OBJECTIVE--To investigate a reported association between dental disease and risk of coronary heart disease. SETTING--National sample of American adults who participated in a health examination survey in the early 1970s. DESIGN--Prospective cohort study in which participants underwent a standard dental examination at baseline and were followed up to 1987. Proportional hazards analysis was used to estimate relative risks adjusted for several covariates. MAIN OUTCOME MEASURES--Incidence of mortality or admission to hospital because of coronary heart disease; total mortality. RESULTS--Among all 9760 subjects included in the analysis those with periodontitis had a 25% increased risk of coronary heart disease relative to those with minimal periodontal disease. Poor oral hygiene, determined by the extent of dental debris and calculus, was also associated with an increased incidence of coronary heart disease. In men younger than 50 years at baseline periodontal disease was a stronger risk factor for coronary heart disease; men with periodontitis had a relative risk of 1.72. Both periodontal disease and poor oral hygiene showed stronger associations with total mortality than with coronary heart disease. CONCLUSION--Dental disease is associated with an increased risk of coronary heart disease, particularly in young men. Whether this is a causal association is unclear. Dental health may be a more general indicator of personal hygiene and possibly health care practices.

https://www.bmj.com/content/bmj/306/6879/688.full.pdf

Dental disease and risk of coronary heart disease and mortality.

1. The interpretation of epidemiological data of periodontal disease is difficult, due to inconsistencies in the methodology used. It is not possible, therefore, to accurately assess if the prevalence of the periodontal diseases shows a world-wide decline. As long as the disease is assessed through accumulated clinical attachment loss, retention of the natural dentition in older ages entails increased prevalence in these cohorts. Contemporary epidemiological studies should ideally employ full-mouth examination of the periodontal tissues. Partial recording estimates are generally biased, especially when the prevalence of the disease is low. 2. Early-onset periodontitis is infrequent in all populations. Adult periodontitis is rather prevalent; however, advanced disease affects limited subfractions of the population (probably less than 10 to 15%). Although prevalence figures vary with race and geographic region, in most cases, the progression pattern of the disease seems compatible with the retention of a functional dentition throughout life. 3. Of a plethora of behavioral and environmental risk markers identified by multi-variate analysis, smoking and presence of certain subgingival microorganisms have been proven to be true risk factors. The same holds true for diabetes mellitus, a systemic condition that confers a risk for periodontal disease which is independent of the effect of other significant factors. 4. In certain cases, periodontal infections appear to have a systemic impact on the host. Most recent data indicate that periodontal disease may confer risk for coronary heart disease and pre-term low birth weight.

Periodontal Diseases: Epidemiology

Position paper: epidemiology of periodontal diseases.

In 1993, the 1st European Workshop on Periodontology explicitly recognized that there was insufficient knowledge to differentiate truly different forms of periodontal disease from differences in the presentation/severity of the same disease. In spite of recent progress in our understanding of periodontal diseases, the issue is far from having been resolved. Classification of periodontal diseases, therefore, remains based upon the definition of specific clinical syndromes. Early-onset periodontitis (EOP) is one such syndrome and comprises a group of pathological conditions leading to loss of periodontal tissues early in life. The notion that classifies periodontitis syndromes as "early-onset" or "adult" is primarily epidemiological in nature and is based on the observation that periodontitis is rather infrequent in children and young adults. Nevertheless, considerable epidemiological evidence indicates that periodontitis does affect children and young adults to a level of severity that may lead to premature exfoliation of primary and/or permanent teeth. Clinical presentation of periodontitis early in the life of an individual is thought to indicate that the etiologic agents have been able to cause considerable tissue damage over a relatively short period of time. It also implies either infection with highly virulent bacteria and/or a highly susceptible subject. The purpose of this review is to discuss the criteria generally utilized to classify EOP, provide the rationale to designate EOP as a distinct disease entity, and to review the evidence justifying a subclassification into particular subgroups of EOP.

Early-onset periodontitis.

Periodontal Diseases: Diagnosis

Results of 61 CPITN surveys in 39 countries for the age group 15-19 yr, stored in the WHO Global Oral Data Bank as of 1 July 1987, are assembled in an overview showing percentages of persons according to the highest score for each person and the mean numbers of sextants affected per person. The most frequently observed condition was score 2 (calculus with or without bleeding), although some shallow pocketing of 4 or 5 mm was present in most populations surveyed. It should thus be emphasized that the major thrust of activities in periodontal care should be in health promotion and education, leading to improved oral hygiene.

Periodontal conditions in adults, 35–44 years of age: an overview of CPITN data in the WHO Global Oral Data Bank

Profiles of periodontal conditions in adolescents measured by CPITN.

Global results: 15 years of CPITN epidemiology.

The purpose of this study was to evaluate histologically the extent and characteristics of the penetration of a periodontal probe during clinical assessment of loss of periodontal attachment in three different situations: (1) experimental mild gingivitis, (2) experimental severe periodontal inflammation and (3) experimental moderate periodontal inflammation. Mild gingivitis was obtained by merely allowing plaque to accumulate on the teeth. Severe periodontal inflammation was created using copper bands for a period of 3 weeks followed by placement of cotton ligatures for another 11 weeks. Moderate periodontal inflammation group was obtained by allowing the experimental defects to recover for a period of 3 to 31 weeks. At different times gutta percha imitations of a thin periodontal probe were inserted into the pockets using a gentle but unknown force. Histologic observation in 30 specimens showed that epithelium was always present around the probe tip, in most instances forming a continuous layer of epithelial cells. Histometrical analysis showed that in mild gingivitis the probe tip failed to reach the apical termination of the junctional epithelium (mean = -0.84 mm). In severe periodontal inflammation the tip of the probe went past this point (mean = +0.50 mm), while in moderate periodontal inflammation the probe tip came closest to the apical termination of the junctional epithelium (mean = -0.05 mm). It is concluded that the epithelial lining of a pocket stays intact, even in severe periodontal inflammation where the probe tip is situated apical to the apical termination of the junctional epithelium, indicating that during clinical probing the periodontal tissues are compressed and displaced but not perforated. It is also concluded that in beagle dogs the extent of probe penetration in experimentally inflamed periodontal tissues is dependent upon the degree of inflammation.

Histologic evaluation of probe penetration during clinical assessment of periodontal attachment levels. An investigation of experimentally induced periodontal lesions in beagle dogs

The aim of the present overview is to evaluate the periodontal conditions in European populations. Study was made of a number of extensive surveys of periodontal diseases carried out in a number of European countries, primarily North West Europe. These surveys often provide considerable detail. However, international comparisons are difficult to perform because of the different methods applied. Therefore, the latest overviews of results of periodontal surveys, based on the CPITN method and stored in the WHO Global Oral Data Bank, are given for the age groups 15-19 years and 35-44 years. Based on this approach, the conclusions are as follows. Trends and prevalences in periodontal health and disease in Europe are clear, at least up to the age of 60 year. Severe periodontal destruction seems to be a limited problem, seldom leading to tooth loss before age 50 and certainly not a major cause of edentulousness before age 60. For a large majority, in most of the populations observed, the progress of periodontal destruction seems to be compatible with the retention of a natural, functioning dentition into older age. However, the periodontal problem might still be of considerable magnitude and importance as bleeding on probing is widely encountered in the younger age groups. Furthermore, 5-15% of populations affected by a serious, irreversible condition at age 40 years is high, compared with most other diseases.

T Pilot

Papers

Periodontal conditions in adults, 35–44 years of age: an overview of CPITN data in the WHO Global Oral Data Bank

Profiles of periodontal conditions in adolescents measured by CPITN.

Global results: 15 years of CPITN epidemiology.

Histologic evaluation of probe penetration during clinical assessment of periodontal attachment levels. An investigation of experimentally induced periodontal lesions in beagle dogs

Periodontal conditions in Europe.