Prediction of Periodontitis Occurrence: Influence of Classification and Sociodemographic and General Health Information.

BACKGROUND: Prediction of periodontitis development is challenging. Use of oral health-related data alone, especially in a young population, might underestimate disease risk. This study investigates accuracy of oral, systemic, and socioeconomic data on estimating periodontitis development in a population-based prospective cohort. METHODS: General health history and sociodemographic information were collected throughout the life-course of individuals. Oral examinations were performed at ages 24 and 31 years in the Pelotas 1982 birth cohort. Periodontitis at age 31 years according to six classifications was used as the gold standard to compute area under the receiver operating characteristic curve (AUC). Multivariable binomial regression models were used to evaluate the effects of oral health, general health, and socioeconomic characteristics on accuracy of periodontitis development prediction. RESULTS: Complete data for 471 participants were used. Periodontitis classifications with lower thresholds yielded superior predictive power. Calculus, pocket, or bleeding presence at age 24 years separately presented fair accuracy. Accuracy increased using multivariable models; for example, the Beck et al. classification AUC from 0.59 to 0.75 combining proportion of teeth with calculus, bleeding, or pocket with income; number of lost teeth; sex; education; people living in the house; prosthetic needs; or number of decayed, missing, or filled teeth (DMFT). Proportion of teeth with pocket, bleeding, or calculus; number of DMFT; toothbrushing frequency; blood pressure; sex; and income were most frequently associated. CONCLUSIONS: Choice of classification might have an impact on accuracy to predict periodontitis occurrence. Regardless of the classification, predictive value for development of periodontitis in young adults might be increased by combining periodontal information, sociodemographic information, and general health history.

Pocket depth and bleeding on probing and their associations with dental, lifestyle, socioeconomic and blood variables: a cross-sectional, multicenter feasibility study of the German National Cohort.

BACKGROUND: To investigate the periodontal disease status in a multi-center cross-sectional study in Germany. Associations of dental, socio-economic, blood and biomedical variables with periodontal outcome parameters were evaluated. METHODS: From 4 different centers N = 311 persons were included, drawn randomly from the registration offices. Maximal pocket depth (PD) was used as primary indicator for periodontitis. It was classified as: no/mild ≤3 mm, moderate 4-5 mm, severe ≥6 mm. Associations between socioeconomic (household income, education), lifestyle, and biomedical factors and PD or bleeding on probing (BOP) per site ("Yes"/"No") was analyzed with logistic regression analysis. RESULTS: Mean age of subjects was 46.4 (range 20-77) years. A significantly higher risk of deeper pockets for smokers (OR = 2.4, current vs. never smoker) or persons with higher BMI (OR = 1.6, BMI increase by 5) was found. Severity of periodontitis was significantly associated with caries lesions (p = 0.01), bridges (p < .0001), crowns (p < .0001), leukocytes (p = 0.04), HbA1c (p < .0001) and MCV (p = 0.04). PD was positively correlated with BOP. No significant associations with BOP were found in regression analysis. CONCLUSIONS: Earlier findings for BMI and smoking with severity of PD were confirmed. Dental variables might be influenced by potential confounding factors e.g. dental hygiene. For blood parameters interactions with unknown systemic diseases may exist.

Monitoring for periodontal inflammatory disease in the third molar region.

PURPOSE: To assess changes at 2-year intervals in the periodontal status of the third molar region in participants enrolled with asymptomatic third molars and no clinical evidence of third molar region periodontal pathology. PARTICIPANTS AND METHODS: The included participants who presented with a healthy periodontal status (all probing depths [PDs], <4 mm) in the third molar region, defined as distal of second molars and around adjacent third molars, were from a larger longitudinal study of participants with asymptomatic third molars. Full-mouth periodontal PD data from 6 sites per tooth were obtained clinically at enrollment and at subsequent 2-year intervals. Data were aggregated to the patient level. Outcome variables were the presence or absence of periodontal pathology, defined as at least 1 PD of at least 4 mm in the third molar region. RESULTS: One hundred twenty-nine participants had a third molar region PD shallower than 4 mm at enrollment. Most participants were Caucasian (85%), women (60%), younger than 25 years (62%), educated beyond high school (84%), and with good oral health habits. At 6 years, excluding the 61 participants lost to follow-up, 47% participants had had third molars removed, 21% had developed at least 1 PD of at least 4 mm in the third molar region since enrollment, and 32% retained the periodontal status at enrollment (all PDs in third molar region, <4 mm). Demographic characteristics were not statistically different for participants followed for 6 years compared with those lost to follow-up. CONCLUSIONS: Although not all participants could be followed for 6 years after enrollment or chose to retain third molars, one third of participants maintained the third molar region periodontal status assessed at baseline for 6 years after enrollment; no clinical evidence of pathology developed over time.

Incorporating severity and risk as factors to the Fardal cost-effectiveness model to create a cost-benefit model for periodontal treatment.

BACKGROUND: A previously described economic model was based on average values for patients diagnosed with chronic periodontitis (CP). However, tooth loss varies among treated patients and factors for tooth loss include CP severity and risk. The model was refined to incorporate CP severity and risk to determine the cost of treating a specific level of CP severity and risk that is associated with the benefit of tooth preservation. METHODS: A population that received and another that did not receive periodontal treatment were used to determine treatment costs and tooth loss. The number of teeth preserved was the difference of the number of teeth lost between the two populations. The cost of periodontal treatment was divided by the number of teeth preserved for combinations of CP severity and risk. RESULTS: The cost of periodontal treatment divided by the number of teeth preserved ranged from (US) $1,405 to $4,895 for high or moderate risk combined with any severity of CP and was more than $8,639 for low risk combined with mild CP. The cost of a three-unit bridge was $3,416, and the cost of a single-tooth replacement was $4,787. CONCLUSION: Periodontal treatment could be justified on the sole basis of tooth preservation when CP risk is moderate or high regardless of disease severity.

Significance of Periodontal Risk Assessment in the recurrence of periodontitis and tooth loss.

AIM: To investigate the association of the Periodontal Risk Assessment (PRA) model categories with periodontitis recurrence and tooth loss during supportive periodontal therapy (SPT) and to explore the role of patient compliance. MATERIAL AND METHODS: In a retrospective cohort, PRA was performed for 160 patients after active periodontal therapy (APT) and after 9.5 +/- 4.5 years of SPT. The recurrence of periodontitis and tooth loss were analysed according to the patient's risk profile (low, moderate or high) after APT and compliance with SPT. The association of risk factors with tooth loss and recurrence of periodontitis was investigated using logistic regression analysis. RESULTS: In 18.2% of patients with a low-risk profile, in 42.2% of patients with a moderate-risk profile and in 49.2% of patients with a high-risk profile after APT, periodontitis recurred. During SPT, 1.61 +/- 2.8 teeth/patient were lost. High-risk profile patients lost significantly more teeth (2.59 +/- 3.9) than patients with moderate- (1.02 +/- 1.8) or low-risk profiles (1.18 +/- 1.9) (Kruskal-Wallis test, p=0.0229). Patients with erratic compliance lost significantly (Kruskal-Wallis test, p=0.0067) more teeth (3.11 +/- 4.5) than patients compliant with SPT (1.07 +/- 1.6). CONCLUSIONS: In multivariate logistic regression analysis, a high-risk patient profile according to the PRA model at the end of APT was associated with recurrence of periodontitis. Another significant factor for recurrence of periodontitis was an SPT duration of more than 10 years.

Clinical assessment of peri-implant tissues in patients with varying severity of chronic periodontitis.

PURPOSE: This retrospective study assessed the health of peri-implant tissues in patients with varying severity of chronic periodontitis. MATERIALS AND METHODS: Sixty-one subjects aged 44 to 70 years (median age 58 years) were recruited. Based on severity of periodontitis, 31 subjects were classified as having severe generalized chronic periodontitis, and the remaining 30 subjects had mild or no periodontitis. Social and medical histories were obtained from each patient. A comprehensive periodontal examination included: plaque index, gingival index, bleeding index, probing depth, clinical attachment level, and radiographic bone loss. Data were analyzed using Fisher's exact and chi-square tests for categorical variables, and t-test for continuous variables. RESULTS: There was a statistically significant greater loss of attachment (p < .05) around implants in the group with severe periodontitis compared to the no/mild periodontitis group. CONCLUSION: Because of the greater loss of clinical attachment around implants placed in patients with generalized severe chronic periodontitis, close monitoring of these patients is suggested to prevent both development of peri-implantitis and recurrence of periodontal infection.

Assessment of periodontal conditions and systemic disease in older subjects.

BACKGROUND: An increased risk for periodontitis has been associated both with type-1 or insulin dependent diabetes (IDDM) and with type-2 or non-insulin dependent diabetes (NIDDM). AIMS: 1) To describe and analyze periodontal conditions in older low-income ethnic diverse subjects with or without a diagnosis of diabetes. 2) To assess to what extent diabetes mellitus is associated with periodontal status, and 3) how periodontitis ranks as a coexisting disease among other diseases in subjects with diabetes mellitus. MATERIAL AND METHODS: Radiographic signs of alveolar bone loss were studied in 1101 older subjects 60-75 years old (mean age 67.6, SD+/-4.7). The number of periodontal sites and the proportions of teeth with probing depth (PD) > or =5 mm, clinical attachment levels (CAL) > or =4 mm were studied in a subset of 701 of the subjects. RESULTS: IDDM was reported by 2.9% and NIDDM by 9.2% of the subjects. The number of remaining teeth did not differ by diabetic status. The number of sites with PD > or =5 mm and the proportion of PD with > or =5 mm was significantly smaller in the non-diabetic group (chi2=46.8, p<0.01, and chi2=171.1, p<0.001, respectively). Statistical analysis failed to demonstrate group differences for the number and proportions of sites with CAL > or =4 mm and for radiographic findings of alveolar bone loss. Combining all periodontal parameters revealed that the Mantel-Haenszel common odds of having IDDM/NIDDM and periodontitis was 1.8 : 1 (95% CI: 1.1-3.1, p<0.03). The common odds ratio estimate of an association between heart disease and diabetes was 3.6 : 1 (95% CI: 2.1-2.6, p<0.001). CONCLUSIONS: Probing depth differences between IDDM/NIDDM vs. non-diabetic subjects may reflect the presences of pseudo-pockets and not progressive periodontitis in many subjects with diabetes mellitus. Periodontitis is not a predominant coexisting disease in older subjects with diabetes mellitus.

Periodontitis in a 13-year old: an illustration of a new periodontal classification.

This report describes a periodontal abscess and bone loss in a 13-year-old boy being treated as a patient in the Dental Benefit Scheme, a year after his entry to the Scheme. His condition illustrates well the rationale of a new classification for periodontitis. We suggest that periodontal screening is important so that instances such as this can be identified earlier; a small number of young patients require conventional, conservative periodontal treatment and ongoing monitoring of periodontal disease.

Retrospective assessment of clinical and microbiological factors affecting periimplant tissue conditions.

An increasing number of studies point to the detrimental effect of plaque bacteria on periimplant tissue health. The purpose of this retrospective study was to explore a possible relationship between the clinical and microbiological periimplant conditions of osseointegrated oral implants after several years of service and the dental and medical history, as well as the conditions of the residual dentition. 45 partially edentulous patients (mean age: 51 years, range: 27-83 years), with a total of 64 implants participated in this retrospective analysis. The time between examination and the last dental visit ranged from 6 to 24 months (mean: 13 months) and the time since the last maintenance therapy appointment with a dental hygienist ranged between 3 and 24 months (mean 7 months). During 5 to 10 years between implant installation and examination, 9 implants experienced one episode and an additional 6 implants two episodes of periimplantitis. As a consequence of extensive bone loss associated with these infections, one of these implants, in a patient who had a history of diabetes, was lost. With this exception, the other episodes of periimplantitis were successfully treated employing the principles of the Cumulative Interceptive Supportive Therapy (CIST) protocol. At examination, 42 implants (66%) showed a probing pocket depth exceeding 4 mm. Of the periimplantitis sites, four implants showed cultural evidence for presence of Porphyromonas gingivalis, and 2 implants were positive for Actinobacillus actinomycetemcomitans. Statistical analysis revealed a significant relationship between periimplant probing depth and the total anaerobic cultivable microbiota as well as the frequency of detection of P. gingivalis.

Computer-aided risk management--a software tool for the Hidep model.

OBJECTIVE: The Hidep risk management model has been developed and tested in clinical settings with promising results, but a tool facilitating the work has been suggested. The aim of the present study was to create and evaluate a computerized tool capable of creating overviews of the oral health situation as well as identifying risk factors and at-risk patients. The system developed should also facilitate the clinical work, for example, by assisting the user with automatic calculation of suitable Hidep groups and selection and printing of relevant patient information letters. METHOD AND MATERIALS: The system developed was based on the Hidep model, combining a number of available examination methods, risk estimation systems, and treatment suggestions. The development strategy included stepwise improvements and functionality increase based on continuous clinical applicability tests in a large international test bed. RESULTS: The results indicated that the software created was user friendly enough to be used in a common dental clinic and capable of handling the basic data of both patients and their oral health situation. The system could present useful statistics and graphs describing the overall oral health situation and identifying relevant risk groups and risk factors, based on virtually unlimited parameter combinations. CONCLUSION: The computer system developed seems to be an important step toward the possibility of creating a close-to-the-clinic model for oral health care management based on actual and locally derived patient data and risk factors. The results of this project encourage further studies of the Hidep model and its computer support.

Assessment of in vitro interleukin-2-producing capacity of peripheral blood lymphocytes from patients with periodontitis.

In this cross-sectional study, we assessed the in vitro interleukin-2 (IL-2) producing capacity of peripheral blood mononuclear cells (PBMC) and lymphocytes from patients with different forms of periodontitis. 45 patients (12 with localised early onset periodontitis (LEOP), 20 with generalised early onset periodontitis (GEOP), and 13 with adult periodontitis (AP), and 20 periodontally healthy subjects (HS), participated in this study. PBMC and lymphocytes were isolated from the subjects and their cells were stimulated with an anti-CD3 monoclonal antibody (anti-CD3 MoAb) and the secreted IL-2 levels in the culture were bioassayed. No significant differences could be found in IL-2 producing activity of PBMC between the patients and HS group. There was wide interindividual variation and high and low "IL-2 producers" were noted. We found a LEOP patient who was a high producer of IL-2 (> mean + 8 SD) and 2 LEOP patients and a HS who were low producers of IL-2 (< mean - 1.5 SD) with their lymphocytes. Incidentally, the HS became a LEOP patient during 2 years after this study. The low IL-2 producing activity of their PBMC and lymphocytes against anti-CD3 MoAb could not be overcome by stimulation with phorbol myristate acetate and ionomycin. Thus, we found high and low IL-2 producing capacity by PBMC and lymphocytes in certain subjects and these subjects may be useful models in assessing the role of systemic IL-2 productivity associated with their progression of periodontal disease.

Clinical assessment of periodontitis in young adults--evaluation of probing depth and partial recording methods.

The present study was carried out to compare the ability of different methods of periodontal assessment to identify those subjects in a population who had suffered the worst periodontal breakdown. Comparisons were made between full mouth approximal attachment loss (CAL) assessment and methods relying on pocket probing depth (PPD) evaluation or on partial recording of CAL or PPD. Both of the latter types of assessment are commonly used in epidemiological surveys. 202 workers at an electronics factory aged between 20 and 40 yr were examined for approximal PPD and CAL, excluding third molars. The data were used to determine which individuals had the worst periodontitis based on CAL at several thresholds. Further analysis was carried out to determine which of these subjects would have been identified on the basis of the presence of deep (> or = 6 mm) pocketing, or by using one of a battery of partial recording subsets. CAL was frequently present in the absence of deep pocketing. A subset made up of four approximal sites around each of the 10 index teeth recommended by the WHO for partial recording (two molars in each quadrant and maxillary right and mandibular left central incisors) and a subset comprising maxillary buccal and mandibular lingual sites ("Pritchard" sites) performed best of the subsets considered in identifying the subjects who had been found by full mouth assessment to have at least one or at least two approximal sites with CAL at thresholds of 2, 3 or 4 mm. It was concluded that measurements of CAL using either of these subsets should reduce problems of under-recording of the prevalence of periodontitis associated with the use of PPDs alone or on CAL assessment at other partial recording subsets.