Pocket depth and bleeding on probing and their associations with dental, lifestyle, socioeconomic and blood variables: a cross-sectional, multicenter feasibility study of the German National Cohort

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Abstract

Background

To investigate the periodontal disease status in a multi-center cross-sectional study in Germany. Associations of dental, socio-economic, blood and biomedical variables with periodontal outcome parameters were evaluated.

Methods

From 4 different centers N = 311 persons were included, drawn randomly from the registration offices. Maximal pocket depth (PD) was used as primary indicator for periodontitis. It was classified as: no/mild ≤3 mm, moderate 4-5 mm, severe ≥6 mm. Associations between socioeconomic (household income, education), lifestyle, and biomedical factors and PD or bleeding on probing (BOP) per site (“Yes”/”No”) was analyzed with logistic regression analysis.

Results

Mean age of subjects was 46.4 (range 20–77) years. A significantly higher risk of deeper pockets for smokers (OR = 2.4, current vs. never smoker) or persons with higher BMI (OR = 1.6, BMI increase by 5) was found. Severity of periodontitis was significantly associated with caries lesions (p = 0.01), bridges (p < .0001), crowns (p < .0001), leukocytes (p = 0.04), HbA1c (p < .0001) and MCV (p = 0.04). PD was positively correlated with BOP. No significant associations with BOP were found in regression analysis.

Conclusions

Earlier findings for BMI and smoking with severity of PD were confirmed. Dental variables might be influenced by potential confounding factors e.g. dental hygiene. For blood parameters interactions with unknown systemic diseases may exist.

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Most cited references 53

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The International Caries Detection and Assessment System (ICDAS): an integrated system for measuring dental caries.

A. I. Ismail, W. Sohn, M. Tellez … (2007)

This paper describes early findings of evaluations of the International Caries Detection and Assessment System (ICDAS) conducted by the Detroit Center for Research on Oral Health Disparities (DCR-OHD). The lack of consistency among the contemporary criteria systems limits the comparability of outcomes measured in epidemiological and clinical studies. The ICDAS criteria were developed by an international team of caries researchers to integrate several new criteria systems into one standard system for caries detection and assessment. Using ICDAS in the DCR-OHD cohort study, dental examiners first determined whether a clean and dry tooth surface is sound, sealed, restored, crowned, or missing. Afterwards, the examiners classified the carious status of each tooth surface using a seven-point ordinal scale ranging from sound to extensive cavitation. Histological examination of extracted teeth found increased likelihood of carious demineralization in dentin as the ICDAS codes increased in severity. The criteria were also found to have discriminatory validity in analyses of social, behavioral and dietary factors associated with dental caries. The reliability of six examiners to classify tooth surfaces by their ICDAS carious status ranged between good to excellent (kappa coefficients ranged between 0.59 and 0.82). While further work is still needed to define caries activity, validate the criteria and their reliability in assessing dental caries on smooth surfaces, and develop a classification system for assessing preventive and restorative treatment needs, this early evaluation of the ICDAS platform has found that the system is practical; has content validity, correlational validity with histological examination of pits and fissures in extracted teeth; and discriminatory validity.

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Systemic markers of inflammation in periodontitis.

Bruno Loos (2005)

This literature review summarizes current knowledge on the systemic levels of selected markers of inflammation in periodontitis. From samples of peripheral blood the following cellular factors are discussed: total number of white blood cells, red blood cells, and thrombocytes. Further, plasma levels of acute-phase proteins, cytokines, and coagulation factors are reviewed. From the available literature it appears that the total numbers of leukocytes and plasma levels of C-reactive protein are consistently higher in periodontitis patients compared to healthy controls. Numbers of red blood cells and levels of hemoglobin are lower in periodontitis and there is a trend towards anemia of chronic disease. Most systemic markers of inflammation discussed in this review are also regarded as predictive markers for cardiovascular diseases. Therefore, changes in these markers in periodontitis may be part of the explanation why periodontitis is associated with cardiovascular diseases and/or cerebrovascular events in epidemiological studies. It is hypothesized that possibly daily episodes of a bacteremia originating from periodontal lesions are the cause for the changes in systemic markers in periodontitis; the cumulative size of all periodontal lesions in the untreated severe patient may amount to 15 to 20 cm2.

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The prevalence and incidence of coronary heart disease is significantly increased in periodontitis: a meta-analysis.

Amol Bahekar, Sarabjeet Singh, Sandeep Saha … (2007)

Previous studies have shown conflicting results as to whether periodontitis (PD) is associated with increased risk of coronary heart disease (CHD). The aim of the current study was to evaluate whether such an association exists. A systematic review of the literature revealed 5 prospective cohort studies (follow-up >6 years), 5 case-control studies, and 5 cross-sectional studies that were eligible for meta-analysis. Individual studies were adjusted for confounding factors such as age, sex, diabetes mellitus, and smoking. The 3 study categories were analyzed separately. Heterogeneity of the studies was assessed by Cochran Q test. The studies were homogeneous; therefore, the Mantel-Haenszel fixed-effect model was used to compute common relative risk and odds ratio (OR). Meta-analysis of the 5 prospective cohort studies (86092 patients) indicated that individuals with PD had a 1.14 times higher risk of developing CHD than the controls (relative risk 1.14, 95% CI 1.074-1.213, P < .001). The case-control studies (1423 patients) showed an even greater risk of developing CHD (OR 2.22, 95% CI 1.59-3.117, P < .001). The prevalence of CHD in the cross-sectional studies (17724 patients) was significantly greater among individuals with PD than in those without PD (OR 1.59, 95% CI 1.329-1.907, P < .001). When the relationship between number of teeth and incidence of CHD was analyzed, cohort studies showed 1.24 times increased risk (95% CI 1.14-1.36, P < .0001) of development of CHD in patients with <10 teeth. This meta-analysis indicates that both the prevalence and incidence of CHD are significantly increased in PD. Therefore, PD may be a risk factor for CHD. Prospective studies are required to prove this assumption and evaluate risk reduction with the treatment of PD.

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Author and article information

Contributors

Heiko Zimmermann: h.zimmermann@uni-heidelberg.de

Daniel Hagenfeld: daniel.hagenfeld@googlemail.com

Katja Diercke: Katja.Diercke@med.uni-heidelberg.de

Nihad El-Sayed: Nihad.ElSayed@med.uni-heidelberg.de

Julia Fricke: julia.fricke@charite.de

Karin Halina Greiser: h.greiser@Dkfz-Heidelberg.de

Jan Kühnisch: jkuehn@dent.med.uni-muenchen.de

Jakob Linseisen: j.linseisen@helmholtz-muenchen.de

Christa Meisinger: christa.meisinger@helmholtz-muenchen.de

Nicole Pischon: Nicole.Pischon@charite.de

Tobias Pischon: tobias.pischon@mdc-berlin.de

Stefanie Samietz: samietzs@uni-greifswald.de

Marc Schmitter: Marc.Schmitter@med.uni-heidelberg.de

Astrid Steinbrecher: Astrid.Steinbrecher@mdc-berlin.de

Ti-Sun Kim: Ti-Sun.Kim@med.uni-heidelberg.de

Heiko Becher: h.becher@uke.de

Journal

Journal ID (nlm-ta): BMC Oral Health

Journal ID (iso-abbrev): BMC Oral Health

Title: BMC Oral Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6831

Publication date (Electronic): 21 January 2015

Publication date Collection: 2015

Volume: 15

Electronic Location Identifier: 7

Affiliations

[ ]Institute of Public Health, University of Heidelberg, lm Neuenheimer Feld 324, 69120 Heidelberg, Germany

[ ]Department of Conservative Dentistry, Section of Periodontology, University of Heidelberg, lm Neuenheimer Feld 400, 69120 Heidelberg, Germany

[ ]Policlinic of Periodontology, University-Hospital of Münster, Münster, Germany

[ ]Department of Orthodontics, University of Heidelberg, lm Neuenheimer Feld 400, 69120 Heidelberg, Germany

[ ]Division of Cancer Epidemiology, German Cancer Research Center, Im Neuenheimer Feld, 581, 69120 Heidelberg, Germany

[ ]Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Luisenstr. 57, 10117 Berlin, Germany

[ ]Department of Conservative Dentistry and Periodontology, Ludwig-Maximilians-University of Munich, Goethestraße 70, 80336 München, Germany

[ ]Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology II, Neuherberg, Germany

[ ]Department of Periodontology and Synoptic Dentistry, Charité - University Medicine Berlin, Berlin, Germany

[ ]Molecular Epidemiology Research Group, Max Delbrück Center for Molecular Medicine (MDC) Berlin-Buch, Robert-Rössle-Strasse 10, 13125 Berlin, Germany

[ ]Poliklinik für zahnärztliche Prothetik und Medizinische Werkstoffkunde Zentrum für Zahn, Mund- und Kieferheilkunde Universitätsmedizin Greifswald, Greifswald, Germany

[ ]Department of Prosthodontics, lm Neuenheimer Feld 400, 69120 Heidelberg, Germany

[ ]Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany

Article

Publisher ID: 495

DOI: 10.1186/1472-6831-15-7

PMC ID: 4324664

PubMed ID: 25604448

SO-VID: 2ca02c84-be25-486d-8ee2-e1f97ef49e22

License:

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 23 July 2014

Date accepted : 3 January 2015

Custom metadata

ScienceOpen disciplines: Dentistry

Keywords: periodontitis,dental examination,bmi,laboratory parameters,bleeding on probing,german national cohort

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ScienceOpen disciplines: Dentistry

Keywords: periodontitis, dental examination, bmi, laboratory parameters, bleeding on probing, german national cohort

Pocket depth and bleeding on probing and their associations with dental, lifestyle, socioeconomic and blood variables: a cross-sectional, multicenter feasibility study of the German National Cohort

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Abstract

Background

Methods

Results

Conclusions

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International Journal of Medicine and Medical Research

Most cited references 53

The International Caries Detection and Assessment System (ICDAS): an integrated system for measuring dental caries.

Systemic markers of inflammation in periodontitis.

The prevalence and incidence of coronary heart disease is significantly increased in periodontitis: a meta-analysis.

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