregnancy study was conducted. Healthy women at <26 weeks of gestation underwent an oral health examination and had blood collected. Periodontal disease was categorized by clinical criteria, and maternal serum was analyzed for CRP levels using highly sensitive enzyme-linked immunosorbent assay kits. An elevated CRP level was defined as >75th percentile. Demographic and medical data were obtained from the women's charts. Chi-square and multivariable logistic regression models were used to determine maternal factors associated with an elevated CRP. An adjusted odds ratio (OR) for elevated CRP levels was calculated and stratified by race and periodontal disease category. RESULTS: The median (interquartile) CRP level was 4.8 (0.6 to 15.7) microg/ml, and an elevated CRP level (>75th percentile) was 15.7 microg/ml. African American race and moderate/severe periodontal disease were significantly associated with elevated CRP levels. When stratified by race, moderate/severe periodontal disease remained associated with an elevated CRP level among African American women (adjusted OR: 4.0; 95% confidence interval [CI]: 1.2 to 8.5) but not among white women (adjusted OR: 0.9; 95% CI: 0.2 to 3.6) after adjusting for age, smoking, parity, marital status, insurance status, and weight. CONCLUSION: Among African American women, moderate/severe periodontal disease is associated with elevated CRP levels early in pregnancy.