Association between periodontal infection and obesity: results of the Health 2000 Survey.

AIM: To investigate the role of periodontal infection in obesity in an adult population. MATERIAL AND METHODS: This study was based on a subpopulation of the Health 2000 Survey that included dentate, non-diabetic subjects, aged 30-49 years (n=2784). Obesity was measured using the body mass index (BMI), body fat percentage (BF%) and waist circumference (WC). The extent of periodontal infection was measured using the number of teeth with deepened (4 mm deep or deeper) periodontal pockets and was categorized into four categories (0, 1-3, 4-6, 7 or more). RESULTS: The number of teeth with deepened periodontal pockets was found to be associated with BMI in an exposure-response manner among the total study population. The association was found among men and women, and also among never-smokers. The number of teeth with deepened periodontal pockets was also associated with BF% and WC among never-smokers. CONCLUSION: Periodontal infection measured by means of the number of teeth with deepened periodontal pockets appears to be associated with obesity. However, no inferences about causality can be made and further studies are needed to clarify the possible role of periodontal infection in obesity.

Insulin sensitivity and periodontal infection in a non-diabetic, non-smoking adult population.

AIM: The aim of this study was to examine whether there is an association of insulin sensitivity with periodontal infection in a non-diabetic, non-smoking adult population. MATERIALS AND METHODS: A subpopulation of the Health 2000 Survey (effective n=2050) consisted of dentate subjects without any indication of diabetes, aged between 30 and 64, and who had never smoked. The outcome variable was periodontal infection measured by means of the number of teeth with deepened periodontal pockets. Insulin sensitivity was measured using the homeostasis model assessment index for insulin resistance. Poisson regression models were used to estimate the relative risks and 95% confidence intervals. RESULTS: We found that insulin sensitivity was associated with periodontal infection in the age group 30-49, but not in persons aged 50-64. Controlling for body weight made the association between insulin sensitivity and periodontal infection disappear. CONCLUSION: The lack of knowledge of the underlying causal model prevents making definite conclusions about the role of reduced insulin sensitivity in the pathogenesis of periodontal infection.

Overweight and obesity weakly predict the development of periodontal infection.

AIM: The aim of this study was to investigate the association between body weight and periodontal infection in a longitudinal setting. MATERIAL AND METHODS: This study was based on a subpopulation of the Health 2000 Survey that included dentate, non-diabetic subjects aged 30-59 years, who had never smoked and who had participated in the Follow-Up Study on Finnish Adults' Oral Health approximately 4 years later (n=396). The number of new teeth with deepened (4 mm deep or deeper) periodontal pockets in the follow-up examination was used as the outcome variable. Body weight was measured using body mass index, categorized into three categories: <25.0 (normal weight), 25.0-29.9 (overweight) and 30.0 or more (obesity). Incidence rate ratios were estimated using Poisson's regression models. RESULTS: Body weight was weakly, but not statistically significantly, associated with the number of new teeth with deepened periodontal pockets among subjects who were periodontally healthy in the baseline examinations, whereas only a minuscule association was found among subjects who had periodontal infection at baseline. CONCLUSIONS: The results of this follow-up study do not provide evidence that overweight and obesity can be considered significant risk factors in the pathogenesis of periodontal infection.

Patterns of oral cleaning habits and use of fluoride among dentate adults in Finland.

PURPOSE: The aim of the present study was to identify the underlying patterns of oral cleaning habits and the use of fluoride, and to investigate their variations by studying the socioeconomic characteristics among Finnish dentate adults aged 30 to 64 years. MATERIALS AND METHODS: Participants of the nationwide Health 2000 survey who were dentate, aged 30 to 64 years, and underwent a health interview and a clinical oral examination, were included in the present study (n = 4419). RESULTS: In total, 79% of the women and 46% of the men reported to have brushed their teeth twice or more daily; 16% of the women and 14% of the men reported daily use of an electric toothbrush and 14% of the women and 5% of the men reported daily use of dental floss or an interdental brush. Factor analysis revealed five oral cleaning habit patterns, which were named modern, rational, before-breakfast, social and irrational. The modern cleaning pattern was associated with higher levels of education, and the rational cleaning with younger age, female gender and higher levels of education. The before-breakfast cleaning pattern was associated with male gender and lower levels of education, and the social cleaning with older age, female gender and higher levels of education. The irrational cleaning pattern was associated with older age. CONCLUSIONS: Adults have various oral cleaning habit patterns, each of which is associated with the subjects' socioeconomic characteristics.

Salivary MMP-8, TIMP-1, and ICTP as markers of advanced periodontitis.

AIM: Salivary matrix metalloproteinase (MMP)-8 and -14, tissue inhibitor of matrix metalloproteinase (TIMP)-1, and pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (ICTP) were analysed aiming to detect potential markers of advanced periodontitis in saliva. In addition, we compared two MMP-8 detection methods, a time-resolved immunofluorometric assay (IFMA) and an enzyme-linked immunoassay (ELISA), to differentiate periodontitis subjects from controls. MATERIAL AND METHODS: Concentrations of MMP-8, MMP-14, TIMP-1, and ICTP were analysed from salivary specimens of 165 subjects, including 84 subjects having at least 14 teeth with periodontal pocket (pocket depth > or =4 mm) and 81 subjects without pocket depth as their controls. RESULTS: Salivary MMP-8 detection by IFMA differentiated periodontitis subjects from controls more strongly than by ELISA. Salivary MMP-8, TIMP-1, and ICTP concentrations were higher in periodontitis subjects than those in controls. When only smokers were included in the analysis these differences were lost. The MMP-8/TIMP-1 ratio and the combination of MMP-8 and ICTP differentiated periodontitis and control groups even in smoker subjects. CONCLUSION: Salivary MMP-8, TIMP-1, ICTP, and especially their ratios and combinations are potential candidates in the detection of advanced periodontitis. Differentiating periodontitis and control subjects with salivary MMP-8 detection is dependent on the selected techniques.

Prevalence of mucosal abnormalities of the maxillary sinus and their relationship to dental disease in panoramic radiography: results from the Health 2000 Health Examination Survey.

BACKGROUND: Mucosal thickening and mucosal antral cyst (MAC) in the maxillary sinus are incidental findings in panoramic radiographs. METHODS: The study sample consisted of 5021 participants in a nationally representative Health 2000 Health Examination Survey using panoramic radiography. RESULTS: The prevalence of mucosal thickening was 12% and of MACs 7%, both being twice as frequent in men as in women. Mucosal thickening was most common in the 40- to 49-year age group, whereas MACs were most often seen in younger age groups. Pathologic dental findings and root canal treatments were significantly associated with mucosal thickening but not with MACs. The odds ratios of vertical infrabony pockets were 5.2-fold compared with edentulous. CONCLUSION: This nationally representative study indicates that dental infections are etiologic for antral mucosal thickening, but not for MACs.

Symptomatic plate removal after treatment of facial fractures.

AIMS: To identify the rates and reasons for plate removal (PR) among patients treated for facial fractures. MATERIALS AND METHODS: A retrospective review of files of 238 patients. RESULTS: Forty-eight patients (20.2%) had plates removed. The reason for removal was objective in 33.3% and subjective in 29.2%. The most common subjective reason was cold sensitivity, and the most common objective reason was wound dehiscence/infection. Women had PR for subjective reasons more often than men (p=0.018). Removal was performed more often for subjective reasons after zygomatico-orbital fractures than after mandibular fractures (p=0.002). Plates inserted in the mandible from an intraoral approach were removed more frequently than extraorally inserted mandibular plates, intraorally inserted maxillary plates, and extraorally inserted plates in other locations (p<0.001). Orbital rim plates had a higher risk of being removed than maxillary or frontal bone plates (p=0.02). CONCLUSIONS: Subjective discomfort is a notable reason for PR among Finnish patients, suggesting that the cold climate has an influence on the need for removal. Patients receiving mandibular osteosynthesis with miniplates from an intraoral approach are at risk of hardware removal because of wound dehiscence/infection and loose/broken hardware, reminding us that more rigid fixation devices should not be forgotten despite the widespread use of miniplates.

Occurrence and types of associated injuries in patients with fractures of the facial bones.

PURPOSE: To identify the occurrence, types, and severity of associated injuries outside the facial region among patients diagnosed with facial fractures, and to analyze whether there are any factors related to associated injuries. MATERIALS AND METHODS: This was a cross-sectional study of 401 patients diagnosed with facial fractures during the 2-year period from 2003 to 2004. RESULTS: Associated injuries were observed in 101 patients (25.2%). The most common type of injury was a limb injury (13.5%), followed by brain (11.0%), chest (5.5%), spine (2.7%), and abdominal (0.8%) injuries. Multiple associated injuries were observed in 10% and polytrauma in 7.5%. The mortality rate was 0.2%. The occurrence of associated injury correlated significantly with trauma mechanism and fracture type; high-speed accidents and severe facial fractures were significant predictors of associated injury. CONCLUSIONS: Associated injuries are frequent among patients who have sustained facial fractures. The results underscore the importance of multiprofessional collaboration in diagnosis and sequencing of treatment, but also the importance of arranging appropriate clinical rotations for maxillofacial residents in training.

Dual effect of statin medication on the periodontium.

AIM: The aim of this study was to investigate the association between statin medication and periodontal infection in an adult population. MATERIAL AND METHODS: The study was based on a subpopulation of the Health 2000 Survey, which included dentate non-diabetic, non-rheumatic subjects who did not smoke, aged 40-69 years (n=2032). The main outcome variable was the number of teeth with periodontal pockets of 4 mm or more. Statin medication was categorized in two ways: firstly, subjects with statin medication of some sort (n=134) versus those with none, and secondly, subjects taking either simvastatin (n=58), atorvastatin (n=38), some other statin (n=38) or no statin medication. Relative risks (RR) were estimated using negative binomial and Poisson regression models. RESULTS: We found a weak negative association between statin medication and periodontal infection among subjects with dental plaque or gingival bleeding. Among subjects with no gingival bleeding, statin medication was found to be associated with an increased likelihood of having deepened periodontal pockets. CONCLUSION: Statin medication appears to have an effect on the periodontium that is dependent on the inflammatory condition of the periodontium. More evidence is needed to achieve a comprehensive understanding of the effects of statins.

Salivary interleukin-1beta concentration and the presence of multiple pathogens in periodontitis.

AIM: This study aimed to find salivary enzymes and/or cytokines that would reflect periodontitis, alone or in combination with salivary microbial markers. MATERIAL AND METHODS: The salivary concentrations of elastase, lactate dehydrogenase, interleukin-1beta (IL-1beta), interleukin-6, and tumour necrosis factor-alpha, and the presence of five periodontal pathogens, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia, and Treponema denticola, were analysed from salivary specimens of 165 subjects, a subpopulation of Health 2000 Health Examination Survey in Finland; 84 of the subjects had probing pocket depth (PPD) of > or =4 mm at 14 or more teeth (the advanced periodontitis group), while 81 subjects had no teeth with PPD of > or =4 mm (the control group). All subjects had at least 20 teeth and no systemic diseases. RESULTS: Among the salivary cytokines and enzymes tested, IL-1beta was the only biomarker associated with periodontitis. An association was also found with the presence of multiple periodontal pathogens. Salivary IL-1beta and the presence of multiple periodontal pathogens were associated with periodontitis at the same magnitude, when they were in the logistic regression model individually or together. CONCLUSION: We suggest that salivary IL-1beta and the presence of multiple periodontal pathogens in saliva should be studied more thoroughly as markers of periodontitis.

Detection and quantification of five major periodontal pathogens by single copy gene-based real-time PCR.

Periodontitis is a common chronic multibacterial infection in the tooth-supporting tissues. It has been shown that periodontitis patients carry higher number of disease-associated bacteria than healthy ones. The aim of this study was to generate a novel, single copy gene-based quantitative real-time PCR (qPCR) assay for five major periodontal pathogens - Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Treponema denticola, and Tannerella forsythia. The primer/probe sets were designed for conservative lipopolysaccharide-coding gene regions. They proved to be sensitive and able to detect strains representing different serotypes of the target bacteria. The specificity of designed primers was tested using 49 selected bacterial species and no false positive or negative results were observed. We validated the assay with a case-control population, including 165 saliva samples, and proved the diagnostic accuracy by Receiver Operating Characteristic (ROC) curves. All quantified pathogens alone were able to distinguish significantly between the subjects with and without periodontitis, and provided areas under the ROC curve larger than 0.5. The total pathogen burden comprising all five species associated with periodontitis with an area of 0.821 (95% CI, 0.758-0.885, P50.001). Our prominently sensitive and specific assay may have major importance in the diagnosis, prevention, and treatment of periodontitis.

Dental fear and subjective oral impacts among adults in Finland.

We aimed to study the association between subjective oral impacts and dental fear adjusted for age, gender, level of education, and dental attendance, and to evaluate whether this association was modified by the number of remaining teeth. Nationally representative data on Finnish adults, 30+ yr of age (n = 5,987), were gathered through interviews, clinical examination, and questionnaires. Dental fear was measured using the question: 'How afraid are you of visiting a dentist?' and subjective oral impacts were measured using the 14-item Oral Health Impact Profile (OHIP-14) questionnaire. The outcome variables were the percentage of people reporting one or more OHIP-14 items fairly often or very often, and the 'extent' and 'severity'. Those with high dental fear reported higher levels of prevalence, 'extent', and 'severity' of subjective oral impacts than did those with low dental fear or no fear. The association between dental fear and subjective oral impacts was not significantly modified by the number of remaining teeth. The greatest differences between those with high dental fear and low dental fear were found in psychological, social, and handicap dimensions, but not in functional or physical dimensions of the OHIP-14. Treating dental fear could have positive effects on subjective oral impacts by reducing psychological and social stress and by improving regular dental attendance and oral health.

Role of serum cytokines tumour necrosis factor-alpha and interleukin-6 in the association between body weight and periodontal infection.

AIM: To study the role of serum cytokines tumour necrosis factor alpha (TNF-alpha) and interleukin 6 (IL-6) as potential mediators in the association between body weight and periodontal infection among an adult population. MATERIAL AND METHODS: This study was based on a subpopulation of the Health 2000 Health Examination Survey, which included dentate non-diabetic, non-rheumatic subjects, aged between 45 and 64 years, who had never smoked and whose serum levels of TNF-alpha and IL-6 were analysed and whose periodontal status was clinically determined (effective n=425). The number of teeth with periodontal pockets of 4 mm or more and the number of teeth with periodontal pockets of 6 mm or more were used as outcome variables. Relative risks and 95% confidence intervals were estimated using Poisson regression models. RESULTS: Serum IL-6, but not TNF-alpha associated with teeth with deepened periodontal pockets. Multivariate models showed that IL-6, but not TNF-alpha, could mediate the effect of body weight on periodontium. CONCLUSION: In this population of non-diabetic and non-rheumatic subjects, who had never smoked, serum IL-6 was associated with periodontal infection. The results suggest that serum IL-6 could be one mediating factor that connects body weight and periodontal infection.

Detection of multiple pathogenic species in saliva is associated with periodontal infection in adults.

We investigated whether certain bacterial species and their combinations in saliva can be used as markers for periodontitis. In 1,198 subjects, the detection of multiple species, rather than the presence of a certain pathogen, in saliva was associated with periodontitis as determined by the number of teeth with deepened periodontal pockets.

Association between serum lipid levels and periodontal infection.

OBJECTIVE: The aim of the study was to investigate the association between serum lipids and periodontal infection and the role of serum lipids in the association between body weight and periodontal infection. MATERIAL AND METHODS: The Health 2000 Health Examination Survey, which included 8028 subjects aged 30 or older living in continental Finland. This study was based on a subpopulation of dentate, non-diabetic subjects who had never smoked and were aged under 50 years (n=1297). Periodontal infection was defined as the presence of teeth with deepened periodontal pockets. Serum levels of triglycerides, high-density lipoprotein (HDL)-cholesterol and low-density lipoprotein (LDL)-cholesterol were analysed enzymatically. RESULTS: We found no consistent association between serum lipid levels and periodontal infection among normoweight subjects. There was an association of high serum triglycerides and low HDL with periodontal infection among obese subjects. The association between body mass index and periodontal infection was not essentially affected by serum lipids. CONCLUSION: In this study population serum lipid levels were not associated with periodontal infection among normoweight subjects. Obese subjects with a high serum triglyceride level and/or a low HDL-cholesterol level could be at higher risk of periodontal infection. Our results suggest that the association between body weight and periodontal infection was mainly mediated through a mechanism other than serum lipids.

Oral health impacts among adults in Finland: competing effects of age, number of teeth, and removable dentures.

The aims of the present study were to evaluate the prevalence and severity of oral health impacts among adults and to analyse the effects of age, gender, level of education, number of teeth, and removable denture wearing on these impacts. Nationally representative data (n = 5,987) on Finnish adults aged 30+ yr were gathered in an interview, in a clinical examination, and by a questionnaire including the 14-item Oral Health Impact Profile. Subject age and the number of teeth were significantly associated with oral impacts (occurring fairly or very often) when the effects of gender, educational level, and removable dentures were considered. When subjects >/= 75 yr of age were used as the reference group, the odds ratios (95% confidence interval) were 0.5 (0.3-0.8) and 0.7 (0.5-0.9) for 30-34-yr-old and 34-74-yr-old subjects, respectively. The odds ratios for those with 1-9 teeth and for those who were edentate were 3.4 (2.4-4.9) and 4.0 (2.6-6.3), respectively (20+ teeth as reference). Number of teeth modified the effect of denture wearing, and age modified the effect of educational level on oral impacts. Impaired subjective oral health related to many missing teeth might be improved by wearing removable dentures. Population groups needing special attention are young people with low education and those for whom only a few missing teeth are replaced with removable dentures.

Association between body weight and periodontal infection.

BACKGROUND: Besides being a risk factor for cardiovascular diseases, certain cancers and type II diabetes, obesity has been suggested to be a risk factor for periodontitis. A number of epidemiological studies have studied the association between obesity and periodontitis, but the results have been partly inconclusive. The aim of this study was to examine the association of body weight with periodontal infection. MATERIAL AND METHODS: The association between body weight and periodontal infection was examined using a nationally representative Health 2000 Health Examination Survey. The study was based on a subpopulation of dentate non-diabetic subjects aged 30-49 (n=2841). Periodontal infection was measured by the number of teeth with periodontal pockets of 4 mm or deeper and 6 mm or deeper. Body weight was measured using body mass index (BMI). RESULTS: We detected a weak exposure-response association of BMI with teeth with deepened periodontal pockets after controlling for smoking habits by restricting the sample to subjects who have never smoked and for other potential confounders by including them in the multivariate models. CONCLUSIONS: The results showed an association between body weight and periodontal infection among the non-diabetic, non-smoking population aged 30-49. Additional research is needed to determine the nature of this association.

Population-based study of salivary carriage of periodontal pathogens in adults.

Large, general population-based data on carriage rates of periodontal pathogens hardly exist in the current literature. The objectives of the present study were to examine the salivary detection of Aggregatibacter (formerly Actinobacillus) actinomycetemcomitans, Campylobacter rectus, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythensis, and Treponema denticola in a representative sample of the adult population living in southern Finland and to clarify which determinants are associated with the presence of these pathogens in saliva. 16S rRNA-based PCR methods with species-specific primers were employed to determine the presence of the six target bacteria in stimulated saliva samples, which were available from 1,294 subjects aged > or =30 years. The age group, gender, level of education, marital status, smoking history, number of teeth, and number of teeth with deepened pockets were included in the statistical analysis. In general, the carriage of periodontal pathogens was common, since at least one of the examined pathogens was found in 88.2% of the subjects. In descending order, the total detection rates were 56.9%, 38.2%, 35.4%, 31.3%, 20.0%, and 13.9% for T. forsythensis, T. denticola, P. gingivalis, C. rectus, A. actinomycetemcomitans, and P. intermedia, respectively. Age per se was strongly associated with the carriage of P. gingivalis (P = 0.000), and the level of education with that of T. denticola (P = 0.000). There was an association between the number of teeth with deepened pockets and carriage of P. gingivalis (P = 0.000), P. intermedia (P = 0.000), T. denticola (P = 0.000), and A. actinomycetemcomitans (P = 0.004). The data suggest that distinct species have a different carriage profile, depending on variables such as age, educational level, and periodontal status.

Occurrence of clinical signs of temporomandibular disorders in adult Finns.

AIMS: To study the age- and gender-related prevalence of signs of temporomandibular disorders (TMD) in the Finnish adult population. METHODS: A clinical health examination was performed as a part of a Health 2000 Health Examination Survey in 2000 and 2001. A nationally representative sample included 8,028 Finns at least 30 years of age, of whom 79% participated also in an oral health investigation, including examination of the stomatognathic system in order to assess the presence of certain TMD signs: maximum interincisal distance < 40 mm, pain in temporomandibular joints or masticatory muscles, and sounds in temporomandibular joints (crepitation, clicking). RESULTS: Thirty-eight percent of the subjects had at least 1 sign of TMD. All the signs studied were more common in women than men. Overall, signs of TMD were also associated with age; the older the subject, the higher the prevalence of the TMD signs. However, when stratified by gender, the association with age was not as clear, and gender differences were observed in the prevalence of the single TMD signs at different ages. CONCLUSION: Signs of TMD may be more common among the elderly than is usually reported.

A strong sense of coherence promotes regular dental attendance in adults.

OBJECTIVE: To investigate the relationship between the sense of coherence (SOC) and dental attendance pattern. It was hypothesised that the subjects with a stronger SOC have a more regular dental attendance. BASIC RESEARCH DESIGN: In the nationally representative sample including 8,028 persons aged 30, or more, 88% were surveyed. The questionnaire and home interview included information about socio-economic and demographic factors, behavioural and attitudinal variables, such as oral health behaviours (i.e. dental attendance pattern), and the SOC scale (12-item). Chi-square test, unadjusted and adjusted logistic regression models were used in the data analysis. PARTICIPANTS: The sample for this study consisted of 4,263, 30- to 64-year-old dentate, adults. RESULTS: Regular dental attendance was more common among those with a stronger SOC. Gender, education, family income and marital status, but not age, were related with dental attendance. The gender- and age-adjusted associations between the SOC and dental attendance pattern were found to be significantly stronger among those having high-, or middle level of education compared with those having a low education level. CONCLUSION: A stronger SOC is associated with regular dental attendance. This raises the possibility of achieving long-term positive effects on dental attendance in adulthood, if the SOC could be strengthened during adolescence.