Tooth loss in adults: factors associated with the position and number of lost teeth.

OBJECTIVE: To evaluate the factors associated with tooth loss in adults from the position and number of teeth lost in the dental arches. METHODS: This is a cross-sectional, population-based study with adults participating in the epidemiological survey of oral health of São Paulo in 2015. The outcome of the study was tooth loss, assessed by the proposed classification, namely: I) lost up to 12 back teeth; II) lost up to 12 teeth (including front teeth); and III) lost more than 12 teeth. A four-block analysis was conducted, supported by a conceptual theoretical model adapted for tooth loss. For the multinomial logistic regression, "individuals who did not lose teeth due to caries or periodontal disease" was used as reference (p < 0.05). RESULTS: Of 6,051 adults evaluated, 25.3% (n = 1,530) were classified in category I, 32.7% (n = 1,977) in II, 9.4% (n = 568) in III, and 1.9% (n = 117) were edentulous. Lower income and schooling, the perception of need for treatment and the last appointment motivated by routine, pain or extraction were associated with tooth loss, regardless of the classification. The negative evaluation of the dental service was associated with individuals who lost up to 12 teeth, both front and back. The presence of women and periodontal pocket were associated with tooth loss of up to 12 teeth, including front, and more than 12 teeth. Caries were associated with adults who lost up to 12 teeth, including front teeth. CONCLUSION: The proposed classification allowed the identification of differences between the associated factors. Thus, the need to consider such classification in future studies is evident.

Predictive factors for tooth loss during supportive periodontal therapy in patients with severe periodontitis: a Japanese multicenter study.

BACKGROUND: Supportive periodontal therapy (SPT) must take individual patient risk factors into account. We conducted a multicenter joint retrospective cohort study to investigate the value of modified periodontal risk assessment (MPRA) and therapy-resistant periodontitis (TRP) assessment as predictive factors for tooth loss due to periodontal disease in patients with severe periodontitis during SPT. METHODS: The subjects were 82 patients from 11 dental institutions who were diagnosed with severe periodontitis and continued SPT for at least 1 year (mean follow-up = 4.9 years) between 1981 and 2008. The outcome was tooth loss due to periodontal disease during SPT. The Cox proportional hazards model was used to analyze sex, age, diabetes status, smoking history, number of periodontal pockets measuring ≥6 mm, rate of bleeding on probing, bone loss/age ratio, number of teeth lost, MPRA, and TRP assessment as explanatory variables. RESULTS: Univariate analysis showed that loss of ≥8 teeth by the start of SPT [hazard ratio (HR) 2.86], MPRA score indicating moderate risk (HR 8.73) or high risk (HR 11.04), and TRP assessment as poor responsiveness to treatment (HR 2.79) were significantly associated with tooth loss (p < 0.05). In a model in which the explanatory variables of an association that was statistically significant were added simultaneously, the HR for poor responsiveness to treatment and ≥8 teeth lost was significant at 20.17 compared with patients whose TRP assessment indicated that they responded favorably to treatment and who had lost <8 teeth by the start of SPT. CONCLUSION: MPRA and TRP assessment may be useful predictive factors for tooth loss due to periodontal disease during SPT in Japanese patients with severe periodontitis. Additionally, considering the number of teeth lost by the start of SPT in TRP assessment may improve its predictive accuracy.

[The characteristics of microbiota of periodontal recesses in smoking patients with chronic generalized periodontitis].

The clinical examination of 36 tobacco smokers with chronic generalized periodontitis of light, average and severe degree was carried out. The examination established poor hygienic condition of oral cavity, less expressed inflammatory reaction of tissues of periodont and predominance of occurrences of destruction of alveolar portion of bone as compared with the group of 59 non-smoking patients with chronic generalized periodontitis of light, average and severe degree. The study demonstrated higher rate of detection of T. forsythia in smokers as compared with non-smoking patients at all stages of of development of chronic generalized periodontitis. Under light stage of chronic generalized periodontitis increasing of rate of detection of T. forsythia more than twice was registered. P.gigngivalis and P.intermedia were detected in smoking patients with light stage of chronic generalized periodontitis either in the same values or more rarely as compared with non-smokers. In the group of smokers with average stage of chronic generalized periodontitis increasing of rate of occurrence of association of T. forsythia-P. gigngivalis-P. intermedia occurred more than five times in comparison with non-smokers. The obtained results indicate on relationship between alterations of microbiota and aggressive development of chronic generalized periodontitis in smoking patients and on development in periodontal recesses of smokers of favorable conditions for growth of T. forsythia. The presence of T. forsythia is a significant factor of development of destructive processes in tissues of periodont.

Er,Cr:YSGG Laser Application for the Treatment of Periodontal Furcation Involvements.

OBJECTIVE: The purpose of this study was to evaluate the clinical use of an erbium, chromium: yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser in the management of root furcation involvements. BACKGROUND DATA: It has been suggested that the use of laser radiation within the periodontal pocket may be effective in periodontal treatment. However, very limited data from clinical trials exist directly comparing the use of the Er,Cr:YSGG laser to conventional root planing. MATERIALS AND METHODS: Thirty patients with chronic periodontitis were recruited. A total of 128 teeth with degree II or III furcation involvement were included in a split-mouth design such that the teeth on one side of the mouth were established as Group A and treated with the Er,Cr:YSGG laser and the teeth on the other side were established as Group B and treated with manual subgingival debridement. Changes in probing depth (PD), bleeding on probing (BOP), clinical attachment loss (CAL), and visual analogue scale (VAS) pain scores were compared between Groups A and B and within individuals over time at 6 and 12 weeks after treatment, testing the null hypothesis that there would be no clinical difference between treatment modalities. RESULTS: Both treatments significantly reduced the PD, CAL, and BOP in the diseased teeth with degree II or III furcation involvement. The reduction of PD and BOP at weeks 6 and 12 was significantly higher in Group A (laser treated) than in Group B. The VAS pain score was significantly lower in Group A than in Group B (p < 0.01). CONCLUSIONS: Pocket debridement with Er,Cr:YSGG laser is a safe, comfortable, and clinically effective means of subgingival debridement in periodontal therapy.

Periodontal treatment and HbA1c levels in subjects with diabetes mellitus.

It has earlier been reported that individuals with poorly controlled diabetes have severe periodontal disease (PD) compared to well-controlled diabetes. This longitudinal interventional study compared periodontal treatment outcomes with HbA1c level changes in four groups of diabetic and non-diabetic patients with or without PD, respectively. HbA1c, bleeding on probing (BOP), plaque index and periodontal pocket depth (PPD) 4 < 6 mm and ≥6 mm were recorded at baseline to 3 months after non-surgical treatment and 3-6 months for surgical treatment in subjects with or without T2D, and with or without PD. A total of 129 patients were followed from baseline to 6 months. Diabetics with PD and without PD showed reductions in HbA1c levels with a mean value of 0·3% after 3 months and mean values of 1% and 0·8%, respectively, after 6 months. Diabetics with PD showed higher levels of BOP versus non-diabetics without PD (P < 0·01) and versus diabetics without PD (P < 0·05) at baseline. After 6 months, diabetics with PD showed higher number of PPD 4 < 6 mm versus diabetics without PD (P < 0·01) and non-diabetics with PD (P < 0·01). Diabetics without PD showed higher levels of PPD 4 < 6 mm versus non-diabetics without PD (P < 0·01). Surgical and non-surgical periodontal treatment in all groups improved periodontal inflammatory conditions with a decrease in HbA1c levels in a period of three and 6 months. No change was seen in the number of pockets PPD 4 < 6 mm in diabetic subjects with PD after non-surgical and surgical treatment.

Association of Keratinized Mucosa and Periimplant Soft Tissue Stability Around Implants With Platform Switching.

PURPOSE: To investigate the influence of the width of keratinized mucosa (KM) on clinical parameters around dental implants with platform switching. METHODS: One hundred eighteen patients with 320 implants participated in the evaluation. The width of KM, modified sulcus bleeding index (mBI), plaque index (PLI), mucosal recession (MR), and the compliance to the implant maintenance therapy (IMT) were evaluated. RESULTS: A wide band of KM (KM width ≥ 2 mm) was associated with a significant lower mBI (0.12 ± 0.37; P < 0.0001), PLI (0.45 ± 0.56; P = 0.001), and less MR (0.06 ± 0.23; P < 0.0001) than a narrow band of KM (KM width < 2 mm) (Papilla Bleeding Index [PBI], 0.39 ± 0.60; PLI, 0.69 ± 0.63; MR, 0.27 ± 0.44). By "regular" and "irregular" IMT, a statistically significant difference was found between wide and narrow width of KM, for the mBI (wide vs narrow; 0.11 ± 0.31 vs 0.31 ± 0.52, P = 0.004 and 0.14 ± 0.45 vs 0.49 ± 0.69, P = 0.002, respectively). CONCLUSION: Absence of keratinized mucosa was associated with significant higher PLI, mBI, and MR. The IMT does not reject the protective role of KM against inflammation.

Risk factor assessment tools for the prevention of periodontitis progression a systematic review.

OBJECTIVES: (i) To identify characteristics of currently published patient-based tools used to assess levels of risk for periodontitis progression and (ii) systematically review the evidence documenting the use of patient-based risk assessment tools for predicting periodontitis progression. MATERIAL AND METHODS: A systematic review was prepared on the basis of an electronic search of the literature supplemented with manually searching the relevant journals of the latest 5 years. Prospective and retrospective cohort studies were included as no randomized controlled clinical trials were available. RESULTS: The search identified 336 titles, and 19 articles were included in this systematic review. The search identified five different risk assessment tools. Results of nine of 10 cohort studies reporting outcomes of 2110 patients indicate that risk assessment tools are able to identify subjects with different probability of periodontitis progression and/or tooth loss. Subjects with higher risk scores showed more progression of periodontitis and tooth loss. CONCLUSIONS: In treated populations, results of patient-based risk assessments, for example periodontal risk calculator (PRC) and periodontal risk assessment (PRA), predicted periodontitis progression and tooth loss in various populations. Additional research on the utility of risk assessment and results in improving patient management are needed.

Periodontal status of type I diabetics compared to non-diabetic participants: a preliminary study.

A preliminary group matched comparison study of periodontal status was conducted among Indian participants who had type 1 diabetes mellitus (T1DM) and non-diabetic controls. The mean number of bleeding sites, gigival index score, number of periodontal pocket's and number of clinical loss attachment sites were all significantly higher in cases compared to controls. This study provides evidence that people with type I diabetes mellitus have a higher risk of gingival and periodontal disease.

Influence of intra-pocket anesthesia gel on treatment outcome in periodontal patients: a randomized controlled trial.

AIM: Compare the treatment outcome after scaling and root-planing using local anesthesia gel or injected local anesthesia. MATERIAL AND METHOD: Thirty-eight patients with periodontitis and good general health were included in a randomized, single-blind, split-mouth clinical trial. Probing depths and clinical attachment levels were recorded at baseline and 6 weeks after treatment. Performed treatment procedures were scaling and root planing using two types of local anesthesia for separate treatment appointments. Anesthetics used were intra-pocket lidocaine and prilocaine gel (2.5% each) and injected articaine (1:100,000 adrenaline). Type of anesthesia for first appointment was randomized and switched for second appointment. Patients' pain perception and anesthesia acceptance were recorded on questionnaires. RESULTS: No influence of applied type of anesthesia could be detected for change of probing pocket depths and clinical attachment level (p > 0.05). These findings are valid even for deeper pockets. Gel-group had significant higher intra-operative pain perception. In retrospect 69% of patients favored gel. CONCLUSION: Treatment outcome is not compromised by use of anesthesia gel in comparison to injected anesthesia. The same beneficial results for probing pocket depths and clinical attachment gain could be detected. The majority of patients prefer local anesthesia gel despite a slightly greater procedural discomfort.

Is there a positive effect of smoking cessation on periodontal health? A systematic review.

BACKGROUND: Although the detrimental effects of tobacco on the periodontal tissues have been reported extensively, little is known about the potential beneficial effect of smoking cessation on periodontal health. The aim of this systematic review is to evaluate the effect of smoking cessation on periodontitis progression and response to periodontal therapy. METHODS: Two independent reviewers completed the review process through title (n = 118), abstract (n = 24), and whole-paper selection (n = 5). Sources include Medline and EMBASE databases (up to December 2012) and a reference list of selected studies. Prospective studies comparing progression rates of periodontitis between smokers and quitters and clinical trials evaluating the effect of smoking-cessation programs, alone or in combination with periodontal treatment, were included. At least 1 year of follow-up was required for inclusion. RESULTS: Of 331 potentially relevant publications, five studies fulfilled the inclusion criteria. Because of heterogeneity of the studies, a meta-analysis could not be performed. One study reported that the progression of clinical attachment loss (AL) ≥3 mm during a 6-year period was approximately three times higher among smokers than quitters (P <0.001). Two studies (10 and 20 years of follow-up) observed a decrease in radiographic bone loss of ≈30% among quitters when compared with smokers. Among individuals receiving non-surgical periodontal treatment, quitters were more likely to have periodontal probing depth reductions (P <0.05) than non-quitters/oscillators. No differences in AL were observed. CONCLUSION: Based on the limited available evidence, smoking cessation seems to have a positive influence on periodontitis occurrence and periodontal healing.

Pocket-depths-related effectiveness of an intrapocket anaesthesia gel in periodontal maintenance patients.

AIM: The aim of this study was to determine the impact of the pocket depth on the effectiveness of an intrapocket anaesthesia gel during SRP in periodontal maintenance patients. Effectiveness was measured by pain levels during SRP via visual analogue scale (VAS) and verbal rating scale (VRS). Secondary endpoint was the evaluation of patients' preferred choice of anaesthesia for SRP. METHODS: A total of 638 patients undergoing the periodontal maintenance programme and with the need for SRP participated in this observational study. After SRP, patients filled in questionnaires to record pain levels experienced and anaesthesia preference for future use. Mann-Whitney U-test was used to analyse intergroup difference in pain perception and anaesthesia choice. RESULTS: Overall, increasing pocket depths were accompanied by higher pain levels, irrespective of maximum or commonest pocket depths (P < 0.05). For SRP procedures, patients definitely prefer the anaesthesia gel (72.4%). CONCLUSIONS: In this study, an effectiveness of local anaesthesia gel (lidocaine/prilocaine) related to pocket depths was found in periodontal maintenance patients during SRP. Increasing pocket depths were accompanied by increasing procedural pain levels. Nevertheless, the anaesthesia gel is well accepted and in the majority of cases was found to be the preferred option for future SRP treatments.

Role of insulin sensitivity and beta cell function in the development of periodontal disease in adults without diabetes.

AIM: The goal of this study was to explore whether insulin resistance and beta cell function are related to periodontal pocket formation, indicative of infectious periodontal disease in non-smoking adults without manifest diabetes. MATERIAL AND METHODS: We analysed data from a Health 2000 Survey consisting of dentate subjects without any indication of diabetes, aged between 30 and 64, who had never smoked and who had participated in the Follow-up Study on Finnish Adults' Oral Health about 4 years later (n = 157). The Homeostasis Model Assessment Indices were used to measure insulin resistance (HOMA-IR) and ß-cell function (HOMA-B). The development of periodontal disease was measured by means of the incidence of deepened periodontal pockets (4 mm deep or deeper) during the follow-up period. Incidence rate ratios (IRR) were estimated using Poisson regression models. RESULTS: Both HOMA-IR and HOMA-B indices were associated with periodontal pocket formation during the 4-year follow-up. CONCLUSION: The results of this follow-up study suggest that impaired glucose metabolism measured as insulin resistance and altered beta cell function predict the breakdown of periodontal tissues. Further studies about their role in the pathogenesis of periodontal diseases are needed.

Activity of platelet activating factor acetylhydrolase following phase I periodontal therapy.

OBJECTIVE: Elevated levels of platelet activating factor (PAF), a potent inflammatory mediator in periodontal disease and decreased PAF levels following periodontal surgical therapy have been previously detected in gingival tissues and gingival crevicular fluid (GCF). Platelet activating factor acetylhydrolase (PAF-AH) is a calcium-independent phospholipase A2 that catalyses the hydrolysis of PAF, thereby inactivating this mediator The hypothesis, a relationship between activity of PAF-AH and healing following periodontal therapy, was tested by detecting activity of PAF-AH in GCF samples collected from sites that had undergone phase I periodontal therapy with generalized chronic periodontitis. METHODS: Twenty patients with generalized chronic periodontitis were divided into two groups (n = 10): group 1 with probing pocket depth (PPD) 4-5 mm and group 2 with PPD > or = 6-8 mm. Clinical parameters were recorded and GCF was sampled before phase I periodontal therapy and at the 2nd, 7th, 14th, 21st and 28th day follow-up evaluation visits. Activity of PAF-AH in GCF was analysed by enzyme-linked immunosorbent assay (ELISA). RESULTS: Probing pocket depth at the 21st and 28th day in group 1, and PPD at the 14th, 21st and 28th day in group 2 were significantly decreased when compared to the baseline values (p < 0.001). Activity of PAF-AH (micromol/ml) was significantly decreased at the 7th, 14th, 21st and 28th day following phase I periodontal therapy in both groups 1 and 2 compared to the baseline values (p < 0.05). CONCLUSION: Platelet activating factor acetylhydrolase is detectable in GCF by ELISA and showed a continuous decrease following phase I periodontal therapy. Changes in the PAF-AH activity would be a progressive marker of periodontal healing to evaluate the success of periodontal therapies.

The effect of in vitro fertilization on gingival inflammation according to women's periodontal status: clinical data.

OBJECTIVES: To study whether in vitrofertilization (IVF) treatment has any effect on women's preexisting periodontal status and, if pre-existing women's periodontal status has any impact on IVF outcomes, such as superovulation for multiple follicles maturation, oocyte retrieval and embryo transfer, as well as on pregnancy and its outcomes. METHODS: Sixty women aged 29 to 41 years were recruited in the study. Gingival inflammation (simplified gingival index, GI-S), plaque levels (plaque control record index, PCR), bleeding on probing (BOP) and probing depth (PD), were recorded for all participants before and after IVF. Blood tests were performed prior to IVF. RESULTS: A statistically significant increase in GI-S after IVF was observed in all women (31.9 +/- 18.7% to 61.7 +/- 23.5%), and was higher in women with gingivitis (37.1 +/- 5.7% to 77.6 +/- 6.7%). Women with periodontitis demonstrated a statistically significant increase in BOP (67.7 +/- 6.6% to 89.5 +/- 7.1%), and in the sum of probing pocket depths (from 243.8 +/- 56.2 mm to 250.5 +/- 58.3 mm). A trend for negative correlation between the number of follicles and transferred embryos and the gingival index, before and after IVF respectively, was recorded in all women. There was a similar trend with bleeding on probing after IVF in women with periodontitis. CONCLUSIONS: Periodontal clinical parameters worsened in women undergoing IVF treatment. On the other hand, a poor pre-existing periodontal status seems to be associated with poorer outcomes of IVF treatment.

The natural history of periodontal attachment loss during the third and fourth decades of life.

AIM: To describe changes in the occurrence of periodontal attachment loss (AL) through ages 26, 32 and 38 in a complete birth cohort. MATERIALS AND METHODS: Systematic periodontal examinations conducted at ages 26, 32 and 38 in a longstanding New Zealand cohort study (N = 1037). Periodontitis extent data were used to assign participants to periodontitis trajectories using group-based trajectory analysis. RESULTS: Eight hundred and thirty-one individuals were periodontally examined at all three ages; the prevalence and extent of AL increased as the cohort aged. Between 26 and 32, one in nine participants had 1+ sites showing new or progressing AL; that proportion almost doubled between ages 32 and 38. Four periodontitis trajectory groups were identified, comprising 55.2%, 31.5%, 10.7% and 2.5% of the cohort; these were termed the "Very low", "Low", "Moderately increasing" and "Markedly increasing" trajectory groups respectively. Those who had smoked tobacco at all ages from 15 through 38 were at higher risk of being in the "Moderately increasing" or "Markedly increasing" trajectory groups. There was a similar risk gradient for those who were in the highest 20% of cannabis usage. CONCLUSIONS: Periodontitis commences relatively early in adulthood, and its progression accelerates with age, particularly among smokers.

Dental health in smokers with and without COPD.

The association between chronic obstructive pulmonary disease (COPD) and periodontal disease is sparsely studied. The aim was to describe the co-variation of periodontitis and lung function impairment in smokers. The hypothesis was that the destructive processes in the mouth and the lungs are interdependent due to a general individual susceptibility to detrimental effects of tobacco smoke. Smokers with COPD (n = 28) stage II and III according to GOLD guidelines and smokers without COPD (n = 29) and healthy non-smokers (n = 23) participated in the study. The groups of smokers were matched for cumulative exposure to tobacco smoke. Radiographic, general and dental clinical examination, lung function measurements and quality of life (SF-36) assessment were conducted. The relationship between respiratory and dental outcomes was analyzed. Dental health, assessed by plaque, gingival bleeding, periodontal pocket depth and loss of teeth was impaired in the smokers compared with non-smokers with no major differences between smokers with and without COPD. There was, however, a weak correlation between periodontitis and emphysema/impaired diffusion capacity. Impaired quality of life was associated with smoking and impaired lung function but not influenced by dental status. In conclusion periodontitis was strongly associated with smoking, weakly associated with lung tissue destruction and very weakly or even not at all associated with chronic airflow limitation. The results indicate that, although there was a co-variation between periodontitis and pathologic lung processes in smokers, the risk of developing COPD, as defined by spirometric outcomes, is not associated with the risk of impaired dental health in smokers.

Response of pulp sensibility test is strongly influenced by periodontal attachment loss and gingival recession.

INTRODUCTION: To assess, in vivo, the influence of periodontal attachment loss and gingival recession on responses to pulp sensibility tests (PSTs) with cold stimuli in mandibular incisors in adult patients. METHODS: This cross-sectional study included 45 patients aged 30 to 60 years treated at a university dental health service. In each patient, 1 mandibular incisor was randomly selected for analysis. One calibrated dentist performed all periodontal assessments. Periodontal attachment loss and gingival recession were measured at 6 sites of the selected tooth followed by application of the PST on the buccal surface of the tooth by an independent operator. Each patient was asked to indicate a score for pain intensity on a numeric visual analog scale. The Pearson correlation coefficient was used to investigate and quantify the correlation between predictor variables (periodontal attachment loss and gingival recession) and reported pain. Simple and multiple linear regression analyses were performed to determine the impact of periodontal attachment loss and gingival recession on PST pain scores. RESULTS: Multivariate analysis showed that periodontal attachment loss contributed significantly to the prediction of pain in response to the PST (P < .001). Increases of 1 mm in periodontal attachment loss resulted in a decrease of approximately 0.5 score on the pain scale. Gingival recession also contributed as a predictor of the outcome (P < .001) with a decrease of approximately 0.7 in pain scores for every 1-mm increase in gingival recession. The correlations were in the opposite direction than expected. CONCLUSIONS: Periodontal attachment loss and gingival recession strongly influenced reported pain in response to PST with cold stimuli. The effect of both variables was constant (ie, responses to PST decreased gradually with increases in periodontal attachment loss and gingival recession).

Association between cigarette smoking and the intraoral distribution of periodontal disease in Thai men over 50 years of age.

AIM: This study aimed to investigate the effects of cigarette smoking on periodontal conditions in specific tooth regions of older Thai men. METHODS: There were 272 current smokers, 714 former smokers, and 477 non-smokers enrolled in the present study. Differences between groups in the mean probing depth or attachment loss were compared using ancova. The relationship between smoking exposure or cessation duration and periodontal conditions was examined using linear trend analysis. RESULTS: Smokers had deeper pockets and attachment loss than non-smokers. The greatest differences between smokers and non-smokers were observed in the maxillary posterior palatal region, where current smokers had 0.88 mm greater attachment loss than non-smokers, compared to 0.36-0.60 mm observed in other tooth regions. Among the current smokers, there was a trend towards an increase in attachment loss with increasing smoking exposure in the maxillary posterior regions. However, it was not statistically significant. Among the former smokers, a better periodontal condition was observed, depending on the length of time since smoking cessation; this was most pronounced in the maxillary posterior palatal region. CONCLUSIONS: The palatal site of maxillary posterior teeth was the area most affected by cigarette smoke. The results suggest a possible local effect of smoking in addition to its systemic effects.

Changes in molar position associated with missing opposed and/or adjacent tooth: a 12-year study in women.

The aim of this study was to radiographically analyse long-term changes in (i) overeruption of unopposed molars and (ii) tipping of molars with a mesial edentulous space, and whether there is an interaction between the two events. A further aim was to analyse if loss of alveolar bone height might influence overeruption and tipping. The sample consisted of panoramic radiographs taken at an interval of 12 years of 292 subjects from a prospective population study of women. The panoramic radiographs were scanned and analysed. Changes in tipping, overeruption and alveolar bone height of molars and control teeth were measured. The results showed that unopposed molars were more commonly found in the upper jaw and that unopposed molars showed 4·9 times higher risk of overeruption of ≥2 mm (95% CI 1·5-15·3) than opposed molars during the 12-year observation period. The average overeruption for the unopposed molars was 4·5% (s.d. 7·6), which corresponds to approximately 0·9 mm. The degree of overeruption increased with decreased bone support. Molars with a mesial edentulous space were most prevalent in the lower jaw, but neither an edentulous space nor alveolar bone level/bone level change were found to have a significant effect on tipping of the molars. The average mesial tipping was 0·8° (s.d. 5·6). In conclusion, unopposed molars showed a significantly increased risk for overeruption. Molars facing a mesial edentulous space showed a low risk for mesial tipping, but a significant interaction between overeruption and tipping was identified.

Health insurance status is associated with periodontal disease progression among Gullah African-Americans with type 2 diabetes mellitus.

OBJECTIVES: Assess periodontal disease progression among GullahAfrican Americans with type 2 diabetes mellitus (T2DM) according to health insurance coverage. METHODS: From an ongoing clinical trial among T2DM Gullah, we extracted a cohort that was previously enrolled in a cross-sectional study (N=93). Comparing prior exam to trial initiation, total tooth sites/person with periodontal disease progression events [evaluated separately: 2+ mm of clinical attachment loss (CAL), 2+ mm increased periodontal probing depths (PPD), bleeding on probing (BOP) emergence] were evaluated according to health insurance coverage using regression techniques appropriate for data with different counts of potential events per subject (varying tooth sites available). We used negative binomial regression techniques to account for overdispersion and fit multivariable models that also included baseline glycemic control (poor: glycated hemoglobin > OR =7 percent, well: glycated hemoglobin <7 percent), history of established periodontitis, age, gender, body mass index, annual income, and oral hygiene behaviors. Final models included health insurance status, other significant predictors, and any observed confounders. RESULTS: Privately insured were most prevalent (41.94 percent), followed by uninsured (23.66 percent), Medicare (19.35 percent), and Medicaid (15.05 percent). Those with poor glycemic control (65.59 percent) were more prevalent than well-controlled (34.41 percent). CAL events ranged from 0 to 58.8 percent tooth sites/ person (11.83 +/- 12.44 percent), while PPD events ranged from 0 to 44.2 percent (8.66 +/- 10.97 percent) and BOP events ranged from 0 to 95.8 percent (23.65 +/- 17.21 percent). Rates of CAL events were increased among those who were uninsured [rate ratio (RR) = 1.75, P = 0.02], Medicare-insured (RR = 1.90, P = 0.03), and Medicaid-insured (RR = 1.89, P = 0.06). CONCLUSIONS: Increased access to health care, including dental services, may achieve reduction in chronic periodontal disease progression (as determined by CAL) for this study population. These results are very timely given the March 2010 passing of the US healthcare reform bills.