Association between periodontal condition and blood pressure is confounded by smoking.

OBJECTIVE: To investigate the role of smoking as a confounding factor in the association between periodontal pocketing and blood pressure. MATERIAL AND METHODS: After restriction to 45-64-year-old subjects without hypertension, diabetes, rheumatic diseases, obesity and with no history of cardiovascular diseases or ongoing lipid-lowering medications, the study population consisted of 307 subjects of the Health 2000 Survey in Finland. Systolic and diastolic blood pressure and pulse pressure (mmHg) were used as outcome variables. Periodontal condition was measured by the number of teeth with ≥4 mm periodontal pockets. ß-estimates and 95% confidence intervals (CI) were obtained from linear regression models. Analyses were made in the whole study population and stratified according to smoking habits/history. RESULTS: The number of teeth with ≥4 mm periodontal pockets associated statistically significantly with systolic blood pressure and pulse pressure in the whole study population. Among never-smokers or daily smokers, there were no consistent nor statistically significant associations between the number of teeth with ≥4 mm periodontal pockets and systolic/diastolic blood pressure or pulse pressure. CONCLUSIONS: Smoking appeared to confound the association between periodontal condition and blood pressure. Thorough control for the effect of smoking was not obtained using multivariate models.

Periodontal condition and ultrasound-based measures of arterial stiffness: results of the Health 2000 Survey.

BACKGROUND: Periodontitis has been associated with inflammatory processes in arterial walls such as impairment in endothelial function and thickening of intima media. As inflammation plays a role also in arterial stiffening, an association between periodontal inflammation and arterial stiffness can be expected. So far, conflicting results of the association between periodontal disease and arterial stiffness have been reported. Many of the earlier studies were conducted in specific populations and heterogeneous measures of both arterial stiffness and periodontal status were used. In this population-based study we aimed to investigate whether periodontal pocketing and gingival bleeding are associated with ultrasound-based measures of arterial stiffness. METHODS: In this cross-sectional study, two sets of data based on the national Health 2000 Survey in Finland were formed. Data set I comprised never-smoking 45-64-year-old dentate (≥ 10 natural teeth), non-diabetic, non-rheumatic, non-obese (BMI ≤ 30 kg/m2), non-hypertensive subjects with no coronary artery disease or ongoing lipid-lowering medications (n = 157). Data set II was formed of an unrestricted 45-74-year-old dentate population (n = 536). Four arterial stiffness measures (carotid artery compliance, Peterson's elastic modulus, Young's elastic modulus and beta stiffness index) based on an ultrasound examination of the common carotid artery were used. Periodontal parameters included the number of teeth with ≥ 4 mm deep periodontal pockets and the number of sextants with gingival bleeding. ß-estimates, confidence intervals, and p-values were obtained from linear regression models. RESULTS: In Data set I, the adjusted ß-estimates for the association between the number of teeth with ≥ 4 mm deep periodontal pockets and Peterson's elastic modulus and Young's elastic modulus were 15.80 (p = 0.12) and 61.02 (p = 0.22), respectively. The respective ß-estimates were 31.06 (p = 0.17) and 121.16 (p = 0.28) for the association between the number of bleeding sextants and these two stiffness measures. The results in Data set II were in line with the results in Data set I, with the exception that the adjusted ß-estimates for the associations between Peterson's elastic modulus and Young's elastic modulus and periodontal parameters were closer to null. CONCLUSIONS: This population-based study did not provide evidence of an association between periodontal condition and arterial stiffness.

Association of long-term obesity and weight gain with periodontal pocketing: Results of the Northern Finland Birth Cohort 1966 study.

AIM: To investigate whether obesity, central obesity, and weight gain are associated with periodontal pocketing. MATERIALS AND METHODS: A never-smoking sub-population (n = 725) of the Northern Finland Birth Cohort 1966 was categorized based on body mass index (BMI; participants with normal weight, overweight, and obesity) and waist circumference (WC; participants without central obesity and with central obesity) at ages 31 and 46. The categories were combined to define whether the participants stayed in the respective BMI and WC categories or moved on to a higher category during follow-up. A periodontal examination was done at age 46. RESULTS: WC was more consistently associated with periodontal pocketing than BMI. The relative risks for the number of sites with periodontal pocket depth (PPD) ≥4 mm and bleeding PPD ≥4 mm in participants with central obesity both at age 31 and at age 46 were 1.7 (95% confidence interval [CI] 1.4-2.0) and 2.1 (95% CI 1.6-2.6). The corresponding values for participants who had no central obesity at age 31 but had central obesity at age 46 were 1.6 (95% CI 1.4-1.8) and 1.9 (95% CI 1.6-2.3). CONCLUSION: Of all the studied measures, central obesity appeared to be most strongly associated with the inflammatory condition of the periodontium.

Association of hyperglycaemia with periodontal status: Results of the Northern Finland Birth Cohort 1966 study.

AIM: To investigate the association of hyperglycaemia and changes in glycaemic control with periodontal status in non-diabetic individuals. MATERIALS AND METHODS: A sub-population (n = 647) of the Northern Finland Birth Cohort 1966 was studied. We categorized long-term glucose balance based on fasting plasma glucose (FPG) at ages 31 and 46: FPG <5.0 mmol/l (strict normoglycaemia), FPG 5.0-5.59 mmol/l (slightly elevated FPG) and FPG 5.6-6.9 mmol/l (prediabetes). Probing pocket depth (PPD) and alveolar bone level (BL) data were collected at age 46. Relative risks (RR, 95% CI) were estimated using Poisson regression models. RESULTS: Periodontal status was poorer in individuals whose glucose balance worsened from age 31 to 46 years than in those with a stable glucose balance. In the case of strict normoglycaemia at age 31 and slightly elevated FPG or prediabetes at age 46, the RRs for PPD ≥4 mm were 1.8 (95% CI 1.4-2.2) and 2.8 (95% CI 2.0-3.8) and for BL ≥5 mm 1.1 (95% CI 0.8-1.4) and 1.8 (95% CI 1.2-2.8), respectively. CONCLUSION: The results of this population-based cohort study suggest that impairment in glucose control in non-diabetic individuals is associated with periodontal pocketing and alveolar bone loss.

Effect of smoking on periodontal health and validation of self-reported smoking status with serum cotinine levels.

OBJECTIVE: To investigate whether self-reported smoking and serum cotinine levels associate with periodontal pocket development and to determine the accuracy of self-reported smoking using serum cotinine. MATERIALS AND METHODS: This 4-year prospective cohort study included data from 294 dentate adults, aged ≥30 years, who participated in both the Health 2000 Survey and the Follow-up Study of Finnish Adults' Oral Health. Subjectively reported smoking status (daily smokers n = 62, occasional smokers n = 12, quitters n = 49, and never-smokers n = 171), serum cotinine levels, demographic factors, education level, dental behaviours and medical history were collected at baseline. The outcome measure was the number of teeth with periodontal pocketing ≥4 mm over 4 years. RESULTS: Self-reported daily smokers had 1.82 (95% CI: 1.32-2.50) higher incidence of deepened periodontal pockets than never-smokers. A positive association was observed between serum cotinine (≥42.0 µg/L) and the development of periodontal pockets. The misclassification rate of self-reported smoking was 6%. CONCLUSIONS: Both self-reported daily smoking and higher serum cotinine were associated with periodontal pocket development. Self-reported smoking was fairly accurate in this study. However, higher cotinine levels among a few self-reported never-smokers indicated misreporting or passive smoking. Thus, self-reports alone are not enough to assess the smoking-attributable disease burden.

Behavioural and socioeconomic factors associated with the simultaneous occurrence of periodontal disease and dental caries.

Objective: The aim was to evaluate the association of behavioural and socioeconomic factors with the occurrence of periodontal disease and dental caries, paying special attention to the simultaneous occurrence of these diseases.Materials and methods: The study population consisted of 5255 dentate persons aged ≥30 years from a nationally representative survey. Caries and probing pocket depth were recorded by tooth and calculated in relation to the number of existing teeth. The groups were: non-affected (A), the two most affected quintiles for periodontal disease with little or no dental caries (B), the two most affected quintiles for dental caries with little or no periodontal disease (C) and the two most affected quintiles for both periodontal disease and dental caries (D). Presence of dental plaque was determined, and behavioural and socioeconomic factors were established.Results: Dental plaque, smoking, lack of regular dental check-ups, older age and a basic level of education were strongly associated with the simultaneous occurrence of periodontal disease and dental caries.Conclusions: There are many behavioural and socioeconomic factors that associate with the occurrence of both periodontal disease and dental caries. These factors also increase the risk of individuals having these diseases simultaneously.

Periodontitis is associated with incident chronic liver disease-A population-based cohort study.

BACKGROUND & AIMS: Chronic liver disease is a major health concern worldwide and the identification of novel modifiable risk factors may benefit subjects at risk. Few studies have analyzed periodontitis as a risk factor for liver complications. We studied whether periodontitis is associated with incident severe liver disease. METHODS: The study comprised 6165 individuals without baseline liver disease who participated in the Finnish population-based Health 2000 Survey (BRIF8901) during 2000-2001, a nationally representative cohort. Follow-up was until 2013 for liver-related admissions, liver cancer and mortality from National Hospital Discharge, Finnish Cancer Registry and Causes of Death Register, Statistics Finland. Mild to moderate periodontitis was defined as ≥1 tooth with periodontal pocket ≥4 mm deep, and advanced periodontitis as ≥5 teeth with such pockets. Multiple confounders were considered. RESULTS: A total of 79 subjects experienced a severe liver event during follow-up. When adjusted for age, sex and number of teeth, hazards ratios by Cox regression regarding incident severe liver disease were, for mild to moderate periodontitis, 2.12 (95% CI 0.98-4.58), and, for advanced periodontitis, 3.69 (95% CI 1.79-7.60). These risk estimates remained stable after additionally adjusting for alcohol use, smoking, metabolic risk, serum gamma-glutamyltransferase, dental-care habits, lifestyle and socioeconomic status. Periodontal disease-associated liver risk was accentuated among subjects with non-alcoholic fatty liver disease or heavy alcohol use at baseline. CONCLUSIONS: Periodontitis was associated with incident liver disease in the general population independently of various confounders. As a preventable disease, periodontal disease might present a modifiable risk factor for chronic liver disease.

Interdental cleaning and periodontal pocketing among finnish adults.

AIM: To investigate the relationship between frequency of interdental cleaning and 11-year change in teeth with periodontal pocketing in Finnish adults. METHODS: Data from 1667 dentate adults, aged 30 to 82 years, who participated in the Health 2000 survey and were re-examined in 2004 and/or 2011 were analysed. Participants reported their frequency of interdental cleaning (either dental floss or interdental brush) at baseline. Teeth with periodontal pocketing (PD) ≥4 mm were counted in every survey and treated as a repeated outcome. The association between the frequency of interdental cleaning and the number of teeth with PD ≥4 mm was evaluated in linear mixed effects models, controlling for demographic factors, socioeconomic position, diabetes, smoking status, toothbrushing frequency, dental attendance and number of teeth. RESULTS: Twelve per cent of adults reported daily interdental cleaning. Significant inverse linear trends in the number of teeth with PD ≥4 mm were found in every survey according to the frequency of interdental cleaning. However, this association was completely attenuated after adjustment for the full set of confounders. Contrarily, toothbrushing frequency was negatively associated with the baseline number of teeth with PD ≥4 mm and its rate of change over time. CONCLUSION: Interdental cleaning was not associated with 11-year change in periodontal pocketing after accounting for other established risk factors for periodontal disease.

Long-term metabolic syndrome is associated with periodontal pockets and alveolar bone loss.

AIM: To investigate whether the metabolic syndrome (MetS) is associated with deepened periodontal pockets and alveolar bone loss. MATERIALS AND METHODS: This study was based on a subpopulation of the Northern Finland Birth Cohort 1966 survey (n = 1964). The criteria of the AHA/NHLBI were used to determine MetS. The analyses were based on the metabolic data at ages 31 and 46, and probing pocket depth and alveolar bone level data at age 46. Relative risks (RR, 95% CI) were estimated using Poisson regression models. RESULTS: Relative risks for PD ≥ 4 mm and BL ≥ 5 mm were higher in individuals with an exposure to MetS ≥ 15 years (RR 1.8, 95% CI 1.6-2.1 and RR 1.5, 95% CI 1.3-1.9, respectively) than in those whose exposure was <15 years (RR 1.2, 95% CI 1.1-1.3 and RR 1.1, 95% CI 1.0-1.3, respectively). Consistently stronger associations were found in never smokers. Women showed stronger associations of MetS with PD ≥ 4 mm than men. The association with BL ≥ 5 mm was observed only in men. CONCLUSION: A long-term exposure by MetS was associated independently and in an exposure-dependent manner with periodontal pockets and alveolar bone level.

Alcohol use and periodontal pocket development: findings from a 4-yr longitudinal study.

This study investigated whether alcohol use influences periodontal pocket development during a 4-yr follow-up period. The study included those participants who took part in both the Health 2000 Survey and the Follow-up Study on Finnish Adults' Oral Health. The participants at baseline were aged ≥30 yr, periodontally healthy, and did not have diabetes or rheumatoid arthritis. The development of periodontal pockets at follow-up was measured as the number of teeth with periodontal pockets and the presence of periodontal pockets. Alcohol use at baseline was measured as g/wk, frequency, and use over the risk limit. Incidence rate ratios with 95% CI were estimated using negative binomial regression models and Poisson regression models with a robust variance estimator. No consistent association was found between any of the alcohol variables and periodontal pocket development in the total population or among non-smokers. Among smokers, a positive association was found with the frequency of alcohol use. In general, risk estimates were slightly higher for women than for men. In summary, light-to-moderate alcohol use appears not to be consistently associated with the development of periodontal pockets. The adverse effects on the periodontium seem, to some extent, to be dependent on gender and smoking.

Intake of different alcoholic beverages and periodontal condition.

Objective: The objective of this study is to study the association of alcoholic beverages and serum gamma-glutamyltransferase (GGT) level with periodontal condition. Material and methods: The study included 4294 dentate, non-diabetic Finnish adults aged 30-65 years who underwent periodontal examination during the Health 2000 Survey. The number of teeth with deepened (≥4 mm) periodontal pockets was the outcome. The exposures were self-reported beverage-specific alcohol intake (amount and frequency) and serum GGT level. The relative risks (RRs) and 95% confidence intervals (CI) were obtained by fitting zero-inflated negative binomial regression models. Results: We found no consistent association of either the intake of different alcoholic beverages or GGT level with the number of teeth with deepened periodontal pockets in the total study population or among the non-smokers. Among the highly educated non-smokers, spirit intake was associated with a low likelihood of having teeth with deepened periodontal pockets; RRs varied between 0.3 and 0.8. Among the non-smokers who had basic or intermediate education, spirit intake was associated with a higher likelihood of having teeth with deepened periodontal pockets; RRs varied between 1.2 and 1.8. Conclusion: In general, neither the intake of different alcoholic beverages nor the GGT level was consistently associated with the number of teeth with deepened periodontal pockets.

Association between alcohol use and periodontal pockets in Finnish adult population.

OBJECTIVE: To investigate whether alcohol use is associated with deepened periodontal pockets and whether this association is dependent on age, gender or socioeconomic position (SEP). MATERIAL AND METHODS: This cross-sectional study, based on the Health 2000 Survey, consisted of dentate, non-smoking Finnish adults aged 30-65 years (n = 3059). The outcome was the number of teeth with deepened (≥4 mm) periodontal pockets. The exposure was self-reported alcohol use assessed as amount, frequency, and use over the risk limit. Zero-inflated negative binomial regression models were used to estimate relative risks (RRs) and 95% confidence intervals (95% CI). RESULTS: In this study, alcohol use did not consistently associate with the number of teeth with deepened periodontal pockets. An association with the number of teeth with deepened periodontal pockets was found among men, older participants, and those participants belonging to basic or intermediate educational groups. An association with poor periodontal health was observed among men or older participants who belonged to the basic or intermediate educational group, whereas such associations were not observed among those participants belonging to the higher educational group. CONCLUSIONS: The association between alcohol use and periodontal health appears to be confounded by individual characteristics such as age, gender, and especially one's SEP.

Toothbrushing behaviour and periodontal pocketing: An 11-year longitudinal study.

AIM: To explore the association between toothbrushing behaviour and change in periodontal pocketing among adults. METHODS: We pooled data from 1,025 adults, aged 30-89 years, who participated in two national surveys in Finland (Health 2000 and Health 2011, BRIF8901) and reported their toothbrushing frequency. A cumulative measure of regular toothbrushing was created by counting the number of times participants reported brushing twice or more daily across the two surveys (ranging from 0 to 2). The association between toothbrushing behaviour and the number of teeth with periodontal pocket depth (PPD) ≥4 mm over 11 years was assessed in linear regression models adjusting for confounders. RESULTS: There was a clear dose-response relationship between toothbrushing frequency (either at baseline or follow-up) and change in number of teeth with PPD ≥ 4 mm. There was also evidence of a cumulative effect of regular toothbrushing on change in number of teeth with PPD ≥ 4 mm. Participants who reported brushing twice or more a day in both surveys developed 1.99 (95% CI: 1.02-2.95) fewer teeth with PPD ≥ 4 mm than those who did not report this behaviour in any survey. CONCLUSION: This 11-year prospective study showed that toothbrushing behaviour was associated with smaller increments in the number of teeth with periodontal pocketing.

Periodontal condition in relation to the adherence to nutrient recommendations in daily smokers.

AIM: To examine whether a healthy diet based on nutrient recommendations is associated with periodontal condition in smokers. MATERIAL AND METHODS: Daily smokers from the cross-sectional Health 2000 Survey (BRIF 8901) in Finland were analysed in two age groups (30-49 and 50-79 years, n = 704 and 267) and according to the level of oral hygiene. Periodontal condition was measured as the number of sextants with gingival bleeding and teeth with ≥4 mm deepened periodontal pockets. Information on nutrition was collected by a validated food frequency questionnaire and measured using the Baltic Sea Diet Score (BSDS) and the Recommended Finnish Diet Score (RFDS). RESULTS: In the total study population, no association between the scores and periodontal condition was observed. Among 30- to 49-year-old participants with good oral hygiene, diet scores associated inversely with the number of teeth with deepened periodontal pockets (p = .078 (BSDS) and p = .027 (RFDS)). CONCLUSIONS: In a representative sample of Finnish adults who smoke, a healthy diet was not associated with periodontal condition. Among a younger age group with good oral hygiene, a healthy diet associated with better periodontal condition. Age and oral hygiene appeared to modify the association between diet and periodontal condition.

Association between periodontal condition and the development of type 2 diabetes mellitus-Results from a 15-year follow-up study.

AIM: To study whether periodontal condition is associated with the development of type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS: A population-based follow-up study was conducted among persons born in 1935 and living in the city of Oulu, Finland (n = 395). The baseline examinations were done during 1990-1992, and the follow-up examinations were done during 2007-2008. The data were gathered by questionnaires, laboratory tests and clinical measurements. Poisson regression models were used in the data analyses. RESULTS: The adjusted rate ratios (RR) with 95% confidence intervals (95% CI) for the incident T2DM among subjects with 4-5 mm deep periodontal pockets (n = 98), among subjects with 6 mm deep or deeper periodontal pockets (n = 91), and among edentulous subjects (n = 118) were 1.32 (95% CI: 0.69-2.53), 1.56 (95% CI: 0.84-2.92) and 1.00 (95% CI: 0.53-1.89), respectively, compared to dentate subjects without deepened (4 mm deep or deeper) periodontal pockets (n = 88). The adjusted RR per site (the number of sites with deepened periodontal pockets as a continuous variable) was 1.02 (95% CI: 1.00-1.04). CONCLUSIONS: Poor periodontal condition may be a predictor of the development of T2DM. However, the causality between periodontal condition and the development of T2DM remains uncertain.

Dental and periodontal health in Finnish adults in 2000 and 2011.

OBJECTIVE: We assessed dental and periodontal health in adults aged ≥30 years living in southern and northern Finland as part of the Health 2000/2011 Surveys (BRIF8901). MATERIAL AND METHODS: Clinical findings in 2000 (n = 2967) and 2011 (n = 1496) included the presence of teeth and number of teeth with caries, fillings, fractures or periodontal pockets. RESULTS: Edentulousness decreased in all age groups. The prevalence of those with no caries increased from 67% to 69% in men and from 80% to 85% in women, and of those with no periodontal pocketing from 26% to 30% in men and from 39% to 42% in women. In 2011, the mean number of decayed teeth was 0.8 in men and 0.3 in women, and the corresponding mean numbers of teeth with deepened periodontal pockets 5.6 and 3.7. The gender difference had levelled concerning edentulousness, number of teeth and DMF teeth, but still existed in the occurrence of caries and periodontal pocketing. CONCLUSION: The findings were in line with other population-based reports in the 2000s. However, periodontal health in Finland seems not to be as good as in many European countries and in the USA.

Anticholinergic burden and dry mouth among Finnish, community-dwelling older adults.

OBJECTIVE: The aim was to study whether the anticholinergic burden of drugs is related to xerostomia and salivary secretion among community-dwelling elderly people. BACKGROUND: Anticholinergic drugs have been shown to be a risk factor for dry mouth, but little is known about the effects of cumulative exposure to anticholinergic drugs measured by anticholinergic burden on salivary secretion or xerostomia. METHODS: The study population consisted of 152 community-dwelling, dentate, non-smoking, older people from the Oral Health GeMS study. The data were collected by interviews and clinical examinations. Anticholinergic burden was determined using the Anticholinergic Drug Scale (ADS). A Poisson regression model with robust error variance was used to estimate relative risks (RR) with 95% confidence intervals (CI 95%). RESULTS: Participants with a high-anticholinergic burden (ADS ≥ 3) were more likely to have xerostomia (RR: 3.17; CI: 1.44-6.96), low-unstimulated salivary flow (<0.1 mL/min; RR: 2.31, CI: 1.22-4.43) and low-stimulated salivary flow (<1.0 mL/min; RR: 1.50, CI: 0.80-2.81) compared to reference group (ADS 0). In participants with a moderate anticholinergic burden (ADS 1-2), all the risk estimates for xerostomia, unstimulated and stimulated salivary secretion varied between 0.55 and 3.13. Additional adjustment for the total number of drugs, antihypertensives and sedative load caused only slight attenuation of the risk estimates. CONCLUSION: A high-anticholinergic burden was associated with low-unstimulated salivary secretion and xerostomia.

Serum lipids modify periodontal infection - interleukin-6 association.

AIM: The aim of this study was to investigate whether the systemic response against a local inflammatory process in periodontium is dependent on the individual's serum lipid composition. MATERIAL AND METHODS: This study was based on a subpopulation of the Health 2000 Survey that included 878 subjects who were aged between 45 and 64 years, dentate, non-diabetic and non-rheumatic. The inflammatory condition of periodontium was measured by means of the number of teeth with deepened (4 mm or deeper) periodontal pockets. Systemic inflammation was assessed by means of the serum levels of interleukin-6 (IL-6) and tumour necrosis factor alpha (TNF-α). The association between an inflammatory condition in the periodontium and the systemic inflammatory response was analysed using linear regression models. RESULTS: The number of teeth with deepened periodontal pockets was associated with elevated serum IL-6 levels among subjects with an unfavourable lipid composition (low-density lipoprotein cholesterol ≥3.7 mmol/l or high-density lipoprotein cholesterol <1.3 mmol/l). There was no association between serum TNF-α levels and the number of teeth with deepened periodontal pockets in these data. CONCLUSION: The systemic response against the inflammatory condition of periodontium varied between individuals. The variation appeared to be dependent on the serum lipid composition or related factors.

Sedative load, carious teeth and infection in the periodontium among community-dwelling older people.

OBJECTIVE: To study the relation of sedative load to carious teeth and periodontal pocketing - indication of infectious periodontal disease - among older people. MATERIALS AND METHODS: This cross-sectional study was based on a subpopulation of 158 community-dwelling, dentate, non-smoking, 75-year-old or older people from the Oral Health Geriatric Multidisciplinary Strategy study. The data were collected by interviews and clinical oral examinations during 2004-2005. Sedative load was measured by means of the sedative load model, and Poisson multivariate regression models were used to estimate relative risk (RR) with 95% confidence intervals (CI). RESULTS: Participants with a sedative load of either 1-2 (n = 31) or ≥3 (n = 12) had an increased likelihood of having carious teeth (RR: 1.8, CI: 1.2-2.6 and RR: 2.4, CI: 1.4-4.1, respectively) compared to participants without a sedative load. There was an inverse association between sedative load and the number of teeth with periodontal pockets. CONCLUSIONS: Presence of dental caries was associated with the use of drugs with sedative properties. The use of drugs with sedative properties was not associated with the presence of periodontal pockets.

Waist circumference and waist-to-height ratio are associated with periodontal pocketing-results of the Health 2000 Survey.

BACKGROUND: Body mass index (BMI) has been found to associate with different parameters of chronic periodontal disease in previous studies. It is reasonable to expect that central adiposity measures, such as waist circumference and waist-to-height ratio, which indirectly takes into account visceral fat, are more accurate measures of obesity-related oral health risks than BMI. The aim of this study was to examine whether central obesity is associated with periodontal pocketing, an indication of infectious chronic periodontal disease. METHODS: The study was based on a subpopulation from the national Health 2000 Survey in Finland. It included dentate, non-diabetic, never-smoking subjects aged 30-49 (n = 1287). The outcome variable was the number of teeth with deepened periodontal pockets (4 mm or more) and the number of teeth with deep periodontal pockets (6 mm or more). Central obesity was measured by means of waist circumference (WC) and waist-to-height ratio (WHtR). Poisson regression models were used to estimate prevalence rate ratios (PRR) and their 95% confidence intervals. RESULTS: Our main finding was that both WC and WHtR were associated with the number of teeth with deeper (4 mm or more) periodontal pockets; the PRR for the fifth quintile in WC was 1.5, CI: 1.2-1.9 and in WHtR 1.4, CI: 1.1-1.7, when compared to the lowest quintile. Corresponding figures for deep (6 mm or more) periodontal pockets were 2.3, CI: 0.9-6.1 for WC and 1.9, CI: 0.8-4.4 for WHtR. There were no essential differences in the strengths of the associations between WC and WHtR and the number of teeth with deepened periodontal pockets. CONCLUSION: Both central adipose measures-WC and WHtR-seem to be associated with periodontal pocketing in non-diabetic, never-smoking subjects aged 30-49 years old.