Effectiveness of a 30-year periodontist's primary care for 1946 patients during five-year follow-up.

OBJECTIVE: To evaluate the effect of the periodontal primary care (PPC) on the improvement of periodontal probing depth based on a periodontist's 30-year practice. MATERIALS AND METHODS: We enrolled a total of 2,894 patients who underwent periodontal basic treatment between 1987 and 2017 with 84.5% retention rate. The study population was composed of 80% (n = 1,946) of retained patients with complete re-evaluation up to five-year follow-up. The outcome was measured by the improvement of probing depths (graded as 1:1-3 mm; 2:4-6 mm; 3: ≥7 mm) before and after PPC on both sextant and patient levels. Whether a better improvement was seen in the surgical group and the non-smoker group opposed to their comparators was assessed with various multi-variable regression models. RESULTS: On patient (sextant) level, 82% (38%) improved, 13% (59%) unchanged, and 5% (3%) deteriorated. Adjusted better improvement of probing depth was noted for the surgical group by 63% and non-smoker by 31% compared with their counterparts. The similar findings were found for the outcomes based on continuous probing depth scores. CONCLUSIONS: We demonstrate the improvement of probing depth scores with a periodontal primary care offered for the retained patients and larger effect for the surgical group and non-smoker patients.

Prevalence of Dental Caries and Periodontal Disease of High School Students Aged 15 to 18 Years in Taiwan.

The purpose of this study was to assess the prevalence and distribution of dental caries and periodontal disease in Taiwanese high school students aged 15-18. A total of 1069 Taiwanese students participated in a cross-sectional nationwide dental survey. By using a stratified method based on the National Health Insurance administration regions, 24 high schools were randomly sampled in different areas of Taiwan. The participants were examined with dental mirrors and community periodontal index (CPI) probes without using radiographs, to measure dental caries and periodontal status. Demographic information and other relevant risk indicators for the two diseases were gathered via a self-report questionnaire. In this study population, the weighted mean decayed, missing and filled teeth (DMFT) scores for ages 15 to 18 were 5.2, 6.1, 6.1, and 5.7. The weighted mean decayed, missing and filled surfaces (DMFS) scores were 9.0, 12.0, 13.1, and 11.2 at ages 15, 16, 17, and 18, respectively. Additionally, 88.2% of the subjects had periodontal disease, with calculus as the most prevalent type. Moreover, 5.2% of these students showed loss of attachment. There was no significant association between dental caries and periodontal disease. Dental caries and periodontal disease were prevalent among Taiwanese high school students in this national dental survey.

Receiver Operating Characteristic Curve-Based Prediction Model for Periodontal Disease Updated With the Calibrated Community Periodontal Index.

BACKGROUND: The accuracy of a prediction model for periodontal disease using the community periodontal index (CPI) has been undertaken by using an area under a receiver operating characteristics (AUROC) curve. How the uncalibrated CPI, as measured by general dentists trained by periodontists in a large epidemiologic study, and affects the performance in a prediction model, has not been researched yet. METHODS: A two-stage design was conducted by first proposing a validation study to calibrate CPI between a senior periodontal specialist and trained general dentists who measured CPIs in the main study of a nationwide survey. A Bayesian hierarchical logistic regression model was applied to estimate the non-updated and updated clinical weights used for building up risk scores. How the calibrated CPI affected performance of the updated prediction model was quantified by comparing AUROC curves between the original and updated models. RESULTS: Estimates regarding calibration of CPI obtained from the validation study were 66% and 85% for sensitivity and specificity, respectively. After updating, clinical weights of each predictor were inflated, and the risk score for the highest risk category was elevated from 434 to 630. Such an update improved the AUROC performance of the two corresponding prediction models from 62.6% (95% confidence interval [CI]: 61.7% to 63.6%) for the non-updated model to 68.9% (95% CI: 68.0% to 69.6%) for the updated one, reaching a statistically significant difference (P <0.05). CONCLUSION: An improvement in the updated prediction model was demonstrated for periodontal disease as measured by the calibrated CPI derived from a large epidemiologic survey.

A population-based study on the association between the intake of soft drinks and periodontal disease in Taiwanese adults aged 35-44 years (KCIS no. 33).

OBJECTIVE: To elucidate the association between the intake of soft drinks and periodontal disease (PD) among Taiwanese middle-aged adults. DESIGN: The cross-sectional design was employed to assess a dose-response relationship between the intake of soft drinks and PD after controlling for relevant confounding factors, with adjusted odds ratios obtained from a multivariate logistic regression model. SETTING: Keelung Community-based Integrated Screening (KCIS) programme, Keelung, Taiwan. SUBJECTS: Participants (n 10 213) aged 35-44 years who had undergone oral checks for PD between 2005 and 2009. RESULTS: A dose-response relationship between the intake of soft drinks and elevated risk for PD defined by community periodontal index ≥3 (the current status of PD) was noted (P=0·02 by trend test). Compared with infrequent intake of soft drinks (≤2 times/week), the adjusted OR increased from 1·05 (95 % CI 0·92, 1·20) for the frequency of 3-4 times/week to 1·17 (95 % CI 1·03, 1·34) for the frequency of ≥5 times/week. A similar trend (P<0·01) was also observed for PD defined by loss of attachment ≥1 (representing the long-term cumulative gum damage due to PD). CONCLUSIONS: A dose-response relationship between the intake frequency of soft drinks and PD was observed in Taiwanese middle-aged adults. Such evidence could be used in health promotion to support reductions in soft drink intake.

Long-term effectiveness of school-based children oral hygiene program on oral health after 10-year follow-up.

OBJECTIVE: The aim of this study was to evaluate the long-term effectiveness of a school-based child oral hygiene program on oral heath after approximately 10 years of follow-up. METHODS: A prospective cohort study was designed to include 120 schoolchildren aged 10-11 years with instructions on how to practice daily flossing and brushing under the supervision of school nurses for one semester (the intervention group) and to recruit a comparison group with no intervention from 120 classmates matched by gender (the nonintervention group). Both groups participated in a questionnaire survey and received dental examinations after long-term follow-up. RESULTS: The mean value of overall plaque score in the intervention group (16.9%) was lower than that of the nonintervention group (32.6%); the adjusted relative risk (aRR) of having a plaque score for the intervention group versus the nonintervention group was 0.4 (95% CI: 0.3, 0.5). The percentage of pocketing (CPI ≧ 2) in the intervention group (75.0%) was lower than that of the nonintervention group (90.8%); the aRR of having calculus or pocketing (CPI ≧ 2) was 0.3 (95% CI: 0.1, 0.6). The intervention group had lower DMFT values and DMFS score than the nonintervention group (4.1 and 6.6 versus 6.2 and 11.0). Moreover, the intervention group had significantly better dental knowledge and habits and dental conditions than the nonintervention group. CONCLUSIONS: This longitudinal follow-up study demonstrated that a highly targeted oral hygiene program can display positive long-term effectiveness.

A prediction model for periodontal disease: modelling and validation from a National Survey of 4061 Taiwanese adults.

AIMS: The aim of this study was to predict periodontal disease (PD) with demographical features, oral health behaviour, and clinical correlates based on a national survey of periodontal disease in Taiwan. MATERIALS AND METHODS: A total of 4061 subjects who were enrolled in a cross-sectional nationwide survey on periodontal conditions of residents aged 18 years or older in Taiwan between 2007 and 2008 were included. The community periodontal index (CPI) was used to measure the periodontal status at the subject and sextant levels. Information on demographical features and other relevant predictive factors for PD was collected using a questionnaire. RESULTS: In our study population, 56.2% of subjects had CPI grades ≥3. Periodontitis, as defined by CPI ≥3, was best predicted by a model including age, gender, education, brushing frequency, mobile teeth, gingival bleeding, smoking, and BMI. The area under the curve (AUC) for the final prediction model was 0.712 (0.690-0.734). The AUC was 0.702 (0.665-0.740) according to cross-validation. CONCLUSIONS: A prediction model for PD using information obtained from questionnaires was developed. The feasibility of its application to risk stratification of PD should be considered with regard to community-based screening for asymptomatic PD.

Temporal sequence of the bidirectional relationship between hyperglycemia and periodontal disease: a community-based study of 5,885 Taiwanese aged 35-44 years (KCIS No. 32).

The relationship between hyperglycemia (including diabetes) and periodontal disease (PD) has been noted previously, but its temporal sequence in the same study based on a population-based study has been barely addressed. Our study sought to clarify temporal bidirectional relationships between both diseases among Taiwanese aged 35-44 years. A prospective follow-up cohort study was designed by following over time the two normal cohorts (PD-free or hyperglycemia-free) derived from 5,885 subjects aged 35-44 years who were periodically attending a screening program. We ascertained both incident cases of PD (defined by Community Periodontal Index score ≧ 3) and hyperglycemia [fasting plasma glucose (FPG) ≧100 mg/dL] or type 2 diabetes (FPG ≧ 126 mg/dL) with 5-year follow-up. Cox proportional hazards regression model was used to assess the effect of PD on hyperglycemia and vice versa with adjustment for other confounding factors. Participants with PD presented a 33 % increase in their risk of incident hyperglycemia (including diabetes) [adjusted hazard ratio (aHR) = 1.33 (95 % CI 1.09-1.63)] after controlling for potential confounding factors. Conversely, prediabetes and type 2 diabetes mellitus led to a significant elevated risk for PD [aHR = 1.25 (95 % CI 1.00-1.57) and aHR = 1.95 (95 % CI 1.22-3.13)] after adjustment for other confounding factors. In conclusion, a significant bidirectional relationships was found between hyperglycemia and PD, suggesting that both diseases may share common latent traits and pathways that are worthy of being further elucidated by continuing a long-term follow-up of this cohort.

Association between patients' chief complaints and their compliance with periodontal therapy.

AIM: To evaluate the association between patients' chief complaints (CCs) and their compliance with basic periodontal therapy. MATERIALS AND METHODS: Data on CCs and periodontal diseases were obtained from patients attending a periodontal clinic. Patient compliance with basic periodontal therapy was studied in relation to their CCs. RESULTS: The mean age of the 1196 subjects was 47.7±11.6 years. Among them, 36.9% of the subjects had chronic symptomatic CCs; 22.4%, acute symptomatic CCs; and 40.7%, asymptomatic CCs. Four hundred eighty subjects completed basic periodontal therapy; 209, incomplete treatment; and 507, no treatment. The subjects with acute symptomatic CCs were 60% more likely to receive periodontal treatment [odds ratio (OR)=1.661; 95% confidence interval (CI): 1.203-2.293] than chronic symptomatic subjects, as did the asymptomatic subjects (OR=1.669; 95% CI: 1.252-2.223). However, subjects with acute symptomatic CCs were 60% less likely to complete periodontal treatment (OR=0.420; 95% CI: 0.267-0.660). The OR of completing treatment for the copayment requirement was 1.944, while that for being treated by an experienced periodontist was 1.695. CONCLUSIONS: Patients' CCs were associated with their compliance to basic periodontal therapy. Acute symptomatic CCs may be a positive predictor to initiate periodontal treatment but a negative predictor to complete the treatment.

A population-based study on the association between type 2 diabetes and periodontal disease in 12,123 middle-aged Taiwanese (KCIS No. 21).

AIM: We investigated the association between type 2 diabetes mellitus (T2DM) and periodontal disease (PD) in the context of the current periodontal aetiology model. MATERIAL AND METHODS: In total, 14,747 community residents aged 35-44 years were invited to a community-based PD survey between 2003 and 2006 using the community periodontal index. Significant factors modifying the association between T2DM and PD were ascertained. We further assessed the association between T2DM and the risk for PD, within strata of significant effect modifiers, after controlling for other putative factors. RESULTS: The prevalence rate was 10% higher in subjects with T2DM than in those without. After controlling for significant factors, T2DM was positively associated with the risk for PD (adjusted odds ratio=1.34,95% confidence interval: 1.07-1.74). The results of interaction assessment showed that only the waist was identified as a statistically significant effect modifier for such a positive association. CONCLUSIONS: The association between T2DM and the risk for PD among young adult was demonstrated. This finding, together with other aetiological factors, fit with the current hypothesized model of the aetiology of periodontitis. However, the effect of T2DM modified by waist measurement should be verified in future studies.

Functional characterization of the copper-transporting P-type ATPase gene of Penicillium janthinellum strain GXCR.

Copper (Cu)-transporting P-type ATPase (CTPA) genes have been documented to play an important role in resistance to heavy metals. However, our understanding of roles of CTPA genes of the filamentous fungi was based only on sequence similarity prediction before. In a previous study, we isolated a Penicillum janthinellum strain GXCR of higher tolerance to Cu (200 mM). In this study, we cloned the partial cDNA of CTPA gene, named PcpA, from the strain GXCR. Sequence alignment indicated that the cloned cDNA sequence has the highest identity (94.4%) with a predictive CTPA gene of Aspergillus clavatus. The PcpA-encoded protein, termed PcpA, has classical functional domains of CTPAs, and shows differences from reported CTPAs in some specific sequence motifs and transmembrane regions. Expression of the PcpA was induced by extracellular Cu, cadmium (Cd), and silver (Ag). PcpA RNA interference (RNAi) mutants with a reduced level of PcpA mRNA were more sensitive to Cu, iron, Cd, and Ag than the wild-type (WT) strain GXCR. When grown in the presence of Cu, iron, and Cd, intracellular Cu and iron contents in the PcpA RNAi mutant were significantly (P<0.05) lower than those in the WT; However, intracellular Cd content in the mutant was significantly (P<0.05) higher than that in the WT. Taken together, it can be concluded that the PcpA functions in Cu uptake and homeostasis, iron uptake, and Cd export from the cytosol to the extracytosol.

Community-based randomized intervention trial for periodontal disease after 18-month follow-up [Keelung Community-based Integrated Screening (KCIS) No. 4].

OBJECTIVES: As periodontal disease preponderates in adults, early detection and interventional regime is urgently needed. However, there is lack of evidence-based data on evaluation of population-based intervention programme related to periodontal disease. The aim of this study was to assess the efficacy of intervention regime on early periodontal disease identified from a community-based periodontal survey. METHOD: By randomization, 60 subjects were allocated to the intervention group and 49 to the control group respectively. Status on periodontal disease of participants was evaluated at entry and re-evaluated after intervention at 1-month and 18-month follow-up respectively. Primary outcome evaluated was based on Community Periodontal Index and Loss of Attachment on sextant level. RESULTS: The efficacy of intervention was significant in Community Periodontal Index (P<0.001) but not in Loss of Attachment (P=0.53) at 1-month and 18-month follow-up. CONCLUSION: The improvement of periodontal disease owing to intervention regime was seen in Community Periodontal Index but not Loss of Attachment as yet at 18-month follow-up after intervention.

A community-based epidemiological study of periodontal disease in Keelung, Taiwan: a model from Keelung community-based integrated screening programme (KCIS No. 18).

AIMS: To estimate the prevalence and severity of periodontal disease (PD) in the Taiwanese population aged 35-44 years and to investigate the association between demographic factors and PD. MATERIALS AND METHODS: Between 2003 and 2005, residents of Keelung of the appropriate age were invited to screening. The community periodontal index (CPI) and loss of attachment (LA) index were used to measure the periodontal status at subject (prevalence) and sextant levels (severity). Basic demographic information was also collected by a questionnaire. RESULTS: Of 8462 enrollees, 94.8% had some signs of PD, of whom 29.7% had periodontal pockets >3 mm and 35% LA >3 mm. Calculus was the most common problem in terms of both prevalence (49.6%) and severity (affecting an average of 3.0 sextants per person). Risk factors for poor periodontal status (as measured by CPI) were older age (odds ratio, OR: 1.44), male gender (OR: 2.70), low education level (OR: 1.40), and being a manual worker (OR: 1.51). Similar findings were observed for LA. CONCLUSION: The prevalence of PD in 35-44-year-olds was found to be high in this large community-based study of screening for PD with CPI and LA. Poorer periodontal health was observed in males, the less educated, and manual workers.