Self‐Reported Periodontal Disease: Validation in an Epidemiological Survey

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141948/1/jper1407.pd

Periodontal disease: associations with diabetes, glycemic control and complications

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73645/1/j.1601-0825.2008.01442.x.pd

Recent epidemiologic trends in periodontitis in the USA

The most important development in the epidemiology of periodontitis in the USA during the last decade is the result of improvements in survey methodologies and statistical modeling of periodontitis in adults. Most of these advancements have occurred as the direct outcome of work by the joint initiative known as the Periodontal Disease Surveillance Project by the Centers for Disease Control and Prevention and the American Academy of Periodontology that was established in 2006. This report summarizes some of the key findings of this important initiative and its impact on our knowledge of the epidemiology of periodontitis in US adults. This initiative first suggested new periodontitis case definitions for surveillance in 2007 and revised them slightly in 2012. This classification is now regarded as the global standard for periodontitis surveillance and is used worldwide. First, application of such a standard in reporting finally enables results from different researchers in different countries to be meaningfully compared. Second, this initiative tackled the concern that prior national surveys, which used partial‐mouth periodontal examination protocols, grossly underestimated the prevalence of periodontitis of potentially more than 50%. Consequently, because previous national surveys significantly underestimated the true prevalence of periodontitis, it is not possible to extrapolate any trend in periodontitis prevalence in the USA over time. Any difference calculated may not represent any actual change in periodontitis prevalence, but rather is a consequence of using different periodontal examination protocols. Finally, the initiative addressed the gap in the need for state and local data on periodontitis prevalence. Through the direct efforts of the Centers for Disease Control and Prevention and the American Academy of Periodontology initiative, full‐mouth periodontal probing at six sites around all nonthird molar teeth was included in the 6 years of National Health and Nutrition Examination Surveys from 2009‐2014, yielding complete data for 10 683 dentate community‐dwelling US adults aged 30 to 79 years. Applying the 2012 periodontitis case definitions to the 2009‐2014 National Health and Nutrition Examination Surveys data, the periodontitis prevalence turned out to be much greater than previously estimated, namely affecting 42.2% of the population with 7.8% of people experiencing severe periodontitis. It was also discovered that only the moderate type of periodontitis is driving the increase in periodontitis prevalence with age, not the mild or the severe types whose prevalence do not increase consistently with age, but remain ~ 10%‐15% in all age groups of 40 years and older. The greatest risk for having periodontitis of any type was seen in older people, in males, in minority race/ethnic groups, in poorer and less educated groups, and especially in cigarette smokers. The Centers for Disease Control and Prevention and the American Academy of Periodontology initiative reported, for the first time, the periodontitis prevalence estimated at both local and state levels, in addition to the national level. Also, this initiative developed and validated in field studies a set of eight items for self‐reported periodontitis for use in direct survey estimates of periodontitis prevalence in existing state‐based surveys. These items were also included in the 2009‐2014 National Health and Nutrition Examination Surveys for validation against clinically determined cases of periodontitis. Another novel result of this initiative is that, for the first time, the geographic distribution of practicing periodontists in relation to the geographic distribution of people with severe periodontitis is illustrated. In summary, the precise periodontitis prevalence and distribution among subgroups in the dentate US noninstitutionalized population aged 30‐79 years is better understood because of application of valid periodontitis case definitions to full‐mouth periodontal examination, in combination with reliable information on demographic and health‐related measures. We now can monitor the trend of periodontitis prevalence over time as well as guide public health preventive and intervention initiatives for the betterment of the health of the adult US population.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153044/1/prd12323.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/153044/2/prd12323_am.pd

Dental visits among adult Hispanics – BRFSS 1999 and 2006

Objectives: This study examined and compared utilization of dental services by adult US Hispanics 18 years and older in the years 1999 and 2006. Methods: Dental utilization data collected by telephone interviews by the state‐based Behavioral Risk Factor Surveillance System (BRFSS) were analyzed. Results: In 2006, the state mean and median prevalence of adult Hispanics with dental visits during the past year were 56.2 percent and 62.1 percent, respectively, and had not changed significantly since 1999. In 40 states, utilization was well below the national prevalence of 70.3 percent. Frequency of dental visits was significantly higher among females and those with higher income (>$50,000), higher education, nonsmokers, and persons having medical health insurance. Conclusions: Findings from this study suggest that barriers to utilization of dental services among Hispanic adults exist in most states and may contribute to existing oral health disparities. The magnitude of this problem may increase in the future with the expansion of the US Hispanic population.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/87091/1/j.1752-7325.2011.00259.x.pd

Letter to the Editor: Authors’ response:

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141212/1/jper0182.pd

Evaluation and Use of an Index of Oral Health Status

Objectives: The goals of this investigation were (1) to evaluate the Oral Health Status Index in relation to demographic characteristics, socioeconomic status, and preventive behaviors of an adult population; and (2) to understand how individual index components performed as indicators of oral health status compared to the composite index. Methods : The Oral Health Status Index (OHSI) was used on a probability sample of adults, aged 18–93 years, living in the Detroit tricounty area. Data were collected on 509 subjects via in-home dental examinations. Bivariate and multivariate analyses were used to compare the OHSI and its components, including decayed, missing, and replaced teeth, free ends, and moderate and severe periodontal disease measures. Results : The mean OHSI score for subjects was 77.3 (se=1.83) with a range of -8.0 to 100.0. In regression analyses, OHSI scores were positively correlated with subjects' education level, self-rated oral health scores, and frequency of dental checkups and negatively correlated with age, nonwhite race, and smoking. Of the index components, missing teeth performed well as an indicator of oral health status. Missing teeth were positively correlated with age, nonwhite race, and smoking and negatively correlated with education level, self-rated oral health, and use of Medicaid. About 53 percent of variance in OHSI scores was explained by the multivariate models, compared to 46 percent for missing teeth. Conclusions : Choosing an indicator of oral health status likely will depend upon the characteristics of the population to be studied. As a composite measure of oral health status, the OHSI performed acceptably; however, missing teeth, an index component, also worked well. Continued evaluation of the OHSI is warranted.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65652/1/j.1752-7325.1997.tb02980.x.pd

Effect of lifestyle on 6‐year periodontitis incidence or progression and tooth loss in older adults

AimTo evaluate the longitudinal association of combined healthy lifestyle factors with incidence or progression of periodontitis and tooth loss in older adults.Materials and methodsThis 6‐year study included 374 Japanese 70‐year olds with 7,157 teeth, from a source eligible baseline population of 554 individuals. Four lifestyle factors—cigarette smoking, physical activity, relative weight, and dietary quality—were scored as healthy (1 point) or unhealthy (0 point). Adding the individual scores generated the “healthy lifestyle score” (0–4 points). Multilevel mixed‐effects logistic regression models were applied to evaluate tooth‐specific associations between the baseline healthy lifestyle score and the incidence or progression of periodontitis (increase in clinical attachment loss ≥3 mm) and tooth loss.ResultsAfter 6 years, 19.0% of the teeth exhibited periodontitis incidence or progression and 8.2% were lost. Compared with a healthy lifestyle score of 0–1 (least healthy), the highest score (4 points) was associated with a significantly lower tooth‐specific risk of periodontitis (adjusted odds ratio = 0.32; 95% confidence interval: 0.16–0.62) and tooth loss (adjusted odds ratio = 0.42; 95% confidence interval: 0.23–0.77).ConclusionsSimultaneous adherence to multiple healthy lifestyle factors significantly lowers the risk of incidence or progression of periodontitis and tooth loss in older adults.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/145573/1/jcpe12920_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/145573/2/jcpe12920.pd

Risk Indicators for Periodontitis in US Adults: NHANES 2009 to 2012

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142205/1/jper1174.pd

Response to “prognostic biomarkers in oral leukoplakia”

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152757/1/odi13185.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/152757/2/odi13185_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/152757/3/odi13185-sup-0001-AppendixS1.pd

Update on Prevalence of Periodontitis in Adults in the United States: NHANES 2009 to 2012

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141963/1/jper0611.pd