Assessment of risk for periodontal disease. I. Risk indicators for attachment loss

Our plain-English summary of Assessment of risk for periodontal disease. I. Risk indicators for attachment loss, by S.G. Grossi, J.J. Zambon, A.W. Ho, et al (Journal of Periodontology, 1994).

The study

• Authors: S.G. Grossi, J.J. Zambon, A.W. Ho, G. Koch, R.G. Dunford, E.E. Machtei, O.M. Norderyd, R.J. Genco
• Journal: Journal of Periodontology
• Published: 1994;65(3):260-7
• Cited by: 827 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Specific risk indicators associated with either susceptibility or resistance to severe forms of periodontal disease were evaluated in a cross-section of 1,426 subjects, 25 to 74 years of age, mostly metropolitan dwellers, residing in Erie County, New York, and surrounding areas. The study sample exhibited a wide range of periodontal disease experience defined by different levels of attachment loss. Therefore, it was possible to accurately assess associations between the extent of periodontal disease and patient characteristics including age, smoking, systemic diseases, exposure to occupational hazards, and subgingival microbial flora. Age was the factor most strongly associated with attachment loss, with odds ratios for subjects 35 to 44 years old ranging from 1.72 (95% CI: 1.18 to 2.49) to 9.01 (5.86 to 13.89) for subjects 65 to 74 years old. Diabetes mellitus was the only systemic disease positively associated with attachment loss with an odds ratio of 2.32 (95% CI: 1.17-4.60). Smoking had relative risks ranging from 2.05 (95% CI: 1.47-2.87) for light smokers increasing to 4.75 (95% CI: 3.28-6.91) for heavy smokers. The presence of two bacteria, Porphyromonas gingivalis and Bacteroides forsythus, in the subgingival flora represented risks of 1.59 (95% CI: 1.11-2.25) and 2.45 (95% CI: 1.87-3.24), respectively. Our results show that age, smoking, diabetes mellitus, and the presence of subgingival P. gingivalis and B. forsythus are risk indicators for attachment loss. These associations remain valid after controlling for gender, socioeconomic status, income, education, and oral hygiene status expressed in terms of supragingival plaque accumulation and subgingival calculus. Longitudinal, intervention, and etiology-focused studies will establish whether these indicators are true risk factors.

In plain English

This cross-sectional study examined 1,426 adults aged 25 to 74 from Erie County, New York, and surrounding areas. It looked for factors linked to attachment loss, a measure of gum disease. Subjects self-reported job exposures; 10.2% reported asbestos exposure. An unadjusted analysis linked asbestos exposure with attachment loss, odds ratio 9.2 (data not shown). The authors reported this was largely explained by smoking; after adjusting for smoking, asbestos was no longer an important variable. In the adjusted model, compared with ages 25 to 34, the odds ratio for more severe attachment loss was 1.72 (95% CI 1.18-2.49) at ages 35 to 44 and 9.01 (95% CI 5.86-13.89) at ages 65 to 74. It was 2.32 (95% CI 1.17-4.60) for diabetes versus no diabetes, and 2.05 (1.47-2.87) for light and 4.75 (3.28-6.91) for heavy smokers versus non-smokers. Subjects testing positive for gum bacteria had odds ratios of 1.59 (1.11-2.25) for P. gingivalis and 2.45 (1.87-3.24) for B. forsythus. The authors concluded these are risk indicators; longitudinal studies are needed to establish true risk factors.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Cross-sectional study, analysed like a case-control study (subjects without attachment loss as controls, those with attachment loss as cases) using ordinal stepwise logistic regression
• Who was studied: 1,426 adults (741 females, 685 males) aged 25 to 74 living in Erie County, New York, and surrounding areas. They were recruited by random selection from census tract data (365), as patients at the State University of New York at Buffalo dental school (325), and through newspaper advertisements (736). The study dates are not given.
• Exposure: Self-reported history (yes or no) of occupational exposure to chemicals, asbestos, radiation or other hazards. No fiber type is given. The study also examined cigarette smoking (pack-years), self-reported systemic diseases, and eight subgingival bacteria.
• Main results:
  • 146 subjects (10.2% of the study population) reported asbestos exposure; chemical exposure was the most common hazard (18.4%)
  • In an unadjusted rank-correlation analysis, mean attachment loss was significantly greater among subjects reporting exposure to chemicals and to asbestos than among non-exposed subjects
  • Asbestos exposure had an odds ratio of 9.2 for attachment loss in a preliminary unadjusted analysis (data not shown). The authors reported this was largely explained by smoking: after adjustment for smoking level, asbestos was no longer an important explanatory variable.
  • Compared with the youngest age group (25 to 34), the adjusted odds ratio for more severe attachment loss was 1.72 (95% CI: 1.18-2.49) for subjects aged 35 to 44, rising to 9.01 (95% CI: 5.86-13.89) for subjects aged 65 to 74
  • Compared with subjects without diabetes, subjects with a history of diabetes had an adjusted odds ratio of 2.32 (95% CI: 1.17-4.60) for more severe attachment loss
  • Compared with non-smokers, light smokers (up to 15 pack-years) had an odds ratio of 2.05 (95% CI: 1.47-2.87) and heavy smokers (more than 30 pack-years) had an odds ratio of 4.75 (95% CI: 3.28-6.91). Very light or occasional smokers showed no increased risk.
  • Subjects testing positive for P. gingivalis below the gumline had an odds ratio of 1.59 (95% CI: 1.11-2.25). Those testing positive for B. forsythus had an odds ratio of 2.45 (95% CI: 1.87-3.24).
• The authors' conclusion: The authors concluded that age, history of diabetes mellitus, smoking, and subgingival infection with P. gingivalis and B. forsythus are significant risk indicators for attachment loss in adults. They said these associations held after controlling for gender, race, education, income, socio-economic status, plaque and calculus.
• Limitations the authors state:
  • The sample was not designed to represent the population; it was chosen to show a broad range of the variables studied
  • As a cross-sectional study, it identifies risk indicators only. The authors state that longitudinal and intervention studies are needed to determine whether these are true risk factors.

Topics

Medical terms in this study, explained in our Lexicon: Odds Ratio, Relative Risk, Etiology.

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