Measures Of Periodontal Disease Research Articles

Estimating disease prevalence from partially-sampled clusters using the conditional linear family for multivariate Bernoulli data

In periodontal disease surveillance in human populations, full-mouth clinical examinations to classify the disease status of individuals are the gold standard for estimating periodontitis prevalence. However, conducting full-mouth exams is resource intensive, time consuming, and costly, especially in studies involving thousands of participants. Partial-recording protocols have been utilized in oral health surveys worldwide to gather correlated binary outcomes of periodontal disease on selected teeth in lieu of full-mouth exams. Since the use of partial-recording protocols tends to underestimate disease prevalence, a statistical distributional approach considering the pattern of tooth-level disease in the mouth was proposed to substantially reduce bias for the estimation of periodontitis prevalence. This approach employed multivariate Bernoulli distributions for observation (tooth)-level disease indicators to define formulae for the prevalence of disease (periodontitis) at the cluster (person)-level for various full-mouth case definitions. In turn, prevalence estimators were based on plug- in estimates of parameters from a conditional linear family for binary data gathered under partial recording protocols. Work in this article extended existing prevalence estimators for simple case definitions based on single clinical measures of tooth-level periodontal disease to a definition of severe periodontitis using two measures as defined by the Centers for Disease Control and Prevention and the American Academy of Periodontology, and later adopted by the 2017 World Workshop in Periodontology. Simulations evaluated the finite-sample performance of the proposed estimators and their confidence intervals for three established partial-recording protocols. In general, the prevalence estimators performed well relative to bias and coverage when tooth-level probabilities of disease and within-mouth correlation structures were correctly specified and even when the pattern of tooth-pair correlations was misspecified. Journal of Statistical Research 2024, Vol. 58, No. 1, pp. 3-31.

Prevalence and severity of periodontal disease in the host community and Rohingya refugees living in camps in Bangladesh.

To assess the prevalence and severity of periodontal disease of the Rohingya refugees and host community in Bangladesh. An unpublished pilot was conducted for the sample size calculation. Two-stage cluster sampling method was used to select 50 participants from refugee camps and 50 from the host community. Structured questionnaire and periodontal examination were completed. Composite measures of periodontal disease were based on the World Workshop (WW) and Centers for Disease Control and Prevention-American Academy of Periodontology. Linear regression models, for clinical attachment level and periodontal pocket depth (PPD) and ordered logistic regression models, for composite measures, were fitted to test the association of periodontal measures and refugee status. Compared to the host community, a smaller percentage of refugees reported good oral health-related behaviours. Refugees exhibited lower levels of bleeding on probing but higher PPD, hence a higher proportion had severe stages of periodontitis. As per the WW, prevalence of periodontal disease was 88% and 100% in the host and refugee groups, respectively. In the unadjusted models, refugees were three times more likely to have severe stages of periodontitis; this association was attenuated when adjusted for confounders (sociodemographic variables and oral health-related behaviours). Prevalence of periodontitis was high both in the host community and refugees. The refugees exhibited a more severe disease profile. The oral health of both groups is under-researched impacting the response of the health system. Large-scale research systematically exploring the oral health of both groups will inform the design and delivery of community-based interventions.

Association between dietary patterns and periodontal disease: The OsteoPerio cohort study.

To examine the association of dietary patterns with periodontal disease (PD) and its progression over 5 years. Analyses involved 1197 post-menopausal women from the OsteoPerio cohort. Dietary patterns assessed include Healthy Eating Index-2015 (HEI), Alternative HEI (AHEI), Dietary Approaches to Stop Hypertension (DASH) and alternate Mediterranean Diet (aMed) at baseline (the average of two food frequency questionnaires administered between 1993 and 2001). At baseline and the 5-year follow-up, periodontal assessments evaluated alveolar crestal height (ACH), probing pocket depth (PPD), clinical attachment loss (CAL), percentage of gingival sites bleeding on probing (%BOP) and missing teeth due to PD. Linear and logistic regression were used to examine the associations. Cross-sectionally, HEI and aMed were associated with smaller CAL and %BOP; along with DASH, they were associated with a decreased odds of teeth missing due to PD. AHEI and aMed were associated with a decreased odds of severe PD. Prospectively, AHEI was associated with greater ACH progression. This association was attenuated to the null after loss of ACH was imputed for teeth lost due to PD over follow-up, or after excluding participants with diabetes, osteoporosis, hypertension or heart disease at baseline. Better adherence to healthy dietary patterns was associated with better PD measures cross-sectionally but greater progression of ACH over 5 years. The latter might be explained by incident tooth loss due to PD and pre-existing comorbidities.

Knowledge and Attitude of Primary School Teachers for Periodontal Disease

Background: This research study aimed to explore the knowledge and attitudes of primary school teachers regarding periodontal disease. Periodontal disease is a common oral health condition that can affect people of all ages, including children. Teachers play a vital role in promoting oral health among their students, and understanding their knowledge and attitudes towards periodontal disease is essential for designing effective oral health education programs. Materials and Methods: For this study, a survey was conducted among primary school teachers from various schools. The survey included questions related to their knowledge about periodontal disease, its causes, symptoms, and preventive measures. Additionally, it assessed their attitudes towards oral health promotion in the classroom. A total of 300 primary school teachers participated in the survey, providing valuable insights into their perspectives on periodontal disease. Results: Knowledge Level: The study found that 60% of primary school teachers had a basic understanding of periodontal disease. However, only 25% could correctly identify its major causes, and 45% were aware of its common symptoms. Attitudes towards Oral Health: Interestingly, 80% of teachers expressed a positive attitude towards incorporating oral health education into their teaching curriculum. They believed that educating students about oral hygiene was important. Use of Educational Resources: Approximately 70% of teachers reported using oral health educational resources such as pamphlets and videos in their classrooms. Barriers: The study also identified some barriers to effective oral health education, including a lack of time, resources, and training. Conclusion: This study highlights the varying levels of knowledge among primary school teachers regarding periodontal disease. While a majority expressed positive attitudes towards oral health education, there is a need for targeted training and resources to improve their knowledge and confidence in teaching students about periodontal disease. Efforts to overcome existing barriers should also be considered to enhance oral health promotion in primary schools.

Association between periodontitis and cognitive impairment in adults.

To summarize the data on association between periodontal diseases and cognitive impairment in adults this systematic review scrutinized various observational studies till September 2021. This review was carried out in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA 2020) guidelines. The authors used PECO framework question,: population-Adults(18 years or older), exposure-adults suffering from periodontitis, comparator-adult group without periodontitis, outcome-adults at high risk for cognitive impairment. Search for the literature was conducted on PubMed, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Search was limited to human studies with no limitation to year of publication prior to September 2021. Search terms used were related to gingiva, oral bacteria like Porphyromonas gingivalis, gum inflammation, periodontitis, dementia, neuroinflammation, cognitive impairment, Alzheimer's disease, Parkinson disease. Following research, all the studies providing association between periodontal diseases and neurodegenerative diseases with quantitative measures were included in the study. Non-human studies, studies on patients below 18 year old, studies related to influence of treatment and in subjects already suffering from neurological disease were excluded. After removing duplicates, eligible studies were identified and data extracted by two reviewers to make ensure inter examiner reliability and to prevent data entry errors. Data from the studies were tabulated as study design, sample characteristics, diagnosis, exposure biomarkers/measures, outcomes and results. Methodological quality of studies was assessed by adapted Newcastle-Ottawa scale. Selection of study groups, comparability and exposure/outcome were used as parameters. Case-control and cohort studies were considered as high-quality studies if six or more stars were awarded out of nine maximum stars and four or more stars for cross-sectional studies out of six stars. Comparability among the groups was studied by taking into account primary factors for Alzheimer's disease such as age and sex and secondary factors like hypertension, osteoarthritis, depression, diabetes mellitus, and cerebrovascular disease. For cohort studies, 10 year follow up and dropout of <10% was considered to be successful. A total of 3693 studies were identified by two independent reviewers and finally 11 studies were included in the final analysis. Six cohort studies, three cross-sectional and two case-control studies were included after excluding remaining studies. Bias in studies was assessed by adapted Newcastle-Ottawa Scale. All included studies were of high methodological quality. Association between periodontitis and cognitive impairment was determined by using different criteria like International classification of disease, clinical measurement of periodontitis subjects, inflammatory biomarkers, microbes and antibodies. It was suggested that subjects with chronic periodontitis since 8 years or more, are at a higher risk of having dementia. Clinical measures of periodontal disease like probing depth, clinical attachment loss, alveolar bone loss were found to be positively associated with cognitive impairment. Inflammatory biomarkers and pre-existing elevated levels of serum IgG specific to periodontopathogens was reported to be associated with cognitive impairment. Within the limitations of the study, the authors concluded that though the patients with long-standing periodontitis are at greater risk for developing cognitive impairment by neurodegenerative diseases, the mechanism by which periodontitis can lead to cognitive impairment is still vague. Evidence suggests a strong association between periodontitis and cognitive impairment. Still further studies should be done to explore the mechanism involved.

Periodontitis and cardiovascular risk factors in subjects with and without type 1 diabetes: A cross sectional analysis

AimsThis cross-sectional analysis explored the relationships between periodontal disease (PD) and subclinical CVD in a cohort of patients with type 1 diabetes and non-diabetic controls. MethodsData were collected from adults enrolled in the Coronary Artery Calcification in Type 1 Diabetes (CACTI) study or enrolled through the Barbara Davis Center for Diabetes Adult Clinic. A clinical periodontal exam measured attachment loss and probing depth. Brachial artery distensibility (brachD), carotid intima-media thickness (cIMT), and pulse wave velocity (PWV) were assessed as measures of subclinical cardiovascular structure and function. Results144 participants with T1D and 148 non-diabetics were enrolled. Compared to non-diabetic controls, T1D participants had a higher probing depth (2.6 mm vs. 2.5 mm; p = 0.04), higher attachment loss (2.7 mm vs. 2.4 mm; p < 0.01), lower brachD (mean 5.8 vs. 6.4 mmHg; p < 0.01), a higher cIMT (mean 0.68 vs. 0.64 mm; p < 0.01), and a higher PWV (mean 8.3 vs. 7.8 m/s; p < 0.01). There were no significant associations between PD and CVD metrics. ConclusionsPeriodontal and cardiovascular health was worse in participants with T1D compared to non-diabetics. No significant associations between PD measures and CVD were identified.

Oral hygiene and infective endocarditis: a case control study

To determine if oral hygiene is associated with infective endocarditis (IE) among those at moderate risk for IE. This is a case control study of oral hygiene among hospitalized patients with IE (cases) and outpatients with heart valve disease but without IE (controls). The primary outcome was the mean dental calculus index. Secondary outcomes included other measures of oral hygiene and periodontal disease (e.g., dental plaque, gingivitis) and categorization of blood culture bacterial species in case participants. The 62 case participants had 53% greater mean dental calculus index than the 119 control participants (0.84, 0.55, respectively; difference=0.29, 95% CI: 0.11, 0.48; P=.002) and 26% greater mean dental plaque index (0.88, 0.70, respectively; difference=0.18, 95% CI: 0.01.0.36; P=.043). Overall, cases reported fewer dentist and dental hygiene visits (P=.013) and fewer dental visits in the 12 weeks before enrollment than controls (P=.007). Common oral bacteria were identified from blood cultures in 27 of 62 cases (44%). These data provide evidence to support and strengthen current American Heart Association guidance that those at risk for IE can reduce potential sources of IE-related bacteremia by maintaining optimal oral health through regular professional dental care and oral hygiene procedures.

Patterns of site-level periodontal disease and within-mouth correlation among older adults in the Hispanic Community Health Study/Study of Latinos.

Clinical measures of periodontal disease such as attachment loss (CAL) and probing depth (PD) vary considerably between and within individuals with periodontitis and are known to be influenced by person-level factors (e.g. age and race/ethnicity) as well as intraoral characteristics (e.g. tooth type and location). This study sought to characterize site-level disease patterns and correlations using both person-level and intraoral factors through a model-based approach. This study used full-mouth, six sites per tooth, periodontal examination data collected from 2301 Hispanic/Latino adults aged 60-74 years in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). The presence of site-level CAL ≥3 mm and PD ≥4 mm was estimated using generalized estimating equations (GEE), explicitly modelling pairwise periodontal site correlations, while adjusting for number of teeth, sex and Hispanic/Latino background. Subsequently tooth- and tooth-site patterns of intraoral CAL ≥3 mm and PD ≥4 mm were estimated and visualized in the HCHS/SOL population. The findings showed that posterior sites had the highest odds of CAL ≥3 mm and PD ≥4 mm. Sites located in the interproximal space had higher odds of PD ≥4 mm but lower odds of CAL ≥3 mm than non-interproximal sites. Mexicans had the lowest odds of CAL ≥3 mm among all Hispanic/Latino backgrounds. While Mexicans had lower odds of PD ≥4 mm than Central Americans and Cubans, they had higher odds than Dominicans and Puerto Ricans. Site-level proportions and pairwise correlations of PD ≥4 mm were generally smaller than those of CAL ≥3 mm. The patterns of site-level probabilities of clinical measures of periodontal disease can be defined based on tooth, site and individual-level characteristics. Intraoral correlation patterns, while complex, are quantifiable. The risk factors for site-level CAL ≥3 mm may differ from those of PD ≥4 mm. Likewise, participant risk factors for site-level clinical measures of periodontal disease are distinct from those that affect individual-level periodontitis prevalence. Future epidemiological investigations should consider model-based approaches when examining site-level disease probabilities to identify intra-oral patterns of periodontal disease and make inferences about the larger population.

Association between self-reported periodontitis and high-risk oral human papillomavirus infection among Indigenous South Australians: A cross-sectional study.

IntroductionThe incidence of oropharyngeal squamous cell carcinoma (OPSCC) is increasing globally, reflecting an increase in human papillomavirus (HPV)-related lesions. Indigenous populations are disproportionately affected by OPSCCs. Currently, testing for oral HPV is not recommended as a screening tool to permit early detection of OPSCCs due to the high population prevalence of HPV infection. Periodontitis may be a marker of oral HPV infection, but previous research evaluating this association has been inconclusive. Here we report a large population-based study examining the association between high-risk oral HPV infection and periodontitis among Indigenous South Australians.MethodsWe utilised a large convenience sample of Indigenous South Australians aged 18+ years recruited between February 2018 and February 2020. Of the original cohort (n = 1011), 748 (73.9%) participants participated in the 12 month follow-up. Detailed information on sociodemographic characteristics, health-related behaviours, and sexual history were collected at enrolment. Saliva samples were collected at 12 months and tested for the presence of oral HPV DNA using the optimized general primer (GP) + PCR system. The primary outcomes were the prevalence of any high-risk oral HPV DNA, and separately, HPV 16 and/or 18. Periodontitis was assessed at follow-up by using validated self-reported periodontitis screening questions. Logistic regression analyses were undertaken to assess the association between self-reported periodontitis and oral HPV infection with adjustment for potential sociodemographic and behavioural confounders, with estimates presented as odds ratios (OR) and 95% confidence interval (CI).ResultsData on 673 participants (89.9% of the follow-up cohort) were available. Participants ranged in age from 18 to 80 (mean age 42.2, SD 14.7) and 31.5% were male. Overall, 115 (17.1%) participants had self-reported periodontitis, 40 (5.9%) had any high-risk oral HPV and 14 (2.1%) had HPV 16 and/or 18. Any high-risk HPV was detected among seven (17.5%) participants and HPV 16 and/or 18 was detected in three (21.4%) who self-reported periodontitis. In the regression analyses no significant association was found between self-reported periodontitis and high-risk oral HPV (adjusted OR: 1.10; 95% CI: 0.45–2.70) or HPV 16 and/or 18 (adjusted OR: 1.27; 95% CI: 0.32–5.03).ConclusionThis study did not find any association between self-reported periodontitis and high-risk oral HPV among Indigenous South Australians. Further targeted studies with standardized clinical measures of periodontal disease are needed to clarify the link between high-risk oral HPV and periodontal disease. If confirmed this would add further weight to the importance of recommendations about the utility of periodontitis screening to identify individuals at risk of carrying high-risk oral HPV, who may benefit from more intensive screening and ongoing monitoring.

The Effects of Psychological Stress, Depression and Inadequate Coping Behaviors on the Progression of Periodontal Disease

Aim: The aim of the present study was to explore the associations between periodontal diseases, psycho-neuro-immunologic variables like stress and depression by estimating salivary cortisol (CORT), salivary Chromogranin- A (CgA), and salivary C-reactive protein (CRP). Methodology: A total of 100 patients were included in the study and categorized into two groups which included 50 in control group (healthy individuals) and 50 recall periodontal patients. Psycho-neuro-immunologic variables like stress and depression were assessed through the Derogatis Stress Profile (DSP) and Centre of Epidemiologic Studies Depression scale (CES-D). Periodontal parameters like plaque index, gingival index, probing pocket depth and clinical attachment levels were recorded. Saliva samples were collected for estimation of stress markers such as cortisol, Chromogranin- A, and C-reactive protein. Results: Stress, depression and stress markers were correlated with measures of periodontal disease. In addition, oral care neglect during periods of stress and depression was associated with attachment loss and PD &gt;5 mm. Stress markers and CRP levels were also significantly higher in subjects with stress patients when compared to healthy individuals. Conclusions: The results of our study suggest that stress might be associated with periodontal disease through psychologic and behavioral mechanisms. Our result strengthens the suggested hypothesis of association between psychologic factors and markers of periodontal disease.

Markers of periodontal disease and cognitive decline in a diverse, older cohort

AbstractBackgroundPrior studies have reported associations between periodontitis, as a proxy for inflammation, and increased risk of cognitive decline and dementia, but findings for specific markers of periodontal disease (PDD) have been inconsistent with the few longitudinal studies in diverse cohorts. The goal of this study was to assess whether measures of PDD were associated with subsequent cognitive decline in a cohort of older Black and white adults.MethodWe studied 967 Black and white adults, aged 70‐79 at baseline (51.8% female and 32.8% Black), enrolled in the Health, Aging and Body Composition study. Participants received a periodontal exam in year 2 which assessed indicators of PDD: gingival index (a rating of gingival inflammation), mean attachment loss, and mean pocket probing depth. Cognitive testing was repeated at baseline, years 3, 5, 8, 10, and 11, and included the Modified Mini‐Mental State (3MS) Examination and the Digit Symbol Substitution Test (DSST). We evaluated the association between PDD, categorized as tertiles, and cognitive decline over 11 years of follow‐up with linear mixed‐effects models.ResultIn unadjusted models, higher gingival index was associated with greater decline on 3MS (high vs. low gingival index β = ‐0.27, 95% CI ‐0.48 to ‐0.05) but not DSST. This relationship remained significant after adjusting for race, sex, education, and socioeconomic status (β = ‐0.26, 95% CI ‐0.48 to ‐0.04). Models stratified by race suggest that this association was stronger among older Black adults (Black: β = ‐0.44, 95% CI ‐0.81 to ‐0.06; white: β = ‐0.13, 95% CI ‐0.40 to ‐0.12). Mean attachment loss and mean pocket probing depth were not consistently associated with cognitive decline.ConclusionGingival index was associated with worse decline in global cognition among Black and white older adults. Further work is necessary to understand other measures of poor oral health as markers of cognitive aging in diverse populations.

Periodontal disease measures and risk of incident peripheral artery disease: The Atherosclerosis Risk in Communities (ARIC) Study.

The association of periodontal disease with atherosclerotic cardiovascular diseases is well known, but not specifically with incident peripheral artery disease (PAD). Therefore, we studied the associations of periodontal disease with incident PAD in a population-based setting. Among 9,793 participants (aged 53-75 years) without prevalent PAD, self-reported history of periodontal disease was ascertained. Of these, 5,872 participants underwent full-mouth examinations from which periodontal status was defined using the US Centers for Disease Control and Prevention-American Academy of Periodontology (CDC-AAP) definition. We quantified the association of periodontal disease with incident PAD (defined by hospital admission diagnosis or procedures) using multivariable Cox regression models. During a median follow-up of 20.1 years, 360 participants (3.6%) developed PAD. In models accounting for potential confounders including diabetes and smoking pack-years, there was higher hazard of PAD in participants with self-reported tooth loss because of periodontal disease (hazard ratio:1.54 [95% CI:1.20-1.98]), history of periodontal disease treatment (1.37 [1.05-1.80]), and periodontal disease diagnosis (1.38 [1.09-1.74]), compared to their respective counterparts. The clinical measure of periodontal disease (n=5,872) was not significantly associated with incident PAD in the fully adjusted model (e.g., 1.53 [0.94-2.50] in CDC-AAP-defined severe periodontal disease versus no disease). We observed a modest association of self-reported periodontal disease, especially when resulting in tooth loss, with incident PAD in the general population. Nonetheless, a larger study with the clinical measure of periodontal disease is warranted.

Periodontal Pocket Depth in Relation to Salivary Osteonectin among Osteoporotic Old Adult Women

Osteoporosis is a systemic skeletal disorder characterized by compromised bone strength The association between systemic osteoporosis and periodontal health remains controversial many studies found a relationship between clinical measures of periodontal disease and salivary levels of osteonectin asit is essential for normal bone mass. This study was conducted to measure salivary osteonectin in relation to periodontal pocket depth among osteoporotic women and compared to control group.Materials and Methods: 60 females aged 60-65 years attending Al-Yarmook Teaching Hospital were included in the present study , The 30 patients diagnosed with osteoporosis by measuring bone density at the spine and femur with a dual-energy X-ray absorptiometry at T-score of &gt;2.5, and 30 women without osteoporosis with T-score of

Periodontal Disease and Incident CKD in US Hispanics/Latinos: The Hispanic Community Health Study/Study of Latinos

Rationale & ObjectiveRecent studies suggest that periodontal disease may be associated with incident chronic kidney disease (CKD). However, studies have focused on older populations, and US Hispanics/Latinos were not well represented.Study DesignObservational cohort.Setting & ParticipantsWe analyzed data from the Hispanic Community Health Study/Study of Latinos who completed a baseline visit with a periodontal examination and a follow-up visit, and did not have CKD at baseline.PredictorsPredictors included ≥30% of sites with clinical attachment loss ≥3 mm, ≥30% of sites with probing depth ≥4 mm, percentage of sites with bleeding on probing, and absence of functional dentition (<21 permanent teeth present).OutcomesOutcomes were incident low estimated glomerular filtration rate (eGFR) (eGFR <60 mL/min/1.73 m2 and decline in eGFR ≥1 mL/min/year); incident albuminuria (urine albumin:creatinine ratio [ACR] ≥30 mg/g); and change in eGFR and ACR.Analytic ApproachPoisson and linear regression.ResultsFor the sample (n = 7.732), baseline mean age was 41.5 years, 45.2% were male, 11.7% had ≥30% of sites with clinical attachment loss ≥3 mm, 5.1% had ≥30% of sites with probing depth ≥4 mm, 30.7% had ≥50% of sites with bleeding on probing, and 16.2% had absent functional dentition. During a median follow-up of 5.9 years, 149 patients developed low eGFR and 415 patients developed albuminuria. On multivariable analysis, presence versus absence of ≥30% of sites with probing depth ≥4 mm and absence of functional dentition were each associated with increased risk for incident low eGFR (incident density ratio, 2.31; 95% CI, 1.14-4.65 and 1.65, 95% CI, 1.01-2.70, respectively). None of the other predictors were associated with outcomes.LimitationsOnly a single kidney function follow-up measure.ConclusionsIn this cohort of US Hispanics/Latinos, we found that select measures of periodontal disease were associated with incident low eGFR. Future work is needed to assess whether the treatment of periodontal disease may prevent CKD.

Diagnostic accuracy of self-reported measures of periodontal disease: A clinical validation study using the 2017 case definitions.

To clinically validate a self-reported questionnaire for periodontal disease and assess its accuracy for differentiating periodontal health and different stages of periodontitis. A Chinese (Cantonese) version of a self-reported questionnaire was prepared by translating and validating the original English questions proposed by the Centers for Disease Control and Prevention/American Academy of Periodontology (CDC/AAP). The utility of the CDC/AAP questionnaire and its individual questions was assessed against a full-mouth periodontal examination. Periodontal case definition was based on the 2017 World Workshop classification of periodontal diseases. Multivariable logistic regression and the area under the receiver operating characteristic curve (AUROC) analysis were performed to assess the accuracy of the questionnaire. 408 subjects enrolled in this study, including those with periodontal health (16.2%), gingivitis (15.2%), Stages I/II periodontitis (31.8%) and Stages III/IV periodontitis (36.8%). Overall, the questionnaire had poor accuracy in detecting the presence of Stages I/II periodontitis with an AUROC 0.608. While it showed moderate to high accuracy for identifying periodontal disease (gingivitis and periodontitis), periodontitis and Stages III/IV periodontitis with an AUROC of 0.837, 0.803 and 0.870, respectively. Self-reported measures in combination with age and tobacco smoking showed excellent performance for identifying Stages III/IV periodontitis with a high AUROC of 0.953, a sensitivity of 95.7%, and a specificity of 89.0%. Specific questions and combinations provided greater utility to discriminate the various periodontal case definitions. The self-reported CDC/AAP questionnaire may be a feasible tool for detecting periodontitis, and its combination with demographic and lifestyle factors is useful for the identification of individuals with Stages III/IV periodontitis. This questionnaire seems less helpful in screening of Stages I/II periodontitis. Further studies are needed to test the validity in larger community-based populations.

Development and validation of a latent, multidimensional, self-report periodontal disease measure.

Self-report measures of periodontal disease have utility for screening, but have not capitalized on a latent variable approach based on psychometric theory to validate such measures. This study aimed to develop a psychometrically valid self-report measure of periodontal disease using latent variable factor analysis and other evidence-based psychometric analyses. Likert-type items reflecting periodontal disease were administered to a sample of adults (n=828) in the United States via an online survey. Items were adapted from prior self-report measures or were newly developed based on psychometric item development theory and theoretical knowledge of periodontal disease. Psychometric analyses included exploratory and confirmatory factor analysis, parallel analysis, and a calculation of internal consistency. Exploratory factor analysis (EFA) was indicative of the goodness-of-fit with two factors (root mean square error of approximation (RMSEA)=0.08; comparative fit index (CFI)=0.97; Tucker Lewis index (TLI)=0.96; standardized root mean squared residual=0.06); five of the 22 original survey questions were eliminated based on the results of this EFA. Parallel analysis supported a two-factor model to represent the similarities across items-one factor reflecting physiologic components and another reflecting functional components of periodontal disease. Confirmatory Factor Analysis also indicated adequate model fit (RMSEA=0.07; CFI=0.98; TLI=0.98; and weighted root mean square residual=1.20). Psychometric analyses of a new 17-item periodontal disease self-report measure provided initial evidence of construct/factor validity. This approach to developing self-report periodontal disease measures may facilitate useful and cost-effective estimates of periodontal disease and provide a testable scale. Future work should include clinical validation.

Association between periodontal disease and vulnerable plaque morphology in patients undergoing carotid endarterectomy.

Periodontal disease (PD) is a chronic inflammatory oral condition with potentially important systemic sequelae. We sought to determine whether the presence of PD in patients with severe carotid disease was associated with morphological features consistent with carotid plaque instability. A total of 52 dentate patients hospitalized for carotid endarterectomy (CEA) had standardized assessments of their periodontal status, including measurements of probing pocket depth (PPD), clinical attachment level (CAL) and bleeding on probing (BoP). Carotid plaque morphology was assessed by ultrasound using the gray scale median (GSM) score and by immunohistochemistry using anti-CD68 and anti-alpha-actin antibodies, markers for macrophages and smooth muscle cells (SMCs) respectively. In total 30/52 patients (58%) had PD. Significant associations were noted between low GSM on ultrasound and each mm in PPD (p=0.001), each mm in CAL (p=0.002) and with a 10% increase in BoP (p=0.009). Using the standardized PERIO definition the association remained robust (aOR=10.4 [95% CI:2.3-46.3], p=.002). Significant associations were also observed with high macrophage accumulation and each individual PD measure (p<0.01 for PPD, CAL and BoP) and with the PERIO definition (aOR=15 [95% CI:1.8-127.8], p=.01). Similarly, low SMC density was also significantly associated with individual measures of PD (p<0.05 for PPD, CAL and BoP), but not with the PERIO definition (aOR 3.4 [95% CI:0.9-12.8], p=.07). The presence of PD was significantly associated with both ultrasound and immunohistochemistry features of carotid plaque instability in patients undergoing CEA.

Stress and Periodontium―A Review

Stress is an association of physiological and psychological reactions of a person confronted to a change of situation he cannot face. The relationship between stress and any disease is explained by hormonal modifications and behavioural changes induced by the stress. Research has suggested that stress and depression are two factors that play a role inthe development and progression of periodontal disease. It is not clear, however, whether these factors lead to periodontal disease through physiological or behavioural changes, or by some combination of the two. The purpose of the present review article is to explore the associations between psychological factors, psycho immunologic variables, behaviour, and clinical measures of periodontal disease.

Methodological approaches for investigating links between dental and chronic diseases with claims data: A scoping study.

The purpose of this study was to provide an overview of methodological approaches to assess the relationship between dental diseases and other noncommunicable diseases on the basis of claims data. Based on the methodological framework of Arksey and O'Malley, a scoping study was conducted. By searching electronic databases (PubMed, Web of Science, and LILACS), appropriate articles were identified. After extracting relevant information and entering it into a data-charting form, the study characteristics and the methodological approaches were summarized descriptively. Fifty-one articles were identified for inclusion in the analysis. Most of the selected studies (78 percent) originated from Taiwan and employed a cohort design. The majority of studies considered dental diseases, particularly periodontal disease (PD) measures, but no common standard was identified for the definition of PD. Unmeasured confounding, misclassification, and surveillance bias were reported to be the main limitations of the claims data analyses. Claims data provide a very useful information source to further delineate the relationship between PDs and other noncommunicable diseases. If diagnostic codes are available, they seem to be the most suitable tool to assess PD in claims-based studies. In databases that do not contain dental diagnostic codes, e.g., databases in Germany and the United States, the identification of PD is a particular challenge. The inclusion of dental diagnostic codes in all claims databases is strongly recommended. Due to the public health relevance of PD, there is a need for more comprehensive documentation of dental parameters within claims data.

A Prototype Antibody-based Biosensor for Measurement of Salivary MMP-8 in Periodontitis using Surface Acoustic Wave Technology

Periodontitis is an economically important disease which is highly prevalent worldwide. Current diagnostic approaches are time-consuming and require interpretation of multiple aspects of clinical and radiographic assessment. Chair-side monitoring of inflammatory mediators of periodontitis could provide immediate information about disease activity, which can inform patient management. We aimed to develop a novel prototype biosensor to measure salivary matrix metalloproteinase-8 (MMP-8) using specific antibodies and surface acoustic wave (SAW) technology. The analytical performance of the prototype biosensor was compared to standard enzyme-linked immunosorbent assay (ELISA) using unstimulated saliva samples obtained from patients with periodontitis before and after non-surgical treatment (N = 58), patients with gingivitis (N = 54) and periodontally healthy volunteers (N = 65). Receiver operator characteristic (ROC) analysis for distinguishing periodontitis from health revealed an almost identical performance between the sensor and ELISA assays (area under curve values (AUC): ELISA 0.93; SAW 0.89). Furthermore, both analytical approaches yielded readouts which distinguished between heath, gingivitis and periodontitis, correlated identically with clinical measures of periodontal disease and recorded similar post-treatment decreases in salivary MMP-8 in periodontitis. The assay time for our prototype device is 20 minutes. The prototype SAW biosensor is a novel and rapid method of monitoring periodontitis which delivers similar analytical performance to conventional laboratory assays.