History of periodontal disease diagnosis and lung cancer incidence in the Women's Health Initiative Observational Study.

PURPOSE: While some evidence suggests that periodontal disease (PD) might be positively associated with lung cancer, prospective studies in women are limited. Previous findings may reflect residual confounding by smoking. The study aims to determine whether history of PD diagnosis is associated with incident lung cancer in a large cohort of postmenopausal women. METHODS: Prospective analyses were conducted in a cohort of 77,485 postmenopausal women enrolled in the Women's Health Initiative Observational Study. History of PD (prevalence of 26.1 %) was self-reported, and 754 incident lung cancer cases occurred during an average 6.8 (SD ± 2.6) years of follow-up. Cox proportional hazards regression analysis was used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs). RESULTS: Overall, PD was positively associated with lung cancer risk after adjusting for detailed smoking history including smoking status and pack-years of smoking (HR 1.24, 95 % CI 1.07-1.45). There was a positive additive interaction between PD with pack-years of smoking (p = 0.02), suggesting a potential synergistic effect between PD and smoking intensity on lung cancer. The association between PD and lung cancer was stronger in former smokers. When restricted to never-smokers, PD was not associated with lung cancer (HR 1.02, 95 % CI 0.68-1.53). CONCLUSIONS: Periodontal disease was not independently associated with lung cancer in non-smoking postmenopausal women. However, smoking and PD jointly increased lung cancer risk beyond that expected from the sum of the each effect separately. The potential synergism between PD and smoking on lung cancer warrants further examination.

Chronic periodontitis and the risk of tongue cancer.

OBJECTIVE: To assess the association between the history of chronic periodontitis and the risk of tongue cancer. DESIGN: Case-control study using preexisting data from patients admitted between June 15, 1999, and November 17, 2005. SETTING: Department of Dentistry and Maxillofacial Prosthetics at Roswell Park Cancer Institute (RPCI), Buffalo, NY. PATIENTS: The cases comprised 51 non-Hispanic white men newly diagnosed as having primary squamous cell carcinoma of the tongue, and the controls, 54 non-Hispanic white men evaluated during the same period but with negative results for malignancy. Children (aged <21 years), edentulous or immunocompromised patients, and those with history of any cancer were excluded. History of periodontitis was assessed by alveolar bone loss measured from panoramic radiographs by 1 examiner blind to cancer status. MAIN OUTCOME MEASURE: Incidence of tongue cancer obtained from the RPCI Tumor Registry. RESULTS: After adjusting for the effects of age at diagnosis, smoking status, and number of teeth, each millimeter of alveolar bone loss was associated with a 5.23-fold increase in the risk of tongue cancer (odds ratio, 5.23; 95% confidence interval, 2.64-10.35). CONCLUSIONS: This study suggests an association between chronic periodontitis and the risk of tongue cancer in men, independent of smoking status, age, race, ethnicity, and number of teeth. This association needs to be confirmed by larger studies using quantitative assessment of lifetime tobacco exposure. If this association is confirmed, it has a potential impact on understanding the etiology of oral cancer as well as on its prevention and control.

Factors associated with utilization of dental services in a long-term care facility: a descriptive cross-sectional study.

PURPOSE: To describe factors associated with the utilization of dental services in a long-term care facility (LTCF) in Western New York. METHODS AND MATERIALS: A descriptive cross-sectional study reviewed the dental and medical records of residents of an LTCF discharged between January 1, 2008 and December 30, 2012. Information on demographic and health variables at admission was extracted from electronic health records. Information on oral health variables was extracted from patient charts. RESULTS: A total of 2,516 residents were discharged between 2008 and 2012. From those, 259 (10.3%) utilized dental services at least once during their stay. Those who utilized dental services were significantly older at admission (78.5 vs. 82.0 years, p < 0.001), stayed longer (1.6 vs. 3.9 years, p < 0.001), more likely to be female (63.6 vs. 75.6%, p = 0.008), and less likely to be married (37.7 vs. 14.0%, p = < 0.001) compared to those who did not. Patients with endocrine, nutritional, metabolic, and immunity disorders, mental disorders, and circulatory system diseases were more likely to receive dental services. CONCLUSIONS: Dental services appear to be underutilized by residents of LTCF. Significant differences exist in demographic and health variables between residents who utilize these services compared to those who do not.

CD8+ and FoxP3+ T-cell infiltration in actinic cheilitis.

BACKGROUND: Differences in immune profile between actinic cheilitis (AC), a precursor of lip squamous cell carcinoma, and normal lip vermillion (NL) have not been elucidated. OBJECTIVES: To compare density, distribution, and ratios of CD8+ and FoxP3+ cells between AC and NL and assess their associations with clinicopathologic variables. METHODS: Samples of AC and NL obtained between 2001 and 2013 at the College of Dentistry of the University of Concepcion, Chile, were retrospectively analyzed for immunohistochemical detection of CD8+ and FoxP3+ cells. Differences between groups were tested by Mann-Whitney U and Fisher's exact tests. Independent effects of cell densities and CD8/FoxP3 ratio with AC were assessed by multiple logistic regression analysis after adjustment for potential confounding. RESULTS: A total of 62 AC and 24 NL biopsies were included. Densities of CD8+ and FoxP3+ cells in AC were significantly higher than in NL. Conversely, the CD8+/FoxP3+ ratio was significantly lower in AC as compared to NL. After adjustment for sun exposure, age, gender, and smoking status, a stromal FoxP3+ cell density higher than 0.35 cells/field was significantly associated with increased odds of AC (odds ratio [OR] = 5.01, 95% confidence interval [CI]: 1.18-21.31), while a stromal CD8+/FoxP3+ ratio higher than 5.91 was associated with decreased odds of AC (OR = 0.29, 95% CI: 0.08-1.08). CONCLUSIONS: AC is characterized by increased FoxP3+ cell infiltration and a reduced CD8/FoxP3 ratio as compared to NL. Therefore, increased infiltration of FoxP3+ cells relative to CD8+ cells may contribute to the transition from normal to preneoplastic stages in lip carcinogenesis.

Supragingival plaque may modify the effects of subgingival bacteria on attachment loss.

BACKGROUND: Bacterial interactions in response to local and systemic factors may explain important features of the pathogenesis of periodontal disease. This study evaluates the role of supragingival plaque level on the relationship between subgingival microorganisms and the risk of attachment loss. METHODS: The study population consisted of 386 white women aged 45 years and older who had at least seven teeth. Subgingival plaque samples were taken from the mesio-buccal surface of six maxillary and six mandibular teeth using paper point technique. The samples were pooled, and immunofluorescence microscopy was performed to identify the following target microorganisms: Actinobacillus actinomycetemcomitans (Aa), Tannerella forsythensis (Tf), Campylobacter rectus (Cr), Prevotella intermedia (Pi), Capnocytophaga species (Cs), Porphyromonas gingivalis (Pg), Eubacterium saburreum (Es), and Fusobacterium nucleatum (Fn). The presence or absence of supragingival plaque and clinical attachment loss (CAL) were assessed at the same 12 sites where subgingival plaque samples were taken. The association of each microorganism with CAL was tested using multiple logistic regressions controlling for age, smoking status, and diabetes. Odds ratios (OR) and their 95% confidence intervals (CI) were calculated. RESULTS: At low supragingival plaque levels, only the presence of Pg was significantly associated with CAL (OR: 6.41, 95% CI: 1.30 to 31.70); all remaining microorganisms were also associated with increased but non-significant risk of CAL. At high supragingival plaque levels, the presence of Tf (OR: 2.40, 95% CI: 1.42 to 4.04) and Pg (OR: 3.71, 95% CI: 1.63 to 8.42) was significantly associated with increased risk of attachment loss. By contrast, the presence of Cs (OR: 0.55, 95% CI: 0.30 to 1.01) and Es (OR: 0.35, 95% CI: 0.15 to 0.82) was associated with decreased risk of attachment loss. Fn, Pi, and Cr were not significantly associated with CAL at either low or high supragingival plaque levels. CONCLUSIONS: This study suggests that the association of certain subgingival microorganisms with CAL changes in relation to supragingival plaque levels in older adult women. It also suggests that the overall effect of dental plaque is a function of the balance between pathogenic and other microorganisms that colonize this environment. Therefore, all microorganisms in the biofilm, including those with no apparent association with overt disease and those with negative associations, may play roles in the pathogenesis of periodontal diseases.

Is periodontitis associated with oral neoplasms?

BACKGROUND: Infections have been suggested in the etiology of oral cancer. This study was carried out to evaluate the effect of periodontal disease on oral soft tissue lesions. METHODS: A total of 13,798 subjects aged 20 years and older with at least six natural teeth and who participated in the Third National Health and Nutrition Examination Survey (NHANES III) constituted the study population. Severity of periodontal disease was represented by clinical attachment loss (CAL) and was dichotomized as < or =1.5 mm versus >1.5 mm according to its distributions in the NHANES III population. Three separate dependent variables were employed: 1) tumor (non-specific); 2) precancerous lesions; and 3) any oral soft tissue lesion. The independent effect of CAL on those three dependent variables was assessed by weighted multiple logistic regression analyses adjusting for the effects of number of filled teeth, number of decayed teeth, presence of prosthesis, age, gender, race/ethnicity, education, tobacco, alcohol, occupational hazard, and interaction term "tobacco*occupational hazard." Odds ratios (OR) and their 95% confidence intervals (CI) were calculated. RESULTS: CAL was not related to the presence of any soft tissue lesion (OR = 1.09, 95% CI: 0.91 to 1.31), but was specifically related to the presence of tumor (OR = 4.57, 95% CI: 2.25 to 9.30) and precancerous lesions (OR = 1.55, 95% CI: 1.06 to 2.27). CONCLUSION: This study suggests associations between periodontal disease and the risk for precancerous lesions and tumors generating a hypothesis about a possible relationship between periodontal disease and oral neoplasms. Prospective or well-designed case-control studies with histologically confirmed incident oral cancer cases are necessary to confirm this relationship.

Periodontal disease and the incidence of tooth loss in postmenopausal women.

BACKGROUND: The role of periodontal disease as a predictor of incident tooth loss in postmenopausal women has not been determined. The aim of this cohort study was to determine the extent of the association between baseline periodontal status and incident tooth loss in a population of postmenopausal women. METHODS: The study population included 106 dentate white postmenopausal women who participated in a cross-sectional study between 1989 and 1991 who were willing and eligible to have a repeat examination after 10 to 13 years. At baseline, full-mouth assessment of periodontal status was performed clinically and radiographically. Assessment of tooth loss during follow- up was assessed clinically by a periodontist. Odds ratio (OR) and its 95% confidence interval (CI) for each periodontal variable was obtained from separate multiple logistic regression analyses adjusting for the effect of age, household income, smoking, hormone therapy, snack consumption, and number of decayed teeth. RESULTS: Sixty-one (57.5%) subjects lost at least one tooth during follow-up. Mean tooth loss per person was 1.81 +/- 2.77. After adjusting for confounders, each millimeter of alveolar bone loss at baseline increased the risk of tooth loss 3-fold (OR = 3.26; 95% CI: 1.60 to 6.64). The risk of tooth loss also increased 2.5 times for each millimeter of clinical attachment loss (OR = 2.50; 95% CI: 1.24 to 5.07). Probing depth (OR = 2.53; 95% CI: 0.98 to 6.53), gingival bleeding (OR = 1.99; 95% CI: 0.21 to 18.94), calculus (OR = 2.05; 95% CI: 0.91 to 4.61), and plaque (OR = 0.70; 95% CI: 0.13 to 3.34) were not significantly associated with incident tooth loss. CONCLUSION: Periodontal disease, especially measured by alveolar bone loss, is a strong and independent predictor for incident tooth loss in postmenopausal women.

Association of serum 17ß-estradiol concentration, hormone therapy, and alveolar crest height in postmenopausal women.

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

Associations between smoking and tooth loss according to the reason for tooth loss: the Buffalo OsteoPerio Study.

BACKGROUND: Smoking is associated with tooth loss. However, smoking's relationship to the specific reason for tooth loss in postmenopausal women is unknown. METHODS: Postmenopausal women (n = 1,106) who joined a Women's Health Initiative ancillary study (The Buffalo OsteoPerio Study) underwent oral examinations for assessment of the number of missing teeth, and they reported the reasons for tooth loss. The authors obtained information about smoking status via a self-administered questionnaire. The authors calculated odds ratios (ORs) and 95 percent confidence intervals (CIs) by means of logistic regression to assess smoking's association with overall tooth loss, as well as with tooth loss due to periodontal disease (PD) and with tooth loss due to caries. RESULTS: After adjusting for age, education, income, body mass index, history of diabetes diagnosis, calcium supplement use and dental visit frequency, the authors found that heavy smokers (≥ 26 pack-years) were significantly more likely to report having experienced tooth loss compared with never smokers (OR = 1.82; 95 percent CI, 1.10-3.00). Smoking status, packs smoked per day, years of smoking, pack-years and years since quitting smoking were significantly associated with tooth loss due to PD. For pack-years, the association for heavy smokers compared with that for never smokers was OR = 6.83 (95 percent CI, 3.40 -13.72). The study results showed no significant associations between smoking and tooth loss due to caries. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Smoking may be a major factor in tooth loss due to PD. However, smoking appears to be a less important factor in tooth loss due to caries. Further study is needed to explore the etiologies by which smoking is associated with different types of tooth loss. Dentists should counsel their patients about the impact of smoking on oral health, including the risk of experiencing tooth loss due to PD.

Dental caries and head and neck cancers.

IMPORTANCE: Dental caries is the demineralization of tooth structures by lactic acid from fermentation of carbohydrates by commensal gram-positive bacteria. Cariogenic bacteria have been shown to elicit a potent Th1 cytokine polarization and a cell-mediated immune response. OBJECTIVE: To test the association between dental caries and head and neck squamous cell carcinoma (HNSCC). DESIGN, SETTING, AND PARTICIPANTS: Case-control study in a comprehensive cancer center including all patients with newly diagnosed primary HNSCC between 1999 and 2007 as cases and all patients without a cancer diagnosis as controls. Those with a history of cancer, dysplasia, or immunodeficiency or who were younger than 21 years were excluded. EXPOSURES: Dental caries, fillings, crowns, and endodontic treatments, measured by the number of affected teeth; missing teeth. We also computed an index variable: decayed, missing, and filled teeth (DMFT). MAIN OUTCOMES AND MEASURES: Incident HNSCC. RESULTS: We included 620 participants (399 cases and 221 controls). Cases had a significantly lower mean (SD) number of teeth with caries (1.58 [2.52] vs 2.04 [2.15]; P = .03), crowns (1.27 [2.65] vs 2.10 [3.57]; P = .01), endodontic treatments (0.56 [1.24] vs 1.01 [2.04]; P = .01), and fillings (5.39 [4.31] vs 6.17 [4.51]; P = .04) but more missing teeth (13.71 [10.27] vs 8.50 [8.32]; P < .001) than controls. There was no significant difference in mean DMFT. After adjustment for age at diagnosis, sex, marital status, smoking status, and alcohol use, those in the upper tertiles of caries (odds ratio [OR], 0.32 [95% CI, 0.19-0.55]; P for trend = .001), crowns (OR, 0.46 [95% CI, 0.26-0.84]; P for trend = .03), and endodontic treatments (OR, 0.55 [95% CI, 0.30-1.01]; P for trend = .15) were less likely to have HNSCC than those in the lower tertiles. Missing teeth was no longer associated with HNSCC after adjustment for confounding. CONCLUSIONS AND RELEVANCE: There is an inverse association between HNSCC and dental caries. This study provides insights for future studies to assess potential beneficial effects of lactic acid bacteria and the associated immune response on HNSCC.

Interaction between Chronic Inflammation and Oral HPV Infection in the Etiology of Head and Neck Cancers.

Incidences of oral tongue, base of the tongue, and tonsil cancers have been increasing steadily in many parts of the world in spite of declining rates of tobacco use over the last four decades. A better understanding of the etiology, interactions between risk factors, and new approaches to prevention and treatment are necessary to change this course. This paper will present evidence supporting a potential role of chronic inflammation in the etiologies of oral human papillomavirus infection and head and neck squamous cell carcinoma, and it will discuss the implications for prevention and treatment.

Local inflammation and human papillomavirus status of head and neck cancers.

OBJECTIVE: To determine whether periodontitis is associated with human papillomavirus (HPV) status of head and neck squamous cell carcinoma (HNSCC). DESIGN AND SETTING: Hospital-based case-control study in a comprehensive cancer center. PATIENTS: Evaluation included all patients diagnosed with incident primary squamous cell carcinoma of the oral cavity, oropharynx, and larynx between 1999 and 2007 for whom tissue samples and dental records were available (N = 124). Patients younger than 21 years and those with a history of cancer were excluded. Periodontitis history was assessed by alveolar bone loss in millimeters from panoramic radiographs by one examiner blinded to cancer status. MAIN OUTCOME MEASURE: The presence of HPV-16 DNA in paraffin-embedded tumor samples was identified by polymerase chain reaction. RESULTS: The prevalence of HPV-positive HNSCC was 50 of 124 patients (40.3%). A higher proportion of oropharyngeal cancers were HPV-positive (32 of 49 [65.3%]) compared with oral cavity (9 of 31 [29.0%]) and laryngeal (9 of 44 [20.5%]) cancers. Each millimeter of alveolar bone loss was associated with 2.6 times increased odds (odds ratio [OR], 2.61; 95% CI, 1.58-4.30) of HPV-positive tumor status after adjustment for age at diagnosis, sex, and smoking status. The strength of the association was greater among patients with oropharyngeal SCC (OR, 11.70; 95% CI, 2.09-65.53) compared with those with oral cavity SCC (OR, 2.32; 95% CI, 0.65-8.27) and laryngeal SCC (OR, 3.89; 95% CI, 0.95-15.99). CONCLUSIONS: A history of chronic inflammatory disease in the oral cavity may be associated with tumor HPV status in patients with HNSCC. This association seems to be stronger among patients with oropharyngeal cancer compared with those who have oral cavity or laryngeal SCC.

Chronic periodontitis-human papillomavirus synergy in base of tongue cancers.

OBJECTIVE: To assess whether chronic periodontitis history predicts human papillomavirus (HPV) status in patients with base of tongue cancers. DESIGN: Case-control study using existing patient data. SETTING: Roswell Park Cancer Institute. PATIENTS: Thirty patients newly diagnosed with base of tongue squamous cell carcinoma between 1999 and 2005 for whom both tumor samples and periodontal records were available. Patients younger than 21 years, edentulous, immunocompromised, and those with a history of cancer were excluded. Periodontitis history was assessed on the basis of alveolar bone loss (in millimeters) from panoramic radiographs by one examiner who was blinded to cancer status. MAIN OUTCOME MEASURE: HPV-16 and HPV-18 DNA were identified on paraffin-embedded tumor samples by polymerase chain reaction. Multiple logistic regression was used to estimate odds ratios and 95% confidence intervals. RESULTS: The prevalence of tumors positive for HPV-16 DNA was 21 of 30 (70%). None of the samples were positive for HPV-18 DNA. Compared with participants with HPV-negative tumors, patients with HPV-positive tumors had significantly higher mean alveolar bone loss (3.90 mm vs 2.85 mm, P = .01). After adjustment for age at diagnosis, sex, race/ethnicity, alcohol use, smoking status, and number of missing teeth, every millimeter of alveolar bone loss was associated with an approximately 4-fold (odds ratio, 3.96; 95% confidence interval, 1.18-13.36) increased risk of HPV-positive tumor status. Number of missing teeth was not associated with tumor HPV status (odds ratio, 0.95; 95% confidence interval, 0.74-1.21). CONCLUSIONS: Chronic periodontitis may be a significant factor in the natural history of HPV infection in patients with base of tongue cancers. Additional confirmation in larger studies is required.

Chronic periodontitis and the incidence of head and neck squamous cell carcinoma.

Substantial evidence supports an association between chronic infections/inflammation, and cancer. The aim of this study was to assess the effect of chronic periodontitis on head and neck squamous cell carcinoma (HNSCC). The study population consisted of new patients at the Department of Dentistry and Maxillofacial Prosthetics, Roswell Park Cancer Institute between 1999 and 2005. Cases were patients diagnosed with primary HNSCC. Controls were all patients seen during the same time period but negative for malignancy. Patients age <21 years, edentulous, immunocompromised, and those with history of cancer were excluded. Periodontitis was measured by alveolar bone loss (ABL) from panoramic radiographs by one examiner blind to cancer status. A total of 473 patients (266 cases and 207 controls) were included in the study. Each millimeter of ABL was associated with >4-fold increased risk of HNSCC (odds ratio, 4.36; 95% confidence interval, 3.16-6.01) after adjustment for age, gender, race/ethnicity, marital status, smoking status, alcohol use, and missing teeth. The strength of the association was greatest in the oral cavity, followed by oropharynx and larynx. The association persisted in subjects who never used tobacco and alcohol. There was a significant interaction between smoking and ABL (P = 0.03). Patients with periodontitis were more likely to have poorly differentiated oral cavity SCC than those without periodontitis (32.8% versus 11.5%; P = 0.038). This study suggests that chronic periodontitis is an independent risk factor for HNSCC and smoking modifies this association. These results have implications for practical and safe strategies for prevention, diagnosis, and treatment of HNSCC.

Alcohol consumption and periodontal disease. The Third National Health and Nutrition Examination Survey.

OBJECTIVE: This study was carried out to evaluate the effect of alcohol consumption on the severity of periodontal disease. MATERIAL AND METHODS: This cross-sectional study employed 13,198 subjects of the Third National Health and Nutrition Examination Survey (NHANES III) aged 20 and older who have at least six natural teeth. Alcohol intake was represented both as a continuous variable and dichotomized using 5, 10, 15, and 20 drinks/week as cut-points. Periodontal disease was represented by clinical attachment loss (CAL) and was assessed both as a continuous variable and dichotomized as <1.5 mm and >/=1.5 mm. Independent effect of alcohol on CAL was assessed by weighted multiple linear and logistic regression analyses adjusting simultaneously for the effects of age, gender, race, education, income, smoking, diet, diabetes, gingival bleeding, number of remaining teeth. RESULTS: There was a significant linear relationship between number of drinks per week and log CAL (p=0.0001). Odds ratios for the risk of attachment loss using 5, 10, 15, and 20 drinks/week as cut-points were 1.22 [1.02-1.47], 1.39 [1.13-1.71], 1.54 [1.22-1.93], and 1.67 [1.25-2.23], respectively. CONCLUSION: Alcohol consumption may be associated with increased severity of CAL in a dose-dependent fashion. Prospective studies and studies of mechanism are needed to confirm the role of alcohol as a risk factor for periodontal disease.

The Role of Osteopenia in Oral Bone Loss and Periodontal Disease.

Osteoporosis and periodontitis are diseases which affect a large number of women and men, with incidence increasing with advancing age. Osteopenia is a reduction in bone mass due to an imbalance between bone resorption and formation, favoring resorption, resulting in demineralization and leading to osteoporosis. Osteoporosis is a disease characterized by low bone mass and fragility and a consequent increase in fracture risk. Periodontitis is characterized by inflammation of the supporting tissues of the teeth, resulting in resorption of the alveolar bone as well as loss of the soft tissue attachment to the tooth and is a major cause of tooth loss and edentulousness in adults. The relationship of osteopenia to oral bone loss and periodontal disease has been addressed in a limited number of studies. A review of current knowledge regarding this relationship is presented. Interpretation of the literature is complicated by the variety of methods used to assess osteopenia, oral bone mass, and periodontitis, as well as varying definitions of outcomes of interest. Results of a previously unpublished study are presented which suggest that severity of osteopenia is related to loss of alveolar crestal height and tooth loss in post-menopausal women. The literature on the relationship among these disorders is limited and points to the need for additional studies which thoroughly evaluate the influence of potential confounding factors to further define the relationship between low bone mineral density and periodontal disease in larger populations. Clearer understanding of this relationship may aid health care providers in their efforts to detect and prevent osteoporosis and periodontal disease. Increased dialogue among medical and dental professionals will be increasingly important in achieving and maintaining patients' optimal health. J Periodontol 1996;67:1076-1084.