Risk for periodontal disease in a Swedish adult population. Cross-sectional and longitudinal studies over two decades.

The overall aim of this thesis was to describe changes in the prevalence and severity of periodontal diseases and to identify risk factors for severe periodontal disease in adults living in Jönköping County, Sweden, by analysing the cross-sectional, epidemiological studies that had been carried out in the city of Jönköping in 1973, 1983, and 1993. Individuals were randomly selected from the following age groups: 20, 30, 40, 50, 60, and 70 years. The number of dentate subjects was 537 in 1973, 550 in 1983, and 552 in 1993. The cross-sectional study in 1993 was expanded to include an additional 1192 dentate individuals from the rest of the county. A longitudinal follow-up was also performed based on a re-examination in 1988-91 of 361 of the individuals examined in 1973. The main findings were as follows: Oral hygiene among 20-year-olds had deteriorated in 1993 compared with the 1983 results and the prevalence of gingivitis in this age group reverted to levels similar to those in 1973. The largest increase in mean number of teeth was found among the 70-year-olds who had an average of five more teeth per subject in 1993 than in 1973. Similar findings regarding tooth loss and levels of alveolar bone could be seen in individuals living in the city of Jönköping and in the rest of the county. The prevalence of individuals diagnosed with severe periodontal disease experience (13%) was unchanged between 1983 and 1993. These subjects had, on the average, two-four more teeth in 1993 than in 1983. Higher levels of supragingival plaque were significantly associated with severe periodontal disease/disease progression. A mean plaque level of 10 cigarettes/day) was strongly correlated with severe periodontal disease, but no association was found for light smoking (1-9 cigarettes/day). Female gender was found to be correlated with severe periodontal disease progression. The potential risk factors identified in the cross-sectional study were similar to the risk factors identified in the longitudinal study

Evaluation of a periodontal risk assessment model in subjects with severe periodontitis. A 5-year retrospective study

The aim of this study was to evaluate a well-established periodontal risk assessment tool in patients with severe periodontitis included in a supportive periodontal treatment (SPT) program. In total 20 individuals were included in the analysis. All subjects were randomly selected after successful periodontal treatment and at least 5 years SPT. Clinical and radiographic measurements were collected from patient records and analyzed according to the periodontal risk assessment model. Using the periodontal risk assessment model all subjects were classified as low, moderate, or high-risk patients. According to the model 7 patients were classified as moderate risk patients and 13 as high-risk patients. When comparing all the patients using only bleeding on probing (BoP) mean prevalence of 20% as a cut-off point, 15 patients were categorised as having low-moderate risk for periodontitis progression and 5 subjects as having high-risk for disease progression. The periodontal risk assessment model seems to overestimate the risk for disease progression. However the model is a suitable tool to visualize for both the clinician and the patient different variables of importance for periodontal health. The model is also beneficial to show how periodontal treatment can reduce further risk for periodontal disease

Prevalence of intrabony defects in a Swedish adult population : A radiographic epidemiological study

Aim: The purpose of this radiographic study was to evaluate the prevalence of intrabony defects and to study the correlation between these defects and clinical variables in a Swedish adult population. Another aim was to study the combined relationship of intrabony defects and furcation involvement with clinical variable. Materials and methods: The present study was performed using bitewing and apical radiographs from 329 subjects. The clinical and radiographic data were collected from the study that was carried out in Jonkoping 2003. Intrabony defects were measured from the bottom of the pocket to the highest point of alveolar bone crest. Furcations were considered healthy if the furcation was filled with bone up to the fornix. SPSS was used to analyze the results. Results: 2014 molars and 5898 non-molars were included in the study. The prevalence of intrabony defects was 2.2% in the whole population. Multivariate analysis showed that periodontal pockets (p <0.0001), plaque (p <0.001), age (p <0.02) and gender (p <0.03) had a significant relationship with the occurrence of intrabony defects. On the other hand, gingivitis, smoking habits and education level were not associated with intrabony defects. Multivariate analysis showed that the only variable associated with presence of intrabony defects and furcation involvement was presence of periodontal pockets (p <0.0001). Whilst, gingivitis, education level, plaque, gender, age and smoking habits were not associated with the outcome. Conclusions: Mandibular second molars were most likely to display intrabony defects, whilst mandibular incisors were the least likely to do so

Prevalence of furcation-involved molars in a Swedish adult population. A radiographic epidemiological study

The purpose of this study was to identify the prevalence of molars with furcation involvements grades II and III in adults participating in the Jonkoping Oral Health Study 2003. The second aim was to study correlations between different variables and the presence of furcation involvement in these individuals. The present study was performed using bitewing and apical radiographs from 329 subjects. Furcations were considered healthy if the furcation was filled with bone up to the fornix. Two thousand fourteen molars fulfilled the inclusion criteria. The prevalence of molars with furcation involvements was 8.3%. Univariate analysis showed that plaque, age, and presence of periodontal pockets were significantly correlated with furcation-involved molar/s (P 0.0001). Gingivitis and education were also significantly correlated to the presence of furcation involvement (P 0.006) and (P <= 0.01), respectively. Gender had no association with presence of involvements. Multivariate analysis showed that age and presence of periodontal pockets were significantly correlated with furcation involvement (P 0.0001). Smoking was also found to be associated with furcation involvement (P 0.04). The tooth most frequently and least likely displaying furcation involvement was the maxillary first molar and the mandibular second molar, respectively. Periodontal pockets, age, and smoking were risk indicators for furcation involvement

'Caries disease among an elderly population-A 10-year longitudinal study'

OBJECTIVES: To investigate the prevalence of dental caries and to identify risk factors for dental caries in an elderly population between 2008 and 2018. METHODS: This longitudinal study used data from a questionnaire survey and a clinical examination administered on two occasions 10 years apart to 273 individuals who were 65 and 75 years of age in 2008. The variables included were prevalence of dental caries as well as socioeconomic and socio-behavioural factors. RESULTS: The number of teeth decreased in both age groups by a mean of 2 over the 10-year study period, but the prevalence of dental caries remained stable. Approximately, a quarter of the participants had caries lesions. Toothbrushing once a day or less was the factor most strongly correlated with dental caries lesions (OR: 3.82, 95% CI: 1.68-8.66, p = 0.001), followed by need for homecare (OR: 3.50, 95% CI: 1.55-7.93, p = 0.003) and interproximal cleaning less than once a day (OR: 2.65, 95% CI: 1.36-5.19, p = 0.004). CONCLUSIONS: This longitudinal study revealed no increase in the prevalence of dental caries lesions, indicating that good oral health can be preserved among elderly people. The highest risk for dental caries lesions was among participants with inadequate oral hygiene routines (toothbrushing once a day or less and seldom using interproximal devices) and in need of help in daily living, emphasizing the importance of oral hygiene and collaboration between dental services and community-based health care

Association of sense of coherence and periodontal disease severity, in two cross-sectional studies

Objectives: To investigate the association between the individuals’ level of sense of coherence (SOC) and periodontal disease severity. Methods: The study populations originated from two stratified cross-sectional random samples of residents in a medium-sized Swedish city in 2003 and 2013, respectively. The final samples constituted 491 individuals in 2003 and 538 individuals in 2013. The samples were classified into three groups according to the severity of periodontitis (no/minor, moderate and severe). The 13-item Swedish version of Antonovsky’s “Orientation to life” questionnaire, measuring the individual’s SOC, was filled out. Descriptive statistics were performed as well as multinomial logistic regression analysis. Dependent variable was the severity of periodontal disease and independent variables, age in years, presently smoking and education at university level. Results: In the multinomial regression analysis, smoking, age, and total SOC score were significantly associated with severe periodontitis at both examinations. The strongest predictor of severe periodontal disease was smoking. The total SOC score did not differ between the examinations, but there was a statistically significant difference in two of the SOC dimensions, manageability (lower), and comprehensibility (higher), over time. Conclusions: Individuals with severe periodontitis had significantly lower SOC compared to subjects periodontally having no/minor periodontal disease. Smoking was the strongest overall predictor of having severe periodontitis.

Periodontal health and disease in an older population : A 10-year longitudinal study

Objectives To investigate alveolar bone loss (ABL), which is an indicator of periodontitis, and to identify risk factors for ABL in an older population between 2008 and 2018. Methods This longitudinal study used data from a questionnaire survey and a clinical examination administered on two occasions ten years apart to 273 individuals who were 65 years and 75 years in 2008. Results The mean number of teeth decreased significantly over the ten-year study period, while the proportion of individuals with calculus and moderate ABL visible on radiographs increased. For both ages, the number of teeth decreased by a mean of 2 teeth. The proportions of participants reporting poor general health, daily medication, xerostomia, living singly, visiting dental care irregularly and being in need of extra support in their homes all increased over the observation period. Conclusions Despite an increased progression of moderate alveolar bone loss, a fairly good dentition and chewing capacity was retained in this older population. However, the individual's age and fragility are important indicators that need to be considered when planning oral health care and the availability of dental care

Periodontal disease in Norwegian old-age pensioners

PURPOSE:  To identify factors of importance for periodontal health and disease on an old-age Norwegian population. MATERIALS AND METHODS: From a random sample of 1152 urban and rural elderly Norwegians, aged 67 years or older, 582 individuals were agreed to participate in the study. After exclusion of edentulous individuals, 394 individuals were remained. A standardised clinical examination was performed by the same examiner. In conjunction with the clinical examination, a questionnaire was filled out regarding demographic and social status, educational level, tobacco habits and general condition. RESULTS: In the examined population, 33% of the subjects had periodontal disease. Out of those, 12% had severe periodontitis, that is, ≥3 periodontal pockets ≥6 mm. All variables were tested separately in a logistic regression model with periodontal pockets 6 mm and above, as the outcome variable. After univariate testing the following variables were included in a multivariate logistic regression model: daily smoking, higher plaque score, rural living and lower education. Only daily smoking remained significantly correlated to periodontal disease in the multivariate model. CONCLUSIONS:  This study has shown a prevalence of periodontal disease in 33% of the study population. Out of those approximately 12% had more severe periodontitis. Daily tobacco use was the only factor significantly correlated to presence of periodontal disease

PR156 – Dietary intake in relation to oral health in adults with severe periodontitis

Background &amp; Aim: Periodontitis is a chronic disease which can result in progressive loss of the teeth's supportive tissue. About 40% of the world's population is affected by periodontitis of which approximately 10% have a severe form. Periodontitis can affect the dietary intake for diseased individuals due to mobile teeth that making it painful to eat or by missing teeth. The aim of the study was to investigate self-assessed oral health in relation to dietary intake in adult individuals with severe periodontitis treated in specialist-dental care. The aim was also to study self-assessed oral health and dietary intake in relation to the number of teeth, age and sex. Methods: The study was a cross-sectional study including 62 participants. The material was collected via questionnaires regarding background and the areas of oral health and dietary intake. Participants were recruited via a special-dental care clinic in Sweden during September 2017. Referred patients diagnosed with severe periodontitis were invited to participate in the study and the participation was confidential. Chi-square test, Fisher's exact test and Mann Whitney U test were used. Alpha was set at p&lt;0.05. Results: Half of the participants reported that their oral health condition constituted an obstacle to eating the foods they wanted. Participants who had ≥20 teeth ate fruits and berries, red meat, fish and poultry more often than participants with fewer teeth. Participants with ≤19 teeth assessed their chewing and biting ability as poorer than individuals with ≥20 teeth. Conclusion: The result shows that a large proportion of the participants with periodontitis experience that their oral health affects dietary intake . Multidisciplinary collaboration between dental care and dietitian clinic could increase the ability to prevent and/or treat further ill-health in individuals with periodontitis that adversely affects the energy and nutritional intake due to oral health condition. Disclosure: No significant relationships