Periodontal diseases are infections, and many forms of the disease are associated with specific pathogenic bacteria which colonize the subgingival area. At least two of these microorganisms, Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans, also invade the periodontal tissue and are virulent organisms. Initiation and progression of periodontal infections are clearly modified by local and systemic conditions called risk factors. The local factors include pre-existing disease as evidenced by deep probing depths and plaque retention areas associated with defective restorations. Systemic risk factors recently have been identified by large epidemiologic studies using multifactorial statistical analyses to correct for confounding or associated co-risk factors. Risk factors which we know today as important include diabetes mellitus, especially in individuals in whom metabolic control is poor, and cigarette smoking. These two risk factors markedly affect the initiation and progression of periodontitis, and attempts to manage these factors are now an important component of prevention and treatment of adult periodontitis. Systemic conditions associated with reduced neutrophil numbers or function are also important risk factors in children, juveniles, and young adults. Diseases in which neutrophil dysfunction occurs include the lazy leukocyte syndrome associated with localized juvenile periodontitis, cyclic neutropenia, and congenital neutropenia. Recent studies also point to several potentially important periodontal risk indicators. These include stress and coping behaviors, and osteopenia associated with estrogen deficiency. There are also background determinants associated with periodontal disease including gender (with males having more disease), age (with more disease seen in the elderly), and hereditary factors. The study of risk in periodontal disease is a rapidly emerging field and much is yet to be learned. However, there are at least two significant risk factors-smoking and diabetes-which demand attention in current management of periodontal disease. J Periodontol 1996;67:1041-1049.

Current View of Risk Factors for Periodontal Diseases.

Bones provide mechanical and protective function, while also serving as housing for marrow and a site for regulation of calcium ion homeostasis. The properties of bones do not remain constant with age; rather, they change throughout life, in some cases improving in function, but in others, function deteriorates. Here we review the modifications in the mechanical function and shape of bones, the bone cells, the matrix they produce, and the mineral that is deposited on this matrix, while presenting recent theories about the factors leading to these changes.

Aging and Bone

The diagnostic efficacies of three panoramic-based indices were compared with classification of bone mineral density by dual-energy x-ray absorptiometry. The panoramic indices were 1) cortical bone height, 2) an ordinal classification, and 3) the Panoramic Mandibular Index. The results indicate that panoramic dental radiographs should not be used to assess the patient's status regarding osteoporosis, although the means of the variables in different mineral density groups of skeleton may differ significantly.

Pantomography in assessment of the osteoporosis risk group.

This study compared dental findings in normal and osteoporotic women and evaluated the variables that best separated the two groups. The osteoporotic group had less mandibular bone mass and density and a thinner cortex at the gonion than the normal group. The osteoporotic group also had a greater percentage of subjects who were edentulous. In subjects who had natural teeth, there was greater tooth loss. No differences in periodontal measurements were found between osteoporotic and normal groups. Mandibular bone mass and the number of teeth were statistically most effective for separating the populations. However, considerable overlap was found between the osteoporotic and normal groups in all variables.

Comparison of mandibular bone in normal and osteoporotic women

Background: Systemic bone loss has been proposed as a risk factor for periodontal disease; however, the relationship between these two diseases is still not clear. The objective of this study was to assess the relationship between systemic bone mineral density and periodontal disease, controlling for known confounders. Methods: The study population included 70 postmenopausal Caucasian women aged 51 to 78 (mean ± SD: 62.10 ± 7.1 years). Skeletal bone mineral density (BMD) was assessed by dual energy x-ray absorptiometry (DXA) at the neck, trochanter, intertrochanter, Ward's triangle, and total regions of the femur, and from the anterior-posterior view of the lumbar spine. Periodontal disease severity was represented by clinical attachment loss (CAL) and interproximal alveolar bone loss (ABL). Other measures of periodontal status included probing depth (PD), supragingival plaque, gingival bleeding on probing, and calculus. DXA and oral examinations were performed by calibrated examiners. Partial correlation...

The relationship between bone mineral density and periodontitis in postmenopausal women.

This study attempted to determine relationships between bone mass in the mandible and skeletal bone mass in a group of 85 postmenopausal women with osteoporosis. Mandibular bone mass was determined by microdensitometry, cortical thickness at the gonion, the height of the alveolar ridge in subjects who were edentulous, and periodontal probings. Skeletal measures were made up of total body calcium, bone mass at the radius, and the two newer bone mass measures of dual photon and computed tomography of the vertebrae. The height of the edentulous ridge correlated with total body calcium and mandibular mass. Most of the edentulous patients had ridges that were extremely resorbed. Mandibular mass correlated with all skeletal measures.

Relationships between mandibular and skeletal bone in an osteoporotic population.

In this study, we measured mandibular bone mass and density and cortical thickness at gonion in 50 normal women between the ages of 20 and 90. The subjects showed neither radiographic nor metabolic evidence of osteoporosis. Comparisons (by age) were made between mandibular measurements. Mandibular measurements were also compared with measurements of bone mass in the spine and the wrist. Mandibular bone mass was not significantly affected with age but mandibular bone mass was significantly correlated with skeletal bone mass.

Relationships between mandibular and skeletal bone in a population of normal women

0 steoporosis is a major health problem for the elderly.’ The underlying clinical problem is a deficiency of bone mass, or skeletal osteopenia, resulting in fractures of the spine, the distal of the radius and ulna bones, and the neck of the femoral bone. It is estimated that 25% to 30% of all Caucasian women in the United States will experience a fracture related to osteoporosis by age 65.’ A possibly related and significant mandibular osteopenia (residual ridge resorption) appears to occur in edentulous patients, resulting in extensive residual ridge reduction. Extensive loss of bone may occur; and in patients who have no residual ridge, treatment with dentures is difficult and comfort and function are compromised.2-4 It has been suggested that there may be a relationship between residual ridge reduction and osteopenia of the remaining skeleton.‘, 5 It has also been suggested that periodontal disease, tooth mobility, and tooth loss are affected by and related to osteopenia.6-” The purpose of this study was to document the dentai findings in a group of female osteoporotic subjects and to determine the relationship between systemic and oral findings. Dental status was evaluated in terms of loss of mandibular ridge height, mandibular bone density, periodontal bone loss, and loss of teeth. The degree of generalized osteopenia was measured by determining total body calcium (total bone mass) by

Patricia J. Kribbs

Papers

Comparison of mandibular bone in normal and osteoporotic women

Relationships between mandibular and skeletal bone in an osteoporotic population.

Relationships between mandibular and skeletal bone in a population of normal women

Oral findings in osteoporosis. Part II: Relationship between residual ridge and alveolar bone resorption and generalized skeletal osteopenia

Oral findings in osteoporosis. Part I: Measurement of mandibular bone density☆☆☆